孟元　王雨　赵文景　王悦芬　崔方强　张涛静　高彦彬

摘要 IgA肾病是引起原发性肾小球肾炎的最常见病因。高彦彬教授认为IgA肾病属中医“络病”范畴，病性本虚标实，辨证分型主张“以虚定型，以实定候”，本虚分为肝肾亏虚、气阴两虚、脾肾两虚、阴阳两虚4个证型，标实分为热毒伤络、风伏肾络、湿热壅络、肾络瘀阻、浊毒闭络5个证候;治疗上主张分期论治，以通络为主;急性发作期以邪实为主，治以祛邪通络;慢性缓解期，以正虚为主，虚实夹杂，治以扶正通络;辨证施治，随证加减，疗效满意。

关键词 IgA肾病;络病;中医药;分期论治;辨证论治;通络法;临床经验

Professor GAO Yanbin′s Experience in Treating IgA Nephropathy from Collateral Disease

MENG Yuan1，WANG Yu1，ZHAO Wenjing1，WANG Yuefen 1，CUI Fangqiang1，ZHANG Taojing3，GAO Yanbin2

（1 Department of Nephrology，Beijing Chinese Medicine Hospital，Capital Medical University，Beijing 100010，China; 2 Capital Medical University，Beijing 100069，China; 3 Oriental Hospital of Beijing University of Chinese Medicine，Beijing 100078，China）

Abstract IgA nephropathy is the most common cause of primary glomerulonephritis.Professor GAP Yanbin believes that IgA nephropathy belongs to the category of“collateral disease”of traditional Chinese medicine.The pathological nature of the deficiency and standardization.The nature of the diease is deficiency root causese and manifestation excess.Syndrome differentiation classification advocates the“deficiency determines syndromes and excess determines symptoms.deficiency” of root causes is divided into liver and kidney deficiency，qi and yin deficiency，spleen and kidney deficiency，yin and yang deficiency of 4 syndrome types.Excess of manifestation is divided into 5 syndromes of heat poisoning damages collateral，wind and kidney collaterals，dampness and heat obstructed in collaterals，turbidity and toxin obstructed in collaterals.In the treatment，it is advocated by stage treatment，mainly through collaterals; the acute attack period is mainly dampness and evil.The treatment is to eliminate evil and remove obstructions in collaterals; in the chronic remission period.Healthy qi deficiency is the dominant，combined with deficiency and excess.The treatment is to support the healthy energy and remove obstructions in collateral; syndrome differentiation，modify the prescriptions according to the syndromes and the effect is satisfactory.

Keywords IgA nephropathy; Collateral disease; Chinese medicine; Treatment by stages; Syndrome differentiation and treatment; Law of Tongluo; Clinical experience

中圖分类号：R249.2/.7;R256.5文献标识码：Bdoi：10.3969/j.issn.1673-7202.2020.15.020

IgA肾病（IgA Nephropathy，IgAN）是引起原发性肾小球肾炎的最常见病因[1]，在我国约占原发性肾小球病肾活检病例的45%[2]。目前IgAN机制尚不明确，部分患者预后不良，病程10年进展至终末期肾脏病（End Stage Renal Disease，ESRD）或肾小球滤过率估算值减半者约为27%[3]。西医治疗取得了一定的成果，但手段有限，亟待拓展。中医药治疗本病的优势在于改善患者体质状态、控制诱发因素、阻断病程的迁延发展[4-6]。近年来，中医药干预IgAN在降低蛋白尿、保护肾功能[7-8]，免疫调节[9-11]、抗炎[12-15]，减轻系膜细胞增生[16-18]、足细胞损伤[19-20]，抗纤维化[21-25]等方面取得一定进展。高彦彬教授是第六批全国老中医药专家学术经验继承工作指导老师，临证30余载，治疗慢性肾脏病（Chronic Kidney Disease，CKD）经验丰富，独辟蹊径，从络病论治IgAN疗效满意。我有幸跟师随诊，管窥蠡测，受益匪浅。今梳理归纳，以供鉴验。

1 IgAN与络病理论

络病理论是中医理论独特的组成部分。……