糖尿病肾病中医病因病机探要

糖尿病肾病中医病因主要有六淫邪毒、先天禀赋、饮食失宜、情志失调、劳欲过度、药物误用;其总体病机为本虚标实、虚实夹杂,本虚指气阴两虚、五脏内虚,终末阴损及阳,阴阳两虚,涉及脏器主要有脾肝肾,其中尤以脾肾两脏亏虚为根本;标实多为燥热、瘀血、痰浊、水湿等。糖尿病肾病从糖尿病发病到终末肾功能衰竭的中医病机演变规律可总结为:阴虚-气阴两虚-偏阴虚者发为肝肾阴虚;偏气虚者发为脾肾气虚-脾肾阳虚-阴损及阳,阴阳两虚。由于DN病因病机复杂,标本虚实错杂,临床辨治本病应把握总体病机,确定病理因素,明确病因,辨证治疗,标本兼治。

Research Overview of the TCM Etiology and Pathogenesis of Diabetic Nephropathy

In recent years,TCM practitioners intensively study and explore diabetic nephropathy (DN) and this paper summarizes its etiology and pathogenesis.It indicates that the TCM etiology includes six pathogenic climatic factors,natural endowment,improper diet,emotional imbalance,overexertion and excessive sexual intercourse and misuse of drugs.The pathogenesis lies in deficiency root cause and excess manifestations and deficiency complicated with excess.Deficient root cause refers to deficiency of qi and yin,deficiency of the five zang-organs,yin impairment involving yang and leading to deficiency of both yin and yang;the organs involved include the spleen,liver and kidney,especially the deficiency lies in the spleen and kidney and the excess manifestations involve dry heat,blood stasis,phlegm,water damp,etc.The evolvement rule of the DN from the attack of DN to the final kidney failure can be summarized as:yin deficiency-deficiency of qi and yin-yin deficiency of the liver and kidney for patients with predominance of yin deficiency or qi deficiency of the liver and kidney for patients with predominance of qi deficiency -yang deficiency of the spleen and kidney-yin impairment involving yang and deficiency of both yin and yang.Due to the complicated etiology and pathogenesis of DN and mixed deficiency and excessive of the root cause and manifestations,the general pathogenesis,pathological factors,etiology should be identified in order to conduct syndrome differentiation and treatment and simultaneous treatment of the root cause and manifestations.