中医杂志

总结王耀献教授基于“内热致癥”从脾胃论治糖尿病肾脏疾病（DKD）的临证经验。认为内热致癥是DKD的核心病机，脾胃为内热之源，治疗主张从脾胃论治。DKD早期脾胃失运，内热始生，常见胃肠结热、肝胃郁热证，分别以葛根芩连汤加减清泄热结，大柴胡汤加减清胃疏肝；DKD中期脾胃虚弱，癥瘕初成，常见脾虚湿盛、脾肾两虚证，分别以升阳益胃汤加减健脾化湿、升阳益胃，参芪地黄汤加减补益脾肾、散结消癥；DKD晚期脾胃衰败，浊毒肆虐，常见湿浊中阻、脾肾阳虚证，分别以大黄甘草汤合橘皮竹茹汤加减化浊和胃，保元汤合理中汤加减温肾暖脾兼泄浊。临证时根据具体证型灵活选用方药施治。

This paper summarizes Professor WANG Yaoxian's experience in treating diabetic kidney disease(DKD) from the perspective of spleen and stomach based on the "internal heat leading to concretions" theory. It is considered that internal heat leading to concretions constitutes the core pathogenesis of DKD, with the spleen and stomach serving as the source of internal heat; therefore, treatment should be based on regulating the spleen and stomach. In the early stage of DKD, dysfunction of the spleen and stomach leads to the initial generation of internal heat. Common syndrome patterns include gastrointestinal heat accumulation and constrained heat in the liver and stomach, for which modified Gegen Qinlian Decoction （葛根芩连汤） can be used to clear heat bind while modified Dachaihu Decoction （大柴胡汤） is used to clear stomach and soothe liver, respectively. In the middle stage of DKD, weakness of the spleen and stomach results in the initial formation of concretions and conglomerations. Common pat‑terns include spleen deficiency with prevalence of dampness and deficiency of both the spleen and kidney. Treatment emphasizes strengthening the spleen and resolving dampness, raising yang and boosting the stomach with modified Shengyang Yiwei Decoction （升阳益胃汤）, or supplementing spleen and boosting kidney, dissipating bind and dispering concretions with modified Shenqi Dihuang Decoction （参芪地黄汤）, respectively. In the late stage of DKD, it is characterized by spleen and stomach depletion, and rampant accumulation of turbidity and toxin, and the common syndrome patterns are damp-turbidity obstruction in the middle jiao （焦） and spleen-kidney yang deficiency. Treatment aims to remove turbidity and harmonize the stomach, or to warm the kidney and strengthen the spleen while eliminating turbidity, using modified Dahuang Gancao Decoction（大黄甘草汤） and Jupi Zhuru Decoction （橘皮竹茹汤） or modified Baoyuan Decoction （保元汤） and Lizhong Decoction （理中汤）, respectively. In clinical practice, appropriate formulas and medications are flexibly selected according to specific syndromes.