基于“五脏元真通畅”理论从温阳法论治慢性肾衰竭的研究

Research on the Treatment of Chronic Renal Failure via Yang-Warming Therapy Based on the Theory of Unobstructed Primordial Qi in the Five Zang Organs

摘要: “五脏元真通畅”理论源自于《金匮要略》，是张仲景杂病证治思想精髓。文章以该理论为依据，探讨了温阳法在慢性肾衰竭(CRF)治疗中的应用及其理论依据。结合文献研究、病机推演，发现肾阳虚衰是CRF的核心病机，肾阳为脏腑阳气之本，肾阳式微会导致其他脏腑功能失调，进而形成全身性功能代偿失衡的状态。本文分析了温阳法在CRF治疗中的具体应用，如截邪在表、通里护阳、固补温阳、阴中求阳等治则，进一步阐释了温阳法在恢复肾阳、调节脏腑功能、祛除病理产物等方面的重要作用。温阳法通过温补阳气，恢复脏腑功能，促进气血津液的正常运行，从而达到“五脏元真通畅”的治疗目标。阐释“五脏元真通畅”理论有助于完善CRF的辨证论治体系，为临床治疗本病提供新思路。

Abstract: The theory of “Unobstructed Primordial Qi in the Five Zang Organs” originates from the Synopsis of the Golden Chamber (Jin Gui Yao Lue), encapsulating the essence of Zhang Zhongjing’s therapeutic principles for miscellaneous diseases. Based on this theory, this article explores the application and theoretical foundations of Yang-Warming Therapy in the treatment of chronic renal failure (CRF). Through literature review and pathogenesis analysis, it identifies “decline of Kidney Yang” as the core pathological mechanism of CRF. As Kidney Yang serves as the root of Yang energy in the Zang-fu organs, its deficiency leads to systemic functional imbalance due to compensatory dysregulation of other organs. This study analyzes specific therapeutic strategies of Yang-Warming Therapy in CRF treatment, such as expelling pathogens at the exterior, clearing internal pathogens to protect Yang, consolidating and replenishing Yang, and seeking Yang within Yin, further elucidating its pivotal role in restoring Kidney Yang, regulating Zang-fu functions, and eliminating pathological products (e.g., dampness, turbidity, stasis, and toxins). By warming and tonifying Yang energy, Yang-Warming Therapy revitalizes organ functions and promotes the normal circulation of Qi, blood, and body fluids, thereby achieving the therapeutic goal of “Unobstructed Primordial Qi in the Five Zang Organs.” Clarifying this theory enhances the syndrome differentiation and treatment system for CRF, offering novel insights for clinical management of the disease.