基于“膏脂生邪”理论探讨2型糖尿病肾病的中医证治

Exploration of Traditional Chinese Medicine Syndrome Differentiation and Treatment for Type 2 Diabetic Kidney Disease Based on the “Lipid-Derived Pathogens” Theory

摘要: 2型糖尿病肾病(Diabetic Kidney Disease, DKD)目前是糖尿病最严重的微血管并发症之一，也是终末期肾病的主要病因。现有的现代医学治疗可在一定程度上延缓DKD进展，但仍难以从根本上阻断其病理进程。而中医学基于“膏脂生邪”理论，可为DKD的防治提供另一种思路。这一理论认为，禀赋不足、饮食不节、情志失调等因素致使脾胃运化失司，膏脂不归正化，异生为湿、浊、痰、瘀、毒等病理产物。这些产物贯穿DKD发生发展的始终，并随着疾病进展而呈现出“膏脂不运–湿浊内蕴–痰瘀互结–浊毒损络”的动态演变规律。基于此，本文提出分期论治的策略，同时结合现代药理研究，探讨中药治疗DKD在分子机制上的科学内涵，以期为DKD的临床诊疗提供另一种可行的理论与实践设想。

Abstract: Type 2 diabetic kidney disease (DKD) represents the worst form of microvascular complications associated with diabetes mellitus, becoming the major cause for end-stage renal disease around the globe. While current biomedicine-based therapies may alleviate DKD to some extent, they are still not enough to stop the disease’s pathologic process. The traditional Chinese medicine (TCM) based on the “lipid-derived pathogens” theory offers an additional mechanistically founded perspective of complementing DKD prevention and treatment. According to this concept, the constitutional deficiency, unwholesome diet, and depression affect the spleen- and stomach-related transport and transformation functions. Thus, sugar and fat cannot be properly decomposed but abnormally transformed into pathogens—moisture, turbid fluid, phlegm, stasis, and toxicity. They exist during the entire process from the occurrence to development of DKD and change constantly with an incremental trend: “abnormality of glucose-lipid metabolism→internal generation of turbid fluid-dampness→phlegm-stasis coagulation→turbid toxic pathogen injury.” Based on these ideas, this article will design the stage-based treatment plan and combine with modern pharmacology studies to find out the mechanism of Chinese medicine intervention for DKD at the molecular level.” The ultimate objective is to provide a feasible theoretical and practical approach for the diagnosis and management of DKD.