基于“血水同治”理论探析经方辨治糖尿病肾病的思路与应用  

Analysis of the thought and application of Zhang Zhongjing’s prescriptions in treating diabetic kidney disease based on the theory of"regulating blood stasis and water retention simultaneously"

作　　者：常瑞婷 陈玉鹏 张珊 王皓朔 倪青[2] CHANG Ruiting;CHEN Yupeng;ZHANG Shan;WANG Haoshuo;NI Qing(Beijing University of Chinese Medicine,Beijing 100029,China;Department of Endocrinology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]北京中医药大学,北京100029 [2]中国中医科学院广安门医院内分泌科,北京100053

出　　处：《吉林中医药》2025年第3期282-287,共6页Jilin Journal of Chinese Medicine

基　　金：国家自然科学基金青年科学基金项目(82405365);北京市自然科学基金青年项目(7244496);中国博士后科学基金第73批面上项目(2023M733912);中央高水平中医医院临床科研项目(HLCMHPP2023084)。

摘　　要：“血”与“水”都是构成人体和维持生命活动的基础物质,生理状态下两者同根同源,且互化共行脉中,病理状态下同病互害,其病理产物水湿痰饮、瘀血互相胶着凝结,加重病情。倪青教授紧扣糖尿病肾病微循环障碍的瘀血证特征和临床水肿、蛋白尿等典型临床征象,提出治疗糖尿病肾病核心治则为“血水同治”。倪青临床擅用仲景经方血水同调治疗糖尿病肾病,提出临床治疗糖尿病肾病分期-辨证-辨症结合探讨糖尿病肾病血水同病的病机机要,注重辨水病和血病轻重,辨治水与治血主次,即利水消肿与活血化瘀两者相辅相成,祛邪的同时兼顾正气虚补,切中病机,从而改善糖尿病微血管病变。"Blood"and"water"are both fundamental substances that constitute the human body and sustain vital activities.In a physiological state,they have the same root and origin,interconverting and circulating together within the vessels,while in a pathological state,they can mutually exacerbate one another's detrimental effects,with their pathological products,such as dampness,phlegm,fluid retention,as well as blood stasis,adhering and coagulating together,aggravating a disease.Professor Ni Qing,focusing on the characteristics of blood stasis syndrome in diabetic kidney disease(DKD)related to microcirculation disturbance,as well as typical clinical manifestations such as edema and proteinuria,proposes its core therapeutic principle of"regulating blood stasis and water retention simultaneously".He excels in employing classical prescriptions by Zhang Zhongjing that harmonize the treatment of both blood and water disorders in DKD.He advocates a comprehensive approach integrating staging,syndrome differentiation,and symptom differentiation to delve into the pathogenesis of both blood and water disorders in DKD,with an emphasis on differentiating the severity of water-related and blood-related pathologies.The prioritization of treating water disorders(i.e.,promoting diuresis and alleviating edema)and blood disorders(i.e.,promoting blood circulation and removing blood stasis)is complementary,addressing pathogenic factors while also nourishing vital qi,thereby improving diabetic microvascular complications.This article aims to briefly analyze Professor Ni Qing's clinical thinking,methodology,and medication characteristics in utilizing classical prescriptions to treat DKD,hoping to provide insights and references for the traditional Chinese medicine treatment of this disease.

关 键 词：血不利则为水 糖尿病肾病 仲景经方 辨证论治 血水同治 活血利水 

分 类 号：R587.2[医药卫生—内分泌]