张兆元教授肾炎血尿辨治举隅.docVIP

张兆元教授肾炎血尿辨治举隅 　　[摘要] 肾小球肾炎为临床常见病、多见病。血尿是其主要症状之一，常反复发作，病情迁延难愈。目前西医尚无有效的治疗方法。吾师张兆元基于经方中“下血谵语者，此为热入血室……随其实而泻之”，热迫血溢，不循常道所致，以降火、 清热、利湿为基本原则，若病症迁延日久，气阴两虚，随证加减。治疗上用药平和，辨证与辨病相结合，总结出一套有效的治疗肾炎血尿的辨治方法。 　　[关键词] 肾小球肾炎；血尿；辨证五法；张兆元 　　[中图分类号] R249 [文献标识码] A [文章编号] 1674-4721（2014）09（c）-0119-03 　　Professor Zhang Zhao-yuan nephritis treatment for corner 　　DOU Xiao-ni1 ZHANG Zhao-yuan2 　　1.Department of Traditional Chinese Medicine，Shijingshan Hospital of Beijing City；Shijingshan Teaching Hospital of the Capital Medical University in Beijing City，Beijing 100043，China；2.Department of Traditional Chinese Medicine，the Sixth Hospital of Beijing City，Beijing 100007，China 　　[Abstract] Glomerulonephritis is the clinical common disease，hematuria is one of the main symptoms，which is often recurrent，refractory protracted illness.Western medicine is no effective treatment currently.Zhang Zhao-yuan of my teacher was based on delirium of blood，this is the heat into the blood chamber ...... with reduction for excess syndrome hot forced blood spill，and blood does not follow the normal road，to send fire，heat，dampness as the basic principle.If symptoms is protracted，which leads to deficiency of Qi and Yin，modification according to symptoms.Peace on drug therapy，a combination of differentiation with disease，summed up a set of effective methods to treated nephritis treatment. 　　[Key words] Glomerulonephritis；Hematuria；Dialectical five law；Zhang Zhao-yuan 　　肾小球肾炎血尿是多种原发或继发性肾小球疾病常见的临床表现之一，病情缠绵难愈，如失治误治，日久亦可发展成慢性肾功能不全。因此，重视血尿的治疗，对于延缓病情的进展乃至疾病的康复至关重要[1-2]。目前西医尚无有效的治疗方法。张兆元教授从事中医临床工作20余载，尤其善长肾脏疾病的诊治。现将吾师治疗肾小球肾炎血尿之学术思想与临床经验整理如下。 　　1 血尿急发，八正散清热利水加减为宜 　　急性肾小球肾炎、IgA肾病、过敏性紫癜肾炎等因感染等诱因而出现湿热蕴结证候，症见血尿鲜红或尿黄赤，尿常规检测有大量红细胞，伴有五心烦热，口舌生疮，咽干口燥，咽痛，或伴眼睑、颜面及双下肢水肿，腰酸痛，舌质红，苔白干，脉滑数[3]。方用八正散加减。药用：?蓄、瞿麦、大黄、白花蛇舌草、地黄、小蓟、车前子、甘草。 　　本方临床还适用于泌尿系感染属于湿热蕴结下焦者，证见小便短涩，点滴而下，色赤或黄赤，腰痛，小腹胀或下坠；尿检白细胞增多，有脓细胞；肉眼血尿，或镜下血尿。属中医热淋、血淋等证。?蓄、瞿麦、车前子、滑石皆具有清热利水通淋之作用；白茅根、生地黄、小蓟清热凉血止血；邪热侵入肾与膀胱，伤及血络则出现血尿，热邪蕴结则白细胞增多，可在方中加入清热解毒之金银花、白花蛇舌草、蒲公英等。大黄为苦寒泻下药，