糖尿病肾病病机层次分析与辨治

Analysis of Pathogenesis Level and Treatment Differentiation of Diabetic Nephropathy

病机是中医学理论研究的基础,具有一定的层次性,根据不同标准可有不同的层次划分。论述症状病机、证候病机、疾病病机三者的内涵与关系,尤其强调疾病病机的重要性。糖尿病肾病的疾病病机为阴精丢损,导致命门真阴亏虚,继发肾气、肾阴、肾阳化源均不足,治疗当填补真阴;证候病机为肾气、肾阴、肾阳亏虚,继而产生痰湿、瘀血等邪实停留的"虚气留滞"病机,强调正虚是产生邪滞的前提,治疗强调扶正以祛邪;症状病机是表现于外的直接病机,是辨证、辨病的基础。

Pathogenesis is the basis of Chinese medicine theory research,with a certain hierarchy. According to different standards,it is divided in different levels. This article is to explain the connotation and relationship among symptom pathogenesis,syndrome pathogenesis and disease pathogenesis,especially emphasizing the importance of disease pathogenesis. The disease pathogenesis of diabetic nephropathy is that Yin-essence loss leads to deficiency of vital gate genuine Yin and then results in secondary inadequate sources of kidney Qi,kidney Yin and kidney Yang.As for treatment,invigorating genuine Yin should be carried out. The syndrome pathogenesis is the ＂deficiency-Qi causing stagnation＂pathogenesis which means deficiency of kidney Qi,kidney Yin and kidney Yang leading to pathogen and excess stagnation,such as phlegm-damp,blood stasis. The authors emphasize that healthy Qi deficiency is the premise of pathogen stagnation. As for treatment,strengthening vital Qi is emphasized to eliminate pathogenic factor. The symptom pathogenesis is the external direct pathogenesis,which is the basis of syndrome and disease differentiation.