李延从肝论治糖尿病肾病经验

LI Yan’s Experience in Treating Diabetic Nephropathy from Liver

糖尿病肾病多从肺、脾、肾三脏立论,调肝在临床中重视不足。李延教授认真研习中医经典,博采众长,结合自身临证经验,强调肝主疏泄、藏血功能失职是糖尿病肾病发病的关键因素,气津亏虚、瘀气停滞是糖尿病肾病常见病机,提出糖尿病肾病从肝辨治,以“调肝养肝以和气血”为原则治疗糖尿病肾病,以疏肝散郁、补肝养血之法调节肝的生理功能,助气顺血盈疏泄有常,调控有度,诸症皆安;辅以滋阴、化瘀之法祛脉络之瘀,调和阴阳,余症弗生。其处方用药以“桃仁红花煎”为基础方加减,灵活变化,善用辛散药,巧用补血生津药,慎用活血药,同时指导患者生活中注重身心调护,临床治疗效果显著,现总结从肝论治糖尿病肾病的经验,并附医案一则以飨同道。

Diabetic nephropathy is mostly based on the lungs, spleen and kidneys.Inadequate attention to liver regulation in clinical practise.Professor LI Yan studied the classics of traditional Chinese medicine earnestly, learned from others’ strong points, combined with his own clinical experience, and emphasized that the liver governs dredging, and the dereliction of function of storing blood is the key factor in the pathogenesis of diabetic nephropathy. Diabetic nephropathy is treated from liver differentiation and treatment, with the principle of "regulating liver and nourishing liver to harmonize Qi and blood" to treat diabetic nephropathy, regulating the physiological function of the liver with the methods of soothing the liver and dispelling stagnation, nourishing the liver and nourishing blood, helping the Qi to flow along the blood and dispersing is regularity, the regulation is moderate, and all symptoms are disappear;supplemented by the methods of nourishing Yin and removing blood stasis, reconcile Yin and Yang, and the remaining symptoms are inseparable. Its prescriptions are based on "Taoren Honghua Decoction", which can be modified flexibly, skillfully use blood-boosting and invigorating drugs, and use blood-activating drugs with caution. This article summarizes Professor LI Yan’s experience in treating diabetic nephropathy from the perspective of the liver, and attaches a medical case for the sake of fellow practitioners.