从"三焦-膜原-肾络"探析IgA肾病的病机与防治OA

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.