糖尿病肾病从络病论治研究进展  

Treatment of Diabetic Nephropathy from Collateral Diseases:A Review

作　　者：陈慧楠 林敏[2] CHEN Hui-nan;LIN Min(Zhejiang Chinese Medical University,Hangzhou 310051,China;College of Traditional Chinese Medicine(TCM),Fujian University of TCM,Fuzhou 350122,China)

机构地区：[1]浙江中医药大学,杭州310051 [2]福建中医药大学中医学院,福州350122

出　　处：《中国实验方剂学杂志》2022年第8期265-271,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(82104713);福建中医药大学高层次人才科研启动基金项目(X20200007-人才)。

摘　　要：对近年来糖尿病肾病从络病论治的临床研究及基础研究进行综述、分析和讨论,发现目前中医对糖尿病肾病的络病治疗以补虚通络法为主要原则,基础研究显示其作用机制主要与改善氧化应激和内质网应激、减轻炎症反应、改善微循环障碍和血管内皮损伤及减轻肾脏损伤有关。中医络病理论可为糖尿病肾病的临床和基础研究提供更多思路,也在临床运用中显示出一定优势。但目前补虚通络法的临床运用以补虚药物与化瘀药物的联合使用为主,而血瘀证与络病虽有重叠但并非同一范畴,因此当前糖尿病肾病的络病辨治未能结合络脉自身病变与主要致病因素及继发病机变化进行更有针对性的分期辨治,未能充分重视辛味药、藤类药及虫类药等经典络药的对证使用。此外,糖尿病肾病治络方药的基础研究缺乏与临床症状与实验室指标的关联分析。据此,倡导中医络病理论指导下更具体系的糖尿病肾病研究,进一步探索糖尿病肾病的络病实质,强调络药和微观辨证在糖尿病肾病靶药筛选过程中的重要性,探索糖尿病肾病中络药发挥作用的可能机制,以期为进一步推动络病理论和治络方药在糖尿病肾病的临床运用提供依据。Diabetic nephropathy(DN)is classified into"collateral diseases"in traditional Chinese medicine(TCM).This study reviewed,analyzed,and discussed the clinical and basic research on DN treatment from collateral diseases in recent years.The main TCM therapeutic principles of DN from collateral diseases are dominated by reinforcing the deficiency and dredging collaterals.Fundamental research showed that the relevant mechanism is related to the improvement of oxidative stress and endoplasmic reticulum stress,reduction of inflammatory responses,coping with microcirculation disorder and vascular endothelial damage,and alleviation of renal injury.The theory of collateral diseases can provide ideas for clinical and basic research on DN and also shows advantages in clinical application.However,the present clinical application of this therapeutic principle is mainly based on the combination of deficiency-reinforcing drugs and blood stasis-resolving drugs.In spite of some overlap,blood stasis syndrome and collateral diseases are not in the same category.Therefore,the current diagnosis and treatment of DN from collateral diseases fail to combine with the changes of collateral vessels,main pathogenic factors,and the changes of the secondary pathogenesis.The application of classic collateral drugs such as pungent drugs,rattan drugs,and insect drugs has not been paid enough attention in syndrome differentiation and treatment.In addition,there is a lack of correlation with clinical symptoms and laboratory indexes in the basic research on the treatment of DN by Chinese medicinal prescriptions.Accordingly,the present study advocates systematic research on DN under the guidance of collateral diseases theory,clarifying the essence of DN in collateral diseases and emphasizing the importance of collateral drugs and microscopic syndrome differentiation in screening target drugs for DN to explore the underlying mechanism of collateral drugs in the treatment of DN,so as to provide evidence for the clinical application of collateral diseases

关 键 词：糖尿病肾病 络病 络药 理论 临床 进展 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学]