| 引用本文: |
辛闯, 郝和, 韩瑞洋, 杨宇轩, 王欣怡, 谢宇婷, 李欣烨, 赵文景, 王悦芬.从“三焦-膜原-伏邪-肾络”四位一体探讨糖尿病肾病浊毒病机及临床论治[J].湖南中医药大学学报,2026,46(2):355-359[点击复制] |
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| 从“三焦-膜原-伏邪-肾络”四位一体探讨糖尿病肾病浊毒病机及临床论治 |
| 辛闯,郝和,韩瑞洋,杨宇轩,王欣怡,谢宇婷,李欣烨,赵文景,王悦芬 |
| (首都医科大学附属北京中医医院肾病科, 北京 100010;首都医科大学中医药临床医学院, 北京 100069;北京中医药大学, 北京 100029) |
| 摘要: |
| 糖尿病肾病（DN）迁延难愈的核心病机在于浊毒蕴结与肾络损伤的恶性循环。浊毒理论的提出开辟了DN论治的新视角，但其对DN隐匿起病、伏邪深藏、络损精泄等关键环节的阐释仍有不足。本文创新性地构建“三焦-膜原-伏邪-肾络”四位一体理论体系，该体系提出：三焦气化失司是浊毒生成的病理基础，肾之膜原是伏邪潜匿与浊毒转化传变的枢纽，伏邪深伏是浊毒酝酿的始动因子与持续驱动力，肾络损伤是浊毒致病及疾病进展的最终靶点。四者环环相扣，形成DN“三焦失司-伏邪潜匿-化生浊毒-损伤肾络”的动态病机循环链条。临床论治立足通调三焦气机以杜绝伏邪之源，透达膜原以除伏邪之巢，分消清解浊毒以护肾络，并全程贯穿活血通络之法。该体系整合了三焦气化、伏邪、络病及肾之膜原理论，深化了对DN浊毒病机的认识，并通过现代医学晚期糖基化终末产物-晚期糖基化终末产物受体信号轴（AGEs-RAGE轴）、代谢记忆等研究提供佐证，为DN的中医药精准防治提供了新思路和循证依据。 |
| 关键词: 糖尿病肾病 浊毒 三焦 膜原 伏邪 肾络 |
| DOI：10.3969/j.issn.1674-070X.2026.02.019 |
| 投稿时间：2025-10-05 |
| 基金项目:国家自然科学基金项目(8237151496)。 |
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| Turbid toxin pathogenesis and clinical management of diabetic nephropathy through the integrated framework of “sanjiao, membrane source, latent pathogens, and kidney collaterals” |
| XIN Chuang, HAO He, HAN Ruiyang, YANG Yuxuan, WANG Xinyi, XIE Yuting, LI Xinye, ZHAO Wenjing, WANG Yuefen |
| (Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China;Clinical Medical School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China;Beijing University of Chinese Medicine, Beijing 100029, China) |
| Abstract: |
| The core pathological mechanism behind the chronic and refractory nature of diabetic nephropathy (DN) lies in the maladaptive cycle between the accumulation of turbid toxins and damage to the kidney collaterals. The proposition of the turbid toxin theory has opened up new perspectives for the diagnosis and treatment of DN, yet it remains insufficient in explanations regarding key aspects of this disease such as the insidious onset, deeply latent pathogens, and the loss of essence due to collateral damage. This paper innovatively constructs an integrated theoretical framework of the "sanjiao, membrane source, latent pathogens, and kidney collaterals." This system posits that the failure of the sanjiao's qi transformation constitutes the pathological foundation for turbid toxin formation; the kidney membrane source serves as the pivot for latent pathogen concealment and the transformation and transmission of turbid toxins; deeply entrenched latent pathogens act as the initiating factor and sustained driving force for the brewing of turbid toxins; and kidney collateral damage represents the ultimate target of turbid toxin-induced disease progression. These four interlinked components form a dynamic pathogenic cycle in DN:"sanjiao dysfunction → latent pathogen concealment → turbid toxin generation → kidney collateral damage." In clinical practice, treatment is based on regulating qi movements in sanjiao to eliminate the source of latent pathogens; penetrating and reaching the kidney membrane source to eradicate their nest; dispersing and clearing turbid toxins to protect the kidney collaterals; and consistently applying the methods of circulating blood and unblocking the collaterals throughout the entire treatment course. By integrating the theories of sanjiao qi transformation, latent pathogens, collateral diseases, and the kidney membrane source, the system deepens the understanding of the turbid toxin pathogenesis in DN. Moreover, it is supported by modern medical research on advanced glycation end products-receptor for advanced glycation end products signaling axis (AGEs-RAGE axis) and metabolic memory, thereby providing new ideas and evidence-based approaches for the precise prevention and treatment of DN with Chinese medicine. |
| Key words: diabetic nephropathy turbid toxin sanjiao membrane source latent pathogens kidney collaterals |
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