IgA nephropathy is currently considered a group of progressive glomerulopathies with complex and diverse renal pathology and a prolonged course, which can easily develop into moderate to severe IgA nephropathy and lead to glomerulosclerosis and interstitial fibrosis. There is still no good way to delay the progression of the disease to end-stage renal disease (ESRD) and enter renal replacement therapy. In recent years, Chinese medicine has made some progress in the treatment of IgA nephropathy, and most scholars now advocate that the Chinese medical mechanism of the disease is a combination of deficiency and deficiency. In clinical practice, the treatment is based on their own experience from different perspectives: some identify the disease from the stage, distinguishing between acute attack and chronic progression; some identify the disease according to the classification of hematuria/proteinuria, classifying it into hematuria and proteinuria before treating it; some identify the disease according to the microscopic pathology of nephropathy, treating it according to its microscopic pathological manifestations as blood stasis and damp-heat. All of these have made useful attempts to explore the treatment of IgA nephropathy in Chinese medicine, and have accumulated rich clinical experience and achieved certain curative effects. However, the identification scheme is still not unified and the classification methods are numerous and complicated, which is very unfavorable to the academic research, promotion and development of Chinese medicine for the treatment of IgA nephropathy and hinders the further improvement of clinical efficacy. For this reason, Chen and Chen Xiangmei took the lead in the “Research on the rules of Chinese medicine evidence and treatment of IgA nephropathy”, which is a pioneer to explore the rules of Chinese medicine evidence of IgA nephropathy. The results of the study showed that the TCM evidence pattern of IgA nephropathy evolved from Qi deficiency to Qi and Yin deficiency, Liver and Kidney Yin deficiency, and Spleen and Kidney Yang deficiency, and this process reflected the progressive aggravation of IgA nephropathy to a certain extent. With the increasing understanding of IgA nephropathy in Chinese and Western medicine, the search for safer and more effective treatment options, especially treatment strategies to effectively delay and/or interrupt the progression of moderate to severe IgA nephropathy, is an important task before scholars of combined Chinese and Western medicine. Chen has been exploring and experimenting in his clinical practice for many years, and has been diligent in generalizing and summarizing in his practice, gradually forming a unique treatment strategy. Chen pointed out that IgA nephropathy is a group of clinical syndromes with common immunopathological features due to its complex and diverse clinical manifestations and multiple renal pathological changes, although it is collectively called IgA nephropathy. If treated with a single solution, it is inevitable that one will lose the other and the effect will be poor; however, if treated according to clinical manifestations or pathological types, the situation of complex typing, cumbersome identification and difficult to unify will occur. There are still 32 types of evidence after summarizing those with similarities [2]. Therefore, it is necessary to explore the core pathogenesis of IgA nephropathy through the complicated appearance in order to find a solution that is more effective and more efficient. Looking at the whole pathogenesis of IgA nephropathy, whether the disease is initially caused by external evils such as pulmonary exopathogens or intestinal toxins, or aggravated by recurrent evils during the course of the disease, or the disease is characterized by spleen and kidney deficiency, water and dampness flooding and blood stasis blocking the ligaments, or even the disease is prolonged and entangled with turbid toxins until critical symptoms such as kidney yang deficiency, liver and kidney yin deficiency, or yin and yang deficiency occur, the pathogenesis is always related to the dysfunction of the upper, middle and lower jiao. The pathological mechanism is always related to the disorder of the upper, middle and lower jiao functions, the diffusion of evil and toxins from above and below, inside and outside, and the confusion of positive and evil, deficiency and reality. According to this pathological mechanism, Dr. Chen pointed out that the key to resolving the complex disease of IgA nephropathy, especially the moderately severe IgA nephropathy, is to mediate between the three jiao and eliminate the diffuse internal and external evil toxins; to harmonize the water and fire, and to reconcile the deficiency and reality. Specifically in the use of subtle formulas, Dr. Chen’s ingenuity, with Xiao Chai Hu Tang as the mainstay, subtle addition and subtraction, and tailoring to the symptoms, and supplemented with immunosuppressants and other western drugs when appropriate, has enabled many patients with moderate or severe IgA nephropathy with heavy pathological typing or even decompensated renal function to be effectively controlled and their renal function to be greatly improved, or their residual renal function to be effectively protected for a long period of time, and In the process of treatment, western drugs such as immunosuppressants are successfully withdrawn, and the quality of survival of patients is significantly improved. Although there are many controversies in the understanding of the structure of the “three jiao” by ancient and modern scholars, there is no doubt that it is “the path of water and grain and the end of qi” and that “the upper jiao is like fog” and “the middle jiao is like compost”. However, there is basically a consensus in the understanding of its functions and behavioral characteristics, such as “the path of water and grain, the end of qi” and “the upper jiao is like fog”, “the middle jiao is like compost” and “the lower jiao is like dou”. As in the book “Zhongzangjing? On the method of the three jiao deficiency, cold, heat, life, death, obedience and rebellion pulse evidence”, “the three jiao is also the three yuan of human qi, called the clear internal organs, leading the five viscera, six bowels, Ying and Wei, meridians, internal and external, left and right, upper and lower qi. If the San Jiao is open, the internal and external, left and right, and upper and lower are open. This is the most important thing for the body to be able to harmonize the internal and external, the left and the right, and the top and the bottom. In his clinical practice, Chen also attaches great importance to the maintenance of San Jiao’s qi-chemistry function, and suggests that “Shaoyang pivot” is the key to maintaining San Jiao’s qi-chemistry function. ”Shaoyang” has three meanings in the Huangdi Neijing: First, it means the amount of yang energy, as stated in Suwen? The “Yin and Yang Class Theory” cloud “a Yang for the Department of travel. …… a Yang, Shaoyang also”; two words hand Shaoyang Sanjiao and foot Shaoyang bile meridians; three words internal organs, refers to the bile and Sanjiao internal organs. In a nutshell, shaoyang is the body of the yang in and out of the procession of the place, scattered throughout the body, play the function of warming and warming all the departments, the upper and lower inside and outside the smooth flow is appropriate, stagnation is harmful; hand shaoyang three jiao from the top down through the upper, middle and lower three jiao, foot shaoyang bile meridian belongs to the bile under the liver, liver and bile together with the main drainage, regulate the smooth qi. It can be seen that Shaoyang qi is actually the pivot of the whole body qi rise and fall, its structure on the external coup and pass in the skin, internal diaphragm and wrap the upper and lower organs, in the function of presiding over the pivot, coordinate the qi of the organs and the whole body water and fire rise and fall in and out. In clinical practice, Dr. Chen has obtained good results by adding and subtracting Xiao Chai Hu Tang, the representative formula for reconciling Shao Yang, which is a powerful proof of his insight that “the treatment of Shao Yang is related to the internal organs of the three jiao, and the agent of Chai Hu is valuable in transferring the pivot”. In response to the important understanding that the core pathogenesis of IgA nephropathy, especially in moderately severe IgA nephropathy, is the intertwining of water and fire in the three jiao qi, Chen Shi Zong Xiao Chai Hu Tang, the original meaning of the formula, took a broad view and created a new formula named “Ren Ping”, which means to mediate the three jiao and harmonize water and fire, in order to set things right and regain the secret of yin and yang. This formula is composed of Chai Hu, Scutellaria, Fructus Lycii, Chrysanthemum, Rhizoma Atractylodis Macrocephalae and Radix Paeoniae Alba. In this formula, Chai Hu is the ruler, by virtue of its pungent and ascending nature, it not only relaxes the biliary organs, but also unobstructs the three jiao, so that the pivot can be facilitated, the qi can be harmonized, and the membrane coup can be unblocked, so that the vital energy can be stretched and the depressed evil can be reached outside; the minister uses Scutellaria baicalensis, by virtue of its bitter-cold nature, to clear the accumulated phase fire; then it is accompanied by the light and clear Chrysanthemum to disperse the heat in the upper jiao; it is accompanied by Bai Shao to benefit the yin and soften the liver, which is a medicine for the middle jiao, and because it can stop all the dampness and benefit the fluids, so that the urine can It is also combined with Atractylodes Macrocephala to warm the middle and strengthen the spleen to transform the dampness in the middle jiao, which together form the posture of governing the middle jiao; supplemented with sweet and flat Fructus Lycii to tonify the kidney and benefit the essence, nourish the liver and nourish the blood, so as to appease the deficiency in the lower jiao. The whole formula uses both cold and warmth, attacking and tonifying, taking into account the three jiao, but focusing on the circulation of qi to relieve the depression in the upper and middle jiao, and reconciling Shaoyang to reopen the blocked pivot. In the clinical evidence, the more round machine live method, according to the symptoms of the tailor-made, clever to adapt: damp-heat signs significant, add Cang Zhu, Coix Seed, pig ling, Poria, etc. to clear damp-heat, light penetration of water-damp; signs of spleen and kidney deficiency significant, heavy use of Astragalus, Yam, Huang Jing, Eucommia, Bacopa monniera, Cornu Cervi Pantotrichum, etc. to strengthen the spleen and benefit the kidneys; treatment throughout, especially the method of activating blood circulation and removing blood stasis, often with Ge Gen, Chuan Xiong, Paeoniae and other products as a must; more with rhubarb, must get The combination of rhubarb must be “healed by going down”, and it is feasible to invigorate blood stagnation, and finally achieve the function of removing blood stasis and dispersing knots. In summary, the whole formula is legislated in response to the machine, and the opposite is accomplished, regulating the qi flow, reconciling Shaoyang, benefiting qi and invigorating blood, strengthening the spleen and benefiting the kidney, synergistically achieving the purpose of sparing the membrane couples to harmonize the surface and the interior, harmonizing water and fire to calm cold and heat, and supporting the righteousness and dispelling evil to balance the deficiency. The treatment is in Shaoyang, the work is in the three jiao; set aside the chaos and return to the right path, smooth the stagnation in order to regulate, and finally make the qi flow and water channels pass, water and dampness return to the drains, blood flow within the veins, dampness, heat, stasis and toxicity of the knot and then resolved. For the diagnosis and treatment of moderately severe IgA nephropathy, Dr. Chen pioneered the treatment rule of “mediating the three jiao”, which fully reflects his profound knowledge of the ancient and modern world, and his diligent spirit of practicing and summarizing, and has made great contributions to establishing the important status of Chinese medicine in the treatment of refractory nephropathy. He has made great contributions to the establishment of the status of Chinese medicine in the treatment of intractable kidney disease, and has become a model for future generations to follow.