基于辨机论治探讨伏热在糖尿病肾脏疾病中的作用  

Discussion on the role of latent heat in diabetic kidney disease based on symptomatic treatment based on pathogenesis differentiation

作　　者：赵乐滢 王珍[1] 刘晴晴[1] 李丹婷 艾思南 陶嘉茵 王耀献[2] ZHAO Leying;WANG Zhen;LIU Qingqing;LI Danting;AI Sinan;TAO Jiayin;WANG Yaoxian(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医药大学

出　　处：《北京中医药大学学报》2024年第4期454-458,共5页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(No.82274460);国家中医药管理局中医药传承与创新“百千万”人才工程项目(国中医药人教发[2018]12号);北京中医药大学揭榜挂帅项目(No.2022-JYB-JBZR-038)。

摘　　要：糖尿病肾脏疾病是糖尿病的严重并发症之一,其发生率逐年上升,给公共卫生带来沉重负担。辨机论治以识别病机为思维主线,对于糖尿病肾脏疾病等复杂多变的慢性疾病具有较好的指导意义。伏热状态贯穿糖尿病肾脏疾病始终,作为核心病机,“伏热致癥”影响并促进了糖尿病肾脏疾病的发生、发展。本文围绕“伏热致癥”病机,以辨机论治为纲领,探讨了伏热在糖尿病肾脏疾病中的作用,指出糖尿病肾脏疾病的发生涉及“伏热蕴藏”的环境病机与体质病机,“郁热入络”是发病的初始病机,“伏热致癥”是核心病机,“次生浊热”是衍生病机。这些病机因素共同作用影响着糖尿病肾脏疾病的症状、转归与预后。本文针对不同病机特点,给出相应方药,旨在为糖尿病肾脏疾病的中医药治疗提供参考。Diabetic kidney disease(DKD)is a severe complication of diabetes.Its incidence increases annually,posing a significant burden on public health.The strategy of symptomatic treatment based on pathogenesis differentiation,focusing on identifying pathogenesis,is particularly meaningful for managing complex and variable chronic diseases like DKD.Within this framework,the state of latent heat persists throughout DKD,with"latent heat causing accumulation"identified as the core pathogenesis affecting and promoting the development and progression of DKD.This paper is centered on the concept of"latent heat causing accumulation"and adopts symptomatic treatment based on pathogenesis differentiation as its guiding principle to explore the role of latent heat in DKD.It highlights that the onset of DKD involves environmental and constitutional pathogenesis associated with"the concealment of latent heat"and"stagnant⁃heat invading collaterals"as the initial pathogenesis,"latent heat causing accumulation"as the core mechanism,and"secondary turbid heat"as the derivative pathogenesis.These pathogenesis factors collectively influence the symptoms,sequelae,and prognosis of DKD.Moreover,this paper provides commonly used prescriptions for different stages,syndrome types,and complications of the disease,aiming to offer a reference for clinical practice in flexibly addressing changes in disease conditions based on varied pathogenesis.

关 键 词：辨机论治 伏热致癥 糖尿病肾脏疾病 消渴肾病 

分 类 号：R259.872[医药卫生—中西医结合]