基于“一气周流”理论论治IgA肾病  

Treating immunoglobulin A nephropathy based on the "qi cycle in round" theory

作　　者：赵乐滢 王耀献[1,2,3] 王珍[1] 李垚锬 曹博宁 陶嘉茵 李丹婷 刘晴晴[1] ZHAO Leying;WANG Yaoxian;WANG Zhen;LI Yaotan;CAO Boning;TAO Jiayin;LI Danting;LIU Qingqing(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Beijing University of Chinese Medicine,Beijing 100029,China;Henan University of Chinese Medicine,Zhengzhou 450046,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医药大学 [3]河南中医药大学

出　　处：《北京中医药大学学报》2025年第2期223-228,共6页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金区域创新发展联合基金重点支持项目(No.U22A203373);国家中医药管理局高水平中医药重点学科建设项目(No.zyyzdxk-2023260)。

摘　　要：免疫球蛋白A(IgA)肾病是全球范围内常见的原发性肾小球肾炎,具有症状复杂、病情多样等特点。国际上广泛认同的“多重打击学说”揭示了IgA肾病全身性免疫疾病的特征。然而,当前的治疗策略主要聚焦于局部病理变化,未能充分应对其复杂的系统性机制。“一气周流”理论是清代医家黄元御学术思想的重要组成部分,其思辨方式简洁易懂,对于阐释IgA肾病病机及指导临床治疗可起到执简驭繁的作用。本文基于“一气周流”理论,认为IgA肾病患者由于中气虚衰与湿热蕴结,导致“一气周流”难以维持,这种失衡在体内表现为泄泻,在体表表现为易感,上部症状为咽痛,下部症状为血尿及蛋白尿,病理上呈现出免疫复合物的沉积。在治疗策略上,本文强调应补益中气以健运枢轴功能、理气开郁以调节升降平衡、降浊通络以改善气化功能,从而促进脏腑气机运行与气化功能的恢复。本文旨在基于“一气周流”理论,为IgA肾病的中医药辨证与治疗提供参考。Immunoglobulin A(IgA) nephropathy is a globally prevalent type of primary glomerulonephritis,characterized by complex symptoms and diverse clinical manifestations.The internationally recognized "multiple hit hypothesis" explains the systemic immune disease features of IgA nephropathy.However,current treatment strategies primarily focus on local pathological changes,inadequately addressing its complex systemic mechanisms.The "qi cycle in round" theory,an integral concept of the academic thought of HUANG Yuanyu,a prominent medical expert from the Qing Dynasty,offers a concise and insightful framework for understanding complex pathologies.For example,this theory provides valuable insights for elucidating the pathogenesis of IgA nephropathy and guiding its clinical management by simplifying intricate systemic processes.This study applies the "qi cycle in round" theory to postulate that patients with IgA nephropathy experience disrupted qi flow owing to spleen-stomach qi deficiency and dampness-heat accumulation.These imbalances manifest as internal symptoms,such as diarrhea;external vulnerability to illness;upper body symptoms,like sore throat;and lower body symptoms,such as hematuria and proteinuria.Pathologically,the condition is characterized by immune complex deposition.This article also emphasizes strategies that prioritize tonifying spleen-stomach qi to enhance the pivotal functions of transportation and transformation.Regulating qi and relieving stagnation are emphasized to harmonize ascending and descending dynamics.Additionally,eliminating turbidity and unblocking collaterals are highlighted to promote qi transformation.These approaches aim to restore the harmonious operation of organ qi dynamics and harmonious qi transformation functions.This study aims to provide a reference for syndrome differentiation and IgA nephropathy treatment using traditional Chinese medicine based on the "qi cycle in round" theory.

关 键 词：免疫球蛋白A肾病 血尿 一气周流 黄元御 

分 类 号：R259[医药卫生—中西医结合]