李留霞分型论治糖尿病肾病经验  

Li Liuxia′s Experience in Syndrome Differentiation and Treatment of Diabetic Kidney Disease

作　　者：李明 马媛媛 LI Ming;MA Yuanyuan(Shang Qiu City Hospital of Traditional Chinese Medicine,Shangqiu,Henan,China,476100)

机构地区：[1]商丘市中医院,河南商丘476100

出　　处：《河南中医》2025年第5期694-699,共6页Henan Traditional Chinese Medicine

基　　金：河南省第三批中医药青苗人才培养项目{豫卫中医药科教〔2024〕4号}。

摘　　要：李留霞主任医师认为糖尿病肾病的发病,一方面,责之于先天禀赋,禀赋不足,肾气亏虚,酿成肾消;另一方面,饮食因素在本病的发生有重要的推动作用。阴虚燥热为其基本病机,病位责之于肾。李留霞主任医师认为,临床上应该动态把握糖尿病肾病病机,糖尿病肾病病机复杂,虚实夹杂、寒热错杂、本虚标实,本虚以肾阴虚、脾肾气虚、脾肾阳虚为主,邪热、湿、浊、瘀等为病理产物,将糖尿病肾病分为肾阴亏虚兼浊热证、脾肾气虚兼浊湿证、脾肾阳虚兼浊瘀证三个证型治疗,方用知柏地黄汤合升降散加减、脾肾双调汤加减、真武汤合桂枝茯苓丸加减。李留霞主任医师治疗糖尿病肾病时,不仅给予患者汤药,而且会配合中药直肠滴入以增加疗效,此外,补泻兼施,标本兼顾,重视浊邪理论,总结出治浊五法,坚持中西医结合治疗,以提高治疗疗效。Chief physician Li Liuxia thinks that the pathogenesis of diabetic kidney disease(DKD)stems from two primary factors.On one hand,it arises from congenital defect and deficiency of kidney qi,leading to kidney consumption;on the other hand,dietary habits play a significant role in its development.The fundamental pathogenesis involves yin deficiency and dry heat,with the disease rooted in the kidney.Li emphasizes that in clinical practice,it is necessary to dynamically understand the complex pathogenesis of DKD,which intertwines deficiency and excess,cold and heat,and combines root deficiency with superficial manifestations.Root deficiency is primarily characterized by kidney yin deficiency,spleen-kidney qi deficiency,or spleen-kidney yang deficiency,with pathological factors such as pathogenic heat,dampness,turbidity,and blood stasis.Li classifies DKD into three syndromes for treatment:For kidney yin deficiency with turbid-heat syndrome,Modified Anemarrhena and Phellodendron and Rehmannia Decoction combined with Ascending and Descending Power can be used.For spleen-kidney qi deficiency with turbid-dampness syndrome,Modified Spleen-Kidney Harmonizing Decoction can be used.For spleen-kidney yang deficiency with turbid-stasis syndrome,Modified True Warrior Decoction combined with Cinnamon Twig and Poria Pill can be used.Beyond decoctions,Li enhances efficacy by incorporating Chinese medicinal rectal drips.Her approach integrates tonification and purgation,addresses both root and branch,emphasizes the theory of turbidity pathogen,and has summarized five methods for treating turbidity.She advocates combining traditional Chinese and Western medicine to optimize therapeutic efficacies.

关 键 词：糖尿病肾病 分型论治 肾阴亏虚兼浊热证 脾肾气虚兼浊湿证 脾肾阳虚兼浊瘀证 扶正治浊法 升清降浊法 芳香化浊法 淡渗利浊法 辛开苦降法 李留霞 

分 类 号：R259.872[医药卫生—中西医结合]