从“脾不散精、浊毒内蕴”的角度探析糖尿病肾病的中医病机

An analysis of TCM pathogenesis of diabetic nephropathy based on incapability of spleen to disperse essence,internal amassment of turbid and poison

糖尿病肾病为糖尿病的微血管并发症之一,可出现水肿、蛋白尿、渐进性肾功能损害、高血压病、肾功能衰竭等症状。临床上应关注糖尿病肾病中医病机,探索发病机制,防治本病。在传统中医学中并未记载“糖尿病肾病”的名称,根据糖尿病肾病的临床症状,其多属“肾消”“水肿”“尿浊”的范畴,现代医家多称之为“消渴病肾病”。大多数当代医家认为糖尿病肾病病性为本虚标实。关于糖尿病肾病的病机,目前并未统一。文章介绍浊毒学说,分析“脾不散精”与糖尿病肾病的关系,认为浊毒分为湿浊毒、谷浊毒、瘀毒,从“脾不散精、浊毒内蕴”继而“损伤肾络”的角度探析糖尿病肾病的中医病机,提出在治疗方面应遵从中医的整体观念,辨证论治,综合调理,采用“助脾散精、化浊解毒、化瘀通络”,兼补肾健脾扶正、利水消肿、通腑泄浊、搜风通络等治疗方法。

Diabetic nephropathy is one of the microvascular complications of diabetes,symptoms such as edema,proteinuria,progressive renal impairment,hypertension,and renal failure may occur.Clinically,we should pay attention to the TCM pathogenesis of diabetic nephropathy,explore the pathogenesis,prevent and treat the disease.The name of diabetic nephropathy is not recorded in TCM.According to the clinical symptoms of diabetic nephropathy,it mostly belongs to the category of Shenxiao(肾消),edema and turbid urine.Modern doctors call it diabetes nephropathy.Most contemporary doctors believe that diabetic nephropathy belongs to the syndrome of asthenia in origin and excess in superficiality.At present,the pathogenesis of diabetic nephropathy is not unified.This paper introduces the theory of turbid and poison,analyzes the relationship between incapability of spleen to disperse essence and diabetic nephropathy,and holds that turbid and poison can be divided into turbid damp poison,valley turbid poison and static poison.This paper probes into the TCM pathogenesis of diabetic nephropathy from incapability of spleen to disperse essence,internal amassment of turbid and poison and then damage of collaterals in kidney.In the treatment,we should follow the overall concept of TCM,syndrome differentiation and treatment,and comprehensive conditioning.The treatment methods such as helping spleen to disperse essence,dissolving turbidity and detoxification,dispersing blood stasis and dredging collateral were applied,as well as notifying kidney and spleen,strengthening the body resistance,inducing diuresis to alleviate edema,eliminating turbidity by purgation,expelling wind and activating meridians and so on.