糖尿病肾病“精损络痹”病机的生物学内涵

Biological Implications of Diabetic Nephropathy Pathogenesis of"Jing Sun Luo Bi"

糖尿病肾病是在糖尿病气阴两虚病机基础之上发展而来,长期气阴两虚势必耗伤人体阴精,人体阴精又藏于肾,络脉受损,后天之精无法灌注补充,机体失养,脏腑生理功能失职,影响肾的固摄藏精功能,蛋白等精微物质从尿液漏出,加重肾精亏损并渐至肾气、肾阴、肾阳无从化生。肾的生理功能逐渐下降,痰、热、瘀血等病理产物胶结于肾络,肾络痹阻,病理上可见“微型癥瘕”。因而糖尿病肾病病机可归纳为“精损络痹”。随着对糖尿病肾病发病机制的深入研究,该病中医病因病机的生物学内涵也得以明确:糖尿病肾病肾络热郁与炎症损伤、肾络痰阻与糖脂代谢异常、肾络瘀痹与内皮细胞损伤、肾络痹阻与肾病理改变均具有一定的相关性。

Diabetic nephropathy develops on the basis of the pathogenesis of Qi and Yin deficiency in diabetes.Long-term Qi and Yin deficiency inevitably depletes the body′s Yin Essence,which is stored in the Kidney.Damage to the collaterals impairs the replenishment of acquired Essence,leading to malnourishment of the body and dysfunction of organ physiology.This affects the Kidney′s function of storing and securing Essence,causing leakage of protein and other subtle substances in the urine,exacerbating the deficiency of Kidney Essence,and eventually leading to the inability of Kidney Qi,Kidney Yin,and Kidney Yang generation.The physiological function of the Kidney gradually declines,and the pathological products such as Phlegm,Heat,and stagnant blood accumulate in the Kidney collaterals,causing obstruction.Pathologically,"microscopic nodules"can be observed.Therefore,the pathogenesis of diabetic nephropathy can be summarized as"Jing Sun Luo Bi".With further research on the pathogenesis of diabetic nephropathy,the biological implications of TCM etiology and pathogenesis have also been clarified:there is a certain correlation between renal collateral heat stagnation and inflammatory injury,renal collateral phlegm obstruction and abnormal glucose and lipid metabolism,renal collateral blood stasis obstruction and endothelial cell damage as well as renal collateral obstruction and pathological changes in the Kidney.