新冠肺炎患者肾脏损伤的中医病机及治疗初探

Preliminary Discussion on TCM Pathogenesis and Treatment of Kidney Injury in Patients with Corona Virus Disease 2019

[目的]探讨新型冠状病毒肺炎(corona virus disease 2019,COVID-19)患者肾脏损伤的中医病机及治疗对策,为临床提供参考。[方法]复习文献报道的COVID-19的临床表现及中医证候特征,分析COVID-19患者肾脏损伤的病因病位、传变规律等发病特点,并结合笔者临床肾脏病诊治经验,提出相应的治疗方法。[结果]COVID-19患者肾脏损伤的主要病理机制为"湿毒乖戾,直犯肾脏""邪热入营,灼伤肾络""痰瘀毒结,痹阻肾络""津液匮乏,肾无所主"。根据以上病机特征,分别予祛湿解毒、凉血止血、祛瘀化痰、养阴生津等治疗方法,并列举达原饮合五苓散、犀角地黄汤合小蓟饮子、越婢加半夏汤合用桃核承气汤、生脉散合增液汤等方药。[结论]治疗COVID-19患者时,需关注肾脏损伤情况,并采取相应的中医辨证治疗,以降低死亡率,提高临床疗效。

[Objective]To explore the traditional Chinese medicine(TCM)pathogenesis and treatment of kidney injury in patients with corona virus disease2019(COVID-19),and to provide clinical reference.[Methods]Through reviewing the clinical manifestations and characteristics of TCM syndromes of COVID-19 reported in the literatures,analyze the etiology,pathology and disease changes of kidney injury in patients with COVID-19,and combine with the author’s clinical experience in the diagnosis and treatment of kidney disease,propose the corresponding treatment methods.[Results]The pathogenesis are"violent toxic dampness directly invading the kidney""pathogenic heat intruding Ying-blood and burning the kidney collaterals""combination of phlegm,blood stasis and toxic,and blood stasis stagnating the kidney collaterals"and"impairment of body fluids and hypoperfusion of the kidney".According to the above pathogenesis characteristics,the therapeutic methods of dispelling dampness and detoxifying,cooling blood and stopping bleeding,dispelling stasis and resolving phlegm,replenishing Yin to encourage body fluids were given respectively,and the prescriptions such as Dayuan decoction and Wuling powder,Xijiao Dihuang decoction and Xiaoji Yinzi decoction,Yuebi Jia Banxia decoction and Taohe Chengqi decoction,Shengmai powder and Zengye decoction and other prescriptions were listed and adopted.[Conclusion]When treating COVID-19 patients,it is necessary to pay attention to the situation of kidney injury,and take corresponding TCM syndrome differentiation treatment to reduce mortality and improve clinical efficacy.