Diabetic nephropathy is the name of a modern medical condition. Although Chinese medicine does not have this name, the clinical manifestations of diabetic nephropathy are very similar to those of edema, bloating, urinary turbidity, vomiting, kidney dissipation, and guangs, which occur with prolonged thirst in Chinese medical literature. For example, the Treatise on the Origin of the Diseases contains the cloud: “The disease becomes carbuncles and gangrene over time, or becomes a water disease. In the General Record of Shengji, it is said that “if this disease does not heal for a long time, it can become a disease of edema and carbuncle and gangrene”.
The “Source of Miscellaneous Diseases and Rhinoceroses” says: “There are those who have swollen bodies after thirst, and those who have swollen faces, eyes, feet and knees with little urine after thirst”. It is pointed out that the disease of thirst can be complicated by edema and fullness over time. The “evidence of treatment” cloud: “three elimination for a long time and urine does not stink, but made sweet gas, rolling in the drowning surge, more floating drowning face like pig fat, this essence is not prohibited, the real element exhausted. This kind of cloudy urine like fat is mostly seen in diabetic nephropathy with a large amount of protein in the urine. The “Ancient and Modern Recorded Experiments” cloud: “thirsty but can not drink much water, but the legs swell, feet first thin, Yin impotence, weak, number of urine, this is the kidney elimination disease also”. The symptoms of kidney dissipation described here are very similar to the late manifestation of diabetic nephropathy.
I. Etiology and pathogenesis
The basic pathogenesis of this disease is characterized by “deficiency at the origin and actuality at the symptoms”. The deficiency refers to the deficiency of heart, liver, spleen, kidney, qi, blood, yin and yang; the symptoms refer to phlegm, water and blood stasis. The focus of the disease mechanism is different at different stages of development. In the early stage, the deficiency of both qi and yin is the main focus, while in the middle and late stage, the deficiency of both yin and yang is transformed. In the course of the disease, the internal organs become dysfunctional, and the imbalance of qi and yin and yang leads to many symptoms and changes in the evidence, among which stasis of blood is the most critical, and kidney deficiency and blood stasis run through the whole process of diabetic nephropathy.
1.Qi and Yin deficiency The basic pathogenesis of thirst disease is the loss of yin and fluid, dryness and heat, dryness and heat injure fluid and consume qi, coupled with internal injury to the seven emotions, depression and fire deplete the yin essence, kidney yin deficiency, liver wood loss of nourishment, resulting in liver and kidney deficiency, and Qi and Yin deficiency.
2. Kidney deficiency and blood stasis Qi deficiency is weak in transporting blood, Yin deficiency is difficult for blood to move, blood does not run smoothly and stagnates in the meridians, resulting in kidney deficiency and blood stasis symptoms.
3.Spleen and kidney deficiency The spleen is the origin of the latter, and the kidney is the origin of the first. In case of prolonged thirst, the spleen and stomach are weak and there is no source of biochemistry; the spleen does not rise and clear, and there is no source of biochemistry of qi and blood. In addition to the congenital deficiency, the latter is not nourished, the congenital essence is not nourished by the latter essence, resulting in the kidney more deficient, the essence is not solid, no power of intake, the essence down the drain. As time goes by, the spleen and kidney qi is deficient, which in turn leads to spleen and kidney yang deficiency. On the contrary, if the vital gate fire fails, the spleen is deficient in transporting water and dampness, the kidney is deficient in transpiration and gasification, and the opening and closing are not in order, water and dampness will stop inside, overflowing in the skin and developing edema, and the condition will progress with the deficiency of spleen and yang and the weakening of kidney yang, and the internal accumulation of turbidity and toxicity, which will lead to urinary closure and guangs.
4.Yin and Yang deficiency The deficiency of Yin and Yang is the basis of thirst. The thirst disease is prolonged, Yin loss and Yang, Yin and Yang deficiency, resulting in Yang deficiency can not transform Qi and move water, and the disease is prolonged into the complex, blood stagnation, forming the evidence of Yin and Yang deficiency of the kidney, blood stagnation and water stoppage.
Treatment by type
1. Liver and kidney deficiency, Qi and Yin deficiency type
Main symptoms: fatigue, lazy speech, dry mouth and tongue, soreness and weakness of the waist and knees, dizziness and tinnitus, dizziness and faintness of the eyes.
High urine volume, red tongue with little fluid, sunken pulse.
Analysis: This type is due to prolonged thirst, deficiency of both Qi and Yin, involving the liver and kidney. Spleen Qi deficiency can not moisten the body and feel tired, less breath and lazy speech; yin deficiency and fluid on the upper support, dry mouth and tongue; yin deficiency and lower, liver and kidney deficiency, wood loss of connotation, eyes astringent and faint flowers; deficiency Yang floating up, dizziness and tinnitus; waist for the kidney, kidney deficiency, waist and knees are sore and weak, urine volume is high. The tongue and pulse are both signs of Qi and Yin deficiency.
Treatment: Nourishing the liver and kidney, benefiting Qi and activating Blood.
Formula: Liu Wei Di Huang Wan with reduction
Radix Rehmanniae 15g Yam 10g Yam 10g Semen Cuscutae 15g Radix Astragali 30g Radix Puerariae 30g Fructus Schisandrae 6g Radix et Rhizoma Ginseng 10g Radix Paeoniae 15g
Adding and subtracting: for yin deficiency and yang hyperactivity with dizziness and headache, add asparagus and hooked vine; for insomnia and dreaminess, add sour date palm and lily of the valley; for yin deficiency and blood stasis, add salvia, Chuanxiong and angelica.
In the late stage of the disease, true yin is exhausted in the lower part of the body and deficient yang floats in the upper part of the body, which leads to internal movement of false wind, resulting in confusion and twitching of the limbs. The formula is Antelope and Hooked Vine Tang with addition and subtraction. The treatment should be combined with Western medical treatment.
2. Kidney deficiency and blood stasis type
Main symptoms: soreness and weakness of the waist and knees, tiredness and weakness, emaciation, tinnitus, heat in the hands and feet, unfavorable urination
The tongue is dark red with little coating and the pulse is thin and astringent.
Analysis: Qi and yin deficiency in aching thirst disease, the disease is long lasting and affects the kidneys, the waist is the capital of the kidneys, kidney deficiency leads to lassitude and weakness; qi deficiency leads to tiredness and weakness; yin deficiency turns into fire over time and shrivels up the essence, the body loses moistening, the body is emaciated, the hands and feet are hot; qi deficiency is unable to carry blood, yin deficiency is difficult and astringent for blood flow, blood flow is not smooth and stagnates the meridians. The tongue and pulse are all signs of blood stasis.
Treatment: Tonifying the Kidney and invigorating Blood
Formula: Invigorating Blood to benefit the Kidney
Radix Salviae Miltiorrhiza 15g, Radix Paeoniae Alba 15g, Radix Codonopsis Pilosulae 15g, Radix Rehmanniae 15g, Semen Cuscutae 15g, Radix Achyranthes Bidentatae 15g, Fructus Lycii 15g, Fructus Yam 15g, Fructus Yam 12g.
Adding and subtracting for identification of symptoms: adding Phellodendron and Radix et Rhizoma if yin deficiency is obvious; adding Astragalus if weakness is obvious; adding pollen, Pueraria Mirifica and Medlar for dry mouth and excessive drinking.
3.Spleen and kidney Yang deficiency, dampness and stagnation type
Evidence: Lethargy and weakness, emaciation, dark complexion, general swelling, swelling below the waist, chest tightness, cold in the extremities, unfavorable urination, loose stools, dark red tongue, white fur, sunken and thin pulse.
Analysis: Spleen qi deficiency, can not produce water and grain essence to nourish the whole body, then tiredness and weakness, the body is thin, loose stools; kidney qi deficiency, then the waist and knees are sore and weak; in the Yang deficiency for a long time, involving the kidney Yang, spleen and kidney Yang deficiency, gas does not transform water, water-damp flooding, so the whole body puffy, swelling below the waist is even, urine is unfavorable; Yang deficiency can not warm, then fear of cold limbs cold; water qi up the rebellion over the heart, then chest tightness; Yang deficiency cold condensation, blood vessels run unfavorable, appear stasis signs The symptoms of stagnation occur.
Treatment: Strengthening the spleen, warming the kidney, invigorating the blood and promoting water circulation.
Recipe: Spleen Drinking with Addition and Reduction
Radix et Rhizoma Atractylodis Macrocephala 6g, Ginger 9g, Atractylodes Macrocephala 12g, Thicket 12g, Poria 15g, Radix Achyranthes bidentata 15g, Plantago ovata 15g, Astragalus membranaceus 30g, Fructus Panax 15g, Salviae Miltiorrhizae 15g, Semen Aegypti 15g, Semen Cimicifugae 15g
Adding and subtracting evidence: edema plus five-skin drink; dullness and bloating plus Chen Pi, Neijin; loose stools plus Coix seeds, lotus seeds; blood stasis plus peach kernel, safflower, Ze Xie.
4.Yin and Yang deficiency, turbidity and toxicity congestion type
Main symptoms: emaciation, sallow face, fear of cold, swelling, tiredness, weakness, soreness of the waist and knees, heat in the hands and feet, dizziness and heavy head, nausea and vomiting, unfavorable urination, inability to pass stool, pale tongue with white coating and thick pulse.
Analysis: late stage of the disease, yin loss and yang, yin and yang deficiency, the vital gate fire failure, warming powerless, see the fear of cold extremities cold; Yang deficiency gasification powerless, water dampness turbidity poison internal stop, see the whole body swelling, urine is not conducive, stool does not pass; water evil on the flood is sallow, nausea, vomiting, dizziness head heavy; Yin deficiency into fire, the hands and feet heart heat; tongue and pulse is also the performance of the disease.
Treatment: Nourish Yin and warm Yang, invigorate Blood and promote water circulation, and drain turbidity from the internal organs.
Recipe: Jin Kui Kidney Qi Pill, plus or minus
Radix et Rhizoma Pseudostellariae 6g, Cinnamon 6g, Radix Rehmanniae 15g, Yam 12g, Cornu Cervi Pantotrichum 10g, Poria 12g, Zedoary 12g, Peach kernel 10g, Safflower 10g, Salviae 12g, Plantago ovata 30g, Motherwort 15g, Acorus calamus 10g, Pericarpium 10g, Bamboo Roo 10g, Rhubarb 6g.
Adding and subtracting for identification of symptoms: adding Cyperus rotundus and Zhi Mu for yin deficiency and fire; adding Pueraria lobata and Mai Dong for severe thirst; adding Astragalus for obvious weakness.