The original text says: “Shaoyin disease, the four reversals, the person may have cough, or palpitation, or urinary inconvenience, or pain in the abdomen, or catharsis, the lower heavy, the four reversals are main. The Four Reverse Herbs have been used to relieve depression in the liver and gallbladder system or gynecological diseases, but rarely applied to kidney diseases. In his long-term clinical treatment, Prof. Lu Renhe has used Sibei-San for the treatment of chronic nephritis according to the evidence, in order to de-stagnate the qi, resolve the stagnation in the middle jiao, and facilitate the flow of water channels in the three jiao, often obtaining good results. The formula consists of Chai Hu, Bai Shao, Citrus aurantium, and roasted licorice, in which Chai Hu is the main ascending, dispersing and draining agent into the liver and gallbladder, which can dredge the liver and relieve depression, unblock the Qi and blood, and permeate the surface to drain heat; Bai Shao can lower liver rebellion, astringent liver yin, nourish liver blood, clear liver heat, and diarrhea liver fire; Citrus aurantium breaks Qi and removes lumpiness, disperses nodules and eliminates accumulation; licorice clears heat and detoxifies the lung, eases urgency and moistens the lung, and harmonizes the medicinal properties. In terms of drug meridians, Chai Hu belongs to the liver and gallbladder, Bai Shao to the liver and spleen, Citrus aurantium to the spleen, stomach and large intestine, and Glycyrrhiza glabra to the heart, lung, spleen and stomach. It can be seen that the Four Reversals of the Treatise on Typhoid is intended to dredge the liver and spleen, to regulate the qi flow, and to relieve depression and heat. It is not exclusively for relieving liver and depression. The fact that Zhang Zhongjing included the formula of Si Yan San in the chapter of “Identification of Shao Yin pulse evidence and treatment” shows the depth of his intention. Chronic nephritis is a clinical syndrome with hematuria, proteinuria, edema, and hypertension as the main manifestations, with a slow clinical onset and mostly insidious onset. As the disease progresses, anemia, electrolyte disorders and renal failure may appear. Due to the long duration of the disease, patients are often anxious, and the symptoms of liver depression, spleen deficiency and middle-jiao obstruction are common, such as distension and fullness in the abdomen, impatience, irritability, poor appetite and poor bowel movement. If the liver is depressed, the qi is not smooth; if the spleen is deficient, it cannot be transported and transformed; if the middle jiao is stagnant, the water channels do not work, which not only aggravates the original disease, but also affects the absorption of drugs. Therefore, it is especially important to regulate the qi flow, resolve the stagnation in the middle jiao, and unblock the water channels to stop chronic nephritis at the early stage of the disease or delay its progress. Professor Lv Renhe uses Typhoid fever Si-an as the basic formula, adding Red peony to clear heat, cool blood and disperse blood stasis, and Citrus aurantium shell with Citrus aurantium as a complementary formula, which can straighten up and down, regulate both qi and blood, promote the flow of qi and eliminate distension. It is combined with the original formula of Typhoid Fever Four Reversals to strengthen the function of the original formula in regulating the Qi flow, resolving stagnation and clearing the heat. Here are two cases to illustrate its specific application. 1, occult nephritis Ma, male, 28 years old, Changchun, was first diagnosed on April 29, 2008, complaining of occult blood in the urine for 3 years. 3+ occult blood in the urine (BLD) was found during physical examination in 2005, and the patient had no discomfort. Later, he repeatedly reviewed the urine occult blood fluctuates between 3+ and 4+, and has been seen in several hospitals, and has taken nephritis rehabilitation tablets, Coxua, and Bering capsules, etc., but the results were not good. At the time of consultation, he had a slightly dark complexion, irritability, occasional fatigue, mild edema of both lower extremities after exertion, but no significant discomfort, sleep, stool regulation, dark red tongue with teeth marks on the fat side, yellow thick and greasy moss, and smooth pulse. Investigation: urine BLD3+, full field of view on microscopy. The diagnosis is wind and toxin injury to the kidneys, dampness blocking the middle jiao, and poor qi flow. Treatment: Expel wind and detoxify the kidney, regulate the qi flow, invigorate blood and induce diuresis. Prescription: 6 g each of fried Atractylodes macrocephala, 10 g of cypress, 30 g of coix seed, 20 g of hyssop, 10 g of bupleurum, 10 g each of red and white peony, 6 g of hedgehog shell, 10 g of raw licorice, 30 g of poria, 30 g of snake’s tongue, 20 g of zelenium, 30 g of salvia, 1 dose/d. After taking 14 doses, second consultation: complained of significant reduction of fatigue after taking the medicine, edema of both lower extremities did not appear again, still had irritability, the rest did not The rest is not obvious discomfort, good sleep, stool regulation, dark red fat tongue, thin yellow greasy coating, smooth pulse. Urine BLD (2+), microscopy: 25-30/field of view. Treatment Zong April 29 formula remove Zeilan, add 10g of aromatic herb, 10g of wu yao, decoction in water, 1 dose / d. After taking 30 payments of the third diagnosis: complaints adhere to take the above, feel good state, did not complain of obvious discomfort. Dark red tongue, thin yellow coating, smooth pulse. Check: urine BLD (+), microscopy: 5-8/field of view. Prescription Zong April 29 prescription remove Zeilan, add 10g of bamboo leaves, decoction in water, 1 dose / d, 30 payments. After telephone follow-up, intermittent consumption of Chinese medicine, urinary routine is basically normal, the condition is stable. Note: Occult nephritis mostly has no obvious symptoms and is often diagnosed when abnormalities are found during urinalysis. Professor Lv Renhe believes that the symptoms are caused by the wind attacking the kidneys and damaging the kidney ligaments, so the treatment should be based on the supplementation of deficiency and the use of blood-vitalizing and wind-eliminating drugs. In this case, in addition to wind and toxin injury to the kidney, dampness is also seen to block the middle jiao. Therefore, in addition to dispelling the wind and detoxifying the kidney, invigorating the blood and promoting the flow of water, the prescription should also regulate the qi and release the stagnation in the middle jiao. 2. IgA nephropathy Li, male, 39 years old, Beijing, was first seen on April 10, 2009, complaining of occult blood and protein in the urine for 12 years. 1997, due to edema of both lower limbs after exertion, he went to a Chinese medicine hospital and was examined for urine routine: urine BLD (3+), urine protein (PRO) 3+, blood routine, liver and kidney function normal. In January 2008, a kidney puncture biopsy showed mild thylakoid proliferative IgA nephropathy. At the time of consultation, he had a dull complexion, fatigue, lumbar and leg pain, dry mouth and sore throat, irritability, distention and fullness, poor appetite, occasional nausea or vomiting, moderate concave edema in both lower extremities, fear of cold, easy to catch cold, sleep is still possible, stool is one line for three days, dry in quality, small volume of urine, foamy, nocturnal urination 3-4 times. The tongue is dark red, the coating is yellow and greasy, and the pulse is sunken and thin. Urinalysis: BLD (3+), PRO (3+); blood: RBC (3.42×1012/L), HGB (91g/L); normal liver and kidney function. The diagnosis belongs to deficiency of qi and blood, obstruction in the middle jiao, wind and toxin injury to the kidney, and irregularities in the meridians. The treatment is to benefit qi and replenish blood, regulate qi flow, dispel wind and detoxification, and activate blood circulation. Prescription: Astragalus membranaceus 30 g, Radix Angelicae Sinensis 10 g, Radix et Rhizoma Chai Hu 10 g, Radix et Rhizoma Paeoniae 15 g, Citrus Aurantium 10 g, Radix Glycyrrhiza Uralensis 10 g, Citrus Aurantium 10 g, Radix Fructus Fructus 10 g, Salviae Miltiorrhizae 30 g, Radix Aromaticae 10 g, Poriae 20 g, Radix et Rhizoma Spinosa 10 g, Radix et Rhizoma Ochraceae 10 g, Radix et Rhizoma Rhamnoides 15 g, Radix et Rhizoma Carthamus tinctorius 30 g, 14 doses. Decoction in water, 1 dose/d; Prednisone is still taken according to the original dosage. Second diagnosis: complained of general relaxation, fatigue and weakness reduced, stool 1~2 times/d, not dry, abdominal fullness reduced, food intake improved, nausea and vomiting basically disappeared, lower limb edema reduced, dizziness and head swelling sometimes, dark red tongue, thin yellow coating, sunken string pulse. The prescription: April 10 prescription with the removal of Fritillaria, Ocimum sanctum and Psyllium, with the addition of 10 g of Tianma and 15 g of Rhizoma Chuanxiong, 14 doses in water, 1 dose/d. The dosage of prednisone was gradually reduced with no significant increase in urine protein. Third diagnosis: complaints of disappearance of distention and fullness in the abdomen, good appetite, smooth stool, mild edema in both lower limbs, occasional pain in the lower back, dark red tongue, thin yellow coating, sunken pulse. The patient’s urine routine was reviewed: BLD2+, PRO+, RBC3.82×1012/L, HGB: 102 g/L. The patient’s middle-jiao stagnation improved, and the prescription was changed to focus on tonifying the liver and kidney, benefiting qi and nourishing blood, and activating blood circulation. Prescription: Dog’s backbone 10 g, Chuan Jian 10 g, Niubizi 30 g, Dan Shen 30 g, Tian Ma 10 g, Safflower 10 g, Safflower 10 g, Tao Ren 10 g, Chuan Xiong 15 g, Poria 30 g, Ze Lan 30 g, Xiang Shen 10 g, Wu Yao 10 g, 14 doses in water, 1 dose/d. Follow-up for more than 5 months: still taking Chinese medicine, Prednisone has been reduced to 20 mg, taken orally every other day. The urine protein has turned negative, all symptoms are stable, and the overall condition is good. The treatment should not be purely for deficiency, but should always be based on whether the disease is wind-heat, heat toxicity, qi stagnation or rheumatism. At the time of consultation, this patient was suffering from Qi and Blood deficiency and Qi stagnation, so the initial treatment was to benefit Qi, tonify Blood and regulate Qi. When the stagnation in the middle Jiao is relieved and the water channels of the three Jiao are clear, the focus of treatment will be on tonifying the liver and kidney and benefiting the Qi and nourishing the blood. The treatment is gradual according to the disease mechanism, so the effect is better. The Su Wen – Ling Lan Secret Discourse says: “San Jiao is the official of Q and the water channels come out of it”. If the liver is depressed and the spleen is deficient and the qi is stagnant, the water channels in the middle jiao will not run smoothly, and the upper jiao cannot moisten the heart and lungs and the lower jiao cannot nourish the kidney water, so the water in the middle jiao will not be transported and transformed and diseases will occur. Therefore, the middle jiao plays an important role in the operation of water and fluid. In the treatment of chronic nephritis, Prof. Lu Renhe added Sibei San to patients with liver depression, spleen deficiency and qi obstruction to resolve the stagnation in the middle jiao and regulate the qi flow, thus obtaining good results. By extension, all diseases with liver depression, spleen deficiency and Qi blockage in the middle jiao can be treated with the addition of Si Yan San to relieve liver depression, regulate the Qi flow and unblock the water channels in the middle jiao, so that the up and down can be cleared and the water can be transported, and all the diseases will be removed.