Nephrotic edema belongs to the category of “water gas disease” in Chinese medicine, which is one of the prominent clinical manifestations and main symptoms in various stages of kidney disease, and is difficult to be cured and treated. Modern medicine believes that nephrotic edema is mostly related to body immunity, hypoproteinemia, glomerular filtration rate, water and sodium retention, and interstitial infiltration of renal tubules. According to traditional Chinese medicine, the formation of edema is mostly caused by the dysfunction of water and fluid metabolism in the internal organs of the body, which is related to several internal organs, especially the lungs, spleen and kidneys are the most critical. Although the cause of this disease is clearer in Western medicine, there is still a lack of safe and effective means of treatment; Chinese medicine is often effective in treating refractory nephrotic edema, but because its medical interpretation is too abstract and its clinical manifestations are complicated, how to achieve accurate identification and proper selection of drugs is the key to its success or failure, and it is also the key to hinder its clinical promotion. Prof. Chen Yiping has gathered the wisdom of previous sages, accumulated decades of clinical experience, integrated Chinese and Western medical theories, and in the complex pathological changes and clinical manifestations of this disease, he has managed the complexity with simplicity, sought the commonality between Chinese and Western, and gradually summarized the solution of mutual reference between Chinese and Western, and proposed the basic rules for the treatment of nephrotic edema. 1.Strengthening the spleen for the treatment of nephrotic edema in hypoproteinemia – the specific application of the rule of controlling water with the earth. The spleen is responsible for raising the qing, likes dryness and hates dampness, and is responsible for transporting water and dampness. If the spleen is deficient in spleen qi for various reasons, the transport function is not normal or the dampness is too strong, the spleen is trapped by the dampness and hinders its transport, which can lead to the inability of the spleen to transfer water-dampness and the accumulation and flooding of water-dampness in the body, resulting in edema, which is the meaning of “all dampness swelling and fullness belong to the spleen”. The root cause of edema is spleen deficiency and dampness. Spleen deficiency and inability to transport water and grain essence reduces the production of plasma protein and increases its discharge, and spleen deficiency and abnormal lifting and lowering result in the non-distribution of water essence and the loss of earth control of water, thus causing clinical manifestations such as hyperproteinuria, hyperlipidemia, high edema and hypoproteinemia. Western medicine believes that one of the main causes of nephrotic edema lies in the loss of large amounts of protein from the urine resulting in a decrease in blood albumin concentration, a decrease in plasma colloid osmotic pressure, and the transfer of large amounts of body fluid from the blood vessels into the tissue interstices, thus causing edema. Based on his predecessors’ discussions and his many years of clinical experience, Dr. Chen combined Chinese and Western medical theory to propose that the treatment of nephrotic edema in hypoproteinemia should focus on strengthening spleen transportation, as the saying goes: “When the spleen is strong, transportation and chemistry will be carried out and clear turbidity will be divided”, and he clarified the specific application of the principle of “controlling water with earth”. Chen pointed out that the role of strengthening spleen transport in the treatment of nephrotic edema is mainly reflected in the following two aspects: First, the use of Astragalus, Radix Codonopsis, Atractylodes, Poria and other products that benefit the qi and strengthen the spleen can promote the spleen to strengthen the transport, so that loose stools and diarrhea can be effectively controlled, thus reducing the loss of protein in the gastrointestinal tract, reflecting the source of clarification to plug the flow; at the same time, the gastric qi to restore, the stomach to turn better, conducive to improving the intake, absorption and synthesis of protein, so that the plasma protein level can be maintained. The second is the long-term application of large doses of attacking drugs, such as immunosuppressants, so that the spleen and stomach are too much restrained, resulting in the exhaustion of stomach qi, poor appetite and vomiting and other symptoms, when the qi and stomach products, such as Chen Pi, Mu Xiang, cardamom, grain malt, etc., can reduce the adverse effects of Western medicine on the gastrointestinal tract. “Regulate the middle and strengthen the spleen, the spleen will be able to lift and run, then water and dampness will be removed”. In the clinical evidence, Chen Shi formulated his own black material and bean pill for the treatment of hypoproteinemia in the clinic achieved an efficiency of 92, 5% [1], the increase of plasma protein not only has an important role in reducing edema, preventing the recurrence of edema and lowering blood lipids, but also helps to restore the righteousness and promote the elimination of proteinuria. 2. warming the heart and kidneys to treat nephrotic edema with water and sodium retention-the specific application of the law of warming the Yang and promoting water. The kidney plays a vital role in regulating the distribution and excretion of water in the body. Insufficient kidney yang and weakening of the vital gate fire prevent the bladder from transforming qi and moving water, resulting in abnormal qi-transformation of the bladder, unfavorable opening and closing, and internal stagnation of water, leading to edema. Su Wen? Water heat point theory” said: “the kidney is the stomach of the off also, closed the door is not conducive, so gather water and from its class also, up and down overflow in the skin, so for i swelling”. In his clinical evidence, he often said that “where Yang does not reach is where water-dampness floods”, and further pointed out that in the process of treating nephrotic edema with the method of warming Yang and promoting water, the regulation of Heart Yang should not be neglected. According to Chen, in the relationship between the heart and kidney, special attention should be paid to the relationship between the heart and kidney water. Only the mutual nurturing and warming of the two fires of the heart and kidney can the kidney yang play its normal role of presiding over the water and gasification; the kidney yang must be generated by the kidney yin, and the kidney yin, in addition to the warming of the kidney yang, also needs to be assisted by the heart yang, otherwise the kidney yin will be cold and no opportunity for biochemistry, and the kidney yin and kidney yang will be out of balance and unable to perform the duty of the main water. Therefore, if the heart yang is not deficient, it can play a deterrent role in water metabolism, so that the water evil in the lower jiao can not rush upward. Modern medicine believes that water-sodium retention is one of the important factors triggering nephrotic edema. The classical theory of underfilling suggests that low blood volume leads to changes in neurohumoral factors stimulating water-sodium retention in the kidney. At the same time, modern medicine also attaches great importance to the relationship between the heart and kidney, and studies have shown that the accumulation of inflammatory mediators and the hyperactive renin and angiotensin systems in renal disease can easily contribute to cardiovascular pathology, which may first manifest as structural remodeling of the heart and an increase in the left ventricular mass index, which can then progress to heart failure and myocardial infarction [2]. Modern pharmacological studies have also shown that the classical formula Zhen Wu Tang, which warms the yang and stimulates the water, has the ability to significantly alleviate and prevent chemical-induced heart failure, improve adrenocortical function, and have a significant diuretic function [3]. In his many years of clinical practice, he found that for nephrotic edema caused by water and sodium retention, the treatment should be to warm the kidney yang; for those with cardiothoracic symptoms such as palpitations and shortness of breath, chest tightness, or even inability to lie down, the treatment should also be to warm the heart yang, thus clarifying the specific application of the law of warming yang and promoting water. For those who are in serious condition, we use Ji Sheng Kidney Qi Tang with addition and subtraction to warm the heart and kidneys, transform the Qi and move the water, and use Niubizi and Che Qian Zi to induce water downward, diuretic and reduce swelling; for those who are still in mild condition or have Qi and fluid deficiency, we use Epimedium, Baji Tian, Cuscuta, Cistanches and other warm and moist products to replace the dryness of Gui, and then add Huludao and Ze Xie to strengthen the function of promoting water and reducing swelling. The whole formula is tonifying without stagnation and beneficial without cutting. By regulating the immune function, it can promote the reduction of urine protein and recovery of plasma protein, and achieve the purpose of eliminating edema. It can be applied at the initial stage of edema in nephropathy to achieve obvious effect of decreasing edema, with the onset of effect after 5-6 days, and generally after 1 week of medication, the urine volume gradually increases and edema then subsides or significantly reduces [4]. More noteworthy is that Chen Shi especially makes good use of deer antler in the treatment of refractory edema in diabetic nephropathy. It is sweet, salty, and warm in nature, and is attributed to the kidney and liver meridians, tonifying kidney yang and benefiting essence and blood, and is used for the treatment of cold fear, cold extremities, long and clear urination, frequent nocturnal urination, and soreness and weakness of the waist and knees caused by deficiency of kidney yang. According to the Compendium of Materia Medica, deer antler is “good at tonifying the kidney and strengthening the Yang, generating blood, and nourishing the marrow and strengthening the bones”. Modern pharmacological studies have found that deer antler can enhance cardiac output, especially for fatigued hearts; increase hemoglobin content, accelerate wound healing, stimulate the adrenal cortex, and have anti-aging, antioxidant, and immune function effects. Chen combined Chinese and Western pharmacology, for the intractable edema of diabetic nephropathy, adding this product on the basis of evidence-based medicine has achieved remarkable efficacy, and the cover has brought into play the function of heart and kidney together to improve microcirculation, which is worthy of in-depth taste and research. 3, pay attention to the regulation of the liver – the specific application of the principle of the same treatment of the liver and kidney. ”It profoundly reveals the close relationship between the liver and kidney, which live together in the lower jiao, in terms of physiology and pathology: the mother and child of liver and kidney are born together, the essence and blood of liver and kidney are transformed into each other, the meridians of liver and kidney are connected, and they are attached to the odd meridian, the liver and kidney are unified, and the yang energy of liver and kidney is warmed by each other. The liver and kidneys are related to each other. Modern medicine believes that the liver plays an important role in the synthesis and metabolism of proteins. Among the plasma proteins, except for gamma-jugin, albumin, prothrombin, fibrinogen and plasma lipoproteins are synthesized in the liver. Adult liver synthesizes about 12g of albumin per day, accounting for a quarter of the total protein synthesized by the liver, and plasma albumin plays an important role in maintaining plasma colloid osmotic pressure. Therefore, when liver function is severely impaired, edema and blood coagulation dysfunction often occur. In particular, for those who have been treated by warming the Yang and toning the water, strengthening the spleen and toning the water, but the effect is not obvious, or those who clearly have liver injury and/or abnormal liver function, it is more important to pay attention to the maintenance of the liver, reflecting the rule of treating the liver for kidney disease and treating the liver and kidney together, to improve the liver’s ability to synthesize albumin, and finally achieve the purpose of reducing edema. Chen concluded that for those patients who have been ill for a long time, and for whom all medicines are ineffective and plasma albumin continues to be at a low level, there is a complex situation in which qi stagnation, blood stasis and water obstruction coexist, which is the end of liver loss, and is also the culprit of aggravating liver depression and qi rebellion, which will inevitably lead to the decline of many functions of the liver, such as protein synthesis. At this time, regardless of clinical indications of liver damage, if the functional status of the liver cannot be fundamentally improved and other methods are used, it is difficult to be effective. For this type of patients, Dr. Chen prefers to apply Fu Zheng Hua Yu Capsules to improve the function of the liver on the basis of evidence-based treatment, which has indeed increased the plasma albumin and strengthened the function of diuresis to reduce swelling. Fu Zheng Hua Yu Capsule is an anti-liver fibrosis drug developed by Shanghai University of Traditional Chinese Medicine. Its main ingredients include: Salvia miltiorrhiza, fermented Cordyceps powder, peach kernel, pine pollen, gynostemma and Schisandra chinensis, which has the effect of activating blood circulation and eliminating blood stasis, benefiting essence and nourishing liver. Many years of clinical and experimental studies have confirmed that it has multiple pathways of anti-liver fibrosis integrated mechanism of action [5]. 4, invigorate blood and eliminate blood stasis to carry out the specific application of the law of invigorating blood and promoting water. Water is a Yin evil, its nature is sticky and difficult to heal. When the kidney is deficient for a long time, water enters the channels and obstructs the channels and blood, causing blood stasis. It is manifested in the tongue as petechiae or petechiae, and in the pulse as astringency and other signs. In Su Wen? It is clearly pointed out in the Treatise on the Regulation of Menstruation that “if blood stasis does not go away, its water will become” and “if water overflows in the Sun Loop, blood will be retained in the meridian”. Jin Kui? The “Treatment of Water-Qi Diseases” says: “If the blood is unfavorable, it is water”, all of which illustrate the truth that water and blood are mutually dependent, and water and blood have the same origin. Modern medicine believes that the low blood volume, blood concentration, slow blood flow, hyperlipidemia and the use of hormones in nephropathy edema can increase the blood viscosity and aggravate the hypercoagulable state of nephropathy. In contrast, nephropathy itself is an immune disease, mostly due to the formation of in situ or circulating immune complexes, which are deposited in the glomerulus, and the complement system is activated to produce a variety of bioactive substances, thus increasing the permeability of glomerular capillaries, promoting the deposition of immune complexes in the vessel wall and aggravating kidney damage [6]. Chen Shi believes that nephrotic edema, which is difficult to heal over time, is characterized by the failure of yin and yang, and the internal accumulation of water and dampness, which makes the qi and blood run poorly and gradually leads to renal stasis; the blockage of qi and blood also aggravates the obstruction of water and fluid metabolism, thus making the edema stubborn and difficult to go away. Therefore, when treating this kind of edema, we often combine the treatment of the lung, spleen and kidney with blood-activating and stasis-transforming drugs, often accompanied by Zeilan, Yimu Cao, Red Peony and Chuan Niu Kne, etc. to remove blood stasis and promote water retention; if the effect is not obvious, we can add leech, scorpion and dilong to remove blood stasis and open the channels; peach kernel, safflower, Chuan Shao and Danshen to activate blood stasis and achieve the purpose of promoting water retention by removing blood stasis. Many years of clinical experience have proved that the method of invigorating blood and promoting water is particularly effective in the treatment of patients with nephrotic edema. Modern medicine also believes that the treatment of nephrotic edema, supplemented with blood activation and diuresis, can reduce fibrin cleavage products, decrease blood viscosity, and improve renal microcirculation.