温肾健脾泻浊法干预慢性肾脏病合并肾性贫血的研究进展

Research Progress on the Intervention of Chronic Kidney Disease Complicated with Renal Anemia by the Method of Warming Kidney, Strengthening Spleen, and Purging Turbidity

摘要: 目的：系统梳理温肾健脾泻浊法治疗慢性肾脏病(Chronic Kidney Disease, CKD)合并肾性贫血(Renal Anemia, RA)的研究现状，为临床诊疗与科研设计提供参考。方法：检索近十年相关文献，从中医病因病机、治则方药、临床研究证据及现代医学作用机制等方面进行归纳分析。结果：RA核心病机为脾肾阳虚为本、湿浊瘀毒为标，温肾健脾泻浊法切中病机，临床应用广泛。随机对照试验证实，该治法联合西医常规治疗可显著提升患者血红蛋白水平，改善铁代谢，降低促红细胞生成素抵抗，总有效率为85%~100%。现代机制研究表明，该治法可通过调控脯氨酰羟化酶–低氧诱导因子–促红细胞生成素(PHD-HIF-EPO)信号通路、抑制微炎症、改善造血微环、保护残余肾功能等多途径发挥作用。结论：温肾健脾泻浊法是治疗CKD合并RA的有效治则，但目前仍存在辨证标准化不足、机制研究深度不够、高质量循证证据缺乏等问题，后续研究需着力于推进辨证标准化、深化机制探索与优化给药方案，以提升其临床转化价值。

Abstract: Objective: To systematically review the research progress of the Warming Kidney, Strengthening Spleen, and Purging Turbidity Method in the treatment of CKD complicated with RA, and to provide references for clinical practice and scientific research design. Methods: Relevant literature of the past decade was retrieved and analyzed with respect to traditional Chinese medicine (TCM) etiology and pathogenesis, therapeutic principles and formulas, clinical evidence, and modern pharmacological mechanisms. Results: The core pathogenesis of RA is spleen-kidney yang deficiency as the root cause and damp-turbidity, blood stasis and toxin retention as the branch manifestations. The Warming Kidney, Strengthening Spleen, and Purging Turbidity Method, which targets this pathogenesis, has been widely applied in clinical practice. Randomized controlled trials have confirmed that this method combined with conventional Western medicine can significantly increase hemoglobin levels, improve iron metabolism, and reduce erythropoietin resistance, with a total effective rate of 85%~100%. Modern mechanistic studies indicate that this method exerts therapeutic effects through multiple pathways, including regulating the PHD-HIF-EPO signaling pathway, inhibiting micro-inflammation, improving the hematopoietic microenvironment, and protecting residual renal function. Conclusion: The Warming Kidney, Strengthening Spleen, and Purging Turbidity Method is an effective therapeutic principle for CKD complicated with RA. However, problems remain, such as insufficient standardization of syndrome differentiation, limited depth of mechanistic research, and lack of high-quality evidence. Future studies should focus on promoting standardized research, deepening mechanistic exploration, and optimizing administration regimens to enhance its clinical translation value.