中医对糖尿病肾病水肿病因病机及治法的认识

Cognition of TCM in Pathogeny,Pathogenesis and Treatment Method of Diabetic Nephropathy Edema

糖尿病肾病主要是指毛细血管间肾小球硬化症,是糖尿病引起的主要微血管并发症之一。现代医学对糖尿病肾病水肿的病理机制尚未完全明了,而中医药在认识及治疗糖尿病肾病水肿方面有其独到见解,本文通过文献整理、查阅相关学术论文及书籍、临床收集验案,总结糖尿病肾病水肿的病因病机及治法。认为本病病机是以肺脾肾亏虚为本,痰湿瘀阻滞为标,这其中又以脾肾亏虚最为关键,属正虚邪实、本虚标实之证。治疗糖尿病肾病水肿,最主要是调理肺、脾、肾三脏,而其关键又在脾肾先后天之本。后天不足,气血化源亏虚,无力推动濡养,水液停滞。先天不足,肾失开阖,膀胱气化失司,精微外溢。先后天充足,脾肾得健,则元气充沛,水液代谢有序,精微得固。同时,水液停滞必然导致瘀血、痰湿等病理产物形成,在健脾益肾、培补先后天之本的同时要活血化瘀、淡渗利湿。因此,治疗糖尿病肾病水肿应辨别虚实,分清主次,调理脏腑,固其根本,蠲痰化饮,利湿消肿,活血化瘀,推陈致新,为临床治疗糖尿病肾病水肿提供参考。

Diabetic nephropathy edema mainly pointed to intercapillary glomerulosclerosis,which was the main microvascular complication caused by diabetes mellitus. The cognition of modern medicine in the pathogenesis of diabetic nephropathy edema was unknown,but that of TCM in this problem had an unique understanding. According to the arrangement of document and reference of related academic thesis,books and clinical examples,this article summarized and extracted the pathogeny,pathogenesis and treatment of diabetic nephropathy edema by TCM theory. Writer viewed that this disease rooted in the deficiency of lung,spleen and kidney,and phlegm dampness and blood stasis as the treetop,in which the key located at the deficiency of kidney and spleen. It belongs to the syndrome of healthy Qi deficiency and pathogen excess,deficiency in the root and excess on the treetop. Deficiency of acquired spleen and Qi,blood lead to the weakness nourishing and water retention. Insufficiency of congenital constitution,the abnormality of kidney opening-closing and bladder Qi dysfunction lead to out-going of refined essence. The sufficiency of both spleen and kidney were beneficial to the sufficiency of primordial Qi. Meanwhile,blood,essence and liquid originated from one.Water retention must lead to pathogen such as blood stasis,phlegm and so on. Benefiting spleen and supplementing kidney coincide with activating blood circle and promoting diuresis with bland medicinal. So,the treatment of diabetic nephropathy edema should distinguish between deficiency and excess,the primary and the secondary. To regulate Zang and Fu,consolidate root,clear away phlegm,resolve water,drain damp,activate blood,resolve stasis and bring new through the old provided reference to clinical cognition and treatment for diabetic nephropathy edema.