基于久病入络理论探讨糖尿病肾病与瘀血的关系

Relationship between Diabetic Nephropathy and Blood Stasis Based on the Theory of Chronic Disease Involving Collaterals

糖尿病肾病(DN)是糖尿病微血管并发症之一,近年发病率随着糖尿病发病率增高而升高。中医称之为“消渴肾病”“尿浊”“肾劳”“溺毒”等。随着络病理论研究的深入,其被用于临床治疗的范围越来越广。络病学说最重要的观点是“久病入络”,是清代著名医家叶桂提出的。DN常在糖尿病的基础上发展而来,是“久病入络”之前提。久病致虚致瘀,同时络脉逐层分级,延伸至肾部为肾络。肾络具有“支横别处、网络分布、纵横交错、细窄纤曲”的生理学特点,故邪易入而难出致瘀血形成。现代医学研究发现瘀血的产生与微循环不畅、凝血因子失调、炎症反应、氧化应激、血小板功能障碍、血液流变学等因素有关。中医学将其归为络病范围,络虚血瘀为其中医病机,瘀血是其发生发展的重要因素。根据“络以通为用”的理论,在DN治疗过程中使用补虚通络法配合辛味、藤类、虫类、活血类中药,可起调补肾络的作用,对于延缓患者的病情及提高其生命质量有益处。

Diabetic nephropathy is one of diabetic microvascular complications with increasing incidence in recent years.With the deepening of research,the collateral disease theory has been increasingly applied in clinical treatment.This theory was put forward by Ye Tianshi,a famous physician in the Qing Dynasty.The most important point of collateral disease theory is chronic disease involving collaterals.Diabetic nephropathy is developed from long-term hyperglycemia,which is the premise of involving collaterals.Long-term illness causes deficiency and stasis.The collaterals are stratified and extend to the kidney as kidney collaterals,which are thin and present crossing and wandering distribution.Pathogenic factors are easy to get in but hard to get out of kidney collaterals,which lead to the formation of blood stasis.Modern medical studies have proved that the formation of blood stasis is associated with microcirculation disturbance,dysregulation of coagulation factors,inflammatory response,oxidative stress,platelet dysfunction,and hemorheological changes.In the system of traditional Chinese medicine,diabetic nephropathy is classified as a collateral disease with the pathogenesis of collateral deficiency and blood stasis.Blood stasis is a key factor in the occurrence and development of this disease.According to the theory that collaterals are in function only when dredged,the therapy of tonifying deficiency and dredging collaterals can be combined with pungent herbs,vine herbs,insect medicines,and blood-activating medicines to tonify kidney collaterals in the treatment of diabetic nephropathy.Such therapy can alleviate the symptoms and improve the quality of life of the patients.