张莹雯运用温潜法治疗难治性肾病综合征经验

ZHANG Yingwen’s Experience in Treatment of Refractory Nephrotic Syndrome with Warming and Subduing Method

张莹雯教授认为难治性肾病综合征(RNS)的核心病机为相火变动,具体而言,激素抵抗型RNS的病机为浊邪内盛、相火妄动,激素依赖型RNS的病机为命门火衰、相火浮越。因此,其提出运用温潜法治疗RNS。激素抵抗型RNS的治疗以清热、利湿、活血、祛风等祛邪法为先,辅以温补肾中精血、潜降妄动相火;激素依赖型RNS则根据激素撤减过程分期论治,把握好温补药物与潜降药物的主次先后。附验案1则。

Professor ZHANG Yingwen believes that the core pathogenesis of refractory nephrotic syndrome(RNS)is the change of ministerial fire.Specifically,the pathogenesis of steroid-resistant RNS is characterized by turbid pathogens accumulating internally and hyperactivity of ministerial fire,while the pathogenesis of steroid-dependent RNS is characterized by decline of vital gate fire and excessive floating of ministerial fire.Therefore,she suggests using the warming and subduing method for treating RNS.The treatment of steroidresistant RNS prioritizes methods such as clearing heat,promoting diuresis,activating blood circulation,and dispelling wind to eliminate pathogenic factors.It is supplemented with warming and nourishing kidney essence and blood,as well as subduing hyperactivity of ministerial fire.For steroid-dependent RNS,the treatment is based on a staged approach during the process of tapering off hormones to ensure the proper sequence of warm tonifying medicinals and medicinals that subdue excessive movement.One proved case is attached.