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¡¡¡¡Õª    Òª£º¡¡ÄÑÖÎÐÔÉö²¡£¨Refractory Nephritic Syndrome,RNS£©ÊǶù¿Æ½ÏΪ¼¬ÊÖµÄÃÚÄòϵͳ¼²²¡£¬ÍõÑ©·å½ÌÊÚ»ùÓÚ¶ÔÆøÓë»ðµÄÀí½â£¬¸ù¾ÝÄÚ¾­ÖГÉÙ»ðÉúÆø£¬×³»ðʳÆø”ÀíÂÛ£¬¶ÔRNSµÄ²¡»úÑݱäÓÐÁËеÄÈÏʶ£¬Ìá³öÇåÈÈÒæÆøÑøÒõΪÖÎÁÆС¶ùÄÑÖÎÐÔÉö²¡µÄ»ù±¾ÖÎÁƴ󷨣¬²¢Öð²½½ÒʾRNS¼¤ËØÁÆ·¨ÖлáÒÀ´Î³öÏ֓׳»ð£¨×³»ðÄڳ㣩”¡¢“׳»ðʳÆø”¼°“ÆøʳÉÙ»ð£¨ÉÙ»ð²»×㣩”Èý¸ö½×¶Î¡£ÆäÈÏΪ“׳»ðʳÆø”ÊǼ¤ËØÒÀÀµÐÍÉö²¡¼°Æµ¸´·¢ÐÍÉö²¡µÄ²¡»ú¹Ø¼ü£¬¶øά³Ö»úÌå“ÉÙ»ðÉúÆø”ÊDZ¾²¡µÄÖÎÁÆÖص㡣ÔÚÁÙ´²ÖÐÒª×ۺϷÖÎöRNSµÄ²¡³Ì¼°²¡Çé±ä»¯¹æÂÉ£¬ÔËÓÓÉÙ»ðÉúÆø”ÕâÒ»ÀíÄîÒýµ¼±æÖ¤ÂÛÖΡ¢Á¢·¨´¦·½ÒÔ¼õÇἤËصĸ±×÷Óü°·ÀÖ¹RNS¸´·¢¡£

¡¡¡¡¹Ø¼ü´Ê£º¡¡ÄÑÖÎÐÔÉö²¡; ¼¤ËØÒÀÀµÐÍÉö²¡; Ƶ¸´·¢ÐÍÉö²¡; ÉÙ»ðÉúÆø; ׳»ðʳÆø;

¡¡¡¡Abstract£º¡¡Pediatric refractory nephritic syndrome(RNS)is a more difficult urinary tract disease in pediatrics,professor Wang Xuefeng based on understanding of gas and fire,according to Inner Canon of Huangdi of“strong fire consuming Qi”theory,a new understanding of pathogenesis of RNS evolution,the basic treatment of RNS by heat clearing,Qi nourishing and Yin nourishing were proposed,the three stages of“strong fire”“strong fire consuming Qi”and“Qi consuming junior fire”were revealed in the RNS hormone therapy. Professor WANG Xuefeng believes that“strong fire consuming Qi”is the key to the pathogenesis of steroid dependent nephropathy syndrome and frequently relapsing nephritic syndrome,and maintain the body's“junior fire supporting vital Qi”is the treatment of the disease.To comprehensive analysis of RNS in clinical course of the disease and illness change rule,using the“junior fire supporting vital Qi”this concept to guide treatment based on syndrome differentiation,legislative prescription in order to reduce the side effect of hormone and prevent the recurrence of RNS.

¡¡¡¡Keyword£º¡¡refractory nephritic syndrome; frequently relapsing nephritic syndrome; steroid dependent nephritic syndrome; junior fire supporting vital Qi; strong fire consuming Qi;

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¡¡¡¡[1] ÖлªÒ½Ñ§»á¶ù¿Æѧ·Ö»áÉöÔಡѧ×é.¶ùͯ³£¼ûÉöÔ༲²¡ÕïÖÎÑ­Ö¤Ö¸ÄÏ£¨Ò»£©£º¼¤ËØÃô¸Ð¡¢¸´·¢/ÒÀÀµÉö²¡×ÛºÏÕ÷ÕïÖÎÑ­Ö¤Ö¸ÄÏ£¨ÊÔÐУ©[J].Öлª¶ù¿ÆÔÓÖ¾£¬2009,47(3):167-170.
¡¡¡¡[2] KOSKIMIES O,VILSKA J,RAPOLA J,et al.Long-term outcome of primary nephrotic syndrome[J].Arch Dis Child,1982,57(7):544-548.
¡¡¡¡[3] TARSHISH P,TOBIN JN,BERNSTEIN J,et al.Prognostic significance ofthe early course of minimal change nephrotic syndrome:report of the International Study of Kidney Disease in Children[J].J Am Soc Nephrol,1997,8(5):769-776
¡¡¡¡[4] TARSHISH P,TOBIN JN,BERNSTEIN J,et al.Prognostic significance ofthe early course of minimal change nephrotic syndrome:report of the International Study of Kidney Disease in Children[J].J Am Soc Nephrol,1997,8(5):769-776.
¡¡¡¡[5] LOMBEL RM,GIPSON D,SAND HODSON EM.Treatment ofsteroid-sensitive nephrotic syndrome:new guidelines from KDIGO[J].Pediatr Nephrol,2013,28(3):415-426.
¡¡¡¡[6] ÏÄÕýÀ¤£¬½ðÓñ£¬Â¹ÁᣬµÈ.¶ùͯ³£¼ûÉöÔ༲²¡ÕïÖÎÑ­Ö¤Ö¸ÄÏ£¨ÊÔÐУ©½â¶Á£¨Èý£©£º¼¤ËØÄÍÒ©ÐÍÉö²¡×ÛºÏÕ÷ÕïÖÎ[J].Öлª¶ù¿ÆÔÓÖ¾£¬2010,48(1):76-78.
¡¡¡¡[7]²ñïɽ.С¶ùÄÑÖÎÐÔÉö²¡ÖÐÒ½Èý²½ÖÎÁÆ·¨[J].ÖйúÖÐÒ½»ù´¡Ò½Ñ§ÔÓÖ¾£¬1999,5(10):44-45.
¡¡¡¡[8]´÷¶÷À´£¬ËïºìÐñ£¬Àʡ.Áõ±¦ºñ½ÌÊÚÖÎÁÆÄÑÖÎÐÔÉö²¡×ÛºÏÕ÷µÄÓÃÒ©¾­Ñé[J].ÖйúÖÐÎ÷Ò½½áºÏÉö²¡ÔÓÖ¾£¬2006,7(2):67-68.
¡¡¡¡[9]ÄôÀò·¼.ÄÑÖÎÐÔÉö²¡×ÛºÏÕ÷µÄÖÐÒ½±æÖξ­Ñé[J].ÖÐÒ½ÔÓÖ¾£¬2005,16(1):61-62.
¡¡¡¡[10]ÑϺì÷£¬ÕųàÖ¾.ÖÐÒ½ÂÛ“»ð”[J].¹âÃ÷ÖÐÒ½£¬2007,22(6):7-9.
¡¡¡¡[11]Óàì³£¬Ëïΰ.Ëïΰ½ÌÊÚÖÎÁÆÄÑÖÎÐÔÉö²¡×ÛºÏÕ÷µÄÁÙ´²¾­Ñé[J].ÖйúÖÐÎ÷Ò½½áºÏÉö²¡ÔÓÖ¾£¬2014,15(12):1039-1042.
¡¡¡¡[12]ÈÎÓñ½¿£¬ÕÅΰ.´Ó²¹ÉöÒæÆøÂÛ·ÀÖÎÌÇƤÖʼ¤ËصIJ»Á¼·´Ó¦[J].ÖÐÒ½ÔÓÖ¾£¬2016,57(15):1345-1347.
¡¡¡¡[13]¸ÊÄþ·å£¬»Æ¹ó»ª.ÖÐÒ½¶ÔÌÇƤÖʼ¤ËØÀàÒ©ÎïµÄÈÏʶ[J].¹ãÎ÷ÖÐÒ½Ò©£¬2008,31(2):40-41.
¡¡¡¡[14]Ò¶Èθß.Éö²¡×ÛºÏÕ÷µÄÖÐÎ÷Ò½½áºÏÖÎÁÆ[J].½­ËÕÖÐÒ½£¬1999,20(11):3-4.
¡¡¡¡[15]Å˕וף¬Ê·Õý¸Õ.Ò½Ô´ÐÔƤÖÊ´¼Ôö¶àÖ¢Ñо¿ÊöÂÔ[J].ÖÐҽҩѧ¿¯£¬2004,22(4):643-658.
¡¡¡¡[16]ÁõÏþÓ¥£¬ÄßÖéÓ¢£¬¹¨ºìÎÀ.С¶ùÉö²¡×ÛºÏÕ÷ÖÐÒ½·Ö¶ÎÖÎÁÆ·¨[J].ºþ±±ÖÐҽѧԺѧ±¨£¬2003,5(2):31-32.
¡¡¡¡[17]ÖлªÒ½Ñ§»á¶ù¿Æѧ·Ö»áÉöÔಡѧ×é.С¶ùÉöСÇò¼²²¡µÄÁÙ´²·ÖÀà¡¢Õï¶Ï¼°ÖÎÁÆ[J].Öлª¶ù¿ÆÔÓÖ¾£¬2001,39(12):746-749.
¡¡¡¡[18]ÀîÓÀÇå.ÌÇƤÖʼ¤ËصÄÒ©Àí×÷Óü°²»Á¼·´Ó¦[J].±±·½Ò©Ñ§£¬2013,10(11):32-33.
¡¡¡¡[19]ÍõѧҶ.ÌÇƤÖʼ¤ËصIJ»Á¼·´Ó¦[J].ÁÙ´²ºÍʵÑéҽѧÔÓÖ¾£¬2008,7(10):133-134.

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