CRF常用中医药治疗方法CommonTCMtreatmentofCRF

CRF常用中医药治疗方法CommonTCMtreatmentofCRF（一）中药汤方TCMdecoction：通常可将其分为下述中医类型Thesyndrometype：1、脾肾气虚型qi-deficiencyofspleenandkindey临床表现：倦怠乏力tired，气短懒言shortofbreath，纳呆badapetite腹胀abdominalbloating，腰膝酸软sorenessofwaistandknee，夜尿清长clearurineinlargeamountsatnight,大便薄溏thestooliswatery。脉细threadypulse，舌淡lightcolorintongue，苔薄白thinandwhitefur。多见于氮质血症早期Azotemiaearly。治法：补肾益精tonifykidneyandnourishessence方药：参苓白术散shenlingbaizhupowder合右归丸youguiwan加减：党参dangshen（人参renshen）15g茯苓fuling15g白术baizhu10g淮山药huaishanyao15g苡米yimi20g熟地shudihuang15g山萸肉shanyurou6g杜仲duzhong10g当归danggui10g枸杞子gouqi12g菟丝子tusizi12g等。若易感冒者加ifyouhaveacoldeasily,youcanadd黄芪huangqi15g白术baizhu10g防风fangfeng9g；伴有手足心热，盗汗等阴虚者加ifyouhaveafeverinyourpalmandsole,havenightsweating,youcanadd熟地shudihuang15g当归danggui12g。2、气阴俱虚型deficiencyofqiandyin临床表现：面色萎黄sallowcomplexion，倦怠乏力tired，少气shortofbreath懒言tootiredtospeak，腰膝酸软sorenessofwaistandknee，，皮肤少津dryskin，手足不温coldinhandsandfeet，大便不实或干结thestoolisdryorwatery，尿少色黄littleandyellourine，夜尿清长butclearurineinlargeamountsatnight，舌质淡有齿痕lightcolorintongueandhavetoothmarkaroundthetongue，脉沉细deepthreadypulse。多见于氮质血症期Azotemia。治法：益气养阴，滋补脾肾invogorateqinourishyin,strengthenspleenandkidney方药：大补元煎dabuyuanjian加减：党参dangshen（或人参renshen）15g熟地shudinghuang15g淮山药huaishanyao15g山萸肉shanyurou6g茯苓fuling15g北黄芪beihuangqi15g枸杞子gouqizi15g当归danggui10g等。气虚重者加ifqidificiencybadly,add黄芪huangqi15g；水肿重者加ifedema,add泽泻zexie12g、茯苓fuling9g、茅根maogen30g。3、脾肾阳虚型yangdeficiencyofspleenandkidney临床表现：面色苍白pale，形寒肢冷feelcold，腰膝酸冷sorenessofwaistandknee，腹胀abdominalbloating便溏waterystool，溲少littleurine夜尿多buttoomuchurineatnight，肢体浮肿edemainlimbs，舌质淡lightcolorintongue，体胖边有齿痕fattongueanghavetoothmarkaroundtongue，脉沉细或沉迟deepthreadypulseordeepslowpulse。多见于氮质血症期Azotemia。治法：温补脾肾warmingandinvigoratingspleenandkidney方药：真武汤zhenwutang加减：茯苓fuling12g、白术baizhu9g、附子fuzi6g、草果caoguo10g、干姜ganjiang10g、大腹皮dafupi15g、甘草gancao6g。伴阴虚者去yindeficiencysubtract附子fuzi、干姜ganjiang，加add巴戟天bajitian15g、仙灵脾xianlingpi12g；水肿重者加edemaadd猪苓zhuling12g、泽泻zexie9g；气虚者qideficiencyadd加黄芪haungqi9g、党参dangshen12g。4、肝肾阴虚型yindeficiencyofliverandkidney临床表现：头晕dizziness耳鸣tinitus，烦躁anxious易怒angereasily，视物不清visionloss，失眠insomnia多梦dreamtoomuch，口干thirst咽燥drythroat，手足心热feverinpalmandsole，腰膝酸软sorenessofwaistandknee，大便干结drystool，小便色黄yellowurine，舌质红redtongue，苔薄黄thinandyellowfur，脉弦细wiryandthreadypulse。多见于氮质血症早期Azotemiaearly。治法：滋养肝肾nourishliverandkidney方药：杞菊地黄丸qijudihuangwan合二至丸erzhiwan加减：熟地shudihuang15g、山萸肉shanyurou6g、淮山药huaishanyao15g、茯苓fuling15g、丹皮danpi9g、枸杞子gouqizi12g、菊花juhua12g、女贞子nvzhenzi15g。心烦失眠者vexationandinsomnia加add酸枣仁suanzaoren30g、夜交藤yejiaoteng15g；头痛眩晕dizzinessandheadache者加add天麻tianma12g、钩藤gouteng12g。5、阴阳俱虚defiencyofyinandyang临床表现：本型的病情比气阴俱虚更进一步加重worsethanthesyndromeofqiandyindeficiency，精神萎靡listlessness，极度乏力tootired，畏寒肢冷feelcold，手足心热feverinpalmandsole，头晕眼花dizzinessandblurredvision，腰膝酸软sorenessofwaistandknee，纳呆badapetitle便溏waterystool，小便黄赤或尿多deep-coloredurineormuchurine，舌质淡有齿痕lightcolorintongueandtoothmarkarounthetongue，脉沉细或细弦deepthreadypulseorthreadywirypulse。多见于肾功能衰竭期renalfailurestage。治法：阴阳双补nourishyinandyang方药：地黄饮子dihuangyinzi加减：熟地shudihuang9g、巴戟天bajitian15g、山萸肉shanyurou12g、石斛shihu12g、肉苁蓉roucongrong10g、制附子zhifuzi6g、肉桂rougui6g，茯苓fuling12g、麦冬maidong10g、甘草gancao3g。若伴有小便不利者dysuriaadd加车前子cheqianzi（另包）30g、泽泻zexie12g；阴虚重yindeficiencybadly者去subtract附子fuzi，加山药addshanyao12g，丹皮danpi9g，泽泻zexie9g。各方剂中，一律加入大黄dahuang（后入）8—12g。并随病人的个体差异性进行调节剂量accordingindividualdifferencetoregulatethedose，务使每次排软便makesurepurgingthesoftstooltwiceaday2次为度。每日1剂adoseoneday，水煎服。Cookwithwater上述分型，仅按是肾衰的主证（正虚）分thesyndrometypeisdifferentiatedbymaindiagnosisofkidneydeficiency，但在临床上，butinfact肾衰病人的兼证（邪实）颇为常thekidneydeficiency’spatienthaveaccompanyingsymptomsofstheniapathogenicfactoralways，尤其是常兼有血瘀和湿浊especiallystasisofbloodanddampnessretention。有血瘀者，可于治本方中加入活血化瘀药，ifhavingstasisofblood,canaddherbsforpromotingbloodcirculationg,suchashonghua,danshen,yimucao,zelan,chuanxiongandsoon如红花、丹参、益母草、泽兰、川芎等。有湿浊者，在治本方中加化湿泄浊药，ifhavingdampness,canaddherbsforremovingdampness,suchasbanxia,shengjiang,zhishi,sharen,huoxiang,peilan,huangqin,andsoon如半夏、生姜、枳实、砂仁、藿香、佩兰、黄芩等。（说明：叶任高教授professoryefound在研究中发现，慢性肾衰中医病机主要是脾肾虚衰，浊毒瘀血内停。Chronickidneydeficiency‘smiansyndromeisdeficiencyofspleenandkidney,stasisofbloodandtoxicity早期以脾肾气阴两虚为主，attheearlystage,itisbasedwithbothqiandyindeficiencyofspleenandkidney晚期则表现为脾肾阳气虚衰atthelatestage,it’sbasedwithbothyangandqideficiencyofspleenandkidney。根据慢性肾衰早期脾肾气阴两虚的病机特点，accrodingtothecharacteristic,hefondshenshuaifang研制了肾衰方。方中党参、麦冬益气养阴，Herbs:dangshenandmaimendongcaninvigorateqiandnourishyin,丹参、当归、赤芍活血祛瘀danshen,dangguiandchishaocanpromotebloodcircu.ationandremovestasis，大黄泻浊解毒dahuangcanremovetoxicity，白术运脾祛湿baizhucaninvigoratespleenandremovedampness，生牡蛎降逆潜阳shengmulicanloweradverseqiandcheckyangsufficiency。用肾衰方配合依那普利及低蛋白饮食治疗慢性肾衰氮质血症useshenshuaifangaddingenalapril,andLowproteindiettherapytocurechronicAzotemia，治疗后血清肌酐及血尿素氮显著降低aftertreatment,Serumcreatinineandbloodureanitrogenreducedobviously，且Scr下降幅度显著高于对照组andScrreducemorethanContrastgroup，Ccr较治疗前极显著增高Ccrimproveobviously。以血肌酐倒数与时间作回归分析，regressionanalysisw