糖尿病肾病“精损络痹”病机探讨
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摘要
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.
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.
引文
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[13]柳红芳,张向伟.张景岳真阴精气理论在糖尿病肾病治疗中的应用探讨[J].北京中医药大学学报,2016,39(1):5-9.Liu HF,Zhang XW.Application of ZHANG Jingyue's theory of genuine yin and vital essence on the treatment of diabetic nephropathy[J].Journal of Beijing University of Traditional Chinese Medicine,2016,39(1):5-9.
[14]张向伟,柳红芳,胡济源,等.金匮肾气丸隐藏的治肾法则[J].环球中医药,2017,10(9):1124-1125.Zhang XW,Liu HF,Hu JY,et al.Therapeutic rules of treating kidney hidden in Jinkui Shenqi Pill[J].Global Traditional Chinese Medicine,2017,10(9):1124-1125.
[2]陆健,杨芳,韩正.毒损肾络与糖尿病肾病[J].辽宁中医杂志,2016,43(12):2522-2523.Lu J,Yang F,Han Z.Treating diabetic nephropathy based on damage of kidney collateral by poison[J].Liaoning Journal of Traditional Chinese Medicine,2016,43(12):2522-2523.
[3]冯辉,刘永林,陈益民,等.痰、瘀、毒与糖尿病肾病[J].江西中医药大学学报,2016,28(2):11-12.Feng H,Liu YL,Chen YM,et al.Phlegm,stasis,toxin and diabetic nephropathy[J].Journal of Jiangxi University of Traditional Chinese Medicine,2016,28(2):11-12.
[4]曾胜,林斌.糖尿病肾病三焦辨治[J].中国中医药信息杂志,2011,18(9):83-84.Zeng S,Lin B.Differentiation and treatment of diabetic nephropathy based on triple energizers[J].Chinese Journal of Information on Traditional Chinese Medicine,2011,18(9):83-84.
[5]胡佳卉,谢晴宇,孟庆刚.从脾论治糖尿病及其并发症的文献计量分析[J].中华中医药杂志,2017,32(2):713-717.Hu JH,Xie QY,Meng QG.Bibliometrical analysis of treating diabetes mellitus and its complications from spleen[J].China Journal of Traditional Chinese Medicine and Pharmacy,2017,32(2):713-717.
[6]邹建琴,余海源.从“瘀”论治糖尿病肾病的研究进展[J].中国中医药科技,2013,20(4):438-439.Zou JQ,Yu HY.Advances in research on treatment of diabetic nephropathy from blood stasis[J].Chinese Journal of Traditional Medical Science and Technology,2013,20(4):438-439.
[7]姚荷生,潘佛巖,廖家兴.藏象学说与诊断应用的文献探讨---肾脏[M].北京:人民卫生出版社,2013:83-88.Yao HS,Pan FY,Liao JX.Discussion on Literature of Diagnostic Applications of Visceral Manifestation TheoryKidney[M].Beijing:People's Medical Publishing House,2013:83-88.
[8]章增加.肾阴肾阳源流考略[J].广西中医药,1991,14(5):220-222.Zhang ZJ.Origin examination of kidney yin and kidney yang[J].Guangxi Journal of Traditional Chinese Medicine,1991,14(5):220-222.
[9]张向伟,柳红芳,王养忠,等.金匮肾气丸在慢性肾功能不全治疗中应用探讨[J].中华中医药杂志,2017,32(7):3106-3108.Zhang XW,Liu HF,Wang YZ,et al.Application of Jinkui Shenqi Pills in treatment of chronic renal in-sufficiency diseases[J].China Journal of Traditional Chinese Medicine and Pharmacy,2017,32(7):3106-3108.
[10]柳红芳,张向伟,张先慧.糖尿病肾脏病的“形气神”论治[J].北京中医药大学学报,2016,39(10):817-819.Liu HF,Zhang XW,Zhang XH.Different iation treatment of diabetic kidney disease based on body-qi-spirit[J].Journal of Beijing University of Traditional Chinese Medicine,2016,39(10):817-819.
[11]邱幸凡.“脏虚络痹”理论探讨[J].中国中医基础医学杂志,2007,13(5):334-335.Qiu XF.Discussion on theory of visceral deficiency and collaterals impediment[J].Chinese Journal of Basic Medicine in Traditional Chinese Medicine,2007,13(5):334-335.
[12]柳红芳,张先慧.糖尿病肾病“虚气留滞”病机探微[J].现代中医临床,2012,19(6):4-6.Liu HF,Zhang XH.Pathogenesis of diabetic nephropathy with deficiency qi retention[J].Modern Chinese Clinical Medicine,2012,19(6):4-6.
[13]柳红芳,张向伟.张景岳真阴精气理论在糖尿病肾病治疗中的应用探讨[J].北京中医药大学学报,2016,39(1):5-9.Liu HF,Zhang XW.Application of ZHANG Jingyue's theory of genuine yin and vital essence on the treatment of diabetic nephropathy[J].Journal of Beijing University of Traditional Chinese Medicine,2016,39(1):5-9.
[14]张向伟,柳红芳,胡济源,等.金匮肾气丸隐藏的治肾法则[J].环球中医药,2017,10(9):1124-1125.Zhang XW,Liu HF,Hu JY,et al.Therapeutic rules of treating kidney hidden in Jinkui Shenqi Pill[J].Global Traditional Chinese Medicine,2017,10(9):1124-1125.