| 引用本文: |
杨运劼, 郑敏麟, 余永鑫, 李鹏飞, 阮诗玮, 何友成, 王建挺.基于“肝生血气”探讨从肝虚证辨治肾性贫血[J].湖南中医药大学学报,2025,45(6):1122-1126[点击复制] |
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| 基于“肝生血气”探讨从肝虚证辨治肾性贫血 |
| 杨运劼,郑敏麟,余永鑫,李鹏飞,阮诗玮,何友成,王建挺 |
| (福建中医药大学附属人民医院, 福建 福州 350004;福建中医药大学中西医结合学院, 福建 福州 350122;上海中医药大学附属曙光医院, 上海 201203;上海中医药大学附属龙华医院, 上海 200032) |
| 摘要: |
| 肾性贫血（RA）是慢性肾脏病常见的并发症之一，其形成与血气不生、无法滋养全身脏腑经脉密切相关。肝生血气是气血生成和运行的关键环节，其功能的正常发挥依赖于肝血充盈以滋补肝体、肝气条达以生发肝用，以及脾、肺、心、肾四脏对肝之体用的孜孜濡养。基于“肝生血气”理论，试阐述肝虚证“肝体用俱虚，血气不生”的新内涵。RA以肝血、肝气虚弱，或肝虚致脾、肺、心、肾四脏受损，影响血气化生为核心病机，这与中医学既往多从脾肾两虚、湿浊瘀毒互结致血气不生的视角认识本病不同。治疗上主张以肝为重，调衡体用，燮理四脏，选用左归丸、逍遥散、酸枣仁汤、薯蓣丸等方药，旨在恢复肝生血气功能，从而为RA的治疗提供新思路。 |
| 关键词: 肾性贫血 肝生血气 肝虚证 肝体虚 肝用虚 |
| DOI：10.3969/j.issn.1674-070X.2025.06.021 |
| 投稿时间：2025-03-02 |
| 基金项目:阮诗玮全国名老中医药专家传承工作室建设项目（国中医药人教函〔2022〕75号）；福建省自然科学基金项目（2024J01762，2024J01769）；福建中医药大学附属人民医院中医临床优秀人才研修培养项目（闽人院〔2024〕217号）；福建中医药大学附属人民医院第二批科研团队建设项目（闽人院〔2023〕25号）。 |
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| Differentiating and treating renal anemia from the perspective of liver deficiency pattern based on the theory of "liver generating blood and qi" |
| YANG Yunjie, ZHENG Minlin, YU Yongxin, LI Pengfei, RUAN Shiwei, HE Youcheng, WANG Jianting |
| (The People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350004, China;College of Integrated Traditional Chinese and Western Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China;Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201213, China;Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China) |
| Abstract: |
| Renal anemia (RA) is one of the common complications of chronic kidney disease, and its formation is closely related to the failure of blood and qi generation, which leads to an inability to nourish the body’s organs and meridians. The liver plays a pivotal role in the generation and circulation of blood and qi, which is a process termed “liver generates blood and qi” in TCM. The normal functioning of the liver in this regard relies on the abundance of liver blood to nourish the liver substance, the smooth flow of liver qi to activate its functions, as well as the continuous nourishment of the liver’s substance and functions by the spleen, lung, heart, and kidney. Based on the theory of “liver generating blood and qi”, this paper elucidates the new connotation of “deficiency in both liver substance and function, leading to the failure of blood and qi generation” in liver deficiency pattern. The core pathogenesis of RA is characterized by weakness of liver blood and liver qi, or liver deficiency leading to impairment of the spleen, lung, heart, and kidney, thereby affecting the generation of blood and qi.?This perspective differs from the traditional understanding in TCM, which has predominantly focused on the deficiency of both the spleen and kidney, along with the intermingling of dampness, turbidity, blood stasis, and toxins as the cause of the failure in blood and qi generation. In terms of treatment, it is advocated to prioritize the liver, harmonize its substance and function, regulate the four aforementioned organs, and select formulas such as Zuogui Pill, Xiaoyao Powder, Suanzaoren Decoction, and Shuyu Pill. The aim is to restore the liver’s function of generating blood and qi, thereby providing a novel approach for the treatment of RA. |
| Key words: renal anemia. liver generating blood and qi liver deficiency pattern deficiency of liver substance deficiency of liver function |
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