基于“脾瘅”理论的高尿酸血症中医辨治理论探析

A Theoretical Exploration of Traditional Chinese Medicine Treatment for Hyperuricemia Based on the Theory of “Pi Dan”

摘要: 基于“脾瘅”理论，对高尿酸血症的中医辨治进行了系统梳理与理论探析。通过阐释脾瘅的概念及病因病机，明确其与代谢综合征、高尿酸血症之间的内在联系。脾瘅的核心病机是中满内热(瘅热壅积)所致的膏脂精微及嘌呤代谢紊乱。结合现代医学视角，瘅热壅滞血分、脾失健运、肠肾失司是高尿酸血症发生发展的关键机制。治法上认为在清利中下二焦、促进尿酸排泄的基础思路上，可配合健运脾气、运通血脉的治法以促进代谢、清消瘅热，改善尿酸的生成与排泄失衡。

Abstract: Grounded in the theory of Pi Dan, this work offers a systematic synthesis and theoretical exploration of the traditional Chinese medicine (TCM) pattern differentiation and treatment of hyperuricemia. By elucidating the concept and etiopathogenesis of Pi Dan, it clarifies the intrinsic links between Pi Dan, metabolic syndrome, and hyperuricemia. Central to “Pi Dan” is internal heat accumulation (“Dan Re”), disrupting lipid metabolism and uric acid balance. From a modern medical perspective, Dan Re congesting the blood aspect, failure of the spleen’s transportation and transformation, and dysregulation of intestinal-renal governance are key mechanisms in the onset and progression of hyperuricemia. Therapeutically, on the foundation of clearing and disinhibiting the middle and lower jiao to promote uricacid excretion, one may combine methods that fortify spleenQi and its transportive function and that course the vessels, so as to enhance metabolism, clear and dissipate Dan Re, and rectify the imbalance between uricacid production and excretion.