A review of Chinese medicine therapy for chronic uric acid nephropathy
Chronic Uronic Acid Nephropathy (CNAN), commonly known as Gouty Nephropathy (GN) in the past, is a nephropathy caused by the disorder of purine metabolism in the body, which causes excessive production of uric acid in the blood, or the decrease of uric acid excretion by the kidneys, which increases the blood uric acid and deposits uric acid salts in the blood in a supersaturated state. This is a nephropathy caused by supersaturation of urate in the blood. In recent years, with the change of dietary structure of our people, the increase of protein and purine-rich food intake, the aging process of society and the improvement of medical treatment, the incidence of CUAN has increased year by year, and thousands of cases have been reported in China, which has attracted wide attention of medical profession.
According to the main manifestations of CUAN proteinuria, microscopic hematuria, leukocyturia, edema, accompanied by back pain, lumbago, fatigue, nocturia, joint swelling or unfavorable flexion and extension, and even panic and shortness of breath, dizziness, tinnitus, nausea and vomiting, urinary odor in the mouth, skin itching, urine and other symptoms, can be categorized as different diseases of Chinese medicine. If proteinuria is the main symptom, it belongs to the category of “deficiency of essence” and “deficiency labor” in TCM; if renal insufficiency or renal failure is the main symptom, it belongs to the category of “deficiency loss” and “guan ge”. If the main manifestation is kidney insufficiency or kidney failure, it belongs to the categories of “deficiency loss” and “guangs”; if the main manifestation is uric acid stones or hematuria or leukocyturia, it can be classified as “hematuria”, “hot gonorrhea” or “stone gonorrhea”. Those who have gouty arthritis can be classified as “gout”, “paralysis”, “history of arthritis”, “white tiger history of arthritis”, etc. If combined with hypertension, coronary heart disease, hyperlipidemia, etc., it should be considered as “vertigo”, “palpitation”, “heart paralysis”, “chest paralysis”, etc. in Chinese medicine. If it is combined with hypertension, coronary heart disease, hyperlipidemia, etc., it should be considered as “vertigo”, “palpitation”, “heart paralysis”, “chest paralysis” and other diseases in Chinese medicine. The Chinese medicine research on CUAN is of great significance as there is no effective way to control the rate of progression of CUAN kidney function in Western medicine. What is the level of research on CUAN in Chinese medicine? In this regard, on the basis of the theoretical and practical experience of CUAN by our supervisor, Prof. Shi Zhensheng, we review the following literature in the past 10 years.
1. Awareness of etiology
According to the academic thought and clinical experience of our mentor, Professor Shi Zhensheng, the etiology of CUAN should be understood from the combination of external sensation (wind, cold, dampness, heat (poison)) and internal injury (deficiency of endowment, diet, seven emotions, fatigue).
1.1 External sensation, stagnation of skin and hair meridians
Insufficient endowment, old age and physical decline, the first deficiency of the right qi, outside the guard is not solid, the coup is loose, or the climate is hot and cold sudden changes, “or wading in cold water, or standing on wet ground, or fan to get cool, or lying when the wind, cold and cold outside the fight” (“Ge Zhi Yu Lun? Gout”), the wind, cold, moisture, heat (poison) evil to take advantage of the deficiency and enter, often together as a disease, resulting in changes in the function of the viscera, the body’s qi, blood and fluid transportation, transport and metabolic disorders, the poor flow of qi and blood, stagnation, stagnation, manifested as stagnation of the skin and hair meridians, and bone loss of nourishment and edema, joint swelling and pain and other symptoms, as the “Secret Guide to Wai Tai” said: ” …… wind and cold with warmth of the poison, due to deficiency, will aid the loss of reason, subject to this wind evil, meridian stagnation, stored in the joints between, or in the limbs, its disease day quiet and night, when the hair through the bone soreness.” The more the external evil invades the body for a long time, the more the positive energy is lost, the more the internal organs of the spleen and kidneys become deficient, the spleen loses its health and control, the kidneys lose their opening and closing, the lungs lose their propagation and suction, water-dampness, heat toxicity, phlegm and turbidity stagnate in the internal organs, meridians and blood vessels, and the upper kidneys are damaged, resulting in proteinuria, hematuria, gonorrhea, or frequent and clear long urination at night, or lumbago, fatigue, or both the spleen and kidneys are damaged, and the turbid toxicity is internally attacked, resulting in edema, nausea and vomiting, and The symptoms of “Guange” include itching all over the body, urine odor in the mouth, etc.
1.2 Internal injury and disorder of internal organs
CUAN is a metabolic kidney damage caused by the disorder of purine metabolism in the body, and is most closely related to the lungs, spleen and kidneys. Su Wen? The chapter of the meridians and veins, “drink into the stomach, overflowing essence, upward transmission in the spleen, spleen qi dispersed essence, up to the lungs, through the water channel, downward transmission of bladder, water essence four cloth, five parallel.” The normal metabolic process of body fluids depends on the coordinated action of the lungs, spleen and kidneys (bladder) to complete, with the Sanjiao as the channel of transmission throughout the body. If you do not eat well, if you eat fat, sweet and alcoholic drinks, then dampness and heat will be contained within the body, and the production, distribution and metabolism of fluids will be impaired. As stated in the book “Paralysis”, “diet and residence are the basis of the disease” and “Suwen? The five viscera generation” chapter said: “eat more sweet, it is bone pain and hair fall”. If the kidneys are not in good condition, or if the kidneys are injured by exertion, the kidneys are damaged, and the kidneys’ transpiration and gasification, and the production, distribution and metabolism of fluid are low, then the fluid cannot produce urine normally and is discharged from the bladder, and the kidneys lose their control and the essence is lost in the urine, causing dampness and heat, turbidity and toxicity, and phlegm to remain in the body, stagnating and not going away, or the fluid stops gathering and edema, or the essence is lost and becomes protein urine; or dampness and heat and turbidity and toxicity damage the kidney complex and become hematuria In addition, the liver and kidney have the same origin, the seven emotions hurt the liver, thoughts hurt the spleen, kidney disease and liver, often affecting the qi flow in and out of the internal organs, making the condition recur or worsen. “The loss of drainage of the liver impairs the liver’s function of regulating the qi and promoting the transportation of the spleen and stomach, resulting in blood stagnation and stagnation of blood, fluid distribution and metabolic disorders, leading to pathological changes such as blood stasis, fluid stagnation, and blood not following the meridians. It can be seen that the consumption of fatty, sweet and alcoholic beverages, the seven emotions, and room strain can cause the spleen to lose its health, the liver to lose its drainage, the kidneys to lose their clearing and draining, the lungs to lose their declamation and lowering, and the qi to lose its elevation, so that the metabolism of qi, blood, water and other body fluids is disturbed. If the joints and meridians are blocked, the bones lose their support and become paralyzed and painful, and if the kidneys are damaged, edema, lumbago, proteinuria and guangs occur.
CUAN is often triggered when the internal organs are disordered, dampness and heat accumulate, and toxins are stagnant, and when external evils coincide, or when alcohol is consumed, or when fat and sweet are eaten, or when labor and fatigue are internal injuries, or when the seven emotions are harmful. As the “Ten Thousand Diseases” said: “or labor, cold water, or drunkenness, when the wind to take sweat, or lying on wet ground, or rain, sweat, wet clothes, steam body and become”.
2. Understanding of disease mechanism
The occurrence of CUAN is mainly related to the disorder of purine metabolism and excessive production of blood uric acid in the body. Blood uric acid can be considered as one of the substances produced in the process of metabolism of internal organs and body fluids. Under the physiological condition, the “overflowing essence” of the stomach, “dispersing essence” of the spleen, “regulating water channels” of the lung and “separating clear and turbid” of the small intestine all depend on the transpiration of the kidney. “All rely on the kidney’s transpiration and vaporization. The whole body’s qi, blood and fluid, through the kidney’s transpiration and vaporization, “the clear” transpires and rises to spread throughout the body, while “the turbid” descends to urine or is injected into the bladder with urine and then expelled from the body. Diseases in the kidneys, lungs and spleen affect the production, distribution and excretion of fluids and disrupt the metabolic balance of fluids, resulting in the formation of water, dampness, phlegm, and drinking, making the circulation of fluids obstructed and causing a series of pathological changes of water stagnation and accumulation. Water, dampness, phlegm, and beverages seep into the veins as part of the blood, and “the fluids are harmonized, and change and become red as blood” (Ling Shu? The key to the pathogenesis is the deficiency of the kidneys, which is not conducive to steam and gasification, and the failure of the lungs, spleen and liver. Therefore, Prof. Zhen-Sheng Shi emphasized that the pathogenesis of CUAN should be grasped dynamically from a holistic point of view, and that deficiency of the spleen and kidney is the basis of the pathogenesis, and deficiency of both qi and yin is the basic pathogenesis. At present, there are three views on the Chinese pathogenesis of CUAN in China as follows.
2.1 Theory of deficiency of spleen and kidney
The lack of diet, fatty and sweet, or greed for alcoholic beverages damage the spleen and stomach, the card loss of health and movement, lifting and lowering disorders, water and grain can not be properly transported and become turbid phlegm and stasis, blocked in the blood, accumulation in the kidneys, resulting in adverse renal gasification and protein urine, gravel gonorrhea, etc., blocking the meridians, congestion of Qi and blood to become a disease of joint paralysis and pain. The kidneys are weak, the kidneys are weak, the kidneys are weak, the kidneys are weak, the kidneys are weak, the kidneys are weak, the kidneys are weak. Deficiency of the spleen and kidney is the basic pathogenesis of CUAN.
2.2 Theory of deficiency of liver and kidney
Liver collects blood, kidney collects essence, liver and kidney have the same origin, and essence and blood are produced by each other. The kidney essence is abundant and depends on the nourishment of the liver blood; the liver blood is generated and depends on the gasification of the kidney essence. If the kidney essence is deficient, the liver blood is insufficient, and if the liver blood is insufficient, the kidney essence is more damaged. If Liver and Kidney Yin is deficient, Yang loses its concealment, phase fire is hyperactive, dampness, heat, phlegm and stasis are generated internally, robbing Kidney Yin, damaging Kidney ligaments and developing gonorrhea, sand and stones, blocking joints for paralysis and pain; uric acid is deposited in the kidneys, dampness, heat and stasis tend to go down, resulting in frequent urination, urgent urination, painful urination and even blood in urination, little or no urination; if Liver Yang is hyperactive, dizziness and tinnitus, dry eyes, heat in the heart of the hands and feet, dry mouth and drink, dry throat and sore throat, and other symptoms of Yin deficiency and internal heat.
2.3 Theory of deficiency of both qi and yin
Spleen and kidney deficiency or liver and kidney Yin deficiency can be transformed into Qi and Yin deficiency if the course of the disease is prolonged Yin deficiency and Qi, and Qi deficiency and Yin. Qi and Yin deficiency is the main line of the pathogenesis of CUAN and is most common in clinical practice. According to the mentor, Qi-Yin deficiency is between Qi deficiency and Yin deficiency, with clinical manifestations of both Spleen Qi deficiency and Kidney Yin deficiency, but the pathogenesis is a dynamic evolutionary process. In addition, the disease is also accompanied by damp-heat, blood stasis, water-dampness, phlegm and other symptoms, making the pathogenesis more intricate and complex. Clinically, it is important to recognize the dynamic evolution of the disease mechanism in order to know the changes and grasp the initiative of treatment.
In summary, the etiology of CUAN is based on deficiency (mainly kidney deficiency), and the evil (wind, cold, dampness, heat
1, the accumulation of deficiency of the spleen and kidney deficiency and deficiency of the lungs, liver and other viscera to varying degrees is the cause of the onset of CUAN; spleen and kidney Qi deficiency, liver and kidney Yin deficiency, etc., resulting in impairment of the function of the spleen and kidney, internal disorders of Qi, blood and fluid metabolism to form hyperuricemia is the main cause of the onset of the disease; wind, cold, damp, heat (poison) and other external attacks, as well as fatty, sweet, alcoholic wine, the seven emotions, fatigue (room and physical exertion), etc. is the cause of the onset of CUAN The causes of CUAN are According to the factors, main causes and triggers, take appropriate measures to prevent them, which may reduce the incidence of CUAN.
2, dampness, heat, phlegm and stagnation, recurring The metabolic dysfunction of the internal organs, Qi, blood and fluid transport, transport and transformation disorders of the pathological products of water and dampness, damp-heat, cold and dampness, dampness, stagnation of blood, etc. often interfere with each other, stopping in the body, kidneys, joints, stay but not go, throughout the entire course of CUAN. Clinical treatment, the correct support to eliminate evil or eliminate evil to support the correct, in order to receive satisfactory results.
3, the qi and yin injuries, yin and yang deficiency CUAN longer course of the disease, often prolonged over time, yin loss and gas or gas loss and yin, qi and yin deficiency in the most prominent clinical manifestations, late spleen and kidney yang deficiency, yang loss and yin, yin and yang deficiency of evidence, or qi and yin deficiency into yin and yang and deficiency. There are also cases with Qi-Yin deficiency as a prominent symptom at the beginning, which should be given special attention in clinical practice.
In addition, damp-heat and phlegm-stasis are the most prominent co-morbidities of CUAN, almost throughout the entire course of the disease. “If there is dampness, there is heat” (Zhi Guiding Medical Case); “Kidney is the origin of phlegm” (Ge Zhi Yu Lun); “Blood accumulation for a long time can also turn into phlegm and water” (Blood Evidence Theory). Damp-heat congestion in the lower jiao, the kidney is not conducive to qi-transformation; if the qi does not transform water, the urine will be red and astringent; if damp-heat tends to go down, the urine will be clear and turbid; if damp-heat injures the kidney, the kidney loses its seal, the essence will be drained down and become proteinuria; if the kidney ligament is damaged, the blood will not return to the meridian and become hematuria. Phlegm and stasis aggravate kidney deficiency, stasis and obstruction, bladder gasification is not conducive to retention of urine, Guange; phlegm and stasis, dampness and turbidity agglomerate into stones, resulting in back pain, gonorrhea, all these, clinical attention should be paid to differentiate.
Diagram of the evolution of the etiology and pathogenesis of CUAN
3.Typing
As there is no unified classification standard for CUAN, the clinical classification varies greatly, mainly five types: Yang deficiency of the kidney, Yin deficiency of the liver and kidney, Yin and Yang deficiency, cold and dampness obstruction, dampness and heat paralysis.
4.About treatment
CUAN is divided into four types, namely liver-kidney yin deficiency, spleen-kidney qi deficiency, qi-yin deficiency, and yin-yang deficiency, to treat the root of the problem, combining the symptoms of water-dampness, cold-dampness, damp-heat, stasis of blood with the root of the problem.
4.1 Liver and kidney yin deficiency type: the main manifestations are lumbago and lumbago, dry eyes, irritable heat, dry mouth and drink, dry stool, urine red or gravel urine, urinalysis can be seen proteinuria, biochemical tests can be seen elevated blood uric acid, or there are indicators of renal insufficiency, light red tongue or red tongue with little moss, thin pulse.
Treatment: Nourishing the liver and kidney is the mainstay
Treatment: nourish the liver and kidney, plus reduction of Radix Paeoniae and Dihuang Tang or Liu Wei Dihuang Tang.
4.2 Spleen-kidney qi deficiency type: mainly manifesting as shortage of breath and weakness, less energy and abdominal distension, lack of warmth in the limbs, soreness and weakness of the waist and knees, nocturnal urine is frequent and clear, loose stools, proteinuria or hyperuricemia can be detected, or there are indicators of renal insufficiency, fat tongue, light tongue, tooth marks on the edge of the tongue, and sunken and thin pulse.
Treatment: Strengthening the spleen and kidney is the mainstay
Formula: Bao Yuan Tang with reduction.
4.3 Qi and Yin deficiency type: the most common clinical evidence. The main manifestations are fatigue, spontaneous sweating and shortness of breath, heat in the heart of the hands and feet, dry throat and mouth, thirsty for water or not much water, dry or thin stools, abnormal urinalysis, detectable indicators of hyperuricemia and/or renal insufficiency, light red tongue with tooth marks, and sunken and thin pulse.
Treatment: Benefit Qi and nourish Yin
The formula: Benefit qi, nourish kidney, activate blood, and clear the blood (Professor Shi Zhensheng’s formula, composed of prunus ginseng, raw astragalus, lady’s mantle, dry lotus grass, jiao hawthorn, danshen, atractylodes, cypress, cow’s knee, earth poria, evening silica, etc.). For Qi deficiency, use Wu Zi Yan Zong Wan with Ginseng and Astragalus; for Yin deficiency, use Da Teng Yuan Decoction with addition and reduction.
4.4 Yin and Yang deficiency type: mostly seen in the end of CUAN. The main manifestations are less facial energy, fear of cold, cold limbs, lumbago, dry mouth and desire to drink, or edema, dry or dilute stools, usually accompanied by hyperuricemia and serious impairment of kidney function indicators, fat tongue and light texture, sunken or weak pulse.
Treatment: Yin and Yang should be tonified.
Treatment: Gui and Dihuang Tang with Gui Ban Gum, Deer Horns Gum, Xian Mao and Xian Ling Spleen.
CUAN is a mixture of deficiency and reality, treatment must be based on the support of the righteousness to pay attention to the elimination of evil, that is, pay great attention to the treatment of the following concurrent symptoms.
Damp-heat: can also see joint swelling and pain fever, thirst and irritability, yellow and red urine, red tongue with yellow and greasy coating. Can be added to the FuZheng formula CangZhu, HuangBao, cow knee, TuFuLing, Ligustrum, evening silica sand, raw coicis, HaitongPi, etc. to clear heat and dampness.
Cold dampness: joint pain can be seen at the same time, aggravated by cold, and reduced by warmth. Cinnamon stick, Phellodendron, Ephedra, Hosanna, Ginger, Atractylodes, Atractylodes, Paeonia, Licorice, etc. can be added to Fu Zheng formula to warm and disperse cold dampness and relieve pain.
Holding water-dampness: the main manifestation is edema. In mild cases, the lower extremities are slightly swollen, which can be treated by adding hyssop, psyllium, bangji, adzuki bean and donggua peel in the Fu Zheng formula; in severe cases, it is advisable to warm the Yang and promote water, which can be treated by using the Spleen Drink, Ji Sheng Kidney Qi Tang, Fang Ji Huang Qi Tang and Fang Ji Fu Ling Tang. In the water formula to add mucuna pruriens, hammer, Chen Pi, incense and other qi products, to help the qi line water also line, every time as effective as the rafter, so that edema quickly subside.
Dampness and turbidity: dampness and turbidity on the road can be seen in nausea, vomiting, tongue bitter yellow greasy, can be added in the Fu Zheng formula, Huang Lian, Bamboo Ru, even first clear dampness and heat with Su Ye Huang Lian Tang, Huang Lian warm gall bladder soup, after the vomiting stop and then Fu Zheng; white tongue greasy, can be added in the Fu Zheng formula, Chen Pi, ginger, Bamboo Ru, even the first turbidity and vomiting control with Xiao Han Xia plus Fu Ling Tang. If the dampness and turbidity rebellious, urinary odor in the mouth is obvious, can be added on the basis of the Fu Zheng, or combined with rhubarb enema, so that the warm turbidity out of the drainage, symptoms relief.
Stasis of blood: Clinical symptoms of stasis of blood often include limb pain, limb numbness, unfavorable joints, dark lips, dark tongue or petechiae or petechiae spots, and the addition of Salvia miltiorrhiza, Radix et Rhizoma Gastrodiae, Rhizoma Zeleniae, Radix et Rhizoma Peach Blossom, Rhizoma Ligustici, and Rhizoma Chuanxiong to activate blood and resolve stasis.
The above-mentioned evils are often combined with each other, so the clinic should follow the principle of helping the righteous without forgetting to remove the evil and not to harm the righteous.
In the early stage, phlegm and dampness block the ligaments and paralyze the joints, and the treatment is Peach Red Four Objects Tang with San Miao Wan plus reduction; in the middle stage, spleen and kidney deficiency, water and dampness do not transform, and the treatment is Jin Kui Kidney Qi Wan with Ginseng and Bai Zhu San plus reduction; in the late stage, spleen and kidney deficiency and dampness stagnation, and the treatment is Warm Kidney and Detoxification Tang plus reduction (Zishu, Dang Shen, Atractylodes Macrocephala, Radix Phellodendron, Radix Panax, Huang Lian, Sheng rhubarb, Junxue, Sharen, ginger). The basic formula used is mainly to remove dampness by promoting kidney circulation and stasis (raw Astragalus, Danshen, Xianling spleen, rice seed, mulberry branch, late silkworm sand, gentiana, motherwort), Liu Wei Di Huang Tang with addition and subtraction (raw earth, dogwood, poria, zedoary, Astragalus, Danshen, motherwort, mulberry parasite, gentiana), Fang Wei Huang Qi Tang with addition and subtraction (Fang Wei Huang Qi Tang with green peel, Chen Pi, Wang Bu Liu Xing, Chuan Niu Kne), and Xing Qi and Drainage. The basic formula for inducing diuresis (Dong Gua Pi, Da Gui Pi, Sang Bai Pi, Chen Pi, Mu Xiang, Fu Ling Pi) and Yi Kidney Treasure (Da Sheng Di, Mi Ren Root, Gu Qi Root, Tian Tian Fan, Mai Dong, Shan Yao, Ze Di, Gan Cao). All of them have achieved certain therapeutic effects. In addition, there are also case reports of treating CUAN with Hematopoietic and Blood Stasis Tang combined with Propofol.
5. About the efficacy
From the analysis of the collected literature, the total effective rate of the treatment of CUAN with the basic formula and addition and subtraction in Chinese medicine ranged from 73.3% to 89.3%. Although the efficacy assessment criteria and treatment methods vary from place to place, they basically reflect the overall level of current Chinese medicine treatment for CUAN.
6. Summary and discussion
6.1 About the name of CUAN in Chinese medicine
Research data show that CUAN caused by gout accounts for 10-20%, and most CUAN patients can be accompanied by gouty arthritis, so in the past, CUAN is commonly known as gouty nephropathy.
Both Chinese and Western medicine have the name “gout”. The name “gout” in Chinese medicine was formed in the Jin-Yuan period, for example, Zhu Danxi’s “Ge Zhi Yu Lun” and “Danxi Xin Fa” both have special discussions on “gout”. The “Ge Zhi Yu Lun” and the “Dan Xi Xin Fa” both contain special discussions on “gout”. Gout” cloud: “he gout also, the big stroke because the blood by the heat, has been boiling, after or wading in cold water, or standing wet, or fan to get cool, or lying when the wind, cold and cold outside the fight, hot blood to sweat turbidity condensation, so pain, night pain is very, line in the yin also.” Danxi Xinfa? Gout” is also said: “…… day quiet and night hair, when the hair through the bones sore”, “pain has a regular place, the pain where the red swelling burning, or all over the body strong heat”. The discussion on gout can be traced back to the Nei Jing era. For example, in the article “Ling Shu? The chapter of “Paralysis of the Week” contains: “Paralysis is caused by the wind, cold and moisture guest between the flesh, urgent and froth, froth to get cold is gathered, gathered is row of flesh and split, split is pain, ……” is quite close to the formation of gout. Mr. Fan Xingjun in the “New Meaning of the History of Chinese Diseases” said, “The text ‘froth gets cold is gathered’ seems to mean that uric acid is formed, similar to the gout stone of modern medicine.” Su Wen? In the “Treatise on Paralysis”, the cause of paralysis is discussed as “the spleen and stomach are injured when the diet is doubled”; “Ling Shu? The cold paralysis is discussed in the chapter “Thieves’ Wind”: “This is a case of injury from dampness, which is hidden in the blood veins and does not stay for a long time. If there is a fall, bad blood within and does not go, the year but the joy and anger is not moderate, eating discomfort, cold and temperature from time to time …… and so the attack of evil, it is cold paralysis. With today’s gout alcoholism, over-eating, fatigue, emotional discomfort, trauma and other causative factors recognized consistent.
The “Golden Killing Essentials” by Zhang Zhongjing of the Han Dynasty not only covers the causes and mechanisms of gout, but also details its evidence and treatment. The chapter of “The Essentials of Golden Kui? The chapter of “Stroke and joint disease” says that the cause of gout is “astringent small pulse, short breath, sweating, joint pain can not be flexed and stretched, this are drinking and sweating when the wind, is injured in acid into”; says that its pathogenesis is “inch mouth pulse sinking and weak, sinking that is the main bone, weak that is the main tendon, sinking that is the kidney, weak that is the liver, sweating in and out of water, like water sad The sweat in and out of the water, like the water is sad, and the yellow sweat in the calendar section, so it is called the calendar section. The inch mouth pulse is sunken and weak, sunken is the disease in the kidney, the kidney is insufficient, the kidney is the main bone, so said “sink that is the main bone”, “sink that is the kidney”; weak for the liver blood is insufficient, the liver collects blood, liver blood is insufficient, the liver is the main tendon, so the day “weak that is the main tendon “, “weak that is the liver”, liver and kidney deficiency is the cause of its internal causes, liver and kidney Qi and blood deficiency, sweat membrane reason open drainage, and because of sweat in and out of water, cold and dampness take advantage of the internal invasion, injury to the blood vessels, infiltration of tendons and bones, injected into the joints, Qi and blood run coagulation, resulting in joint pain, painful swelling, overflow “Yellow sweat”, that is, local infection of the joint secretes yellow exudate. It can be seen that “yellow sweat of the joints” is a symptom of the disease of the joints, which is consistent with the present-day “gouty arthritis” and “gouty ulcerative fluid”.
The “yellow sweating” disease in “The Essentials of the Golden Horoscope” may also be similar to the gouty nephropathy of today. In the article “The Essentials of Golden Kui? The “Water Gas Disease Pulse Evidence” chapter has: “yellow sweat its pulse is sluggish, body fever, chest tightness, head and face swelling of the limbs”; “yellow sweat of the disease, the two shins since the cold …… if sweat has been, but fever, … … waist and hip flaccid pain, such as things in the skin-like, dramatic people can not eat, body pain heavy, irritable, urine is not conducive, this is yellow sweat”; “body swelling and cold, like a week paralysis, chest chamber, can not eat, anti-gathering pain, dryness at night can not sleep, this is yellow sweat, pain in the bones” [39]. Zhongjing’s master clearly described the “yellow sweat” and “yellow sweat” separately to show that the different names and the same source, under different sections to tell people to distinguish. In contrast, it is clear that “yellow sweat” is mainly in the joints, while “yellow sweat” emphasizes that the key to the disease is in the internal organs (kidneys). Gouty nephropathy with uric acid or uric acid crystals deposited in the interstitial tubules of the kidneys can cause edema and low urine, so patients appear to have symptoms such as “body swelling” and “unfavorable urination”; gouty nephropathy with acute attacks of wind can have “fever “CUAN disease over time, glomerular involvement into chronic renal insufficiency, there are often water, electrolyte imbalance symptoms, “sweating has been anti-fever” caused by dehydration. “A long time its body will be a mistake”. In the end stage of uremia, there are “warmth and vomiting”, “inability to eat”, “suffocation in the chest”, “dizziness”, “shortness of breath”, “shortness of breath”, and “dizziness in the head”. CUAN is often combined with hypertension, hyperlipidemia, secondary heart disease, etc., so often “body heavy, sweating has always been light”. The “waist and hip pain” is the renal colic caused by uric acid stones blocking the renal tubules and the following urinary tract.
CUAN has gout for a long time, from the joint involved in the ‘kidney, there is the onset of kidney damage and no joint symptoms, so some of the “waist and hip pain …… sharp people can not eat …… The actual fact is that you can find a lot of people who are not able to get a lot of money from the internet. The acute attack of gouty arthritis is almost always accompanied by acute inflammatory manifestations such as “fever” and “swelling of the feet as if they were detached”.
It can be seen that the “calendar section” and “yellow sweat of the calendar section” in “Jin Kui Dai Lu” are in fact the present-day “gout”, while “yellow sweat The “yellow sweat” may be similar to “gouty nephropathy”.
As Zhang Lu’s “Zhang’s Medical General”, a famous doctor of the Qing Dynasty, says: “Gout a evidence, the “Ling Shu” is called thief wind, the “Su Wen” is called paralysis, the “Jin Kui” name calendar section, later renamed the White Tiger calendar section, in recent times commonly known as arrow wind.” [40] The ancient concept of gout has three views: ① refers to the cold paralysis caused by wind evil, such as “Jing Yue Quan Shu? On the evidence of paralysis: “wind paralysis a certificate, that is, today’s so-called gout also.” The first is that the painful paralysis is caused by the cold, such as the “Medical Six Essentials? Gout”: “Gout, that is, the internal meridian pain paralysis.” ③ is pain in the joints of the extremities, such as the “Compendium of Materia Medica” gout is “pain in the joints of the extremities, wandering indefinitely.” It is not the same disease as “gout” caused by high blood uric acid, which is an alias of “paralysis” in modern medicine.
The term “gout” in Western medicine is derived from the Latin word “drip (quta)”, which is thought to be caused by malodorous body fluids dripping into weakened joints, and is related to the modern disorder of purine metabolism. The history of the disease shows that the diagnosis was made in Western medicine in 500 B.C. and was called “the king’s disease”, while the Greek physician Hipocrates mentioned that gout was a hereditary disease. More than 100 years ago, Arlred Garrod recognized that gout was related to blood uric acid, and in 1931, A. Egarrod confirmed that gout was a metabolic disease and that gout could cause kidney damage. Nearly half a century of medical research has shown that CUAN is only partly caused by gout secondary to gout, or CUAN secondary to gouty arthritis.
Western medical disease names were greatly influenced by Chinese medicine when they were translated and introduced into China. Since there are many similarities and differences between the research methods and the level of understanding of diseases in Chinese and Western medicine, there are often some mutually inclusive phenomena in the concepts of the two types of medicine. In Western medicine, “gout” is often associated with joint symptoms and uric acid stones; in Chinese medicine, “gout” has long been described as “easy to treat if it enters the internal organs, but difficult to treat if it enters the organs” (Zhongzangjing? Five paralysis”). The concept of “gout” in Chinese medicine seems to be more extended than the concept of “gout” in Western medicine, and also includes “gouty nephropathy” with obvious joint symptoms. In Western medicine, “hyperuricemia” does not have a corresponding name in Chinese medicine, and it is difficult to find an appropriate name for CUAN in Chinese medicine.
6.2 Physical and genetic factors for the development of CUAN
Chinese medicine physical theory that the occurrence of CUAN and the lack of endowment, fatty, sweet, thick and greasy, spicy tobacco and alcohol, spleen and soil damage over time, the ascending and descending of the muddy function malfunction of the body rich and obese, excess nutrients, increased metabolic products, resulting in muddy phlegm and stagnation, external injection of flesh and joints, internal stay in the internal organs, that is, the “spleen and stomach theory” said “internal injury to the spleen and stomach, all diseases from the birth of This is what the “Treatise on the Spleen and Stomach” says: “Internal injury to the spleen and stomach causes all diseases. In the “Treatise on Spleen and Stomach”, it is said that “internal injury to the spleen and stomach causes all diseases”. She was nearly 30 years old and suffered from gout contracture due to her heavy food and impatient nature. Xu Lingtai also said in his “Treatise on the Cunningham of the Yuan Qi” that “when one is born, there is already a definite division”, emphasizing the decisive role of innate endowment in the process of disease change. This is consistent with the discussion on the etiology of CUAN in Western medicine, such as family genetic history and obese physique.
6.3 Analysis of medication pattern
In the literature on the treatment of CUAN in Chinese medicine, the drugs that are used more frequently in their order are: zedoary, atractylodes, astragalus, epiphyllum, poria, raw earth, hyssop, angelica, motherwort, cypress, rhubarb, gentiana, barley, earth poria, danshen, atractylodes, money grass, codonopsis, shan ying meat, chenpi, wei ling xian, etc. Basically, it is based on benefiting Qi and nourishing the kidney, activating blood circulation and removing blood stasis, and clearing heat and diuretic drugs.
From the analysis of literature data, the study of CUAN in TCM currently lacks systematic and large number of case reports, but it has shown unique advantages and promising seeds. Compared with Western medicine treatment, TCM evidence-based treatment of CUAN has the advantages of quick effect and less side effects. Clinical practice and pharmacology of Chinese medicine in the past 10 years have confirmed that some phlegm- and dampness-reducing, detoxifying and diuretic, and blood-activating drugs can promote the metabolism and excretion of excess or superfluous acids (including purine, uric acid, etc.) in human body, which is very consistent with the mechanism of Western medicine in treating CUAN with drugs that inhibit uric acid synthesis and promote uric acid excretion. Some of the herbal medicines with seeds can be summarized into the following four categories.
1, lowering blood uric acid medicine: mainly for some clearing and draining, detoxification and dry damp products, such as Tu Fu Ling, evening silica sand, etc.
2, dissolve uric acid and relieve uric acid pain medicine: mainly for Wei Ling Xian, Gentiana, etc.
3, excretion of uric acid drugs: mainly some diuretic and turbidity-discharging drugs, which enhance renal blood flow and promote the excretion of uric acid. Such as raw coix seeds, zedoary, psyllium, yellow cypress, cloud ling, ground dragon, mountain mushroom, slippery stone, Qin Pi, plantain, white flower and snake tongue grass, cornus, stone garlic, rhubarb, etc.
4.Inhibit uric acid synthesis medicine: mainly for activating blood circulation and removing blood stasis, pushing the old to the new, such as the above-mentioned Dilong, rhubarb, as well as Zeilan, peach kernel, angelica, etc.
On the basis of evidence-based treatment, the correct selection of some promising blood uric acid-lowering herbs can indeed improve the efficacy of CUAN, but we should pay attention to the need to identify the selection of drugs, otherwise it will not be effective, such as Yang deficiency of the body and put into Huang Bai and so on is really not appropriate.
6.4 Problems in research and possible ways to solve them
In recent years, Chinese medicine research CUAN, although there are promising results, but there are also some problems. The problems and possible ways to solve them are as follows.
1, the concept of disease name is easy to mix, more misdiagnosis and omission
Chinese medicine is influenced by a variety of factors, and most of the naming methods of diseases are based on the main clinical characteristics, resulting in the connotation and extension of disease names are more ambiguous, this diversity of concepts, inconsistency, easy to produce ambiguity, to clinical, scientific research, teaching brings certain difficulties. The literature shows that Chinese medicine is used to discuss CUAN under “gout”, which is prone to some conceptual ambiguity. As far as the Chinese medical name of “gout” is concerned, there are those who name it by symptoms, such as “painful paralysis”; those who name it by the cause, such as “thieves’ wind”; and those who name it by regional differences, such as The name of the disease is based on the symptom, called “painful paralysis”; the name of the disease is based on the cause, called “thieves’ wind”; the name of the disease is based on regional differences, such as “people in Jiangdong call ‘Baihu’ as ‘Lijie wind'”; the name of the disease is based on the season, such as “Ling Shu? The “Jing Tendon” is called “Zhongchun paralysis”, “Mengqiu paralysis”, etc.; some are named after the time of onset and symptoms, such as “Baihu”, “Baihu calendar festival “The name “gout” is also used in Western medicine, which often makes people confused. Because there is no unified name for the disease, some primary care doctors lack knowledge of CUAN and often misdiagnose it as “paralysis” and “rheumatoid arthritis”, “synovitis”, “joint tuberculosis” and so on. “For example, there are reports of 54 cases of primary gout diagnosed in TCM, 28 cases were diagnosed as unknown, 11 cases were misdiagnosed as rheumatoid arthritis, and 5 cases were misdiagnosed as rheumatoid arthritis before the diagnosis was confirmed. The misdiagnosis rate of CUAN was reported in the TCM literature to be between 29.6 and 81.4%. The unification of gout and CUAN disease names is an important guarantee to improve the recognition of CUAN.
The name of the disease is a diagnostic concept that reflects the abnormal changes in body function or form or pathological state from the general aspect, and the correct name of the disease is a comprehensive overview of the whole process of contradictory movement of the disease, which often has a certain independence and a relatively regular evolutionary trajectory and is expressed in several corresponding symptoms. Modern scientific means, combined with Western medicine laboratory tests and other objective indicators, first easy and then difficult to gradually establish a unified disease name in line with the “dual diagnosis of Chinese and Western medicine” requirements.
2. Self-defined criteria for the preparation of land, which makes it difficult to compare the efficacy of treatment
Since there is no unified Chinese medicine diagnosis, classification and efficacy assessment standard for CUAN, many data reported in different places vary greatly and lack comparability, making it difficult to correctly assess the treatment methods and levels.
3. The disease mechanism needs to be investigated.
The collected TCM literature shows that the current TCM understanding of CUAN’s pathogenesis is still limited to traditional theories, lacking in depth and breadth, and experimental studies are lacking due to the difficulty of making models. In the future, we should draw on modern technology to conduct deeper research on the pathogenesis of CUAN: to fully understand the connotation of etiology and the multi-causal nature and complexity of the disease, to conduct synchronized research on disease and evidence, and to establish stable and reliable TCM animal models that are consistent with both pathogenesis and clinical practice.
4.Single treatment method Not enough in-depth research
The Chinese medicine treatment methods of CUAN in the literature are basically based on internal treatment (internal medicine), while acupuncture, tui-na, external treatment methods and other characteristic Chinese medicine methods are rarely reported, or even absent. It can be seen that the treatment of CUAN by Chinese medicine is relatively single and the research is not deep enough. In the future, on the basis of the experience of previous authors, we should carry out research on the combination of disease identification and evidence identification, and the integrated application of multiple treatment methods, so as to bring the Chinese medicine treatment of CUAN to a deeper level.
5, effective drug scattering must be summarized and organized
Many prescriptions and medicines are scattered in the literature of the past generations; some promising uric acid-lowering drugs found in modern Chinese pharmacology are also scattered in various pharmacological literature, so it is important to systematically organize and summarize the ancient and modern rules of medicine for CUAN.