基于“态靶辨证”分析大黄黄连泻心汤加减对中满内热型糖尿病肾病的治疗作用

Analysis of Modified and Subtracted Pairs of Rhubarb Huanglian Xiexin Decoction Based on"State Target Syndrome Differentiation"Therapeutic effect of full internal heat syndrome in diabetic nephropathy

糖尿病肾病(DKD)是糖尿病常见慢性并发症之一,现已经成为慢性肾脏病和终末期肾病的主要原因。仝小林教授基于多年临床实践,将中医药辨证论治的宏观内涵与现代医学对疾病认识的微观化相结合,提出“态靶辨证”理论,将糖尿病及其并发症进行分类、分期、分证,形成“态-靶-因-果”处方策略。DKD从早中期临床表现和理化指标来看,多为“中满内热”之态,选用“大黄黄连泻心汤”为调态方,在调节内热的基础上加入打靶药葛根、西洋参、三七、干姜,达到通腑泄浊、活血化瘀、益气养阴的目的。本文拟通过仝小林教授对糖尿病态靶辨证思路,对大黄黄连泻心汤加减进行分析,阐述其“态靶结合”辨证组方思想,审因用药,提高治病靶向性。

Diabetic nephropathy(DKD)is one of the common chronic complications of diabetes,and has now become the main cause of chronic kiDKDey disease and end-stage renal disease.Based on years of clinical practice,Professor Tong Xiaolin combines the macro connotation of syndrome differentiation and treatment in traditional Chinese medicine with the micro-level understanding of diseases in modern medicine,and proposes the theory of"state target syndrome differentiation".Based on clinical experience,Chief Physician Wang Zhigang found that DKD is mostly"medium and full of internal heat"in terms of early and mid-stage clinical manifestations and physical and chemical indicators.He chose"Rhubarb Lianxiaxie Heart Decoction"as the state-regulating prescription.On the basis of regulating internal heat,he added the targeting drugs Pueraria,American ginseng,Panax notoginseng,and dried ginger to achieve the effects of passing through the organs and draining turbidity,promoting blood circulation and removing blood stasis,and nourishing qi and nourishing yin.This article intends to analyze the modification and subtraction of Rhubarb Huanglian Xiexin Decoction through Professor Tong Xiaolin's idea of diabetes target syndrome differentiation,expound its idea of"state target combination"syndrome differentiation,review the cause and medication,and improve the targeting of disease treatment.