肾性血尿的中医药治疗进展

Treatment of Renal Hematuria with Traditional Chinese Medicine:A Review

肾性血尿是由于凝血功能障碍、缺血缺氧及免疫功能损伤等致使肾小球受损及基底膜断裂,导致红细胞经肾小球滤过膜渗出并随尿液排出,主要表现为镜下和肉眼血尿,其中,镜下血尿表现为显微镜尿沉渣检查每高倍镜视野有3个及以上的红细胞。中医认为肾性血尿的病机总属于“本虚标实”,“本虚”责之于肺脾肾三脏虚甚,“标实”责之于湿瘀互结,风邪外扰,以“虚、湿、热、瘀、风”作为其关键病机特点。笔者通过查阅肾性血尿相关的中医药文献后发现临床中肾性血尿的证型以气阴两虚型、阴虚火旺型、肾气不固型、脾肾阳虚型、风热伤络型、湿热阻滞型及血瘀内阻型等较为常见;常用的经方或时方以参芪地黄汤、知柏地黄汤、无比山药丸、济生肾气丸、四神丸、银翘散、八正散、三仁汤、血府逐瘀汤、当归芍药散、小蓟饮子及补中益气汤等加减作为临床常用方剂;自拟方则是以通络宁血方、清热止血方及五藤通络饮等治疗为主;中成药治疗则以血尿灵冲剂、血尿安胶囊、宁泌泰胶囊、黄葵胶囊及益肾溺血消颗粒较为常用,不断地丰富了肾性血尿的治疗。中西医结合治疗具有明显的优势,临床中肾性血尿的治疗常联合现代医学手段,对于肾性血尿的症状和指标的改善具有良好的治疗效果。目前,多位医家对肾性血尿的病因病机和临床治疗进行了深入探索,但近年来却少有学者对其作详尽的归纳整理,故笔者整理了近10年来应用中医药治疗肾性血尿的临床资料,从病因病机和临床研究两方面展开综述,以期更全面地为临床干预本病和延缓肾脏病的进展提供有益的参考。

Renal hematuria is caused by glomerular damage and basement membrane rupture due to coagulation dysfunction,ischemia and hypoxia,and immune function damage,resulting in red blood cells exuding through glomerular filtration membrane and excreting with urine.It is mainly manifested as microscopic and macroscopic hematuria.Among them,microscopic hematuria is characterized by microscopic urine sediment examination,there are three or more red blood cells per high-power microscopic field.Traditional Chinese medicine(TCM)believes that the pathogenesis of renal hematuria always belongs to"asthenia in origin and sthenia in superficiality",and"asthenia in origin"is caused by the deficiency of the three viscera of the lung,spleen,and kidney,while"sthenia in superficiality"is caused by the combination of dampness and blood stasis and the external disturbance of wind pathogens.The key pathogenesis features are"deficiency,dampness,heat,blood stasis,and wind".After consulting the TCM literature related to renal hematuria,the author found that the common syndrome types of renal hematuria in clinical practice were the deficiency of both Qi and Yin,the deficiency of both Yin and fire,the unsteadiness of kidney Qi,the deficiency of spleen and kidney Yang,the wind heat hurting the collateral,the dampness-heat blocking,and the blood stasis and internal resistance.The commonly used classical or temporal prescriptions included Shenqi Dihuangtang(参芪地黄汤),Zhibai Dihuangtang(知柏地黄汤),Wubi Shanyaowan(无比山药丸),Jisheng Shenqiwan(济生肾气丸),Sishenwan(四神丸),Yinqiaosan(银翘散),Bazhengsan(八正散),Sanrentang(三仁汤),Xuefu Zhuyutang(血府逐瘀汤),Danggui Shaoyaosan(当归芍药散),Xiaoji Yinzi(小蓟饮子),Buzhong Yiqitang(补中益气汤),et al.Self prepared prescriptions mainly include Tongluo Ningxue prescription(通络宁血方),Qingre Zhixue prescription(清热止血方)and Wuteng Tongluo drink(五藤通络饮).The traditional Chinese medicine is commonly used for the treatment of Xueniaoling granules(血尿灵冲剂),Xueniaoan capsules(血尿安胶囊),Ningmitai capsules(宁泌泰胶囊),Huangkui capsules(黄葵胶囊)and Yishen nixuexiao granules(益肾溺血消颗粒),which constantly enriched the treatment of renal hematuria.The combination of TCM and western medicine has obvious advantages.The treatment of renal hematuria in clinical practice often combines with modern medical methods,which has a good therapeutic effect on the improvement of symptoms and indicators of renal hematuria.At present,many doctors have made in-depth exploration on the etiology,pathogenesis,and clinical treatment of renal hematuria,but few scholars have made detailed induction and collation in recent years.Therefore,the author has collated the clinical data on the treatment of renal hematuria with TCM in the past ten years,and reviewed it from the aspects of etiology,pathogenesis,and clinical research,to provide useful references for clinical intervention and delay the progress of renal disease.