文章摘要
张敏,王自敏,邢海燕.王自敏教授治疗原发性肾病综合征的临床思辨经验[J].浙江中医药大学学报,2021,(3):244-247, 259.
王自敏教授治疗原发性肾病综合征的临床思辨经验
Professor WANG Zimin‘s Experience of Clinical Thinking and Differentiation in Treating Primary Nephrotic Syndrome
投稿时间:2020-07-02  
DOI:10.16466/j.issn1005-5509.2021.03.008
中文关键词: 原发性肾病综合征  病因病机  健脾益肾  名医经验  王自敏  生活调护  验案
英文关键词: primary nephrotic syndrome  etiology and pathogenesis  invigorating the spleen and tonifying the kidney  the experiences of famous doctor  WANG Zimin  nursing  medical cases
基金项目:河南省中医管理局国家中医临床研究基地科研专项(2018JDZX090)
作者单位E-mail
张敏 河南中医药大学 郑州 450000  
王自敏 河南中医药大学第一附属医院  
邢海燕 河南中医药大学第一附属医院 hnxinghaiyan@126.com 
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中文摘要:
      [目的]总结王自敏教授治疗原发性肾病综合征的经验。[方法]通过临床跟诊,收集病案,总结王自敏教授对原发性肾病综合征病因病机的认识,探析其从不同临床表现、糖皮质激素使用不同阶段、生活调护三方面治疗原发性肾病综合征的思辨经验,并辅以验案佐证。[结果]王自敏教授认为脾肾两虚为原发性肾病综合征发生的根本,脾肾功能失调,精微外泄,水湿、湿热、痰浊、瘀血等浊邪潴留,乃发此病,治疗时应以健脾益肾为治疗大法,同时兼以祛邪,标本兼顾。根据水肿、蛋白尿、低蛋白血症、高脂血症的不同临床表现,辨证与辨病相结合,主张“活血化瘀”法应贯穿疾病始终。王自敏教授常根据患者不同临床表现选方用药,并在糖皮质激素使用的不同阶段辅以中药汤剂,以缓解糖皮质激素的不良反应,改善患者阴虚阳亢、气虚、阳虚的证候。同时,王自敏教授亦重视生活调护,指出日常生活中应注重预防感冒、防治感染、避免劳累,防止疾病复发。所举案例首诊时以脾虚湿盛、胃失和降为主要病机,治疗以健脾燥湿、理气和胃为大法;而后出现阳虚、外感之象,加以清肺补肾之品。患者久病气阴两虚,故宜益气、滋阴、养肾以调护机体,诊治过程以“活血化瘀”之法贯穿始终,随证治疗3个月余后痊愈。[结论]王自敏教授治疗原发性肾病综合征注重标本兼顾,辨证与辨病结合,其临床思辨经验值得广大后辈参悟学习。
英文摘要:
      [Objective]To summarize Professor WANG Zimin‘s experience in treating primary nephrotic syndrome(PNS).[Methods]Through clinical follow-up learning and collecting medical records, summarizing Professor WANG Zimin‘s understanding of the etiology and pathogenesis of PNS. It analyzes its speculative experience in the treatment of PNS from different clinical manifestations, different stages of glucocorticoid use, and nursing.At the same time it is supplemented by case verification.[Results] Professor WANG believes that the deficiency of both the spleen and kidney is the root of PNS. Dysfunction of the spleen and kidney leads to the leakage of essences, and the retention of turbid pathogens such as water and dampness, dampness and heat, phlegm turbidity and blood stasis and so on. Treatment should be based on invigorating the spleen and tonifying the kidney, meanwhile, it is necessary to remove pathogenic factors and takes both the origin and manifestation into consideration. According to the clinical manifestations of edema, proteinuria, hypoproteinemia and hyperlipidemia, syndrome differentiation and disease differentiation should be combined, and the method of “promoting blood circulation and removing blood stasis” should run through the whole process of diagnosis and treatment. Professor WANG often chooses prescriptions and medications according to the different clinical manifestations of patients, and supplements Chinese herbal decoctions at different stages of glucocorticoid to alleviate the adverse effects of glucocorticoid and relieve the syndromes of Yin deficiency and Yang hyperactivity, Qi deficiency, and Yang deficiency. At the same time, Professor WANG also attaches importance to nursing and points out that in daily life, patients should pay attention to preventing colds, preventing infections, avoiding fatigue, and preventing disease recurrence.The main pathogenesis of the case cited in the first visit was damp abundance due to splenic asthenia and disharmony of stomach, and the treatment was based on strengthening the spleen, removing dampness, regulating Qi and harmonizing the stomach. Then there were signs of Yang deficiency and diseases caused by external factors, and drugs of clearing the lung and tonifying the kidney were added. Due to the deficiency of Qi and Yin for a long time, it was necessary to replenish Qi, nourish Yin and tonify the kidney to regulate and protect the body. The method of “promoting blood circulation and removing blood stasis” ran through the whole process of diagnosis and treatment, and good results were achieved after about 3 months of treatment. [Conclusion]Professor WANG Zimin‘s treatment of PNS pays attention to both the origin and manifestation and the combination of syndrome differentiation and disease differentiation. His clinical speculative experience is worthy of understanding and learning by the majority of younger generations.
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