魏子孝教授治疗糖尿病肾病学术特色整理及经验总结
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摘要
目的：
运用数据挖掘技术,结合魏子孝老师反馈意见,提炼导师诊治DN的临床思路,并通过整理古代文献及现代文献中医治疗DN的常用方法及药物,对魏教授治疗DN的理论基础加以溯源和对比分析,二者结合总结导师治疗DN的学术特色及经验。
方法：
采用由中国科学院系统所及中国中医科学院联合开的SQL Server系统,运用频次统计及关联、聚类、网络分析等数据挖掘方法,针对辨证、治疗、选方用药等方面,对导师治疗的69例95诊次糖尿病肾病医案进行统一录入、数据清洗、挖掘分析。古代文献部分通过查阅相关古籍,从病因病机、辨证治疗两方面进行梳理,现代文献部分通过文献检索,从分型分期论治、专方专用、单味药及中成药、其他治疗四个方面进行述评,最后将三个部分横向比较,对导师治疗DN的学术特色及经验进行全面总结整理。
结果：
对本研究纳入的69例共计95诊次的DN医案数据挖掘结果显示,中医病名诊断示水肿(50次)和尿浊(37次)出现次数最多,另有癃闭、呕吐、瘙痒、虚劳。主要以肢体浮肿、尿中泡沫,乏力等为主要症状,约25%左右的患者出现肌酐升高。出现次数最多的舌脉象情况为：舌苔薄白腻(51次)、舌体胖大(50次)、舌色暗红(23次)及脉细(16次)、脉弦(16次)。消渴肾病常见单证型为：水停证,血瘀证,脾虚证,肾虚证等。总体治法关联网络分析图可见,出现次数最多的治法是以活血为中心,关联补肾、健脾、利水三方面。处方共用药物129种,其中使用次数最多的药物为川牛膝(69.5%),排在前20位的药物中,主要为四大类：利水药、活血药、健脾药、补肾药。在具体药物,药量比例上有一定规律,白术-苍术,用药比例为1：1,此外还有陈皮-黄芪比例为1：3等。尿浊医案中使用次数最多的药物为蝉蜕(75.7%),土茯苓(70.3%)、益母草(70.3%)等。
在尿浊医案中很多药物的使用显示出较高关联性,尤其是蝉蜕、土茯苓、益母草、苏叶几味,尿浊脾肾两虚证主要用药有：茯苓(100%)、山药(100%)、山萸肉(85.7%)、生黄芪(85.7%)、太子参(85.7%)、生地(57.1%).中医诊断为水肿一病的医案中,关联度最高的药对为：车前子--牛膝(0.55102),其次为川牛膝-茯苓、白术-苍术、陈皮-生黄芪,白芍-赤芍等配伍。脾虚水停证的主要用药有：茯苓、白术、苍术、泽泻、猪苓、桂枝、党参等。肾虚水停之水肿用药主要有：川牛膝、车前子、茯苓、怀牛膝(75%)、山药、山萸肉、丹皮、冬瓜皮、泽泻等。脾肾两虚水停证排在前十位的常用药物有：生黄芪、陈皮、党参、熟地、山萸肉、山药、车前子、川牛膝、冬瓜皮等。血瘀水停用药主要有：当归、赤芍、茯苓、泽泻及车前子、川牛膝等。
结论：
(1)导师治疗糖尿病肾病的经验有以下几方面：
①病机认识方面,其病机关键为本虚标实,脾虚、肾虚为本,水停、血瘀、浊毒等为标。
②注重四诊合参,尤重舌、脉象。
③“辨病—标本先后--抓主症---辨证--确定基本方--加减”的辨治步骤。
④在治法及用药方面,重视活血利水；重视饮食疗法。处方选择方面,主症为水肿者,脾虚予春泽汤加减,肾虚予济生肾气丸,脾肾两虚,予参芪地黄汤加减,血瘀水停以当归芍药散加减；主症为尿浊者,常予参芪地黄汤加减；视舌苔情况,予春泽汤或泻黄散合苏连饮加减等。用药方面,既注重中药的传统用法,又恰当借鉴现代药理研究结果。
(2)运用数据挖掘技术结合临床跟师体会,能够更好地总结整理名老中医临床经验,有较好的应用前景。
Object:
Applying data mining technology, with Professor Wei'feedback opinions, to find out his clinical thought on treatment of DN;By arrangement of ancient and contemporary literatures on the diagnosis and treatment of DN, to finish the traceability and analysis of Professor Wei' theoretical basis;At last, combined with data mining, to achieve the academic characteristic collation and experience summary on treatment of diabetic nephropathy of Zixiao Wei.
Method:
Using the SQL Server system which was exploited by China Academy Of Chinese Medicine Sciences and the System Science Institute of China Science Academy, applying kinds of data mining technologies, such as frequency statistical, association analysis, and so on, input, unify and mine the 95 medical cases on DN which were treated by Professor Wei Zixiao. Study on the ancient literatures consisted of etiology and pathogenesis of DN, treatment based on syndrome differentiation.Study on the modern literatures was composed of differentiation for syndrome classification,specific prescription for certain illness, single medicine and Chinese patent medicine and other treatment. At last, analyze the three parts and comprehensively summarize Professor Wei'academic characteristic and clinical experience on treatment of diabetic nephropathy
Result:
Data mining of the 95 medical cases on DN suggested that in the TCM diagnosis, edema (50 cases) and turbid urine (37 cases) was the most, and there were retention of urine, pruritus, vomit, consumptive diseases.The main symptoms were edema, foam in the urine, hypodynamia and so on. One quarter of cases manifested high serum creatinine. The main conditions of the tongue and coating and pulse-taking were White and greasy tongue coating (51 cases), plump tongue (50 cases), dark red tongue (23 cases), thin pulse (16 cases) and tant pulse (16 cases). The main Chinese medicine syndromes contained water retention syndrome, blood stasis syndrome, spleen-deficiency syndrome, kidney-deficiency syndrome, and so on. The association analysis diagram suggested that the most common therapeutic method were the combination, whose center was invigorating blood circulation, of supplementing the kidney, strengthening the spleen and eliminating retention of fluid.The 95 prescriptions included 129 Chinese herbal medicine, and the most common one was medicinal cyathula root.account for 69.5%.The top 20 drugs were mainly for eliminating retention of fluid, invigorating blood circulation, supplementing the kidney and strengthening the spleen. The dosage had some regular patterns, for example, the ratio of the rhizome of large-headed atractylodes to Chinese atracty lodes was 1 to 1. The ratio of Pericarpium Citri Reticulatae to radix astragali was 1 to 3.
In the turbid urine cases, the most common herbal medicine was cicada slough, china root, motherwort and so on. Many drugs had tight associations, especially cicada slough, china root, motherwort and beef-steak plant leaf. The common drugs used in the spleen-kidney deficiency syndrome were Tuckahoe, yam, dogwood fruit, astragali radix, radix pseudostellariae, dried rhizome of rehmannia, account for 100% 100%、85.7%、85.7%、57.1%. In the edema cases, drugs which had tight associations contained Asiatic plantain seed and medicinal cyathula root. The common drugs used in edema due to spleen-deficiency were Tuckahoe, the rhizome of large-headed atractylodes, Chinese atractylodes, Alisma orientale, cassia twig, radix codonopsitis. Drugs commonly used in edema due to kidney-deficiency were radix cyathulae, Asiatic plantain seed, radix achyranthis bidentatae, yam, dogwood fruit, root bark of the peony tree and so on. Drugs commonly used in edema due to spleen-kidney deficiency were Pericarpium Citri Reticulatae, radix astragali, radix codonopsitis, old arable soil, dogwood fruit and so on. Herbal medicines used in blood stasis causing water retention were angelica, red paeonia, Tuckahoe, Alisma orientale, Asiatic plantain seed, radix cyathulae and so on.
Conclusion:
(1) The clinical experience on treatment of diabetic nephropathy of Professor Wei:
①Referring to pathogenesis, the key point was asthenia in origin and asthenia in superficiality. It contained spleen-deficiency, kidney-deficiency, water retention, blood stasis and so on.
②Emphasize combined use of the four diagnostic methods, especially conditions of the tongue and coating and pulse-taking.
③Use the special way of thought, which was "differentiation of disease——differentiate the root cause and symptoms of a disease——grasp primary symptom——differentiation of symptoms and signs——formulate the basic prescription——addition or subtraction of changes"
④Put emphasis on invigorating blood circulation to eliminate retention of fluid and pay attention to dietotherapy. When the primary syndrome was edema, spleen- deficiency syndrome was treated by Chunze Decoction, while kidney-deficiency was Jishengshenqi Decoction. Spleen-kidney deficiency syndrome was treated by Shenqidihuang Decoction, while blood stasis causing water retention syndrome was Dangguishaoyao Decoction. When the primary syndrome was turbid urine, the common basic prescription was Shenqidihuang Decoction. Professor Wei applied herbal medicines according to both traditional usage and the modern pharmacology research.
(2)Combination of data mining and the way of apprenticeship can better summarize the clinical experience of famous TCM doctors, and data mining will have an extensive future in TCM.
运用数据挖掘技术,结合魏子孝老师反馈意见,提炼导师诊治DN的临床思路,并通过整理古代文献及现代文献中医治疗DN的常用方法及药物,对魏教授治疗DN的理论基础加以溯源和对比分析,二者结合总结导师治疗DN的学术特色及经验。
方法：
采用由中国科学院系统所及中国中医科学院联合开的SQL Server系统,运用频次统计及关联、聚类、网络分析等数据挖掘方法,针对辨证、治疗、选方用药等方面,对导师治疗的69例95诊次糖尿病肾病医案进行统一录入、数据清洗、挖掘分析。古代文献部分通过查阅相关古籍,从病因病机、辨证治疗两方面进行梳理,现代文献部分通过文献检索,从分型分期论治、专方专用、单味药及中成药、其他治疗四个方面进行述评,最后将三个部分横向比较,对导师治疗DN的学术特色及经验进行全面总结整理。
结果：
对本研究纳入的69例共计95诊次的DN医案数据挖掘结果显示,中医病名诊断示水肿(50次)和尿浊(37次)出现次数最多,另有癃闭、呕吐、瘙痒、虚劳。主要以肢体浮肿、尿中泡沫,乏力等为主要症状,约25%左右的患者出现肌酐升高。出现次数最多的舌脉象情况为：舌苔薄白腻(51次)、舌体胖大(50次)、舌色暗红(23次)及脉细(16次)、脉弦(16次)。消渴肾病常见单证型为：水停证,血瘀证,脾虚证,肾虚证等。总体治法关联网络分析图可见,出现次数最多的治法是以活血为中心,关联补肾、健脾、利水三方面。处方共用药物129种,其中使用次数最多的药物为川牛膝(69.5%),排在前20位的药物中,主要为四大类：利水药、活血药、健脾药、补肾药。在具体药物,药量比例上有一定规律,白术-苍术,用药比例为1：1,此外还有陈皮-黄芪比例为1：3等。尿浊医案中使用次数最多的药物为蝉蜕(75.7%),土茯苓(70.3%)、益母草(70.3%)等。
在尿浊医案中很多药物的使用显示出较高关联性,尤其是蝉蜕、土茯苓、益母草、苏叶几味,尿浊脾肾两虚证主要用药有：茯苓(100%)、山药(100%)、山萸肉(85.7%)、生黄芪(85.7%)、太子参(85.7%)、生地(57.1%).中医诊断为水肿一病的医案中,关联度最高的药对为：车前子--牛膝(0.55102),其次为川牛膝-茯苓、白术-苍术、陈皮-生黄芪,白芍-赤芍等配伍。脾虚水停证的主要用药有：茯苓、白术、苍术、泽泻、猪苓、桂枝、党参等。肾虚水停之水肿用药主要有：川牛膝、车前子、茯苓、怀牛膝(75%)、山药、山萸肉、丹皮、冬瓜皮、泽泻等。脾肾两虚水停证排在前十位的常用药物有：生黄芪、陈皮、党参、熟地、山萸肉、山药、车前子、川牛膝、冬瓜皮等。血瘀水停用药主要有：当归、赤芍、茯苓、泽泻及车前子、川牛膝等。
结论：
(1)导师治疗糖尿病肾病的经验有以下几方面：
①病机认识方面,其病机关键为本虚标实,脾虚、肾虚为本,水停、血瘀、浊毒等为标。
②注重四诊合参,尤重舌、脉象。
③“辨病—标本先后--抓主症---辨证--确定基本方--加减”的辨治步骤。
④在治法及用药方面,重视活血利水；重视饮食疗法。处方选择方面,主症为水肿者,脾虚予春泽汤加减,肾虚予济生肾气丸,脾肾两虚,予参芪地黄汤加减,血瘀水停以当归芍药散加减；主症为尿浊者,常予参芪地黄汤加减；视舌苔情况,予春泽汤或泻黄散合苏连饮加减等。用药方面,既注重中药的传统用法,又恰当借鉴现代药理研究结果。
(2)运用数据挖掘技术结合临床跟师体会,能够更好地总结整理名老中医临床经验,有较好的应用前景。
Object:
Applying data mining technology, with Professor Wei'feedback opinions, to find out his clinical thought on treatment of DN;By arrangement of ancient and contemporary literatures on the diagnosis and treatment of DN, to finish the traceability and analysis of Professor Wei' theoretical basis;At last, combined with data mining, to achieve the academic characteristic collation and experience summary on treatment of diabetic nephropathy of Zixiao Wei.
Method:
Using the SQL Server system which was exploited by China Academy Of Chinese Medicine Sciences and the System Science Institute of China Science Academy, applying kinds of data mining technologies, such as frequency statistical, association analysis, and so on, input, unify and mine the 95 medical cases on DN which were treated by Professor Wei Zixiao. Study on the ancient literatures consisted of etiology and pathogenesis of DN, treatment based on syndrome differentiation.Study on the modern literatures was composed of differentiation for syndrome classification,specific prescription for certain illness, single medicine and Chinese patent medicine and other treatment. At last, analyze the three parts and comprehensively summarize Professor Wei'academic characteristic and clinical experience on treatment of diabetic nephropathy
Result:
Data mining of the 95 medical cases on DN suggested that in the TCM diagnosis, edema (50 cases) and turbid urine (37 cases) was the most, and there were retention of urine, pruritus, vomit, consumptive diseases.The main symptoms were edema, foam in the urine, hypodynamia and so on. One quarter of cases manifested high serum creatinine. The main conditions of the tongue and coating and pulse-taking were White and greasy tongue coating (51 cases), plump tongue (50 cases), dark red tongue (23 cases), thin pulse (16 cases) and tant pulse (16 cases). The main Chinese medicine syndromes contained water retention syndrome, blood stasis syndrome, spleen-deficiency syndrome, kidney-deficiency syndrome, and so on. The association analysis diagram suggested that the most common therapeutic method were the combination, whose center was invigorating blood circulation, of supplementing the kidney, strengthening the spleen and eliminating retention of fluid.The 95 prescriptions included 129 Chinese herbal medicine, and the most common one was medicinal cyathula root.account for 69.5%.The top 20 drugs were mainly for eliminating retention of fluid, invigorating blood circulation, supplementing the kidney and strengthening the spleen. The dosage had some regular patterns, for example, the ratio of the rhizome of large-headed atractylodes to Chinese atracty lodes was 1 to 1. The ratio of Pericarpium Citri Reticulatae to radix astragali was 1 to 3.
In the turbid urine cases, the most common herbal medicine was cicada slough, china root, motherwort and so on. Many drugs had tight associations, especially cicada slough, china root, motherwort and beef-steak plant leaf. The common drugs used in the spleen-kidney deficiency syndrome were Tuckahoe, yam, dogwood fruit, astragali radix, radix pseudostellariae, dried rhizome of rehmannia, account for 100% 100%、85.7%、85.7%、57.1%. In the edema cases, drugs which had tight associations contained Asiatic plantain seed and medicinal cyathula root. The common drugs used in edema due to spleen-deficiency were Tuckahoe, the rhizome of large-headed atractylodes, Chinese atractylodes, Alisma orientale, cassia twig, radix codonopsitis. Drugs commonly used in edema due to kidney-deficiency were radix cyathulae, Asiatic plantain seed, radix achyranthis bidentatae, yam, dogwood fruit, root bark of the peony tree and so on. Drugs commonly used in edema due to spleen-kidney deficiency were Pericarpium Citri Reticulatae, radix astragali, radix codonopsitis, old arable soil, dogwood fruit and so on. Herbal medicines used in blood stasis causing water retention were angelica, red paeonia, Tuckahoe, Alisma orientale, Asiatic plantain seed, radix cyathulae and so on.
Conclusion:
(1) The clinical experience on treatment of diabetic nephropathy of Professor Wei:
①Referring to pathogenesis, the key point was asthenia in origin and asthenia in superficiality. It contained spleen-deficiency, kidney-deficiency, water retention, blood stasis and so on.
②Emphasize combined use of the four diagnostic methods, especially conditions of the tongue and coating and pulse-taking.
③Use the special way of thought, which was "differentiation of disease——differentiate the root cause and symptoms of a disease——grasp primary symptom——differentiation of symptoms and signs——formulate the basic prescription——addition or subtraction of changes"
④Put emphasis on invigorating blood circulation to eliminate retention of fluid and pay attention to dietotherapy. When the primary syndrome was edema, spleen- deficiency syndrome was treated by Chunze Decoction, while kidney-deficiency was Jishengshenqi Decoction. Spleen-kidney deficiency syndrome was treated by Shenqidihuang Decoction, while blood stasis causing water retention syndrome was Dangguishaoyao Decoction. When the primary syndrome was turbid urine, the common basic prescription was Shenqidihuang Decoction. Professor Wei applied herbal medicines according to both traditional usage and the modern pharmacology research.
(2)Combination of data mining and the way of apprenticeship can better summarize the clinical experience of famous TCM doctors, and data mining will have an extensive future in TCM.
引文
[1]Wenying Yang, M. D, Juming Lu, M. D., et al. Prevalence of Diabetes among Men and Women in China[J]N Engl J Med,2010, 24:362(25):2433.
[2]崔极贵.糖尿病肾病研究进展[J].浙江中西医结合杂志,2006,16(2)：67-69.
[3]林兰,郭力.糖微康对糖尿病肾病患者血液流变学的影响[J].中国中西医结合肾病杂志,2003,4(43)：215.
[4]吕仁和.糖尿病及其并发症中西医诊治学[M].北京：人民卫生出版社,1997：328.
[5]田风胜,苏秀海等.糖尿病肾病中医病名规范化研究[J].中华中医药杂志,2009,4(11)：1425.
[6]Hoshi S, Shu Y, Yoshida F, et al.Podocyte Injury Promotes Progressive Nephropathy in Zucker Diabetic Fatty Rats[J]. Lab invest,2002,82(1):25-35.
[7]王昱,鲍晓荣.细胞因子与糖尿病肾病[J].实用诊断与治疗杂志,2007,21(11)：843-845.
[8]Tada H, Isogai S. The Fibronectin Production is Increased by Thrombospondin Via Activation of TGF-bete in Cultured Human Mesangial Cells[J].Nephron,1998,79(1):38-43.
[9]Pettitt D J, Saad M F,Bennett P H, et al. Familial Predisposition to Renal Disease in two Generations of Pima Indians with Type2 (Non-insulin-dependent)DiabetesMellitus [J]. Diabetologia, 1990,33:438-443.
[10]Sacks DB, Bruns DE, Goldstein DE, et al. Guidelines and recommendation for laboratory analysis in the diagnosis and management diabetes mellitus[J]. Clin Chem,2002,48(3):436-472.
[11]杨春林,曹伟建.尿微量蛋白测定在糖尿病肾病早期诊断的应用[J].临床中老年保健,2002(5)：18-19.
[12]董晖,寿松涛,等.微球蛋白、转铁蛋白联合检测在糖尿病早期诊断的临床意义[J].天津医科大学学报,2002,8：253-254.
[13]钟淑婷.2型糖尿病并发肾病的危险因素分析[D].广州：中山大学,2006.
[14]雷铭德.2型糖尿病并发肾病危险因素探讨[D].天津：天津医科大学,2005.
[15]Karamanos B, Porta M, Songini M, et al. Different risk factors of microangiopathy in patients with type 1 diabetes mellitus of shortversus long duration:the Eurodiab IDDM Complications Study. Diabetologia,2000,43:348-355.
[16]Mogensen CE, Schmitz A, Christensen CK.DiabetesMetabolism Bev.1998,4:453.
[17]Kim SI,Kwak JH, Zachariah M, et al. TGF2-activated kinase 1 and TAK 1-binding protein lcooperate to mediate TGF212 inducedMKK32p38 MAPK activation and stimulation of type 1 collagen[J].AmJ Physiol Renal Physiol,2007,292(5):1471-1478.
[18]Fernandez-Juorez G, Barrio V, de Vinuesa S G, et al. Dual Blockade of the Rennin-angiotensin System in the Progression of Renal Disease:the Need for More Clinical Trials[J]. JAm Soc Nephrol, 2006,17 (S3):250-254.
[19]王悦芳.黄芪注射液配合丹参注射液治疗糖尿病肾病的临床观察[J].临床荟萃,2002,17(21)：1280-1281.
[20]王秀霞,赵明耀.中西医结合治疗糖尿病肾病的临床研究.中国现代医药杂志2009,11(2)：57-58.
[21]林兰.现代中医糖尿病学[M].北京：人民卫生出版社,2008：550-553.
[22]孙红颖.聂莉芳教授治疗糖尿病肾病的经验[J].中国中西医结合肾病杂志,2009,10(5)：380-381.
[23]赵迪.高彦彬教授治疗糖尿病肾病学术思想和经验[J].中医研究,2007,20(1)：4243.
[24]伍新林,李俊彪,等.中西医结合治疗糖尿病肾病的临床研究[J].中国中西医结合肾病杂志,2008,9(1)：51-53.
[25]王世东,黄允瑜,等.中医防治方案对糖尿病肾病肾功能不全代偿期肾功能和血脂代谢的影响[J].北京中医,2007,26(4)：211-214.
[26]苗桂珍,曹柏龙.健脾补肾活血化痰法治疗早期糖尿病肾病的临床观察[J].中国中医药现代远程教育,2009,7(10)：101-102.
[27]向少伟,黄国东,蒙宇华,等.益气活血方治疗糖尿病肾病的临床观察[J].湖北中医杂志,2005,27(4)：12-13.
[28]黄丽华.中西医结合治疗糖尿病肾病临床观察[J].山西中医,2009,25(10)：28-29.
[29]周英.加味真武汤治疗糖尿病肾病的临床与实验研究[D].广州：广州中医药大学,2007.
[30]周小琳.中西医结合治疗糖尿病肾病51例临床研究[J].江苏中医药,2009,41(9)：35-36.
[31]任琴敏.加味参芪地黄汤治疗糖尿病肾病气阴两虚型61例的临床观察[D].陕西：陕西中医学院,2008.
[32]王玉中,王秀霞,等.中药联合贝那普利治疗糖尿病肾病的临床研究[J].中国中西医结合杂志,2007,27(8)：683-685.
[33]王庆向.养阴温肾活血法治疗糖尿病性肾病临床观察.天津中医药2010,27(2)：105.
[34]刘仪红,田浩明.黄芪治疗糖尿病肾病的系统评价[J].中国循证医学杂志,2007,7(10)715-727.
[35]阎铺,王志强.百令胶囊治疗早期糖尿病肾病疗效观察[J].中国中西医结合肾病杂志,2005,6(1)：47.
[36]石咏军,刘征宇,等.雷公藤多苷治疗早中期糖尿病肾病的临床研究[J].现代中西医结合杂志,2006,15(8)：987.
[37]耿峰,滕涛.中西医结合治疗早期糖尿病肾病30例临床观察[J].实用中西医结合临床,2010,10(2)：22-23.
[38]金劫,张伟文,等.血脂康治疗血脂异常的糖尿病肾病60例临床观察 [J].浙江医学,2007,29,(9)：973-974.
[39]吉学群,于颂华,等.针刺配合低蛋白膳食对糖尿病早期肾病的影响[J].中国针灸,2004,24(9)：597-599.
[40]姜秀云.中药灌肠治疗糖尿病晚期肾病的疗效观察.中国全科医学,2005,8(4)：321-322.
[41]陈波.东垣脾胃方配伍规律之关联分析评述.中医药学刊[J].2004,22(4)：611-612.
[42]李秀娟.基于数据挖掘探索董建华治疗老年病的药对规律.福建中医药[J].2009,40(2)：38-40.
[43]杜业勤,刘晶,等.清代医家治疗噎膈高频药聚类分析.中医杂志.2010,51(8)：759-760.
[44]吴丽丽,周莺,等.古代情志病证医案中组方用药规律分析.安徽中医学院学报,2008,27(01)：25-28.
[1]郭霭春.黄帝内经素问校注语译[M].天津：天津科学技术出版社,1981.
[2]魏·吴普等.神农本草经[M].北京：人民卫生出版社,1963.
[3]中医研究院.金匮要略语译[M].北京：人民卫生出版社,1959.
[4]南京中医学院.诸病源候论校释[M].北京：人民卫生出版社,1980.
[5]宋·王怀隐.太平圣惠方[M].北京：人民卫生出版社,1982.
[6]宋·赵佶.圣济总录[M].北京：人民卫生出版社,1962.
[7]清·唐宗海.血证论[M].北京：人民卫生出版社,1977.
[8]唐·王焘.外台秘要[M].北京：人民卫生出版社,1955.
[9]宋·严用和.济生方[M].北京：人民卫生出版社,1956.
[10]宋·陈言.三因极—病证方论[M].北京：人民卫生出版社,1957.
[11]明·张介宾.景岳全书[M].北京：人民卫生出版社,2007.
[12]清·程国彭.医学心悟[M].北京：人民卫生出版社,1963.
[13]明·朱棣.普济方集要[M].辽宁：辽宁科学技术出版社,2007.
[14]明·戴原礼.证治要诀[M].北京：人民卫生出版社,2006.
[2]崔极贵.糖尿病肾病研究进展[J].浙江中西医结合杂志,2006,16(2)：67-69.
[3]林兰,郭力.糖微康对糖尿病肾病患者血液流变学的影响[J].中国中西医结合肾病杂志,2003,4(43)：215.
[4]吕仁和.糖尿病及其并发症中西医诊治学[M].北京：人民卫生出版社,1997：328.
[5]田风胜,苏秀海等.糖尿病肾病中医病名规范化研究[J].中华中医药杂志,2009,4(11)：1425.
[6]Hoshi S, Shu Y, Yoshida F, et al.Podocyte Injury Promotes Progressive Nephropathy in Zucker Diabetic Fatty Rats[J]. Lab invest,2002,82(1):25-35.
[7]王昱,鲍晓荣.细胞因子与糖尿病肾病[J].实用诊断与治疗杂志,2007,21(11)：843-845.
[8]Tada H, Isogai S. The Fibronectin Production is Increased by Thrombospondin Via Activation of TGF-bete in Cultured Human Mesangial Cells[J].Nephron,1998,79(1):38-43.
[9]Pettitt D J, Saad M F,Bennett P H, et al. Familial Predisposition to Renal Disease in two Generations of Pima Indians with Type2 (Non-insulin-dependent)DiabetesMellitus [J]. Diabetologia, 1990,33:438-443.
[10]Sacks DB, Bruns DE, Goldstein DE, et al. Guidelines and recommendation for laboratory analysis in the diagnosis and management diabetes mellitus[J]. Clin Chem,2002,48(3):436-472.
[11]杨春林,曹伟建.尿微量蛋白测定在糖尿病肾病早期诊断的应用[J].临床中老年保健,2002(5)：18-19.
[12]董晖,寿松涛,等.微球蛋白、转铁蛋白联合检测在糖尿病早期诊断的临床意义[J].天津医科大学学报,2002,8：253-254.
[13]钟淑婷.2型糖尿病并发肾病的危险因素分析[D].广州：中山大学,2006.
[14]雷铭德.2型糖尿病并发肾病危险因素探讨[D].天津：天津医科大学,2005.
[15]Karamanos B, Porta M, Songini M, et al. Different risk factors of microangiopathy in patients with type 1 diabetes mellitus of shortversus long duration:the Eurodiab IDDM Complications Study. Diabetologia,2000,43:348-355.
[16]Mogensen CE, Schmitz A, Christensen CK.DiabetesMetabolism Bev.1998,4:453.
[17]Kim SI,Kwak JH, Zachariah M, et al. TGF2-activated kinase 1 and TAK 1-binding protein lcooperate to mediate TGF212 inducedMKK32p38 MAPK activation and stimulation of type 1 collagen[J].AmJ Physiol Renal Physiol,2007,292(5):1471-1478.
[18]Fernandez-Juorez G, Barrio V, de Vinuesa S G, et al. Dual Blockade of the Rennin-angiotensin System in the Progression of Renal Disease:the Need for More Clinical Trials[J]. JAm Soc Nephrol, 2006,17 (S3):250-254.
[19]王悦芳.黄芪注射液配合丹参注射液治疗糖尿病肾病的临床观察[J].临床荟萃,2002,17(21)：1280-1281.
[20]王秀霞,赵明耀.中西医结合治疗糖尿病肾病的临床研究.中国现代医药杂志2009,11(2)：57-58.
[21]林兰.现代中医糖尿病学[M].北京：人民卫生出版社,2008：550-553.
[22]孙红颖.聂莉芳教授治疗糖尿病肾病的经验[J].中国中西医结合肾病杂志,2009,10(5)：380-381.
[23]赵迪.高彦彬教授治疗糖尿病肾病学术思想和经验[J].中医研究,2007,20(1)：4243.
[24]伍新林,李俊彪,等.中西医结合治疗糖尿病肾病的临床研究[J].中国中西医结合肾病杂志,2008,9(1)：51-53.
[25]王世东,黄允瑜,等.中医防治方案对糖尿病肾病肾功能不全代偿期肾功能和血脂代谢的影响[J].北京中医,2007,26(4)：211-214.
[26]苗桂珍,曹柏龙.健脾补肾活血化痰法治疗早期糖尿病肾病的临床观察[J].中国中医药现代远程教育,2009,7(10)：101-102.
[27]向少伟,黄国东,蒙宇华,等.益气活血方治疗糖尿病肾病的临床观察[J].湖北中医杂志,2005,27(4)：12-13.
[28]黄丽华.中西医结合治疗糖尿病肾病临床观察[J].山西中医,2009,25(10)：28-29.
[29]周英.加味真武汤治疗糖尿病肾病的临床与实验研究[D].广州：广州中医药大学,2007.
[30]周小琳.中西医结合治疗糖尿病肾病51例临床研究[J].江苏中医药,2009,41(9)：35-36.
[31]任琴敏.加味参芪地黄汤治疗糖尿病肾病气阴两虚型61例的临床观察[D].陕西：陕西中医学院,2008.
[32]王玉中,王秀霞,等.中药联合贝那普利治疗糖尿病肾病的临床研究[J].中国中西医结合杂志,2007,27(8)：683-685.
[33]王庆向.养阴温肾活血法治疗糖尿病性肾病临床观察.天津中医药2010,27(2)：105.
[34]刘仪红,田浩明.黄芪治疗糖尿病肾病的系统评价[J].中国循证医学杂志,2007,7(10)715-727.
[35]阎铺,王志强.百令胶囊治疗早期糖尿病肾病疗效观察[J].中国中西医结合肾病杂志,2005,6(1)：47.
[36]石咏军,刘征宇,等.雷公藤多苷治疗早中期糖尿病肾病的临床研究[J].现代中西医结合杂志,2006,15(8)：987.
[37]耿峰,滕涛.中西医结合治疗早期糖尿病肾病30例临床观察[J].实用中西医结合临床,2010,10(2)：22-23.
[38]金劫,张伟文,等.血脂康治疗血脂异常的糖尿病肾病60例临床观察 [J].浙江医学,2007,29,(9)：973-974.
[39]吉学群,于颂华,等.针刺配合低蛋白膳食对糖尿病早期肾病的影响[J].中国针灸,2004,24(9)：597-599.
[40]姜秀云.中药灌肠治疗糖尿病晚期肾病的疗效观察.中国全科医学,2005,8(4)：321-322.
[41]陈波.东垣脾胃方配伍规律之关联分析评述.中医药学刊[J].2004,22(4)：611-612.
[42]李秀娟.基于数据挖掘探索董建华治疗老年病的药对规律.福建中医药[J].2009,40(2)：38-40.
[43]杜业勤,刘晶,等.清代医家治疗噎膈高频药聚类分析.中医杂志.2010,51(8)：759-760.
[44]吴丽丽,周莺,等.古代情志病证医案中组方用药规律分析.安徽中医学院学报,2008,27(01)：25-28.
[1]郭霭春.黄帝内经素问校注语译[M].天津：天津科学技术出版社,1981.
[2]魏·吴普等.神农本草经[M].北京：人民卫生出版社,1963.
[3]中医研究院.金匮要略语译[M].北京：人民卫生出版社,1959.
[4]南京中医学院.诸病源候论校释[M].北京：人民卫生出版社,1980.
[5]宋·王怀隐.太平圣惠方[M].北京：人民卫生出版社,1982.
[6]宋·赵佶.圣济总录[M].北京：人民卫生出版社,1962.
[7]清·唐宗海.血证论[M].北京：人民卫生出版社,1977.
[8]唐·王焘.外台秘要[M].北京：人民卫生出版社,1955.
[9]宋·严用和.济生方[M].北京：人民卫生出版社,1956.
[10]宋·陈言.三因极—病证方论[M].北京：人民卫生出版社,1957.
[11]明·张介宾.景岳全书[M].北京：人民卫生出版社,2007.
[12]清·程国彭.医学心悟[M].北京：人民卫生出版社,1963.
[13]明·朱棣.普济方集要[M].辽宁：辽宁科学技术出版社,2007.
[14]明·戴原礼.证治要诀[M].北京：人民卫生出版社,2006.