文献类型：期刊文献

中文题名：基于群体名老中医共识的慢性肾脏病辨治规律研究

英文题名：Study on the rule of differentiation and treatment of chronic kidney disease based on the consensus of group illustrious senior traditional Chinese medicine practitioners

作者：王振东[1,2];高彦彬[3];孙晓光[1];李福生[4];鲍鹏杰[5];侯海晶[6];赵进喜[7];张杰[8];黄旭[5];郭玲[9];刘新瑞[10];王兆忻[7];于河[1];谷晓红[1]

第一作者：王振东

机构：[1]北京中医药大学中医学院,北京100029;[2]北京市鼓楼中医医院,北京100009;[3]首都医科大学,北京100069;[4]江西中医药大学附属医院,南昌330006;[5]长春中医药大学附属医院,长春130021;[6]广东省中医院,广州510120;[7]北京中医药大学东直门医院,北京100700;[8]甘肃中医药大学,兰州730000;[9]辽宁中医药大学附属医院,沈阳110000;[10]吉林省中医药科学院第一临床医院,长春130022

第一机构：北京中医药大学中医学院,北京100029

年份：2025

卷号：40

期号：9

起止页码：4670

中文期刊名：中华中医药杂志

外文期刊名：China Journal of Traditional Chinese Medicine and Pharmacy

收录：;北大核心:【北大核心2023】；

基金：国家重点研发计划(No.2018YFC1704100,No.2018YFC1704101);国家中医药管理局高水平中医药重点学科建设项目(No.zyyzdxk-2023264)。

语种：中文

中文关键词：慢性肾脏病;名老中医;道术结合;比较分析;问卷调查;共识

外文关键词：Chronic kidney disease(CKD);Illustrious senior traditional Chinese medicine practitioners;Tao and Shu inheritance;Comparative analysis;Questionnaire survey;Consensus

摘要：目的:以善治慢性肾脏病的多位国家级名老中医为研究对象,形成基于名老中医共识的慢性肾脏病诊疗规范,以补充现有诊疗规范的名医经验与智慧。方法:基于10位名老中医的治疗慢性肾脏病的医案数据挖掘结果、定性研究资料及文献资料,设计名医治疗慢性肾脏病经验的问卷,通过对名老中医本人或其弟子进行2轮问卷调查,形成来自名老中医的诊疗共识意见,深入剖析名医的差异,获得名医与众不同的特点。结果:名医共性认识包括:慢性肾脏病以肾元亏虚为基础,初期以水湿瘀热为基础,逐渐毒邪内生,发为肾衰,瘀血贯穿疾病全期,部分原发病属伏邪致病。不同病理类型肾病病机具有特异性,如膜性肾病以肾虚、血瘀、水湿为主,IgA肾病以肾虚、风邪为主,糖尿病肾病以肾虚、血瘀为主等。另外获得了配合激素使用时中医药的不同治法,减量期益气养阴,维持期温肾健脾,停止阶段阴阳双补,做到衷中参西,西为中用。血尿为主以清热凉血止血为主,水肿为主以利水宣肺为主,蛋白尿为主以疏风胜湿为主,肌酐升高为主以通腑化瘀为主,其中药物上以黄芪、丹参、大黄等最为常用。另外凉血化瘀大法、交替用药治法等名老中医独特的经验虽未形成共识,亦为临床提供新的启示。结论:形成的共识方案为慢性肾脏病的治疗提供来自名老中医经验的视角,丰富了主流指南共识,为名老中医经验传承与创新研究提供了新的方向。
Objective:To formulate a chronic kidney disease(CKD)treatment protocol based on the consensus of multiple national-level renowned traditional Chinese medicine(TCM)physicians,to supplement the experience and wisdom of renowned physicians in the existing CKD treatment protocol.Methods:Based on the data mining results of 10 renowned TCM physicians treatment of CKD,qualitative research materials,and published literature,a questionnaire was designed to investigate the experience of renowned physicians in treating chronic kidney disease.Two rounds of questionnaires were conducted with the physicians themselves or their disciples to form consensus opinions on the treatment of CKD from renowned physicians,and the unique features of renowned physicians were obtained by analyzing the differences between them.Results:The consensus among renowned physicians encompasses the following common understanding:CKD is predicated on the deficiency of kidney essence,with water dampness,blood stasis,and heat serving as the initial foundation,leading to the progression to kidney failure.Blood stasis persists throughout the entire disease course,and certain original diseases are triggered by latent pathogenic factors.The pathogenesis of various pathological types of kidney diseases has specific traits.For instance,membranous nephropathy is mainly characterized by kidney deficiency,blood stasis,and water dampness;IgA nephropathy is mainly marked by kidney deficiency and wind pathogen;and diabetic nephropathy is primarily defined by kidney deficiency and blood stasis.Additionally,the distinct treatment principles for integrating Chinese medicine with steroids have been obtained,including benefiting qi and nourishing yin during the tapering period,warming the kidneys and fortifying the spleen during the maintenance period,and supplementing yin and yang during the cessation period,achieving a harmonious integration of Eastern and Western medicine.When hematuria is the predominant symptom,the main treatment principle is to clear heat and cool blood for hemostasis.When edema is the main manifestation,the main treatment principle is to drain water and eliminate phlegm from the lungs.When proteinuria is the principal symptom,the main treatment principle is to dispel wind and eliminate dampness.When the creatinine level rises,the main treatment principle is to unclog the intestines and eliminate blood stasis,with Huangqi,Danshen,and Dahuang being the most frequently used drugs.Furthermore,the unique experiences of renowned veteran physicians,such as cooling blood and resolving blood stasis and alternating drug therapy,have yet to reach a consensus,but they do offer new perspectives for clinical practice.Conclusion:The consensus scheme formed integrates the essence of the experience of Illustrious senior traditional chinese medicine practitioners,providing a perspective from the experience of elderly TCM practitioners for the treatment of CKD,enriching the mainstream guideline consensus,and providing a new direction for the research on the inheritance and innovation of the experience of elderly TCM practitioners.