通讯作者: 王丽, wl15840214382@qq.com

DOI：10.12201/bmr.202605.00036

Based on the principle of

• 摘要：本文以叶天士“上下交损,当治其中”理论为中心,系统探讨糖毒性在DKD演变中的核心作用,并构建相应辨治体系。DKD常多系统受累表现为“上损心肺、下伤肝肾”的复杂病理状态,其根源在于中焦失运,水谷不化而异生“糖毒”。糖毒性作为始动因素,随病程进展由浅入深:积聚期壅滞中焦,导致气机升降失常；耗散期气虚血瘀,虚实夹杂；虚损期胶结成癥,致使阴阳两虚。据此确立“治中”为主导,分期论治:积聚期糖毒聚积中焦健脾化浊、苦酸泄热以截病势；耗散期益气养阴、通络化糖以修复损；虚损期泄浊消癥,扶正祛邪。该策略旨在通过恢复脾胃运化功能以阻断糖毒源头,解决上下同病的局面,为提高DKD临床疗效提供了具有中医特色的诊疗方案。

  关键词： DKD 上下交损; 治其中 糖毒性; 

   

  Abstract: This article centers on Ye Tianshis theory that when the upper and lower parts are damaged, the middle part should be treated, systematically explores the core role of glycotoxicity in the evolution of DKD(DKD), and constructs the corresponding diagnosis and treatment system. DKD often involves multiple systems and is characterized by a complex pathological state of upper damage to the heart and lungs and lower damage to the liver and kidneys. The root cause lies in the failure of the middle jiao to transport and transform, resulting in the generation of sugar toxins due to the lack of digestion of food and water. Glycotoxicity, as the initiating factor, progresses from superficial to profound as the disease progresses: during the accumulation stage, it blocks the middle jiao, leading to abnormal ascending and descending of qi movement; During the dissipation period, there is qi deficiency and blood stasis, with a mixture of deficiency and excess. During the period of deficiency and loss, the syndrome of cemented formation occurs, resulting in deficiency of both Yin and Yang. Based on this, the principle of treating the middle is established as the leading approach, and treatment is carried out in stages: during the accumulation period, when sugar toxins accumulate in the middle jiao, strengthening the spleen, eliminating turbidity, and using bitter and sour flavors to clear heat can curb the progression of the disease. During the dissipation period, it is necessary to tonify qi and nourish Yin, unblock meridians and dissolve sugar to repair damage. During the period of deficiency and weakness, it is necessary to eliminate turbidity and symptoms, support the bodys resistance and expel pathogenic factors. This strategy aims to block the source of glucotoxicity by restoring the spleen and stomachs transformation and transportation functions, solve the situation of the same disease in the upper and lower parts, and provide a diagnosis and treatment plan with traditional Chinese medicine characteristics for improving the clinical efficacy of DKD.

  Key words: DKD; When there is a loss between the upper and lower parts, treat the middle part; glucose toxicity

  提交时间：2026-05-09

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2026-03-04	10.12201/bmr.202605.00036V1	下载

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