| 闫蒙蒙,任永朋,邢海燕,等.王自敏教授辨治狼疮性肾炎的经验及医案举隅[J].浙江中医药大学学报,2020,44(9):881-884. |
| 王自敏教授辨治狼疮性肾炎的经验及医案举隅 |
| Clinical Experience of Professor WANG Zimin in Treating Lupus Nephritis and Proved Cases |
| DOI：10.16466/j.issn1005-5509.2020.09.010 |
| 中文关键词: 狼疮性肾炎 病因病机 中西医结合 药对 医案 名医经验 分期 王自敏 |
| 英文关键词: lupus nephritis etiology and pathogenesis integrated traditional Chinese and western medicine drug pairs medical case records the experiences of noble doctors in stages WANG Zimin |
| 基金项目:河南省中医药科学研究专项课题(2018JDZX090) |
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| 中文摘要: |
| [目的]总结王自敏教授辨治狼疮性肾炎(lupus nephritis，LN)的临床经验。[方法]通过跟师临诊，收集病案，从病因病机、分期辨证探讨王自敏教授治疗LN的特色经验，对其临证心得进行总结分析，并附医案一则。[结果]王自敏教授认为本病的病因有内、外因之分，病机可概括为“虚、热、瘀、毒”，病程可划分为急性期(风热瘀毒证)、发展期(气阴两虚证、肝肾阴虚证)、慢性期(脾肾阳虚证、湿热瘀毒证)三个阶段，对其各期不同证型，分别予荆防败毒散合银翘散、黄芪地黄汤、杞菊地黄丸合四物汤、实脾饮或真武汤、四妙丸等进行加减治疗。王自敏教授认为本病治疗宜早、疗程宜长，主张中西医结合，并善用药对精准治疗。所附一则医案，首诊时辨为肝肾阴虚兼湿热证，治以滋补肝肾、清利湿热，针对热淋，予清热利湿、利尿通淋治疗，症状明显改善；而后辨为气阴两虚兼火旺证，治以益气滋阴清热，投以经验方黄芪地黄汤，收效甚佳。[结论]王自敏教授对LN“虚、热、瘀、毒”病机的深刻认识、注重分期分型论治及中西医结合等经验，具有较高的现实指导意义，值得深入学习和借鉴。 |
| 英文摘要: |
| [Objective]To summarize Professor WANG Zimin's clinical experience in the treatment of lupus nephritis(LN) based on syndrome differentiation.[Methods]Through clinical consultation with the teacher， collecting medical records， this paper discussed Professor WANG Zimin's special experience in treating LN from the etiology， pathogenesis， and syndrome differentiation in stage， summarized and analyzed his clinical experience， and a medical record was attached.[Results]Professor WANG Zimin believes that the etiology of LN can be divided into internal and external causes， and the pathogenesis can be summarized as “deficiency， heat， blood stasis and toxin”. The pathological process can be divided into three stages: Acute stage(wind heat and stasis and toxin syndrome)， development stage(deficiency of both Qi and Yin， Yin deficiency of the liver and kidney syndrome)， and chronic stage(Yang deficiency of the spleen and kidney， dampness heat and stasis and toxin syndrome). The syndrome types of each stage can be treated with Jingfang Baidu San combined with Yinqiao San， Huangqi Dihuang Decoction， Qiju Dihuang Pill combined with Siwu Decoction， Shipi Drink or Zhenwu Decoction， Simiao Pill. Professor WANG Zimin thinks that the treatment of this disease should be early and the course of treatment should be long， and advocates the combination of traditional Chinese and western medicine and she is good at using drug pairs to treat LN accurately.The attached medical record was identified as Yin deficiency of the liver and kidney combined with damp-heat syndrome at the first diagnosis， the patient was treated with nourishing the liver and kidney， clearing away damp-heat. For stranguria of heat type， the treatment of clearing heat， removing dampness and promoting diuresis and relieving stranguria could improve the symptoms obviously. Then， the patient was identified as deficiency of both Qi and Yin and hyperactivity of fire， and achieved good effects after treated by self-made Huangqi Dihuang Decoction to replenish Qi， nourish Yin and clear heat.[Conclusion]Professor WANG Zimin's profound understanding of the pathogenesis of LN "deficiency， heat， blood stasis and toxin" ， and his experience in treating LN by stages and types， as well as the combination of traditional Chinese medicine and western medicine， are of great practical significance and worth learning and using for reference. |
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