基于“脾肾互赞”理论探讨肝肾综合征的病机与治疗

Exploration of the Pathogenesis and Treatment of Hepatorenal Syndrome Based on the Theory of “Mutual Promotion between Spleen and Kidney”

摘要: 肝肾综合征(Hepatorenal Syndrome, HRS)是肝病晚期出现的功能性肾衰竭，西医治疗仍有部分患者反应不佳。文章梳理李中梓“脾肾互赞”理论的内涵与源流，提出HRS的核心病机为脾肾互赞失司。肝病日久累及脾肾，脾不运化精微以充肾精，肾不温煦脾土以助运化，精亏阳衰互为因果，终致水毒互结。据此确立“奠中固下、精阳兼济”治法体系，提出奠中健运脾胃以复“脾赞肾”之职，固下补肾固精以保“肾赞脾”之质，精阳兼济填精温阳并举，佐以疏肝理气、宣肺利水等整体调治，并附验案印证。

Abstract: Hepatorenal syndrome (HRS) is a functional renal failure occurring in the advanced stage of liver disease, for which some patients still respond poorly to Western medical therapy. This paper reviews the connotation and origin of the theory of “Mutual Promotion between Spleen and Kidney” proposed by Li Zhongzi in the Ming Dynasty, and proposes that the core pathogenesis of HRS lies in the failure of this mutual promotion. It is held that prolonged liver disease involves the spleen and kidney: the spleen fails to transport and transform essential substances to replenish kidney essence, while the kidney fails to warm the spleen earth to assist transportation and transformation. Deficiency of essence and decline of yang become mutually causative, eventually leading to the intermingling of water and toxin. Accordingly, a therapeutic system of “stabilizing the middle, consolidating the lower, and combining essence with yang” is established. Specifically, stabilizing the middle means fortifying the spleen and stomach to restore the spleen’s role of “supporting the kidney”; consolidating the lower means tonifying the kidney and securing essence to ensure the kidney’s quality of “supporting the spleen”; combining essence with yang simultaneously replenishes essence and warms yang to revive the dynamic of inter-rooted essence and yang. This is complemented by holistic viscera regulation, such as soothing the liver and regulating qi, as well as ventilating the lung and promoting diuresis. A proven case is also appended for validation.