基于阴火学说探讨IgA肾病的中医治疗  

Discussion on the Chinese Medicine Treatment of IgA Nephropathy Based on the Theory of Yin Fire

作　　者：任飞鸿 金秋百 刘童童 占永立[2] REN Feihong;JIN Qiubai;LIU Tongtong;ZHAN Yongli(Graduate School of Beijing University of Chinese Medicine,Beijing 100029,China;Guang anmen Hospital,China Academy Of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]中国中医科学院广安门医院,北京100053

出　　处：《中医药学报》2023年第12期5-9,共5页Acta Chinese Medicine and Pharmacology

基　　金：国家自然科学基金面上项目(82074393)。

摘　　要：IgA肾病(IgAN)是我国最常见的原发性肾小球疾病,其中医基本病机以脾肾气虚兼湿热为主。阴火学说为李东垣学术思想重要组成部分,阴火的病机为脾胃元气亏虚,阴火内生,治法主要为“补中、升阳、降火”。IgAN的基本病机与阴火病机相似,故可取法东垣,以“补中升阳、除湿降火”之法治疗脾肾气虚兼湿热型IgAN。本虚为主者,以补中之剂如补中益气汤、四君子汤等培补中气,加用升阳风药如柴胡、升麻、羌活等调理气机,以引阳气上升,复元气于本位以补中。标实为重者,若湿重于热,需以淡渗之品如茯苓、猪苓、泽泻等利湿,加用升阳风药如葛根、升麻、防风、柴胡等,升提清气鼓舞脾胃,以其辛散之性,风动胜湿;若热重于湿,需在补中药基础上,以苦寒之品如黄连、黄柏、黄芩等降泻阴火,加用升阳风药如防风、羌活、柴胡、升麻等升散阴火。如此,中虚得补,湿热得除,阳气得升,元气来复,则阴火自消。用宜从权,临证需斟酌比例,执简驭繁。IgA nephropathy(IgAN)is the most common primary glomerular disease in China.The basic Traditional Chinese Medicine(TCM)pathogenesis of IgAN is spleen and kidney qi deficiency combined with damp-heat.The theory of yin fire is an important part of Li Dongyuan's academic thoughts.The pathogenesis of yin fire is that yin fire is internally generated due to spleen-stomach source qi deficiency.The therapy of tonifying the middle,raising yang and downbearing fire is the main treatments for yin fire.The basic pathogenesis of IgAN is similar to the pathogenesis of yin fire.We have draws lessons from Li Dongyuan's experiences and mainly use the method of“tonifying the middle(spleen and stomach),raiseing yang,removing dampness,and downbearing fire”to treat IgAN of spleen and kidney qi deficiency and damp-heat type.If deficient root is the main case,the patients should be treated with center-supplementing formulae,such as Middle-Tonifying Qi-Replenishing Decoction,and Four Gentlemen Decoction,plus yang wind raising medicinals,such as Chaihu(radix bupleuri),Shengma(rhizoma cimicifugae)and Qianghuo(rhizoma seu radix notopterygii)to regulate qi mechanism,raise yang qi,restore source qi to the normal state,and supplement the middle.If the pattern is in severe excess in superficiality and dampness predominating over heat,bland medicinals should be employed,such as Fuling(poria cocos),Zhuling(polyporus umbellatus)and Zexie(alisma orientalis),to drain dampness.Yang wind raising medicinals can be added,such as Gegen(puerariae radix),Shengma(rhizoma cimicifugae),Fangfeng(saposhnikovia radix)and Chaihu(radix bupleuri),to raise yang-qi and promote spleen qi,because these medicinals are pungent,have dispersing nature,and can disperse dampness.If heat predominates over dampness,bitter-cold medicinals can be added,such as Huanglian(coptidis rhizoma),Huangbo(phellodendri chinensis cortex)and Huangqin(scutellariae radix)to reduce yin-fire,and yang wind raising medicinals can be added,such as Fangfeng(saposhnikovia radix),Qianghuo(rhizom

关 键 词：阴火学说 升阳法 IGAN 脾肾气虚 湿热 

分 类 号：R256.5[医药卫生—中医内科学]