基于风毒探讨糖尿病肾脏病病机演变及治疗策略

Exploring the Pathogenesis Evolution and Therapeutic Strategies of Diabetic Kidney Disease from the Perspective of Wind-Toxin

  • 摘要: 糖尿病肾脏病(DKD)归属于中医学“肾消”“消渴肾病”等范畴,以蛋白尿及肾功能进行性减退为主要表现,临床治疗难点在于大量蛋白尿难以有效控制,导致肾功能持续恶化。风毒作为DKD病机演变过程中的重要病理产物,贯穿疾病始终,兼具风邪善行数变与毒邪暴戾胶结等特性。DKD早期内热壅盛,风毒潜匿;中期诸邪化风,风毒肆虐;晚期浊毒内生,风毒缠绵。本文基于风毒致病的动态演变规律,提出分期论治思路:早期透邪防传,截病于先;中期以虫类、藤类药物搜风通络;晚期则宜分消风毒浊毒,调和脏腑。本文旨在系统阐释DKD从风毒论治的理论框架,为临床实践提供新的辨治思路。

     

    Abstract: Diabetic kidney disease (DKD), categorized as “kidney consumption” or “Xiaoke kidney disease” in traditional Chinese medicine, is primarily characterized by proteinuria and progressive renal impairment. Controlling severe proteinuria remains a major therapeutic challenge, often leading to relentless functional decline. “Wind-toxin” serves as a crucial pathological product in the evolution of DKD’s pathogenesis, persisting throughout the course of the disease and exhibiting the characteristics of both “wind” pathogens (mobility and rapid change) and “toxin” pathogens (virulence and tenacious stagnation). In the early stage, internal heat is exuberant while wind-toxin remains latent; in the intermediate stage, various pathogens transform into wind, and wind-toxin runs rampant; in the late stage, turbid toxins are generated internally, and wind-toxin lingers persistently. Based on the dynamic evolutionary patterns of wind-toxin pathogenesis, this paper proposes a stage-specific treatment strategy: in the early stage, expel pathogens to prevent disease progression and intercept the illness at its onset; in the intermediate stage, utilize insect-based and vine-type medicinal agents to search out wind and unblock the collaterals; and in the late stage, resolve and disperse wind-toxin and turbid toxins while harmonizing the internal organs. This study systematically elucidates a theoretical framework for managing DKD from the wind-toxin perspective, thereby providing a novel strategy for pattern differentiation and treatment in clinical practice.

     

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