祝凤桂　　陈洪宇

[关键词] 陈洪宇;IgA肾病;病因病机;治疗经验

[中图分类号] R692.3          [文献标识码] B          [文章编号] 1673-9701（2021）21-0135-04

Professor Chen Hongyu′s experience in treating IgA nephropathy

ZHU Fenggui   CHEN Hongyu

Department of Nephrology， Hangzhou Traditional Chinese Medicine Hospital， Hangzhou 310007， China

[Abstract] This article summarizes the experience of Professor CHEN Hongyu in the diagnosis and treatment of IgA nephropathy from the understanding of the history of doctors， etiology and pathogenesis， treatment principles， and treatment methods， and examples of medical records. IgA nephropathy′s etiology and pathogenesis were explored based on the knowledge of physicians of the past dynasties. Professor CHEN Hongyu proposed that the deficiency of both Qi and Yin is the most critical pathological basis for the pathogenesis of IgA nephropathy.Qi stagnation， rheumatism，damp heat，and blood stasis are critical pathogenic factors.Cold pathogens， heat pathogens，wind pathogens， etc. are important inducements. Attention should be paid to the application of dispelling wind and promoting lung and relieving appearance， replenishing qi and nourishing yin， invigorating spleen and kidney， promoting qi， dispelling wind and removing dampness， promoting blood circulation and removing blood stasis in IgA nephropathy.The clinical practice proved that Professor CHEN Hongyu′s experience in the diagnosis and treatment of IgA nephropathy has a good effect，which can be used as a reference for colleagues.

[Key words] CHEN Hongyu; IgA nephropathy; Etiology and pathogenesis; Treatment experience

陈洪宇教授系浙江中医药大学附属广兴医院主任医师，博士生导师，从事临床教学科研工作20余年，擅长中西医结合治疗IgA肾病、急慢性肾炎、慢性肾衰竭、紫癜性肾炎、痛风性肾病、糖尿病腎病等多种肾脏疾病。笔者长期跟随陈洪宇教授门诊，发现陈洪宇教授治疗IgA肾病屡有良效，故将陈洪宇教授诊治IgA肾病的经验进行归纳总结，以飧同道。

IgA肾病是一组以IgA为主的免疫复合物在肾小球系膜区沉积，系膜细胞不断增殖活化，临床表现为反复发作肉眼性血尿或镜下血尿，伴或不伴蛋白尿、水肿、高血压的慢性肾小球肾炎。是我国最为常见的肾小球疾病之一，也是我国导致慢性肾衰竭、终末期肾脏病最常见的原发性疾病之一[1]。IgA肾病在诊断后5～25年内，约有15%～40%患者会发展为终末期肾病而不得不接受肾脏替代治疗[2]。目前IgA肾病发病机制尚未完全阐明，西医治疗包括ACEI、ARB、激素、免疫抑制剂等，目前尚无统一治疗方法。中医治疗IgA肾病颇有良效，故从中医论治IgA肾病越来越受到医家们的关注。

1 历代医家认识

古代医著中未见IgA肾病病名，根据其临床表现归为“尿血”“尿浊”“肾风”等范畴。最早可见于《素问·气厥论篇》：“肾足少阴之脉，起于小指之下，斜走足心，出于然谷之下，循内踝之后，別入跟中，以上腨内，出腘内廉，上股内后廉，贯脊，属肾，络膀胱。其直者，从肾上贯肝膈，入肺中，循喉咙，夹舌本……是主肾所生病者，口热舌干，咽肿上气，噫干及痛。