赵玉庸教授治疗特发性膜性肾病临证经验浅析

Clinical Experience of Professor Zhao Yuyong in the Treatment of Idiopathic Membranous Nephropathy

赵玉庸教授是首届河北十二大名中医,从事肾脏病研究50余年,积累了丰富的临床经验。赵老认为特发性膜性肾病的病机特点为本虚标实,本虚以脾肾亏虚为主,标实以风、湿、热、瘀、毒互结为要。从肾脏病理形态学角度论证“肾络瘀阻”的客观性,提出特发性膜性肾病的病机关键为“肾络瘀阻”;从“微观辨证”立论,认为膜攻击复合物致足细胞损伤而致特发性膜性肾病的发病机制中,膜攻击复合物与中医“邪气凝聚”相通,确立“扶助正气,祛邪通络”的治疗方法。在治疗特发性膜性肾病高凝、易栓状态及大量蛋白尿方面,遣方用药,独辟蹊径,并擅用“取类比象”之法。现将赵玉庸教授治疗特发性膜性肾病临证经验进行浅析,以飨同道。

Professor Zhao Yuyong is one of the first twelve famous Chinese medicine practitioners in Hebei province.He has been engaged in kidney disease research for more than 50 years and has rich clinical experience.Professor Zhao believes that the pathogenesis of idiopathic membranous nephropathy(IMN)is characterized by deficiency of the essence and excess of the essence,with deficiency of the spleen and kidney as the main deficiency,and the excess of the essence is the combination of wind,dampness,heat,blood stasis and toxin.This paper demonstrates the objectivity of"kidney collateral stasis"from the perspective of renal pathomorphology,and puts forward that the key to the pathogenesis of IMN is"kidney collateral stasis";Based on the microscopic differentiation of symptoms and signs,it is considered that in the pathogenesis of IMN caused by podocyte injury caused by membrane attack complex,membrane attack complex is interlinked with pathogenic Qi coagulation in traditional Chinese medicine,and the treatment method of"supporting healthy Qi,eliminating pathogenic factors and dredging collaterals"is established.In the treatment of IMN,such as hypercoagulability,thrombophilia and massive proteinuria,the prescription is used in a unique way,and the method of"taking analogy"is used skillfully.Professor Zhao Yuyong's clinical experience in treating IMN is now analyzed.