从肝脾肾论治过敏性紫癜性肾炎

肝脾肾三脏功能失调在过敏性紫癜(henoch-schonlein purpura,HSP)中后期的发病过程中起着至关重要的作用,发病过程中相互影响、相互转化,任何一脏功能失调,久治不愈,必会影响其他两脏功能的正常运行,进而导致全身气机紊乱,疾病久治不愈。肝主藏血、疏泄功能失和,脾主运化、统血功能失职,肾主封藏、主水功能失司等都会导致气、血、津液代谢障碍,引起全身气机紊乱,产生新的病理产物——瘀血、湿邪等,从而进一步加重病情。对于肝气郁结明显的患者,治疗时应注重疏理肝气、调畅气血,方用柴胡疏肝散或逍遥散加减。对于脾胃虚弱的患者,治疗时应注重健脾益气、利水消肿,常以参苓白术散为基础方加减。对于肾气虚的患者,治疗时应注重补肾益气、收敛固涩,在应用补气药的基础上,常加收敛固涩药,如芡实、金樱子、益智仁、五味子、桑螵蛸等。

Treatment of Henoch-Chonlein Purpura Nephritis from Liver and Spleen and Kidney

The dysfunction of the liver,spleen and kidney plays an important role in the pathogenesis of henoch schonlein purpura(HSP)in the middle and late stages.In the process of pathogenesis,they affect and transform each other.If any of them is dys-functional and cannot be cured for a long time,it will affect the normal operation of the other two organs,which will lead to the disorder of the whole body qi movement and the disease will not be cured for a long time.The liver is in charge of storing blood;the spleen is in charge of transporting and transforming nutrients;the kidney is in charge of sealing water.If any of them is dysfunctional,it will lead to the metabolic disorder of qi,blood and body fluid,cause the disorder of qi movement in the whole body,and produce new pathological products-blood stasis,dampness,etc.,which will further aggravate the disease.For the patients with obvious stagnation of liver qi,the treatment should focus on soothing liver qi and regulating qi and blood circulation.Bupleurum Liver-Soothing Powder or Modified Free Wanderer Powder can be used.For the patients with weakness of spleen and stomach,the treatment should focus on invigorating the spleen,nourishing qi,promoting urination and reducing swelling.Modified Ginseng and Poria and White Atractylodes Powder can be used.For those with deficient kidney qi,the treatment should focus on nourishing kidney qi,astringent therapy.On the basis of qi-tonifying medicinals,astringent medicinals are often used,such as Qianshi(Semen Euryales),Jinyingzi(Fructus Rosae Laevigatae),Yizhiren(Fructus Alpiniae Oxyphyllae),Wuweizi(Fructus Schisandrae Chinensis),Sangpiaoxiao(Ootheca Mantidis),etc.