Chronic glomerulonephritis, nephrotic syndrome, no hypertension and azotemia, edema subsides after the appearance of body fatigue, shortage of breath, general debility, lumbago, palpitations and weakness, dry mouth, dry throat, heat in the hands and feet, loss of appetite, yellow urine, red tongue with thin coating or light red tongue, sunken or counted pulse.
Chronic pyelonephritis and chronic urinary tract infection: frequent urination, urinary urgency, painful urination with exertion, cold or emotional changes, fatigue, lumbago, five heartburn, dry mouth and tongue, red tongue tip or edge red or white tongue coating with less fluid, smooth or slightly counted pulse. Urinalysis with recurrent white blood cells or both red blood cells and pus cells, bacteriuria.
Pathogenesis and treatment
Chronic glomerulonephritis, nephrotic syndrome in the initial stage is mostly qi deficiency, yang deficiency, the evolution of time is transformed into qi deficiency and yin deficiency, from a large number of clinical observations for this disease is common law, consider the causes of the disease began mostly edema delayed, most of the spleen and kidney yang deficiency qi deficiency, the evolution of time for qi deficiency and yin deficiency, to yin and yang mutual root, yang injury for a long time is bound to damage and yin liquid, the so-called “yang loss and yin “;
Secondly, this disease is mostly treated with adrenocorticotropic hormone and the dosage is large for a long time. Glucocorticotropic hormone is a masculine agent, and its application for a long time depletes qi and yin, resulting in both qi and yin deficiency.
Analysis of the formula and application of addition and subtraction
The original formula uses stone lotus seeds as the ruler for its effect of clearing heart fire and astringing essence. Astragalus and Radix Codonopsis nourish Qi and raise Yang; Dioscorea and Medlar nourish Yin; Scutellaria clear the heat of the upper jiao heart and lung; Lung heat is cleared to clear the downward movement; Che Qian Zi and Poria lightly percolate and damp; Chai Hu disperses the heat of the liver and gallbladder. The combination of tonifying Qi and nourishing Yin, clearing heat and dampness, and secret essence complements each other. Chronic nephritis and blood stasis, so in the original formula plus motherwort to promote blood circulation, clear heat and detoxify the snake tongue herb, re-use of astragalus and codonopsis to nourish the qi and consolidate the regimen, applicable to chronic nephritis proteinuria for a long time does not disappear.
Astragalus is a sweet warm products, large amount of long time to take more prone to heat, so the above applies to Qi deficiency is mainly better. If the yin deficiency relatively heavier people such as five heart trouble hot, throat red mouth dry, urine yellow red, tongue red less moss, the pulse is fine or slippery number, it is appropriate to add raw earth yellow, XuanShen, JinYinFu, dandelion; such as accompanied by hematuria can increase thistle, small thistle, thatch root, PuHuang, side cypress leaf and other clear heat and cool the blood to stop the agent.
Examples of test cases
Case 1
Zhang, female, 26 years old, cadre, Daqing City. She was first seen on December 7, 2001. She had chronic glomerulonephritis for one year, urine protein (++++), occult blood (++++), blood pressure 130/90 mmHg, mild swelling of eyelids, dry mouth, red and slightly painful pharyngeal isthmus, lumbago, general weakness, shortness of breath, palpitations, red tongue, white fur, sunken and weak pulse. Once the local hospital treatment for more than a year, with prednisone, leigong doside and other treatments are ineffective, can not work, general weakness and fatigue as refractory nephritis, according to the appeal evidence pulse identified as qi and yin deficiency to qi deficiency mainly to be qi nourishing yin clear heat secret essence method. Prescription: Astragalus membranaceus 50g, Radix Codonopsis pilosulae 20g, 15g of stone lotus seeds, 15g of ground bones, 15g of red poria, 15g of bupleurum, 30g of thatch root, 30g of small thistle, 15g of maidenhair, 30g of plantain, 30g of white flower tongue snake grass, 30g of heavy floor, 20g of raw yam, 15g of gorgonian, 15g of licorice, water decoction twice a day.
Taking 21 doses of the above, urine protein +, occult blood ++, 20g of Di Jin Cao, 20g of Capsella. Continuing 21 doses of the above, occult blood (±), protein in the morning (±), in the afternoon (+) D (++), continuing 21 doses of the above, urine test occult blood (-), urine protein (-), sometimes + in the afternoon, but after rest protein is still (-), advised to continue to use the front, with 6 doses of the patient after the test has been pregnant and thus get relief.
Di Jin Cao invigorates the blood and stops bleeding, treats damp heat in the kidney and bladder and urinates blood, with the characteristics of stopping bleeding without leaving stasis; Capsicum cools the blood and stops bleeding, clears heat and detoxifies the blood as a good treatment for hematuria. In this case, after adding these two medicines, the occult blood improved until it disappeared.
Case 2
Lin, male, 37 years old, cadre, Taikang County, Heilongjiang Province, came to the initial consultation on September 10, 99. He had been suffering from chronic glomerulonephritis for more than one year and had been treated with Radix Polygoni, Prednisone and Torch Flower Root Tablets by a hospital with no significant effect. His blood pressure was 160/100mmHg, urine protein (++), occult blood (+), plasma total protein and albumin were normal, blood creatinine was 225umol/l, urea nitrogen was 11.5mmol/l, carbon dioxide binding capacity was 20mmol/l, no swelling, generalized weakness, lumbago and leg weakness, heat in the hands and feet, purple tongue and thick white fur.
He was diagnosed with chronic glomerulonephritis, chronic renal insufficiency, and azotemia stage. After 3 months of treatment with more than 60 doses of the above, urine protein and occult blood turned negative, blood creatinine 75umol/l, urea nitrogen 7.8mmol/l. After several times of examination of renal function and urinary routine were not abnormal, thus remission.
Case 3
Zhang, female, 38 years old, a cadre of an institution, was first diagnosed on June 6, 2001. She had a history of chronic pyelonephritis, which was relieved by treatment, but occasionally flared up when she was overworked or had a cold. Recently, he was hospitalized in a hospital with various antibiotics and anti-inflammatory drugs to relieve his symptoms, but his urinalysis was full of white blood cells, red blood cells 30-40, pus cells 5-7, pulse count, red tongue, thin white fur and little fluid. The TCM diagnosis of laborious gonorrhea was identified as deficiency of both Qi and Yin with dampness and heat in the lower jiao not removed.
Prescription: Astragalus membranaceus 30g, Radix et Rhizoma prunus 20g, Radix et Rhizoma Dioscorea 15g, Rhizoma Polygonati 15g, Radix et Rhizoma Chaihu 15g, Poria 15g, Radix et Rhizoma Medica 15g, Plantago ovata 20g, Radix et Rhizoma Polygonati 30g, Radix et Rhizoma Gingko 30g, Radix et Rhizoma Forsythiae 20g, Radix et Rhizoma Sulfori 30g, Radix et Rhizoma Glycyrrhiza 15g, decoction in water twice daily.
June 15, the second diagnosis: take the above 7 doses, urination, pain and astringency greatly reduced, waist and less abdominal pain is also reduced, the tip of the tongue is still red, moss see moist, pulse is still count, urinalysis leukocytes 10-15 / Hp, red blood cells 3-5 / Hp, pus cells (C). With the above plus wolfberry 20g, yam 15g, after the second review a total of 14 doses, pulse countless, all the symptoms disappeared, urinalysis all turn negative, advised to continue to take the above a number of doses to consolidate.
Application experience
Chronic glomerulonephritis identified as Qi and Yin deficiency with this formula has a good effect, symptoms improved, urine protein reduced or disappeared, kidney function also has some improvement. However, there are some patients who have no significant improvement in urine protein after using this formula, but the physical strength is enhanced, back pain, fatigue, shortness of breath, irritable heat in the five hearts then improved, the tongue coating becomes thin and the pulse is strong, and often suffer from colds before using the medicine after using the medicine to reduce colds.
It can be seen that TCM treatment is different from prednisone and immunosuppressant treatment for localized treatment in terms of adjusting the balance of qi, blood, yin and yang from a holistic view.
Chronic pyelonephritis is comparable to the Chinese medicine’s “labor lymphatic”, which is characterized by the onset of labor and cold. Most of the pathological mechanism is the deficiency of both qi and yin, the weakened ability to resist evil, and the retention of dampness, which can be summarized as “positive deficiency of evil”, and therefore recurrent attacks.
Although the formula book points out that there are heart, spleen, kidney and labor gonorrhea, but according to my experience, only focusing on helping the positive without removing the evil can not be effective. According to the “Bureau of Recipe”, this formula “treats astringent pains of leaking…five gonorrhea.” The effect of this formula is very good with the addition of heat-clearing and detoxifying agents such as honeysuckle, white flower tongue snake herb, forsythia, gong ying, raw earth, guanzhong, septoria, etc. Although the symptoms of astringent urine and painful urination can often disappear, bacteriuria, stubborn white blood cells or stubborn hematuria are caused by the deficiency of qi and yin without regulating damp heat, this formula can obtain good results by benefiting qi, nourishing yin and consolidating regimen plus clearing heat and detoxifying.
Secondly, Dihuang Tang with added flavor
Composition
Radix Rehmanniae 20g, Radix yam 15g, Radix yam 15g, Poria 15g, Danpi 15g, Zedoary 15, Zhi Mu 15g, Phellodendron 10g, Tortoise Aconite 20g, Radix chasteensis 20g, Radix aristolochiae 15g, Radix astragali 20-30g, Radix codonopsis 20-30g, Radix bark 15g, Radix glycyrrhiza 15g.
Indications
1, Chronic glomerulonephritis hematuria, proteinuria for a long time does not disappear.
2.IgA nephropathy with recurrent hematuria.
Key points for identification
1.Lumbar pain, soreness and weakness of the waist and legs, heat in the hands and feet, fatigue and weakness, shortness of breath and palpitations, lazy speech, dizziness and tinnitus, dimming of vision, dryness of the throat and mouth;
2. Red tongue with little coating, red or dark yellow urine, dry stool, fine or sunken pulse.
Analysis of pathogenesis and prescription
This formula is an agent to nourish the kidney, nourish yin, and benefit qi consolidation. It is used to treat chronic nephritis with hematuria and proteinuria of long duration that do not subside, as evidenced by the above pulse evidence of yin deficiency and fire exuberance, and qi deficiency and inability to consolidate, resulting in hematuria and proteinuria of long duration that do not subside. Most of the hematuria of long duration belongs to kidney yin deficiency and deficiency fire, so the formula is based on Zhi Bai Di Huang Tang with Ginseng and Astragalus, the former nourishes kidney yin to lower the fire and the latter benefits qi to fix the regimen. Proteinuria belongs to water and grain essence.
Nourishing the kidney and benefiting the qi to consolidate the regimen can cure both the hematuria of yin deficiency and fire and the proteinuria of qi deficiency, which has a dual effect. The combination of Zhi Mu, Gui Pan and Huang Bai can enhance the function of nourishing Yin and lowering fire, which is especially suitable for hematuria caused by Yin deficiency and fire in which the kidneys are not sealed. The combination of Ligustrum lucidum and Dry Lotus Grass as the second to the pill, and Ground Bone Bark can nourish yin and lower fire in one side of the formula.
Examples of test cases
Case 4
Jiang, female, 53 years old, a worker, was first diagnosed on June 17, 1999. She had been suffering from chronic glomerulonephritis for more than a year, with urine protein (++)-(+++), full field of red blood cells, sometimes 30-50 recurrent, more than full, less than 30-50, occult blood (+++), blood pressure 150/100mmHg, because the patient did not agree to not do pathological examination, had used prednisone, Leigongjiang multi-glucoside tablets and herbs to clear heat and stop bleeding in other hospitals are The patient did not agree to the pathological examination. The symptoms include general weakness, shortage of breath, lumbar pain, weakness of the lower limbs, soreness of the hindquarters, sunken and slightly counted pulse, and red tongue. Based on the disease duration of more than one year, the large amount of hematuria and proteinuria, combined with the symptoms and pulse analysis, it belongs to the evidence of kidney yin deficiency and qi deficiency without the ability to consolidate the regimen.
Prescription: Shu Di 20g, Yam 20g, Yam 15g, Poria 15g, Dan Pi 15g, Ze Di 15g, Zhi Mu 15g, Huang Bai 10g, Huang Qi 30g, Dang Shen 20g, Gui Pan 20g, Blood Yu Char 20g, Zhen Zhen Zi 20g, Dry Lotus Grass 20g, Sidebark Char 20g, Ground Bone Bark 15g, taken twice daily with water decoction.
Since June 17, 1999 initial diagnosis to July 20, a total of 28 doses of the above, blood pressure with antihypertensive drugs to maintain normal, lumbago and knee weakness greatly reduced, feel strong spirit is also good, urine test 2-3 red blood cells, occult blood (C), urine protein (±), smooth pulse, tongue light red to moist, and then after several urine test are between 2-3 red blood cells, protein (±), thus relieved.