基于《黄帝内经》“水郁折之”理论探讨糖尿病肾病

Discussion on Diabetic Nephropathy Based on the Theory of “Shui Yu Zhe Zhi” in Huangdi Neijing

摘要: 作为糖尿病主要微血管并发症，糖尿病肾病的病理表现为蛋白尿、水肿及肾功能进行性下降。基于《黄帝内经》“水郁折之”理论，提出糖尿病肾病“肾阳亏虚为本，水湿郁滞–肾络瘀阻为标”的核心病机，并强调其病机演变具有糖浊内蕴、痰瘀胶结的糖尿病特异性。水郁本质为肾阳气化失司，并与肝、脾、肺、膀胱等多脏腑协同失调密切相关，最终形成“水郁–络瘀”恶性循环。治疗以温肾化气消水郁之源，疏肝理气调气机之枢，健脾制水绝湿浊之生，宣肺利水通水道之壅，开利膀胱助三焦气化，化痰逐瘀通肾络之痹。结合现代药理学证据(如真武汤兴奋下丘脑–垂体轴、五苓散调控肾素–血管紧张素–醛固酮系统)，阐明“以脏为纲、以郁为机、以通为用”的治疗理念，并通过临床案例分析佐证理论应用，为糖尿病肾病的中西医结合临床管理提供新思路。

Abstract: As a major microvascular complication of diabetes mellitus, diabetic nephropathy is characterised by proteinuria, oedema and progressive decline in renal function. Based on the theory of “Shui Yu Zhe Zhi” in Huangdi Neijing, the core pathogenesis of diabetic nephropathy is ‘deficiency of kidney yang as the root cause, stagnation of water and dampness - stagnation of renal collaterals as the symptom’. It emphasizes that the pathological evolution of DN is specific to diabetes, featuring internal accumulation of glucose-turbidity and intertwining of phlegm and stasis. The essence of water stagnation lies in the failure of kidney yang in qi transformation, closely related to the dysfunction of multiple organs such as the liver, spleen, lungs, and bladder, ultimately forming a vicious cycle of “water stagnation - collateral stasis”. The treatment is to warm the kidneys to eliminate the source of water depressions, dredge the liver to regulate qi and regulate the pivot of qi, strengthen the spleen to control water to stop the birth of dampness and turbidity, promote the lungs to relieve the congestion of the watercourses, open up the urinary bladder to support the vitality of the three visceral cavities, and dissolve phlegm and expel blood stasis to relieve the paralysis of the kidney complexes. Combined with modern pharmacological evidence (e.g. Zhenwu Tang excites the hypothalamic-pituitary axis, Wu Ling San regulates the renin-angiotensin-aldosterone system), the treatment concept of “taking the organ as the outline, depression as the mechanism, and communication as the function” is clarified, and the application of the theory is supported by clinical case studies, which provides a new way of thinking on the clinical management of diabetic nephropathy by combining Chinese and Western medicines.