从“肾者，胃之关”探析慢性肾衰竭胃肠功能障碍的病机与治法

Approach to Pathogenesis and Therapeutic Methods of Gastrointestinal Dysfunction in Chronic Renal Failure Based on “The Kidney Is the Gate of the Stomach”

摘要: 慢性肾衰竭患者常合并恶心、呕吐、纳差等胃肠道症状，临床多从脾胃辨证施治，然而单纯调治脾胃常收效欠佳。本文立足于《素问·水热穴论》“肾者，胃之关也”经典理论，结合现代“肠–肾轴”学说，提出肾失气化、关门失司、浊毒上逆为慢性肾衰竭胃肠道症状核心病机。文中梳理出“肾虚→关门不利→浊毒蕴蓄→上逆犯胃”的病机传变脉络，阐释通腑泄浊法“启胃关以通肾关”的内在施治逻辑，并以小承气汤合旋覆代赭汤为例探析组方要义与临证运用，旨在为肾源性胃肠功能障碍的中医辨治提供理论参考。

Abstract: Patients with chronic renal failure often suffer from gastrointestinal symptoms such as nausea, vomiting and poor appetite. Clinically, treatment is mostly based on syndrome differentiation of the spleen and stomach, yet simple regulation of the spleen and stomach often yields unsatisfactory efficacy. Based on the classic theory of “the kidney is the gate of the stomach” from Suwen·Shuirexue Lun, combined with the modern “gut-kidney axis” theory, this paper proposes that impaired qi transformation of the kidney, dysfunction of gate control and upward counterflow of turbid toxin constitute the core pathogenesis of gastrointestinal symptoms in chronic renal failure. This article sorts out the pathogenesis transmission sequence of “kidney deficiency → dysfunction of gate control → accumulation of turbid toxin → upward counterflow attacking the stomach”, and illustrates the internal therapeutic logic of “unblocking the stomach gate to dredge the kidney gate” by the method of dredging fu-organs and descending the turbid. Taking Xiaochengqi Decoction combined with Xuanfu Daizhe Decoction as an example, this paper explores the prescription essentials and clinical application, so as to provide theoretical reference for TCM syndrome differentiation and treatment of renal-derived gastrointestinal dysfunction.