王耀献基于"内热致癥"从脾胃论治糖尿病肾脏疾病经验OA

This paper summarizes Professor WANG Yaoxian's experience in treating diabetic kidney disease(DKD)from the perspective of spleen and stomach based on the"internal heat leading to concretions"theory.It is considered that internal heat leading to concretions constitutes the core pathogenesis of DKD,with the spleen and stomach serving as the source of internal heat;therefore,treatment should be based on regulating the spleen and stomach.In the early stage of DKD,dysfunction of the spleen and stomach leads to the initial generation of internal heat.Common syndrome patterns include gastrointestinal heat accumulation and constrained heat in the liver and stomach,for which modified Gegen Qinlian Decoction(葛根芩连汤)can be used to clear heat bind while modified Dachaihu Decoction(大柴胡汤)is used to clear stomach and soothe liver,respectively.In the middle stage of DKD,weakness of the spleen and stomach results in the initial formation of concretions and conglomerations.Common pat-terns include spleen deficiency with prevalence of dampness and deficiency of both the spleen and kidney.Treatment emphasizes strengthening the spleen and resolving dampness,raising yang and boosting the stomach with modified Shengyang Yiwei Decoction(升阳益胃汤),or supplementing spleen and boosting kidney,dissipating bind and dispe-ring concretions with modified Shenqi Dihuang Decoction(参芪地黄汤),respectively.In the late stage of DKD,it is characterized by spleen and stomach depletion,and rampant accumulation of turbidity and toxin,and the common syndrome patterns are damp-turbidity obstruction in the middle jiao(焦)and spleen-kidney yang deficiency.Treatment aims to remove turbidity and harmonize the stomach,or to warm the kidney and strengthen the spleen while elimina-ting turbidity,using modified Dahuang Gancao Decoction(大黄甘草汤)and Jupi Zhuru Decoction(橘皮竹茹汤)or modified Baoyuan Decoction(保元汤)and Lizhong Decoction(理中汤),respectively.In clinical practice,appropriate formulas and medications are flexibly selected according to specific syndromes.