長期慢性免疫疾病致萎縮性腎衰竭（尿毒）中西醫結合治療淺介

An Introduction to Integrated Traditional Chinese Medicine (TCM) and Western Medicine Treatment of Chronic Enduring Autoimmune Disease Inducing Chronic Renal Failure (Atrophy and Uremia)

李政育(Chen-Yu Lee) ； 吳哲豪(Che-Hao Wu) ； 柯中龍(Zhong-Long Ke) ； 羅瑞陽(Rui-Yang Luo) ； 張文淮(Wen-Huai Zhang) ； 羅晉專(Jin-Zhuan Luo) ； 陳俐蓉(Li-Rong Chen) ； 黃景宏(Jing-XIung Huang) ； 陳怡蓉(Yi-Rong Chen) ； 爐氷林 (Yong-Lin Liao) ； 廖炎智(Yan-Chih Liao)

《中國鍼灸學雜誌》 3卷1期 (2015/12) Pp. 9-17

https://doi.org/10.6528/CAMS.2015.0001

摘要

長期慢性免疫疾病（例如：紅斑性狼瘡、免疫性腎炎等……）引發萎縮性腎衰竭，以目前西醫的治療，僅能長期服用免疫抑制劑、類固醇、奎寧等……來抑制免疫疾病。腎臟功能只能定期血檢追蹤其惡化狀況，末期僅能靠洗腎來處理。不管是藥物的副作用或是洗腎，給病人帶來莫大的壓力與副作用。中醫治療相對的細膩且無副作用。中醫治療需分多種證型：若各種血液檢查指數偏高者，屬於瘀熱症、瘀血症，可用活血化瘀而涼血、破血的方劑；若長期服用類固醇或免疫抑制劑，伴隨體力差、臉色蒼白，屬於氣虛、陽虛症，可用補氣補陽方劑；若血小板偏低形成紫斑症，女性偏向血虛以養肝血方劑如育生聖愈湯加方、男性偏向大補腎陽，以右歸飲加方為主；若各種血象偏低，進入骨髓乾枯者屬於腎陽虛，宜用大補腎陽方劑為主；若水腫嚴重，屬於水蓄寒濕症者，可用淡滲利濕方劑如五苓散（腎炎方）為主；上述為常見的中醫辨證論治下之中西醫結合治療慢性免疫性萎縮性腎衰竭的証型，供中西醫同道臨床參考。

關鍵字

中西醫治腎衰竭 ； 免疫性腎衰竭 ； 藥物性腎衰竭 ； 萎縮性腎衰竭

並列摘要

Longstanding chronic autoimmune diseases (e.g., systemic lupus erythematosus (SLE), autoimmune-induced renal failure, etc.) may induce chronic atrophic renal failure. Currently, Western medicine treatment for this condition simply involves long-term administration of immunosuppressants, corticosteroids, quinine, etc. to suppress the immune system. Periodic blood tests are performed to assess renal function to determine whether there has been damage or further deterioration, and in the advanced stages of disease the only option is to perform dialysis. The side effects from the drugs and dialysis puts a lot of stress and suffering on the patient. Conversely, Traditional Chinese medicine (TCM) treatment is comparatively mild and without side effects. TCM treatment should be divided into the following patterns: If blood test results reveal increased levels of key indicators, then this is stasis heat and stasis blood pattern, requiring the administration of blood-quickening and stasis-transforming, blood-cooling, and blood-breaking medicinals. If long-term administration of corticosteroids and/ or immunosuppressants have been administered and generalized weakness and pale face presents, then this is qi and yang vacuity pattern, requiring the administration of yang and qi-supplementing formulas. If PLT count is low (thrombocytopenia) and purpura presents, then for females this is blood vacuity, requiring administration of liver blood-nourishing medicinals such as (Yu Sheng) Sheng Yu Tang variant, and for males requires the administration of great kidney yang supplementing medicinals such as You Gui Yin variant. If blood test results reveal decreased levels of key indicators, then the condition can be classified as marrow desiccation (suppressed marrow function) and is kidney yang vacuity pattern, requiring the administration of great kidney yang supplementing medicinals. If severe edema presents, then this is water amassment cold-damp pattern, requiring the administration of dampness-disinhibiting by bland percolation medicinals such as Wu Ling San (Nephritis Formula). These are the most common TCM pattern identification and treatment approaches administered for TCM and Western medicine integrated treatment of chronic autoimmune-induced renal failure conditions. Both TCM and Western medicine doctors can use this material as a reference for clinical application.

並列關鍵字

TCM and Western medicine integrated treatment of renal failure ； autoimmune-induced renal failure ； drug-induced renal failure ； chronic atrophic renal failure

參考文獻

Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. (2008). Harrison's principles of internal medicine (17th ed.). New York: McGraw-Hill Medical Publishing Division.

Windus, editor, David(2008). The Washington manual nephrology subspecialty consult (2nd ed.). Philadelphia: Wolters Kluwer Health / Lippincott