基于益脾肾、祛湿毒、破癥瘕的思想辨治慢性肾功能衰竭思路

The idea of differentiating and treating chronic renal failure based on the theory of invigorating the spleen and kidney,removing dampness and toxin,and eliminating stagnation

慢性肾功能衰竭是临床常见严重危害人体生命健康的疾病之一,调查发现我国成年人群中慢性肾脏病的患病率为10.8%。慢性肾功能衰竭发病率高且起病隐匿,进展缓慢,预后较差。目前,西医治疗主要是对症支持以及透析和肾移植。治疗费用较高,患者的生活质量下降,给患者家庭带来巨大的经济压力。而中医中药在治疗慢性肾功能衰竭有着独特的优势,不良反应小、患者依从性高,中医药治疗慢性肾功能衰竭机制仍在发展探索之中,但已经显示出良好的前景且正在逐步彰显其优势。赵怡蕊教授,山西省中西医结合医院肾内科主任,师承国医大师张大宁教授,从事肾病临床、科研、教学近30年,中医基础深厚,临床辨证清晰,运用中医中药治疗糖尿病肾病、急慢性肾炎、急慢性肾功能衰竭等方面临床经验丰富。文章总结了赵怡蕊教授治疗慢性肾功能衰竭的多年临床用药经验及临床辨证施治。赵怡蕊教授通过长期的临床观察,依据“久病及肾”“久病多虚”“久病多瘀”“怪病多痰”“难病多毒”的中医理论,提出慢性肾功能衰竭的核心病机为虚、湿、瘀、毒,并以“益脾肾、祛湿毒、破瘕”为基本治疗原则的辨证思路,灵活遣方用药,临床效果较好。文章通过则验案分析,总结了导师治疗慢性肾功能衰竭的临床经验,对临床具有指导意义。

Chronic renal failure is one of the common clinical diseases that seriously endanger human life and health.The survey found that the prevalence rate of chronic kidney disease in Chinese adults is 10.8%.The incidence of chronic renal failure is high and the onset is hidden,the progress is slow,and the prognosis is poor.At present,Western medicine is mainly symptomatic treatment,as well as dialysis and kidney transplantation.The cost of treatment is high,and the quality of life of patients is declining,which brings great economic pressure to patients’families.TCM medicine has unique advantages in the treatment of chronic renal failure,with small adverse reactions and high patient compliance.The mechanism of TCM medicine in the treatment of chronic renal failure is still under development and exploration,but it has shown a good prospect and is gradually showing its advantages.Professor ZHAO Yirui,director of the Department of Nephrology,Shanxi Integrated traditional Chinese and Western Medicine Hospital,learns from Professor ZHANG Daning.Engaged in nephropathy clinical,scientific research,teaching for nearly 30 years,the foundation of TCM is profound,clinical syndrome differentiation is clear.She has rich clinical experience in the treatment of diabetes nephropathy,acute and chronic nephritis,and acute and chronic renal failure in TCM.Professor ZHAO Yirui’s many years of clinical medication experience and clinical syndrome differentiation in the treatment of chronic renal failure are summarized in this paper.After long-term clinical observation,Professor ZHAO Yirui proposes that the core pathogenesis of chronic renal failure is deficiency,dampness,blood stasis,and toxin according to the TCM theories of long illness affects the kidneys,most of the chronically ill are frail,most patients with chronic illness have stasis in their bodies,patients with strange diseases tend to have more phlegm,most of the intractable diseases are caused by poison.Taking invigorating the spleen and kidney,removing dampness and toxin,and eliminating stagnation as the basic treatment principle,the professor flexibly dispatched prescription and medication,and the clinical effect was good.This paper analyzed a case and summarizes the tutor’s experience in treating chronic renal failure now.