Exploring the Pathogenesis and Circadian Rhythm Regulation of Nocturnal Hypertension in Patients with Chronic Kidney Disease Based on the Kai-He-Shu Theory

Nocturnal hypertension is a common abnormal blood pressure rhythm in patients with chronic kidney disease (CKD), characterized by insufficient nocturnal blood pressure decline or a paradoxical increase at night, and is associated with an increased risk of cardiovascular and cerebrovascular events.The Kai-He-Shu theory describes the dynamic changes of qi activity in the three yin and three yang systems through three modes of movement-"opening", "closing" and "pivoting"-and provides a theoretical framework for understanding the circadian rhythm of blood pressure.In CKD-associated nocturnal hypertension, impaired renal qi transformation is considered the fundamental pathological mechanism, with deficiency of the spleen and kidney as the root and retention of water-dampness, phlegm, and blood stasis as the manifestations.On this basis, failure of the Taiyin to open, failure of the Yangming to close, and dysfunction of the Shaoyin pivot constitute important pathological mechanisms underlying nocturnal hypertension in CKD.Treatment should integrate syndrome differentiation with time-phase differentiation.Specifically, failure of Taiyin opening should be addressed by strengthening the spleen and promoting transportation and transformation; failure of Yangming closing by harmonizing the stomach and directing turbid substances downward; and dysfunction of the Shaoyin pivot by regulating and tonifying the heart and kidney.Through restoring the coordinated movement of opening, closing, and pivoting within the three yin and three yang systems, the circadian rhythm of blood pressure may be modulated.