Regardless of whether it is based on the diagnosis and treatment of disease or evidence, or the microscopic diagnosis method recently proposed, renal hematuria may belong to the category of “blood in the urine” and “blood in the urine” in the “blood evidence” of Chinese medicine. In this way, the prescriptions and medicines should be used. This is undeniable, and we can achieve certain curative effects by taking prescriptions and using medicines.
However, in fact, there are many patients with complicated causes of hematuria, and their conditions are variable, so although they can get temporary results by using the methods of “treating blood”, they are very unstable and recurrent. I would like to cite a few cases of hematuria that I occasionally obtained in the clinical evidence, in order to make progress together with my colleagues.
I. The method of strengthening the spleen and stomach is effective
The patient, female, 35 years old, presented on July 8, 2009, complained of renal hematuria for more than 3 years, with microscopic examination of red blood cells between +-++, no proteinuria, normal renal function, no history of hypertension, no history of eyelid and bilateral lower limb swelling. He had been treated with Chinese medicine for more than 2 years, with recurrence. In the past 3 months, he often felt uncomfortable in the stomach due to taking Chinese medicine, nausea and vomiting, poor appetite, and insubstantial stools. He stopped taking the medicine 2 weeks ago, and now a routine urine examination showed microscopic red blood cells, so he came to see the doctor.
The patient’s stomach and stomach discomfort, insubstantial stools, pale tongue with pure coating, tooth marks on the side, and thin pulse should not be used to cool the blood and nourish the blood, so we simply use the method of strengthening the spleen and stomach, the prescription is as follows.
Radix Codonopsis pilosulae 12 fried atractylodes 15 white lentils 9 poria 12 rice kernel 15 sand kernel (after) 3 yam 15 ginger half summer 12 Chen Pi 9 bamboo rhizome 9 raw grain buds 12 roasted licorice 3. 7 doses.
On July 15, the patient re-examined, complained of no gastric discomfort, bowel movement, can, urine routine shows red blood cells, think this time the Chinese medicine less medicine, taste fresh, willing to take medicine again. So in the above remove the raw grain buds, add Fangfeng 3, night cross vine 15, * 14 doses.
Two weeks later, the patient returned to the clinic, complaining of no special discomfort, urinary routine red blood cells (2-3)/HP. Since then long-term use of this formula for six months, follow-up to date, hematuria are in the normal range.
The patient’s symptoms of blood in urine are often treated by strengthening the spleen and tonifying the kidneys, but it has become a habit to add several flavors to cool the blood and stop bleeding at every turn. In this case, the patient had been taking herbs to cool the blood and tonify the kidneys for a long time, which is actually an obstacle to strengthening the stomach. In this treatment, the blood in the urine was stabilized for a long time without using a single hemostatic medicine, so Chinese medicine treatment still needs to use the right medicine for the right condition, and sometimes we cannot be confined to a routine.
The method of relieving the symptoms and promoting the lung is effective
The patient, male, 52 years old, presented to the clinic on May 22, 2009. He complained of chronic nephritis and hematuria for more than 10 years, microscopic examination of red blood cells, no proteinuria, a history of hypertension for 10 years, taking Zhenju antihypertensive tablets, maintained at 130/85 mmHg. had taken Chinese medicine for a long time, the effect is general, so a year ago to replace the nephritis rehabilitation tablets. This time, he had a cold and fever one month ago, and after taking antibiotics, he had a cough with frequent coughing, sputum, white color, sticky texture, sore throat, dark red tongue, especially the tip of the tongue, and thin yellow coating. The urine was checked for red blood cells. He was prescribed the following formula for relieving the cough by decongesting the surface of the lung and combining Sanjiao Tang with Stop Cough San.
The prescription was as follows: water roasted ephedra 9 almonds 12 roasted licorice 3 baiqian 12 orris 3 aster 12 dong 15 thorny mustard charcoal 12 mulberry white peel 12 scutellaria 9 will be the shell 12 ginger half summer 12 bamboo rhizome 9 burdock 15 Chuanbei mother 9, 7 doses.
On May 29th, he returned to the clinic and complained that he had recovered from the cold and had 4-5 red blood cells/HP in the urine routine, while his chronic constipation was also cleared and he was very happy that his body was relaxed, but he sometimes had back pain. He was encouraged to continue taking Chinese herbal medicine, and the prescription was formulated with the method of strengthening the spleen and tonifying the kidneys. Two weeks later, the patient returned to the clinic, complaining of no special discomfort, but the stool is not blocked, lumbago is not reduced, urinary routine red blood cells. The patient complained of no special discomfort, but the stool was not blocked and the lumbago did not decrease. Two weeks later, the patient’s stool still does not work, lumbar acidity, urinary routine red cells, and asked to continue to take the May 22 prescription. When asked about his condition, he complained of occasional sore throat and yellow and red urine. The tip of the tongue was red, the coating was thin and yellow, and the pulse was stringent and slippery. The formula of May 22 was followed by reducing Tianjiangshell, Aster, and Zangdong, and adding Yu Liren 5, 7 doses.
Two weeks later, the patient complained of one line of stool per day, and lumbago improved significantly. Urine routine red blood cells. He was given the above minus water roasted ephedra, plus Guanzhong charcoal 12, mulberry leaf 10, maitong 12. Follow-up urine routine has been stable.
Experience: nephritis hematuria, traditional Chinese medicine that its pathogenesis and lung, spleen and kidney three organs are closely related, and stable treatment to the spleen and kidney, acute nephritis or chronic nephritis combined with the acute period after the sense, more from the lung treatment, most of the disease that stop, long-term use is contrary to the normal way. In this case, after using the method of relieving the surface of the lung to promote the lung for a cold was effective, and after using the method of strengthening the spleen and tonifying the kidneys, not only did the blood in the urine increase, but also the symptoms of lumbago and constipation appeared, and then, according to the symptoms of sore throat, yellow and red urine, and the tip of the tongue, the method of promoting the lung to relieve heat was adhered to, and the blood in the urine stabilized and the clinical symptoms improved. Therefore, patients with blood in urine have different causes, different constitutions and different symptoms, and the treatment principles should be different from person to person.
Third, the method of draining the liver and relieving depression takes effect
The patient, female, 31, came to the clinic on August 22, 2009. Complained of finding simple renal hematuria for 3 years with the highest hematuria. Long-term use of the method of strengthening the spleen, tonifying the kidneys, activating blood circulation and stopping hematuria, the hematuria was controlled. However, recently, because her husband was hospitalized due to illness, so she was mentally and physically fatigued, her condition fluctuated, hematuria ++, lumbago and weakness, poor sleep at night, constipation, red tongue with clear coating and small string pulse. Then on the above to strengthen Yi Qi and calm the mind.
On September 5, the follow-up, urine routine red blood cells, lumbar weakness improved, night sleep is not good, stool two days a line. The patient’s history showed that he had always been irritable, and he was easily irritated by locking things up at home (especially recently), with burning hot yellow urine and irregular menstruation. He was given the following formula to clear the liver.
Chai Hu 12, Radix Panax notoginseng 12, Scutellaria baicalensis 12, Radix Aromaticus 12, Shengjun 9, Citrus aurantium 18, Ulva lucidum 6, Fructus Hempen 12, Fried Gardenia 12, Radix Cyperus roots 12, Guanzhong char 12, Blood Seeing Worry 30, Capsicum flower 30, Cyperus rotundus 12, Dry Lotus Grass 15, Fried Dragon’s tooth 15, Chen Pi 6, Bamboo Roo 6. 14 doses. The patient was given spiritual comfort and relaxation.
Two weeks later, he was seen again with urine routine of 5-6 erythrocytes/HP, his spirit was fine, his stool was one line a day, and he was sleeping peacefully. The above prescription was reduced by Guanzhong charcoal, Blood Seeing Worry, Capsella flower and Xianhecao, and 14 more doses were given. After two weeks, urine red blood cells 1-2/HP, the above formula was supplemented with Xuan Shen 12. All the symptoms have been settled since the follow-up.
Experience: there are some patients with hematuria, irritable and irritable temper, emotional depression, anxiety and sleeplessness, women and accompanied by menstrual irregularities. Medical Heart Enlightenment” cloud: “Liver fire is strong, also makes people urinate blood”. This kind of patients choose to dredge the liver, liver cleaning, liver nourishing method, is a feasible method. The clinical treatment requires detailed investigation of the medical history and treatment of the mind and body together.
Fourth, the method of regulating menstruation is effective
The patient, female, 15 years old, was first diagnosed on January 30, 2010. She has had recurrent microscopic nephrogenic hematuria for 10 years. The patient’s mother complained of microscopic hematuria and red blood cells since early childhood. 10 years of repeated treatment with Chinese herbal medicine to clear heat and detoxify, cool blood and stop bleeding, generally maintained at RBC 6-8, no proteinuria and hypertension. 08 September 1, after the patient’s first menstruation, menstruation came again after six months, since then the menstrual cycle has been delayed often 3 to 4 months a line, and the amount of menstruation is very small. 09 early, began to In early 2009, she began to suffer from recurrent nosebleeds and the symptoms did not stop. She was treated with Chinese herbal medicine to clear heat and fire, cool blood and stop bleeding. The patient was fatigued, with heavy limbs, occasional lumbar acidity and cold fear, fat body shape, puffy face, no swelling of both lower limbs, nasal discharge and bowel movement, menstruation had not been performed for 3 months, occasional distention and pain in the lower abdomen, frequent nosebleeds, thin tongue with tooth marks and thin pulse. Urine routine shows: RBC 3-4, the rest is negative. Treatment is to expel blood stasis and clear the menstruation, move Qi and dissolve phlegm, prescribed as follows.
Radix Angelicae Sinensis 12g, Rhizoma Ligustici Chuanxiong 6g, Radix Cinnamomum Cassiae 6g, Peach kernel 10g, Safflower 10g, Radix Aromaticae Sinensis 12g, Neem 10g, Yanyusuo 10g, Lutong 12g, Zelen 12g, Zedoary 12g, Yimou 30g, Chuan Niu Kne 12g, Acorus calamus 12g, Yuan Zhi 3g, Qing Pores 30g (first decoction), Sha Ren 3g (later down), Gan Song 3g x 7 posts Revisited on February 6, menstruation The patient has not had menstruation, the swelling of the face has been reduced, the spirit has improved, there is no nosebleed within one week of taking the medicine, the urine routine shows: RBC2~3. The tongue and pulse are as before. The above prescription was supplemented with 12 grams of San Ling and 12 grams of Curcuma longa. ×Two weeks later, she complained that her menstruation had arrived with low volume and red color. He still had lumbago, fatigue and chilliness. The swelling of the face and eyes had receded and there was no rhinorrhea. Urine routine shows: RBC (-). The tongue is light with thin coating and the pulse is thin. The medicine is used to tonify the kidney, warm the Yang, and benefit the Qi and nourish the Blood. All the symptoms have been well since the follow-up.
The patient was born with a deficiency of kidney qi, so hematuria appeared under the mirror since she was a toddler. Although the hematuria was controlled by the long-term use of herbs to clear heat and detoxify the blood and cool the blood, the bitter-cold products tend to damage the kidney yang, and the cool-blood medicine tends to stop the blood and leave stasis. Due to stagnation of the uterine vessels, the menstrual blood cannot go down as scheduled, so the epistaxis is reversed upwards. Firstly, we should activate the blood to promote menstruation and regulate qi to resolve phlegm, so that when menstruation comes, there will be a way out for the evil, and then we should use cultivation and tonic to collect the power. In the treatment of this patient, although a large amount of medicine was used to invigorate blood circulation and break down blood stasis and to warm Yang and expel phlegm, the hematuria did not worsen and the epistaxis also recurred, indicating that the method of regulating the yin and yang from the whole body as a whole, first opening up the ground channels and then tonifying the kidney yang, can help treat the hematuria at the root.
Due to the complexity of the etiology and pathogenesis of renal hematuria, treatment methods vary depending on age, gender, personality and professional family background. With the above-mentioned exceptions, there are also those who have been cured by treating chronic allergic rhinitis, chronic gastritis and cholecystitis, etc., but the clinical treatment is also a lot of twists and turns. In the case of patients who are difficult to treat for a long time, the clinical evidence must be investigated in detail, the identification of evidence must be carefully into the button, and the prescription must be careful. Therefore, to a certain extent, the treatment of hematuria is more reflective of the “holistic view” and “discriminatory treatment” of Chinese medicine. It is true that, in the current clinical practice, the treatment of hematuria is also one of the indispensable methods in the clinical practice of TCM, which should be absorbed and developed with the progress of science.
[Funded by] Shanghai Municipal Education Commission, E-Institute Construction Program, Project No. E03008, and Shanghai Municipal Education Commission, University Innovation Team Project.