基于“苦欲补泻”理论论治糖尿病肾脏病  

Treating diabetic kidney disease based on"using bitter herbs to nourish or purge"theory

作　　者：姜伟民 王耀献[1,2] 魏蜀吴 张佳乐 侠晨辉 杨杰[1] 孙立巧 李鑫荣 孙卫卫[1] JIANG Weimin;WANG Yaoxian;WEI Shuwu;ZHANG Jiale;XIA Chenhui;YANG Jie;SUN Liqiao;LI Xinrong;SUN Weiwei(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Henan University of Chinese Medicine,Zhengzhou 450046,China;Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]河南中医药大学 [3]中国中医科学院广安门医院 [4]沧州市中心医院

出　　处：《北京中医药大学学报》2025年第1期1-7,共7页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(No.82174356);北京中医药大学“岐黄英才·名医培育计划”(No.Y2023B08)。

摘　　要：基于五脏的生理特点及功能,并结合药物的性味,《黄帝内经》提出“苦欲补泻”理论,以指导临床遣药组方。本文基于“苦欲补泻”理论探讨糖尿病肾脏病的病机及治疗方法,认为肾燥是糖尿病肾脏病的关键病理因素,肾燥不合是糖尿病肾脏病的重要病机,坚固肾用为其主要治则。本团队认为,肾燥贯穿糖尿病肾脏病发生、发展始终,其早期病机为热伤气阴,肾燥内生;中期病机为气虚络瘀,肾燥生浊;晚期病机为阴阳两虚,肾燥不合。本团队在治疗方面提出分期论治,遵循肾脏“欲坚”特性,合理运用辛味、苦味、咸味药物以滋润肾燥、坚固肾用,以期为中医临证诊疗提供新思路,并推动糖尿病肾脏病不同分期的精准辨证与个性化治疗,从而提升临床疗效。The Huangdi Neijing proposes the"using bitter herbs to nourish or purge"theory to guide clinical prescription and formulation of herbal remedies based on the physiological characteristics and functions of the five zang viscera,along with the properties and flavors of medicinal herbs.This study explored diabetic kidney disease pathogenesis and treatment based on the"using bitter herbs to nourish or purge"theory.Kidney dryness is a key pathological factor in diabetic kidney disease,and the disharmony of kidney dryness is an essential aspect of its pathogenesis.Strengthening is the primary therapeutic principle,and kidney dryness is a persistent factor throughout the occurrence and progression of diabetic kidney disease.In the early stage,the pathogenesis involves heat-consuming qi and injuring yin,leading to kidney dryness.In the middle stage,the pathogenesis manifests as qi deficiency and blood stasis in the collaterals,resulting in turbidity owing to kidney dryness.In the late stage,the pathogenesis involves yin and yang deficiency,with kidney dryness and disharmony.This study proposes the staging-based treatment based on the"need for firmness"characteristic of the kidney.The aim is to provide new insights for clinical diagnosis and treatment in traditional Chinese medicine by rationally using pungent,bitter,and salty medicinal herbs to nourish and moisturize the kidney.This approach seeks to promote precise syndrome differentiation and personalized treatment for different stages of diabetic kidney disease,thereby enhancing clinical efficacy.

关 键 词：苦欲补泄 肾燥 糖尿病肾脏病 分期论治 

分 类 号：R259.872[医药卫生—中西医结合]