肾病综合征分阶段论治临床体会

肾病综合征从临床症状的表现可分为无(少)尿期、多尿期、恢复期。无(少)尿期多数患者服用大剂量激素,易耗阴液,表现为阴虚火旺、脾虚不能制水、水湿泛溢肌肤之证,治宜滋阴清热利水。多尿期多为阴阳气血两虚(尤其为脾肾阳虚),治宜温补脾肾之阳;恢复期多为肝肾阴虚,治宜补益肝肾为主。隔药饼灸配合中药汤剂治疗肾病综合征既有扶正固本的作用,又有调节免疫、提高肾脏免疫之功能,于肾病综合征不同阶段进行辨证论治,对临床治疗具有重要意义。     

从“五脏相关”论治小儿慢性荨麻疹

"五脏相关"是岭南医家邓铁涛教授基于传统中医五行学说提出的概念。小儿慢性荨麻疹病因复杂,以风、火、湿邪多见,导致心火过亢、肝气郁滞、脾虚湿蕴、肺卫不固、阴阳两虚。治疗该病多从五脏着手,以清泄心火、疏肝理气、健脾祛湿、调和营卫、调和阴阳为法,标本同治、消补兼施。     

Urine osmotic pressure and deficiency-excess syndrome of renal disease: analysis of 428 cases

By means of TCM differentiation of symptom-complexes, the authors tested and analysed the urine osmotic pressure (UOP) and the urine and plasma osmotic ratio (UPOR) for 428 cases of renal disease, with the conclusion that the UOP and the UPOR were within the normal value range for not only the 36 cases lack of clinical symptoms so as to be unable to have TCM classification identified, but also for 24 cases of Wind edema excess syndrome mainly caused by pathogenic Wind's invasion to the Lung. But for 74 cases of damp-heat Kidney impairment and 294 cases with the main symptom being Kidney deficiency [including weakness of Qi of Kidney, Yang deficiency of Spleen and Kidney, Yin deficiency of Liver and Kidney], the value of their UOP and the UPOR had the tendency of reduction (P less than 0.01), among which the value of the patients of Kidney Yang deficiency reduced most obviously. The further observation showed that, for the nocturia patients caused by renal disease, the value of UOP and the UPOR reduced more obviously than usual. Therefore the authors assert that the test on UOP and UPOR will offer an objective index to patients' nocturia and Kidney-Qi weakness. 60 cases with renal disease of Kidney deficiency syndrome and 27 cases of damp-heat Kidney impairment syndrome under the diagnosis and treatment based on an overall analysis of symptoms and signs leads to the following conclusion: With the elimination of pathogenic factors and recovery of kidney, the damp-heat Kidney impairment patients' UOP will be increased. The low UOP of patients caused simply by Kidney deficiency, however, will recover slower.     

从圆运动理论治疗不寐

人体的气机通过降、沉、升、浮,如环无端不停地进行圆运动。人体中焦轴轮不利,气机升、降、浮、沉失和,脏腑阴阳失交,便会引起圆运动运转失常,从而产生不寐。治疗应以"复圆"为原则,顺应圆运动的规律,恢复人体气机、调整脏腑阴阳,阴平阳秘,气血调和,神安则寐。在临床上,可将不寐分为心阴不足证、肾阳亏虚证、肝阳不足证、脾胃失和证,其中,心阴不足证治以滋阴降火、安神定志,方选天王补心丹合交泰丸加减;肾阳亏虚证治以温补肾阳、宁心安神,方选附子汤合桂枝甘草龙骨牡蛎汤加减;肝阳不足证治以养肝镇惊、安神定志,采用"升肝降胆"之法,方选酸枣仁汤加减;脾胃失和证治以补阳泻阴、宁心安神,方选补脾胃泻阴火升阳汤加减。     

慢性乙型肝炎后肝硬化患者中医证候与血清TGF-β1、HA、LN、IV-C、PC-Ⅲ水平相关性研究

目的:观察慢性乙型肝炎后肝硬化患者中医证候与血清TGF-β1、HA、LN、IV-C、PC-Ⅲ水平的相关性。方法:选取147例慢性乙型肝炎后肝硬化患者作为观察组,另选同期健康成人30例作为对照组。空腹抽取静脉血液,检测并记录不同中医证候患者和正常成人血清中转化生长因子-β1(transforming growth factor-β,TGF-β1)、透明质酸((hyaluronic acid,HA)、层黏连蛋白(laminin,LN)、IV型胶原(type IV-collagen,IV-C)以及前胶原蛋白Ⅲ(before collagenⅢ,PC-Ⅲ)含量,对患者进行肝功能分级,综合分析比较。结果:肝硬化患者TGF-β1含量显著高于正常成人(P0.05),且各证候肝硬化患者血清内TGF-β1由低到高依次为:肝气郁结证水湿内阻证湿热内蕴证瘀血内阻证肝肾阴虚证脾肾阳虚证。肝硬化患者HA、PC-Ⅲ、LN以及IV-C含量显著高于正常成人,差异有统计学意义(P0.05),且瘀血内阻证肝硬化患者各项肝纤维化指标均较高。瘀血内阻证、肝肾阴虚证以及脾肾阳虚证患者血清内HA和PC-Ⅲ水平显著高于水湿内阻证和湿热内阻证患者,差异有统计学意义(P0.05)。除瘀血内阻证患者LN含量较高以外,其余各证候肝硬化患者血清内LN水平比较,差异无显著差异(P0.05)。肝气郁结证患者血清中IV-C含量相对较低,与其他各证候肝硬化患者比较,差异有统计学意义(P0.05)。肝气郁结证和水湿内阻证肝硬化患者肝功能分级A级较为常见,显著高于其他证候患者,差异有统计学意义(P0.05);湿热内蕴证和瘀血内阻证患者肝功能分级B级明显高于其他证型患者,差异有统计学意义(P0.05);肝肾阴虚证和脾肾阳虚证患者肝功能C级患者较多,与其他证型患者比较,差异有统计学意义(P0.05)。结论:通过对慢性乙型肝炎后肝硬化患者进行中医证候判定,结合肝纤维化指标可大致了解患者肝功能分级和肝硬化程度,有助于临床诊治,阻止病情恶化,有利于判断预后,提高患者生活质量。     

从虚探讨慢性咳嗽的病机

虚是慢性咳嗽的重要病机之一,而以肺、脾、肾三脏虚为甚。慢性咳嗽可因肾虚动水或肾虚火炎;或因肾虚,冲气上逆干肺;若咳嗽日久未愈,继而伤及肺脾肾,易致气阴两虚,则内生诸邪而干肺。如咳嗽迁延日久,伤及脾胃,可致脾气虚弱,土不生金,肺气失充而咳嗽。故慢性咳嗽在临床辨证治疗时,要做到理论结合实际,理清其证的具体病机,提高辨证的准确率,才能有效治疗疾病。     

常占杰教授益脾养肝法治疗药物性肝损伤经验

常占杰教授在药物性肝损伤的治疗中以脾胃虚弱为辨证中心,强调未病先防、既病防变的治未病理念,在治疗中注重脾胃阳气,时时顾护胃气,故治疗中以益脾养肝为法。初期治以清热利湿、疏肝理气,即便是湿热内蕴,脾胃虚弱者,少佐以健脾益气之味,仍要注意湿热伤阴的问题;后期需顾护阴津、温通气血。常教授在临床实际中形成了独特的思维模式:以平淡之法,用平和之药而达到非常之效。益脾养肝法治疗药物性肝损伤切中病机,具有较好的临床疗效。     

任青玲运用滋阴补阳序贯法治疗多囊卵巢综合征伴胰岛素抵抗

肾为天癸之源、气血之根,女子以血为主,经、孕、产、乳皆以血为用。月经来潮及其周期性演变需在心肾交济、肝脾协调的整体配合下周而复始地完成。心肾燮理阴阳,肝脾协调气血,气血阴阳调摄有度,月经周期圆运动才能节律适常。故本病的治疗以心肾为核心,辨证论治兼调四脏,使得阴平阳秘,达到调经促孕的目的。任青玲教授在补养心肾调周法的基础上提出滋阴补阳序贯法,结合卵巢局部发生胰岛素抵抗的表现是卵巢局部“痰浊”的特点,对于多囊卵巢综合征伴胰岛素抵抗的治疗强调经前期以补阳为主,常用右归饮;经后期以滋阴为要,常用滋肾生肝饮;经间期温化痰湿以治标,常用苍附导痰汤。治疗上以补肾为主,兼以化痰、疏肝、活血等方法,配合周期不同阶段用药,使治疗更具有针对性。     

胃肠病辨治初探

气阴两虚、湿热内蕴是胃肠病的基本病机。按邪正斗争态势分,正虚有气虚、阴虚、气阴两虚、阳虚、阴阳两虚、血虚之异,邪实有湿滞、热郁、滞结和血瘀之别。胃肠病的治疗重在补中清化。     

Clinical observation and experimental study of the treatment of aplastic anemia by warming and tonifying the spleen and kidney

84 cases observed were divided into 4 types according to principles of diagnosis and treatment based on an overall analysis of symptoms and signs, namely: Yang-deficiency of the Spleen and Kidney (62 cases, 73.8%), Yin-deficiency leads to internal heat (6 cases), deficiency of both the Heart and the Spleen (7 cases), and prostration of Qi after loss of blood (9 cases). The patients were treated with the method of warming and tonifying the Spleen and Kidney by using Er-Xian decoction of warming the Kidney. The three other types were also treated with the method after being relieved with the methods of tonifying the Heart and the Spleen, of nourishing Yin to relieve internal heat and cooling blood, and of strengthening Yang to stop chronic hemorrhage respectively so that function of the blood and Qi would promote each other and be improved. The total effective rate was 84.5%, and remission rate was 47.6% among 84 cases, but 91.9% and 50.0% in the type of Yang-deficiency of the Spleen and Kidney alone. Among the effective cases there was a remarkable improvement in the hemogram after treatment (P less than 0.001, less than 0.01), and the long-termed curative effect was also exciting. The mechanism of Er-Xian decoction of warming the Kidney was investigated through the nourishment of the hemopoiesis stem cell. The experiment showed that the decoction could increase CFU-S and GM-CFU in the bone marrow under the lower hemopoietic function of the bone marrow, and increase GM-CFU and CFU-E in the bone marrow of normal rats (P less than 0.001, less than 0.01, less than 0.05). The histological findings showed that there was a reduction in hemorrhage and hyperemia in the bone marrow between the decoction group and the control group, and the recovery of hemopoietic function was better than the latter.     

浅析2型糖尿病合并冠心病的辨证及用药思路

2型糖尿病合并冠状动脉粥样硬化性心脏病多为久病痼疾,应属本虚标实。根据临证经验将2型糖尿病分为阴虚火旺兼血瘀证、气阴两虚兼血瘀证和阴阳两虚兼血瘀证。临证时主要从"培肾固本""调和脾胃""交通阴阳"3个方面着手,并辅以通阳散结、活血祛瘀、行气化痰。根据"方证对应"的原则,确定治则为"扶正祛邪,攻补兼施",治法以"养心阴,益心气,培补肾元,宽胸调胃,活血宣痹"为主。针对阴虚火旺兼血瘀证,以六味地黄丸合桃红四物汤加减;气阴两虚兼血瘀证,以生脉汤合补阳还五汤加减;阴阳两虚兼血瘀证,以炙甘草汤合血府逐瘀汤加减。     

COPD阳气虚衰证和气阴两虚证患者细胞因子浓度的研究

目的研究慢性阻塞性肺病(COPD)阳气虚衰证和气阴两虚证患者TNF-α、IL-8、IL-1β的浓度并比较其差异。方法分别检测30例COPD阳气虚衰证患者、30例COPD气阴两虚证患者和30例健康对照者血清中TNF-α、IL-8、IL-1β的浓度。结果 COPD阳气虚衰证和气阴两虚证患者血清TNF-α、IL-8、IL-1β的浓度均高于健康对照组,差异有显著统计学意义(P<0.01),且阳气虚衰组高于气阴两虚组,差异有统计学意义(P<0.05)。结论与气阴两虚证患者相比,阳气虚衰证患者气道炎症反应更明显;通过扶阳固本延缓气阴两虚证向阳气虚衰证发展的治法,能减轻患者炎症反应带来的病理损伤。     

阴火刍探

阴火理论源于李东垣,但对于阴火的认识,至今尚未有定论。关于阴火学说的起源,有阴虚内热说和壮火散气说两种。关于阴火学说的内涵,有阴火即心火说、阴火即肾火说、阴火即脾胃火说、阴火即脉中伏火说、阴火即三焦火说、阴火即相火说几种观点。心火,有心阴虚火旺、离位之心火、代君之火之分;肾火,有肾阴虚火旺、肾中真阳外越、肾气郁火之分;脾胃之火,有脾胃郁火、血虚之火、脾胃虚火之分;脉中伏火,有心火煎熬血脉、气郁血脉、火邪下陷血脉、卫气下陷血脉之分;三焦火,有三焦气郁化火、三焦流行之火之分;相火,有妄行相火、离位相火、病理相火之分。     

广西地区100例慢性肾衰竭中医证型分布调查研究

目的:研究广西地区慢性肾衰竭的中医证型的分布特点。方法:采用临床调研的方法,收集广西中医药大学第一附属医院肾病科门诊、病房及血透室的慢性肾衰竭患者100例,进行中医辨证分型,运用医学统计学的方法,研究慢性肾衰竭的中医各证型分布规律。结果:在100例慢性肾衰竭患者中,正虚证型以脾肾阳虚证患者最多(38.0%),其次为脾肾气虚证(26.0%),气阴两虚证和阴阳两虚证患者接近(15.0%),肝肾阴虚证最少(7.0%)。邪实证型以湿热证患者出现频率最多(51.0%),湿浊证及血瘀证次之,分别占43.0%和49.0%,水气证和风动证较少(35%)。在中医各虚证证候与肾功能衰竭各期的关系统计中,脾肾气虚证主要见于肾功能代偿期、失代偿期及衰竭期,在尿毒症期降低(P0.05);脾肾阳虚证中尿毒症期为最多,代偿期、失代偿期和衰竭期均较少(P0.05);气阴两虚证主要见于失代偿期、肾衰竭期和尿毒症期,代偿期较少,差异无统计学意义(P0.05);肝肾阴虚证散在见于肾功能衰竭各期中,无明显差异;阴阳两虚证主要见于肾衰竭期和尿毒症期,尿毒症所占比例较大(P0.05)。在中医正虚与邪实兼夹的分布中,纯虚证未兼挟邪实者以脾肾气虚证为最多;湿浊证在脾肾亏虚证中出现最多,湿热证在气阴两虚证中出现最多,水气证在脾肾阳虚证出现最多,在肝肾阴虚证出现最少,血瘀证主要在脾肾阳虚和脾肾气虚证出现最多,风动证在各虚证中较少见,缺乏统计学意义。慢性肾衰竭不同证型之间的年龄分布差异无统计学意义。结论:慢性肾衰竭的中医证型分布具有一定的规律性,将为今后的临床中医治疗提供依据。     

1490例2型糖尿病临床辨证分型调查分析

目的 了解2型糖尿病及其并发症中医临床辩证分型的现状，为制定2型糖尿病及其并发症的中医诊疗方案提供依据。方法 采用临床流行病学调查方法，对2型糖尿病及其并发症1490例、64项证候指标进行频数分析，归纳得出2型糖尿病及其并发症的基本证侯，按证候出现率归纳各证的主要证候。结果 2型糖尿病及并发症临床上主要分为热盛伤津、肝肾阴虚、气阴两虚、阴阳两虚、湿热内蕴5类证型，体现了中医“久病多虚，久病多瘀”的观点。结论 2型糖尿病及并发症临床上可按脏腑气血阴阳盛衰分型论治。     

基于“阳化气,阴成形”理论探讨排卵障碍的中医证治

"阳化气,阴成形"功能失调与排卵障碍的发生密切相关。卵子失去精微的滋养则"阴成形"不足,难以长大成为成熟卵泡;卵子失于温煦则"阳化气"虚弱,动力不足,难以在排卵期突破胞膜而排出。平调阴阳对于排卵障碍的治疗至关重要。对于"阴成形"不足者,应以补肾填精养血为主,滋阴以充形;对于"阳化气"虚弱者,应以温补脾肾为主,扶阳以益气。在整体辨证的同时还需兼顾卵子的生长周期,以期达到"阴平阳秘"的最佳状态。     

慢性胃炎的证素特点

目的观察慢性胃炎主要病名下的证素分布特点,总结慢性胃炎的发病规律。方法选择慢性胃炎中医诊断为"胃痛"、"胃痞"患者各60例,运用证素辨证方法对其证候表现进行统计分析。结果胃痛和胃痞主要病位证素相同,为胃、脾、肝;主要病性证素相同,为气滞、阳虚、气虚、湿;证素组合频率较高的有:肝脾胃加气滞加气虚、脾胃气虚、脾胃湿、脾胃阳虚、肝脾胃气滞。结论慢性胃炎的证素特点和发病规律基本相同,病变实质为虚实夹杂,虚证以脾气虚弱、脾阳不足为主,实证以胃气不降、肝气郁滞、湿邪阻滞为主。     

《金匮要略》从脏腑论治神志病学术思想探析

中医认为,五脏藏神,情志活动亦为五脏所主,五脏功能不调,神明被扰,可引发情志病。《金匮要略》从脏腑论治情志病,以调整五脏阴阳为切入点,尤其重视调阴阳、立中气,通过调和五脏阴阳以镇心安神、宁心安神。《金匮要略》记载的情志病的证治主要有:从心肺阴虚内热论治百合病,方选百合地黄汤以养心肺之阴治本,兼清虚热治标;从心肝血虚、虚火内扰心神论治不眠,方选酸枣仁汤以补肝体、养肝血、清虚热、养心安神;从心肾不交、阴阳俱虚论治梦交,方选桂枝加龙骨牡蛎汤以交通心肾、潜镇摄纳、调畅阴阳;从心脾气血不足论治脏躁,方选甘麦大枣汤以调补气血、养心安神;从肝胆气血虚弱、邪热入里论治谵语,方选小柴胡汤解郁达邪以复少阳之机。     

李春婷治疗胃癌经验

李春婷认为胃癌为患者久病,气血亏虚,体质羸弱,癌毒伺机入侵而发病,其发生、发展是因虚致实,病位在脾胃。脾虚为发病根本,治疗益气健脾;久病气耗,或情志内伤,进而胃阴亏耗,治宜益胃养阴;脾喜燥恶湿,脾虚湿浊蕴久化痰,与病情进展关系密切,影响津血运行而化瘀,治以涤痰化瘀;肝助胃和降,患者情志不舒,治以疏肝理气、养血柔肝;癌毒内犯者,毒瘀交结,以解毒散结为要务。根据患者综合情况,辨病与辨证结合,治疗上则治本与治标各有主次,虚实兼顾。治本以健脾益气、益胃养阴;治标则根据致病因素以涤痰化瘀、疏肝和胃、抗癌解毒。从中医整体观念出发,因人而异,补泄有度。     

脑卒中合并重症肺炎患者不同体质类型与血清降钙素原水平的关系

[目的] 观察脑卒中患者合并重症肺炎的不同体质类型,来探讨不同体质类型与血清降钙素原(PCT)水平的关系。[方法] 运用王氏体质分类法对临床上220例脑卒中合并重症肺炎的患者进行体质分型,分析其中主要的体质类型分布,及不同体质类型与PCT水平之间的关系。[结果] 该患者群体的体质类型分布主要集中在气虚质、痰湿质、阴虚质和阳虚质4种体质类型。在各体质类型间PCT水平中,痰湿质、阴虚质的两组PCT水平明显高于气虚质、阳虚质两组;痰湿质与阴虚质两组PCT水平比较,差异无统计学意义(P>0.05);气虚质与阳虚质两组PCT水平比较,差异无统计学意义(P>0.05);痰湿质与气虚质、阳虚质两组PCT水平比较,差异有统计学意义(P<0.05);阴虚质与气虚质、阳虚质两组PCT水平比较,差异有统计学意义(P<0.05)。[结论] 气虚质、痰湿质、阴虚质、阳虚质为脑卒中合并重症肺炎的易感体质,患者不同体质类型间的PCT水平具有差异性,痰湿质、阴虚质患者发病更为危重,炎症反应更为剧烈。