从肾虚痰瘀论治糖尿病肾病
|
摘要
糖尿病肾病是糖尿病最常见的微血管病变,也是糖尿病患者死亡的主要原因之一。临床一般早期表现为尿中微量白蛋白,续之出现临床蛋白尿,逐渐发展为肾功能不全乃至肾功衰竭。近年来,随着人们生活水平的提高,我国糖尿病发病率呈逐年迅速上升趋势,糖尿病肾病的发病率也随之迅速升高,已成为严重危害人民生命健康的疾病之一。本文通过查阅近年来国内重要学者研究肾虚痰瘀与糖尿病肾病的相关文献并结合临床工作中经验总结,以传统中医理论及现代研究为基础,根据其基本病机为肾虚,痰瘀内阻是其基本病理改变,并贯穿于疾病始终。分别从痰饮和瘀血在消渴病变过程中的形成,痰瘀与糖尿病肾病的关系,以及补肾活血化痰法是治疗糖尿病肾病最重要且行之有效的方法等方面进行详细论述。最后辅以病例具体言之。在治疗中当以补肾以治其本,活血化痰以治其标。灵活潜方用药,以期达到未病先防,既病防变的目的。更加充分体现中医治疗疾病的优势。
Diabetic nephropathy is the most common capillary pathological change of diabetes, and it’s also one of the leading causes of death. In clinic, it usualy performs as urine-determination microalbuminuria at early, renewal with clinical albuminuria, and gradually develops into renal insufficiency and kidney reactive power failure. In recent years in China, with the development of people's living level, the incidence of diabetes is rising rapidly, and the incidence of diabetic nephropathy is subsequently rising quickly. Diabetes become one of the most serious diseases which harms to our life and health. By reading the famous Chinese scholars’researches related to kidney empty and phlegm stasis and diabetic nephropathy in recent years, and combined with authors’clinical experience, based on the TCM theory and modern researches, and the kidney empty, phlegm and blood stasis as the basic pathogenesis and pathological changes throughout the disease from beginning to end, the authors discussed the treatment of diabetic nephropathy in detail from the forming of phlegm retention and blood stasis in the process of diabetes, the relationship between phlegm stasis and diabetic nephropathy, and also discussed the tonify kidney, promotion of blood circulation and remove of blood stasis as the most important and effective method in the treatment of diabetic nephropathy. The authors also explained this complementary with specific cases. in the treatment, we should tonify kidney to affect a permanent cure and take temporary solution, and promoting blood circulation and removing blood stasis to affect a permanent cure. We should use the medication flexibly to prevent before the disease arises and prevent disease from exacerbating. The advantage of TCM therapy for disease will be fully exhibited.
Diabetic nephropathy is the most common capillary pathological change of diabetes, and it’s also one of the leading causes of death. In clinic, it usualy performs as urine-determination microalbuminuria at early, renewal with clinical albuminuria, and gradually develops into renal insufficiency and kidney reactive power failure. In recent years in China, with the development of people's living level, the incidence of diabetes is rising rapidly, and the incidence of diabetic nephropathy is subsequently rising quickly. Diabetes become one of the most serious diseases which harms to our life and health. By reading the famous Chinese scholars’researches related to kidney empty and phlegm stasis and diabetic nephropathy in recent years, and combined with authors’clinical experience, based on the TCM theory and modern researches, and the kidney empty, phlegm and blood stasis as the basic pathogenesis and pathological changes throughout the disease from beginning to end, the authors discussed the treatment of diabetic nephropathy in detail from the forming of phlegm retention and blood stasis in the process of diabetes, the relationship between phlegm stasis and diabetic nephropathy, and also discussed the tonify kidney, promotion of blood circulation and remove of blood stasis as the most important and effective method in the treatment of diabetic nephropathy. The authors also explained this complementary with specific cases. in the treatment, we should tonify kidney to affect a permanent cure and take temporary solution, and promoting blood circulation and removing blood stasis to affect a permanent cure. We should use the medication flexibly to prevent before the disease arises and prevent disease from exacerbating. The advantage of TCM therapy for disease will be fully exhibited.
引文
[1]林兰.中西医结合糖尿病学[M].北京:中国医药科技出版社, 1999 , 394.
[2]封翠云.糖尿病肾病的中医病名探讨[J].国医论坛,2007, 22 (2) : 22.
[3]李明霞,李明,骆国平.中西医结合治疗糖尿病肾病的疗效研究[J].河北医学,2008,14(11):1296-1298.
[4]吕仁和.糖尿病肾病的中医诊治[J] .北京中医, 1996, 7( 2) : 3-9.
[5]王莉.中西医结合治疗糖尿病肾病疗效观察[J].辽宁中医杂志,2006,33(11):1472.
[6]龚旭红.中西医结合治疗糖尿病肾病临床观察[J].浙江中西医结合杂志,2004,14(7):406.
[7]罗会新.中西医结合治疗糖尿病肾病尿蛋白的临床观察[J].天津中医药,2007,24(4):277.
[8]杜长欣,郑桂琴,李倩.补脾益肾活血方治疗2型糖尿病34例[J].陕西中医,2005,26(6):486-487.
[9]于敏,张波,史耀勋,等.南征教授“毒损肾络”理论学说探析及临床运用[J].中华中医药学刊,2010,28(2):246.
[10]魏聪,吴以岭,贾振华,等.从络病学说论治糖尿病肾病的理论探讨及相关实验研究[A]:300-303.
[11]沈欣,罗斌.论肾虚痰瘀与糖尿病肾病的关系[J].中国中医基础医学杂志, 2010, 16(1):17.
[12]王改勤.辨证论治糖尿病肾病体会[J].江西中医药,2004, 35(8):49.
[13]李大钧.糖尿病肾病的中医辨证论治[J].河北中医,2001, 23(9):682-683.
[14]林兰.糖息康胶囊治疗糖尿病肾病的临床观察[J].中国中西医结合杂志, 2002,20(11):811.
[15]王建萍.126例糖尿病肾病中医辨证分析[J].光明中医,2010,25(2):252.
[16]邵帅,远方.远方教授从瘀论治糖尿病肾病经验管窥[J].辽宁中医药大学学报,2010,12(2):119-120.
[17]杨东升.糖尿病肾病的中医辨治[J].社区医学杂志,2010,8(8):55.
[18邓经林.48例糖尿病肾病的中医辨证论治[J].江西中医药,2001,32(5):29.
[19]林玮.糖尿病肾病辨治体会[J].实用中医药杂志,2008,24(11):741.
[20]楼季华.参芪地黄汤为主治疗糖尿病肾病127例[J].浙江中医杂志,2006,41(12):708.
[21]张国胜,谢跃萍.补肾汤治疗糖尿病肾病82例[J].河南中医,2005,25(11):40.
[22]李丽萍,王延丰,张建坡.保肾汤治疗糖尿病肾病96例临床观察[J].中国自然医学杂志,2006,8(1):56.
[23]李成彦.二参地黄汤治疗糖尿病肾病临床疗效观察[J].时珍国医国药,2006,17(5):817.
[24]许陵冬,郭惠芳.化痰活血通络法治疗糖尿病肾病82例[J].辽宁中医杂志,2000,27(1):17-18.
[25]徐好利.补肾活血汤治疗糖尿病肾病60例[J].陕西中医,2010 ,31(8):963-964.
[26]付晓,李敬林,卞镝等.糖克煎剂对糖尿病大鼠肾脏病理组织结构的影响[J].中医药学刊, 2006,24(4):657-658.
[27]刘小菊,叶玉珠.补阳还五汤加减治疗早期糖尿病肾病58例[N].浙江中医药大学学报,2009,33(1):75.
[28]张红宇,高菊珍,张晓华.补阳还五汤对气虚血瘀大鼠血液流变学的影响[J].云南中医学院学报,2000 ,23 (3) :10.
[29]阎奇,刘鹰.血府逐瘀汤为主治疗糖尿病肾病48例疗效观察[J].中国中医药信息杂志,2007,14(4):70.
[30]李文红.活血化瘀法在糖尿病肾病治疗中的重要作用[J].实用中医内科杂志,2005,19(1):80.
[31]高建东.加味地黄汤治疗糖尿病肾病蛋白尿临床观察[N].山东中医药大学学报, 2007, 31(4):297.
[32]陈辉,刘菊.真武汤加减联合西药治疗老年糖尿病肾病的临床观察[J].中国医院药学杂志,2009 ,29(18) :1552-1554.
[33]郑强,尉冬英,李雪梅,等.黄芪注射液治疗糖尿病肾病的疗效观察与分析[J].华西医学,2009, 24( 9):2319-2320.
[34]徐锡兰,彭书磊.保肾汤治疗糖尿病肾病临床观察[A].论文汇编[C].
[35]赵恒侠.参附注射液治疗糖尿病肾病性水肿的疗效观察[J].世界中西医结合杂志,2006,1(3):171.
[36]冯兴中,高彦彬,姜敏,等.补肾降浊、祛瘀化痰法治疗糖尿病肾病早期的临床与实验研究[M].中国学术期刊电子出版社:270-272.
[37]张秀峰,高慧燕.黄芪治疗早期DN疗效观察[J].上海医药,1999,20 (11):20.
[38]王新嘉.槲皮素对糖尿病大鼠肾脏并发症的保护作用及其机理研究[J].中华肾脏病杂志,1997,(2):108.
[39]赵洪军,韩学忠,徐梅,等.大黄治疗糖尿病肾病32例[J].中国中西医结合杂志,1996,16 (7):429-430.
[40]陈发胜.百令胶囊治疗Ⅱ型糖尿病肾病的临床观察[J].新中医,1997 ,29 (3) :31.
[41]刘长山,董砚虎,逢力男,等.中药黄芩甙与黄连素对糖尿病鼠醛糖还原酶活性作用的观察[J].中国糖尿病杂志,1996 ,4 (3) :163-166.
[42]宁云绸,张跃华.舒血宁配合西药治疗早期糖尿病肾病33例[J].陕西中医,2009,30(4):403.
[43]王涛,沈水娟,胡作祥.刺五加注射液治疗糖尿病肾病疗效观察[J].现代中西医结合杂志,2006,15(4):475-476.
[44]马明福,马淑梅.中药灌肠方治疗糖尿病肾病慢性肾功能不全84例临床观察[J].新中医,2010,42(4):62-63.
[45]焦敏侠,蔡艳丽.结肠透析治疗糖尿病肾病44例观察[J].实用中医内科杂志,2005,19(6):577.
[46]褚芹,王琳.针药并用治疗糖尿病肾病疗效观察[J].中医针灸,2007,27(7):488-490.
[47]黄学民,赵进喜.糖尿病肾病的中医分期分型辨证探讨[J].中国老年保健医学, 2005, 3( 1 ): 28.
[48]杨霓芝,李芳,徐大基,等.糖尿病肾病分期辨证治疗的探讨[J].辽宁中医杂志, 1999, 26 (1) : 35-37.
[49]肖相如.肾病中的瘀血[J].辽宁中医杂志,2003,30(2):85.
[50]吕仁和,赵进喜,王越,等.糖尿病肾病临床研究述评[N].北京中医药大学学报,1994;17(2):2-6.
[51]韩学杰,沈绍功.痰瘀相关病因初探[J].中国中医基础医学杂志,1998, 4( 3) : 47-48.
[52]于俊生.略论痰瘀之间的相互转化关系[J].辽宁中医药杂志,1994, 21( 6) : 247-247.
[53]陆纪宏.试论中医辨治高脂血症[J].辽宁中医杂志, 1991,(2) : 1.
[54]杨玉芳.活血化瘀与喘证方药研究[M].北京:中国中医药出版社, 1994. 85.
[55]卞镝.从瘀论治糖尿病肾病[J].辽宁中医杂志,2006 ,33 ( 10) :1266– 1267.
[56]李锋,等.肾小球硬化的中医病机初探[J].中国医药学报, 2001, 16( 2) : 50- 52.
[57]刘洪陆,郭惠芳.从痰瘀论治临床期糖尿病肾病:附181例临床分析[J].国医论坛,1999 ,14 (3) :22-23.
[58]王明惠,刘启庭.糖尿病名医秘验绝技[M]北京:人民军医出版社.2005.
[59]胡明阁,胡保同,唐明巧.辨证论治消渴132例[N].河南中医学院学报, 2005, 20(6) : 51- 52.
[60]郭立仪.中西医结合治疗糖尿病肾病疗效比较[J].中国现代医生, 2008, 46(14):81-82.
[61]张国胜,谢跃萍.补肾汤治疗糖尿病肾病82例[J].河南中医, 2005,25(11):40-41.
[62]玄绪丽,李金海.利湿化瘀法治疗糖尿病肾病临床观察[J].中国中西医结合肾病杂志,2008,9(3):265-266.
[63]杨丽霞,李娟娥,吴丽丽,等.刘铜华教授治疗糖尿病肾病顽固性蛋白尿验案[J].甘肃中医,2010,23(7):49.
[2]封翠云.糖尿病肾病的中医病名探讨[J].国医论坛,2007, 22 (2) : 22.
[3]李明霞,李明,骆国平.中西医结合治疗糖尿病肾病的疗效研究[J].河北医学,2008,14(11):1296-1298.
[4]吕仁和.糖尿病肾病的中医诊治[J] .北京中医, 1996, 7( 2) : 3-9.
[5]王莉.中西医结合治疗糖尿病肾病疗效观察[J].辽宁中医杂志,2006,33(11):1472.
[6]龚旭红.中西医结合治疗糖尿病肾病临床观察[J].浙江中西医结合杂志,2004,14(7):406.
[7]罗会新.中西医结合治疗糖尿病肾病尿蛋白的临床观察[J].天津中医药,2007,24(4):277.
[8]杜长欣,郑桂琴,李倩.补脾益肾活血方治疗2型糖尿病34例[J].陕西中医,2005,26(6):486-487.
[9]于敏,张波,史耀勋,等.南征教授“毒损肾络”理论学说探析及临床运用[J].中华中医药学刊,2010,28(2):246.
[10]魏聪,吴以岭,贾振华,等.从络病学说论治糖尿病肾病的理论探讨及相关实验研究[A]:300-303.
[11]沈欣,罗斌.论肾虚痰瘀与糖尿病肾病的关系[J].中国中医基础医学杂志, 2010, 16(1):17.
[12]王改勤.辨证论治糖尿病肾病体会[J].江西中医药,2004, 35(8):49.
[13]李大钧.糖尿病肾病的中医辨证论治[J].河北中医,2001, 23(9):682-683.
[14]林兰.糖息康胶囊治疗糖尿病肾病的临床观察[J].中国中西医结合杂志, 2002,20(11):811.
[15]王建萍.126例糖尿病肾病中医辨证分析[J].光明中医,2010,25(2):252.
[16]邵帅,远方.远方教授从瘀论治糖尿病肾病经验管窥[J].辽宁中医药大学学报,2010,12(2):119-120.
[17]杨东升.糖尿病肾病的中医辨治[J].社区医学杂志,2010,8(8):55.
[18邓经林.48例糖尿病肾病的中医辨证论治[J].江西中医药,2001,32(5):29.
[19]林玮.糖尿病肾病辨治体会[J].实用中医药杂志,2008,24(11):741.
[20]楼季华.参芪地黄汤为主治疗糖尿病肾病127例[J].浙江中医杂志,2006,41(12):708.
[21]张国胜,谢跃萍.补肾汤治疗糖尿病肾病82例[J].河南中医,2005,25(11):40.
[22]李丽萍,王延丰,张建坡.保肾汤治疗糖尿病肾病96例临床观察[J].中国自然医学杂志,2006,8(1):56.
[23]李成彦.二参地黄汤治疗糖尿病肾病临床疗效观察[J].时珍国医国药,2006,17(5):817.
[24]许陵冬,郭惠芳.化痰活血通络法治疗糖尿病肾病82例[J].辽宁中医杂志,2000,27(1):17-18.
[25]徐好利.补肾活血汤治疗糖尿病肾病60例[J].陕西中医,2010 ,31(8):963-964.
[26]付晓,李敬林,卞镝等.糖克煎剂对糖尿病大鼠肾脏病理组织结构的影响[J].中医药学刊, 2006,24(4):657-658.
[27]刘小菊,叶玉珠.补阳还五汤加减治疗早期糖尿病肾病58例[N].浙江中医药大学学报,2009,33(1):75.
[28]张红宇,高菊珍,张晓华.补阳还五汤对气虚血瘀大鼠血液流变学的影响[J].云南中医学院学报,2000 ,23 (3) :10.
[29]阎奇,刘鹰.血府逐瘀汤为主治疗糖尿病肾病48例疗效观察[J].中国中医药信息杂志,2007,14(4):70.
[30]李文红.活血化瘀法在糖尿病肾病治疗中的重要作用[J].实用中医内科杂志,2005,19(1):80.
[31]高建东.加味地黄汤治疗糖尿病肾病蛋白尿临床观察[N].山东中医药大学学报, 2007, 31(4):297.
[32]陈辉,刘菊.真武汤加减联合西药治疗老年糖尿病肾病的临床观察[J].中国医院药学杂志,2009 ,29(18) :1552-1554.
[33]郑强,尉冬英,李雪梅,等.黄芪注射液治疗糖尿病肾病的疗效观察与分析[J].华西医学,2009, 24( 9):2319-2320.
[34]徐锡兰,彭书磊.保肾汤治疗糖尿病肾病临床观察[A].论文汇编[C].
[35]赵恒侠.参附注射液治疗糖尿病肾病性水肿的疗效观察[J].世界中西医结合杂志,2006,1(3):171.
[36]冯兴中,高彦彬,姜敏,等.补肾降浊、祛瘀化痰法治疗糖尿病肾病早期的临床与实验研究[M].中国学术期刊电子出版社:270-272.
[37]张秀峰,高慧燕.黄芪治疗早期DN疗效观察[J].上海医药,1999,20 (11):20.
[38]王新嘉.槲皮素对糖尿病大鼠肾脏并发症的保护作用及其机理研究[J].中华肾脏病杂志,1997,(2):108.
[39]赵洪军,韩学忠,徐梅,等.大黄治疗糖尿病肾病32例[J].中国中西医结合杂志,1996,16 (7):429-430.
[40]陈发胜.百令胶囊治疗Ⅱ型糖尿病肾病的临床观察[J].新中医,1997 ,29 (3) :31.
[41]刘长山,董砚虎,逢力男,等.中药黄芩甙与黄连素对糖尿病鼠醛糖还原酶活性作用的观察[J].中国糖尿病杂志,1996 ,4 (3) :163-166.
[42]宁云绸,张跃华.舒血宁配合西药治疗早期糖尿病肾病33例[J].陕西中医,2009,30(4):403.
[43]王涛,沈水娟,胡作祥.刺五加注射液治疗糖尿病肾病疗效观察[J].现代中西医结合杂志,2006,15(4):475-476.
[44]马明福,马淑梅.中药灌肠方治疗糖尿病肾病慢性肾功能不全84例临床观察[J].新中医,2010,42(4):62-63.
[45]焦敏侠,蔡艳丽.结肠透析治疗糖尿病肾病44例观察[J].实用中医内科杂志,2005,19(6):577.
[46]褚芹,王琳.针药并用治疗糖尿病肾病疗效观察[J].中医针灸,2007,27(7):488-490.
[47]黄学民,赵进喜.糖尿病肾病的中医分期分型辨证探讨[J].中国老年保健医学, 2005, 3( 1 ): 28.
[48]杨霓芝,李芳,徐大基,等.糖尿病肾病分期辨证治疗的探讨[J].辽宁中医杂志, 1999, 26 (1) : 35-37.
[49]肖相如.肾病中的瘀血[J].辽宁中医杂志,2003,30(2):85.
[50]吕仁和,赵进喜,王越,等.糖尿病肾病临床研究述评[N].北京中医药大学学报,1994;17(2):2-6.
[51]韩学杰,沈绍功.痰瘀相关病因初探[J].中国中医基础医学杂志,1998, 4( 3) : 47-48.
[52]于俊生.略论痰瘀之间的相互转化关系[J].辽宁中医药杂志,1994, 21( 6) : 247-247.
[53]陆纪宏.试论中医辨治高脂血症[J].辽宁中医杂志, 1991,(2) : 1.
[54]杨玉芳.活血化瘀与喘证方药研究[M].北京:中国中医药出版社, 1994. 85.
[55]卞镝.从瘀论治糖尿病肾病[J].辽宁中医杂志,2006 ,33 ( 10) :1266– 1267.
[56]李锋,等.肾小球硬化的中医病机初探[J].中国医药学报, 2001, 16( 2) : 50- 52.
[57]刘洪陆,郭惠芳.从痰瘀论治临床期糖尿病肾病:附181例临床分析[J].国医论坛,1999 ,14 (3) :22-23.
[58]王明惠,刘启庭.糖尿病名医秘验绝技[M]北京:人民军医出版社.2005.
[59]胡明阁,胡保同,唐明巧.辨证论治消渴132例[N].河南中医学院学报, 2005, 20(6) : 51- 52.
[60]郭立仪.中西医结合治疗糖尿病肾病疗效比较[J].中国现代医生, 2008, 46(14):81-82.
[61]张国胜,谢跃萍.补肾汤治疗糖尿病肾病82例[J].河南中医, 2005,25(11):40-41.
[62]玄绪丽,李金海.利湿化瘀法治疗糖尿病肾病临床观察[J].中国中西医结合肾病杂志,2008,9(3):265-266.
[63]杨丽霞,李娟娥,吴丽丽,等.刘铜华教授治疗糖尿病肾病顽固性蛋白尿验案[J].甘肃中医,2010,23(7):49.