桂定坤运用益气滋阴活血法治疗糖尿病肾病的经验  

GUI Dingkun’s experience in treating diabetic kidney disease by the therapy of tonifying Qi,nourshing Yin and activating blood

作　　者：林康鸿 桂定坤[2] LIN Kanghong

机构地区：[1]江西中医药大学研究生院,江西南昌330004 [2]上海交通大学医学院附属第六人民医院,上海200233

出　　处：《中医临床研究》2024年第10期129-134,共6页Clinical Journal Of Chinese Medicine

基　　金：国家重点研发计划项目(2019YFE0110500)。

摘　　要：糖尿病肾病是导致终末期肾病的原因之一,是以蛋白尿和肾小球滤过率进行性下降为主要临床表现的慢性疾病。中医学认为糖尿病肾病属“消渴”“水肿”“尿浊”“关格”等证。该病病程长,本虚标实为其主要特点,但以正气亏虚为本,湿、浊、瘀、毒等实浊晦邪为标,气阴两虚夹瘀血贯穿疾病始终。文章介绍桂定坤主任医师运用益气活血滋阴法治疗糖尿病肾病经验。桂老师认为,脾肾之气相互化生、相互滋养,脾失健运则肾精不藏,下元不固,治疗应着重补脾肾之气、滋肝肾之阴,重用黄芪、黄精等益气滋阴药健脾益肾、滋阴固精,补一身之气,使正气存内,邪不可干。糖尿病肾病久病瘀浊实邪阻滞经络,阻碍脏腑气机,则应在辨证基础上加强活血化瘀法的运用,如予三七等以通肾络之瘀血。临床治疗时灵活遣方用药,在益气滋阴活血法的基础上,针对疾病各期症状不同,如出现肌酐升高、蛋白尿、水肿等症时,运用中医辨证论治的方法标本兼顾的同时又有所侧重。临床中运用上述方法能减轻患者症状,降低蛋白尿,延缓糖尿病肾病患者肾功能衰竭进展,改善患者生活质量。现附病案二则,以验证益气滋阴活血法治疗糖尿病肾病的临床疗效。Diabetic nephropathy,one of the causes of end-stage renal disease,is a chronic disease characterized by progressive decline in proteinuria and glomerular filtration rate.TCM believes that diabetic nephropathy is a syndrome of Xiaoke(消渴),edema,turbid urine and Guan’ge(关格).The course of the disease is long,and the main characteristics of this disease are root deficiency and excessive superficiality,but the main responsibility is based on the deficiency of healthy Qi(气),and the solid turbidity and obscurity such as dampness,turbidity,stasis,and poison are the external symptoms,and it is emphasized that the deficiency of Qi and Yin(阴)and blood stasis run through the whole disease.This article introduces Chief Physician GUI Dingkun’s experience in the treatment of diabetic nephropathy by the therapy of tonifying Qi,nourshing Yin and achivating blood.Teacher GUI believes that the Qi of spleen and kidney are mutually regenerated and nourished by each other,and if the spleen is not healthy,the kidney essence is not hidden,and instability of kidney-Qi.In terms of the treatment of this disease,it is emphasized to invigorate Qi of spleen and kidney,and nourish Yin of liver and kidney.Huangqi(Radix Astragali),Huangjing(Rhizoma Polygonati)and other nourishing Qi and Yin medicines should be used emphatically to strengthen the spleen and kidneys,nourish Yin and solidify essence,so that the healthy Qi is stored in the body,pathogenic Qi have on way to invade the body.Due to long-term of diabetic kidney disease,stasis and solid evil block the meridians,and hinder the Qi of the viscera,we should strengthen the application of the therapy of activating blood to resolve stasis on the basis of syndrome differentiation,and Sanqi(Radix Notoginseng)and so on can be used to remove blood stasis of the kidney and meridians.In clinical treatment,on the basis of the therapy of tonifying Qi,nourshing Yin and achivating blood,according to the different symptoms of each stage of the disease,such as increased creatinine,proteinuri

关 键 词：糖尿病肾病 益气活血滋阴法 治疗经验 

分 类 号：R256.5[医药卫生—中医内科学]