基于“糖毒”探讨糖尿病肾脏疾病“内热致癥”病机及其辨治思路  

Exploring the pathogenesis of"internal heat leading to zheng"in diabetic kidney disease from the perspective of"glucose toxicity"and its differential diagnosis and treatment

作　　者：胡聿昕 曹博宁 王琳[1,3] 高子衡[1,2] 林茂炫 薛泽宇 刘伟敬 王耀献[1,3,4] HU Yuxin;CAO Boning;WANG Lin;GAO Ziheng;LIN Maoxuan;XUE Zeyu;LIU Weijing;WANG Yaoxian(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Beijing University of Chinese Medicine,Beijing 100029,China;Renal Research Institution of Beijing University of Chinese Medicine,Beijing 100029,China;Henan University of Chinese Medicine,Zhengzhou 450046,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 [3]北京中医药大学肾病研究所 [4]河南中医药大学

出　　处：《北京中医药大学学报》2025年第3期386-391,共6页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金区域创新发展联合基金重点支持项目(No.U22A203373);中医药传承与创新“百千万”人才工程(岐黄工程)岐黄学者项目(国中医药人教发〔2018〕12号);国家中医药管理局高水平中医药重点学科建设项目北京中医药大学中医肾病学(No.zyyzdxk-2023260);北京市自然科学基金项目(No.7244487)。

摘　　要：糖尿病肾脏疾病(DKD)是糖尿病最常见的微血管并发症。“内热致癥”是DKD的核心病机,而“糖毒”由精微物质经“内热”作用与多种病理产物胶结后形成,是糖尿病向DKD转化的关键。“糖毒”具有热深而广、合邪致病、胶结难消的特点,可对肾络产生严重损害。“糖毒”初起为阳邪,伴随病情进展至后期可转化为阴邪。临证时,应分期论治,把握“内热致癥”病机,识别“糖毒”性质。糖尿病期,以清热为法,常以越鞠丸、大柴胡汤出入;DKD早期,以清透伏热为主,防止毒热由气入血,清热重透、解毒重清,常用自拟清热消癥方加减;DKD中晚期,注重清热消癥、扶正泄浊,常用自拟泄浊消癥方、金匮肾气丸、真武汤进退。Diabetic kidney disease(DKD)is a common microvascular complication of diabetes."Internal heat leading to zheng"is the core pathogenesis of DKD,while"glucose toxicity"is transformed from subtle substances through"internal heat"and the cementation of various pathological products,which is pivotal to the transformation of diabetes to DKD."Glucose toxicity"is characterized by deep and widespread heat,caused by various pathological factors,and its sticky nature makes it difficult to resolve,which can cause severe damage to the kidney collaterals.In the early stage of"glucose toxicity",it is yang pathogen,which can be transformed into yin pathogen in the later stage with disease progression.In clinical practice,treatment should be based on disease staging,with attention on grasping the pathogenesis of"internal heat leading to zheng"and identifying the nature of"glucose toxicity".During the diabetic period,clearing heat is the primary method,often using modified Yueju Pill and Dachaihu Decoction.In the early stage of DKD,treatment primarily focuses on clearing and penetrating latent heat to treat DKD,aiming to prevent toxic heat from transitioning from qi to blood.The approach emphasizes clearing heat and re-penetrating,detoxification,and re-clearing,often using a self-made modified Qingre Xiaozheng Decoction.In the middle and late stages of DKD,the focus shifts to clearing heat,eliminating zheng,strengthening vital qi,and dispelling turbidity,with commonly used treatments including the self-made modified Xiezhuo Xiaozheng Formula,Jingui Shenqi Pill,and Zhenwu Decoction.

关 键 词：糖尿病肾脏疾病 糖尿病 糖毒 内热 内热致癥 

分 类 号：R259[医药卫生—中西医结合]