Thoughts and Practices on Establishing a Diagnostic and Therapeutic System for Chronic Kidney Disease Based on the Shendu Theory

Chronic kidney disease (CKD) is a chronic progressive disease characterized primarily by impaired renal function, which can also affect multiple organs throughout the body. Traditional Chinese medicine (TCM) has significant advantages in delaying the progression and improving the prognosis of CKD. This paper proposes that Shendu is a core factor in the pathogenesis and progression of CKD. Shendu mainly refers to severe pathogenic toxins that invade the kidney or abnormal pathological products accumulated in the body. Its sources include external invasion, internal generation, and drug toxicity. It is characterized by scorching heat damaging Yin, filthy turbidity impairing Yin, latent occurrence with sudden onset, and concurrent pathogenesis. According to the pathological nature, it can be classified into six types: Fengdu, Shidu, Redu, Zhuodu, Yudu, and Tandu. Shendu and the deficiency of Shenyuan form a vicious cycle of mutual reinforcement. In the early stage, Fengdu invading the kidney is the main issue, while in the middle and late stages, Zhuodu obstructing the kidney is the key pathological feature. The fundamental treatment principle is to resolve Shendu. In the early stage, the Yishen Qufeng formula is used to dispel Fengdu and tonify the Shenyuan, while in the middle and late stages, the Suyin Jiedu formula is adopted to eliminate turbidity and detoxify, and nourish the Shenyuan. Mechanism studies suggest that they may exert protective effects on the kidney by regulating the gut microbiota-microbial metabolites-kidney axis and reducing programmed cell death in renal cells. Based on TCM theory and clinical experience, this paper establishes a diagnostic and treatment system for CKD centered on the concept of Shendu, aiming to provide new perspectives and references for clinical practice.