从肠道微生态探讨“敦土制水”辨治慢性肾脏病的思路

Discussion on the Thoughts of"Cultivating Soil to Prevent Water"in Treating Chronic Kidney Disease from the Perspective of Intestinal Microecological

探讨中医“脾”功能失调与慢性肾脏病肠道微生态失调的内在关系,阐述“脾”影响肠道菌群的组成和功能,机体代谢、免疫功能,从而参与慢性肾脏病的发生发展过程,为中医药“敦土制水”法治疗慢性肾脏病提供现代理论依据。“敦土制水”是我国中西医结合肾脏病奠基人之一陈以平“斡旋三焦”治肾理论体系的重要组成部分。肠道微生物构成的微生态系统在各方面深刻影响着慢性肾脏病的进展与其相关并发症的发生。“脾肾失调”是CKD的病因之本,而脾居中焦,具有“升清”“运化”和“卫”的功能,与肠道菌群的组成和功能及其对机体代谢、免疫等作用相似,肠道菌群的组成平衡和功能稳定可视为“脾主升清”的正常状态。慢性肾脏病患者脾肾亏虚,脾不升清、土不制水,则肠道微生态平衡失调,肠道菌群失去自我稳定状态,组成和功能发生改变,引起CKD的发生发展。“敦土制水”法重在强健脾运,可调节肠道菌群,治疗慢性肾脏病有良好临床疗效。

This article explores the intrinsic relationship between the dysfunction of"spleen"in traditional Chinese medicine and the dysbiosis of the gut microbiota in chronic kidney disease(CKD).It elaborates on the influence of"spleen"on the composition and function of the gut microbiota,as well as the metabolism and immune function of the body,thereby participating in the occurrence and development of CKD.This provided a modern theoretical basis for the treatment of CKD using the"cultivating soil to prevent water"method in traditional Chinese medicine.The term"cultivating soil to prevent water"is an important component of"mediation of the three jiao"theory system for treating kidney disease by CHEN Yiping,one of the founders of integrated traditional Chinese and Western medicine for kidney disease in China.The microbiota composed of gut microbiota has a profound impact on the progress of CKD and the occurrence of related complications in various aspects."Spleen kidney imbalance"is the root cause of chronic kidney disease.The spleen is located in the middle energizer and has the functions of"ascending clearing","promoting circulation",and"defending",which is similar to the composition and function of intestinal microbiota,and its effect on metabolism and immunity function of the body.The composition balance and functional stability of the gut microbiota can be regarded as the normal state of"spleen controlling ascending clearance".CKD patients suffer from spleen and kidney deficiency,where the spleen fails to clear and the soil fails to prevent water.This leads to an imbalance in the gut microbiota,a loss of self stability in the gut microbiota,changes in composition and function,and the occurrence and development of CKD.The"cultivating soil to prevent water"method focuses on strengthening spleen circulation,regulating intestinal flora,and has good clinical efficacy in treating CKD.