基于铁稳态失衡探析“肾藏精生血”理论与慢性心力衰竭  

Analysis of the"Kidney Storing Essence and Producing Blood"Theory and Chronic Heart Failure Based on Iron Homeostasis Imbalance

作　　者：王雪薇 张艳[2] 王雅琴 WANG Xuewei;ZHANG Yan;WANG Yaqin(Liaoning University of Traditional Chinese Medicine,Shenyang Liaoning 110847,China;The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang Liaoning 110032,China)

机构地区：[1]辽宁中医药大学,辽宁沈阳110847 [2]辽宁中医药大学附属医院,辽宁沈阳110032

出　　处：《中医药导报》2024年第11期115-120,共6页Guiding Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金项目(81774157,82174241);全国名老中医药专家传承工作室建设项目(2022-304)。

摘　　要：慢性心力衰竭(CHF)的基本病机是本虚标实,其中“肾藏精生血”理论在CHF的治疗中尤为重要。从“肾藏精-根元气-气生血成血”“肾藏精-主骨-生髓-化血”“肾藏精-主水-生津-化血”“肾藏精-生肾阴肾阳-助生血”4个方面探讨了肾藏精生血的生理过程,并结合现代医学的铁稳态失衡(铁缺乏/铁过载)探讨了“肾藏精”与CHF的关系。铁缺乏是CHF中最常见的贫血原因,与铁稳态失衡密切相关,铁缺乏及贫血既是CHF常见伴症,亦是促进CHF发生、发展的重要因素,而铁过载则可能导致氧化应激和细胞损伤,加重CHF进程。“肾藏精生血”的生理过程可缓解贫血及铁缺乏;小肠受盛化物、泌别清浊及肝藏血与肝之疏泄等参与铁稳态的生理活动又受“肾藏精”功能的精密调控,进而系统调控铁稳态,影响CHF发生、发展。中医药治疗CHF具有一定优势,强调了“肾藏精生血”理论体系在中、西医治疗CHF中的重要性:肾藏精为生血之源,肾藏精参与调控铁稳态,二者皆可影响CHF进程,丰富了中医药治疗CHF的研究方向。The basic pathogenesis of chronic heart failure(CHF)is deficiency of the essence and excess of the substance,among which the theory of"kidney storing essence and producing blood"is particularly important in the treatment of CHF.The article discussed the physiological process of"kidney storing essence and producing blood"from four aspects:"kidney storing essence-rooting original Qi-Qi generating blood","kidney storing essence-governing bones-producing marrow-transforming blood","kidney storing essence-governing water-generating fluids-transforming blood",and"kidney storing essence-producing kidney Yin and Yang-assisting in blood production".It also explored the relationship between"kidney storing essence"and CHF in conjunction with modern medicine's concept of iron homeostasis imbalance(iron deficiency/iron overload).Research indicated that iron deficiency is the most common cause of anemia in CHF and is closely related to the imbalance of iron homeostasis.Both iron deficiency and anemia are not only common comorbidities of CHF but also important factors that promote the occurrence and progression of CHF.Iron overload,on the other hand,can lead to oxidative stress and cell damage,exacerbating the progression of CHF.The physiological process of"kidney storing essence and producing blood"can alleviate anemia and iron deficiency.The physiological activities of the small intestine in receiving and transforming substances,separating clear from turbid,and the liver in storing blood and its dispersing and descending functions,which are involved in iron homeostasis,are precisely regulated by the function of"kidney storing essence",thus systematically regulating iron homeostasis and affecting the occurrence and progression of CHF.Traditional Chinese medicine(TCM)has certain advantages in the treatment of CHF.The article emphasized the importance of the"kidney stores essence and generates blood"theoretical system in both Chinese and Western medicine for treating CHF:kidney essence storage is the source of blood generation,a

关 键 词：慢性心力衰竭 铁稳态 铁缺乏 铁过载 肾藏精 肾生血 

分 类 号：R259[医药卫生—中西医结合]