北京中医药大学学报2026，Vol.49Issue(6)：755-762,8.DOI:10.3969/j.issn.1006-2157.2026.06.003
从"三焦-膜原-肾络"探析IgA肾病的病机与防治
Analysis of the pathogenesis and prevention and treatment of IgA nephropathy based on the"sanjiao-membrane source-kidney collaterals"
摘要
Abstract
IgA nephropathy(IgAN)is a common primary glomerular disease in China.The understanding of its pathogenesis remains limited,and existing theories are insufficient to fully elucidate the evolutionary process of the disease,from its insidious onset and progression to irreversible damage.Under the guidance of the"harmonizing sanjiao"theoretical system,our team innovatively proposes the"sanjiao-membrane source-kidney collaterals"pathogenesis hypothesis for IgAN.This theory posits that the pathogenic evolution of IgAN can be summarized as follows:initially,the dysfunction of sanjiao qi transformation serves as the root cause of the onset.Subsequently,damp-heat and toxic pathogens encumber the membrane source,accumulating to generate turbid toxins that attach and deposit,which acts as the pivot of the pathogenesis.Ultimately,the deeply latent turbid toxins back up against the kidney collaterals,leading to collateral spasm and the formation of micro-pelvic mass(micro-accumulations),which is a consequence of the damage.This traditional Chinese medicine(TCM)pathogenic transmission process highly aligns with the"four-hit"hypothesis of IgAN in Western medicine.The dysfunction of sanjiao qi transformation is analogous to mucosal immune dysregulation and galactose-deficient IgA1 overproduction(the first hit);the generation and deposition of damp-heat turbid toxins in the membrane source correspond to the pivotal transition involving the breakdown of immune tolerance,the formation of circulating immune complexes,and their deposition in the mesangial region(the second and third hits);the mass formed by turbid toxins damaging the kidney collaterals microscopically resembles microthrombosis,chronic ischemia and hypoxia,and irreversible histological damage(the fourth hit).Consequently,our team proposes a stratified intervention strategy,regulating the sanjiao to modulate qi transformation,freeing the membrane source to vent latent pathogens,and dredging the kidney collaterals to resolve pelvic masses.This theoretical and methodological framework integrates the theories of sanjiao qi transformation,latent pathogens in membrane source,and collateral disease theory.Combining these with the Western medical"four-hit"hypothesis provides a novel perspective for the precise prevention and treatment of IgAN using TCM.关键词
三焦/膜原/肾络/IgA肾病Key words
sanjiao/membrane source/kidney collaterals/IgA nephropathy分类
医药卫生引用本文复制引用
武婧希,李文诗,王琳..从"三焦-膜原-肾络"探析IgA肾病的病机与防治[J].北京中医药大学学报,2026,49(6):755-762,8.基金项目
国家自然科学基金面上项目(No.82474400) （No.82474400）
上海市中医药高层次人才引领计划[No.ZY(2021-2023)-0403] National Natural Science Foundation of China(No.82474400) （2021-2023）
