辛通畅络法治疗慢性肾脏病述评

A Review on the Treatment of Chronic Kidney Disease with Method of Dredging Collaterals with Pungent Medicinals

毒损肾络贯穿慢性肾脏病全程,辛通畅络法是中医治疗慢性肾脏病的基本法则。辛香通络、活血通络、补虚通络类药物,能散、能行,可畅达三焦,破瘀消癥,搜剔肾络,使周身气机得畅,脏腑气血阴阳得调,逐步改善慢性肾脏病患者的低蛋白血症、高凝高脂状态,减少尿蛋白,缓解乏力、水肿等症状。但目前辛通畅络法治疗慢性肾脏病的临床观察仅涉及肾病主证,未涉及其他兼证;对中医证型的判定,尚无客观标准;尚无慢性肾脏病的大样本临床对照试验研究,动物及细胞实验研究也停留在分子生物学层面,中医药治疗慢性肾脏病的蛋白组学、基因组学、代谢组学的报道较少。今后可通过大样本临床观察,利用蛋白组学、基因组学、代谢组学的方法进行补充验证,明确慢性肾脏病的发病机制,筛查关键病变基因,探寻药物作用的通路及靶点,为中医药治疗慢性肾脏病提供科学依据。

Toxin damaging kidney collaterals runs through the whole process of chronic kidney disease(CKD),and method of dredging collaterals with pungent medicinals is the basic principle of TCM in the treatment of CKD.Collateral-dredging pungent medicinals,medicinals for promoting blood circulation and dredging collaterals,and medicinals for supplementing deficiency and dredging collaterals can scatter,and move stagnated qi,sooth shaoyang,regulate three energizers,remove blood stasis and abdominal mass,dredge kidney collaterals,make the whole body qi smooth,regulate the qi and blood,yin and yang of viscera,gradually improve the hypoproteinemia,hypercoagulability and hyperlipidemia state of patients with CKD,reduce urinary protein,relieve fatigue,edema and other symptoms.However,at present,the clinical observation on the treatment of CKD with method of dredging collaterals with pungent medicinals only involves some dominant syndromes of kidney disease,and other secondary syndromes are not involved.There is no objective standard for the determination of syndrome types of TCM.There is no large sample clinical controlled trial study on CKD.Animal and cell experimental research also stays at the level of molecular biology,while there are few reports on proteomics,genomics and metabolism of TCM.In the future,we can carry out clinical observation on large samples,make use of proteomics,genomics and metabonomics for supplementary verification,clarify the pathogenesis of CKD,screen key disease genes,and explore the pathway and target of drug action,so as to provide scientific basis for the treatment of CKD with TCM.