从"戊癸合化火"视角探讨二黄益肾颗粒治疗糖尿病肾病合并慢性肾衰竭的病机及治疗OA

Based on the theoretical origin of"Wu(戊)-Gui(癸)combining to transform into fire"from the Su Wen(《素问》),this study innovatively proposes that the core pathogenesis of diabetic kidney disease(DKD)with chronic renal failure(CRF)is an"imbalance in the Wu-Gui combining to transform into fire."This theory breaks through the traditional Chinese medicine(TCM)therapeutic framework centered on the spleen and kidney,and systematically constructs the dynamic mutual-transformation mechanism of the"stomach(Wu)-kidney(Gui)axis"in terms of nutrient transformation,fluid metabolism,and Qi(气)-transformation dynamics.It further elucidates the dynamic progression pattern of the disease,namely the triphasic transmission model:"dysfunction of Wu-earth(stomach)→ failure of Gui-water(kidney)transformation → fire decline with turbidity and stasis."In this model,the initial phase of"dysfunction of Wu-earth"manifests as impaired Qi transformation in the stomach organ,leading to failure in receiving,decomposing,and directing turbidity downward,thereby causing stagnation of nutrients.The middle phase of"failure of Gui-water transformation"results from dysfunction of the kidney's Qi-transformation,disrupting fluid metabolism and causing internal retention of damp-turbidity,which subsequently intermingles with stasis and heat.The late phase of"fire decline with turbidity and stasis"signifies the decline of the"fire"generated from the Wu-Gui combination and transformation,indicating severe dysregulation of the stomach-kidney Qi-transformation pivot.This leads to the pervasive obstruction of turbid toxins and stasis throughout the Sanjiao,and ultimately results in the critical pattern of Guange(a severe and potentially life-threatening TCM syndrome caused by failure of the stomach,kidney and triple energizer Qi transformation).This study is the first to elucidate the deep-seated mechanism of mutual impairment between Stomach and Kidney Qi transformation in the course of DKD from the perspective of"Wu-Gui combining to transform into fire."Accordingly,a diagnostic and therapeutic framework has been established with"mediating the Wu and Gui"as the guiding principle and reactivating three pivotal mechanisms—"fluid metabolism,""nutrient transformation and retention,"and"Qi-transformation dynamics"—as the targeted therapeutic objectives.This framework emphasizes restoring the dynamic balance between Wu-earth and Gui-water to recover the synergy between the stomach's downward-directed turbidity and the kidney's Qi-transforming functions,rebuild the link between the stomach's transformation of nutrients and the kidney's storage of essence,and restore the warming and propelling function of the fire in the Wu-Gui combination.To further validate and apply this theory,the abovementioned theoretical framework is specifically applied to the treatment of DKD with chronic renal failure,and the formulation rationale of the core formula,Erhuang Yishen Keli(二黄益肾颗粒),is also discussed.This provides a novel paradigm for the diagnosis and treatment of DKD in traditional Chinese medicine.