基于络病理论探讨益气养阴通络法治疗糖尿病肾脏病

Study on the Method of Replenishing Qi and Nourishing Yin and Dredging Collaterals for Treating Diabetic Kidney Disease Based on the Theory of Collateral Diseases

糖尿病肾脏病为本虚标实之证,本虚为气阴两虚,标实为瘀血、痰浊,治疗宜益气养阴通络,益气用黄芪、党参、太子参,养阴用生地黄、熟地黄、铁皮石斛、黄精等补络脉之不足,行络脉之气血。气阴亏虚于内,水不涵木,则易生风动风,此为内风;本虚于内,易受外邪侵扰,此为外风。外风宜散,内风宜熄,临床常用僵蚕、生龙骨、生牡蛎平熄内风;穿山甲、乌梢蛇、海风藤、牛蒡子等散外风。祛痰通络用半夏、瓜蒌、白芥子以消肾络之痰浊。散结通络常用醋鳖甲、醋莪术等通络消积。络病日久,瘀血阻滞络脉,凝聚成形,络熄成积,痼结难解,此时单用草木之品难以奏效,常配伍虫类药以搜剔化瘀通络,常在丹参、川芎的基础上配伍地龙、全蝎、水蛭等虫类药。益气养阴药配伍祛风通络药、祛痰通络药、散结通络药以及化瘀通络药,有益气养阴、通畅肾络之效。

Diabetic kidney disease(DKD)is the syndrome of deficient root causes and excessive manifestations.The deficient root causes refer to qi-yin deficiency,while excessive manifestations refer to blood stasis and phlegm.Treatment should aim to replenish qi and nourish yin and dredge collaterals,so Huangqi(Radix Scutellariae),Dangshen(Radix Codonopsis),Taizishen(Radix Pseudostellariae)can be used to replenish qi,while Shengdihuang(Radix Rehmanniae),Shudihuang(Radix Rehmanniae Praeparata),Tiepishihu(Caulis Dendrobi),and Huangjing(Rhizoma Polygonati)can be used to nourish qi and yin of the collaterals and promote the flow of qi and blood.There is internal deficiency of qi and yin,so water cannot nourish the wood element,leading to the generation of wind and disturbance of wind.This is known as internal wind.There is also external wind caused by the body being susceptible to external pathogens due to internal deficiency.External wind should be dispersed,while internal wind should be extinguished.In clinical practice,Jiangcan(Bombyx Batryticatus),Shenglonggu(Os Draconis)and Shengmuli(Concha Ostreae)are often used to extinguish internal wind,while Chuanshanlong(Rhizoma Dioscoreae Nipponicae),Wushaoshe(Zaocys),Haifengteng(Caulis Piperis Kadsurae)and Niubangzi(Fructus Arcti)etc.are used to disperse external wind;Banxia(Rhizoma Pinelliae),Gualou(Fructus Trichosanthis)and Baijiezi(Semen Sinapis)are used to remove phlegm turbidity of kidney collateral;vinegar-soaked Biejia(Carapax Trionycis)and vinegarsoaked Ezhu(Rhizoma Curcumae)are often used to dredge collaterals and eliminate stagnation.Long-term collateral diseases can cause blood stasis and blockage of the meridians,leading to coagulation and stagnation of the collaterals.When the collaterals become stagnant and difficult to resolve,it is not easy to remove the pathogens by using only herbal products.Therefore,it is often combined with insect medicines to search for and remove blood stasis and unblock the collaterals.On the basis of Danshen(Radix Codonopsis)and Chuanxiong(Rhizoma Chuanxiong),insect medicines such as Dilong(Pheretima),Quanxie(Scorpio),and Shuizi(Hirudo)are often used in combination.The combination of qi-tonifying and yin-nourishing medicines with wind-dispelling and meridian-unblocking medicines,phlegm-dispelling and meridian-unblocking medicines,stagnation-dispersing and meridian-unblocking medicines,and blood stasis-removing and meridian-unblocking medicines has the effect of nourishing qi and yin,and unblocking the kidney collateral.