王自敏教授分期分型辨治IgA肾病经验

Professor WANG Zimin's Experience in Treating IgA Nephropathy by Stages and Types

[目的]总结王自敏教授分期分型辨治IgA肾病的经验。[方法]通过跟师学习,收集病案,总结探讨王老治疗IgA肾病的经验,并附医案一则。[结果]王老认为,IgA肾病属本虚标实、虚实夹杂之病,病位主要在肾,与肝、脾、肺密切相关,病因分为内因和外因,两者合而为病,并认为本病核心病机为“湿、热、瘀、虚”,将本病分为急性发作期和慢性持续期,急性发作期分为风热袭肺型、心火亢盛型、湿浊犯脾型和下焦湿热型,慢性持续期分为阴虚火旺型、气阴两虚型、脾肾亏虚型以及瘀毒阻络型。王老针对不同证型,分别给予银翘散、导赤散、小蓟饮子、知柏地黄丸合二至丸、黄芪地黄汤、六君子汤合右归丸、自拟黄槐温胆汤合血府逐瘀汤等加减治疗。王老指出,本病治疗以扶正祛邪、攻补兼施为治则,主张中西医结合,并善用药对精准治疗。所附医案首诊时辨为阴虚火旺型,治以滋阴降火、清热凉血,予知柏地黄丸合二至丸加减,后随证加减,疗效甚佳。[结论]王老分期分型治疗IgA肾病经验丰富,提出本病核心病机为“湿、热、瘀、虚”,对治疗本病有较高的指导意义。

[Objective]To summarize Professor WANG Zimin's experience in the differentiation and treatment of IgA nephropathy by stages and types.[Methods]Through learning from teachers,collecting medical records,summarizing and exploring Professor WANG's experience in treating IgA nephropathy,and attaching a medical record.[Results]Professor WANG believes that IgA nephropathy belongs to a disease with a combination of deficiency and excess,mainly located in the kidney and closely related to the liver,spleen and lungs.The etiology is divided into internal and external causes,which are combined to form the disease.He also believes that the core pathogenesis of this disease is“dampness,heat,blood stasis and deficiency”.The disease is divided into acute attack stage and chronic persistent stage.The acute attack stage is divided into wind heat attacking the lung type,heart fire hyperactivity type,dampness turbidity invading the spleen type and lower Jiao dampness heat type;chronic persistent stage can be divided into Yin deficiency and fire excess type,Qi and Yin deficiency type,spleen and kidney deficiency type,and blood stasis and toxin obstruction type.Professor WANG treats different syndrome types with Yinqiao Powder,Daochi Powder,Xiaoji Yinzi,Zhibai Dihuang Pill and Erzhi Pill,Huangqi Dihuang Decoction,Liujunzi Decoction and Yougui Pill,self-made Huanghuai Wendan Decoction and Xuefu Zhuyu Decoction,and other modified treatments.Professor WANG points out that the treatment of this disease should be based on the principles of nourishing the body,dispelling pathogenic factors,and combining traditional Chinese and western medicine,and advocates for a combination of traditional Chinese and western medicine,and he is good at using drug pair for precise treatment.In the attached medical record,the initial diagnosis was identified as Yin deficiency and excessive fire type.The treatment was to nourish Yin and reduce fire,clear heat and cool blood,modified Zhibai Dihuang Pill and Erzhi Pill were used,and then added or subtracted the herbs according to the symptoms,resulting in excellent therapeutic effects.[Conclusion]Professor WANG has rich experience in staging and typing the treatment of IgA nephropathy,and proposes that the core pathogenesis of this disease is“dampness,heat,stasis and deficiency”,which has high guiding significance for the treatment of this disease.