| 朱月玲,杨斌斌,董敖,等.儿童特发性肾病综合征的中医病机及辨治体会[J].浙江中医药大学学报,2022,46(10):1133-1135, 1140. |
| 儿童特发性肾病综合征的中医病机及辨治体会 |
| Analyse the TCM Pathogenesis， Differentiation and Treatment of Idiopathic Nephrotic Syndrome in Children |
| DOI：10.16466/j.issn1005-5509.2022.10.014 |
| 中文关键词: 特发性肾病综合征 儿童 中医 病机 治法 扶正 祛邪 |
| 英文关键词: idiopathic nephrotic syndrome children traditional Chinese medicine pathogenesis method of treatment reinforcing healthy Qi eliminating the pathogenic factors |
| 基金项目:浙江省自然科学基金项目(LY19H190005) |
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| 中文摘要: |
| [目的] 论述儿童特发性肾病综合征(idiopathic nephrotic syndrome，INS)中医病机及辨治体会。[方法] 结合小儿生理特点肺脾肾三脏不足、INS常因外感复发、蛋白尿反复等病理特点，提出儿童INS中医病机及相应的治法，并辅以典型病案。[结果] 儿童INS的中医主要病机为肺、脾、肾三脏本虚，兼夹风、湿、瘀标证。治疗应扶正祛邪，标本兼顾，重在益肺健脾、补肾固摄以控制蛋白尿，预防呼吸道感染；灵活应用疏风宣肺、清热利湿、行气化湿、活血祛瘀之法使水利气行，减少病情反复，改善患儿的长期预后。所附医案首诊时属肾阴虚，治以滋阴补肾固摄，药用“加味六味地黄汤”等；二诊属风热袭肺，治以疏风宣肺，药用“六味汤”加减；后续重在益气健脾固表，以预防复发，药用“玉屏风汤、六君子汤”加减，随访一年半未复发。[结论] 中医治疗儿童INS应扶正祛邪、标本兼顾，重在益肺健脾、补肾固摄，灵活应用祛邪之法，有较好的临床指导价值。 |
| 英文摘要: |
| [Objective] To discuss the traditional Chinese medicine(TCM) pathogenesis， differentiation and treatment of idiopathic nephrotic syndrome(INS) in children. [Methods] Combining with the physiological characteristics of children， such as deficiency of the lung， spleen and kidney， and the pathological characteristics of INS in children such as exogenous recurrence， repeated proteinuria， etc.， the TCM pathogenesis and corresponding treatment methods in INS in children are proposed， and it is supplemented by a typical case. [Results] The root of the pathogenesis of INS in children is essential deficiency of the lung， spleen and kidney， and the manifestation is wind， dampness and blood stasis. The treatment should consider both the root and manifestation， reinforcing healthy Qi and eliminating the pathogenic factors， and should focus on nourishing the lung and invigorating the spleen， tonifying the kidney and reinforcing the absorption to control proteinuria and prevent respiratory tract infections. It is necessary to flexibly apply the methods of dispelling wind and dispersing lung Qi， clearing heat and removing dampness， promoting Qi and resolving dampness， promoting blood circulation and removing blood stasis， so as to promote water and Qi circulation， reduce the recurrence of the disease and improve the long-term prognosis. In the typical case， the patient was differentiated as deficiency of Yin of the kidney in the first visit， the treatment was nourishing Yin and tonifying the kidney to control proteinuria， and “Jiawei Liuwei Dihuang Decoction” was adopted; the second visit was due to the wind-heat attacking the lung， “Liuwei Decoction” was used for dispelling wind and dispersing lung Qi; the treatment of the follow-up prevention stage was nourishing Qi， invigorating the spleen and consolidating exterior， “Yupingfeng Decoction” and “Liujunzi Decoction” were adopted， there was no recurrence after one and a half years of follow-up. [Conclusion] The TCM treatment of INS in children should reinforce healthy Qi and eliminate the pathogenic factors. It should focus on nourishing the lung Qi， invigorating the spleen， tonifying the kidney and reinforcing the absorption， flexibly apply the methods to eliminate pathogenic factors， which has good clinical guiding value. |
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