“肝肾同源”理论在肛肠术后尿潴留中的现代机制诠释

Modern Mechanistic Interpretation of the “Homology of Liver and Kidney” Theory in Postoperative Urinary Retention after Anorectal Surgery

摘要: 背景与目的：肛肠手术后尿潴留(POUR)是常见的临床并发症，发生率约为5%~25%。传统中医多从“肝主疏泄”与“肾主气化”角度探讨其病机，而现代医学则强调“神经–体液–免疫”网络的调控失衡。两者虽语境不同，但在探讨局部病理与整体状态的关系上具有相通之处。本研究旨在梳理“肝–肾”病机与现代“神经–体液–免疫”网络机制的对应联系，以期为POUR的临床辨证与中西医结合治疗提供思路。研究方法：通过梳理相关文献，本文首先分析了现代医学关于POUR的网络调控机制，并探讨了其与中医“肝”“肾”生理病理特点的对应关系。研究主要围绕三个方面展开：一是神经内分泌的稳态维持，二是应激反应的动态调节，三是“肝肾同源”的病理交互。本文旨在阐明中医发病机理背后的现代生物学内涵，并据此提出相应的临床协同干预策略。结果与结论：本研究结果提示：1. 中医理论中“肾”藏精、主水，与现代网络中下丘脑–垂体–靶腺轴、线粒体能量代谢等维持生理稳态的机制具有相关性；2. “肝”主疏泄的生理特性，可能与交感–肾上腺髓质轴、局部神经源性炎症等应激反应机制在调节通路上相关；3.“肝肾同源”学说反映出机体在应激状态下的反应过程与能量平衡之间存在相互调节、相互影响的内在联系。术后尿潴留的核心病机多以肾虚气化失司为本，肝郁气滞不畅为标。据此提出的急性应激、功能抑制、迁延不愈三期辩证思路，结合中西医联合干预方案，能够增强临床诊治的精准性与实效性。

Abstract: Background and Objective: Postoperative Urinary Retention (POUR) is a common clinical complication following anorectal surgery, with an incidence of approximately 5%~25%. Traditional Chinese Medicine (TCM) mainly explores its pathogenesis from the perspectives of “Liver governing dispersion” and “Kidney governing Qi transformation”, whereas modern medicine emphasizes the regulatory imbalance of the “Neuro-Endocrine-Immune” (NEI) network. Although the terminologies differ, they share common ground in elucidating the relationship between local pathology and the overall systemic state. This study aims to clarify the correspondence between the “Liver-Kidney” pathogenesis and the modern NEI network mechanisms, to provide novel insights for clinical syndrome differentiation and the integrated Chinese and Western medicine treatment of POUR. Methods: Through a comprehensive literature review combined with modern medical explorations of the NEI mechanisms underlying POUR, this study analyzes its correlation with the physiological and pathological characteristics of the “Liver” and “Kidney” in TCM. From the perspectives of neuroendocrine homeostasis maintenance, stress response regulatory mechanisms, and the systemic interactions of the “Homology of Liver and Kidney”, we explored the modern biological basis of the TCM pathogenesis, and subsequently proposed corresponding clinical intervention strategies. Results and Conclusion: The study indicates that: 1. The “Kidney” in TCM, which governs the storage of essence and water, correlates with mechanisms maintaining physiological homeostasis in the modern network, such as the hypothalamic-pituitary-target gland axis and mitochondrial energy metabolism; 2. The “Liver” in TCM, which governs dispersion, corresponds closely with stress response mechanisms, including the Sympatho-Adrenomedullary (SAM) axis and local neurogenic inflammation; 3. The theory of “Homology of Liver and Kidney” reflects the interactive influence between the body’s stress response and energy homeostasis. The core pathogenesis of POUR can be summarized as “Kidney deficiency with failure of Qi transformation as the root, and Liver depression with Qi stagnation as the manifestation”. The three-phase dynamic syndrome differentiation(acute stress phase, functional inhibition phase, and subacute prolonged phase) and the integrated Chinese and Western medicine collaborative treatment strategy proposed on this basis will help improve the precision and efficacy of clinical diagnosis and treatment.