1.河南中医药大学第一附属医院儿科医院,河南省郑州市金水区人民路19号,450000
2.河南中医药大学儿科医学院
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收稿:2024-09-24,
修回:2024-12-02,
纸质出版:2025-05-17
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袁振华,蔡明阳,姜盈盈等.基于“玄府-气液-肾络”探讨儿童肾病综合征动态序贯辨治思路[J].中医杂志,2025,66(10):1007-1010.
YUAN Zhenhua,CAI Mingyang,JIANG Yingying,et al.Dynamic Sequential Diagnosis and Treatment of Pediatric Nephrotic Syndrome Based on the "Sweat Pore-Qi and Liquid-Kidney Collaterals"[J].Journal of Traditional Chinese Medicine,2025,66(10):1007-1010.
袁振华,蔡明阳,姜盈盈等.基于“玄府-气液-肾络”探讨儿童肾病综合征动态序贯辨治思路[J].中医杂志,2025,66(10):1007-1010. DOI: 10.13288/j.11-2166/r.2025.10.006.
YUAN Zhenhua,CAI Mingyang,JIANG Yingying,et al.Dynamic Sequential Diagnosis and Treatment of Pediatric Nephrotic Syndrome Based on the "Sweat Pore-Qi and Liquid-Kidney Collaterals"[J].Journal of Traditional Chinese Medicine,2025,66(10):1007-1010. DOI: 10.13288/j.11-2166/r.2025.10.006.
基于“玄府-气液-肾络”观点,认为儿童肾病综合征以玄府郁闭、气液失调、肾络受损为核心病机,提出以通养玄府、调畅气液、补肾通络为治疗原则。临证采用序贯疗法,根据疾病初期、激素诱导期、激素减量期、激素维持期四个时期的不同病机特点进行分期动态辨治。疾病初期阳虚水泛,治宜温阳利水,选用真武汤加减;激素诱导期阴虚火旺,治宜滋阴降火,选用知柏地黄丸合二至丸加减;激素减量期气阴两亏,治宜益气养阴,选用参芪地黄汤加减;激素维持期阴阳两虚,治宜阴阳双补,选用肾气丸加减。同时重视配伍藤类或虫类通络药,以期为临床治疗提供新思路。
Based on the viewpoint of "sweat pore-
qi
and liquid-kidney collaterals", it is believed that children's nephrotic syndrome is caused by the core mechanism of sweat pore constraint and closure,
qi
and liquid imbalance, and kidney collaterals impairment, and it is proposed that the treatment principle is to nourish the sweat pore, regulate
qi
and fluid, and supplement the kidney and unblock the collaterals. In clinic, guided by sequential therapy and according to the different disease mechanism characteristics of the four stages, including early stage of the disease, hormone induction stage, hormone reduction stage, hormone maintenance stage, the staged dynamic identification and treatment was applied. For early stage of the disease with edema due to
yang
deficiency, modified
Zhenwu Decoction
(真武汤) was applied to warm
yang
and drain water; for hormone induction stage with
yin
deficiency resulting in effulgent fire, modified
Zhibai Dihuang Pill
(知柏地黄丸) plus
Erzhi Pill
(二至丸) was used to enrich
yin
and reduce fire; for hormone reduction stage with
qi
and
yin
deficiency, modified
Shenqi Dihuang Decoction
(参芪地黄汤) was used to boost
qi
and nourish
yin
; for hormone maintenance stage, modified
Shenqi Pill
(肾气丸) was used to supplement
yin
and
yang
. Meanwhile, the treatment also attaches importance to the combination of vine-based or worm medicinals to dredge collaterals, so as to providing ideas for clinical treatment.
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翁秀平 . 二至丸合知柏地黄丸联合常规疗法治疗肾病综合征肝肾阴虚证临床研究 [J]. 新中医 , 2021 , 53 ( 16 ): 16 - 20 .
杜琳 , 赵阳 . 黄芪及其有效成分治疗肾病综合征的研究进展 [J]. 临床医学进展 , 2024 , 14 ( 1 ): 1532 - 1535 .
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姜淼 , 张海波 , 丁樱 . 雷公藤多苷药理作用及临床应用研究进展 [J]. 中华中医药学刊 , 2021 , 39 ( 3 ): 59 - 63 .
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