曹式丽从湿热论治蛋白尿学术经验

Experience of CAO Shili for Treatment of Damp-Heat in Proteinuria

蛋白尿是加速肾脏病变、影响肾脏疾病患者预后的独立危险因素,大量丢失蛋白会导致患者血浆白蛋白降低、免疫功能下降以及出现水肿等症状。中医认为蛋白尿以肺脾肾亏虚为本,兼湿浊、瘀血、风邪等合而为病,故治疗时多用健脾祛湿、补益肾气、清热除湿、活血化瘀、散风熄风之法。曹式丽教授认为蛋白尿的病位在肾络,属本虚标实之证,肾络亏虚为本,邪气壅滞肾络为标,运用络病理论治疗蛋白尿,应采用不同的通络方法,“不通”是络病的共性,故治疗蛋白尿时多以攻邪为主,兼以补虚。湿热内蕴为慢性肾病迁延期的常见证型,湿热证在慢性肾小球疾病的发病中起着重要的作用,其消减与蛋白尿量的变化存在密切关联,肺脾肾亏虚是蛋白尿本虚的主要表现,湿热则是蛋白尿标实的重要因素。清热利湿法是从湿热论治蛋白尿的常用治疗思路,曹教授从蛋白尿的中医病机出发,明辨证型,治疗上从三脏入手,攻补兼施,在临床上取得了较好的疗效。

Proteinuria is an independent risk factor that accelerates kidney disease and affects the prognosis of patients with kidney disease.A large amount of protein loss will cause the patients′ plasma albumin to decrease,immune function to decrease,and symptoms such as edema.In the idea of traditional Chinese medicine,proteinuria is caused by the damage of lung,spleen and kidney,also it can be caused by damp,congestion and wind.Therefore,traditional Chinese medicine treatments includes restoring functionality of spleen and kidney to clear the damp-heat,and removing the congestion and wind.Professor CAO Shili believes that the disease of proteinuria is in the kidney venation,and kidney collateral deficiency is defined as original cause while congealing is the superficial cause,combined with the theory of collateral disease in the treatment of proteinuria,different methods should be adopted as a therapeutic method in the process of proteinuria.The general characteristics of collateral diseases is collaterals obstruction,so Professor CAO treats proteinuria by clearing damage and recovering functionality.Damp-heat syndrome is a common syndrome in the protracted period of chronic kidney disease.Damp-heat syndrome plays an important role in the pathogenesis of chronic glomerular disease,and its reduction is closely related to changes in proteinuria.Deficiency of lung,spleen and kidney is the main internal cause of proteinuria,and damp-heat is an important factor of proteinuria.Based on the TCM pathogenesis of proteinuria and syndrome differentiation,clearing the damp-heat and recovering functionality is the most commonl-used method of professor CAO Shili and has achieved good results in clinical practice.