| 引用本文: |
戴振烽, 陈伟杰, 黄寅銮, 庞琳蓉, 尚智涛, 韩雨欣, 杨辰华.基于“玄府-气液-络脉”理论的糖尿病肾病分期辨治体系构建[J].湖南中医药大学学报,2026,46(5):1036-1045[点击复制] |
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| 基于“玄府-气液-络脉”理论的糖尿病肾病分期辨治体系构建 |
| 戴振烽,陈伟杰,黄寅銮,庞琳蓉,尚智涛,韩雨欣,杨辰华 |
| (广州中医药大学研究生院, 广东 广州 510000;深圳市宝安纯中医治疗医院内科, 广东 深圳 518000;深圳市宝安区中医院糖尿病科, 广东 深圳 518000;广州中医药大学第七临床医学院, 广东 深圳 518000;香港中文大学(深圳)医院中医科, 广东 深圳 518000) |
| 摘要: |
| 糖尿病肾病（DKD）是糖尿病最常见的微血管并发症之一，临床治疗难度大、预后差。中医辨治虽在改善症状、延缓进展方面具有一定优势，然其病机阐释多侧重于该病某一环节或证型，对糖尿病肾病全病程动态演变规律及分期辨治框架的系统论述仍显不足。本文运用中医取象比类思维，通过系统梳理“玄府-气液-络脉”理论内涵，并借鉴现代医学对DKD病理生理演变的认识，提出“气液失宣为因，肾虚为本，玄络失常为枢，湿痰瘀毒为标”的核心病机，进而阐释其从早期“肾虚渐著、气液壅滞、玄络同病”，到中期“阴阳两虚、痰瘀浊痼、玄损络伤”，至末期“肾元衰败、浊毒泛滥、玄废络坏、五脏皆病”的动态演变规律。在此基础上，确立以“培补肾元，调玄治络，燮理气液”为核心的分期治疗策略：早期以益肾固摄、培补气液、调玄畅络为主；中期重在阴阳并补、化痰祛瘀、畅玄通络；晚期以扶正固本、化浊解毒、多脏同治为要。本文旨在构建一个融贯中医病机理论与现代疾病分期、兼具病证结合与分期论治特点的DKD辨治体系，为其中医诊治提供新的理论依据与实践路径。 |
| 关键词: 糖尿病肾病|玄府理论|络脉|气液代谢|分期论治 |
| DOI：10.3969/j.issn.1674-070X.2026.05.024 |
| 投稿时间：2026-01-14 |
| 基金项目:广东省中医药管理局科研项目（20261341）；深圳市科技计划项目（JCYJ20230807113700001）；深圳市自然科学基金计划项目（JCYJ20250604183322030）；宝安区中医药临床专项（2023ZYYLCZX-32）。 |
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| Construction of a stage-based pattern differentiation and treatment system for diabetic kidney disease based on the "mysterious mansion, qi-fluid, and collaterals" theory |
| DAI Zhenfeng, CHEN Weijie, HUANG Yinluan, PANG Linrong, SHANG Zhitao, HAN Yuxin, YANG Chenhua |
| (Graduate school, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510000, China;Department of Internal Medicine, Shenzhen Bao'an Authentic TCM Therapy Hospital, Shenzhen, Guangdong 518000, China;Department of Diabetes, Shenzhen Bao'an Traditional Chinese Medicine Hospital Group, Shenzhen, Guangdong 518000, China;The Seventh Clinical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518000, China;Department of Traditional Chinese Medicine, The Chinese University of Hong Kong, Shenzhen Medical Centre, Shenzhen, Guangdong 518000, China) |
| Abstract: |
| Diabetic kidney disease (DKD) is one of the most common microvascular complications of diabetes, characterized by difficult clinical management and poor prognosis. Although TCM pattern differentiation and treatment have certain advantages in alleviating symptoms and delaying disease progression, current pathogenetic interpretations mostly focus on a specific aspect or pattern of the disease. A systematic elaboration of the dynamic evolution pattern throughout the entire course of DKD and a stage-based pattern differentiation and treatment framework remain insufficient. This article employs the TCM methodology of analogical thinking. By systematically reviewing the theoretical connotations of the "mysterious mansion (a collective term for the minute pathways for dispersion and flowing of qi and fluid), qi-fluid, and collaterals" and drawing on the modern medical understanding of DKD pathophysiological evolution, it proposes the core pathogenesis as follows: "dysfunction of qi-fluid distribution as the cause, kidney deficiency as the root, dysfunction of the mysterious mansion and collaterals as the pivot, and dampness, phlegm, stasis, and toxin as the manifestations." Accordingly, it elucidates the dynamic evolution pattern from the early stage (progressive kidney deficiency, qi-fluid stagnation, concurrent disorder of mysterious mansion and collaterals), through the middle stage (dual deficiency of yin and yang, entrenched phlegm, stasis, and turbidity, damage to mysterious mansion and collaterals), to the end stage (decline of kidney primordial qi, diffusion of turbid toxin, collapse of mysterious mansion and collaterals, and involvement of all five viscera). On this basis, a stage-based treatment strategy centered on "nourishing and replenishing kidney primordial qi, regulating the mysterious mansion and treating the collaterals, and harmonizing qi and fluid" is established. In the early stage, the focus is on tonifying the kidney to facilitate its astringent function, supplementing qi and fluid, and regulating the mysterious mansion and smoothing the collaterals. In the middle stage, the emphasis is on tonifying both yin and yang, resolving phlegm and eliminating stasis, and unblocking the mysterious mansion and collaterals. In the end stage, the priority is on reinforcing healthy qi to strengthen the body, transforming turbidity and resolving toxin, and treating multiple viscera simultaneously. This article aims to construct a DKD pattern differentiation and treatment system that integrates TCM pathogenesis theory with modern disease staging, combining pattern differentiation with disease identification and featuring stage-based treatment, thereby providing a new theoretical basis and practical approach for the TCM diagnosis and treatment of DKD. |
| Key words: diabetic kidney disease|mysterious mansion theory|collaterals|qi-fluid metabolism|stage-based treatment |
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