基于“微型癥瘕”理论探讨糖尿病肾病的分期论治

Exploration on Staging Treatment of Diabetic Nephropathy Based on the Theory of“Micro Aggregation-Accumulation”

糖尿病肾病是糖尿病患者的主要微血管并发症之一,也是导致糖尿病患者死亡的重要原因。国医大师吕仁和教授基于长期的临床经验创造性地提出了“微型癥瘕”理论。本文旨从“热伤气阴”的特点及“癥瘕致病,虚实相因”这一总病机切入,从糖尿病肾病病程的三期分析病机,进而分期论治及用药:初期益气补虚,养阴清热;中期补益脾肾,祛痰散瘀;后期阴阳并补,消散癥结。意将扶正和消癥相结合,从而维持肾中络脉血流通畅。通过总结和分析目前糖尿病肾病的研究现状,将糖尿病肾病初期、中期和晚期的治法和用药进行总结,以期为中医药临床实践提供用药理论依据,为临床从中医药角度防治糖尿病肾病提供参考。

Diabetic nephropathy is one of the major microvascular complications in diabetic patients and an important cause of death of the patients.Based on his long-term clinical experience,Professor Lv Renhe,a master of Chinese medicine,has creatively proposed the theory of“micro-aggregation-accumulation”.This paper aims to analyze the pathogenesis of the three stages of diabetic nephropathy from the characteristics that“heat injures qi yin”and the general pathogenesis that“when aggregation-accumulation causes disease,deficiency and excess are each other s cause”,to analyze the disease mechanism from the three stages of diabetic nephropathy,and then to discuss the treatment in the three stages.In the early stage,the treatment should be focused on benefiting qi,tonifying deficiency,nourishing yin and clearing heat;tonifying the spleen and kidney,dispelling phlegm and dissipating stasis are the treatment for the middle stage;and in the late stage,the treatment is to combine the yin and yang to tonify deficiency and dispel stasis.The aim is to combine the two treatment methods,reinforce of the healthy qi and eliminate the conglomeration,so as to maintain the smooth blood flow in the kidney channels.By summarizing and analyzing the current research status of diabetic nephropathy,we summarized the treatment of the early,middle and late stages of diabetic nephropathy,with a view to providing a theoretical basis for the use of Chinese medicine in clinical practice and providing a reference for clinical prevention and treatment of diabetic nephropathy from the perspective of Chinese medicine.