慢性肾脏病3~5期气阴两虚证中医辨治与创新探析

Differentiation, Treatment and Innovative Analysis of Qi-Yin Deficiency Syndrome in Stage 3~5 Chronic Kidney Disease

摘要: 气阴两虚是慢性肾脏病3~5期核心病机。本文梳理该证候演变规律与益气养阴方药体系，构建气虚、阴虚、血瘀分别对应线粒体损伤、神经内分泌免疫紊乱、肾微循环障碍的证–机–效理论体系，提出益气养阴·梯级祛邪治则，依据肾功能分期量化划分攻补权重，建立分层用药规范。该治则实现动态精准辨证，弥补传统论治配比模糊的短板。后续应完善量化辨证标准，开展临床试验验证分层方案，并打造基层适用诊疗方案。

Abstract: Qi-yin deficiency constitutes the core pathogenesis of chronic kidney disease (CKD) stages 3~5. This paper sorts out the evolution rule of this syndrome and the prescription system for replenishing qi and nourishing yin. A syndrome-mechanism-efficacy theoretical framework is established, in which qi deficiency, yin deficiency and blood stasis correspond to mitochondrial injury, neuroendocrine-immune disorder and renal microcirculation disturbance respectively. The therapeutic principle of replenishing qi and nourishing yin with stepwise pathogen elimination is proposed. The weight of tonification and purgation is quantitatively divided according to renal function stages, and standardized hierarchical medication protocols are formulated. This therapeutic principle enables dynamic and precise syndrome differentiation and remedies the deficiency of ambiguous proportioning in traditional treatment. Further research should improve quantitative criteria for syndrome differentiation, conduct clinical trials to verify the hierarchical regimen, and develop grassroots-applicable diagnosis and treatment protocols.