朱辟疆治疗慢性肾小球肾炎经验(1)
摘要：慢性肾小球肾炎病程较长，病情缠綿难愈，临床治疗十分棘手。朱辟疆教授从事肾脏疾病诊治工作近50余年，临床经验丰富，朱教授认为本病主要责之脾肾虚损，而瘀血、浊邪、痰湿、毒热等病理因素贯穿病变始终，治疗注重温补脾肾为主，兼顾清利湿热、活血祛瘀、解毒祛浊之法，注重预防和调护工作，避免疾病的复发，在临床获效颇丰。
关键词：名医经验;朱辟疆;慢性肾炎;温补脾肾
中图分类号：R272.969.23 文献标识码：A 文章编号：1005-5304(2019)09-0120-03
Experience of ZHU Pijiang in Treating Chronic Nephritis
FEI Jia， MA Yuan， Instructor： ZHU Pijiang
Zhenjiang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine，ZHU Pijiang Famous TCM Master Clinics， Zhenjiang 212000， China
Abstract： Chronic nephritis is featured as long disease courses， disease relapse and difficulty to cure. Professor ZHU Pijiang has been engaged into the treatment of kidney diseases for nearly fifty years in helping him to gain the rich experiences in clinical practice. He believes that chronic nephritis shall be attributable to the spleen-kidney deficiency with the pathological factors of blood stasis， turbid pathogen， phlegm stagnation and heat toxic syndrome， etc. In this way， it is to primarily tonify the spleen and kidney， combined with eliminating the dampness and heat， removing the blood stasis， relieving the internal heat and expelling the turbid pathogen. The focus on the prevention measures and nursing interventions is of great importance to avoid the recurrence of chronic nephritis， with abundant clinical achievements.
Keywords： experience of famous doctors; ZHU Pijiang; chronic nephritis; warming and tonifying spleen and kidney
本院朱辟疆教授是国内知名的中西医结合肾脏病学家、江苏省名老中医药专家学术经验继承工作指导老师，从医近50年，治学严谨，医德高尚，在慢性肾小球肾炎(以下简称“慢性肾炎”)诊治方面有独到见解。笔者有幸师从朱师，收益颇丰，现将朱师应用自拟温补脾肾方治疗慢性肾炎经验介绍如下。
1 病因病机
临床上，慢性肾炎症状以血尿、蛋白尿、水肿、高血压等较为常见，起病隐匿，病情缠绵，部分患者伴有不同程度肾功能损伤，最终可发展为慢性肾功能衰竭。本病属中医学“水肿”“虚劳”范畴，为脾肾虚损、正气不足，复感风寒外邪、情志内伤、饮食不洁、禀赋不足等，导致机体肺失宣通、脾失运化、肾失开阖，内外相加，引起肺、脾、肾三脏功能障碍，水液代谢紊乱而出现水肿，或精微外泄可见蛋白尿。朱师认为，脾肾虚损是本病主要病机，脾肾之气充足则邪气易祛，脏腑功能调顺，外邪不能侵犯人体;脾肾不足，则易出现脏腑功能受损，出现湿热、痰浊、瘀血、热毒等病理产物。故临床多表现为本虚标实征象。所谓“正气存内，邪不可干”，脏腑功能失调，必然使气化功能失司，致水液代谢功能失调。如肾阳虚衰则水液泛滥，水液逆行于肺，则肺气不顺，通调水道功能失司，使水肿愈加明显;脾阳虚则水湿蕴结，日久肾阳衰惫不能温煦脾脏，脾肾虚弱使病情危重。张景岳总结为“凡水肿等证，乃肺、脾、肾三脏相干之病。盖水为至阴，故其本在肾;水化于气，故其标在肺;水惟畏土，故其制在脾。今肺虚气不化精而化水，脾虚土不制水而反克，肾虚则水无所主而妄行”。可见，慢性肾炎与肺、脾、肾相关，而以脾肾二脏更为重要。, http://www.100md.com(费佳 马源 指导 朱辟疆)
关键词：名医经验;朱辟疆;慢性肾炎;温补脾肾
中图分类号：R272.969.23 文献标识码：A 文章编号：1005-5304(2019)09-0120-03
Experience of ZHU Pijiang in Treating Chronic Nephritis
FEI Jia， MA Yuan， Instructor： ZHU Pijiang
Zhenjiang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine，ZHU Pijiang Famous TCM Master Clinics， Zhenjiang 212000， China
Abstract： Chronic nephritis is featured as long disease courses， disease relapse and difficulty to cure. Professor ZHU Pijiang has been engaged into the treatment of kidney diseases for nearly fifty years in helping him to gain the rich experiences in clinical practice. He believes that chronic nephritis shall be attributable to the spleen-kidney deficiency with the pathological factors of blood stasis， turbid pathogen， phlegm stagnation and heat toxic syndrome， etc. In this way， it is to primarily tonify the spleen and kidney， combined with eliminating the dampness and heat， removing the blood stasis， relieving the internal heat and expelling the turbid pathogen. The focus on the prevention measures and nursing interventions is of great importance to avoid the recurrence of chronic nephritis， with abundant clinical achievements.
Keywords： experience of famous doctors; ZHU Pijiang; chronic nephritis; warming and tonifying spleen and kidney
本院朱辟疆教授是国内知名的中西医结合肾脏病学家、江苏省名老中医药专家学术经验继承工作指导老师，从医近50年，治学严谨，医德高尚，在慢性肾小球肾炎(以下简称“慢性肾炎”)诊治方面有独到见解。笔者有幸师从朱师，收益颇丰，现将朱师应用自拟温补脾肾方治疗慢性肾炎经验介绍如下。
1 病因病机
临床上，慢性肾炎症状以血尿、蛋白尿、水肿、高血压等较为常见，起病隐匿，病情缠绵，部分患者伴有不同程度肾功能损伤，最终可发展为慢性肾功能衰竭。本病属中医学“水肿”“虚劳”范畴，为脾肾虚损、正气不足，复感风寒外邪、情志内伤、饮食不洁、禀赋不足等，导致机体肺失宣通、脾失运化、肾失开阖，内外相加，引起肺、脾、肾三脏功能障碍，水液代谢紊乱而出现水肿，或精微外泄可见蛋白尿。朱师认为，脾肾虚损是本病主要病机，脾肾之气充足则邪气易祛，脏腑功能调顺，外邪不能侵犯人体;脾肾不足，则易出现脏腑功能受损，出现湿热、痰浊、瘀血、热毒等病理产物。故临床多表现为本虚标实征象。所谓“正气存内，邪不可干”，脏腑功能失调，必然使气化功能失司，致水液代谢功能失调。如肾阳虚衰则水液泛滥，水液逆行于肺，则肺气不顺，通调水道功能失司，使水肿愈加明显;脾阳虚则水湿蕴结，日久肾阳衰惫不能温煦脾脏，脾肾虚弱使病情危重。张景岳总结为“凡水肿等证，乃肺、脾、肾三脏相干之病。盖水为至阴，故其本在肾;水化于气，故其标在肺;水惟畏土，故其制在脾。今肺虚气不化精而化水，脾虚土不制水而反克，肾虚则水无所主而妄行”。可见，慢性肾炎与肺、脾、肾相关，而以脾肾二脏更为重要。, http://www.100md.com(费佳 马源 指导 朱辟疆)