国医大师邹燕勤从瘀论治过敏性紫癜性肾炎经验撷要

陈彦霖 张颖煜 沈佳丽 杨晓宇 易岚 周恩超 高坤

〔摘要〕 过敏性紫癜性肾炎是临床常见疑难肾脏病。国医大师邹燕勤认为过敏性紫癜性肾炎的病机以热、虚、瘀为主，以“瘀”为要。疾病分急性期和缓解期，急性期以皮肤紫斑而鲜、血尿、烦躁为主要临床表现，而缓解期皮肤以紫斑消退，反复发作的血尿为主要临床表现，在此基础上提出以治血为主，活血化瘀贯穿始终;分期论治，急性期以清热凉血为主，缓解期以补肾凉血为重。

〔关键词〕 过敏性紫癜性肾炎;活血化瘀;清热凉血;补肾凉血;邹燕勤

〔中图分类号〕R256.5;R692.3+4       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.05.002

Experience of National Chinese Medicine Master Zou Yanqin on Treating Henoch-Schonlein Purpura Nephritis From Blood Stasis

CHEN Yanlin1， ZHANG Yingyu1， SHEN Jiali1， YANG Xiaoyu1， YI Lan1，2， ZHOU Enchao1，2， GAO Kun1，2*

（1. Affiliated Hospital of Nanjing University of Chinese Medicine， Nanjing， Jiangsu 210029， China;

2. Inheritance Studio of Traditional Chinese Medicine Master ZOU Yanqin， Nanjing， Jiangsu 210029， China）

〔Abstract〕 Henoch-Schonlein purpura nephritis （HSPN） is a kind of common but complicated kidney diseases. Professor Zou Yanqin believes that the pathogenesis of HSPN is heat， deficiency and blood stasis， “blood stasis” plays an important role in HSPN. HSPN can be divided into acute stage and remission stage. The main clinical manifestations on acute stage are purple and fresh spots， hematuria and irritability. The main clinical manifestations on remission period are the the fading of skin purple spots， while hematuria is often recurrent. On this basis， professor Zou promotes that the treatment of HSPN is mainly for blood. Promoting blood circulation and removing blood stasis are throughout the treatment of HSPN. Besides， professor Zou believes HSPN should be treated by stages， the main treatment on the acute stage is to clear heat and cool blood， and on the remission stage is to tonify the kidney and cool blood.

〔Keywords〕 Henoch-Schonlein purpura nephritis; promoting blood circulation and removing blood stasis; clear heat and cool blood; tonify the kidney and cool blood; Zou Yanqin

過敏性紫癜性肾炎（Henoch-Schonlein purpura nephritis， HSPN）是一种以坏死性小血管炎为基本病变的免疫性疾病，临床以皮肤紫癜、出血性胃肠炎、关节炎及肾脏损害为特征[1]，是临床常见病，归属于中医学“紫斑”“水肿”“葡萄疫”等范畴。国医大师邹燕勤，从医六十余年，潜心耕作于肾脏疾病的临床工作，对多种慢性肾脏病的治疗方面有着独到的见解，现将邹教授辨病与辨证相结合，从瘀论治HSPN经验介绍如下。

1 病机以“瘀”为要

中医学认为HSPN多是外感风热之邪引发伏热，致风热相搏或血热相结，如王肯堂在《证治准绳·疡医》中提到：“夫紫癜风者……此皆风湿邪气客于腠理，气血相博，致荣卫否涩，风冷在肌肉间，故令色紫也。”邹教授认为邪热迫血妄行，血溢于脉外为离经之血，离经之血排出体外就是出血，蓄积于体内就是瘀血。正如唐宗海所云：“然即是离经之血，虽清血鲜血，亦是瘀血。