韦芳宁治疗糖尿病肾脏病蛋白尿经验

Experience of WEI Fang-Ning in Treating Proteinuria in Diabetic Nephropathy Patients

总结韦芳宁教授采用"辨体-辨病-辨证"诊疗模式诊治糖尿病肾脏病蛋白尿的经验。韦芳宁教授认为糖尿病肾脏病蛋白尿患者的辨体以气虚质、阳虚质、瘀血质为主;辨病可分为早、中、晚3期,早期表现为微量白蛋白尿,中期表现为显性蛋白尿和肾病综合征,晚期则发展为氮质血症和肾功能衰竭;辨证以脾不摄精、肾不藏精为基础,主要兼夹外邪侵袭证、湿热阻滞证、瘀血阻络证及痰浊阻滞证4型。其药物治疗基于疾病分期、证候分型,分别采用中西药联合治疗以减轻和控制蛋白尿、延缓病程的进展,中药辨证治疗根据分型结果分别采用玉屏风散合六味地黄丸加减、三仁汤合水陆二仙丹加减、桃红四物汤合六味地黄丸加减以及猪苓汤或真武汤加减。并根据体质辨析结果,嘱患者调整饮食起居,配合养生保健类体育锻炼以改善患者的预后,取得了较显著的疗效。

The experience of Professor WEI Fang-Ning in treating proteinuria in diabetic nephropathy patients by the combined medical mode of physical constitution differentiation,disease differentiation,and syndrome differentiation was summarized.Professor WEI Fang-Ning believes that the physical constitution of proteinuria patients with diabetic nephropathy was predominated by qi deficiency type,yang deficiency type,and blood stasis type.The disease differentiation in proteinuria patients with diabetic nephropathy could be classified into early stage,middle stage,and late stage,which was manifested by microalbuminuria,dominant proteinuria and nephrotic syndrome,and azotemia and renal failure,respectively.The syndrome differentiation in proteinuria patients with diabetic nephropathy was characterized by spleen failing in nourishing essence and kidney failing in storing essence,and was mainly complicated by the 4 syndrome types of attack of exopathogens,stagnation of damp heat,blood stasis blocking the collaterals,and stagnation of phlegm turbidity.The medication for the proteinuria in diabetic nephropathy patients was based on the disease staging and syndrome differentiation,and the integrated Chinese and western medicine was usually adopted to relieve and control proteinurian and to delay the development of the disease.Based on the syndrome differentiation,the commonly-used prescriptions were the modification of Yupingfeng Powder combined with Liuwei Dihuang Pills,Sanren Decoction combined with Shuilu Erxian Pills,Tao Hong Siwu Decoction combined with Liuwei Dihuang Pills,Zhuling Decoction,and Zhenwu Decoction.Proper management of diet,daily living and health-care exercise was suggested to improve the prognosis of the disease according to the physical constitution differentiation results.By using the combined medical mode of physical constitution differentiation,disease differentiation,and syndrome differentiation,satisfactory effect can be achieved for the treatment of proteinuria in diabetic nephropathy patients.