基于“态靶辨证”分析葛根芩连汤加减在早中期糖尿病肾病的治疗作用

An Analysis of the Therapeutic Effect of Modified Pueraria and Scutellaria and Coptis Decoction on Early and Middle Stage Diabetes Nephropathy Based on "State Target Syndrome Differentiation"

“态靶辨证”之“态”为整体证候及特征,“靶”为疾病具体的症状或异常指标。从“态”来看,热邪在早中期DKD的发生发展中发挥了主要作用。从“靶”来看,早中期DKD的临床表现、病理特征及理化指标等亦体现了热邪的致病作用。“态靶结合”以葛根芩连汤清内热,根据病情的轻重、症状变化及理化指标等加黄芪、水蛭、大黄,水蛭用量多为3~6 g,大黄常用剂量为3~15 g,对于素体亏虚、年老体弱等不耐重剂之人,宜从小量开始。对于部分存在出血倾向的患者来说,水蛭亦当慎用甚至禁服,可少量代替选用桃仁、红花等药性平和之品。

The "state" of "state target syndrome differentiation" refers to the overall syndrome and characteristics,and the "target" refers to the specific symptoms or abnormal indicators of a disease.From the perspective of "state",heat pathogen plays a major role in the occurrence and development of diabetes nephropathy(DKD) in the early and middle stages.From the "target" point of view,the clinical manifestations,pathological characteristics,physical and chemical indicators of DKD in the early and middle stages also reflect the pathogenic effect of heat pathogen."Combination of state and target":Pueraria and Scutellaria and Coptis Decoction is used to clear internal heat.Huangqi(Radix Scutellariae),Shuizhi(Hirudo),and Dahuang(Radix et Rhizoma Rhei) can be added according to the severity of the disease,symptom changes,physical and chemical indicators.The dosage of Shuizhi is mostly 3-6 g,and the commonly used dosage of Dahuang is 3-15 g.For people who are not resistant to heavy agents such as constant deficient constitution,old age with weakness,it is advisable to start from a small amount of dosage.For some patients with bleeding tendency,Shuizhi should also be used with caution or even forbidden.A small amount of Taoren(Semen Persicae) and Honghua(Flos Carthami) and other medicinals with mild properties can be used instead of Shuizhi.