常茵 邢海燕 王自敏

〔摘要〕 多囊肾（polycystic kidney disease， PKD）是一种遗传性肾囊肿疾病。国家级名中医王自敏认为PKD的病机本质为本虚标实，以先天禀赋不足、正气亏虚为本，气滞血瘀、痰浊内蕴为标。PKD初期多为肝肾亏虚、气血瘀阻型和湿热内蕴、气滞血瘀型;中期多为肾虚肝旺、痰瘀内结型;后期多为正气亏虚、痰瘀浊毒型。治疗遵循扶正与祛邪兼施、防治并行、预后防复的原则。

〔关键词〕 多囊肾;分期分型论治;名医经验;王自敏

〔中图分类号〕R256.5       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.10.024

Professor Wang Zimin's Experience in Treating Polycystic Kidney Disease by Stages and Types

CHANG Yin1， XING Haiyan2*， WANG Zimin2

（1. Henan University of Chinese Medicine， Zhengzhou， Henan 450046， China;

2. The First Affiliated Hospital of Henan University of Chinese Medicine， Zhengzhou， Henan 450099， China）

〔Abstract〕 Polycystic kidney disease （PKD） is an inherited kidney cyst disease. Professor Wang Zimin， a national famous traditional Chinese medicine doctor， believes that the essence of pathogenesis of PKD is deficiency and excess， based on deficiency of innate endowment and vital Qi， and marked by stagnation of Qi and blood stasis and turbid phlegm. In the early stage of PKD， it is mostly liver and kidney deficiency， Qi and blood stasis， damp heat accumulation， Qi stagnation and blood stasis; in the middle stage， it is mostly kidney deficiency， liver hyperactivity， phlegm and blood stasis internal accumulation; and in the later stage， it is mostly positive Qi deficiency， phlegm and blood stasis and turbid toxin. The treatment follows the principles of strengthening body resistance and eliminating pathogenic factors， preventing and treating simultaneously， and prognosis and recurrence prevention. 〔Keywords〕 polycystic kidney disease; syndrome differentiation and treatment according to period and syndrome type; experience of famous doctors; Wang Zimin

多囊腎（polycystic kidney disease， PKD）是一种遗传性肾囊肿疾病，临床上分为常染色体显性多囊肾（autosomal dominant polycystic kidney disease，ADPKD）和常染色体隐性多囊肾（autosomal recessive polycystic kidney disease， ARPKD）。据报道，ADPKD是最常见的遗传性肾脏疾病，占全球肾脏替代治疗患者的7%～10%，其患病率达到1/1 000～1/2 500，约50%患者在60岁时进展至终末期肾脏病[1]，占终末期肾病病因第4位[2]。据相关统计，全国约有1 200万例ADPKD[3]。西医多根据PKD的发展阶段采取基因治疗、药物治疗、并发症对症治疗、手术治疗、肾移植、腹膜透析等疗法[4-7]，尚缺乏行之有效的治疗措施以及在延缓肾功能进展方面的有力证据。近年来中医药在治疗PKD方面展现出独特的优势[8-9]，医家们在治疗方面各有侧重，大多以扶正、祛邪为治则，采用补肾强腰、利水渗湿、活血化瘀、益气养阴、健脾疏肝、化痰降浊、软坚散结等治法[10-13]。SHAO G Y等[14]总结了中草药治疗ADPKD的药理作用及其潜在的作用机制。王自敏教授为第四批全国老中医药专家学术经验继承工作指导老师，河南中医药大学第一附属医院肾病科创始人及学术带头人，从事中医内科肾病临床工作近六十年，在治疗PKD方面经验丰富，主张分期分型论治，取得良好的临床疗效。……