摘要
目的
中医药在治疗糖尿病及其并发症方面,已显示出独特的优势,在延缓病情进展及控制疾病的恶化等方面,已取得了较为满意的疗效。本课题为了进一步探讨益气活血法在糖尿病肾病中医治疗中的地位而开展此项调查研究。
方法
通过古今医家对本病的看法及通过对广东省中医院糖尿病肾病患者符合筛选条件者进行回顾性调查,搜集临床资料,分析糖尿病肾病气虚血瘀证的证候特点,和治疗过程中益气活血法的应用状况。
结果
通过古代和现代文献的调查研究,提示脾肾气虚血脉瘀阻气机升降失常是糖尿病肾病重要的病因病机。因此总结出运用益气活血法治疗糖尿病肾病有其可靠的理论基础及肯定的临床疗效,可作为今后诊治本病的参考依据;益气活血法是从古至今治疗糖尿病肾病必用之法。
在回顾性病例调查中,我们发现患者都有不同程度气虚血瘀的证候特点,其中具有气虚血瘀表现的证候及舌象和脉象均较普遍,如气虚证以倦怠乏力为主占82%、口干多饮占71%、面浮肢肿占68%、食少纳呆占40%;瘀血证以舌质紫暗或有瘀点瘀斑为主占81%、视物模糊占45%、肢体麻木占35%、胸闷痛占26%,脉象以沉细或沉细涩为主。提示除临床体征外舌脉象亦是糖尿病肾病气虚血瘀的重要临床征象。
从糖尿病肾病的辩证分型来看,脾肾气虚兼夹瘀血证及气阴两虚兼夹瘀血证占了病例的绝大部分。治疗上均使用了益气活血的药物,常用的益气活血药物有白术、茯苓、甘草、丹参、党参、北芪、山药等。
从回顾性病例调查糖尿病肾病的疗效可知,运用益气活血法治疗气虚血瘀证的患者,中医证侯疗效评定总有效率达87.6%,益气活血法使清阳得升浊阴得降,何患疾病不除。
结论
综合古代、现代文献调查和临床回顾性的观察,可以得出如下结论:人体精微的丧失与脾肾功能的失调有关,同时瘀血、湿浊等因素又加重了精微的丧失。脾肾气虚血脉瘀阻气机升降失常是糖尿病肾病重要的病因病机,在糖尿病肾病的病程中始终伴随着气虚血瘀的证候特点。并随着疾病的进程,气虚血瘀愈发严重;益气活血法可以有效的改善糖尿病肾病气虚血瘀的症状,从而改善糖尿病肾病的病情。由此可知益气活血法是治疗糖尿病肾病必用之法。
Objective
To explore the position of the method of tonifying qi to promote blood circulation in the Chinese medicine treatment for diabetic nephropathy.
Methods
Through reviewing the views of the Chinese medicine doctors in the history and the cases, analyze the characteristic of TCM syndrome in patients with diabetic nephropathy with the syndrome of blood stasis due to qi deficiency and the situation of applying the method of the tonifying qi to promote blood circulation in the treatment.
Results
Through reviewing the records in the history, it implys that abnormal motion of qi and stasis of blood circulation due to qi deficiency of spleen and kidney is the important etiopathogenisis and pathogenesis of diabetic nephropathy. So there are reliable theory for applying the method of tonifying qi to promote blood circulation to cure diabetic nephropathy, this can be reference for diagnosis and treatment of the disease in the future. The method of tonifying qi to promote blood circulation is the essential method for the treatment of diabetic nephropathy in the history.
From cases reviewed we found that each case had characteristic of the syndrome of blood stasis due to qi deficiency to different degree, especially for the syndromes, the tongue demonstration and pulse tracings. For example, there are eighty-two percent patients with fatigue, eighty-one percent patients' tongue is dark purple or with purple spots, the pulse is mainly deep and thready or deep and thready and unsmooth. These show that the tongue demonstration and pulse tracings are important signs of the diabetic nephropathy with syndrome of blood stasis due to qi deficiency except symptoms.
In the view of differentiation of diabetic nephropathy, both syndrome of qi deficiency of spleen and kidney with stasis of blood circulation and syndrome of qi and yin deficiency with stasis of blood circulation are in large part of cases.
On the effect observation of diabetic nephropathy, the total effective rate of the treatment for diabetic nephropathy with the syndrome of qi deficiency in company with stasis of blood circulation is eighty-seven point six percent, which applied the method of tonifying qi to promote blood circulation. It is necessary to apply the method of tonifying qi to promote blood circulation to diabetic nephropathy.
Conclusions
Through reviewing the records in the history and the cases, we can conclude that abnormal motion of qi and stasis of blood circulation due to qi deficiency of spleen and kidney is the important etiopathogenisis and pathogenesis of diabetic nephropathy. Patients with diabetic nephropathy would have the syndrome of blood stasis due to qi deficiency in its duration. The method of tonifying qi to promote blood circulation can improve the symptoms of diabetic nephropathy effectively and control the disease.
It can infer that applying the method of tonifying qi to promote blood circulation to diabetic nephropathy is necessary.
引文
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