巴元明基于“络以通为用”理论辨治免疫球蛋白A肾病经验
张涂贝 , 何启旺 , 胡鑫宇 , 王林群 , 李成银 , 巴元明
长春中医药大学学报 ›› 2026, Vol. 42 ›› Issue (9) : 1068 -1072.
巴元明基于“络以通为用”理论辨治免疫球蛋白A肾病经验
Ba Yuanming's experience in the treatment based on syndrome differentiation of immunoglobulin A nephropathy based on the theory of collaterals functioning normally when unblocked
本文总结了巴元明基于“络以通为用”理论辨治免疫球蛋白A肾病(IgAN)的临证经验。巴元明认为IgAN以肾络“不通”与“不荣”为核心病机,临床呈现“络滞-络虚-络损”的病情演变规律,提出肾络“以通为用,以荣为要”的核心治疗原则。针对风热犯肺,邪伏肾络证,治宜疏风清热、凉血宁络,方予自拟桑菊银翘散加减;湿热下注、肾络阻滞,治宜清热利湿,疏瀹肾络,方以自拟二妙四土汤加减;气阴两虚、肾络不荣,宜益气养阴、补通荣络,方以自拟参芪地黄汤加减;水瘀互结、浊毒闭络,宜利水化瘀、通络泻浊,方以自拟精天苓黄汤加减。同时临证善用大黄及藤类药物通经入络。
This paper summarizes Ba Yuanming's clinical experience in the treatment based on syndrome differentiation of immunoglobulin A nephropathy (IgAN) based on the theory of "collaterals functioning normally when unblocked". Ba Yuanming believes that IgAN is based on the core pathogenesis of "obstruction" and "deficient malnutrition" of the renal collaterals,with the clinical progression characterized by a pattern of "collateral stagnation - collateral deficiency - collateral damage". Ba Yuanming proposes the core treatment principle of "taking unobstruction as function, taking nourishment as priority" for the kidney meridian. For the pattern of wind-heat invading the lung with pathogenic factors lurking in the renal collaterals, the treatment should disperse wind and clear heat, cool blood and calm the collaterals, using a modified self-formulated Sangju Yinqiao powder; For dampness-heat pouring downward with obstruction of the renal collaterals,the treatment should clear heat and resolve dampness, dredge and unblock the renal collaterals, using a modified self-formulated Ermiao Situ decoction; For qi-yin deficiency with malnourishment of the renal collaterals, the treatment should replenish qi and nourish yin, supplement and unblock to nourish the collaterals, using a modified self-formulated Shenqi Dihuang decoction; For the combination of water and stasis with turbid toxins blocking the collaterals, the treatment should promote diuresis and resolve stasis, unblock collaterals and drain turbidity, using a modified self-formulated Jingtian Linghuang decoction. In clinical practice, Ba Yuanming makes good use of rhubarb and vine-derived herbs to unblock the meridians and enter the collaterals.
| [1] |
于柏松,刘冰. 原发性IgA肾病的治疗进展[J]. 中国全科医学,2021,24(23):2985-2991. |
| [2] |
|
| [3] |
王菲菲,李玲旭,陈春苗, |
| [4] |
李锦青,王奕,马晓燕, |
| [5] |
刘璐,田耘. IgA肾病的现代中西医治疗研究进展[J]. 西部中医药,2023,36(10):161-166. |
| [6] |
戴浩然,赵启涵,姜韩雪, |
| [7] |
卢程程,王东,王亿平. 中医药治疗IgA肾病研究进展[J]. 陕西中医药大学学报,2022,45(4):158-161. |
| [8] |
李红蓉,吴以岭. 络病研究的传承与创新[J]. 南京中医药大学学报,2022,38(12):1075-1085. |
| [9] |
邓钦华,邹迪,张守琳, |
| [10] |
艾山江·艾合买提,田耘. 从湿热论治IgA肾病[J]. 陕西中医,2024,45(3):380-383,402. |
| [11] |
钱会南. 张景岳治血证十三法[J]. 浙江中医学院学报,1992,16(6):28-29. |
| [12] |
张淑孜,苏杭,袁振华, |
| [13] |
叶天士. 临证指南医案[M]. 北京:中国中医药出版社,2018. |
| [14] |
王宏安,刘艳华,张守琳. 任继学从“毒损肾络”论治IgA肾病[J]. 长春中医药大学学报,2022,38(8):851-853. |
| [15] |
刘美茜,王子昆,刘洪凯, |
| [16] |
张智华,韩晗,王世友, |
| [17] |
张淑敏,仇慧鑫,舒乐新, |
| [18] |
刘馥溧,王林群,王瑞, |
| [19] |
|
国家中医药管理局全国名老中医药专家传承工作室建设项目(国中医药人教函〔2022〕75号)
湖北省科技厅省科技重大项目课题(2022ACA003-03)
/
| 〈 |
|
〉 |