孔薇治疗特发性膜性肾病经验

Experience by Professor KONG Wei on Treating Idiopathic Membranous Nephropathy

孔薇教授治疗特发性膜性肾病,紧扣脾肾亏虚为本、湿热瘀阻为标之病机特点,以平补脾肾、化瘀清热为治疗大法。针对大量蛋白尿之患者,用药遵循补而不滞、滋而不腻、温而不燥的原则,以“平”为主;针对水肿较著之患者,以淡渗利湿之品轻药重投;针对湿热症状较著之患者,需在补肾的基础上加用清热化湿泄浊之法;针对久病入络之患者,需适当配伍藤类药及虫类药以活血利水、化瘀消癥;针对使用激素联合免疫抑制剂的患者,需评估患者疾病进展程度,把握病程各阶段治疗重点,从而达到增效减毒的目的。

When treating idiopathic membranous nephropathy,based on the characteristics of disease mecha-nism:spleen and kidney deficiency as the root,while damp-heat and blood stasis blocking as the branch,Professor KONG Wei follows the princle of tonifying spleen and kidney evenly,dissolving stasis and clearing heat.For patients with large amounts of proteinuria,the medications follow the principle of supplementing without stagnation,nourishing but not greasy,warm but not dry,that is,“evenly”;for patients with severe edema,medicinals of bland taste and light nature for draining dampness are used in large dosage;for pa-tients with severe symtoms of damp heat,it is necessary to add medicinals of clearing heat and resolving besides tonifying kidney;for patients with prolonged course and collaterals affected,medicinals of vines or insects should be used to promote blood circulation and urination,and to resolve stasis and remove concre-tions;for patients treated with hormone and immunosuppressive agents,it is necessary to assess the degree of disease progression of patients,and to grasp the treatment priorities at each stage of the disease,so as to achieve the purpose of increasing efficiency and reducing toxicity.