Nephritis is inflammation of the kidneys and may involve the glomeruli, tubules, or interstitial tissue surrounding the glomeruli and tubules. Most seen symptoms are edema, proteinuria, hematuria.
In TCM the main symptom is edema and in a further stage it can lead to kidney failure with difficult of urination causing edema-(隆闭-long bi), dysuria with vomiting -(关格-guan ge),toxic urination -(溺毒-nidu).
Mechanism:
Kidneys control water, restores jing-yin and have the ming men all these factors when are out of balance can lead to edema.
Kd yin xu (imbalance of kidney)
Kd qi xu (water isn`t moving)
Kd Yang xu (no fire/ming men to transform water) àall three pathologies can cause edema.
Kd xu will cause lu qi xu sp qi-yang xu, therefore we can see combinations of Lu-kd, Kd-Sp, or only kd involvement. (qi) (qi+yang) (yin+qi+yang)
Ht involvement is only in later stages and isn’t so important.
The disease appearance is: root – deficient, manifestation- excess.
标 – manifestation:
kd who control water when imbalance can cause dysfunction of BL, symptoms are:
Edema (water retention) in stomach, eyebrow, legs etc..
Edema for long time will change into damp heat
Upper jiao: cough, phlegm, short breath.
Middle jiao: vomiting, nausea, food stag, diarrhea, constipation etc….
Lower jiao: urination problems – pain little amount etc..
Qi xu will cause blood stagnation.
In addition we can sometimes see external pathogen ( cold, wind cold or heat) as a trigger to the disease.
Treatment in edema – open pores (sweating), drain urine, move blood stag and harmonize urine.
Differentiation:
Lu-kd qi xu:
Yellow swollen face, weakness, lumbar pain, Tongue pale, white coating, Pulse fine, deep.
Lu qi isn’t controlling 3 jiao , Bl . tonify qi control exterior, move water & blood
Yu ping feng san + fang ji huang qi tang
Modifications:
Move blood – chuan xiong, yi mu cao, ze lang
Urinating – fu ling, ze xie, gui zhi
sp-kd yang xu:
Yellow face, little sweat, cold limbs, T- swollen tooth marks, P- deep weak.
Warm yang tonify sp, move blood, expel damp.
Jin gui shen qi wan. Zhen wu tang (fu zi till 10g and not long terms)
We need to focus on tonifying yin in order to nourish yang: shan yu rou, sheng di, sang ji sheng.
Move blood to prevent stasis and more acomulation of water: yi mu cao chuan xiong, hong hua, chuan niu xi, dang gui, ze lang, e zhu, di long tu bie chong……
liv –kd yin xu:
Yin signs and deficient heat signs.
Tonify yin reduce liv yang
Qi ju di huang tang.
Deficient heat: huang qin, niu zhen zi… if it doesn’t help add rou gui to point the herbs into Kd.
Toxic: wu wei xiao du yin
Indigestion : mi ren, huang lian, hou po
Damp heat: da huang, zhi ke, shen qu
Urination problems: bai mao gen15, tu fu ling20, che qian cao10-15, bian xu10-20,
blood stagnation:
Gui zhi fu ling wan.
A large amount of huang qi 30-40 can move blood.
In addition single herbs can treat the manifestation of proteinuria:
Huang qi (big amount will move blood small amount will tonify. Tongue can’t be sticky yellow!), fu ling, dan shen, yi mu cao, dang gui, sheng di, shan yao, gou qi zi, dang shen12 (not if there is SLE), ze xie12 , bai zhu20 (only if proteinuria is little), che qian zi10, hong hua, tao ren, sheng gan cao.
Tonify kd herbs : sang ji sheng, xu duan, du zhong, ba ji tain, bu gu zhi
Moving blood: yi mu cao 30, dan shen 30 , chuan xion 20-30.. all are in big amount….
Astringent: jing yin zi 20-30, qian shi 10-15
Expel wind: jing jie, ma huang5-6, lian qiao15, huang qin12, gan cao10-15(if patient takes steroids give small amount)
Edema:
In condition of wind cold – ma xing shi gan tang,
In condition of wind heat – yue pi jia zhu tang.,
In condition of wind damp – huo xiang zheng qi tang..
血尿 – xue niao- hematuria
The reasons are:
1. Heat from excess(damp heat in Bl, external pathogen) or deficient (kd xu)
2. Qi xu which can’t control blood in the vessels.
The differentiation should be focused on whether the problem is due to external pathogen
(Bl-Si-Ht causing bleeding) or internal disease – (kd+sp xu).
external pathogen entering Lu-
hematuria, aversion to cold, throat pain, Pulse – floating fast.
Strategy: Expel wind heat
Formula: Yue pi jia zhu tang.
for heat in the throat add: ku ding cha, lian qiao, yin hua.
Stop bleeding with: bai mao gen, xiao/da ji, qian cao, zi cao30!, ou jie, ce bai ye.
heat in the Bl –
lin syndrome, Tounge – red yellow coating, Pulse – fast.
Strategy: Expel heat, transform damp, open water passages.
Formula: Ba zheng tang.
expel toxic : hua shi, z.hua di ding, ban bian lian , tu fu ling .
clear heat: zhi mu, huang bai.
expel stones: hai jin cao, ji nei jing, jin qian cao.
yin xu + damp heat –
hematuria, yin xu signs, Tounge – red Pulse – fine , zhi bai di huang wan
sp not controlling blood-
chronic disease hematuria, short breath, Tounge – pale .
Formula: Gui pi tang + Bu zhong yi qi tang.
add tonifying yin stoping bleeding herbs: xian he cao, nu zhen zi
kd qi xu –
chronic difficult stage, light red urine, back pain, small sweating, P- deep fine.
Formula: Wu bi san yao wan
Omit fu zi add bai ji tian, gou ji which aren’t so warm.
nucturia add astringents : jin ying zi, sang piao xiao.
For acute nephritis stage, zhu ye shi gao tang or yin qiao san.
In chronic stage move blood with zhi da huang5-6 .
In conclusion nephritis can be due to water, damp and blood stagnation. The two later are mostly seen in chronic stage.
Diet:
Avoid proteins (carrot, oily food and salt. In order not to rise blood pressure which will damage kd function).
