基于“本源同治”学说探讨当归芍药散治疗小儿肾病综合征的理论内涵与研究进展

Theoretical Connotation and Research Progress of Danggui Shaoyao San in Treating Pediatric Nephrotic Syndrome Based on the “Simultaneous Treatment of Origin” Doctrine

摘要: 基于“脾肾为本”“肝肾同源”“血水同源”构建的“本源同治”学说，为小儿肾病综合征的治疗提供了“养血治水、柔肝健脾”的理论框架。当归芍药散出自《金匮要略》，兼具养血柔肝与健脾利湿之功，契合小儿“脾常不足、肾常虚、肝常有余”的生理特点，是体现该治法的代表方剂。现代药理研究表明，该方通过干预多种途径、信号通路改善免疫炎症，改善微循环与抗凝，保护足细胞及血管内皮，并通过干预肾素–血管紧张素系统(RAAS)与水通道蛋白调节水液代谢。临床研究证实，其可降低24 h尿蛋白定量、减少复发率、辅助激素减停，且安全性良好。目前仍存在对于“本源同治”的理论基础深挖、高质量临床研究不足、机制整体性阐释欠缺等问题。相关研究局限于小样本观察与经验总结，缺乏严谨的循证医学支撑，其科学内涵与作用靶点尚未得到系统揭示。未来亟需开展多中心、大样本随机对照试验，为该治法的临床疗效提供更高级别证据；同时结合网络药理学、分子生物学等现代研究方法，深入解析其核心作用机制与调控通路；并立足儿童体质特点，优化个体化诊疗策略，探索安全有效的精准用药方案，进一步完善“本源同治”的理论体系与临床应用规范。

Abstract: The “Simultaneous Treatment of Origin” (本源同治) doctrine, constructed on the principles of “spleen and kidney as the root,” “liver and kidney sharing the same source,” and “blood and water sharing the same origin,” provides a theoretical framework of “nourishing blood to regulate water and softening the liver to strengthen the spleen” for the treatment of pediatric nephrotic syndrome (PNS). Danggui Shaoyao San (DSS), originating from Synopsis of the Golden Chamber (Jingui Yaolue), possesses the dual functions of nourishing blood and softening the liver as well as strengthening the spleen and promoting dampness excretion. It aligns with the physiological characteristics of children—“the spleen is often insufficient, the kidney is often deficient, and the liver is often in excess”—making it a representative formula embodying this therapeutic approach. Modern pharmacological studies have demonstrated that DSS ameliorates immune-inflammatory responses, improves microcirculation and anticoagulation, protects podocytes and vascular endothelium, and regulates water metabolism through intervention in the renin-angiotensin-aldosterone system (RAAS) and aquaporins via multiple pathways and signaling cascades. Clinical studies have confirmed that DSS can reduce 24-hour urinary protein excretion, lower relapse rates, and assist in glucocorticoid tapering and discontinuation, with a favorable safety profile. However, current research still faces several limitations: insufficient in-depth exploration of the theoretical foundation of “Simultaneous Treatment of Origin,” a lack of high-quality clinical studies, and an incomplete holistic elucidation of mechanisms. Existing studies are largely confined to small-sample observations and empirical summaries, lacking rigorous evidence-based medical support, and the scientific connotation and action targets of DSS have not yet been systematically revealed. Future research urgently requires multicenter, large-sample randomized controlled trials to provide higher-level evidence for the clinical efficacy of this therapeutic approach. Concurrently, modern research methods such as network pharmacology and molecular biology should be integrated to deeply analyze the core mechanisms and regulatory pathways. Furthermore, individualized diagnostic and therapeutic strategies should be optimized based on the constitutional characteristics of children, safe and effective precision medication regimens should be explored, and the theoretical system and clinical application standards of “Simultaneous Treatment of Origin” should be further refined.