| 张喆,段炳琪,刘瑜.李平“肝脾肾同治”理念指导老年糖尿病肾病论治的理论探析[J].中国临床保健杂志,2026,29(3):404-408. |
| 李平“肝脾肾同治”理念指导老年糖尿病肾病论治的理论探析 |
| Theoretical exploration of the treatment of diabetic kidney disease in the elderly under the guidance of Li Ping′s concept of "treating the liver,spleen,and kidney simultaneously" |
| 投稿时间：2026-02-27 |
| DOI：10.3969/J.issn.1672-6790.2026.03.021 |
| 中文关键词: 糖尿病肾病 名医经验 辨证论治 标本兼治 老年人 |
| 英文关键词: Diabetic nephropathies Famous doctor′s experience Treating both symptoms and radical Treatment based on syndrome differentiation Aged 〖FL |
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| 中文摘要: |
| 老年糖尿病肾病(DKD)病程迁延、病机虚实错杂,且老年患者多兼年高肾精渐亏、脾气渐虚、久病入络与多病共存,用药耐受性和证候层次更为复杂。现代医学虽可通过降糖、降压、调脂及肾脏保护治疗延缓进展,但患者远期不良事件风险依旧较高。李平教授基于长期中西医结合肾病临床与基础研究,提出“以肾为根、以脾为本、以肝为枢”的“肝脾肾同治”学术思想,结合老年患者年高体衰、肾精渐亏、脾虚失运、肝气易郁及络脉瘀阻常较突出的特点,认为老年DKD虽病位在肾,但其发生发展实为先天肾精亏虚、后天脾失升清、肝失疏泄枢机不利相互影响之结果,病机以肝、脾、肾亏虚为本,以湿、热、瘀、浊、毒互结为标,并呈由气阴两虚渐至阴阳两虚、由络脉失和渐至癥瘕浊毒胶结的动态演变。治疗上强调分期辨治、三脏同调、补泻兼施:早期重在滋水涵木、疏肝清热、益气固摄；中期重在健脾益气、培土制水、活血通络、疏利三焦；晚期重在温补脾肾、暖肝助阳、泄浊解毒。本文对李平教授“肝脾肾同治”论治老年DKD的理论源流、分期病机、方药特色及现代科学内涵加以系统梳理,以期为老年DKD中医辨证治疗提供参考。 |
| 英文摘要: |
| The course of senile diabetic kidney disease (DKD) is prolonged,the pathogenesis is mixed,and the elderly patients are often accompanied by high kidney essence deficiency,spleen qi deficiency,long-term disease entering collaterals and multiple diseases,and the drug tolerance and syndrome level are more complicated.Although modern medicine can delay progress through hypoglycemic,antihypertensive,lipid-lowering and renal protection treatment,the risk of long-term adverse events in patients is still high.Based on the long-term clinical and basic research of integrated traditional Chinese and Western medicine for kidney disease,Professor Li Ping put forward the academic thought of " simultaneous treatment of liver,spleen and kidney " with " kidney as the root,spleen as the root and liver as the pivot." Combined with the prominent characteristics of senile patients,such as high age and body failure,gradual loss of kidney essence,spleen deficiency and loss of transport,liver qi depression and collateral stasis,it is believed that although the disease location of senile DKD is in the kidney,its occurrence and development are actually the result of congenital deficiency of kidney essence,acquired spleen failure to ascend and clear,and liver failure to disperse the pivot.The pathogenesis is based on the deficiency of liver,spleen and kidney,and the symptoms are dampness,heat,stasis,turbidity and toxin.It showed a dynamic evolution from deficiency of both qi and yin to deficiency of both yin and yang,from loss of collaterals to turbidity and toxin cementation of Zhengjia.In the treatment,it is emphasized that the treatment should be based on syndrome differentiation and treatment by stages,the three internal organs should be coordinated,and the combination of tonifying and reducing should be carried out.In the early stage,the emphasis should be placed on nourishing water and wood,soothing liver and clearing heat,benefiting qi and consolidating;in the middle stage,it focuses on invigorating spleen and replenishing qi,cultivating soil to make water,promoting blood circulation and dredging collaterals,and dredging triple energizer;in the late stage,the emphasis is on warming and tonifying spleen and kidney,warming liver and helping yang,relieving turbidity and detoxification.This article systematically sorts out the theoretical origin,staging pathogenesis,prescription characteristics and modern scientific connotation of Professor Li Ping′s " simultaneous treatment of liver,spleen and kidney " in the treatment of elderly DKD,in order to provide reference for TCM syndrome differentiation and treatment of elderly DKD. |
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