Pathogenesis of "shaoyin pivot" dysregulation and three-element regulation therapy in pediatric nephrotic syndrome from the perspective of "shaoyang body"

Children with nephrotic syndrome face a prolonged disease course and steroid dependence. The core pathogenesis of nephrotic syndrome involves lung, spleen, and kidney dysfunction, which leads to fluid overflow and edema. Based on the pediatric "shaoyang body" and "shaoyin pivot" theory, this paper proposes that the primary pathogenesis of pediatric nephrotic syndrome lies in pivot dysregulation. Owing to their "immature yin and yang" and underdeveloped shaoyang generative qi, children are susceptible to external pathogens disturbing the body, resulting in shaoyin water-fire pivot dysregulation. The disease begins with external invasion of wind pathogens, thereby disturbing the shaoyang pivot and leading to pivot dysfunction and disturbance of the water-controlling organs. This progresses to yang decline and water overflow, where the shaoyin fails in its qi-transforming function, causing leakage of essential substances. Furthermore, high-dose glucocorticoid intervention consumes yin and assists fire,leading to yin-yang imbalance and pivot instability. Ultimately, when turbid phlegm and blood stasis combine, the pivot becomes debilitated, and the sanjiao becomes obstructed. Consequently, the therapeutic principle of three-element regulation is proposed. In the acute episode stage, the heaven element focuses on regulating qi, diffusing the lung, and unblocking and smoothing the shaoyang using modified Yinqiao Powder combined with Mahuang Lianyao Chixiaodou Decoction. The human element aims to regulate shaoyin and balance water and fire with stage-specific treatment: during severe edema stage, modified Zhenwu Decoction combined with Danggui Shaoyao Powder should be used; during steroid induction stage, modified Zhibai Dihuang Pill, Erzhi Pill, and Dabuyin Pill should be used; during the steroid tapering stage, a self-formulated Yishen Decoction combined with modified Jisheng Shenqi Pill is often administered. In the prolonged refractory stage, the earth element consolidates the root, fosters the source, fortifies the spleen, and supplements the kidney using modified Shenqi Dihuang Decoction combined with Dahuang Fuzi Decoction. Regulating these three-element restores normal pivot function. The entire discussion is grounded in classical theory and integrated with clinical practice, aiming to provide a traditional Chinese medicine diagnostic and therapeutic approach for children with nephrotic syndrome that embodies the advantages of a holistic view and pattern differentiation-based treatment of traditional Chinese medicine.