基于“骨肉不相亲”理论探讨慢性肾脏病–矿物质与骨异常的脾肾病机及治疗思路

Discussion on the Spleen-Kidney Pathogenesis and Treatment Approaches of Chronic Kidney Disease-Mineral and Bone Disorder Based on the Theory of “Disharmony between Bone and Flesh”

摘要: 慢性肾脏病–矿物质与骨异常(CKD-MBD)是慢性肾脏病(CKD)常见并发症，主要表现为矿物质与骨代谢异常、骨骼损害及肌肉功能下降等，严重影响患者生活质量。现代医学治疗主要围绕纠正钙磷代谢紊乱、改善相关并发症及延缓疾病进展展开，但整体干预仍存在一定局限。中医学根据其骨痛、骨萎、肌肉失养等临床表现，多将其归属于“骨痿”范畴，认为其发生发展与脾肾亏虚、精血不足、骨肉失养密切相关。“骨肉不相亲”理论源于《黄帝内经》，是中医学关于骨肉关系及其病理变化的重要认识。后世医家结合“肾主骨生髓”“脾主肌肉四肢”等藏象理论，逐渐形成脾肾两虚、骨肉失和的病机认识。基于该理论，肾性骨病的发生可概括为肾精亏虚、髓失充养导致骨失所养，脾失健运、气血化源不足导致肉失所荣，最终形成骨肉失和的病理状态。本文基于“骨肉不相亲”理论，从脾肾关系、骨肉失养及病机演变等方面探讨肾性骨病的中医认识，并提出健脾益肾、调和骨肉的治疗思路。针对肾虚骨亏、脾虚肉损及脾肾两虚等不同病理阶段，可分别采用补肾填精、健脾益气及脾肾同调等治法。该理论为肾性骨病的中医辨治提供了新的理论视角，但目前相关研究仍以理论阐释和临床观察为主，未来需结合现代医学研究方法进一步探索其作用基础。

Abstract: Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a common complication of chronic kidney disease (CKD), which mainly manifests as mineral and bone metabolism abnormalities, bone damage and muscle function decline, which seriously affect the quality of life of patients. Modern medical treatment mainly focuses on correcting calcium and phosphorus metabolism disorders, improving related complications and delaying disease progression, but the overall intervention still has certain limitations. According to the clinical manifestations of bone pain, bone wilt, muscle dystrophy and so on, traditional Chinese medicine mostly attributes it to the category of “bone wilt”, and believes that its occurrence and development are closely related to spleen and kidney deficiency, blood essence deficiency, bone and meat dystrophy. The theory of “disharmony between bone and flesh” originated from the Yellow Emperor’s Canon of internal medicine, which is an important understanding of the relationship between bone and flesh and its pathological changes in traditional Chinese medicine. Later generations of doctors combined with the theory of “kidney governs bone and marrow”, “spleen governs muscle and limbs”, and gradually formed the understanding of the pathogenesis of spleen kidney deficiency and bone and flesh loss. Based on this theory, the occurrence of renal bone disease can be summarized as deficiency of kidney essence, bone loss due to marrow insufficiency, spleen failure and insufficient source of Qi and blood, resulting in the loss of meat and ultimately the pathological state of bone and meat loss. Based on the theory of “disharmony between bone and flesh”, this paper discusses the TCM understanding of renal bone disease from the aspects of spleen kidney relationship, bone and flesh dystrophy and pathogenesis evolution, and puts forward the treatment ideas of strengthening spleen and kidney, and harmonizing bone and flesh. According to the different pathological stages of kidney deficiency and bone deficiency, spleen deficiency and meat damage, spleen and kidney deficiency, we can adopt the treatment methods of Tonifying the kidney and replenishing essence, invigorating the spleen and replenishing qi, and regulating the spleen and kidney respectively. This theory provides a new theoretical perspective for the TCM syndrome differentiation and treatment of renal bone disease, but at present, the relevant research is still based on theoretical interpretation and clinical observation. In the future, it is necessary to further explore its role basis in combination with modern medical research methods.