基于“治未病”思想探讨糖尿病肾病分期辨治思路

Differentiation and Treatment by Stages for Diabetic Kidney Disease Based on Idea of“Treating Disease Before Its Onset”

“治未病”思想始载于《黄帝内经》,是中医的核心理念,包括未病先防、既病防变、瘥后防复。基于中医“治未病”思想,探析糖尿病肾病的病因病机与各期证治规律,认为该病呈现出虚、瘀、浊的病机特点,疾病前期应以未病先防为纲,佐以益气养阴清热和(或)活血化瘀之法,预防疾病发生。早、中、晚期以既病防变为要,其中早期重在治其未盛,益气养阴清热、健脾益肾的同时,辅以疏肝、养肝、平肝之法;中期重在治其未盛和治其未传,以温肾健脾为主,补益气血阴阳之法贯彻始终;晚期重在治其未传,温阳养阴益气、补益肾阳、养血通络同时,辅以通腑泄浊。

The idea of“treating disease before its onset”originated from Huangdi’s Canon of Internal Medicine,which is the core concept of traditional Chinese medicine,including prevention before disease onset,controlling development of existing disease and preventing recurrence after recovery.This article analyzes the etiology,pathogenesis and the regularity of syndrome differentiation and treatment of each stage in diabetic kidney disease(DKD)based on the idea of“treating disease before its onset”.It is considered that the disease presents the pathogenic characteristics of deficiency,blood stasis and turbidity.It is believed that in the earlier stage of DKD,the principle of“prevention before disease onset”should be taken,assisted by the methods of replenishing qi,nourishing yin,clearing heat and/or activating blood and resolving blood stasis,to prevent diseases.In the early,middle and late stages,the priority is to“controlling development of existing disease”.In the early stage,the focus is on treating the deficiency,replenishing qi,nourishing yin,clearing heat,invigorating spleen and replenishing kidney while supplemented by the methods of soothing liver,nourishing and pacifying liver.In the middle stage,the focus is on treating the deficiency and before transition,mainly by warming kidney and invigorating spleen,the methods of replenishing qi,blood,yin and yang applied throughout.In the late stage,the focus is on treating before transition,warming yang,nourishing yin and replenishing qi,tonifying kidney yang,nourishing blood and dredging collaterals while supplemented by relaxing bowels and discharging turbidity.