中医辨治特发性膜性肾病

TCM Treatment of Idiopathic Membranous Nephropathy

中医辨治特发性膜性肾病从分期辨治、分症辨治、中西医结合分期辨治、常见并发症特色辨治等方面进行。分期辨治中病之初期病机为表虚不固,易兼他邪,治以疏风解表,兼祛他邪;疾病进展期病机为风湿瘀毒充斥三焦,治以宣畅三焦,调理气机;病至后期病机为久病入络,浊毒互结,治疗应平衡阴阳,临证权衡。分症辨治时,水肿急性期病机为气机壅滞不利,瘀水常为互结,在发汗、利尿、逐水的基础上酌情配伍行气、活血等药物;缓解期除加强补肾通络之功、调理平衡机体水液代谢外,还应固护先天之本,调理脾胃。治疗尿浊的总则为标本兼顾,辛开苦降,清热除湿以治标,补肾健脾以固本。中西医结合分期辨治时,在激素初始应用阶段以清热解毒、养阴活血为主,方用二至丸合知柏地黄丸加减;激素撤减阶段当以补益气血、温脾补肾为主;维持治疗阶段以补肾为主,健脾益肺为辅。常见并发症特色辨治中低蛋白血症在健脾、固肾的基础上重视护肝,常用茵陈蒿汤、茵陈四苓散、一贯煎、二至丸、六味地黄丸、柴苓汤、鳖甲煎丸等;治疗高凝状态引起的血栓栓塞时,则在疾病初始加用散瘀通络之品。

In terms of idiopathic membranous nephropathy,TCM syndrome differentiation and treatments include treatment by stages,treatment by symptoms,treatment by stages based on integrated traditional Chinese and Western medicine,characteristic syndrome differentiation and treatment of common complications,etc.For treatment by stages,in the early stage,the pathogenesis is manifested as deficient exterior combined with other pathogens,so the treatment is to expel the wind,relieve the exterior and dispel other pathogens.In the disease progression stage,the pathogenesis is wind,dampness,blood stasis and toxin,which is stagnated in triple energizer,so the treatment is to dredge triple energizer and regulate qi movement.In the late stage of the disease,the pathogenesis is that long-term pathogens entering the collaterals,turbidity and toxin in complexity,and the treatment is to balance yin and yang and regulate clinical syndrome accordingly.For treatment by symptoms,in the acute stage of edema,the pathogenesis is stagnated qi movement,blood stasis and water in complexity,so the treatment should properly add drugs for moving qi and promoting blood circulation on the basis of sweating,inducing diuresis and expelling water.In the remission period,in addition to strengthening tonifying the kidney and dredging the collaterals,regulating and balancing the body's water and fluid metabolism,it is also necessary to strengthen the innate essence and regulate the spleen and stomach.The general principle for the treatment of urinary turbidity is to treat manifestation and root cause concurrently,disperse with the pungent and purge with the bitter,clear away heat and dampness for treating manifestation,tonify the kidney and activate the spleen to consolidate the foundation.For treatment by stages based on integrated traditional Chinese and Western medicine,in the initial application stage of hormone,the treatment is mainly to clear away heat and remove toxin,nourish yin and activate blood circulation,and the formula is Modified Double Supreme Pill combined with Anemarrhena and Phellodendron and Rehmannia Pill.In the stage of hormone withdrawal,the main treatment to tonify qi and blood,warm the spleen and tonify the kidney.The maintenance treatment stage is mainly to tonify the kidney,supplemented by activating the spleen and benefiting the lung.For characteristic syndrome differentiation and treatment of common complications,in terms of low proteinemia,the treatment should paying attention to protecting the liver on the basis of activating the spleen and consolidating the kidney.Virgate Wormwood Decoction,Four Substances Powder with Poria Plus Virgate Wormwood,Effective Integration Decoction,Double Supreme Pill,Six-Ingredient Rehmannia Pill,Bupleurum Decoction Plus Poria,Turtle Shell Decocted Pill,etc.are often adopted.When treating thromboembolism caused by hypercoagulable state,the drugs for dispersing blood stasis and dredging collaterals should be added at the beginning of the disease.