糖尿病肾病“精损络痹”病机探讨

Pathogenesis of diabetic nephropathy with essence depletion and collateral impediment

糖尿病肾病的核心病机可以概括为精损络痹。强调病变以肾为核心,肾虚以精损为要,精损指肾精虚损。络痹指因虚而滞,湿、瘀、浊等邪痹阻肾络,甚则化生癥瘕,具有因虚至实的特点。据此提出以填精通络为核心治法治疗糖尿病肾病,填精即填补肾精,通络即祛邪通络。填补肾精是治疗糖尿病肾病的基石,在疾病中后期的应用尤为突出。祛邪通络包括早期重视祛邪除痹的消通之法及后期重视扶正祛邪的补通之法,祛邪而不伤正。

The pathogenesis of essence depletion and collateral impediment can summarize the characteristics of core pathogenesis of diabetic nephropathy(DN)and guide clinical treatment effectively.The pathogenesis of essence depletion emphasizes that kidney lesions is the core of five viscera lesions.Kidney deficiency indicates the consumption of kidney essence and deficiency induces the production of stagnation,dampness,stasis and turbidity.The pathogenesis of collateral impediment indicates that dampness,stasis and turbidity due to deficiency obstruct kidney collateral,even aggregation-accumulation is produced.Therefore collateral impediment is characterized by excess due to deficiency.The therapy of filling essence and freeing collaterals is proposed for DN treatment in the paper.The filling essence refers to nourishing kidney essence,and freeing collaterals refers to eliminating pathogens to free collaterals.It is a kernel therapy for DN.The nourishing kidney essence is a cornerstone in DN treatment,especially in middle or late stages of DN treatment.In early stage eliminating pathogens to resolve impediment(eliminating-freeing therapy)is stressed,and in late stage reinforcing healthy qi and eliminating pathogens(nourishing-freeing therapy)is emphasized.The healthy qi will not be damaged during eliminating pathogens.