基于“主客交–络病”理论探讨虫药在肾纤维化的应用

Exploring the Application of Insect-Derived Medicinals in Renal Fibrosis Based on the Theory of “Host-Pathogen Interaction and Collateral Disease”

摘要: 肾纤维化(renal fibrosis, RF)是慢性肾脏损伤持续进展的重要病理基础，其发生发展涉及损伤迁延与组织修复失衡。本文从“主客交”与络病理论的联系入手，探讨RF的病机演变及虫类药的辨治依据。脾肾虚损使精微化生、输布与固摄失常，肾络因而失于濡养；湿热乘虚留滞，既妨碍络中气血运行，又进一步耗伤正气；瘀血与浊邪相互胶结，则使络阻与失养持续加重，形成病久难复之势。据此，治疗应围绕“强主清客、通络透邪”，将搜风通络、剔痰祛湿、逐瘀散结及扶正固本等法与具体证候相结合。现有实验研究提示，部分虫类及相关动物药或其活性成分具有一定的抗炎、抗纤维化潜力，但临床证据仍较有限，且部分药物存在毒性、过敏及出血风险，应用时应严格掌握剂量、禁忌及配伍。本文旨在为RF的中医辨治及虫类药的规范应用提供理论参考。

Abstract: Renal fibrosis (RF) is an important pathological basis for the progression of chronic kidney injury and involves persistent injury and dysregulated tissue repair. Drawing on the relationship between “host-pathogen interaction” and collateral disease theory, this article explores the evolution of RF pathogenesis and the rationale for the pattern-based use of insect-derived medicinals. Spleen and kidney deficiency impairs the production, distribution, and retention of essential substances, leaving the renal collaterals inadequately nourished. Dampness-heat exploits this deficiency and persists, obstructing the circulation of qi and blood within the collaterals while further depleting healthy qi. The binding of blood stasis and turbid pathogens progressively aggravates collateral obstruction and inadequate nourishment, resulting in a prolonged condition that is difficult to reverse. Accordingly, treatment should focus on “strengthening the host, clearing pathogens, unblocking the collaterals, and expelling latent pathogens.” Therapeutic approaches—including dispelling wind and unblocking the collaterals, removing phlegm and dampness, dispelling blood stasis and resolving masses, and supporting healthy qi and consolidating the root—should be tailored to specific patterns. Existing experimental studies suggest that some insect-derived and related animal medicinals, or their active constituents, have some anti-inflammatory and anti-fibrotic potential; however, clinical evidence remains limited, and some medicinals carry risks of toxicity, allergy, and bleeding, so dosage, contraindications, and compatibility should be strictly observed in practice. This article aims to provide a theoretical reference for the diagnosis and treatment of RF in traditional Chinese medicine and the standardized use of insect-derived medicinals.