Membranous nephropathy is divided into idiopathic membranous nephropathy and secondary membranous nephropathy according to its pathogenesis and clinical characteristics [1]. 1, hepatitis B virus-associated membranous nephropathy Hepatitis B virus-associated nephropathy is one of the secondary renal diseases with a high incidence in China at present, commonly found in adolescents, and patients are mostly accompanied by hepatitis B activity or high replication of the virus at the onset, which often leads to outbreaks of viral hepatitis B or aggravates the disease if the indications for hormonal and immunosuppressive therapy are not well mastered at this time. In the process of clinical treatment, she never adheres to one method and one party, on the one hand, she follows the combination of identification and disease identification, i.e., the combination of macroscopic symptoms and microscopic pathology, on the other hand, she insists on using the right formula for the right evidence, dipping the actual and supplementing the deficient, and the Chinese and western medicine together, with good clinical results [3]. Case 1 Xu, male, 18 years old, was first diagnosed on 2005-12-20. Complaint: swelling of both lower limbs for 1 month. The patient was diagnosed with hepatitis B-associated membranous nephropathy after a renal puncture biopsy at a tertiary care hospital in Shanghai 2 months ago when he found swelling in both lower extremities with no obvious cause and no uncomfortable symptoms. He was diagnosed with hepatitis B-associated membranous nephropathy at a tertiary hospital in Shanghai. Laboratory examination: urine routine: protein 3+, occult blood 2+, 24h urine volume 700-800mL, urine protein quantification 2.24g, blood creatinine 86umoL/L, urea nitrogen 6.7mmoL/L, blood albumin 24g/L, total protein 55g/L, hepatitis B five items suggest small triple positive, hepatitis B virus DNA negative, no hormone and immunosuppressant treatment, oral lamivudine The liver function was basically normal. Western medicine diagnosis: hepatitis B-associated membranous nephropathy. TCM diagnosis: edema. The evidence belongs to damp-heat congestion in the three jiao, the treatment should be to distribute damp-heat, promote water and reduce swelling. Chen’s formula for decreasing swelling in nephropathy was given as follows: 30 g of C. alba, 30 g of C. semifolium, 15 g of Atractylodes macrocephala, 15 g of Atractylodes cantonensis, 15 g of Poria cocos, 9 g of roasted ephedra, 30 g of Morinda citrifolia, 30 g of Melon peel, 9 g of Chuanxiong rhizome, 15 g of Rhizoma ligustici, 10 g of Mucuna pruriens, 15 g of C. yi, 30 g of C. fulva. 1 dose daily, 300 mL of juice in water, divided into 2 warm doses in the morning and evening. 2006- 01-04 Second diagnosis: Decrease in swelling and abdominal distension, but still poor in appetite, dry mouth, bitter mouth, 1 line of stool for 3 days, urine is acceptable. Laboratory examination: urine routine: protein 3+, occult blood 3+, 24h urine volume 1100mL, urine protein quantification 4.15g/L, blood creatinine 97umoL/L, urea nitrogen 7.6mmoL/L, blood albumin 25g/L, total protein 53g/L; red tongue with yellow greasy coating, smooth pulse. The evidence belongs to damp-heat in the liver and gallbladder. Treatment is to dredge the liver and strengthen the spleen, clear the liver and detoxify the toxin. Prescription: Radix Angelicae Sinensis 15g, Fructus Lycii 15g, Radix Polygoni Multiflori 15g, Radix Chrysanthemi 30g, Radix Angelicae Sinensis 30g, Radix Angelicae Sinensis 30g, Rhizoma Atractylodis Macrocephalae 15g, Rhizoma Atractylodis Macrocephalae 15g, Poria 15g, Ganoderma Lucidum 30g, Rhizoma Malva 30g, Rhizoma Yam 30g, Rhizoma Rice 30g; 1 dose daily, decoction 300mL, divided into 2 warm doses in the morning and evening. 2006-01-25 Third diagnosis: no eyelid swelling, mild swelling of both lower limbs, no abdominal distension, nasal can be, but coughing and coughing sputum, sputum yellow and thick, the left lower lung can be heard obvious dry and wet stalls” service hours rely on the sang-froid and wish to sang 1 line per day for 2 days. Laboratory examination: urine routine: protein 3+, occult blood 3+, 24h urine volume 1500mL, urine protein quantification 3.85g/L, blood creatinine 87umoL/L, urea nitrogen 7.1mmoL/L, blood albumin 26g/L, total protein 59g/L; red tongue with yellow greasy coating, smooth pulse. The evidence belongs to congestion of lung heat, and the treatment should be to promote lung heat and clear heat. Prescription: 9g of roasted ephedra, 9g of almonds, 30g of raw gypsum, 9g of roasted licorice, 30g of rice kernel, 30g of winter melon seed. 1 dose per day, decocted in water to extract 300mL of juice, divided into 2 warm doses in the morning and evening. 2006-02-03 Fourth Diagnosis: Decrease in peripheral swelling, cough and sputum, no abdominal distension, nasal discharge, urine volume and stool, 1 line in 2 days; red tongue with white greasy coating, sluggish pulse. Laboratory examination: 24h white quantification 0.76g, blood albumin 29g/L, total protein 61g/L. Evidence of liver-depression and spleen-deficiency, treatment should be to strengthen the spleen, resolve dampness, tonify the kidney and soften the liver. Chen’s formula: Astragalus membranaceus 30 g, Radix Angelicae Sinensis 12 g, Radix Codonopsis Pilosulae 30 g, Salviae Miltiorrhizae 30 g, Radix et Rhizoma Yam 15 g, Rhizoma Polygonati 15 g, Rhizoma Atractylodis Macrocephalae 30 g, Rhizoma Atractylodis Macrocephalae 12 g, Rhizoma Poria 15 g, Rhizoma Polygonati 15 g, Rhizoma Tinctoriae 15 g, Rhizoma Polygonati 15 g, Rhizoma Inulae 30 g, Rhizoma Epimedium 15 g, Rhizoma Polygonati 30 g. 1 dose daily, decoction with water to extract 300 mL of juice, divided into 2 times in the morning and evening. 2006-03-03 Five Diagnosis: No eyelid swelling, mild swelling of both lower extremities, no abdominal distension, nasal discharge, no cough and sputum, nasal discharge, urine volume, normal stool; red tongue with thin and greasy coating, slow pulse. Laboratory examination: urine routine: protein 3+, occult blood 2+, 24-hour urine volume 1600mL, urine protein quantification 1.73g/L, blood creatinine 92umoL/L, urea nitrogen 7.5mmoL/L, blood albumin 31g/L, total protein 65g/L. Continue to give the above medicine, while taking black material bean pill orally. After several times to the above plus or minus taking, urine protein gradually decreased, 6 months after the re-examination of 24h urine protein 0.32g, symptoms relief. According to: the patient’s initial diagnosis, swelling is obvious, damp-heat congestion, to Chen’s kidney disease to reduce swelling formula treatment to divert damp-heat, water to reduce swelling. In the second consultation, the patient’s swelling gradually subsided, and he was given Chicken Bone Cao, Tian Ji Huang, Yin Chen, and Tiger Balm to clear the liver and gallbladder, and to clear Damp-Heat, together with Angelica Sinensis, Lycium barbarum, He Shou Wu, and Dan Shen to nourish the liver and soften the liver. At the third consultation, the patient presented with congestion of lung heat, which is characterized by wood and fire interfering with gold, and Chen’s clinical preference was to use hemp apricot, stone and sweet soup and reed stem soup with addition and subtraction to clear and promote lung heat. After the acute treatment, the recovery period gradually revealed the evidence of liver depression and spleen deficiency, so Mr. Chen used the formula of Hepatitis B Membranous Nephropathy to strengthen the spleen and remove dampness, and tonify the kidney and soften the liver. 2. Lupus nephritis type V Lupus nephritis still has a high incidence of secondary kidney diseases in China. Mr. Chen believes that the internal causes of lupus nephritis are mostly due to congenital endowment deficiency, liver and kidney deficiency, and stasis of the ligaments and veins, while the external causes are mostly related to factors such as feeling evil toxins, overwork, and internal injuries of the seven emotions. Yin deficiency, heat and toxicity, and blood stasis are always present in lupus nephritis. Treatment advocates a combination of Chinese and Western medicine, treating the symptoms in an acute manner and the root cause in a slow manner [4]. During acute exacerbation, Western hormones are used in combination with products to clear heat and detoxify the blood and activate blood stasis, with the addition of raw earth, Zhi Mu and Xuan Shen to prevent pharmacogenic Cushing’s syndrome, with drugs to benefit Qi and strengthen the spleen to alleviate the gastrointestinal discomfort caused by immunosuppressive drugs, and with drugs to nourish the kidney and blood to reduce the suppression of bone marrow and gonads by Western drugs. In the remission period, herbal treatment is based on the effect of Radix Codonopsis, Radix Astragali and Atractylodes to improve immune function, Shengdi, Xuangshen and Maitong to prolong the antibody production period, and Bupleurum to stimulate the reticuloendothelial system and increase leukocyte phagocytosis [5]. Case 2 Zhuang, female, 14 years old, was first diagnosed on 2007-02-03. Chief complaint: swelling of the face and both lower limbs for 3 months. The patient was found to have facial and bilateral lower extremity swelling with no obvious cause 3 months ago, no oliguria, no urinary frequency and pain, no light allergy, oral ulcers and hair loss. Urine routine: protein 3+, occult blood 2+, blood anti-nuclear antibody 1:360, anti-sm antibody 1:240, anti-double-stranded DNA antibody negative, kidney puncture biopsy performed outside the hospital showed: lupus nephritis type V. Methylprednisolone tablets 44mg was given orally for 1 month, but the swelling was not significantly reduced. He was given 44 mg of methylprednisolone tablets orally for 1 month, but there was no significant reduction of swelling. He had swelling of the face and both lower limbs, no dry mouth, no bitterness in the mouth, acceptable stool for 2 days and urine for 2 days. Laboratory tests: urine routine: protein 3+, occult blood 1+, 24h urine volume 1300mL, urine protein quantification 8.58g, blood creatinine 86umoL/L, urea nitrogen 4.5mmoL/L, blood albumin 27.8g/L, total protein 56.4g/L. Western medicine diagnosis: lupus nephritis type V, secondary membranous nephropathy. Traditional Chinese medicine diagnosis: edema. The evidence is that the liver and kidney are insufficient, the spleen is deficient and damp, and the veins and vasculature are stagnant. Treatment is to nourish the liver and kidney, strengthen the spleen, resolve dampness, and activate blood circulation to remove blood stasis. Prescription: Radix Codonopsis Pilosulae 30g, Radix Salviae Miltiorrhiza 30g, Atractylodes Macrocephala 15g, Atractylodes Macrocephala 15g, Rhizoma Atractylodis Macrocephala 12g, Rhizoma Polygonati 12g, Rhizoma Polygonati 12g, Rhizoma Mudanpi 15g, Rhizoma Silkworm 15g, Rhizoma Tortoise 12g, Rhizoma Sarsaparilla 30g, Rhizoma Ghostly 30g, Radix Paeoniae Alba 12g, Rhizoma Yellow Essence 12g, Rhizoma Poria 15g, Rhizoma Polygonati 30g, Rhizoma Rice 30g, Radix Angelicae Sinensis 15g. 2007-05-07 Second Diagnosis: Facial and bilateral lower limb swelling reduced; red tongue, thin yellow coating, fine pulse. Laboratory examination: 24h urine protein quantification 4.64g. on the basis of the above gradually reduce hormone, add blood circulation capsule, Fu Zheng Hua Yu capsule and black material bean powder (the hospital agreement prescription) treatment. 2007-10-27 third diagnosis: 24h urine protein quantification 1.50g, blood albumin 32.1g / L, total protein 63.7g / L; maintain methylprednisolone tablets 8mg every other day, prescription On 2008-01-29, his mother reported that the 24h urine protein quantification was 0.67g, the evidence was the same as before, the prescription was the same as before. 2008-04-06, the fifth consultation: 24h urine protein quantification was 0.21g, reduced methylprednisolone tablets 4mg taken orally every other day, swelling was reduced. The swelling was reduced, no dry mouth, no bitterness, nasal and bowel movements, red tongue, thin coating, thin pulse. The evidence belongs to deficiency of spleen and kidney, treatment is to strengthen the spleen, tonify the kidney, activate the blood and promote dampness. On 2008-06-20, the sixth diagnosis: 24h urine protein quantification 0.11g, continue to take the above plus or minus. Press: The patient in this case had obvious swelling at the initial diagnosis, massive proteinuria, hypoproteinemia, clinically consistent with the diagnostic criteria of nephrotic syndrome, serological indicators suggesting systemic lupus erythematosus, and renal pathological biopsy confirmed lupus nephritis type V. On the basis of western medicine immunosuppression, Mr. Chen used Chinese medicine to nourish Yin and clear heat and dampness, and the swelling was obviously relieved at the follow-up examination, urine protein quantification gradually decreased, and blood albumin gradually increased. Mr. Chen also believes that the cause of SLE is mostly due to heat, which is most likely to injure yin, and that it is important to protect yin when the evil is in full bloom or when the evil is receding and deficient. When kidney damage occurs in lupus nephritis, most of the evidence belongs to kidney yang deficiency, and even if there are yang deficiency symptoms, they are also mixed with cold and heat. 3, heavy metal poisoning secondary to membranous nephropathy With the development of industry and society, environmental pollution is becoming increasingly serious, resulting in an obvious increase in heavy metal poisoning. Heavy metal poisoning can not only cause systemic multi-system symptoms, but also appear nephrotoxic reactions. Heavy metal poisoning can cause irreversible changes in the structure of human proteins, so that the normal function of proteins can be lost. Metal poisoning can cause both acute kidney injury with decreased glomerular filtration rate and tubulointerstitial dysfunction. Clinical manifestations may include nephrotic syndromes, such as gold agents can cause membranous glomerulonephritis, and some manifest chronic interstitial nephritis, such as lithium toxicity [6]. According to Chen, most refractory nephropathies are treated in terms of toxicity, which means that their refractory treatment is mostly related to the internal presence of toxic evil. The poisonous evil can be generated by the presence of evil, and the poison must be accompanied by evil, regardless of its nature, which can be called “poisonous evil”. Poisonous evil can be felt externally as well as from within. Externally felt poison is mostly associated with six kinds of poison and tropical disease, causing rapid onset, fierce, rapid transmission, and easy internal trapping, making the disease critical and difficult to treat, with many changes. The internal toxin is a variety of pathological products produced by the dysfunction of internal organs in the process of disease development and evolution, such as wind, heat, dampness, stasis, etc. The internal and external toxins are intertwined and often make the disease difficult to be cured. Mr. Chen clinically tries to attack the toxin with the toxin, combining internal and external treatment, and clinically achieves gradual remission of the disease. Case 3: He, male, 22 years old, student. 2006-09-25 initial diagnosis. Complaint: recurrent bilateral lower extremity swelling with foamy urine for 4 years. The patient was found to have bilateral lower extremity swelling with no obvious cause 4 years ago, and her urine was found to be positive for urine protein several times, and two renal biopsies in a tertiary hospital in Nanjing in January 2003 and July 2004 showed secondary membranous nephropathy (considering heavy metal poisoning). He was treated with prednisone, raltegravir, cyclosporine and FK506 for 4 years. The tongue is light, with teeth marks on the sides, thin white tongue coating and thin pulse. Physical examination: Bp: 130/80 mmHg, clear, mental, no abnormalities in heart, lungs and abdomen, mild swelling of both lower limbs. Laboratory examination: urine routine: protein 3+, occult blood 2+, renal function: blood creatinine 153umol/L, urea nitrogen 13.3mmol/L, uric acid 369umol/L, plasma albumin 31.3g/L, 24h urine volume 1850ml, urine protein quantification 6.11g. Western medicine diagnosis: chronic glomerulonephritis, Chinese medicine diagnosis: edema, evidence of spleen and kidney deficiency, water-dampness Internal aggregation. Treatment is to tonify the spleen, benefit the kidney, and clear water-dampness. Prescription: Rhizoma Atractylodis Macrocephala 30g, Rhizoma Atractylodis Macrocephala 30g, Rhizoma Atractylodis 15g, Rhizoma Atractylodis 15g, Rhizoma Poria 30g, Rhizoma Rice 30g, Rhizoma Yam 30g, Rhizoma Polygonatum 30g, Radix Astragali 30g, Radix Angelicae Sinensis 15g, Radix Codonopsis Pilosulae 30g, Radix Salviae Miltiorrhizae 30g, Rhizoma Danshen 30g, Rhizoma Polygonatum 30g, Rhizoma Dogbane 30g, Rhizoma Polygonatum 20g, Rhizoma Epimedium 15g, Radix Bacopa Monnieri 15g. 300mL, divided into 2 times in the morning and evening to take warm. On 2006-12-26, the second consultation, the patient’s swelling decreased, weakness decreased, 24h urine protein quantification 2.43g, blood creatinine 131umoL/L, plasma albumin 37.6g/L. The patient was given the above plus 15g of Phellodendron Bark, 15g of Dandelion, 12g of Sclerotinia sinensis, 12g of Dilong, 30g of Fu Ling, 15g of Bupleurum. 2007-10-16 Third diagnosis: 24-hour urine protein quantification 1.8g, blood creatinine 97.5umoL/L, plasma albumin 41.6g/L. Give the above minus Dilong, Tu Fu Ling, Panax notoginseng, Phellodendron, plus 15g of Pueraria Mirifica, 15g of henbane, lotus seeds The patient was given the above minus Dilong, Tu Fu Ling, Dang Shan A, Huang Bai plus Ge Gen 15g, Chicken Blood Vine 15g, Lotus Seed 20g, Yam 30g. 1 dose per day, decoction of water to get juice 300mL, divided into morning and evening 2 times warm. 2008-01-21 four diagnosis: urine routine: protein 1+, occult blood 1+, 24h urine protein quantification 0.6g, blood creatinine 106.5umoL/L, plasma albumin 45.7g/L. Continue to take the above. Press: the patient is a young male, the consultation was found to be increased blood creatinine with proteinuria, and asked the medical history, the patient had worked in a battery factory for more than 1 year, there is a history of exposure to metal lead, outside the hospital renal biopsy suggests secondary membranous nephropathy. At the first consultation, Dr. Chen used the usual tonic spleen and kidney plus heat and dampness products to cast a stone to ask for a solution. At the second consultation, there were signs of improvement, and Dr. Chen believed that his long-standing illness had both heavy metal poisoning and poisonous evil was the key to prevent his disease from healing, so he used Phellodendron and dandelion to remove heat and toxicity, stiff silkworm and dilong to remove wind and toxicity, Tu Fu Ling and Bupleurum to remove dampness and detoxify, and Centella asiatica, Imperata, and ghost arrow feather to remove stasis and detoxify. The third diagnosis of urine protein quantification decreased significantly, blood albumin rose, the disease was stopped, reduce the detoxification of the product plus Ge Gen, chicken blood vine, lotus seed flesh, yam and other drugs to invigorate the blood and strengthen the spleen to close the work, so that the condition completely relieved. This case is an exemplary example of Dr. Chen’s bold attempt to “detoxify and attack poison” in the treatment of difficult and serious diseases. 4.Membranous nephropathy secondary to leukemia bone marrow transplantation Acute leukemia is a malignant clonal disease of hematopoietic stem cells, in which abnormal primitive and infantile cells in the bone marrow proliferate and inhibit normal hematopoiesis, extensively infiltrating the liver, spleen and lymph nodes. The disease is characterized by anemia, hemorrhage, infection and infiltration. Allogeneic bone marrow transplantation is a clinically effective treatment for acute leukemia. With the development of bone marrow transplantation, chronic graft-versus-host disease (cGVHD) occurs in approximately 50% of HLA (human leukocyte antigen) compatible allogeneic bone marrow transplant patients. cGVHD often occurs after 100 d of bone marrow transplantation and presents as a systemic disease with multi-organ involvement, similar to auto immune disease, often involving the skin, mouth, eyes, liver, and upper respiratory tract. Renal damage caused by cGVHD was first reported by Hiesse in 1988 [7], and so far only 16 cases have been reported abroad and only 2 cases have been reported in China, with pathological damage being more common in membranous nephropathy [8, 9]. Chen has always followed the principle of flexible addition and subtraction and treatment with evidence in the treatment of membranous nephropathy secondary to leukemia bone marrow transplantation, and often paid attention to the treatment of its controllable factors in the process of identification and treatment, that is, on the basis of the treatment of membranous nephropathy secondary to leukemia bone marrow transplantation, he was good at discovering its related factors that might lead to the recurrence or aggravation of the disease, and often obtained unexpected results. Case 4 Ye, female, 24 years old. 2006-11-16 Initial diagnosis. Complaint: abnormal urinalysis for 2 years and swelling of both lower limbs for 3 months. The patient underwent allogeneic hematopoietic stem cell transplantation in Shanghai Long March Hospital on 2004-03 for acute lymphoblastic leukemia. Proteinuria was found after leukemia remission, and atypical membranous nephropathy was diagnosed by renal puncture (considered to be related to leukemia bone marrow transplantation), and treatment with methylprednisolone, tacrolimus, and Pulcoflor was given. The patient’s urine protein fluctuated at 2.16g, and the immunosuppressant was gradually discontinued and the hormone was reduced to maintenance dose. The patient had a slightly red tongue with a thin, white, greasy coating and a smooth pulse. Urine routine: protein 3+, occult blood 1+, 24h urine protein quantification l.98g, blood albumin 49g/L. Western medicine diagnosis: chronic graft-versus-host disease, chronic glomerulonephritis, Chinese medicine diagnosis: edema. Dr. Chen analyzed the symptoms as weakness of spleen qi and internal dampness-heat, which should be treated by strengthening the spleen, relieving dampness, benefiting qi and activating blood. On 2007-01-31, he was given 30g of Atractylodes alba, 15g of Atractylodes macrocephala, 15g of Atractylodes alba, 30g of Poria, 30g of Poria, 30g of Rice kernel, 30g of Astragalus, 15g of Radix Angelicae Sinensis, 30g of Radix Codonopsis, 30g of Salviae Miltiorrhizae, 15g of Dendrobium, and 10mg of prednisone, taken orally once a day. 2007-01-31, second consultation: 24h urine protein quantification is still 2.68g. The patient has a history of chronic pharyngitis, often recurring, and recently recurrence of upper sensation with pharyngeal pain is obvious, consider the increase in urine protein to pharyngitis related. The evidence is wind-heat, the treatment should be accompanied by clearing heat and promoting lung. The recipe was given to 12g of turtle plate, 12g of raw earth, 12g of chasteberry, 20g of dried lotus grass, 10g of raw cattail, 15g of atractylodes, 15g of atractylodes, 30g of poria, 30g of poria, 30g of rice kernel, 30g of rice root, 30g of yam, 30g of Radix Codonopsis, 30g of Salvia, 12g of hanging gold lamp, 12g of Xiqing fruit, 12g of Xuan Shen. 1 dose per day, decocted in water to obtain 300mL of juice, divided into 2 times in the morning and evening. Take warm. 2007-04-19 Third diagnosis: 24h urine protein quantification is still 0.73g, pharyngitis improved, prednisone reduced to 5mg and taken orally once every other day. 2007-06-21 fourth consultation: 24h urine protein quantification 0.33g, the patient had fever and sore throat again, urine protein did not increase, the above plus wild chrysanthemum, west green fruit, xuan ginseng. 2008-02-14 fifth consultation: 24h urine protein quantification was checked twice for 0.35g and 0.45g respectively. the patient has been taking the above in the second half of the year, and felt good symptoms. The patient has been taking the above medication for the second half of the year and feels good about his symptoms. At present, he stopped taking prednisone orally, and gave the cream formula with reduction to regulate the application. Press: this case in the renal puncture biopsy after consideration of leukemia bone marrow transplantation secondary to membranous nephropathy, in the course of treatment had applied a variety of immunosuppressive therapy without significant effect. Mr. Chen later asked him about the patient’s history of pharyngitis for many years, so he added drugs to clear heat and detoxify the pharynx based on strengthening the spleen and dampness, benefiting qi and activating blood, and the condition gradually stabilized after the pharyngitis was relieved. According to Chen, various clinical manifestations can appear at different stages in the development of chronic kidney disease, and timely capture of information closely related to disease development is the key to treating the disease. Master Chen often adopts different treatment methods according to different conditions and stages. In this case, the patient showed a deficiency of positive energy on the one hand and residual evil on the other. Mr. Chen used the formula to strengthen the spleen and dampness, benefit the qi and invigorate the blood to strengthen the positive qi, and at the same time to clear the heat, detoxify the throat and clear the residual evil, which is both complementary and clear, and not astringent, and there is diarrhea in the complementary, and diarrhea does not hurt the positive. In the later stage, for those who are relatively stable, as long as the clinical evidence is based on the deficiency of positive Qi, and the evil Qi is gradually diminishing, they are often given cream formula, with both attack and supplementation, and the effect is quite good, while the disease reaches the end stage of kidney and renal failure, although the positive Qi is deficient and the evil poison is strong inside, it is not appropriate to take cream formula, so as not to help the evil stay in the kung fu.