CKD Basic Theory And Clinical Practice Of Chinese And Western Medicine
Dec 27, 2022
Chronic kidney disease (CKD) is a serious public health problem with high morbidity, prevalence, and complications. The global incidence of CKD is 9.1%. China has more than 140 million CKD patients, which is the country with the largest number of CKD patients in the world. It has become a serious chronic disease burden in China and the world. In recent years, with the increasing attention to Chinese medicine, the attention to Chinese medicine treatment of CKD is self-evident. Based on this, this article discusses the "'Treatment from the Spleen' CKD basic theory of traditional Chinese and Western medicine, and the "Clinical Practice" experience is summarized for readers.
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Understanding of CKD in Traditional Chinese Medicine
CKD belongs to the categories of "consumption", "off-grid", "infirmity" and "drug addiction" in traditional Chinese medicine. Professor Zhang Qi believes that the main cause of CKD is a deficiency of the spleen and kidney, blood stasis, and accumulation of turbidity. It is caused by kidney deficiency, stagnation of blood stasis, internal stagnation of turbidity and toxins, and the treatment mainly focuses on nourishing the kidney and promoting blood circulation, removing dampness, and reducing turbidity; Professor Zou Yanqin believes that it is mainly caused by kidney deficiency, spleen deficiency, and blood stasis. The method is mainly to invigorate the spleen and kidney, harmonize the collaterals, and remove blood stasis; Professor Nie Lifang, Professor Huang Chunlin, and Professor Yang Nishi all have their unique ideas on the understanding of CKD.
The role of "spleen" in the occurrence and progression of CKD
The spleen is the foundation of the acquired constitution, and its main function is transportation and transformation. Both "Su Wen·Jing Yong Bie Lun" and "Fu Qingzhu Gynecology" fully mentioned the important role of the spleen in the development of CKD. Many clinical studies have confirmed that the deficiency syndrome of CKD patients is mainly a "deficiency of the spleen and kidney", which is mainly manifested in three aspects: (1) The course of CKD is prolonged, kidney qi declines, qi transformation fails, water dampness stops internally, Fire does not produce soil, which hinders the spleen yang; (2) kidney yang is exhausted, and the force of warmth and impetus is weakened, resulting in impaired spleen transportation and transformation, spleen deficiency is unable to raise clearness and lower turbidity, and dampness and turbidity stop internally; (3) spleen and stomach are weak, The ups and downs of the qi movement are out of balance, the transportation and transformation are out of order, the fine and subtle substances cannot be ascended, and the kidney essence cannot be filled.
Relationship between intestinal flora and physiological characteristics of "spleen"
In recent years, through research on the intestinal flora, it has been found that it has a greater connection with the spleen. There are similarities in physiological functions, which are mainly manifested in the following aspects: (1) The spleen is the "official of the storehouse, the foundation of the acquired constitution, and the source of the biochemistry of qi and blood", and it is in charge of transportation and transformation. water solution. Intestinal flora is a variety of physiological bacteria that can produce a variety of metabolic enzymes and participate in host physiological processes through enzymes. At the same time, the intestinal flora grows and reproduces through the substances in the intestinal tract. (2) The theory of the spleen as its defense holds that the spleen has the functions of defending the outside world and resisting pathogenic factors. The intestinal flora has three functions: ① It has the function of regulating the immune microenvironment, which can resist the invasion of pathogens, activate the immune system, participate in the synthesis of multivitamins, and regulate the metabolism of substances; ② The intestinal-related immune system is The largest lymphoid immune active cell bank in the human body; ③ activate macrophage activity, promote the secretion of cytokine mediators, and improve the host's disease resistance.
Relationship between intestinal flora and pathological characteristics of "spleen"
Intestinal flora and "spleen" have similarities in pathological manifestations.
Pathological features of the spleen:
(1) Impaired spleen movement: Impaired spleen movement is mainly manifested by the inability to transform water and grains, excessive biochemical sources of qi and blood, failure to fill limbs and muscles, and loss of oxygen in the body. At the same time, if the spleen fails to move well, dampness and turbidity will be generated in the body, accumulating and turning into heat, and the dampness, heat, and stasis will coalesce into poison, hindering the whole body's Qi movement, and can also damage other viscera and organs.
(2) Protection against spleen loss: In recent years, a large number of animal experiments and clinical studies have proved that the change in the immune system and immune function is one of the important contents of the research on the essence of "spleen deficiency syndrome", which involves the non-specific immunity of modern immunology. , humoral immunity, cellular immunity, molecular immunity, and immune genetics.
Pathological characteristics of intestinal flora:
(1) Intestinal flora imbalance: ①When the intestinal flora is disturbed, the number of probiotics will decrease, which will affect the body’s absorption of nutrients and reduce the body’s immunity; Metabolism disorder, producing harmful substances.
(2) Imbalance in the microenvironment of immune cells: ①The intestinal flora affects the host through the interaction with the host immune system; ②Microbiological imbalance and intestinal epithelial barrier dysfunction lead to the production of toxic compounds, which leak into the circulatory system and interact with the whole body. Inflammation accelerated atherosclerosis and cardiovascular disease.
Intestinal flora dysbiosis is an important pathological manifestation of CKD
Studies have shown that there are significant differences between the intestinal microbiota of patients with end-stage renal disease and healthy people. At the same time, studies have also found that there are intestinal microbes such as indoxyl sulfate, p-cresol sulfate, trimethylamine oxide, and short-chain fatty acids in the serum of CKD patients and animals. Metabolites related to intestinal flora increased, and an endogenous amino acid, lipid, purine, bile acid, and phospholipid metabolism related to intestinal flora were abnormal. These all suggest that the imbalance of intestinal flora is an important pathophysiological manifestation of CKD, and it can also cause metabolic disorders in the host.
All in all, the disturbance of intestinal flora and the occurrence and development of CKD affect each other: on the one hand, due to many factors such as the increase of metabolic waste of CKD itself, the change of diet structure, the use of drugs and the existence of the micro-inflammation state, the disturbance of intestinal flora, intestinal toxins, etc. accumulation, aggravating kidney damage; on the other hand, in the state of CKD, the intestinal barrier is destroyed, the intestinal mucosal immunity is activated, and the circulation of pro-inflammatory cells and cytokines causes damage to the immune microenvironment of the kidney. These all point to a link between the gut microbiota and the spleen.
"Treating from the spleen" can delay the progress of CKD by regulating the intestinal flora
Professor Chen Ming combined with the TCM treatment law and rule of "'Cong Pai Lun Governance' CKD", constructed an empirical prescription with a "combination of tonic and use, taking into account both specimens and specimens" - "Fuzheng Huayu Jiangzhuo Tongluo Fang", and carried out a series of basic research.
The study found that "Fuzheng Huayu Jiangzhuo Tongluo Prescription" has the following effects: (1) It can improve the renal function of rats in the rat renal interstitial fibrosis model (UUO), reduce renal fibrosis, and protect the kidneys (2) It can improve the colonic tissue damage of UUO rats; (3) It can reduce the inflammatory cytokines such as CRP, TNF-α, IL-6 and IL-1 in the UUO model to reduce the inflammatory response; (4) It can balance the intestinal flora of UUO rats; (5) It can improve the imbalance of plasma metabolites in UUO rats.
In conclusion, the proven prescription constructed with the guiding ideology of "treating from the spleen" - "Fuzheng Huayu Jiangzhuo Tongluo Fang" can restore the homeostasis of intestinal flora, regulate host metabolism, and delay the progress of CKD.
The functions of the "spleen" in traditional Chinese medicine governing "transformation" and "anti-evil" are very similar to the functions of the intestinal flora, which coincides with the "gut-kidney axis" theory of the interaction between the kidney and the intestine proposed by modern medicine. "Treating from the spleen" can improve the disorder of intestinal flora in CKD patients, maintain the stability of intestinal flora, and reduce toxin damage to kidney function, which provides a theoretical basis for "treating from the spleen" CKD.
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