焦茂中医治疗糖尿病肾病的经验.docVIP

焦茂中医治疗糖尿病肾病的经验 　　DOI：10.16658/j.cnki.1672-4062.2017.12.197 　　[摘要] 糖尿病肾病是临床常见肾脏病，多进展较快，预后不良，以致终末期肾功能衰竭而接受肾脏替代治疗。焦茂主任医师临床经验丰富，认为糖尿病肾病病机以脾肾亏虚、瘀血阻络为主.又水为阴邪，得阳始化，治疗上则以健脾温肾，活血利水为原则，同时需注意守法守方，忌大裁大变，强调中西合用、医患配合，临床疗效良好。 　　[关键词] 糖尿病肾病；脾肾亏虚；瘀血阻络；名医经验 　　[中图分类号] R587.2 [文献标识码] A [文章编号] 1672-4062（2017）06（b）-0197-02 　　Experience of Jiaomao Traditional Chinese Medicine in Treatment of Diabetic Nephropathy 　　LIU Ying1， JIAO Mao2 　　1.Tianjin University of Traditional Chinese Medicine， Tianjin， 300193 China；2.Tianjin First Hospital， Tianjin， 300457 China 　　[Abstract] Diabetic nephropathy is a clinical common renal disease with rapid progress and bad prognosis thus causing the renal function failure during the terminal stage. The clinical experience of jiaomao chief physician is rich， who thinks that the mechanism of diabetic nephropathy was mainly spleen-kidney deficiency and obstruction of collaterals by blood stasis， namely water being a kind of yin pathogen， initiation under the effect of yang， and the treatment principle is invigorating spleen， warming kidney， activating blood circulation and promoting dieresis， meanwhile， we should pay attention to knowing the laws and abiding by them and prohibit the huge changes， and we should also attach importance to the combination of traditional Chinese medicine and western medicine and cooperation between the patients and doctors， and the clinical curative effect is good. 　　[Key words] Diabetic nephropathy； Invigorating spleen and warming kidney； Activating blood circulation and promoting dieresis； Experience of famous doctors 　　糖尿病?I病（简称DN）是临床上常见的糖尿病并发症，会通过肾功能衰竭导致进行肾脏移植治疗的重要原因之一。DN起病缓慢，早期不易察觉，缺少特异性症状，查肾功能并无明显异常，但是一旦进展成临床DN，肾功能则进一步恶化，最终导致肾功能衰竭。其主要病理变化是肾小球病变，包括肾小球硬化、肾小球炎症，临床特征为蛋白尿阳性、渐进性肾功能损害、明显水肿、高血压，晚期会进展成肾功能衰退[1]。焦茂主任医师是原天津市第四中心医院中医科主任，至今服务临床工作50余年，对糖尿病肾病治疗有独到见解，笔者跟随焦茂主任侍诊期间，获益匪浅，现试将焦师治疗糖尿病肾病的经验总结如下： 　　1 辨证为先，重视脾肾 　　DN属于中医“消渴―下消”范围，后期发展到肾衰竭，患者出现水肿、贫血、少尿等症，则归属于“虚劳”“水肿”等范畴，DN是糖尿病的变证，现代中医称为“消渴肾病”[2]。正如《圣济总录》曰：“消渴日久，肾气受伤，肾主水，肾气虚衰