温阳解表法治疗特发性膜性肾病的机理及临床实践

Mechanism and clinical practice of the treatment of idiopathic membranous nephropathy with the method of warming yang and releasing the exterior

特发性膜性肾病(IMN)是成人特发性肾病综合征的最常见原因,可归属于中医学“水肿”“尿浊”范畴。中医学认为,主管水液代谢的脾肾二脏与水肿关系密切,其阳气虚为功能失调的根本原因。温阳解表法是建立在对水肿病病性及病位辨识基础上的治法。本团队应用温阳解表法治疗IMN多以麻黄附子汤合肾着汤为主方,其中,麻黄伍附子为核心药对。温阳解表法治疗IMN的机制之一可能是调节Treg细胞功能,上调IL-35表达,从而抑制体内过度活跃的自身免疫反应,维持免疫耐受以达到缓解的目的。结合临床验案对温阳解表法治疗特发性膜性肾病进行介绍。

Idiopathic membranous nephropathy(IMN) is the most prevalent cause of idiopathic nephrotic syndrome in adults,falling within the realm of shuizhong(edema) and niaozhuo(turbid urine) in traditional Chinese medicine.It is believed in TCM that the spleen and kidney,responsible for water metabolism,is closely related to edema,and its yang-qi deficiency is the fundamental cause of dysfunction.The method of warming yang and releasing the exterior is a therapeutic principle grounded in the identification of the nature and location of edema-related disease.Our team employed the method of warming yang and releasing the exterior to counter IMN primarily using a combination of Mahuang Fuzi Decoction(Ephedra and Aconite Decoction) and Shenzhuo Decoction(Kidney Fixity Decoction) as the main prescription,with Mahuang and Fuzi as the core herb pair.One of the potential mechanisms of the warming yang and releasing the exterior method in treating IMN might involve the modulation of Treg cells functionality and upregulation of IL-35 expression,thereby restraining excessive autoimmune responses and maintain immune tolerance to achieve alleviation.This paper combines clinical cases to present the treatment of IMN through the warming yang and releasing the exterior approach.