从“虚、瘀、浊”互结探讨糖尿病肾病气化失常的病机演变

Exploring the Pathogenesis Evolution of Qi Transformation Dysfunction in Diabetic Nephropathy from the Perspective of the Interplay among “Deficiency, Stasis, and Turbidity”

摘要: 糖尿病肾病是临床常见的糖尿病微血管并发症，是导致终末期肾病的首要病因，但本病病机较为复杂，且病程缠绵、病情易反复、预后较差。中医学将本病归纳为“消渴肾病”范畴，认为本虚标实为本病核心病机。中医认为，气化是人体维持各项生命活动的重要生理过程，故笔者基于气化理论，结合中医经典文献及现代研究，系统梳理了糖尿病肾病发生发展过程中气化失常的病机演变规律，阐释了“虚、瘀、浊”在疾病发生中的关联。正气亏虚为本病气化失常之始，瘀血内阻是贯穿疾病全程、导致气化失常的关键枢纽，而浊邪是本病发展过程中的重要助推因素，是导致终末期肾病的主要原因。笔者从气化理论视角，阐释了糖尿病肾病的病机演变过程，旨在为中医药防治糖尿病肾病提供理论依据，为临床治疗提供思路。

Abstract: Diabetic nephropathy (DN) is a common diabetic microvascular complication and the leading cause of end-stage renal disease. However, its pathogenesis is complex, with a protracted course, frequent relapses, and poor prognosis. In traditional Chinese medicine (TCM), DN is categorized under “Xiao Ke Shen Bing” (kidney disease secondary to diabetes), with deficiency of the root and excess of the manifestation recognized as its core pathogenesis. TCM holds that Qi transformation (Qi Hua) is a vital physiological process sustaining all life activities. Therefore, based on the theory of Qi transformation and integrating classical TCM literature with modern research, this paper systematically reviews the pathogenesis evolution of Qi transformation dysfunction in the occurrence and progression of DN, elucidating the interrelationships among “deficiency (Xu), stasis (Yu), and turbidity (Zhuo)”. Deficiency of vital Qi (Zheng Qi) is the initiating factor of Qi transformation dysfunction in this disease; blood stasis is the key pivot running through the entire disease course and leading to Qi transformation dysfunction; turbid pathogen is an important promoting factor during disease progression and the primary cause leading to end-stage renal disease. From the perspective of Qi transformation theory, this paper elucidates the pathogenesis evolution of DN, aiming to provide a theoretical basis for the TCM prevention and treatment of DN and to offer clinical insights.