“辨体－辨病－辨证”诊疗模式结合治未病理论防治肥胖型2型糖尿病肾病的全程策略*

作者：刘旭龙1，韩佳瑞1,2

单位：1.河南中医药大学第二临床医学院，河南 郑州 450002； 2.河南省中医院/河南中医药大学第二附属医院，河南 郑州 450002

引用：引用：刘旭龙，韩佳瑞.“辨体－辨病－辨证”诊疗模式结合治未病理论防治肥胖型2型糖尿病肾病的全程干预策略[J].中医药导报,2026,32(4):102-108,119.

DOI：10.13862/j.cn43-1446/r.2026.04.016

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摘要：

肥胖型2型糖尿病肾病是一种具有高发病率、进行性发展的糖尿病并发症，已成为全球公共卫生的重要挑战。本文系统综述了基于中医“治未病”理论与“辨体-辨病-辨证”诊疗模式的全程防治研究进展与临床策略。在单纯性肥胖时期，以体质辨识为核心，辨体调理改善痰湿、气虚等肥胖相关偏颇体质为主，辅以辨证调治，实现“未病先防”。糖尿病前期，采用辨体为主、辨病为辅的模式，针对高危体质联合代谢指标干预，实现“欲病救萌”。肥胖型2型糖尿病时期，应用辨体与辨病并重、辨证为辅的模式，调理体质特征并干预核心病机，延缓并发症发生。肥胖型2型糖尿病肾病早期阶段，以辨病与辨证为主、结合辨体论治，针对疾病病理与核心证候重点干预，体现“既病防变”。肥胖型2型糖尿病肾病中期阶段，应用三辨融合模式，侧重辨析疾病阶段与证候虚实主次，针对“脾肾虚损、痰瘀癥瘕”病机截断病势。肥胖型2型糖尿病肾病晚期阶段，则综合应用三辨协同诊疗模式，立足预防尿毒症。这些分阶段、动态调整的干预措施，共同构成了一个“未病先防、欲病救萌、既病防变”的防治体系。

关键词：肥胖；2型糖尿病肾病；治未病；三辨模式；防治体系

Abstract：

Obese type 2 diabetic nephropathy is a progressive diabetic complication with a high incidence rate, which has become an important challenge to global public health. This article systematically reviews the research progress and clinical strategies of whole-course prevention and treatment for obese type 2 diabetic nephropathy based on the theory of Preventive Treatment of Disease in traditional Chinese medicine (TCM) and the "Constitution-Disease-Syndrome Differentiation (Triple Differentiation)" diagnostic and therapeutic model. In the simple obesity stage, constitution identification is the core, focusing on regulating the biased constitutions related to obesity such as phlegm-dampness and qi deficiency, supplemented by syndrome differentiation and treatment, so as to achieve "prevention before disease onset". In the prediabetic stage, a model with constitution differentiation as the main and disease differentiation as the auxiliary is adopted, and interventions are carried out for high-risk constitutions combined with metabolic indicators to achieve "early intervention at the nascent stage of disease". In the obese type 2 diabetes stage, a model with equal emphasis on constitution and disease differentiation, supplemented by syndrome differentiation, is applied to regulate constitutional characteristics and intervene in the core pathogenesis, so as to delay the occurrence of complications. In the early stage of obese type 2 diabetic nephropathy, disease and syndrome differentiation are the main focus combined with constitution-based treatment, and targeted interventions are carried out for the pathological changes and core syndromes of the disease, embodying "preventing disease progression after its onset". In the middle stage of obese type 2 diabetic nephropathy, an integrated Triple Differentiation model is used, focusing on analyzing the disease stage and the priority of deficiency and excess syndromes, and targeting the pathogenesis of "spleen-kidney deficiency with phlegm-stasis accumulation and abdominal mass" to interrupt the disease progression. In the advanced stage of obese type 2 diabetic nephropathy, a collaborative Triple Differentiation model is comprehensively applied, focusing on preventing the occurrence of uremia. These phased and dynamically adjusted intervention measures collectively form a complete prevention and treatment system featuring "prevention before disease onset, early intervention at the nascent stage of disease, and prevention of disease progression after its onset" for obese type 2 diabetic nephropathy.

Key words：obesity; type 2 diabetic nephropathy; TCM theory of preventive treatment of disease; constitution-disease-syndrome differentiation model (triple differentiation) model; prevention and treatment system

发布时间：2026-04-26

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