高彦彬从络病论治肥胖相关性肾小球病经验撷英

Gao Yanbin’s experience in treating obesity-related glomerulopathy based on collateral disease theory

介绍高彦彬教授从络病论治肥胖相关性肾小球病(ORG)的临床经验。高教授认为ORG属中医"络病"范畴,病性本虚标实,治疗应辨证论治结合分期论治:早期(肾络瘀滞)分为脾虚湿盛、湿热内蕴、肝郁胃热证,治以祛邪为主,运用健脾化湿通络、清化湿热通络、疏肝清热通络法;中期(肾络瘀阻)分为肺脾气虚兼湿邪内蕴、肝肾阴虚兼湿热下注证,治以扶正祛邪,运用益气化湿通络、补肝肾清湿热法;晚期(肾体劳衰)分为气阴两虚兼湿热蕴毒、脾肾阳虚兼痰瘀互结证,治以扶正为主,运用益气养阴兼利湿解毒、温补脾肾兼化痰活血通络法。

Professor GaoYanbin’s clinical experience in treating obesity-related glomerulopathy(ORG)based on collateral disease theory was introduced in this paper.According to Professor Gao’s theory,ORG,in the category of"collateral disease"in traditional Chinese medicine,has the nature of deficiency in root and excess in manifestation and should be treated based on syndrome differentiation and stage identification.Syndromes at the early stage(stasis and stagnation of kidney collaterals)include dampness abundance due to spleen deficiency syndrome,damp-heat accumulation syndrome,and liver depression and stomach heat syndrome.The treatment principle is mainly to eliminate pathogenic factors to dredge collaterals by adopting methods of invigorating spleen and eliminating dampness,resolving dampness and clearing heat,soothing liver and clearing heat.Syndromes at the middle stage(stasis and blockage of kidney collaterals)include lung and spleen qi deficiency with dampness accumulation syndrome,liver and kidney yin deficiency with downward flow of damp-heat syndrome.The treatment principle is to strengthen body resistance and eliminate pathogens by adopting methods of replenishing qi,resolving dampness and dredging collaterals,tonifying liver and kidney and clearing damp-heat.Syndromes at the late stage(kidney overstrain and exhaustion)include dual deficiency of qi and yin with accumulation of damp-heat and toxin syndrome,spleen and kidney yang deficiency with intermingled phlegm and blood stasis syndrome.The treatment principle is mainly to strengthen body resistance by adopting methods of invigorating qi and nourishing yin and simultaneously promoting diuresis and removing toxicity,warming and invigorating spleen and kidney and simultaneously eliminating phlegm,promoting blood circulation and dredging collaterals.