摘要
随着糖尿病的诊疗水平持续提升,其急性并发症所致的患者病死率已得到有效控制,然而糖尿病肾病的发病率呈显著上升趋势。糖尿病肾病作为常见的糖尿病严重微血管并发症,已成为终末期肾脏病的重要病因。根据临床症状如水肿、尿量减少、泡沫尿等,古今医家将糖尿病肾病归于“消渴肾病”“水肿”“尿浊”等范畴。该病一经发病则逐年进展,不可逆转,且缺乏特效治疗手段,目前以中西医结合治疗为主。“主客交”学说由明末医家吴有性创立,继承并发展了《黄帝内经》中的发病学,用以阐述正气亏虚、客邪内陷、正邪交织导致气机郁阻,从而形成难治性慢性病症的病理过程。“玄府”理论初见于《黄帝内经》,至金元时期渐趋成熟,医家刘完素强调玄府是气液运行、神机往来之门户。文章从“主客交–玄府”角度出发,将糖尿病肾病的病机演变过程分为三个阶段:肾气亏虚,主气匮乏,玄府开阖失常,为疾病之根本;痰浊、瘀血酿毒互结,客邪久羁不去,致使玄府壅塞不通,成疾病之标实;虚实相互影响,主客交缠,终致玄府郁闭失调,达病情恶化之变。该理论提出“分清主客、调玄”这一核心治则,分别以补肾摄精固玄、祛邪解毒通玄、分解主客开玄为具体治疗方法,以期为中医药防治糖尿病肾病提供新的思路。
With the continuous improvement of the diagnosis and treatment level for diabetes,the mortality rate of patients caused by acute complications has been effectively controlled,while the incidence rate of diabetic nephropathy has shown a significant upward trend.Diabetic nephropathy,as a common and severe microvascular complication of diabetes,has now become an important cause of end-stage renal disease.Based on clinical symptoms such as edema,reduced urine volume,and foamy urine,ancient and modern medical experts have classified diabetic nephropathy into categories such as“diabetes nephropathy”,“edema”,and“turbid urine”.Once this disease occurs,it progresses year by year and is irreversible.Moreover,there is a lack of specific treatment methods.Currently,the combined treatment of traditional Chinese and Western medicine is the main approach.The theory of“host and vip interaction”(主客交)was founded by WU Youxing,a medical expert in the late Ming Dynasty.It inherits and further develops the pathogenesis theory in Huangdi Neijing(《黄帝内经》)to explain the pathological process of chronic diseases that are difficult to treat due to the deficiency of vital energy in the body,the internal invasion of external pathogenic factors,and the interweaving and entanglement of vital energy and pathogenic factors,which leads to the obstruction of Qi(气)movement.The theory of“Xuanfu”(sweat pore)was first seen in Huangdi Neijing,and gradually matured during the Jin and Yuan Dynasties.The ancient medical expert LIU Wansu emphasized that Xuanfu was the gateways of the circulation of Qi and body fluid,and continuous life activities.In this paper,from the perspective of“host and vip interaction-Xuanfu”,the pathogenesis evolution process of diabetic nephropathy was divided into three stages as followed:Qi deficiency of kidney,lack of principal Qi,and abnormal opening and closing of Xuanfu,which is the root cause of the disease;the intermingling of phlegm turbidity and blood stasis with toxins leads to the long-term persistence of external pathogenic factors,causing Xuanfu to be unobstructed,which is the excessive superficiality of the disease;the interplay of deficiency and hyperactivity,and the entanglement of principal Qi and external pathogenic factors,which eventually lead to the blockage and imbalance of Xuanfu,resulting in a deterioration of the condition.This theory puts forward the core therapeutic principle of“distinguishing principal Qi and external pathogenic factors,and regulating Xuanfu”,and respectively takes tonifying the kidney to regulate essence and consolidate Xuanfu,expelling pathogenic factors to detoxify and dredge Xuanfu,and separating principal Qi from external pathogenic factors to open Xuanfu as specific treatment methods,with the aim of providing new ideas for the prevention and treatment of diabetic nephropathy in traditional Chinese medicine.
出处
《中医临床研究》
2025年第27期51-56,共6页
Clinical Journal Of Chinese Medicine
基金
湖南省自然科学基金项目(2024JJ9421)
湖南中医药大学研究生创新课题(2024CX107)。
关键词
糖尿病肾病
玄府
主客交
Diabetic nephropathy
Xuanfu
Host and vip interaction
