摘要
膜性肾病是成人肾病综合征常见的病理类型之一,临床上多表现为水肿、大量蛋白尿及低蛋白血症等,且血栓栓塞并发症高发。西医抗凝治疗虽能缓解症状,但存在出血风险与不良反应。中医药治疗本病具有整体调节优势。中医肾病医家多认为,膜性肾病的基本病机为“本虚标实”,以脾肾亏虚为本,虚、湿、瘀、热、毒为标,其中“瘀”是该病的关键病理因素之一,影响疾病的各个阶段。瘀血的形成与气虚推动无力、湿热灼伤血脉、寒凝脉道拘急及久病入络密切相关,易与水肿相互搏结,形成“水瘀互结”的恶性循环,进一步加重肾络损伤与肾功能恶化,因此活血化瘀法成为治疗的核心思路。基于血瘀病机,临床形成五大活血化瘀治法:活血益气法、活血清热解毒法、温阳利水活血法、活血消癥法、活血补血法,分别对应不同证型。结合疾病进展,分期论治膜性肾病:水肿期固表利水兼活血,蛋白尿期益气温阳、活血消癥,恢复期活血解毒、理气助阳。本研究就膜性肾病的流行病学特征、病因病机、治法等方面加以阐述,总结各医家临床研究经验,探讨膜性肾病与血瘀的关系及辨证用药,旨在为临床提供有价值的参考。
Membranous nephropathy is one of the common pathological types of nephrotic syndrome in adults,clinically manifested as edema,massive proteinuria,and hypoproteinemia,with a high incidence of thromboembolic complications.Although Western medicine anticoagulant therapy can alleviate symptoms,it has bleeding risks and adverse reactions.Traditional Chinese medicine(TCM)treatment has the advantage of overall regulation.Many TCM renal specialists believe that the fundamental pathogenesis of membranous nephropathy is“deficiency in the root and excess in superficiality”,which is based on the deficiency of the spleen and kidney and manifests as the superficial factors of deficiency,dampness,blood stasis,heat,and toxin.Among them,“blood stasis”is one of the key pathological factors of the disease,affecting all stages of its progression.The formation of blood stasis is closely related to the inability of insufficient Qi(气)to promote blood circulation,heat-dampness damaging blood vessels,cold congealing causing vessel constriction,and prolonged illness invading collaterals.Blood stasis is prone to intermingle with edema,forming a vicious cycle of“intertwined water and blood stasis”,which further aggravates renal collateral damage and renal function deterioration.Therefore,the method of activating blood circulation and removing blood stasis has become the core therapeutic approach.Based on the pathogenesis of blood stasis,five major therapeutic methods of activating blood circulation and removing blood stasis have been formed in clinical practice,namely activating blood circulation and replenishing Qi method,activating blood circulation and clearing heat for detoxification method,warming Yang(阳)and promoting diuresis to activate blood circulation method,activating blood circulation to resolve masses method,and activating blood circulation to tonify blood method,each corresponding to different syndrome types.Combined with the progression of membranous nephropathy,staged treatment is adopted:in the edema stage,it focuses on securing the exterior,promoting diuresis and concurrently activating blood circulation;in the proteinuria stage,it emphasizes replenishing Qi and warming Yang,and activating blood circulation and resolving masses;in the recovery stage,it prioritizes activating blood circulation and detoxicating,and regulating Qi to invigorate Yang.This study elaborates on multiple aspects of membranous nephropathy,including its epidemiological characteristics,etiology and pathogenesis,and therapeutic methods,summarizes the clinical research experiences of various physicians,and explores the relationship between membranous nephropathy and blood stasis as well as syndrome differentiation-based medication,aiming to provide valuable references for clinical practice.
出处
《中医临床研究》
2025年第27期36-42,共7页
Clinical Journal Of Chinese Medicine
基金
社会发展关键技术研究项目(20240304069SF)
中医药科技项目(2022152)。
关键词
膜性肾病
活血化瘀法
血瘀
中医治疗
Membranous nephropathy
Promoting blood circulation and removing blood stasis method
Blood stasis
TCM treatment
