Detection of the Level of Urinary FPA in Chronic Nephritis with Renal Failure and Its Clinical Implication

The level of urinary FPA was assayed by high per formance liquid chromatography (HPLC ) in 42 normal controls, 57 cases of chronic glomeru-lonephritis, including 24 with normal renal function, 12 with renal insufficiency and 21 with uremia. Their levels were 24. 40± 10. 30 μg/L, 26. 99±5.77 μg/L,38. 81±6. 28 μg/L, 79. 74± 18. 76 μg/L, respectively. The level of urinary FPA in renal insufficiency function group was significantly higher than those of the con-trol group and normal renal function group (P<0.01). The patients with uremia presented dramatically higher level of urinary FPA than those in the renal insufficiency group (P<0.01). A positive correlation was found between the level of urinary FPA and the blood creatine (r= 0. 9120, P<0. 01 ). It was suggested that a hypercoagulable state existed in the patients with chronic nephritis with renal failure, in which the severity was closely related with the occurrence and development of the disease. The urinary FPA could serve as a good indicator for renal function.

Professor Yumao Du's Experience in Treating Chronic Nephritis

Chronic nephritis is a common clinical kidney disease,with insidious onset and long course,which can eventually develop into chronic renal failure.In Chinese medicine,it belongs to the categories of"edema,""back pain""deficiency,"and epertigo."Professor Du Yumao is a well-known Chinese medicine doctor and a well-known nephropathy expert in China.He has rich clinical experience and unique insights into the treatment of chronic nephritis.He believes that insufficient kidney yin is the key to this disease,and water dampness and blood stasis are important pathological factors.Appropriate change of method according to the situation and flexible use of medicine often lead to good clinical outcomes.

Efficacy and safety of Nephritis rehabilitation tablet combined with Valsartan for chronic glomerulonephritis:A system review and metaanalysis

Objective:To systematically evaluate the efficacy and safety of Nephritis Rehabilitation Tablet(NRT)combined with valsartan in treatment of chronic glomerulonephritis(CGN).Methods:Computer search databases such as CNKI,CBM,VIP,wanfang,Embase,PubMed and Cochrane library,and find all randomized controlled trials(RCTs)comparing NRT combined with valsartan versus valsartan in treatment of chronic glomerulonephritis.The search time limit is to build the database until October 2020.RCTs were screened according to the inclusion and exclusion criteria.After data extraction and quality assessment,the Cochrane risk of bias tool was used to evaluate the methodological quality of these studies.Meta-analysis was performed by Review Manager 5.2,and GRADE system for evidence quality evaluation.Results:We have identified a total of 24 eligible RCTs with 2082 participants and completed a meta-analysis based on these RCTs.The results of the meta-analysis showed that compared with valsartan,NRT combined with valsartan treatment showed effective curative effect in terms of effective treatment rate(OR=4.72;95%CI,3.67,6.08;P<0.00001),24h urine protein quantification(MD=-0.52;95%CI,-0.59,-0.44;P<0.00001),serum creatinine(Scr)(MD=-10.33;95%CI,-14.00,-6.66;P<0.00001),Systolic blood pressure(SBP)(MD=-11.42;95%CI,-17.67,-5.17;P=0.0003),Diastolic blood pressure(DBP)(MD=-6.28;95%CI,-9.14,-3.42;P<0.0001),Blood urine nitrogen(BUN)(MD=-0.02;95%CI,-0.41,0.37;P=0.93),plasma albumin(ALB)(MD=5.05;95%CI,4.27,5.84;P<0.00001),and adverse reactions(OR=0.93,95%CI,0.54,1.60;P=0.78).No serious adverse events were mentioned in these studies.And based on the results of the systematic review,the GRADE system recommended ranking method was used to evaluate the quality of evidence and the recommendation level.The results showed that the level of evidence was moderate and the recommendation intensity was weak recommendation.Conclusions:NRT combined with valsartan has a significant effect on the treatment of CGN,and the treatment effect is better than valsartan alone.There are no obvious adverse reactions during the treatment process.However,due to the generally low quality of the literature included in these studies,and the variability of the evaluation methods of each study,morelarge samples,multi-center,high-quality samples are still needed RCTs are further verified.

Effect of Shenkang granule combined with Atorvastatin on renal function, urinary protein and coagulation function in patients with chronic nephritis

Objective: To investigate the effect of Shenkang granule combined with Atorvastatin on renal function, urinary protein and coagulation function in patients with chronic nephritis. Methods:A total of 100 patients with chronic nephritis who were treated in our hospital between May 2016 to May 2017 were randomly divided into control group and observation group, 50 cases in each group. Patients in the control group were treated with Atorvastatin, while patients in the observation group were treated with Shenkang granule on the basis of the treatment in the control group. The changes of renal function, coagulation function and inflammatory factors were detected and compared between the patients in the two groups before and after treatment. Result: After treatment, the levels of Cr, BUN and 24hUpro in serum of patients in the two groups were significantly decreased, and the levels of ALB were significantly increased, and the changes of the above factors of patients in the observation group were more obvious. After treatment, the levels of PT, APTT and TT of patients in the two groups were significantly increased, and the levels of FIB were significantly decreased, and the changes of the above indexes of patients in the observation group were more obvious. After treatment, the levels of hs-CRP and TNF-α in serum of patients in the two groups were significantly decreased, and the decrease trend of inflammatory factors of patients in the observation group was more obvious. Conclusion: Shenkang granule combined with Atorvastatin has a good effect on treatment of chronic nephritis. It can significantly improve renal function and coagulation function, alleviate inflammation, and has a certain protective effect on kidney of patients.

Clinical observation of 36 patients with chronic nephritis proteinuria treated with Zhuangshen Gujing decoction

Objective:Our goal was to examine the impact of Zhuangshen Gujing decoction on proteinuria associated with chronic nephritis.Methods:72 patients with chronic nephritis proteinuria were divided randomly into two groups;one group was treated with Zhuangshen Gujing(n=36;treatment group)and the other group was treated with irbesartan(n=36;control group).After 6 months’treatment,urine protein and renal function were evaluated.Results:Proteinuria resolved completely in four patients in the treatment group;complete disease resolution was observed only among three individuals in the control group.Of the 32 cases remaining in the treatment group,15 had substantial responses to Zhuangshen Gujing decoction,9 had partial responses,and 8 had no response to treatment;the overall the response rate was 73.33%.Among the 33 cases remaining in the control group,12 had a substantial response to irbesartan,5 had a partial response,and 16 had no response to treatment;the overall response rate among the controls was 57.67%(P=0.031).We also observed statistically significant differences with respect to quantitative comparisons of urinary protein at 24 days after a single course of treatment(P=0.001).Conclusion:Zhuangshen Gujing decoction is effective in treating chronic nephritis proteinuria.

Exploring the mechanism of Astragalus and Salvia miltiorrhiza in the treatment of chronic glomerulonephritis:A network pharmacology approach

To elucidate the mechanism underlying the therapeutic impact of Astragalus-Danshen in chronic glomerulonephritis(CGN),a comprehensive exploration was conducted utilizing network pharmacology.The TCMSP database was employed to aggregate the chemical constituents and targets associated with Astragalus and Danshen.Simultaneously,disease targets specific to CGN were sourced from the Genecards database.The convergence of these datasets yielded a set of intersection genes,representing potential targets for CGN treatment through Astragalus-Danshen formulations.Subsequently,protein interaction networks and“chemical composition-target”networks were meticulously constructed.Core targets were subjected to GO and KEGG enrichment analyses.The investigation revealed a total of 240 targets corresponding to 20 and 65 chemical components of Astragalus and Danshen,respectively.From this pool,86 potential targets associated with CGN treatment were discerned,ultimately identifying 29 core targets.Noteworthy among these were TNF,JUN,TP53,IL1B,RELA,MMP9,CASP3,IL10,MAPK14,MYC,and TGFB1.KEGG enrichment analysis illuminated pathways pertinent to CGN,encompassing the IL-17 signaling pathway,TNF signaling pathway,and the AGE-RAGE signaling pathway in diabetic complications.In summary,Astragalus-Danshen exhibited a potential anti-inflammatory and renoprotective effect on CGN,particularly through modulating the IL-17 signaling pathway,TNF signaling pathway,and AGE-RAGE signaling pathway in diabetic complications,involving key regulators such as TNF,JUN,TP53,IL1B,MAPK14,and others.

Prof.Guan Jinghuan's Experience in Treating Chronic Nephritic Hematuria

Our teacher Guan Jinghuan, a famous veteran TCM physician in Hubei province, has been engaging in clinical research for more than forty years in the treatment of nephrosis by the combined Chinese and western medicine, and he has accumulated a wealth of experience, especially in treating intractable nephritic diseases. The following is an introduction of his experience in treating chronic nephritic hematuria.

Prognostic Aspects of Lupus Nephritis at Aristide Le Dantec University Hospital in Dakar

Introduction: Kidney injury is common in the course of lupus and affects the functional and vital prognosis. The risk of progression to end-stage renal failure can reach 40% to 60%. Thus we carried out this work for the purpose of an evaluation of the renal and vital prognosis and to deduce the factors of poor prognosis. Patients and method: This was a retrospective, descriptive and analytical study conducted over a period of 10 years from January 1, 2007 to December 31, 2016, performed in the Nephrology Department of Aristide Le Dantec Hospital in Dakar. Patients with lupus nephritis were included. The studied parameters were epidemiological, clinical, paraclinical and progression. We had done a crossover of the patients to look for the factors of poor renal and vital prognosis. Results: Out of 93 cases of lupus patients, 64 were included, a prevalence of 69%. The mean age of the patients was 31.97 ± 10.44 years old. There were 81% women and 19% men, a sex ratio of 0.23. Class III was found in 24 cases (37.5%), Class IV in 20 cases (31.25%), Class V in 15 cases (23.4%), Class II in 4 cases (6.25%) and Class I in 1 case (1.6%). The combination of corticosteroids and immunosuppressants was used in 56.25% of cases. After a follow-up of six months, 19 patients were in complete remission, 21 had resistance and 9 had partial remission. Of the 21 patients who had resistance, 8 were in chronic renal failure. Death was observed in 5 patients and the causes were in 3 patients: pulmonary embolism, bacterial meningitis and pulmonary tuberculosis. The cause of death was unknown in 2 patients. The factors of poor renal prognosis were lymphopenia, the presence of anti-native DNA antibodies, nephrotic syndrome, microscopic hematuria, tubular atrophy and interstitial fibrosis. Risk factors affecting renal survival were the presence of native anti-DNA antibodies, microscopic hematuria, leukocyturia and the presence of a proliferative class. The factors of poor prognosis were renal failure, lymphopenia, nephrotic syndrome, glomerular sclerosis, arteriosclerosis, interstitial infiltration and tubular atrophy. Conclusion: The risk conferred by nephropathy is greater for proliferative glomerulonephritis;it is also correlated with the presence of persistent nephrotic syndrome or severe renal failure.

何永生教授基于虚、瘀、湿治疗慢性肾炎经验

慢性肾小球肾炎简称慢性肾炎,临床表现以血尿、蛋白尿、水肿、高血压为主,中医学认识其证候最早。何永生教授临床30余载,治疗该病经验独到,认为慢性肾炎病机不离虚、瘀、湿,在临床诊治中,通过补益肺脾肾、补血通络祛瘀、健脾淡渗利湿,辨证施治,取得了良好临床疗效。

杨霓芝教授治疗不同原发病所致慢性肾功能衰竭用药规律

目的:利用数据挖掘方法分析杨霓芝教授治疗不同原发病所致慢性肾功能衰竭(chronic renal failure,CRF)的用药规律。方法:通过广东省中医院门诊系统收集2019年杨霓芝教授门诊就诊的CRF患者病案资料,按照不同原发病分类总结,利用中医药传承辅助平台进行用药频次、组方规律及聚类分析。结果:收集慢性肾衰患者137例共410个处方,使用频次最高中药分别是泽兰(374)、黄芪(295)、桃仁(293)、丹参(247)、女贞子(231)。原发病分别为慢性肾炎71例、糖尿病肾病16例、高血压肾病15例、梗阻性肾病15例,痛风性肾病5例,其他15例。不同原发病中医症状出现频次以疲倦、尺弱、舌淡暗、舌淡红、夜尿、乏力、小便泡沫、脉沉细、舌齿痕、腰酸、脉细、眠差最高;药物组合频次最高为桃仁-泽兰,泽兰-黄芪,丹参-泽兰;共获得治疗CRF新处方5个。结论:杨霓芝教授治疗CRF以益气活血为核心;以辨病-辨证-辨症-用药为体系,慢性肾小球肾炎患者多重用清热利湿之品,糖尿病肾病患者多重用补肾固精缩尿之品,高血压肾病患者偏重活血化瘀。

李志明从伏邪论治慢性肾炎

中医的伏邪理论源远流长,并与慢性肾小球肾炎密切相关。李志明教授在中西医结合肾脏病临床研究方面有着超过30年的经验,尤其在治疗慢性肾小球肾炎方面具备丰富的经验。李教授认为慢性肾小球肾炎的发病与伏邪有关,其病因病机包括初感邪气侵袭体表、素体虚弱、邪气侵入肾络、浊毒滞留不散、正气与邪气相互纠缠、气血损伤等方面。针对这些病因病机,李教授采用补肾填精养络、透邪祛湿活络等治疗方法,并基于郭恩绵教授的经典方剂如玉肾露进行灵活的加减治疗。方剂的组成不仅能够针对慢性肾小球肾炎的发病机制,还能根据患者的不同症状进行个体化的调整,临床上取得显著的疗效。

慢病健康管理对狼疮肾炎患者疾病活动度及肾损害的影响

目的探讨慢病健康管理对狼疮肾炎(lupus nephritis,LN)患者的疾病活动度及肾损伤的影响。方法选取武汉大学中南医院2022年5月至2022年11月期间就诊的97例LN患者作为研究对象。根据管理模式进行分组,慢病管理组49例,予以慢病健康管理模式管理,对照组48例,予以出院后常规管理。6个月后比较两组患者的疾病活动度、血尿、蛋白尿、白细胞、红细胞、白蛋白、肌酐、尿素氮、用药依从性、生活质量(SF-36量表评估)、医师信任度。结果两组患者干预后,血液、尿液指标均较治疗前有所改善,且慢病管理组的血液、尿液指标优于对照组,慢病管理组红细胞由(3.74±0.61)×10^(12)/L升至(4.37±0.58)×10^(12)/L,白蛋白由(34.99±6.91)g/L升至(39.82±4.59)g/L,肌酐水平由(63.66±26.18)μmol/L降至(58.37±17.11)μmol/L,尿素氮由(5.03±1.95)mmol/L升至(5.13±1.39)mmol/L,血尿例数由23例降至10例,蛋白尿例数由26例降至13例,对照组红细胞由(3.68±0.71)×10^(12)/L升至(4.07±0.65)×10^(12)/L,白蛋白由(35.11±6.42)g/L升至(36.76±7.54)g/L,肌酐水平由(60.66±18.06)μmol/L升至(72.38±39.57)μmol/L,尿素氮由(5.03±1.94)mmol/L升至(5.72±1.32)mmol/L,血尿例数由24例降至19例,蛋白尿由24例降至22例,差异具有统计学意义(P<0.05)。两组患者的疾病活动度均降低,其中慢病管理组低于对照组,差异具有统计学意义(P<0.05)。干预后,慢病管理组的用药依从性高于对照组,差异具有统计学意义(P<0.05)。慢病管理组生活质量方面生理功能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、精神健康方面评分均明显高于对照组(P<0.05)。慢病管理组的医师信任度显著高于对照组,差异具有统计学意义(P<0.05)。结论慢病健康管理有助于降低LN患者疾病活动度,改善肾损害,提高用药积极性,提升生活质量和医师信任度。

运用机器学习构建慢性肾炎中医辨证智能模型及内部验证

目的基于机器学习的方法构建慢性肾炎中医智能辨证模型。方法检索知网、万方、维普、中国生物医学文献服务系统、古今医案云建库至2023年3月公开发表慢性肾炎相关医案文献。建立慢性肾炎中医医案信息数据库,然后将数据按7∶3成为训练集和验证集。运用决策树(decision tree,DT)、随机森林(random forest,RF)、极限梯度提升(extreme gradient boosting,XGBoost)、支持向量机(support vector machine,SVM)、K最邻近节点算法(K-nearest neighbor,KNN)、BP神经网络(back propagation neural network,BPNN)对训练集进行模型构建与超参数调优,并通过验证集对模型进行内部验证。结果最终得到786个医案数据,决策树的准确率81.5%,随机森林的准确率85.4%,极限梯度提升的准确率83.7%,支持向量机的准确率85%,K最邻近节点算法的准确率62.2%,BP神经网络的准确率72.1%。结论随机森林对慢性肾炎证型的判定推断最准确,人工智能应用于慢性肾炎中医辨证方法学上可行。

猪苓汤化学成分及效应机制研究进展

猪苓汤已广泛应用于肾病综合征、慢性肾炎、尿路结石、泌尿系感染、慢性肾小球肾炎等疾病的治疗,并取得了显著疗效。现代研究表明,猪苓汤具有利尿、改善肾脏局部炎症、改善肾功能、抑制肾结石形成等作用。现通过查阅相关文献,从化学成分及药理效应分子机制方面对猪苓汤研究现状进行综述,以期为该方创新药物开发及临床适应证的分析研究提供参考。

肾病方联合泼尼松治疗慢性肾炎疗效观察

目的探究中药肾病方联合泼尼松治疗慢性肾炎的临床疗效。方法选取贺州市中医医院2021年1月—2022年4月收治的76例慢性肾炎患者,按照随机数字表法分为参照组与试验组,各38例,参照组给予糖皮质激素(泼尼松)药物治疗,试验组在使用泼尼松的基础上联合中药肾病方治疗。比较治疗后两组治疗总有效率、炎症因子水平、肾功能指标及生活质量水平。结果试验组总有效率为84.21%(32/38),显著高于参照组60.53%(23/38)(P<0.05),中药肾病方联合西药可明显增强疗效。治疗后,两组24 h尿蛋白定量(urinary protein quantification,UP)、血肌酐(serum creatinine,Scr)、尿素氮(blood urea nitrogen,BUN)值均明显下降(P<0.05),且试验组24 h UP、Scr、BUN值明显低于参照组(P<0.05),试验组肾功能改善优于参照组。治疗后,两组白细胞介素6(interleukin-6,IL-6)、白细胞介素8(interleukin-8,IL-8)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)值均下降(P<0.05),且试验组明显低于参照组(P<0.05),中药肾病方能加强消炎作用。治疗后,两组WHOQOL-BRE评分值均升高(P<0.05),且试验组明显高于参照组(P<0.05),联用中药肾病方提高生活质量更佳。结论中药肾病方联合泼尼松治疗慢性肾炎疗效突出。

金水宝对慢性肾炎的治疗作用分析

目的 分析金水宝对慢性肾炎的治疗作用。方法 84例慢性肾炎患者,采用随机数字表法分为参照组和研讨组,每组42例。参照组患者采用缬沙坦进行治疗,研讨组患者在参照组基础上配合金水宝进行治疗。比较两组患者肾功能指标[血肌酐(Scr)、尿素氮(BUN)]、24 h尿蛋白定量、炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)]水平及临床疗效。结果 治疗3个月后,研讨组患者的24 h尿蛋白定量、Scr、BUN分别为(1.12±0.51)g/24 h、(92.13±10.90)μmol/L、(5.13±1.09)mmol/L,均低于参照组的(1.51±0.76)g/24 h、(101.54±11.72)μmol/L、(5.94±1.17)mmol/L,组间比较结果具有统计学差异(P<0.05)。治疗3个月后,研讨组患者的TNF-α、IL-6、hs-CRP水平分别为(1.02±0.29)ng/ml、(116.13±25.34)ng/L、(7.08±1.05)mg/L,均低于参照组的(1.44±0.31)ng/ml、(149.12±26.59)ng/L、(10.13±1.54)mg/L,组间比较结果具有统计学差异(P<0.05)。研讨组患者的治疗总有效率为88.10%,高于参照组患者的66.67%,组间比较结果具有统计学差异(P<0.05)。结论 金水宝对慢性肾炎的治疗作用显著,在提升疗效的同时,兼具培元、固本之功。

补中益气汤加减治疗慢性肾炎蛋白尿的临床效果观察

目的探讨补中益气汤加减治疗慢性肾炎蛋白尿的临床效果。方法将82例慢性肾炎蛋白尿患者随机分为对照组及观察组,每组41例。对照组使用常规西医治疗,观察组在对照组基础上使用补中益气汤加减治疗。对比两组的临床疗效、肾功能指标[血肌酐(Scr)、尿素氮(BUN)]及蛋白尿指标(24 h尿蛋白定量、24 h尿微量白蛋白)水平、中医证候积分、炎性因子[白细胞介素-6(IL-6)、白细胞介素-17(IL-17)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]水平。结果观察组治疗总有效率为95.12%,明显高于对照组的73.17%(P<0.05)。观察组治疗后Scr、BUN、24 h尿蛋白定量、24 h尿微量白蛋白分别为(77.01±21.62)μmol/L、(4.23±1.06)mmol/L、(25.76±3.84)mg/L、(25.43±3.18)mg/L,均低于对照组的(90.47±25.84)μmol/L、(7.17±1.28)mmol/L、(29.64±4.03)mg/L、(31.06±3.49)mg/L(P<0.05)。观察组治疗后肢体浮肿、倦怠乏力、便溏、胃脘胀满中医证候积分分别为(0.98±0.21)、(0.90±0.18)、(0.92±0.19)、(0.89±0.16)分,明显低于对照组的(1.65±0.24)、(1.59±0.22)、(1.64±0.23)、(1.58±0.21)分(P<0.05)。观察组治疗后CRP、IL-6、IL-17、TNF-α水平分别为(16.03±5.78)mg/L、(15.03±3.37)ng/L、(26.89±6.28)ng/L、(37.93±4.76)μg/L,均低于对照组的(25.93±7.33)mg/L、(19.71±3.86)ng/L、(53.49±9.82)ng/L、(46.38±5.14)μg/L(P<0.05)。结论补中益气汤加减治疗慢性肾炎蛋白尿的临床效果显著,能有效降低尿蛋白水平,改善肾功能,减轻炎症反应,缓解证候。

郭恩绵教授治疗慢性肾炎血尿临证经验总结

郭恩绵教授结合多年临床实践经验,将慢性肾炎血尿之病机归纳为以肾络亏损、脾肾两虚为其基本病因,以湿浊、瘀血为其重要的病理因素。郭老师据此所创玉肾露2号方剂,扶正补虚以固本,配以清热利湿、散瘀止血之法,结合实际情况进行灵活加减,中西医结合治疗配合日常生活调护,以求达到理想治疗效果。

肾病方联合糖皮质激素治疗慢性肾炎的临床疗效

目的分析肾病方联合糖皮质激素在慢性肾炎治疗中的作用。方法选取2022年1月—2023年6月贺州市中医医院收治的84例慢性肾炎患者为研究对象,根据不同的治疗方法分为对照组和观察组,各42例。对照组行糖皮质激素治疗,观察组行糖皮质激素+肾病方治疗。比较两组的疗效、不良反应(消化性溃疡、骨质疏松、水钠潴留)发生率、血肌酐、尿素氮、24 h尿蛋白定量及血浆白蛋白水平。结果治疗后,观察组治疗总有效率为95.24%(40/42),高于对照组的76.19%(32/42),差异有统计学意义(χ^(2)=6.222,P<0.05)。观察组不良反应发生率为4.76%(2/42),低于对照组的19.05%(8/42),差异有统计学意义(χ^(2)=4.087,P<0.05)。治疗后,观察组血浆白蛋白高于对照组,24 h尿蛋白定量、尿素氮、血肌酐水平低于对照组,差异有统计学意义(P均<0.05)。结论糖皮质激素+肾病方治疗慢性肾炎可改善患者肾功能,提高治疗总有效率,减少不良反应发生率,是一种合理、可靠的治疗策略。

张敏从瘀论治慢性肾炎综合征蛋白尿经验介绍

蛋白尿是慢性肾炎综合征常见临床症状,严重影响患者健康及生活质量。张敏教授认为脾肾亏虚是蛋白尿产生的根本病机,瘀是蛋白尿形成的致病因素,“虚、湿、热”是致瘀的常见病理因素。张教授临床以自拟消蛋白方为主方进行加减化裁治疗,主张分期论治,将从瘀论治理念贯穿整个治疗过程。张教授认为早期脾肾亏虚,久虚成瘀,治以补益脾肾、益气活血;中期由虚蕴久化湿,湿浊瘀阻脉络,以祛风除湿、活血化瘀法治疗;晚期因湿瘀郁而化热,阻滞肾络,治以化瘀消癥、清热通络。张教授强调疾病到了晚期或是经激素、免疫抑制剂等治疗后往往是虚、湿、热兼杂,应在自拟消蛋白方基础上灵活加减用药。张教授临床常用黄芪、白术等大量补气药以补肾健脾,巧用三七、鱼腥草及地龙等虫类药活血化瘀,重视祛风除湿、活血通络,使治疗达到事半功倍,缩短病程,直达病所,减轻患者痛苦。