Chronic renal failure (abbreviated as chronic renal failure, CRF) is a chronic progressive renal parenchymal damage caused by a variety of reasons, so that the kidneys can not maintain their basic functions, resulting in the retention of metabolites in the body, water-electrolyte and acid-base balance imbalance, endocrine disorders, is the end stage of chronic kidney disease, the condition is complex, variable and critical. It belongs to the category of “edema”, “deficiency labor” and “guangs” in Chinese medicine. Jin Yan, Jinan Traditional Chinese Medicine Hospital Nephrology Specialist
(A) Non-dialysis phase: GFR>10 ml/min or Scr<707umol/L.
1. Identification and treatment
(1) Weakness of spleen and kidney, water and stagnation of each other
Symptoms: edema below the waist, cold in the extremities, fullness in the chest and abdomen, soreness and weakness in the waist and knees, loose stools, short urine, pale tongue, greasy coating, sunken or thin pulse. In severe cases, the face is dark, the lips are purple, the waist is painful, the woman’s menstruation is delayed or closed, the tongue is purple with petechiae, and the pulse is sunken and astringent.
Treatment: Strengthening the spleen, tonifying the kidney, warming the yang, promoting water circulation and dispersing blood stasis.
Treatment: Strengthening the spleen, tonifying the kidney, warming the yang, inducing diuresis, clearing stasis. The herbs include Radix et Rhizoma Pseudostellariae, Radix ginger, Fructus hirsutipes, Fructus mucuna pruriens, Poria cocos, Atractylodes macrocephala, Rhizoma lingzhi, Radix et Rhizoma zedoariae, Salviae Miltiorrhizae, Rhizoma Yujin, Rhizoma Chuanxiong, Radix Achyranthes bidentatae, Radix Angelicae Sinensis and Rhizoma peach kernel.
If the symptoms are cold and weakness, clear and long urine, add Gui Zhi and Huang Qi.
(2) Spleen and kidney deficiency of both qi and yin
Symptoms: lumbar soreness and weakness, dry mouth and lips, or heat in the heart of the hands and feet, dry stools, yellow urine, long clear urine at night, pale tongue with teeth marks, sunken and thin pulse.
Treatment: Nourishing Yin, benefiting Qi, tonifying the kidney, clearing the blood and draining turbidity.
Formula: Ginseng, Astragalus, Dihuang Tang, combined with Tai Teng Yuan Decoction, plus or minus. The medicine uses prince’s ginseng, astragalus, rehmannia, poria, yam, dampi, dogwood, wolfberry, angelica, safflower, salvia.
For those with chronic pharyngitis and deficiency of lung yin, add Radix et Rhizoma Ginseng, Madonnas, Radix Platycodon, Radix et Rhizoma Glycyrrhizae.
(3) Spleen and kidney Qi-Yang deficiency
Symptoms: weakness, shortness of breath, lazy speech, dullness, abdominal distension, lumbar soreness and knee weakness, loose stools, clear and long urine, or even cold in the extremities, pale or obscure complexion, pale mouth without thirst. The tongue is pale and fat, with teeth marks, white or white greasy coating, and a sunken weak or sunken string pulse.
Treatment: Tonifying the kidney, strengthening the spleen and warming the kidney.
Remedy: Xiang Sha Liu Jun Zi Tang and Xiang Sha Wu Ren Qi Wan plus or minus. The medicine uses Radix et Rhizoma Ginseng, Radix Astragali, Atractylodes Macrocephalae, Poria, Muxiang, Sharen, Coix Coix Seed, Yam, Radix et Rhizoma Sequoiae, Sang Sang Sang, Eucommia, Bacopa Monnieri, Xian Ling Spleen.
In case of Yang deficiency and obvious edema, add Radix et Rhizoma, Cinnamon, Pepper, Plantago; in case of spleen deficiency and dampness, add Fried Atractylodes, Cardamom, Patchouli; in case of spleen deficiency and diarrhea, add Fried Lentil, Boneset, Ginger.
(4) Damp-heat obstruction, turbid evil offending the stomach
Symptoms: nausea and vomiting, abdominal distension, bitterness and dryness of the mouth, insomnia, or phlegm, constipation, red tongue, yellowish greasy moss, smooth or stringy pulse.
Treatment: Clearing heat, resolving dampness, harmonizing the stomach and stopping vomiting.
Remedy: Huanglian Wenzhi Tang with flavour. Huanglian, ginger, Chen Pi, Poria, Sharen, licorice, Citrus aurantium, bamboo, ginger.
If the stool is closed, add raw rhubarb; if dampness and heat are causing phlegm to obscure the pericardium, add calamus and yujin to open the orifice.
(5) Weakness of the spleen and Yang, internalization of turbid evil
Symptoms: withered complexion, fatigue, nausea and vomiting, abdominal distension, constipation, mucous and tasteless mouth, pale fat tongue, thick and greasy moss, sunken and weak pulse.
Treatment: Warming the spleen and tonifying the spleen-yang, attacking the turbid evil.
Remedy: Warming the spleen with addition of flavor. Raw rhubarb, Radix et Rhizoma, Hou Pu, Citrus aurantium, Radix ginger, Radix Codonopsis, Glycyrrhiza glabra.
In case of nausea and vomiting, add ginger and half-xia, ginger and bamboo rhizome; in case of abdominal distension and belching, add large abdominal bark and mucuna pruriens.
2. The use of effective single herbs
(1) Cordyceps sinensis, 3-5g, powdered and packed in capsules or taken separately by steaming under water, can be taken for a long time.
(2) Rhubarb, according to the patient’s age, constitution and tolerance, use raw rhubarb and prepared rhubarb respectively. Generally 3-6g, stool should be kept at 2-3 times/day, paste-like stool is the degree, diarrhea is not used.
(3) Astragalus injection, 20ml～60ml each time, diluted with 5% glucose injection 250～500ml, once a day.
3. External treatment method
The above types of constipation, often with Chinese medicine retention enema method, usually selected drugs are: raw rhubarb 15g, calcined oyster 60g, gong ying 30g, acacia rice 30. strong decoction to 200ml, retention enema, generally 1 time / day. Indicated for early or middle stage chronic renal failure, where the evil is obvious but the positive deficiency is mild.
In the treatment of chronic renal failure in Chinese medicine, two points should be noted: First, attention should be paid to distinguish the original deficiency from the standard reality, and in stable cases, both the symptoms and the root cause should be treated, while in cases of acute symptoms, the symptoms should be treated urgently; second, attention should be paid to the number of stools to 1-2 soft stools per day, so as not to model the precautions of deficiency.
(B) dialysis phase (uremic phase), GFR <10ml/min or Scr>707uml/L. At this time, hemodialysis, peritoneal dialysis, kidney transplantation as the main treatment, with Chinese medicine treatment can regulate yin and yang, benefit qi and blood, improve dialysis complications, improve immune function, Chinese medicine treatment to supplement the spleen and kidney, drugs such as: red ginseng, astragalus, lady’s mantle, wolfberry, Epimedium, Cuscuta sinensis, Angelica sinensis, etc.