王文凤辨治慢性肾脏病临床经验

WANG Wen-Feng’s Clinical Experience for the Differentiation and Treatment of Chronic Kidney Disease

总结王文凤主任医师辨治慢性肾脏病的经验。王文凤主任医师认为慢性肾脏病的病性为本虚标实,病位在脾肾,基本病机为气虚血瘀,以脾肾亏虚为其本,湿浊毒瘀内阻为其标,"气虚血瘀"贯穿慢性肾脏病始终;提出"攻补兼施,分期辨治,内外同治"的辨治思路。发病初期脾肾气虚为甚,治疗应以扶正为主,辅以祛邪,可选肾康宁I方加减治疗。病变中期正气亏损渐甚,邪浊内壅渐重,治疗应以扶正祛邪兼施为治疗原则,采用肾衰降浊方加减治疗。发病末期脾肾愈亏,而湿浊、毒邪、瘀血阻塞更为突出,治疗应以祛湿降浊、活血化瘀排毒为主,可选用肾衰降浊方加减治疗。临床治疗慢性肾脏病过程中,需注重固护脾肾,脾肾同治,重视"活血泻浊"。

This article summarized. WANG Wen-Feng’s experience for the differentiation and treatment of chronic kidney disease(CKD). The chief physician WANG Wen-Feng believed that the nature of CKD was deficiency in the origin and excess in the superficiality,the disease is located in the spleen and kidney,and the basic pathogenesis is due to qi deficiency and blood stasis. The deficiency in the origin is characterized by insufficiency of spleen and kidney,and the excess in the superficiality is characterized by internal obstruction of damp turbidity,toxicity and blood stasis. Qi deficiency and blood stasis exists throughout the course of the disease. The chief physician WANG Wen-Feng proposed the concept of treatment as “simultaneous application of purging and nourishing therapeutics,staging differentiation and treatment,and treating with both internal and external therapy”. In the early stage of CKD,the deficiency of spleen and kidney qi is the main syndrome,the treatment should mainly focus on supporting healthy qi assisted by eliminating pathogens,and the modified treatment with Shenkangning Prescription I can be used. In the middle stage of CKD, the consumption of healthy qi is obvious and the accumulation of internal pathogenic turbidity becomes severe,simultaneous application of purging and nourishing therapeutics is proposed,and the modified treatment with Shenshuai Jiangzhuo Prescription can be adopted. In the end stage of CKD,the insufficiency of spleen and kidney is getting severe,and the damp turbidity,toxicity and blood stasis become more prominent. Treatment at this stage should be based on dispelling dampness and lowering turbidity,activating blood,removing stasis and expelling toxicity,and the modified treatment with Shenshuai Jiangzhuo Prescription can be adopted. During the clinical treatment of CKD, the focus should be switched to consolidating and protecting the spleen and kidney,treating the spleen and kidneys simultaneously and addressing the importance of activating blood and purging turbidity.