糖尿病肾病临床经验总结

Summary of clinical experience in treating diabetic kidney disease

糖尿病肾病(Diabetic Kidney Disease,DKD)是长期糖尿病引起的肾脏病变,为我国终末期肾病的重要病因。本病迁延难愈,发病率也逐年提高。在西医治疗暂无重大突破之时,如何发挥中医药的独特优势有着重大意义。导师黄新艳,国家重点学科带头人,从事中医临床工作数十载。黄老师认为DKD中医病机以气阴两虚为基础,兼有瘀血、湿浊之邪为标。在治疗上,应抓住患者气阴两虚之本,施以健脾补肾、益气养阴方药,使其正气不致衰惫;并佐以散瘀通络、利湿化浊等法,祛除病邪。黄老师对于患者病之气阴两虚,常选用参芪地黄汤合水陆二仙丹为主方进行加减。方中参芪地黄汤可行补气滋阴,补肾健脾之功;水陆二仙丹则取其补肾固精之效。两方合用共奏固本培元,滋阴益气功效。针对患者瘀血、湿浊之邪,黄老师则辅以牡丹皮、桃仁、红花等药活血化瘀,苍术、泽泻、茯苓等药化湿泄浊。消渴病肾病的病机基础虽为气阴两虚,然临床上患者病情常有所偏重,需根据其气虚、阴虚等的侧重综合分析,随证加减。除此之外,黄师亦常常配合中医外治法,如中药灌肠、针灸、穴位注射、耳针等内外兼治,以求达到最佳疗效,提高患者生活质量。现分享黄师相关诊疗心得如下,以供探讨。

Diabetic kidney disease(DKD)is an important cause of end-stage renal disease in China.The disease is prolonged and difficult to cure,and the incidence is increasing year by year.There is no major breakthrough in Western medicine treatment,it is of great significance to give full play to the unique advantages of traditional Chinese medicine.The tutor HUANG Xinyan is a national key discipline leader and has been engaged in TCM clinical work for decades.According to Master HUANG,the pathogenesis of DKD is based on the deficiency of Qi(气)and Yin(阴),which is coupled with the evil of blood stasis and dampness.In terms of treatment,the root causes of Qi and Yin deficiency of patients should be grasped,and the prescription of invigorating spleen and kidney,invigorating Qi and nourishing Yin should be administered,so that the patients’Qi could be regulated,and be combined with the method of dispersing stasis and regulating collages,removing dampness and turbidity,etc.For patients with Qi and Yin deficiency,modified Shenqi Dihuang decoction and Shuilu Erxian Dan(参芪地黄汤合水陆二仙丹)are often prescribed.Shenqi Dihuang decoction is used to tonify Qi and Yin,which is for tonifying kidney and invigorating spleen.Shuilu Erxian Dan takes its effect of tonifying kidney and reinforcing essence.The combination plays the effect of strengthening the essence and cultivating healthy Qi,nourishing Yin and Qi.For patients with blood stasis and dampness,medicinals of Mudanpi(Cortex moutan),Taoren(Peach kernel)and Honghua(Safflower)are added to promote blood circulation and remove blood stasis,and Cangzhu(Atractylodis),Zexie(Purgatory)and Fuling(Poria)are added to remove dampness and turbidity.Although the pathogenesis of diabetes nephropathy is Qi and Yin deficiency,the patient’s condition is often biased in clinical practice.It is necessary to make a comprehensive analysis according to the condition of Qi deficiency and Yin deficiency,and then add or subtract medicinals according to the syndrome.In addition,Master HUANG also often combines with external treatment of traditional Chinese medicine,such as enema,acupuncture,acupoint injection,auricular acupuncture and other internal and external treatments,in order to achieve the best curative effect and improve the quality of life of patients.Now the following diagnosis and treatment experience of Master HUANG is shared for discussion.