六味地黄汤联合西药治疗早期糖尿病肾病举隅  

Samples of Liu-wei Di-huang Decoction combined with Western Medicine Treatment of Early Diabetic Nephropathy

作　　者：李晓霞[1] 刘素荣[2] 

机构地区：[1]山东中医药大学第一临床学院,济南250014 [2]山东中医药大学附属医院内分泌科,济南250014

出　　处：《实用中医内科杂志》2016年第3期81-83,共3页Journal of Practical Traditional Chinese Internal Medicine

摘　　要：六味地黄汤加减治疗早期糖尿病肾病,连续治疗56d,未有不适,血糖可控。女,75岁,糖尿病19年,伴腰痛2年,空腹血糖6.15mmol/L,腰痛加重1月余;拜糖平50mg TID、睡前皮下注射长秀霖12U,控制血糖;乏力,口干口苦,双目干涩、视物模糊,迎风流泪,右眼睑下垂,右侧面部麻木不适,腰部隐痛,呈阵发性,疼痛可忍,偶有头晕头痛,耳鸣耳聋,无咳嗽咳痰,无心慌胸闷,平素怕热汗多,双下肢轻度凹陷性水肿,四肢无麻木,偶有抽筋,纳可,眠可,小便频数、色黄,尿中有泡沫,大便偏干,两三日一行,舌质暗红,苔少,脉沉细;尿微量白蛋白：41.30mg/L;尿常规：葡萄糖（＋＋＋）,尿蛋白（＋）;葡萄糖：15.2mmol/L;糖化血红蛋白：10.9%;肌酐：3457umol/L,符合早期糖尿病肾病诊断。治以滋补肝肾、活血通络,六味地黄汤加减,山药-炒15g,山萸肉20g,白术30g,茯苓30g,熟地黄15g,黄芪45g,麦冬30g,五味子9g,芡实-炒20g,决明子、枸杞各30g,苍术、薏苡仁各15g,川牛膝、续断各20g,泽泻、泽兰各15g,3剂,水煎服,早晚饭后温服。嘱糖尿病低盐、低脂、优质低蛋白饮食,并予前列地尔改善微循环,肾康注射液降逆泄浊、益气活血,葡萄糖酸钙注射液补充钙质,速尿利水消肿,口服拜糖平、睡前皮下注射长秀霖控制血糖。连续14d为1疗程,每疗程后根据临床表现及生化指标,辨证加减用药,连续治疗4疗程,症状基本消失,尿微量白蛋白：20.5mg/L;尿常规：葡萄糖（＋）,尿蛋白（-）。继7剂巩固治疗,避风寒,适度运动,糖尿病低盐、低脂、优质低蛋白饮食。2周后复查,未述特殊不适,血糖控制可。Under the treatment of Liu-wei Di-huang Decoction＇ addition and subtraction therapy for 56 days,blood glucose is controllable without discomfort.The female,75 years old,with diabetes for 19 years,lumbago for 2 years,FBG with 6.15mmol/L,and Lumbago is worse for more than a month;acarbose with 50 mg TID,hypodermic injection with 12 U Basalin at bedtime to control blood glucose;fatigue,dry mouth,mouth pain,dry eyes,blurred vision,tearing against wind,right eyelid drooping,right facial numbness,the waist pain with paroxysmal attacks that could be beared,occasional dizziness and headache,no cough and expectoration,no palpitate chest tightness,usually can＇t stand heat and has copious sweat,both lower extremities with mild pitting edema,no numbness of limbs,cramp occasionally,eusitia and good sleep,frequent micturition with yellow and foam,dry stool with usually once every two or three days,dark red tongue with scanty fur and thin pulse;urine microalbumin：41.30mg/L;urine routines：glucose（＋＋＋）,urinary protein（＋）;glucose：15.2mmol/L;glycated hemoglo bin：10.9%;creatinine：3457umol/L,are corresponding to the diagnosis of early diabetic nephropathy.We receive treatment with three Liu-wei Di-huang Decoction＇ addition and subtraction that can nourish liver and kidney and promot blood circulation to remove meridian obstruction,which contained 15 g of cyam,20 g of cornus,30 g of Atractylodes,30 g of Poria,15 g of Rehmannia,45 g of Astragalus,30 g of Radix,9g of Schisandra,20 g of stir-frying Gorgon,30 g each Cassia and medlar,15 g each herb and Coix,20 g each Cyathula and dipsacus asperoids,15 g each Alisma and Zeeland by decoction,morning and evening hours service after meals.Ask the diabetic patients to low salt,low fat,low protein diet quality,and treated with alprostadil in improving microcirculation,Shenkang Injection descending inverse discharge,supplementing qi and activating blood circulation,calcium gluconate injection in calcium supplement,furosemide diuresis detumescence,oral worship Tang

关 键 词：期糖尿病肾病 水肿 虚劳 六味地黄汤 三补三泻 滋补肝肾 活血通络 中西医结合治疗 

分 类 号：R587.2[医药卫生—内分泌]