从“风”论治蛋白尿及荆防败毒散的应用与 机制研究

Study on Wind Pathogen-Oriented Treatment for Proteinuria and Practical Application as Well as Functional Mechanism of Jingfang Baidu San

摘要: 蛋白尿作为慢性肾脏病的典型临床表现之一，是推动肾功能持续衰退的危险因素，对患者疾病预后影响显著。在临床采用西医治疗手段时，通常选用糖皮质激素、ACEI/ARB制剂与免疫抑制剂作为主要治疗药物，但存在靶点单一、不良反应明显、经济负担重、部分患者病情易反复等问题。中医无“蛋白尿”对应的病名，依据其临床表现归属于精气外泄范畴，本病核心病机为脾肾两虚、精关不固，以本虚标实为基本特征。本文从风邪致病特点、风药理论、玄府学说出发，系统分析荆防败毒散的配伍特点、现代药理作用及六经辨证加减规律，为中医药从“风”论治蛋白尿提供理论与实验依据，为慢性肾脏病蛋白尿的中西医结合防治提供新方向。

Abstract: As a typical clinical manifestation of chronic kidney disease, proteinuria can progressively exacerbate renal function damage and adversely affect patients’ long-term prognosis. At present, glucocorticoids, ACEI/ARB agents and immunosuppressants are commonly applied in Western medical symptomatic treatment. Nevertheless, such therapeutic regimens are restricted by single pharmacological targets, obvious adverse reactions, high medical expenses and frequent disease recurrence. There is no specific medical term corresponding to proteinuria in traditional Chinese medicine (TCM). According to its clinical manifestations, proteinuria is categorized as the leakage of essential qi. Its core pathogenesis lies in spleen and kidney deficiency as well as insecure essence gate, presenting a pathological feature of root deficiency and superficial excess. Based on the pathogenic characteristics of wind pathogen, wind medicine theory and sweat pore theory, this paper systematically sorts out the compatibility characteristics and modern pharmacological effects of Jingfang Baidu San, and summarizes its modification rules under the six-meridian differentiation. This study intends to consolidate theoretical and experimental foundations for the TCM treatment of proteinuria from the wind perspective, and provide innovative insights for the integrated Chinese and Western medical prevention and treatment of proteinuria in chronic kidney disease.