实用中医内科杂志

IgA肾病是一种临床常见的难治疾病，也是导致终末期肾病的主要原因之一，其临床表现为血尿、腹痛、腰痛、水肿、疲劳等。该病尚无特异性治法，临床多按分型使用ACEI、ARB药物或糖皮质激素、免疫抑制剂进行治疗，疗效有一定局限性且容易反复。文章总结庞敏教授运用“瘀毒”理论辨治IgA肾病的经验，认为IgA肾病以“瘀毒”为核心病机，“瘀”是疾病发生的关键，“毒”是发病的主要诱因，瘀久化毒，久毒致瘀，是疾病反复发作，不易根治的重点所在。针对病机主张以祛瘀解毒法为基本治则，分急性发作期与慢性缓解期进行分期论治，面对患者不同证型的个性化症状与表现，风热袭表证用银翘散合小蓟饮子化裁，下焦湿热证用二妙散合小蓟饮子化裁，肺脾肾气虚证用归脾汤或参芪地黄汤化裁，肝肾亏虚证用六味地黄丸合二至丸化裁，阴虚火旺证用知柏地黄丸化裁，脾肾阳虚证用理中丸合右归丸化裁。既重视本病的共同病机，又关注患者个体症状，病证结合，为IgA肾病的临床治疗提供新的思路。

IgA nephropathy is a clinically common refractory glomerular disease and one of the leading causes of end-stage renal disease. Its clinical manifestations include hematuria, abdominal pain, lumbar pain, edema, and fatigue. There is no specific treatment for this disease. Conventional therapies, such as ACEIs, ARBs, glucocorticoids, and immunosuppressants administered based on pathological classification, exhibit limited efficacy and are prone to recurrence.This article summarizes Professor PANG Min's clinical experience in treating IgAN through the lens of the "stasis-toxin" theory. It posits that "stasis-toxin" constitutes the core pathogenesis of IgAN,wherein "stasis" serves as the critical factor in disease initiation, while "toxin" acts as the primary trigger. The interplay between persistent stasis generating toxins and chronic toxins aggravating stasis underlies the recurrent and refractory nature of the disease.Guided by this pathogenesis, Professor PANG advocates for removing stasis and detoxification as the fundamental therapeutic principle, with stage-specific treatment tailored to acute exacerbation and chronic remission phases. Additionally, personalized regimens are designed according to individual symptom patterns: wind-heat invading the exterior syndrome: modified Yinqiao San(银翘伞) combined with Xiaoji Yinzi(小蓟饮子).Damp-heat in the lower jiao syndrome: modified Ermiao San(二妙丸) combined with Xiaoji Yinzi.Qi deficiency of the lung, spleen, and kidney syndrome: modified Guipi(归脾汤) Decoction or Shenqi Dihuang Decoction(参芪地黄汤).Liver-kidney deficiency syndrome: modified Liuwei Dihuang Wan(六味地黄丸) combined with Erzhi Wan.Yin deficiency with fire effulgence syndrome: modified Zhibai Dihuang Wan(知柏地黄丸).Spleen-kidney yang deficiency syndrome: modified Li zhong Wan(理中丸) combined with Yougui Wan.This approach emphasizes both the common pathogenesis and individualized symptom patterns, integrating disease mechanisms with syndrome differentiation and it offers novel insights into the clinical management of IgAN.