王孟庸从标本论治狼疮性肾炎临床经验(1)
摘要:本文总结王孟庸教授从标本论治狼疮性肾炎的临床经验。王孟庸教授治疗狼疮性肾炎重视以肝脾肾亏虚为本,热毒瘀血为标,本虚标实,内外合邪的临床特点,灵活采用补益肝肾、健脾益胃、清热凉血、活血利水等治法,疗效显著,且有效避免不良反应和降低复发风险,改善患者预后。
关键词:名医经验;王孟庸;狼疮性肾炎;中医疗法
DOI:10.3969/j.issn.1005-5304.2018.01.023
中图分类号:R259.932.4 文献标识码:A 文章编号:1005-5304(2018)01-0105-03
Clinical Experience of WANG Meng-yong in Treating Lupus Nephritis
from Symptoms and Essence
ZHOU Dao-cheng1, ZHAO Heng-xia1, LI Hui-lin1, LIU De-liang,1 LIU Yuan1, ZHENG Xia-jie1,LI Jin-hua1, CHEN Ye2, ZHANG Zhuo-ying3, Instructor: WANG Meng-yong1
1. Traditional Chinese Medicine Hospital of Shenzhen, Shenzhen 518033, China;
2. Longhua Central Hospital of Shenzhen, Shenzhen 518000, China;
3. Traditional Chinese Medicine Hospital of Shangyu, Shangyu 312300, China
Abstract: This article summarized the clinical experience of Professor WANG Meng-yong in treating lupus nephritis from the symptoms and essence. Professor WANG Meng-yong believes that treatment for lupus nephritis should attach importance to clinical features of setting deficiency of liver, spleen and kidney as the essence and toxin and blood stasisas symptoms, in which the essence is deficient and the symptoms are excess and combination of external and internal pathogenesis. He flexibly uses methods of nourishing liver and kidney, tonifying spleen, and stomach, clearing heat and cooling blood, activating blood and promoting diuresis to alleviate water retention, which have obvious efficacy, effectively avoid adverse reactions and reduce the risk of recurrence, and improve patient prognosis.
Keywords: experience of famous doctors; WANG Meng-yong; lupus nephritis; TCM therapy
狼疮性肾炎(lupus nephritis,LN)是系统性红斑狼疮(systemic lupus erythematosus,SLE)最常见且严重的内脏损害,由LN所致的终末期肾衰是SLE患者的主要死亡原因之一。广东省名中医王孟庸教授是国家名中医药专家、深圳市首批名老中医药专家经验传承人指导老师,从事中医肾病临床、教学、科研60年,承古而不泥于古,注重创新。笔者有幸跟师侍诊,获益匪浅。现将王师从标本论治LN经验简述如下。
1 病因病机
中医典籍无“狼疮性肾炎”病名,根据其临床特
基金项目:国家中医药管理局全国名老中医药专家传承工作室建设项目(2012年)
通讯作者:赵恒侠,E-mail:2073558282@qq.com
征可归属中医学“阴阳毒”“蝶疮流注”“鬼脸疮”“水肿”“虚劳”“痹证”等范畴,《金匮要略·百合狐惑阴阳毒病脉证治》有“阳毒之为病,面赤斑斑如锦纹,咽痛,唾脓血”“阴毒之为病,面目青,身痛如被杖,咽喉痛”。王师认为,本病以正虚为本,邪实为标。内因主要为先天禀赋不足,七情内伤,饮食劳倦,致卫外不固,阴阳气血不相顺接。外因多为风、湿、热、毒之邪侵袭,邪从火化,又虚火内生,火热毒邪闭阻经络,热壅血瘀,加重阴阳气血失调程度。本病基本病機为肝、脾、肾三脏亏虚,热毒血瘀闭阻脏腑经络,正虚邪实,内外合邪。“风雨寒热,不得虚,邪不能独伤人”。肾为先天之本,主藏精。肝肾同居下焦,肝藏血,肝肾精血同源。脾胃为后天之本,气血生化之源。先后天脏腑失养,则精血生成不足,卫外不固。外邪侵袭,邪从火化,加之激素等辛热之品易灼伤津液,耗气伤阴,虚火内生,且湿热留恋,热毒伤营,瘀血阻络。正虚邪实,虚实夹杂,病情迁延,复杂难愈。
2 辨证论治特点
王师临证强调,LN的治疗当先分清标本虚实,主次有序,应灵活运用补益肝肾、健脾益胃、清热凉血、活血利水等方法,方可控其势,趋其愈。, http://www.100md.com(周道成 赵恒侠 李惠林 刘德亮 刘媛 郑夏洁 李金花 陈叶 章卓)
关键词:名医经验;王孟庸;狼疮性肾炎;中医疗法
DOI:10.3969/j.issn.1005-5304.2018.01.023
中图分类号:R259.932.4 文献标识码:A 文章编号:1005-5304(2018)01-0105-03
Clinical Experience of WANG Meng-yong in Treating Lupus Nephritis
from Symptoms and Essence
ZHOU Dao-cheng1, ZHAO Heng-xia1, LI Hui-lin1, LIU De-liang,1 LIU Yuan1, ZHENG Xia-jie1,LI Jin-hua1, CHEN Ye2, ZHANG Zhuo-ying3, Instructor: WANG Meng-yong1
1. Traditional Chinese Medicine Hospital of Shenzhen, Shenzhen 518033, China;
2. Longhua Central Hospital of Shenzhen, Shenzhen 518000, China;
3. Traditional Chinese Medicine Hospital of Shangyu, Shangyu 312300, China
Abstract: This article summarized the clinical experience of Professor WANG Meng-yong in treating lupus nephritis from the symptoms and essence. Professor WANG Meng-yong believes that treatment for lupus nephritis should attach importance to clinical features of setting deficiency of liver, spleen and kidney as the essence and toxin and blood stasisas symptoms, in which the essence is deficient and the symptoms are excess and combination of external and internal pathogenesis. He flexibly uses methods of nourishing liver and kidney, tonifying spleen, and stomach, clearing heat and cooling blood, activating blood and promoting diuresis to alleviate water retention, which have obvious efficacy, effectively avoid adverse reactions and reduce the risk of recurrence, and improve patient prognosis.
Keywords: experience of famous doctors; WANG Meng-yong; lupus nephritis; TCM therapy
狼疮性肾炎(lupus nephritis,LN)是系统性红斑狼疮(systemic lupus erythematosus,SLE)最常见且严重的内脏损害,由LN所致的终末期肾衰是SLE患者的主要死亡原因之一。广东省名中医王孟庸教授是国家名中医药专家、深圳市首批名老中医药专家经验传承人指导老师,从事中医肾病临床、教学、科研60年,承古而不泥于古,注重创新。笔者有幸跟师侍诊,获益匪浅。现将王师从标本论治LN经验简述如下。
1 病因病机
中医典籍无“狼疮性肾炎”病名,根据其临床特
基金项目:国家中医药管理局全国名老中医药专家传承工作室建设项目(2012年)
通讯作者:赵恒侠,E-mail:2073558282@qq.com
征可归属中医学“阴阳毒”“蝶疮流注”“鬼脸疮”“水肿”“虚劳”“痹证”等范畴,《金匮要略·百合狐惑阴阳毒病脉证治》有“阳毒之为病,面赤斑斑如锦纹,咽痛,唾脓血”“阴毒之为病,面目青,身痛如被杖,咽喉痛”。王师认为,本病以正虚为本,邪实为标。内因主要为先天禀赋不足,七情内伤,饮食劳倦,致卫外不固,阴阳气血不相顺接。外因多为风、湿、热、毒之邪侵袭,邪从火化,又虚火内生,火热毒邪闭阻经络,热壅血瘀,加重阴阳气血失调程度。本病基本病機为肝、脾、肾三脏亏虚,热毒血瘀闭阻脏腑经络,正虚邪实,内外合邪。“风雨寒热,不得虚,邪不能独伤人”。肾为先天之本,主藏精。肝肾同居下焦,肝藏血,肝肾精血同源。脾胃为后天之本,气血生化之源。先后天脏腑失养,则精血生成不足,卫外不固。外邪侵袭,邪从火化,加之激素等辛热之品易灼伤津液,耗气伤阴,虚火内生,且湿热留恋,热毒伤营,瘀血阻络。正虚邪实,虚实夹杂,病情迁延,复杂难愈。
2 辨证论治特点
王师临证强调,LN的治疗当先分清标本虚实,主次有序,应灵活运用补益肝肾、健脾益胃、清热凉血、活血利水等方法,方可控其势,趋其愈。, http://www.100md.com(周道成 赵恒侠 李惠林 刘德亮 刘媛 郑夏洁 李金花 陈叶 章卓)