升清降浊法拮抗糖尿病肾病肾小球硬化的理论探讨

Discussion on the Counteraction of Glomerulosclerosis in Diabetic Nephropathy with the Method of Lifting Lucid Yang and Lowering Turbid Yin

通过分析糖尿病肾病肾小球硬化的形成原因,认为“清浊相干,浊毒内结”是其关键病机,其主要病位在小肠、脾、肾。病理情况下,小肠“分清泌浊”功能失调及“脾主运化”功能失常为“清浊相干”的源头;浊邪留滞,进入血脉与脏腑,导致血瘀痰凝毒浊;浊毒积聚于肾之络脉,形成“微型癥瘕”。采用升清降浊法(药物可采用黄芪、法半夏、陈皮、土茯苓、积雪草、大黄、槐花、蚕砂、薏苡仁、川芎、丹参、益母草、当归等)治疗糖尿病肾病肾小球硬化,可通过升举脾气及重建小肠的“分清泌浊”功能,体现“升清”的治疗特色;通过祛痰浊、利湿浊、降毒浊、化血浊,体现“降浊”的治疗特色。升清降浊法治疗糖尿病肾病肾小球硬化可取得较好的临床疗效。

Based on the analysis of the etiology of glomerulosclerosis in diabetic nephropathy(DN),it is believed that the key pathogenesis of DN glomerulosclerosis is due to the disorder of lucid yang and turbid yin and the internal accumulation of turbid toxin,which mainly involves the small intestine,spleen and kidney.In the pathological situation,the dysfunction of the small intestine in separating clear yang and excreting turbid yang and the failure of the spleen in transporting and transforming contribute to the root cause of disorder of lucid yang and turbid yin.The retained turbid pathogen enters the blood vessels and viscera and then results into the blood stasis,phlegm accumulation and turbidity toxin;the accumulation of turbid toxin in the kidney collateral results into the formation of miniature abdominal mass.For the treatment of DN glomerulosclerosis,the therapy of lifting lucid yang and lowering turbid yin by using Radix Astragali,Rhizoma Pinelliae Preparatum,Pericarpium Citri Reticulatae,Rhizoma Smilacis Glabrae,Herba Centellae,Radix et Rhizoma Rhei,Flos Sophorae,Feculae Bombycis,Semen Coicis,Rhizoma Chuanxiong,Radix Salviae Miltiorrhizae,Herba Leonuri,and Radix Angelicae Sinensis can be adopted.Lifting lucid yang can be achieved by lifting spleen qi and rebuilding the function of the small intestine in separating clear yang and excreting turbid yang,and lowering turbid yin can be achieved by resolving phlegm turbidity,damp turbidity,toxin turbidity and blood stasis turbidity.The application of therapy of lifting lucid yang and lowering turbid yin has achieved satisfied clinical efficacy in the treatment of DN glomerulosclerosis.