The patient was admitted to a hospital on September 16, 2002 with the main reason of “recurrent lumbar pain for more than 2 years”. She was admitted to the hospital on September 16, 2002 mainly because of “recurrent episodes of lumbar pain for more than 2 years”, and in early February 2000, after catching a cold, she felt lumbar pain and went to a hospital, where she was diagnosed with “chronic glomerulonephritis” after checking urine protein ++ and erythrocytes ++. In order to clarify the pathological diagnosis and further treatment, he was admitted to hospital. At the time of admission, his symptoms were: lumbar pain, fatigue, dry throat, discomfort in the pharynx, dry mouth and desire to drink, irritable heat in the heart, insomnia, excessive dreaming, easy to catch a cold, acceptable food, yellow urine and regulated stool. Past history: past health. No history of hepatitis, tuberculosis, etc. Physical examination: body temperature 36.8℃, pulse 76 times/min, respiration 18 times/min, blood pressure 14/9kPa, clear, mental, bilateral eyelids are not swollen, pharynx is mildly congested, bilateral tonsils are first degree enlarged, heart border is not large, heart rate 76 times/min, rhythmical, respiratory sounds in both lungs are clear, no dry wet rales are heard, liver and spleen are not found, percussion pain in both kidney areas (±), ascites (-), both lower limbs are not swollen. The tongue is red, the coating is slightly yellowish and the pulse is fine and smooth. Laboratory examination: hemoglobin 132g/L, blood erythrocytes 3.6×109/L, blood leukocytes 6.5×109/L, neutrophilic 0.63, lymphatic 0.36, platelets 155×109/L, sedimentation 14mm/h; blood glucose 4.8mmol/L, blood creatinine 68μmol/L, blood urea nitrogen 4.1mmol/L; serum albumin 41g/L. serum albumin 41g/L, serum globulin 29g/L, serum total protein 70g/L; urine protein (++), 24-hour urine protein quantification 1.18g; abdominal ultrasound: left kidney 10.4×5.4cm, right kidney 11.2×5.8cm; chest plain film: no abnormalities in both lungs and heart diaphragm; normal electrocardiogram. Admission diagnosis: chronic glomerulonephritis. Treatment: After admission, renal tissue biopsy was performed on September 23. Light microscopy showed 19 glomeruli. 8 spherical sclerosis, 3 segmental sclerosis, 3 cellular and 2 small cellular crescent formation, and mild diffuse proliferation of glomerular thylakoid cells and stroma with eosinophilic hemoglobin deposition. The renal tubules were multifocal atrophied. The renal interstitium was infiltrated with multifocal lymphatic and mononuclear cells. The walls of the small arteries were thickened. Immunofluorescence: 6 glomeruli with IgA+++, IgG-, IgM-, C3, C1q-, FRA-, and Alb- were seen. Electron microscopy: mild hyperplasia of thylakoid tissue, deposition of electron dense material in the thylakoid and parathylakoid areas, segmental fusion of epithelial cell pedicles, and no lesions in the basement membrane. The renal pathology was diagnosed as proliferative sclerosing IgA nephropathy. Combining the clinical and pathological diagnosis, a case discussion was held on September 27, 2002 to decide the next step of treatment. 2. Medical history discussion Dr. Jiang Peng, an advanced practitioner: The patient’s Western medical diagnosis was clear, i.e., the clinical diagnosis was chronic glomerulonephritis and the pathological diagnosis was hyperplastic sclerosis IgA nephropathy. The patient complained of recurrent lumbar pain for 2 years, which should be diagnosed as “lumbago” in Chinese medicine. The identification of lumbago, as stated in Jing Yue Quan Shu. Lumbago” chapter says: “Covering this evidence has the difference between surface and internal deficiency and cold and heat, knowing the six of them, it is almost complete, and the treatment is not difficult.” Generally speaking, those who feel external evil, the evidence is mostly superficial and real, the onset is more urgent, the treatment is appropriate to dispel the evil and open the ligaments, according to the different cold and damp, damp and heat, etc., respectively, the treatment. For those caused by internal injuries such as kidney essence deficiency, the evidence is mostly internal and deficient, and chronic recurrent attacks are common. However, in patients with low back pain seen in clinical practice, either due to prolonged detention of the guest evil and damage to the righteousness, resulting in deficiency in the actual; or due to prolonged deficiency of the righteousness, deficiency of the guard yang, and new induction of external evil, resulting in actuality in the deficiency. Therefore, in the identification of evidence should be distinguished from the main and secondary importance of the evil, and take into account the symptoms in order to achieve more satisfactory results. “The patient’s waist is the internal organs of the kidney. The patient’s waist is sore and weak, which is a deficiency of kidney qi; dry mouth and desire to drink, irritability of the five hearts, insomnia, and dreams are a deficiency of kidney yin; yellow urine and yellow tongue coating are internal damp heat. Combined with the tongue and pulse, TCM identifies this as Qi-Yin deficiency and Damp-Heat internalization. Treatment is to benefit Qi and nourish Yin, clear heat and dampness. Prescription: Astragalus membranaceus 15g, Radix et Rhizoma prince ginseng 15g, Poria cocos 12g, Radix zedoaria 12g, Dampness 12g, Radix et Rhizoma raw earth 12g, Radix et Rhizoma Huaiyang 9g, Cornu Cervi Pantotrichum 12g, Radix et Rhizoma Zhiyi 12g, Radix et Rhizoma cypress 12g. Refresher physician Yang Xinfang: The patient had marked microscopic hematuria. The presence of blood in urine is divided into two conditions: blood in urine and hematuria. Clinically, those who have no pain or pain in urination are called hematuria; those who have blood in urine with dripping and astringent pain in urine are called hematorrhea. As stated in “Danxi Xinfa. Blood in urine” says: “Blood in urine is called gonorrhea if it is painful, and blood in urine if it is not painful.” Therefore, it is more appropriate to diagnose it as “blood evidence – blood in urine” in Chinese medicine. The location of blood in urine is in the kidney and bladder. The main pathogenesis is heat injury to the veins and ligaments and lack of spleen and kidney consolidation. Among heat injury to the veins and ligaments, there is a distinction between actual heat and deficiency heat; and there is a distinction between spleen and kidney deficiency. The TCM evidence agrees with Dr. Jiang Peng’s analysis, but the Chinese medicine prescription should be appropriately supplemented with products that stop the medicine, such as large and small thistle, Xianhecao, and Phellodendron. Attending physician Li Jun: In terms of TCM diagnosis, “blood in urine” in TCM refers to a condition in which blood or even blood clots are mixed in the urine. Depending on the amount of bleeding, the urine may appear light red, bright red or brown. Although this patient has obvious microscopic hematuria, there is no obvious change in urine color, and there is no blood clot, so the diagnosis of “back pain” is more appropriate in Chinese medicine. The clinical manifestations are mild, i.e. chronic glomerulonephritis with abnormal urinalysis, but the glomerulosclerosis is serious and it is easy to progress to chronic renal insufficiency, so it can be treated with western medicine on the basis of Chinese medicine. The Chinese medicine treatment basically agrees with the above two physicians’ opinions. The kidney biopsy suggests that glomerulosclerosis is more obvious, and from the microscopic identification point of view, it belongs to the category of stasis of blood in Chinese medicine, so the formula can be appropriately added to nourish blood and activate blood, such as angelica, chuanxiong, chicken blood vine, etc. Western medicine can be combined with angiotensin-converting enzyme inhibitors such as Mono, which can both partially reduce urinary protein and slow down the progression of chronic renal insufficiency. Chief physician Zhanyongli: There are three main points: First, when diagnosing diseases in Chinese medicine, the different meanings of “disease”, “evidence” and “illness” should be clarified. “Symptoms” refers to the individual symptoms of the disease as well as signs such as tongue and pulse. For example, patients with back pain, weakness, dry throat, discomfort in the pharynx, dry mouth and desire to drink, irritability of the five hearts, insomnia, excessive dreaming, red tongue, yellowish greasy moss, thin and slippery pulse, etc. are all symptoms. The occurrence and development of any disease is always shown through a number of symptoms, therefore, the disease is the objective manifestation of the organism has a lesion, is the main basis for judging the disease, for identification, therefore, the “dictionary” says: “disease common word, read as positive, the signs of disease test also.” But the symptoms are after all only the phenomenon of the disease, not yet the essence of the disease, only by fully collecting various symptoms and through comprehensive analysis, can we understand the essence of the disease through the phenomenon. The “evidence”, under the guidance of Chinese medicine theory, through comprehensive analysis of various symptoms and signs, etc., the pathological generalization of the disease at a certain stage of the cause, nature and location of the disease. This patient’s TCM diagnosis is kidney qi and yin deficiency with dampness and heat, which means that the nature of the disease is “deficiency at the root and actual at the symptoms”, and the location of the disease is mainly in the “kidney”, so the certificate is a synthesis of both the causative factors and the body’s reaction, and is the understanding of the nature of the disease. “Disease” is a generalization of the characteristics and rules of the whole disease process. There are many disease names mentioned in Chinese medicine, and there are various methods of naming them: (1) those determined according to one or several prominent clinical manifestations, such as thirst, cough, etc., which are the main methods of naming diseases in Chinese medicine; (2) some diseases, due to the rapid development of the disease, the main symptoms are not fixed, or the disease is more complex and the main symptoms are not prominent, etc., therefore, there are also diseases determined according to the etiology of the disease, such as dampness and warmth, deficiency labor, phlegm, lung impotence, etc.; (3) a few diseases are named according to the etiology of the disease. In addition, there are a few diseases named according to their lesion sites, such as pulmonary carbuncle. In addition, lily disease, fox disease, sun disease, syncope disease, etc. belong to some special disease names in ancient times, which were proposed according to the experience of some people under the historical conditions at that time. Now the patient complained of recurrent episodes of lumbar pain for more than 2 years, so the diagnosis of Chinese medicine is “lumbago”. Secondly, the clinical manifestations of IgA nephropathy are complex, and its clinical typing has been clearly described by Dr. Li Jun. There is no fixed pattern in the treatment of IgA nephropathy, and individualized treatment plans should be established by closely combining clinical manifestations and pathological features. According to our previous knowledge and literature reports, the treatment of this disease can be broadly divided into the following categories: 24-hour urine protein quantification of less than 1g, mainly based on Chinese medicine treatment; 24-hour urine protein quantification of 1~3g, on the basis of Chinese medicine treatment, supplemented with angiotensin-converting enzyme inhibitors such as Monor; 24-hour urine protein quantification of more than 3g, on the basis of Chinese medicine treatment, can be combined with a If the 24-hour urine protein quantification is greater than 3g, a course of hormone therapy can be combined with TCM treatment. Regardless of the clinical manifestations, if hypertension is combined, hypertension should be strictly controlled; if glomerulosclerosis is severe, comprehensive treatment measures should be taken to delay the progression of chronic renal insufficiency as much as possible. Although the 24-hour urine protein quantification of this patient was only 1.18g and the blood pressure was not high, the renal biopsy indicated that the glomerulosclerosis was severe, so the main goal of his treatment was to delay the progression of renal insufficiency, and the specific measures included: ① strict control of diet (low salt, low fat, and appropriate high-quality protein as the principle); ② prevention of rapid deterioration of renal function, such as the use of nephrotoxic drugs, severe infection, malignant hypertension, etc.; ③ (iii) treatment for pathogenesis, such as application of angiotensin-converting enzyme inhibitors to reduce glomerular pressure and slow down the process of glomerulosclerosis, and also the use of Chinese medicine such as Danshen injection or Chuanxiongzin injection to intervene in the process of renal fibrosis; (iv) symptomatic treatment and attention to rest, etc. Thirdly, the TCM evidence-based analysis made some supplementary points. Although the patient’s disease location is mainly in the kidney, it is also closely related to the lung. The patient is prone to colds, and each exacerbation is related to colds. The lung is the main source of qi, and the lung is deficient in qi, so it is easy to feel external evil. Therefore, to support the righteousness, we should add Yu Ping Feng San to benefit the lung and consolidate the surface, and at the same time th to his dry throat and discomfort in the pharynx, we should add Gong Ying and stiff silkworm to clear heat and detoxify the pharynx. Chief physician Li Xiuying: The case discussion includes three aspects: First, the diagnosis, including Chinese medicine diagnosis and Western medicine diagnosis. The patient’s Western clinical and pathological diagnosis was clear, and the TCM diagnosis agreed with Dr. Zhanyongli’s analysis. The pathology of IgA nephropathy is divided into six grades: grade I: microscopic lesions; grade II: simple thylakoid proliferation; grade III: thylakoid proliferation with <25% crescent formation and/or glomerulosclerosis; grade IV: the same as grade III, with the proportion of crescent formation and/or glomerulosclerosis ranging from 25% to 50%; grade V: the same as grade III, with crescent formation and/or glomerulosclerosis and/or glomerulosclerosis in the range of 50% to 75%; Grade VI: the same as Grade III, with crescent formation and/or glomerulosclerosis >75%. Of the 19 glomeruli in this patient, 8 had sclerosis, 3 had segmental sclerosis, 3 had cellular and 2 had small cellular crescent formation, and the proportion of crescent formation and/or glomerulosclerosis was 84.2% (16/19), and the pathological damage was grade VI. Therefore, the main treatment was to protect renal function, and the specific treatment measures basically agreed with the opinion of Dr. Jim. Chinese medicine to delay the progression of chronic renal insufficiency includes Chinese medicine intravenous drip, mainly such as Danshen injection or Chuanxiongzin injection, etc. This patient can add Chuanxiongzin intravenous drip; Chinese medicine enema, mainly for patients in the stage of chronic renal insufficiency failure or uremia, this patient’s current blood creatinine is not high, so it can be temporarily not used; Chinese medicine soup, prescribed according to the results of identification and treatment. Agree with the above physicians’ TCM discernment analysis, when prescribing, the disease can be combined with discernment, although the patient’s stool is normal, and from the perspective of delaying the progression of renal insufficiency, a small amount of Jiao Da Huang can be added to the formula, which can activate the blood, improve glomerulosclerosis, and also pass the internal organs to lower turbidity to protect renal function. The prognosis of IgA nephropathy is mainly influenced by the following aspects: (1) age, the prognosis is better for those who are young at the onset of the disease; (2) renal function level, the prognosis is worse for those who have already developed renal insufficiency at the time of consultation; (3) clinical manifestations, the prognosis is worse for those with nephrotic syndrome, hypertension and acute nephritis; (4) nature and extent of lesions, the prognosis is worse for those with pathological classification of grade III-VI. This patient has a better prognosis from the analysis of age, renal function level and clinical manifestations, but a poorer prognosis from pathological analysis, and his overall prognosis is poor and he is prone to develop chronic renal insufficiency. 3. Postscript After discussion, the main treatment plan was established as follows: (1) pay attention to rest, prevent colds, monitor blood pressure and renal function, and do not abuse drugs; (2) dietary control: low salt (3.d-1), low fat, and appropriate high-quality protein (0.8-1.0 g.kg-1.d-1); (3) traditional Chinese medicine prescription: 12 g of raw Astragalus, 9 g of Atractylodes macrocephala, 9 of Fangfeng, 12 g of Shengdi, 12 g of Dampi, 15 g of Gongying, 15 g of (3) Herbal prescription: Astragalus membranaceus 12 g, Atractylodes macrocephala 9 g, Fructus fenghua 9 g, Radix et Rhizoma radix et Rhizoma dangzi 12 g, Radix et Rhizoma chuanxiong 12 g, Radix et Rhizoma jiao 6 g. Decoction with water, 1 dose daily, divided into 2 oral doses; ④5％ glucose injection 250ml, Chuanxiongzin injection 80mg, intravenous injection, 1 time daily, 2 weeks as a course of treatment, a total of 2 courses; ⑤Monnor 10mg, 1 time daily. blood creatinine 65μmol/L, blood urea nitrogen 3.9mmol/L; 24-hour urine protein quantification 0.55g at the time of discharge on October 25. later outpatient He was observed for more than 2 months and his condition was stable without aggravation.