桃核承气汤辨治糖尿病肾病的机制初探  

A Preliminary Study on the Mechanism of Taohe Chengqi Decoction in the Treatment of Diabetic Nephropathy

作　　者：李卓 周津竹 刘莹 樊姿君 于瑶 徐宁[1] 刘小溪[2] LI Zhuo;ZHOU Jinzhu;LIU Ying;FAN Zijun;YU Yao;XU Ning;LIU Xiaoxi(Liaoning University of Traditional Chinese Medicine,Liaoning Shenyang 110847,China;The Hospital Affiliated of Liaoning University of Traditional Chinese Medicine,Liaoning Shenyang 110032,China)

机构地区：[1]辽宁中医药大学,辽宁沈阳110847 [2]辽宁中医药大学附属医院,辽宁沈阳110032

出　　处：《中医药临床杂志》2025年第2期214-218,共5页Clinical Journal of Traditional Chinese Medicine

摘　　要：糖尿病肾病(diabetic kidney disease,DKD)属于中医“消渴肾病”范畴,是糖尿病常见的慢性微血管并发症之一,早期发病隐蔽,不易察觉,临床表现为大量蛋白尿,或肾病综合征,后期进展为慢性肾衰竭,甚至危及生命。中医治疗DKD疗效甚佳,叶天士言:“三消之症,虽有上中下之分,其实不越阴亏阳亢,津涸热淫而已”,燥热偏盛,灼烧阴血津液,以致津亏血少,血液运行不畅,瘀血内生,瘀热互结为病,形成新的病理因素,瘀与热互为因果,热附于血上令疾病缠绵难愈,是临床DKD治疗的关键。而桃核承气汤具有活血化瘀,通腑泻热之功效,活血药配伍泻下药能更好的解除瘀热互结的状态,与DKD病机相应。近年来,多项研究表明桃核承气汤在治疗肾病方面疗效显著,方中桃仁活血化瘀,祛瘀除邪而生新;桂枝通阳化气,与桃仁同用行气活血,经腑同调,同为通经破血之品;大黄与芒硝泻下除热,逐瘀通经,为下瘀而泻湿之品;甘草培补后天之本,为保其中气之药,五药共施,应用于肾病的治疗。现代药理学研究亦表明该方可以降低血脂血糖,减轻肾微炎症状态,延缓糖尿病器官微血管病变,临床应用桃核承气汤治疗DKD时需根据患者不同的临床表现及证型进行灵活加减应用。Diabetic kidney disease(DKD)belongs to the category of“Xiao Ke Nephropathy”in traditional Chinese medicine.It is one of the common chronic micro-vascular complications of diabetes.The early onset is hidden and difficult to detect.The clinical manifestations are massive proteinuria or nephrotic syndrome.In the later stage,it progresses to chronic renal failure and even endangers life.Traditional Chinese medicine has a very good effect in treating DKD.Ye Tianshi said:“Although the three symptoms of Xiao Ke are divided into upper,middle and lower,they are actually nothing more than Yin deficiency and Yang hyperactivity,fluid dryness and heat.”The excessive dryness and heat burn the Yin blood and body fluid,resulting in fluid deficiency and blood deficiency,poor blood circulation,endogenous blood stasis,and the combination of blood stasis and heat,forming a new pathological factor.Stasis and heat are mutually causal.Heat attached to the blood makes the disease lingering and difficult to cure.It is the key to the clinical treatment of DKD.Taohe Chengqi Decoction has the effects of promoting blood circulation and removing blood stasis,clearing the bowels and purging heat.The combination of blood-activating drugs and purging drugs can better relieve the state of blood stasis and heat,which corresponds to the pathogenesis of DKD.In recent years,many studies have shown that Taohe Chengqi Decoction has significant efficacy in the treatment of kidney disease.The peach kernel in the prescription promotes blood circulation and dissipates blood stasis,removes blood stasis and eliminates evil to generate new blood;cinnamon twig promotes yang and transforms qi,and is used together with peach kernel to promote Qi and blood circulation,regulate the meridians and viscera,and is a product for promoting menstruation and removing blood;rhubarb and mirabilite purge heat,remove blood stasis and promote menstruation,and are products for removing blood stasis and removing dampness;licorice nourishes the acquired foundation and is

关 键 词：桃核承气汤 糖尿病肾脏病 消渴 瘀热互结 

分 类 号：R255.4[医药卫生—中医内科学]