Diabetic kidney disease(DKD),a prevalent complication of diabetes mellitus,remains a leading cause of end-stage renal disease.Recent research has identified lipophagy,a novel mechanism in DKD pathogenesis,drawing increasing attention in the field.This paper explores the biological connotation of the"internal heat leading to Zheng"pathogenesis based on lipophagy.The study proposes that lipophagy represents the microscopic biological correlation of liver-spleen coordination in regulating spleen transport and the ascending-descending dynamics of the middle jiao.Under persistent hyperglycemia,the suppression of lipophagic activity mirrors the traditional Chinese medicine(TCM)pathophysiological process described as"excessive fire consuming healthy qi,"whereas aberrant lipid accumulation in the kidney corresponds to the dynamic aggregation and dispersion of micro-zhengjia.Lipotoxicity,a key driver of DKD progression,is interpreted as the biological manifestation of accumulated turbidity transforming into toxicity,resulting in progressive impairment of renal essence and function.The dynamic process of lipophagy dysfunction under hyperglycemia,marked by renal microangiopathy,glomerular and tubular dysfunction,and renal fibrosis,closely mirrors the pathological evolution of"micro-zhengjia"and"internal heat leading to Zheng."Consequently,TCM strategies for DKD prevention and treatment should emphasize heat regulation,stage-specific interventions,liver-spleen harmonization,metabolic modulation,early collateral protection,and blood-activating approaches.

Diabetic kidney disease(DKD),a prevalent complication of diabetes mellitus,remains a leading cause of end-stage renal disease.Recent research has identified lipophagy,a novel mechanism in DKD pathogenesis,drawing increasing attention in the field.This paper explores the biological connotation of the"internal heat leading to Zheng"pathogenesis based on lipophagy.The study proposes that lipophagy represents the microscopic biological correlation of liver-spleen coordination in regulating spleen transport and the ascending-descending dynamics of the middle jiao.Under persistent hyperglycemia,the suppression of lipophagic activity mirrors the traditional Chinese medicine(TCM)pathophysiological process described as"excessive fire consuming healthy qi,"whereas aberrant lipid accumulation in the kidney corresponds to the dynamic aggregation and dispersion of micro-zhengjia.Lipotoxicity,a key driver of DKD progression,is interpreted as the biological manifestation of accumulated turbidity transforming into toxicity,resulting in progressive impairment of renal essence and function.The dynamic process of lipophagy dysfunction under hyperglycemia,marked by renal microangiopathy,glomerular and tubular dysfunction,and renal fibrosis,closely mirrors the pathological evolution of"micro-zhengjia"and"internal heat leading to Zheng."Consequently,TCM strategies for DKD prevention and treatment should emphasize heat regulation,stage-specific interventions,liver-spleen harmonization,metabolic modulation,early collateral protection,and blood-activating approaches.