首页|杨国旺教授辨病分期论治肿瘤相关肾脏病经验

杨国旺教授辨病分期论治肿瘤相关肾脏病经验

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肿瘤相关肾脏病是指一类继发于全身各个器官的由肿瘤导致的肾脏损害性疾病,包括实体肿瘤导致的肾脏损伤和血液系统肿瘤引起的肾脏损伤,另外尚有肿瘤治疗(手术、化疗、分子靶向、免疫调节)过程中导致的急性和慢性肾损伤.临床表现以蛋白尿或肾病综合征或肾功能衰竭为主.肿瘤相关肾脏病的预后主要取决于肿瘤的类型、部位以及疾病分期等.根据肿瘤相关肾损害发病特点可将其归属于中医"癥瘕""积聚""虚劳""关格"等范畴.中医治疗肿瘤相关肾脏病,首先要辨别肾脏损伤的原发病,再进行论治.杨国旺教授倡导辨病论治与分期论治相结合治疗肿瘤相关肾脏病.辨病论治强调首先要辨别引起肾脏损伤的原发病,再进行论治.如肺癌辨病以气阴两虚、痰浊瘀毒阻肺为核心病机,治宜以益气养阴、化痰散结、祛瘀解毒为法;淋巴瘤辨病以"痰"为根本病理因素,"寒""虚""瘀""毒"共同构成其核心病机,治宜以化痰散结、散寒解毒、扶正逐瘀为法.分期论治基于虚损期、虚劳期、虚衰期,在中西医结合综合治疗基础上强调益肺健脾、补肾固精、抗癌解毒、通腑泄浊、攻补兼施、标本兼顾等治疗思路.文章分析杨国旺教授辨病分期论治肿瘤相关肾脏病经验,并附病案1例,以期为临床相关治疗提供参考.
Professor YANG Guowang's experience in treating tumor-related kidney diseases based on disease differentiation and staging
Tumor-related kidney disease refers to a group of kidney-damaging diseases secondary to tumors in various organs throughout the body,including kidney damage caused by solid tumors and kidney damage caused by hematological tumors,as well as acute and chronic kidney injury caused by tumor treatment(surgery,chemotherapy,molecular targeting,immunomodulation).The main clinical manifestations are proteinuria,nephrotic syndrome,or renal failure.The prognosis of tumor-related kidney disease mainly depends on the type and location of the tumor,as well as the stage of the disease.According to the characteristics of tumor-related renal damage,it can be classified as diseases such as abdominal mass,accumulation,consumptive disease,and dysuria and frequent vomiting in traditional Chinese medicine.In the treatment of tumor-related kidney diseases in traditional Chinese medicine,it is crucial to first differentiate the primary cause of kidney damage and then proceed with treatment.Professor YANG Guowang advocates the combination of disease differentiation and staging for the treatment of tumor-related kidney diseases.The treatment based on disease differentiation emphasizes first identifying the primary disease that causes kidney damage,and then treating the disease.For example,the core pathogenesis of lung cancer is Qi(气)and Yin(阴)deficiency,phlegm and blood stasis obstructing the lung,and the treatment methods are to nourish Qi and Yin,dissipate phlegm and resolve nodules,and remove blood stasis and detoxify.Lymphoma is rooted in the pathological cause of phlegm,with cold,deficiency,blood stasis,and toxin jointly constituting its core pathogenesis.The treatment are to resolve phlegm and dissipate mass,dissipate cold and detoxify,and strengthen the body's vital energy to eliminate blood stasis.The theory of treatment by stages is based on the stages of deficiency,exhaustion,and decline,and emphasizes the treatment ideas of benefiting the lungs and spleen,strengthening the kidneys and essence,anti-cancer and detoxification,purging the bowels and eliminating turbidity,combining attack and supplement,and addressing both the symptoms and root causes based on the comprehensive treatment of traditional Chinese medicine and Western medicine.This article analyzes Professor YANG Guowang's experience in the treatment of tumor-related kidney diseases based on disease differentiation and staging,and includes one case to provide a reference for clinical treatment.

Tumor-related kidney diseaseDisease differentiation and treatmentStage-based treatmentTraditional Chinese medicine

申子龙、李姝蒙、张旭、杨国旺

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首都医科大学附属北京中医医院,北京,100010

肿瘤相关肾脏病 辨病论治 分期论治 中医药

国家重点研发计划第六批北京市级中医药专家学术经验继承工作项目北京市属医院科研培育计划

2018YFC1705101PZ20231016

2024

中医临床研究
中华中医药学会

中医临床研究

影响因子:0.839
ISSN:1674-7860
年,卷(期):2024.16(16)