正虚血瘀是中医干预肝肾纤维化异病同治的重要病机基础

Positive Qi Deficiency Combined with Blood Stasis is a Significant Pathogenetic Basis of Traditional Chinese Medicine in the Treatment of Liver and Kidney Fibrosis

"异病同治"是"病证结合"诊疗模式的具体体现,其治法确立的关键在于证候病机的辨识,慢性肝肾疾病具有"正虚血瘀"的病机特点,存在补虚化瘀以异病同治的理论基础。采用补虚化瘀治法方药,如扶正化瘀方、当归补血汤或当归黄芪合剂可有效防治肝肾纤维化,扶正化瘀方拆方配伍实验也发现该方抗肝肾纤维化的主效药物为补虚的虫草菌丝与活血化瘀的丹参。进一步药理实验发现扶正化瘀方抗肝肾纤维化有其共性作用机制,包括:抗脂质过氧化损伤;抑制纤维化组织MMP-2/9活性,保护组织微环境;下调TGF-β等促纤维化病理信号转导途径,抑制肌成纤维细胞活化;调节纤维化病理差异表达蛋白质组包括物质代谢、细胞骨架、氧化应激反应等,这些受药物调节的共性病理机制构成肝肾纤维化"正虚血瘀"病机的重要生物学基础。

＂The same treatment for different diseases＂ is the embodiment and a reified mode of ＂the combination of disease and syndrome＂ in the diagnosis and treatment. It is critical to identify the pathogenesis of syndromes through establishing the treatment options. Chronic liver and kidney diseases feature with the pathgenesis of ＂positive qi deficiency combined with blood stasis＂. For its treatment, prescriptions or medications functioning tonifying deficiency and activating blood circulation are adopted. For example, tonifying deficiency and blood-activating therapy involves prescriptions, such as Fuzheng Huayu（FZHY） recipe and Danggui Buxue（DGBX） decoction and angelica mixture of Radix Astragali, presenting favorable efficacy on the protection and treatment of the liver and kidney fibrosis. Experimental studies on the drug compatibility of FZHY recipe found that the main ingredients of the recipe with anti-liver and kidney fibrosis effect were cordyceps（tonifying deficiency） and salvia（activating the blood circulation）. Further pharmacological experiments found that FZHY recipe showed anti-liver and kidney fibrosis effects with the common mechanisms, including anti-lipid peroxidation injury, the inhibition of MMP-2/9 activity and the protection of tissue microenvironment, the down-regulation of TGF-β and other pathological signal transduction pathways, the inhibition of myofibroblast activation, and the regulation of fibrotic pathology differential expressions of proteomics involving material metabolism, cytoskeleton, oxidative stress response. These common mechanisms behind drug regulation composed an important biological basis of the pathogenesis, ＂positive qi deficiency combined blood stasis＂, of liver and kidney fibrosis.