基于“血不利则为水”探讨糖尿病肾病肾间质纤维化的病机及治疗  

Exploring the pathogenesis and treatment of diabetic nephropathy renal interstitial fibrosis based on"unsmooth blood circulation leading to water retention"theory

作　　者：田曼 左新河 李扬 祁正亮 TIAN Man;ZUO Xinhe;LI Yang;QI Zhengliang(Hubei Hospital of Traditional Chinese Medicine,Affiliated Hospital of Hubei University of Chinese Medicine,Hubei Academy of Traditional Chinese Medicine,Wuhan,Hubei 430074,China)

机构地区：[1]湖北省中医院/湖北中医药大学附属医院/湖北省中医药研究院,湖北武汉430074

出　　处：《湖南中医药大学学报》2025年第2期325-330,共6页Journal of Hunan University of Chinese Medicine

基　　金：湖北省自然科学基金项目(2023AFD175)。

摘　　要：糖尿病肾病肾间质纤维化(DN-RIF)是一种微血管病变。中医学将其归属于“消渴”“水肿”等范畴。“血不利则为水”理论是指血液流动受阻或流动不畅,导致津液输布代谢失常,从而形成水湿。DN-RIF出现的内皮细胞受损、细胞外基质沉积、血液高凝状态和血栓的形成等病理状态和水肿、蛋白尿等症状与中医学瘀血和水饮的表现相似,表明“血不利则为水”与DN-RIF的病理机制之间的相关性。因此,基于“血不利则为水”理论,结合西医对其发病的基本认识,认为脾肾功能失调、瘀水互结、肾络瘀损为DN-RIF发生发展的关键病机。脾肾两虚所导致的瘀血、痰湿、水饮等病理产物是该疾病加重的重要病理因素,瘀血和水饮之间可互相影响,互为因果,形成“由瘀致水,因水致瘀”的恶性循环。肾络瘀损是糖尿病肾病向肾间质纤维化进展中不可缺少的病理环节,并贯穿整个疾病始终。治疗上提出治病求本、活血利水,辅以通络消癥、直达病所,以期为DN-RIF的中医药认识及治疗拓展新的思路。附医案一则加以阐明。Diabetic nephropathy renal interstitial fibrosis(DN-RIF)is a microvascular complication.In Chinese medicine(CM),it is categorized under the scope of"wasting and thirst disorders"and"edema disorders".The theory of"unsmooth blood circulation leading to water retention"refers to the obstruction or sluggishness of blood flow,which disrupts the normal distribution and metabolism of body fluids,ultimately resulting in pathological fluid retention.The pathological states observed in DN-RIF,including endothelial cell damage,extracellular matrix deposition,hypercoagulable state of blood,and thrombosis,along with clinical manifestations like edema and proteinuria,are similar to the manifestations of blood stasis and water-fluid retention in CM.This similarity indicates the correlation between the theory of"unsmooth blood circulation leading to water retention"and the pathogenesis of DN-RIF.Therefore,based on this theory and integrating the modern medical understanding of its pathogenesis,it is believed that the dysfunction of the spleen and kidney,the interplay between blood stasis and water-fluid retention,and the renal collateral damage are the key pathogenesis driving the onset and progression of DN-RIF.The pathological byproducts resulting from spleen-kidney deficiency,such as blood stasis,phlegm dampness,and water-fluid retention,are important factors contributing to disease aggravation.Blood stasis and water-fluid retention can interact with each other,forming a vicious cycle of"stasis leading to water-fluid retention and water-fluid retention causing stasis".Renal collateral damage due to blood stasis is an indispensable pathological link in the progression of diabetic nephropathy to renal interstitial fibrosis and runs through the entire disease process.In terms of treatment,it is proposed to focus on treating the root cause by strengthening the spleen and kidney and activating blood circulation to eliminate fluid retention.Additionally,it is suggested to use methods to unblock the meridians and eliminate masses to

关 键 词：血不利则为水 糖尿病肾病 肾间质纤维化 瘀血 水饮 

分 类 号：R255.4[医药卫生—中医内科学]