糖尿病肾病（DKD）是糖尿病首要的微血管并发症，亦是终末期肾病的主要病因，其进行性发展已严重威胁患者生活质量及生存结局。大量蛋白尿是糖尿病肾病的主要临床表现，西医治疗依赖抗炎药、糖皮质激素等，但副作用显著，亟需更安全有效的干预策略。基于《灵枢·阴阳清浊》中的 “清浊相干，命曰乱气”理论，提出DKD蛋白尿的核心病机为浊邪内生、清浊逆乱，从“肺激浊源”致邪气外侵，浊源始生；“脾酿浊邪”致湿邪内蕴，脂浊周流；“肾虚浊陷”致瘀浊损络，封藏失职三个方面阐述DKD的病机，确立“宣肺调水御浊”、“运脾转枢除浊”、“益肾守络绝浊”的治法，凸显中医药调节清浊、保护肾功能的优势，以期为DKD蛋白尿的中西医结合诊疗提供新的思路与方法。

       Diabetic kidney disease（DKD） is a primary microvascular complication of diabetes and a leading cause of end-stage kidney disease．Its progressive development seriously threatens patients’ quality of life and survival outcomes．Massive proteinuria is the main clinical manifestation of DKD．Western medicine treatments rely on anti-inflammatory drugs，glucocorticoids，etc.，but they have significant side effects，highlighting the urgent need for safer and more effective intervention strategies．Based on the theory of “mutual interference of clear and turbid qi” mentioned in Ling Shu：Yin-Yang and Purity-Turbidity，the core pathogenesis of DKD proteinuria is proposed as the internal generation of turbid pathogens and the disordered reversal of clear and turbid．It is elaborated through three aspects：“lung activating turbid sources”，which leads to the external invasion of pathogenic qi and the initial generation of turbid sources；“spleen brewing turbid evil”，which results in internal retention of damp-evil and the circulation of greasy turbid factors；and “kidney deficiency causing turbid stagnation”，which leads to turbidity-induced stasis damaging the collaterals and impairment of storage function．Correspondingly，the treatment principles are established as “disseminate the lung and regulate water to control turbidity”，“transport the spleen to transform and remove turbidity” and “benefit the kidney and protect the collaterals to eliminate turbidity”．This highlights the advantages of traditional Chinese medicine in regulating clear and turbid qi and protecting kidney function，aiming to provide new ideas and methods for the integrated Chinese and Western diagnosis and treatment of DKD proteinuria．