Chronic renal failure (CKD) is the end stage of many chronic kidney diseases, mainly manifested by renal decompensation, metabolite retention, and imbalance of water-electrolyte and acid-base balance. According to the clinical characteristics of different stages of chronic renal failure, they can be classified as “edema”, “deficiency labor”, “drowning toxicity”, “retention of urine” and “Guange” in Chinese medicine. “retention of urine”, “Guange” and so on.
I. Clinical Staging of Chronic Renal Failure
At present, the K/DOQI staging recommendations for CKD are most widely used clinically. We divide the disease into three stages according to the clinical characteristics of chronic renal failure in TCM: early stage of chronic renal failure , middle stage of chronic renal failure, and late stage of chronic renal failure, which can be flexibly applied in combination with K/DOQI staging.
II. The basic pathogenesis of chronic renal failure and the principles of TCM treatment at each stage
The etiology of chronic renal failure is complex, with the basic pathogenesis of deficiency and mixed deficiency and reality. The original deficiency is different from the deficiency of qi, blood, yin and yang, while the evil deficiency is mostly seen in water and dampness, drowning and poisoning, stasis of blood, etc. The lesions involve many internal organs, mainly the kidney and spleen, and can affect the stomach, Sanjiao, heart, liver, lung, etc. The symptoms of the disease in different stages are manifested as positive deficiency and evil real, mixed with deficiency and real. The symptoms of the disease at different stages of the disease are mixed with deficiency and deficiency, and are more deficiency and less deficiency or more deficiency and less deficiency as the disease progresses.
Early stage of chronic renal failure: In this stage, renal function is mildly impaired and creatinine clearance rate is mildly decreased, but blood creatinine is still maintained at normal level. The clinical symptoms associated with drowning retention are not obvious, but are characterized by clinical evidence of the underlying lesion of chronic renal failure. Chinese medicine treatment mainly focuses on the evidence-based treatment of the underlying lesions.
Middle stage of chronic renal failure: In this stage, renal function is further reduced, creatinine clearance rate is significantly decreased, and serum creatinine is increased to different degrees. Symptoms associated with internal drowning of toxins may be seen clinically. The pathogenesis of this stage is characterized by the further development of chronic kidney disease, which seriously injures the spleen and kidney, resulting in the inability to transport spleen dampness, the failure to transform kidney qi, the failure to open and close, the retention of drowning toxins, the damage to qi and blood, and the blockage of qi flow, which can lead to the appearance of a dull complexion, pale claw and nail, itchy skin, aching tendons and bones, anorexia and vomiting. Therefore, Chinese medicine treatment starts from two aspects, and according to the different ratio of deficiency and actual in the patient’s symptoms, there is a focus on helping the positive and eliminating the evil. Especially in the acute progression of the disease, when the urgent task is to dispel the evil or give the main treatment to eliminate the evil, while in the slow progression of the relative stability, the main treatment can be given to support the main symptoms.
Late stage of chronic renal failure: At this stage, renal function is severely impaired and multiple clinical symptoms of excessive retention of drowning toxins appear. The pathogenesis is that the Qi of the spleen and kidney is greatly weakened, the kidney gates are opened and closed, the drowning toxin congests the three jiao, suffocates the qi, and moves blood to disturb the mind, resulting in panting and palpitations, vomiting, vomiting and urinary shutdown, epistaxis and blood in stool, and mental confusion. Therefore, TCM treatment should be tailored to the clinical characteristics of drowning toxin retention, using TCM methods to remit drowning toxin and combining with hemodialysis for treatment. On the basis of this, the treatment plan should be combined with the treatment of both the symptoms and the root cause to help eliminate the evil.
III. Basic evidence of chronic renal failure
The basic evidence of chronic renal failure is the basic unit that constitutes many complex clinical evidence, including positive deficiency and evil reality, among which the symptoms of positive deficiency include Qi deficiency, blood deficiency, Yin deficiency and Yang deficiency; the symptoms of standard reality include blood stasis, water-dampness and drowning toxicity. Clearly identify the basic evidence, it will help to make a more accurate diagnosis of the complex clinical changes.
(a) Zheng deficiency evidence type.
Qi deficiency evidence: ① fatigue, ② less breath and lazy speech, ③ sweating easily, ④ poor appetite and loose stools, ⑤ fat tongue with marks, ⑥ weak pulse. Two of them can be diagnosed.
Blood deficiency: ① no color, ② pale lips and nails, ③ pale menstruation, ④ fat tongue and pale texture, ⑤ thin pulse. Two of them are diagnostic.
Yin deficiency: ① hot flashes and sweating, or night sweats, ② dry mouth and throat, ③ dry stools, ④ hot hands and feet or five hearts, ⑤ thin red and cracked tongue, ⑥ thin pulse. The diagnosis can be made by having two of them.
Yang deficiency: ① coldness in the limbs, ② coldness in the waist and knees, ③ swelling of the face and feet, ④ frequent nocturia, ⑤ fat tongue with white fur, ⑥ sunken and slow pulse. The diagnosis can be made with two items.
(II) The symptoms of the symptoms of the symptoms.
Blood stasis evidence: ① localized stabbing pain, aggravated at night, ② numbness and pain in the limbs, or hemiplegia, ③ wrong skin nail. ④ purple lips and tongue, or purple and dark, petechiae, and purple and angry veins under the tongue, one of which can be diagnosed.
Water-dampness evidence: ① swelling of the face and limbs, even with hydrothorax, ascites and yin edema, ② heavy and sore limbs, ③ stuffy chest and cachexia, ④ dullness and loose stools, ⑤ light fat tongue with white greasy coating and moist or slow pulse. With two items can be diagnosed.
The diagnosis can be made with three of them.
IV. The main types of evidence of chronic renal failure in the middle and late stages
The main symptoms of chronic renal failure in the middle and late stages are compound symptoms consisting of two or more basic symptoms. According to the clinical characteristics of different stages, the manifestations of the compound evidence are as follows.
(A) Basic evidence of chronic renal failure in the middle stage
1. Mid-term deficiency symptoms
Deficiency of Qi and Blood: Qi deficiency + Blood deficiency.
Qi and Blood Yin deficiency evidence: Qi deficiency evidence + Blood deficiency evidence + Yin deficiency evidence.
Qi and blood yang deficiency evidence: Qi deficiency evidence + blood deficiency evidence + yang deficiency evidence.
2. Intermediate standardized evidence type
Blood stasis and water-dampness evidence: blood stasis evidence + water-dampness evidence.
Blood stasis and drowning toxicity: Blood stasis + drowning toxicity.
Blood stasis, water dampness and drowning toxicity: blood stasis + water dampness + drowning toxicity.
(B) Basic evidence of chronic renal failure in the late stage
1. Late stage deficiency evidence
Qi-Blood-Yin deficiency evidence: Qi deficiency evidence + Blood deficiency evidence + Yin deficiency evidence.
Qi and blood yang deficiency evidence: Qi deficiency evidence + blood deficiency evidence + yang deficiency evidence.
Qi-Blood-Yin-Yang deficiency: Qi deficiency + Blood deficiency + Yin deficiency + Yang deficiency.
2. Late stage of the evidence of the actual symptoms
Blood stasis and drowning toxicity: blood stasis + drowning toxicity.
Blood stasis, water-dampness and drowning toxicity: blood stasis + water-dampness + drowning toxicity.
V. The evidence of chronic renal failure in the middle and late stages
Chronic renal failure in the middle and late stages is often combined with a variety of hostage syndromes, the common hostage syndromes are heat toxicity, damp-heat, qi stagnation, phlegm blockage, drinking stoppage, wind, blood, heart and lung, injury to the mind, and so on. Clinically, it can be accompanied by one or more evidence.
Heat toxicity: (1) fever and chills, (2) sore throat or ulcers, (3) skin sores, (4) cough with shortness of breath, yellow phlegm, (5) red tongue with yellow coating and counted pulse. The diagnosis can be made if two items are present.
Damp-heat evidence: ① heavy and heavy head, ② chest and epigastric boredom, ③ bitter and sticky mouth, thirsty and not much to drink, ④ dull and generalized evil, ⑤ urgent and frequent urination, burning and astringent pain or dripping and stinging pain, yellow and cloudy urine, or hematuria, or urine with gravel, ⑥ sticky stool, ⑦ red tongue with yellow coating, moist pulse or slippery pulse. The diagnosis can be made if two items are present.
Qi stagnation: (1) pain in the chest, hypochondrium and abdomen, sometimes light and sometimes heavy, with moving parts; (2) the condition increases or decreases with mood swings, belching and good breath; (3) abdominal masses, irregularly gathered and dispersed, decreasing with belching or yagging; (4) thin tongue coating and string pulse. The diagnosis can be made if two items are present.
Phlegm obstruction: (1) chest stuffiness, (2) vomiting, nausea, (3) obesity, (4) general drowsiness, (5) head swelling and heavy limbs, (6) white and greasy tongue coating. Diagnosis can be made with three of them.
Drinking stop evidence: ① wheezing and palpitations, leaning and resting, ② intercostal fullness, coughing and salivation leading to pain, ③ abdominal and cavernous abdominal plumpness, watery sound when knocking, ④ heavy limbs, edema, ⑤ coughing and vomiting thin sputum and saliva, ⑥ slippery tongue coating, string or slippery pulse. The diagnosis can be made if two items are present.
Moving wind: ① dizziness and dizziness, ② tendons and flesh leap, ② twitching or trembling of the limbs, ③ tense tendons and veins or spasm of the limbs. One of them can be diagnosed.
Evidence of moving blood: ① epistaxis, ② epistaxis, ③ epistaxis, ④ hemoptysis, ⑤ vomiting blood, ⑥ blood in stool, etc. One of them is diagnostic.
Heart and lung disease: ① palpitation and shortness of breath, ② chest tightness and breath-holding, ③ coughing and wheezing and inability to lie down. Diagnosis can be made if two items are present.
Injury to the mind: ① indifferent expression, ② delirium, ③ confusion and silence. One of them can be diagnosed.
VI. Treatment of chronic renal failure
(a) Treatment of chronic renal failure in the early and middle stages
1. Delay the progression of renal damage
(1) Treatment of the underlying disease
Interventional treatment according to the Chinese and Western medical treatment protocols for the underlying disease to keep it in a stable state in order to reduce the adverse effects of the underlying disease on renal function.
(2) Implement dietary modifications
Low-salt diet: sodium intake <100mmol/d, about 6g of salt; for combined hypertension, strict sodium restriction <65mmol/d (3.8g/d of sodium chloride).
Quality low protein diet [1] (LPD): ① when GFR is 25-60ml/(min・1.73m2), protein intake (DPI) should be controlled at 0.6-0.75g/(Kg–d); ② Very low protein diet (VLPD): when GFR <25ml/(min・1.73m2), protein intake (DPI) should be controlled at 0.3-0.4g/(Kg--d), choosing proteins rich in essential amino acids; ③VLPD plus nitrogen-free essential amino acid analogues (such as α-keto acid).
Low-fat diet: fat energy supply should be controlled at 25%-35% of total energy.
(3) Control of disease progression factors
Common factors that accelerate the progression of nephropathy include hypertension, proteinuria, hyperlipidemia, hyperuricemia, infections, strain, use of nephrotoxic drugs, pregnancy, etc. Active and effective intervention of the disease progression factors can help to slow down the progression of renal failure.
Hypertension: Hypertension accompanying chronic kidney disease is often difficult to control and often requires the combination of multiple antihypertensive drugs. ① ACEI or ARB is preferred; ② the choice of ACEI or ARB should be monitored to monitor the blood creatinine level. When the creatinine level rises to more than 30% of the initial dose, the dose should be reduced or discontinued to find the possible cause, and the drug can be used again after adjusting the status. ③If the combination of ACEI and diuretics still cannot control blood pressure, or if blood pressure reaches the standard but urine protein does not, it is recommended to add calcium channel blockers, especially non-dihydropyridines, such as verapamil; ④α or β receptor antagonists do not have a lowering effect on urine protein independent of the antihypertensive effect, but with their ability to inhibit the increased sympathetic activity caused by impaired renal function in chronic kidney disease, they may improve the long-term prognosis of patients with chronic The long-term prognosis of patients with kidney disease, commonly used drugs are metoprolol, labetalol, and ponerol, etc.
Proteinuria: In addition to treatment for the underlying disease, ACEI and/or ARB and hydroxymethylglutaryl coenzyme A reduction inhibitors (statins) are also available for treatment.
Hyperlipidemia: those with predominantly elevated plasma cholesterol should be treated with statins; those with predominantly elevated serum triglycerides should be treated with fibrate derivatives (betablockers).
Hyperuricemia: drugs that inhibit uric acid synthesis, such as allopurinol and febuxostat, can be used. Allopurinol needs to be reduced when GFR<59ml/L, while febuxostat does not need to be reduced when GFR<59ml/L.
Infection: For different types of infection, use sensitive, potent and non-nephrotoxic anti-pathogenic microbial drugs to control the infection in a timely manner. Recurrent infections can be prevented with a trial of immune enhancers (e.g. thymidine, gammaglobulin).
(4) Removal of metabolic waste
Take drugs containing remission of drowning toxins (mainly containing rhubarb, etc.), activated carbon adsorbent and oxidized starch, etc.
Preservation of Chinese medicine enema, including colonic or rectal enema with Chinese medicine enema solution (mainly containing rhubarb, etc.).
(5) Maintenance of internal environmental balance
① Treatment of water-electrolyte balance disorders: special attention should be paid to the prevention and treatment of hyperkalemia and metabolic acidosis.
The prevention and treatment of hyperkalemia: first of all, all factors that can cause elevated blood potassium should be removed, such as the prohibition of high potassium food, drugs that can cause high potassium or increase the burden on the kidneys; once hyperkalemia occurs, the following measures should be taken to rescue and treat it (a) Intravenous or injectable sodium bicarbonate or sodium lactate, more suitable when there is acidosis. (b) Combined use of glucose and insulin, such as 25% glucose 200ml plus regular insulin (according to 3-4g sugar: 1u insulin) static point. (c) Tab diuretics intramuscularly or intravenously, each dosage is 40-80mg of furosemide, or 20-40mg of torratomide, or 1-2mg of bumetanide. can be repeated if necessary. (d) Oral administration of potassium-lowering resins such as sodium polystyrene sulfonate or calcium polystyrene sulfonate. Alternatively, 10-20 ml of 10% calcium gluconate may be given slowly intravenously to counteract the effects of high potassium on the myocardium. (e) If the above treatment is ineffective and the potassium is ≥6.5 mmol/L, emergency dialysis treatment is feasible.
Treatment of metabolic acidosis: mild cases can be treated with oral sodium bicarbonate; severe cases (serum carbon dioxide binding <13 mmol/L) require intravenous 5% sodium bicarbonate drip treatment. In general, a single drip of 5 ml/Kg can increase the serum carbon dioxide binding capacity by approximately 5 mmol/L.
(2) Treatment of secondary hyperparathyroidism: Abnormal calcium and phosphorus metabolism, secondary hyperparathyroidism and elevated PTH can occur in the middle stage of chronic failure. The treatment plan should be individualized according to the patient’s condition and dynamically adjusted.
Control of hyperphosphatemia: (a) Limit daily phosphorus intake in food, which should be less than 800-1000 mg.
(b) Use phosphorus-binding agents such as calcium carbonate, calcium acetate, sevelamer, and lanthanum carbonate, chewed with meals; when using calcium-containing phosphorus-binding agents, ensure that the daily intake of elemental calcium (including diet) is not higher than 2000 mg/d; for those with hypercalcemia or two consecutive blood iPTH levels below 150 pg/ml or in the presence of severe soft tissue, especially vascular calcification and/or power-deficient bone disease. Phosphorus binding agents without calcium should be switched; phosphorus binding agents containing aluminum can be added for a short period of time when blood phosphorus is higher than 7.0 mg/dl, but their use should not exceed 4 weeks. (c) Dialysis patients should enhance the removal of phosphorus by dialysis. (d) If the blood phosphorus is still greater than 5.5 mg/dl with one phosphorus-binding agent, the combination can be used and the blood phosphorus should be controlled in the normal range as much as possible.
Adjustment of blood calcium levels: In patients with hypercalcemia with high iPTH, calcium preparations and active vitamin D therapy should be given. If hypercalcemia develops, calcium-containing medications need to be promptly discontinued or reduced, active vitamin D suspended, and low-calcium dialysis solutions used to lower blood calcium.
Active vitamin D3 should be considered when iPTH levels exceed the upper target value for each stage of CKD or (and) when serum 25hydroxyvitamin D3 levels are <30ng/ml. /L). The method of administration includes continuous administration of small doses and intermittent treatment with high doses. The former is indicated for patients with mild hyperparathyroidism, taking active vitamin D3 preparations once daily at 0.25 ug. The latter, also known as shock therapy, is indicated for patients with severe hyperparathyroidism, with the following recommended doses: iPTH 300-500 pg/ml at 1-2 μg twice a week; iPTH 500-1000 pg/ml at 2- 4 μg twice a week; iPTH >1000 pg/ml at 4-6 μg twice a week. It is best to take the drug at night when the intestinal calcium load is lowest before sleep, as the incidence of hypercalcemia is low and the same effect of iPTH suppression can be achieved. iPTH, blood calcium and blood phosphorus should be reviewed regularly during the dosing period, and the drug should be discontinued when iPTH drops to the lower limit of the target value.
(iii) Correction of renal anemia: Treatment with recombinant human erythropoietin (EPO) is given. Target target value: Hb level 110-120g/L, recommended not to exceed 130g/L.
EPO dosing and dosage: (a) EPO initial dose: 80-120 IU/kg, approximately 6000-9000
IU/week, divided into 2-3 subcutaneous injections; (b) dose adjustment: Hb rise of about 1g/dl per month is appropriate, 3-4 months to reach the target, if the Hb increase >2.5g/dl in 4 weeks, the dose should be reduced by 30%-50%, if the iron reserve is sufficient under the premise that the Hb rise <1g/dl in 4 weeks, the original dose should be increased by 25%; (c) maintenance treatment: most maintenance treatment requires a dose of about 75% of the initial dose, about 4000-9000
IU/week, with monthly monitoring of Hb.
Iron use: (a) optimal range serum ferritin is maintained within 200-600 μg/L with transferrin saturation >20%, requiring approximately 1000 mg iron supplementation during the first 3 months of EPO therapy and approximately 25-100 mg iron per month thereafter. (b) Iron is administered by both intravenous and oral routes. Intravenous iron supplementation is significantly better than oral iron supplementation. (c) Iron sucrose has the best safety and efficacy, commonly used dose: 100mg per dose for ferritin <200ng/ml, and every 1-2 weeks for ferritin 200-600ng/ml depending on ferritin level. (d) Precautions: when ferritin > 500ng/ml, intravenous iron supplementation is not recommended at this time; because intravenous iron can affect leukocyte function, it should be discontinued during infection.
(b) Treatment of advanced chronic renal failure.
Renal replacement therapy: including hemodialysis (HD), peritoneal dialysis (PD) and renal transplantation.
When patients with CKD progress to GFR <10-15 ml/min (or corresponding blood creatinine level) and have obvious clinical manifestations of uremia, which cannot be relieved by drug treatment, then dialysis treatment and renal transplantation should be given. For patients with non-diabetic nephropathy, when GFR is 8-10
ml/min is more appropriate; when GFR < 6 ml/min is an absolute indication for dialysis treatment. In advanced diabetic nephropathy, dialysis treatment can be appropriately advanced according to the needs of the disease (generally GFR is 10-15 ml/min).
VII. Chinese medicine treatment for chronic renal failure
(a) Identification and treatment of the basic types of chronic renal failure
According to the characteristics of the symptoms of chronic renal failure in the middle and late stages, the following evidence-based treatment methods are used to develop a clinically relevant treatment plan in terms of deficiency and symptoms.
1. Deficiency
Qi and blood deficiency
Treatment: Benefit Qi and tonify Blood.
Main formula: Radix Angelicae Sinensis Blood Tonic Soup or Bazhen Tang plus or minus.
Prepared Chinese medicines: Blood-giving tablets, Eight Precious Granules, Ginseng Yangrong Pill, etc.
Qi and Blood Yin deficiency
Treatment: Benefit qi, nourish blood, nourish kidney and yin.
Radix: Ginseng and Astragalus Dihuang Tang with Danggui Blood Tonic Soup, plus or minus.
Traditional Chinese medicine: Astragalus Injection, Nephrolithiasis Rehabilitation Tablets, Raw Vein Drink, Guei Shao Di Huang Wan, Mai Wei Di Huang Wan, Zhi Bai Di Huang Wan, Zuo Gui Wan, etc.
Qi and Blood Yang Deficiency
Treatment: Benefit the kidney and temperature.
Main formula: Right Return Drink combined with Danggui Blood Tonic Soup, plus or minus.
Traditional Chinese medicine: Astragalus injection, Bai Ling capsule, Zhi Ling capsule, Jin Shui Bao capsule, Right Return Pill, etc.
Deficiency of Qi, Blood, Yin and Yang
Treatment: Benefit qi, tonify blood, warm yang and nourish kidney.
Main formula: Jin Kui Kidney Qi Tang with Dang Gui Blood Tonic Soup plus reduction
Chinese medicine: Jin Kui Kidney Qi Pill, Jisheng Kidney Qi Pill, etc.
2. Standard evidence
Blood stasis and water-dampness
Treatment: Relieve blood stasis and drainage.
Main formula: Peach-Hong Siwu Tang with Wu Ling San plus or minus.
Chinese patent medicines: Chinese patent medicines for activating blood circulation and resolving blood stasis (Dangjianhua injection, Xuesetong injection, Chuanxiongzin injection, piperazine ferulate tablets, earth kinase, compound Danshin tablets, etc.).
The combination of Chinese patent medicines (Ginseng and Atractylodes Pill, Wu Ling Capsule, etc.) and Chinese patent medicines (Ginseng and Atractylodes Pill, Wu Ling Capsule, etc.) can be used to promote blood circulation and eliminate blood stasis.
Blood stasis and drowning toxin evidence
Treatment: Removing blood stasis and removing toxins
Main formula: Peach-Hong Si-Wang Tang combined with Tonggui Chengqi Tang plus or minus.
Chinese patent medicines: combining Chinese patent medicines (Renkang Injection, Haikun Renxi Capsules, Kidney Failure Pills, Urotoxic Qing Granules, Renkai Kang Enema, etc.) and Chinese patent medicines to activate blood stasis and resolve blood stasis.
Blood stasis, water dampness and drowning toxicity
Treatment: Removing blood stasis and relieving water and toxicity.
Main formula: Peach-Hong Si-Wu Tang with Wu Ling San and Tong Gao Cheng Qi Tang plus or minus.
Chinese herbal medicine: activating blood stasis, promoting dampness and diuresis, and releasing drowning toxins.
(II) Treatment of the concurrently hostage evidence
Chronic renal failure is often accompanied by heat toxicity, damp-heat, qi stagnation, phlegm obstruction, and drinking stoppage in the course of the disease. In the late stage, it is especially easy to appear drowning poison over the heart and lungs, into the blood and brain, moving wind and closed orifices, such as moving wind evidence, moving blood evidence, over the heart and lungs evidence and injury to the mind evidence and other critical symptoms. The emergence of most of the evidence of co-passage often becomes an important factor in the acute progression of the disease and rapid deterioration of kidney function. Timely and effective treatment of these symptoms can help to slow down the development of renal failure.
Heat toxicity evidence.
Treatment: Clearing heat and detoxifying toxins
Main formula: Huanglian detoxification soup with reduction
Traditional Chinese medicine: Golden Lotus Capsules, Golden Buckwheat Tablets, Andrographis tablets, Gardenia Golden Flower Pills, etc.
Damp-heat evidence.
Treatment: Clear heat and dampness.
Main formula: Si Miao San with addition and subtraction.
Chinese patent medicines: infirmity clearing tablets, hot gonorrhea clearing pellets, Bazheng capsule, urinary gonorrhea clearing capsule, urinary sensitization pellets, silver flower urolithiasis pellets, etc.
Qi stagnation evidence.
Treatment: Diversify the liver and relieve depression.
Main formula: Si-wei-san plus or minus.
Chinese patent medicines: Yi Yao Wan (water pills, large honey pills, punch), Jia Wei Yi Wan, Chai Hu Shu Liver Pills (San), Yue Ju Wan (Tablets), etc.
Phlegm obstruction.
Treatment: Eliminating phlegm and relieving water.
Main formula: Er Chen Tang plus or minus.
Chinese herbal medicines: compound fresh bamboo lee oral liquid, snake bile and chenpi tablets, snake bile and chuanbei oral liquid, niuhuang snake bile and chuanbei oral liquid.
Evidence of drinking stoppage.
Cure: Dispersing water and expelling drinks.
Treatment: Dislodging water and expelling drinks.
Wind movement.
Treatment: Cool the liver and quench the wind.
Main formula: Tianma and Hooked Vine Drink plus or minus.
Traditional Chinese medicine: Tianma and hooked vine granules, Niuhuang hypotensive pills, Qingbao hypotensive tablets, Quan Tianma capsule, Brain Liqing tablets, Antelope horn capsule, etc.
Blood-activated evidence.
Treatment: Cool the blood and detoxify it to stop bleeding.
Main formula: Rhizoma Dihuang Tang plus or minus.
Chinese patent medicines: blood urine security capsule, water buffalo horn concentrated powder, water buffalo horn detoxification pill, etc.
Heart and lung disease.
Cure: Dissolve the lung and expel water.
Main formula: Scapularis daidze diarrhea lung soup with addition and subtraction.
Chinese patent medicine: Astragalus membranaceus capsule, etc.
Evidence of injury to the mind.
Cure: Clearing the mind and awakening the spirit.
Chinese patent medicines: Angong Niuhuang Pill, Zixue Dan, Awakening Brain Jing Injection, etc.