基于线粒体功能障碍探讨从“玄府”论治糖尿病肾病

Exploring the Treatment of Diabetic Nephropathy Based on Mitochondrial Dysfunction from the Perspective of “Xuanfu” Theory

摘要: 糖尿病肾病(Diabetic Kidney Disease, DKD)作为糖尿病最常见的微血管并发症之一，已成为终末期肾脏病的主要原因，其发病机制复杂，涉及代谢紊乱、线粒体功能障碍、氧化应激、炎症反应等多个环节，其中线粒体功能障碍被认为是驱动DKD进展的核心病理机制，线粒体氧化应激、生物合成紊乱、融合与分裂异常、过度自噬等都会导致线粒体功能障碍，进而导致DKD进展。“玄府”是中医理论的重要组成部分，具有流通气液、渗灌血气、转运神机的生理功能。DKD核心病机总属阴虚为本、燥热为标，又与“风”密切相关，病久阴阳两虚，湿痰瘀内生，致使玄府闭塞不通，功能失调，开泄太过，治疗应以通玄、补玄、固玄为法，改善线粒体功能，进而延缓DKD进展。

Abstract: Diabetic kidney disease (DKD) as one of the most common microvascular complications of diabetes, has become the main cause of end stage renal disease (ESRD). Its pathogenesis is complex, involving multiple pathways such as metabolic disorders, mitochondrial dysfunction, oxidative stress, and inflammatory responses. Among these, mitochondrial dysfunction is considered the core pathological mechanism driving the progression of DKD. Mitochondrial oxidative stress, biosynthetic disorders, abnormalities in fusion and fission, and excessive autophagy can all lead to mitochondrial dysfunction, which in turn drives the progression of DKD. The “Xuanfu theory” is an important part of traditional Chinese medicine theory and has physiological functions such as circulating qi and fluids, permeating blood and qi, and transporting spiritual energy. The core pathogenesis of DKD is fundamentally characterized by yin deficiency and superficially by dry heat, and is closely related to “wind”. DKD is characterized by long-term deficiency of both yin and yang, leading to the accumulation of dampness, phlegm, and stasis internally. This results in the obstruction of the Xuanfu, dysfunction, and excessive dispersion. Treatment should focus on unblocking, tonifying, and consolidating the Xuanfu to improve mitochondrial function and thereby slow the progression of DKD.