摘要
系统性红斑狼疮总体病机以阴虚为本,瘀热为标,尤以急性发作期最为显著。慢性活动期常与急性发作期交替出现,导致病情日益加重,并有痰、湿、瘀、火等诸邪内阻。王庆国教授强调,虽然有些患者由于体质或病久等原因出现畏寒肢冷等阳虚症状,但不可为此蒙蔽,仍需正确认识慢性肾炎的基本病机,在配伍中略施清补即可,待诸症缓解,善后收功之时方可言温补。在辨治特色方面:治法灵活,重在存阴;精确把握病势,判断转归;祛邪扶正,两相兼顾;既病防变,截断病程。在本病相对稳定期,巩固疗效,预防复发。撤减激素时,王教授强调注意以下几点:①须待患者临床症状和实验室指标(如发热,血沉,血常规三系,尿蛋白等)控制良好时方可考虑撤减激素;②长期运用激素并且用量较大的患者,不可贸然撤减,需服用中药至病情稳定时才能徐徐减量;③激素属阳热之品,在激素撤减维持阶段,因激素用量减少,肾阳失去助养,临床上出现由阴虚向阳虚逐渐转化,表现为阳虚为主的阴阳两虚或纯阳虚证。对此王教授常加入温补肾阳、益气养血之品如附子、熟地黄、菟丝子、肉苁蓉、补骨脂、山萸肉、淫羊藿、仙茅、仙鹤草,并合用圣愈汤,减轻激素撤减期产生的不良反应。
The overall pathogenesis of systemic lupus erythematosus is Yin deficiency with stasis and Heat as the symptoms,especially in the acute attack period;the chronic active period often alternates with the acute attack period,resulting in an increasingly worsening condition,with Phlegm,Dampness,Stasis,Fire and other evil internal resistance.Professor Wang Qingguo emphasized that although some patients have symptoms of Yang deficiency such as feeling chill and limbs coldness due to physical constitution or long illness,etc.,it is necessary to correctly recognize the basic pathogenesis of chronic nephritis,and tonification should be applied with clearing heart in the compatibility.Only after the symptoms have been alleviated can warm notification could be used.In terms of the characteristics of differentiation and treatment:the treatment is flexible,focusing on maintaining Yin;by accurately grasping the disease situation and judging the outcome,eliminating evil factors and supporting the Zheng Qi,preventing disease and cutting off the course of disease.In the relatively stable period of the disease,consolidate the curative effect and prevent relapse.When withdrawing hormones,Professor Wang emphasized the following points:①When the patient's clinical symptoms and laboratory indicators(such as fever,erythrocyte sedimentation rate,blood routine three lines,urine protein,etc.)are well controlled,the withdrawal of hormones can be considered;②Long-term patients who use hormones and have large dosages should not be with-drawn rashly.They need to take traditional Chinese medicines until the condition is stable.③Hormones are Yang fever products.During the maintenance phase of hormone withdrawal,Kidney Yang is not helped any longer due to the reduction of hormone dosage.There is a clinical gradual transformation from Yin deficiency to Yang deficiency,which is manifested as Yin and Yang deficiency or pure Yang deficiency syndrome.In this regard,Professor Wang often adds drug to warm and nourish Kidney Yang,supplementing Qi,
作者
杜伟哲
连雅君
谭令
白雪
程发峰
王雪茜
王庆国
DU Weizhe;LIAN Yajun;TAN Ling;BAI Xue;CHENG Fafeng;WANG Xueqian;WANG Qingguo(The Third Affiliated Hospital to Beijing University of Chinese Medicine,Beijing China 100029;Beijing University of Chinese Medicine,Beijing China 100029)
出处
《中医学报》
CAS
2020年第6期1221-1225,共5页
Acta Chinese Medicine
基金
国家自然科学基金项目(81774030)。
关键词
系统性红斑狼疮
瘀热
阴虚火旺证
痰瘀互结证
热郁饮停证
湿热痹阻证
毒邪伤肾证
王庆国
名医经验
systemic lupus erythematosus
stagnant heat
Yin deficiency and Fire syndrome
Phlegm and blood stasis syndrome
Heat depression and Yin stagnation syndrome
Dampness and Heat block syndrome
poison evil injury Kidney syndrome
Wang Qingguo
famous doctor's experience
