The clinical manifestations of nephrotic syndrome are mostly caused by hypoproteinemia due to large amount of proteinuria, which leads to a weakened state of the body as a whole due to the reduced nourishing function of the blood. In all, the clinical disease is characterized by deficiency of both the spleen and the kidneys, while those with serious deficiency of qi will show deficiency of cold and spleen and kidney yang. However, on the premise of the basic pathogenesis of deficiency of both spleen and kidney, there are also differences between actual, deficiency or mixed deficiency and actual evidence.
Our master believes that clinically, we should not only grasp the characteristics of the basic disease mechanism, but also not ignore the transformation or intermixing between the evidence and the evidence, and for the longer duration of the disease and the intermixing of deficiency and reality, we should correctly deal with the dialectical relationship between deficiency and reality. Our master generally follows the following principles to identify and classify the treatment.
Discriminatory treatment
1. Deficiency of lung and kidney qi, wind and water offending evidence
Symptoms: The patient is weak with little qi, prone to colds, and suddenly develops edema of the eyelids and face, followed by high edema of the limbs and the whole body after an external sensation, with a light, fat and moist tongue with teeth marks on the side, white and smooth coating, and a sunken or sunken pulse.
Pathogenesis: The lung is the main source of qi, which is combined with the outer skin and hair to guard the outside; the kidney is the origin of the innate sky, which is the main source of qi of yin and yang, the main source of water, the opening and closing of the bladder, and the main receiver of qi. Lung and kidney Qi deficiency, the patient is weak; lung Qi deficiency, the external guard is not solid, so easy to suffer from colds; lung and kidney Qi deficiency, the Xuanjiang imbalance, water channels do not pass, the gas does not turn water, so easy to cure water and damp internal gathering for disaster. In case of external attack, the wind curbs water blockage, wind drums water overflow, wind-water phase bo, pushing waves, so edema starts in the eyelids, face, quickly spread throughout the body; wind evil attacked the table, Wei Yang is suppressed, the lung qi is not pronounced, so both external symptoms, to the tongue is light fat and moist, the side of the tooth marks, white smooth moss, sunken pulse, etc., are water-damp internal stop, the lung and kidney qi deficiency; if the wind is cold, the pulse is tight, if the wind is hot, the pulse is number.
Treatment: Benefit the qi and consolidate the surface, promote the lung and promote water.
Formula: Fangji Huangqi Tang and Yuequan Tang with addition and subtraction.
Fangji 10g, Astragalus 30g, Atractylodes 15g, Ephedra 6g, gypsum 24g, ginger 6g, jujube 12g, licorice 6g, Shiwei 30g, Baimao Root 30g, Coix Seed 30g, Chrysanthemum 30g, Mulberry Bark 10g, Daggerbark 15g.
Addition and subtraction: if wind-heat attacks the lung, combine with Yin Qiao San to remove wind and clear heat; if the patient is suffering from edema, add Wu Pi Drink to promote water retention and reduce swelling; if the chest and abdomen are full, add Chen Pi and Citrus Aurantium to regulate qi and broaden the middle; if the throat is also sore, add Jin Yin Hua, Burdock and Fishy Herb to clear heat and detoxify.
2.Spleen and kidney Yang deficiency, water-dampness flooding evidence
Symptoms: High degree of edema with concave filling, mainly in the lower extremities and waist and back, or with pleural effusion, ascites, unfavorable urination, poor appetite and loose stools, white face, cold body and cold extremities, pale and moist tongue or fat and tender tongue with tooth marks on the sides, white and slippery tongue coating, and sunken and weak pulse.
Pathogenesis: The spleen is the source of Qi and blood biochemistry; the kidney is the source of innate energy, which is the root of Yang energy in the body. If the spleen and kidney yang is deficient, the limbs are not warmed, so the body is cold and the face is white; if the spleen and kidney yang is deficient, the body is not transported and transformed properly, so the body is poorly fed and loose; if the spleen and kidney yang is deficient, water and dampness are not transformed, the body is not opened and closed, so the water is not discharged properly and stagnates in the body and overflows on the skin, so the body is not urinating, edema, and even the chest and abdomen are flowing, so the body is fluid in the chest and ascites; the tongue is light and moist or the tongue is fat and tender and moist, with teeth marks on the side, white, greasy and slippery coating, and the pulse is sunken and weak. All of them are evidence of spleen and kidney yang deficiency and water-dampness flooding.
Treatment: Warming the spleen and kidney, promoting the flow of water-dampness.
Recipe: Zhen Wu Tang combined with Spleen San plus reduction.
Hou Pu 10g, Bai Zhu 10g, Mu Gua 10g, Mu Xiang 10g, Cao Guo Ren 10g, Da Gui Pi 10g, Fructus Pulchelli 10g, Bai Fu Ling 10g, Gan Jiang 10g, Roasted Licorice 5g, Dang Shen 10g, Gui Zhi 10g, Ze Di 10g, Che Qian Zi 15g, Bai Shao 9g.
Addition and subtraction: qi deficiency, can add astragalus to replenish qi; spleen deficiency is obvious, can add yam, fried two buds, and wind, add wind, qiangwu to disperse wind and remove dampness; swelling below the waist is very much, add Fangqi, coix seeds; protein urine does not disappear for a long time, add cherry, gorgonian to consolidate the essence.
3.Yin deficiency of liver and kidney, dampness and heat interconnection evidence
Symptoms: abdominal distension and fullness, or even blue tendons, soreness and weakness of the waist and knees, distress and sleeplessness, redness and pain in the throat, irritability and bitterness, thirst, short and red urine, thin and hot smelly stools, red and less fluid on the tongue, yellow and greasy moss, and stringy pulse.
Pathogenesis: The patient’s prolonged illness and internal obstruction of water-dampness, combined with the use of hormones to injure yin and turn heat, resulting in deficiency of liver and kidney yin and accumulation of damp-heat. As the water-dampness is not removed and overflows into the skin, the abdomen is enlarged and full, and even the tendons are exposed. The waist is the house of the kidney, the kidney is the main bone, liver and kidney yin deficiency, the waist and knees lose nourishment, so see the waist and knees are sore and weak; liver and kidney yin deficiency, can not control Yang, Yang deficiency on the disturbance of the clear space, so see the heart troubled less sleep; damp heat accumulation in the throat, heat knots blood rotting flesh defeat, so see the throat redness and pain; heat Sheng hurt Yin, and the original liver and kidney yin deficiency, yin and fluid deficiency, can not be carried up, so see irritable hot mouth bitter, thirsty not want to drink; damp heat accumulation in the lower jiao, injuring fluid and depleting Qi, resulting in gasification does not work, Qi Qi The symptoms are short urine and constipation; the tongue is red, less fluid and greasy with yellow fur, and the pulse is stringy, all of which are signs of liver and kidney yin deficiency and damp-heat accumulation.
Treatment: Nourish the liver and kidney and clear damp-heat.
Remedy: Zhi Bai Di Huang Tang plus reduction.
Zhi Mu 6g, Huang Bai 6g, Cornu Cervi Pantotrichum 12g, Yam 12g, Dan Pi 9g, Poria 9g, Ze Di 9g, Slippery Rock 15g, Gardenia 10g, Sheng Di 10g, Yuan Shen 10g, Mai Dong 10g, Tao Ren 10g, Safflower 10g, Chuan Xiong 15g.
Addition and subtraction: If acne infection or sore throat is also present, and heat toxicity is more serious, add Panax quinquefolium, Fishy Herb, Goldenseal, and White Flowering Snake Tongue Herb to clear heat and detoxify the toxin; if the stool is constipated, add Raw Rhubarb to relieve heat and relax the stool; if there is also frequent urination, urgent urination, painful urination and hematuria, add Dandelion, White Mao Root, Artichoke, and Little Thistle to clear damp heat, cool the blood and stop bleeding.
4.Qi stagnation and water obstruction
Symptoms: generalized edema, even with pleural effusion, ascites, abdominal distention and chest fullness, chest and hypochondriac pain, swollen and hard limbs, red tongue, thin and greasy coating, smooth pulse.
Pathogenesis: water-damp internal obstruction for a long time, obstructing the lift of qi, resulting in qi stagnation and edema; water-damp internal obstruction, flooding the skin, so see edema around the body, and even overflowing chest and abdomen to become thoracic effusion, ascites; qi stagnation does not work, so see abdominal distension and chest fullness; qi stagnation and water obstruction, stopping in the limbs, so see the limbs swelling and hardness; red tongue, yellow greasy moss, smooth pulse, etc., are all signs of qi stagnation and water obstruction. The symptoms of Qi stagnation and water blockage.
Treatment: Promote the flow of qi and water.
Remedy: Zhongmanfenxiao Tang plus reduction.
Radix Codonopsis Pilosulae 10g, Atractylodes Macrocephala 10g, Glycyrrhiza Glabra 6g, Curcuma Longa 10g, Scutellaria Baicalensis 10g, Radix Angelicae Sinensis 12g, Rhizoma Zeleniae 5g, Radix Magnoliae Sinensis 15g, Radix Panax Notoginseng 10g, Pericarpium Citri Reticulatae 9g, Rhizoma Huanglian 6g, Poria Cocos 15g, Radix Ginger 6g, Rhizoma Saxifraga 6g, Rhizoma Tigris 15g, Rhizoma Citrus Aurantium 10g, Radix et Rhizoma Umbellatus 15g.
Addition and subtraction: for constipation, add Rhubarb 5-15g, fried betel nut 3-10g; for urinary inconvenience, add small thistle 10-15g, half lotus 10-15g, Tongcao 6-12g.
5.Stasis and water interconnection evidence
Symptoms: Low urine and edema, sallow face or atrophy, stasis or petechiae on the lips and skin, often accompanied by lumbar pain like needles, the pain is fixed and does not move, hematuria, rough skin or wrong skin nail, dark red or dark tongue, or petechiae and petechiae, yellow and greasy tongue coating, thin or sunken pulse.
Pathogenesis: Nephrotic syndrome is characterized by prolonged water-dampness and damp-heat internal stagnation, stagnation of qi and blood flow, and stasis of blood, which stagnates in the body with the evil of water-dampness. Water-dampness does not transform and collects in the body and overflows to the skin, so we can see little urine and edema; stasis of blood, blood flow is not smooth, the skin of the face and limbs lose their glory and nourishment, so we can see sallow or yellow face, lips and skin with petechiae and petechiae, skin roughness or skin nail error; waist is the kidney capital, stasis of blood blocking the kidney ligament, if it does not pass, it hurts, so we can see pain in the waist like a needle stab, the pain is fixed and does not move; stasis of blood blocking the kidney ligament, blood does not follow the meridian and flow, but overflows outside the vein, so we can see Blood in the kidney channels is blocked, blood does not flow through the channels and overflows outside the veins. The tongue is dark red or light dark, or there are petechiae and petechiae, the pulse is astringent as a sign of blood stasis, the moss is thin and greasy as an image of water and dampness stopping inside; the long-standing disease must be deficient then the pulse is thin, the disease is the inner evidence so the pulse is sunken, blood stasis then the qi stagnation does not work so the pulse is string.
Treatment: Promote blood circulation and promote water circulation.
Radicals: Blood stasis and blood stasis soup with reduction.
Peach kernel 12g, safflower 10g, red peony 10g, Chuanxiong 15g, Oxalis 15g, Radix Angelicae Sinensis 15g, Radix et Rhizoma 10g, Citrus Aurantium 10g, Radix et Rhizoma Chai Hu 10g, Glycyrrhiza Glabra 6g.
Addition and subtraction: for those with phlegm-dampness obstruction, add 3-10g of Radix Panax notoginseng, 6-12g of Atractylodes Macrocephala, 3-9g of Asparagus; for those with heat symptoms, add 6-12g of Dampness, and in severe cases, 6-12g of Radix Paeoniae; for those with foamy urine, add 9-30g of Radix Astragali, 3-10g of Cicada; for those with blood in urine, add 15-30g of Radix Bupleurum.