中医药防治糖尿病脂毒性肾损伤的思路与策略
Thoughts and strategies of traditional Chinese medicine in preventing and treating diabetic lipotoxic renal injury
- 北京中医药 2025年44卷第9期 页码：1095-1098
- 作者机构：
1.中日友好医院中西医结合糖尿病科，北京 100029
2.中日友好医院临床研究所，北京 100029
- 作者简介：
王艳梅，女，41岁，博士，副主任医师。研究方向：糖尿病及糖尿病慢性并发症、代谢综合征的中西医结合诊疗。
李平，E-mail：lp8675@163.com
- 基金信息：国家自然科学基金区域联合项目(U23A20504);国家自然科学基金基层组织科普专项(2025-HX-90)
DOI：10.16025/j.1674-1307.2025.09.002
中图分类号：收稿：2025-07-18，
修回：2025-10-19，
录用：2025-10-22，
纸质出版：2025-09-25
- 稿件说明：
移动端阅览
王艳梅，赵海玲，李平.中医药防治糖尿病脂毒性肾损伤的思路与策略［J］.北京中医药，2025，44（9）：1095-1098.
WANG Yanmei,ZHAO Hailing,LI Ping.Thoughts and strategies of traditional Chinese medicine in preventing and treating diabetic lipotoxic renal injury[J]. Beijing Journal of Traditional Chinese Medicine,2025,44(09):1095-1098.
王艳梅，赵海玲，李平.中医药防治糖尿病脂毒性肾损伤的思路与策略［J］.北京中医药，2025，44（9）：1095-1098. DOI： 10.16025/j.1674-1307.2025.09.002.
WANG Yanmei,ZHAO Hailing,LI Ping.Thoughts and strategies of traditional Chinese medicine in preventing and treating diabetic lipotoxic renal injury[J]. Beijing Journal of Traditional Chinese Medicine,2025,44(09):1095-1098. DOI： 10.16025/j.1674-1307.2025.09.002.
摘要
脂毒性肾损伤在糖尿病肾脏病发病机制中占据关键地位，脂质代谢紊乱导致肾脏结构和功能的损伤。中医认为营养过剩或运化代谢功能失常时则形成病理性膏脂，郁积成痰浊、血瘀、浊毒。“脾运失司、痰浊内生；肝失疏泄、气滞瘀阻；浊毒瘀阻、肾络失和”等均可导致糖尿病脂毒性肾损伤的发生发展。因此在治疗中需紧扣“脏腑功能失调、浊毒血瘀内生、脏腑损伤”的核心病机，以肝、脾、肾三脏为核心，把握“三脏联动，代谢同调”，分脏论治。脾为枢纽，治脾化浊，以运为本，以清为功；肝为枢机，治肝调气，以疏为纲，以平为期；肾为根本，治肾补虚，以益为主，以固为调；针对“浊、毒、瘀”等病理产物，化瘀通络，以排为法，以通为要。通过以上运脾、调肝、益肾、通络法，使人体代谢分清泌浊的动态平衡得以恢复，从而延缓糖尿病脂毒性肾损伤的进展，改善患者预后。
Abstract
Lipotoxic renal injury plays a key role in the pathogenesis of diabetic nephropathy， with lipid metabolism disorders leading to structural and functional damage to the kidneys. Traditional Chinese medicine （TCM） holds that when excessive nutrition or dysfunction in transport and metabolism occurs， pathological fat is formed， which accumulates and transforms into phlegm turbidity， blood stasis， and turbid toxins. "Spleen dysfunction leads to internal generation of phlegm turbidity； liver fails in dispersion and dredging， causing qi stagnation and blood stasis； turbid toxins and blood stasis block and disrupt the kidney collaterals"， these mechanisms contribute to the occurrence and progression of diabetic lipotoxic renal injury. Therefore， treatment should focus on the core pathogenesis of "dysfunction of
Zangfu
organs， endogenous turbid toxins and blood stasis， and organ damage"， with the liver， spleen， and kidney as the central targets， emphasizing the "linkage of the thr
ee organs and coordinated metabolism"， and adopting organ-specific therapy. The spleen serves as the hub， treating the spleen and eliminating turbidity， emphasizing transport and cleansing. The liver serves as the pivot， regulating the liver and promoting qi， emphasizing dredging and balance. The kidney serves as the foundation， tonifying the kidney and reinforcing deficiency， emphasizing nourishment and consolidation. Pathological products such as "turbidity， toxins， and stasis" are addressed by resolving stasis and dredging collaterals， emphasizing elimination and patency. Through invigorating the spleen， regulating the liver， tonifying the kidney， and dredging collaterals， the dynamic balance of metabolism and excretion is restored， thereby delaying the progression of diabetic lipotoxic renal injury and improving patient prognosis.
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references
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