▲Zhang Daning, Master of Traditional Chinese Medicine (1944-)
Zhang Daning, Master of Traditional Chinese Medicine, Honorary President, Chief Physician, Professor and Doctoral Supervisor of Tianjin Academy of Traditional Chinese Medicine. He put forward the theory of "heart-kidney axis system" and "kidney deficiency and blood stasis syndrome and kidney tonifying and blood activation", which have been widely used in a variety of diseases except kidney disease.
Chronic nephritis is glomerular lesions caused by a variety of reasons, with slow onset and prolonged disease, with edema, hypertension, proteinuria, hematuria and casts in the clinic, and severe renal dysfunction, anemia, electrolyte disorders, etc., and various types of renal pathology. Zhang Daning, a master of traditional Chinese medicine, has rich experience in the treatment of chronic nephritis, and summarizes Zhang Daning's experience in the treatment of chronic nephritis for the benefit of colleagues.
Etiology and pathogenesis
Zhang Daning believes that "kidney deficiency and blood stasis" is the pathological basis of a specific stage of various chronic diseases, and kidney deficiency and blood stasis is the fundamental pathogenesis of chronic nephritis. Since ancient times, there have been theories of "long-term illness and kidney", "long-term illness into the network" and "long-term illness and multiple stasis", chronic nephritis does not heal, and if it is not treated and mistreated, there will be a deficiency of kidney qi, loss of yin essence or damage of yin and yang, and the pathology of "and kidney", while qi deficiency and blood stasis, yin deficiency and blood stagnation, and yang deficiency and blood coagulation can all lead to "entering the network" and "multiple stasis", thus forming the pathological characteristics of the coexistence of kidney deficiency and blood stasis.
Damp heat is an important pathological feature of chronic nephritis. Causes such as external sensations, eating disorders, fatigue, internal injuries, and poor mood can lead to lung deprivation, spleen deprivation and kidney degasification, resulting in imbalance of water and fluid metabolism and endogenous dampness. Dampness can be turned into dampness and heat over time, and the body can be heated, and improper use of aphrodisiac herbs and glucocorticoids can help dampness and heat.
"Where evil is gathered, its spirit will be empty." Renal deficiency is the basis for the pathogenesis of chronic nephritis; "At the beginning, the qi knot is in the meridians, and after a long time, the blood will be injured in the meridians" ("Clinical Guide Medical Case"), blood stasis and obstruction in the kidney is the result of the deepening of the disease; Wet heavy turbidity sticky, damp heat and evil in the yin are easy to consume yin and blood, so that the disease lingers. Therefore, Zhang Daning concluded that the pathogenesis of chronic nephritis is kidney deficiency, blood stasis, dampness and heat.
Treatment features:
➤ Nourish the kidneys and invigorate the blood, clear away heat and dampness
The method of tonifying the kidney and invigorating blood is the fundamental method for the treatment of chronic nephritis. The method of tonifying the kidney and invigorating the blood is an organic combination of the kidney tonic method and the invigorating blood method, promoting the invigorating blood through the kidney, and strengthening the kidney by using the invigorating blood, and the two synergize with each other to improve the pathological changes of kidney deficiency and blood stasis, so that the body's yin and yang are balanced, and the evil is preserved by the good. Among them, the kidney tonic method is commonly used in the nourishing method, the warm tonic method, the yin and yang combined tonic method, the solid astringency method, the waist strengthening method, etc.; The blood activation method is commonly used to replenish qi and activate blood, practice qi and activate blood, warm meridian and activate blood, warm yang and activate blood, nourish yin and activate blood, dispel wind and activate blood, detoxify and activate blood, conquer and activate blood, infiltrate dampness and activate blood, cool blood and activate blood, break stasis and activate blood, and stop bleeding. By summarizing Zhang Daning's commonly used drug pairs in the treatment of chronic nephritis, it can be seen that he can flexibly use the method of tonifying the kidney and activating blood.
Astragalus, Cordyceps sinensis and Chuanxiong: the three are homogeneous and warm, and Astragalus membranaceus replenishes the qi of Sanjiao; Cordyceps sinensis is good for the kidneys and lungs, nourishes essence and qi, stops bleeding and dissolves phlegm; Chuanxiong is a medicine for blood qi, "although it enters the blood, it can dispel all wind and regulate all qi" ("Huiyan of Materia Medica"). When the blood is warm, it is OK, and the purpose of using warm qi and blood activating drugs is to warm the kidneys, invigorate the blood, and activate the blood. A large dose of Astragalus membranaceus and Chuanxiong are combined to imitate Yang and return five decoctions to invigorate qi and blood, and Astragalus membranaceus and Cordyceps sinensis not only tonify the kidney, but also have the function of protecting the lungs and preventing external sensations. The three drugs are used together to treat backache and fatigue, easy cold, edema, urine protein, hematuria, etc. caused by kidney qi deficiency and blood stasis syndrome.
Psoralen with triangular and curcuma: psoralen can warm water and organs, tonify the kidneys and strengthen yang, and solidify essence and shrink urine. "The power of blood transformation is better than that of curcuma, and the power of regulating qi is better than that of three edges" ("Medical Hearts and Western Records"). The combination of the three medicines is especially suitable for those who are tired and backache, edema, cold extremities, diarrhea, purple and dark tongue caused by kidney yang deficiency and kidney blood stasis.
Panax notoginseng and crane grass and madder: Panax notoginseng and madder grass stop bleeding and stasis, and crane grass converges and stops bleeding, all three of which can not only treat various bleeding syndromes, but also have the effect of tonifying deficiency and strengthening. For example, Panax notoginseng treats weakness and strain, Xianhe grass treats fatigue injury, and madder has the effect of "supplementing" ("Shennong's Materia Medica"). The combination of the three drugs can treat the recurrent blood pattern in urine caused by kidney deficiency and blood stasis, so as to correct and eliminate blood stasis, promote blood circulation and stop bleeding.
Cinnamon branches, leeches and five-skin drinks: Cinnamon branches are wind medicines, which can relieve the causes of blood circulation disorders by dispelling wind and dissipating cold, and can also warm the meridians and help yang qi, so that yang qi can be accessed and blood flow; Leech is an insect medicine, which is good at walking, opening blood stasis, removing stubborn diseases, breaking blood through menstruation, and eliminating stasis; In the five-skin drink, tangerine peel, mulberry white peel, ginger peel, pot-bellied peel, and Poria cocos peel are vaporized and damp and water. "Blood stasis and water, edema, is a blood disease and water" ("Blood Evidence Theory"), "Sun Luo water overflow, then there is blood" ("Su Wen · Regulating the Scriptures"), blood stasis and edema are cause and effect of each other, cinnamon branches, leeches and five skin drink can play together to dispel wind and activate blood, warm meridian and activate blood, infiltrate dampness and activate blood, search and activate blood, invigorate blood to benefit water, water to invigorate blood, especially for chronic nephritis with high edema, low urine with hyperviscosity, hyperlipidemia.
Zhang Daning commonly used dandelion, soybean grass, white flower snake tongue grass, half-branch lotus, Poria cocos and other heat-clearing and dampness-relieving drugs in the treatment of chronic nephritis, and throughout the treatment, they are all detoxification and sore-relieving products, clearing heat and dampness. Dandelion is bitter and sweet in nature, bitter in its nature, sweet in its taste, can be used as a wild vegetable, although it is slow to diarrhea, but it is not easy to hurt the stomach, "Compendium of Materia Medica" said that "black beard, strong muscles and bones", "Medical Forest Compendium" contains: "tonify the spleen and stomach, diarrhea fire, pass milk, cure choking diaphragm." "The defeat of the sauce grass is good at falling, the effect is up to three cokes, and it can also invigorate blood and dispel blood stasis. The white flower snake tongue herb "clears heat and detoxifies, invigorates blood and diuretics" ("Guangxi Chinese Herbal Medicine"). "Jiangsu Plant Medicine Chronicle" first contains half a branch lotus, which has a pungent taste and flat nature, and has the effects of clearing heat, detoxifying, dispersing stasis, stopping bleeding and fixing pain.
Zhang Daning believes that Poria cocos can specifically reduce urine protein, "Compendium of Materia Medica" said that it "strengthens the spleen and stomach, strengthens muscles and bones, dispels rheumatism, improves joints, stops diarrhea, treats spasm and bone pain, sores and carbuncles, mercury powder, silver vermilion poison", and "Materia Medica" contains "Poria cocos, dampness and heat, can enter the network, and search for the poison of dampness and heat". Huang Kui Capsule is a Chinese patent medicine often used by Zhang Daning for the treatment of chronic nephritis damp heat syndrome, its main ingredient is Huang Hollyhock flower, "sweet, cold, slippery, non-toxic" ("Compendium of Materia Medica"), returning to the heart, kidney, bladder meridian, diuretic and drenching, blood circulation and hemostasis, swelling and detoxification. Heat-clearing and dampness drugs can reduce blood viscosity, reduce glomerular capillary permeability, and improve renal microcirculation and glomerular stromal cell matrix proliferation.
➤ Pay attention to the care of the central focus, and improve the qi
Zhang Daning believes that although patients with chronic nephritis have kidney deficiency and blood stasis syndrome, they often have the same spleen and kidney. Astragalus membranaceus with atractylodes, poria cocos, yam, gamp seeds, etc. is used to strengthen the spleen and invigorate qi, replenish the acquired to help the innate nature, and seek vigorous qi and blood to nourish the kidney essence; Use a large dose of raw astragalus with a small amount of cimicifuga to strengthen the spleen, invigorate the spleen, invigorate qi and uplift, treat the subtle depression caused by spleen deficiency and qi trapping, and is effective for urine protein and urine occult blood. Due to the common use of medicinal cold Qingli damp and hot products, for those with spleen and stomach deficiency, Zhang Daning warms the stomach with sand kernels to protect stomach qi.
➤ Protects kidney function and anti-renal fibrosis
If patients with chronic nephritis are not treated and mistreated, they often lead to abnormal kidney function, Zhang Daning is very vigilant about abnormal kidney function in patients with nephritis, and adds turbidity and detoxification agents to reduce the burden on the kidneys and improve kidney function, and the general kidney function can be quickly recovered. Renal fibrosis is the ultimate outcome of all kidney diseases, and modern studies have shown that in addition to the blood-invigorating drugs such as Salvia, Chuanxiong, Panax notoginseng, Curcuma, Rhubarb, etc., which are commonly used by Zhang Daning, have the effect of preventing and treating renal fibrosis, the compound of Schisandra chinensis as the main drug can also intervene in glomerulosclerosis and prevent and treat renal fibrosis, so Zhang Daning must use Schisandra chinensis for the treatment of chronic nephritis, and the daily amount of decoction is 20g.
➤ Create a series of prescription drugs for chronic nephritis
Zhang Daning has developed a series of Chinese patent medicines for the treatment of chronic nephritis, which are combined with traditional Chinese medicine decoction for syndrome differentiation and treatment. For example, the kidney tonifying and strengthening capsule (composed of cordyceps, astragalus, coptis, dogwood, etc.) tonifies the kidney and spleen, supports healthy qi, and is designed for chronic nephritis, shortness of breath, fatigue, backache and edema; Blood-invigorating and stasis removal capsules (composed of Tianxian seed, pangolin, triangular root, red peony, etc.), invigorating blood circulation and removing blood stasis, softening and dispersing knots, and improving kidney blood supply; Kidney Kangning Capsule (composed of Cordyceps sinensis, Astragalus membranaceus, Poria cocos, Salvia, Dandelion, etc.) tonifies the kidney and invigorates blood, invigorates qi and solidifies essence, and is used for chronic nephritis to see soreness in the waist and knees, swelling of the face and limbs, fatigue around the body, oliguria and turbidity, proteinuria, hematuria, etc.; Kidney tonifying and hemostatic capsules (composed of astragalus, cordyceps, rehmannia charcoal, crane grass, etc.) to tonify the kidney, strengthen the kidney, cool the blood and dispel blood stasis, stop bleeding, treat chronic nephritis is kidney deficiency and blood stasis or yin deficiency and blood fever, the symptoms are light or bright red urine blood, accompanied by soreness in the waist and knees, upset and sleeplessness, fatigue, dizziness and tinnitus, etc.; Kidney failure detoxification capsule (composed of cordyceps, rhubarb, rhubarb charcoal, dandelion, artemisia, etc.) tonifies the kidney, promotes blood circulation and dispels stasis, detoxifies and reduces turbidity, and is used for chronic nephritis, chronic renal failure, etc.; Liver-protecting tablets (composed of Schisandra chinensis, Bupleurum chinensis, Angelica sinensis, Salvia miltiorrhizae, etc.) help correct and soothe the liver, clear away heat and dampness, and prevent and treat patients with chronic nephritis who have abnormal liver function due to the use of tripterygium wilfordii polyglycoside tablets or glucocorticoids.
➤ Rational use of immunosuppressants
Zhang Daning's clinical treatment of chronic nephritis is considered and the pros and cons are weighed. In patients with chronic nephritis with massive proteinuria, if the pathology of renal puncture suggests minimal lesions, regular treatment with adequate glucocorticoids can be considered, because the efficacy of this treatment regimen has been recognized; If there is no renal pathology report to support, half a dose of hormones can be taken orally, and Tripterygium wilfordii polyglycoside tablets (20mg, 3 times a day) and hepatoprotective tablets (4 tablets, 3 times a day) can stimulate the hypothalamic-pituitary-adrenal axis, which has the function of enhancing the adrenergic cortex, and the pharmacological effects of glucocorticoids are complementary. For patients with moderate proteinuria, Zhang Daning Linzheng mostly takes Tripterygium wilfordii polyglycoside tablets (10~20mg, 3 times a day) and hepatoprotective tablets (4 tablets, 3 times a day), and Huangkui capsules (5 capsules, 3 times a day). For patients with chronic nephritis with proteinuria and hematuria, Tripterygium wilfordii polyglycoside tablets (20mg, 3 times a day), Huangkui capsules (5 capsules, 3 times a day) and hepatoprotective tablets (4 tablets, 3 times a day) are given to chronic nephritis, at this time, the efficacy of hormones is uncertain, and Tripterygium wilfordii polyglycoside tablets can control the disease through immunomodulation, anti-inflammatory, and protection of kidney podocytes, and Huangkui capsules can remove the damp heat factors in chronic nephritis. For patients with chronic nephritis mainly blood in the urine, no hormones and Tripterygium wilfordii polyglycoside tablets are used, and the treatment is mainly based on syndrome differentiation of traditional Chinese medicine, which can be combined with Huangkui capsules (5 capsules, 3 times a day).
➤ Actively eliminate triggers
Infections, colds, fatigue, unstable blood pressure, and high blood sugar may all be triggers for chronic nephritis. Zhang Daning proposed to avoid 7 kinds of infections: pharyngitis, gingivitis, sinusitis, otitis media, bronchitis, skin infection, and urinary tract infection, all of which are manifestations of dampness and heat; Four "effective" controls are proposed: effective control of blood pressure, effective control of blood glucose, effective control of blood lipids, and effective protection of the kidneys, because hypertension, hyperglycemia, and hyperlipidemia all have negative effects on chronic nephritis, so various predisposing factors should be actively treated.
summary
According to the specific condition of the patient, the treatment is differentiated, and the method of tonifying the kidney and activating blood is flexibly used. Pay attention to the selection of drugs that have the effects of strengthening the spleen and stomach, invigorating blood and removing blood stasis, which can not only dispel dampness and heat, but also assist in removing blood stasis and blood stasis, and will not hurt the spleen and stomach if taken for a long time. On the one hand, it strengthens the spleen and tonifies the middle, and the qi can be used to treat proteinuria and hematuria, and on the other hand, it can warm the stomach and prevent cold drugs from hurting the stomach.
Zhang Daning has also developed a variety of Chinese patent medicines, which are designed for different types of chronic nephritis and have good curative effects. According to the specific situation of chronic nephritis, proteinuria and hematuria, the application plan of immunosuppressants has also been formulated, which is clinically safe and effective. Clinical syndrome focuses on prevention, actively preventing and treating renal damage caused by chronic nephritis, preventing renal fibrosis, and eliminating the predisposing factors of chronic nephritis.
Zheng reiterates:
Since each person's constitution and condition are different, the prescription and dosage in this case are only applicable to the patient's condition at that time. Without TCM syndrome differentiation diagnosis and treatment, the prescription and dosage in this case must not be copied. If necessary, readers should go to a regular hospital for diagnosis and treatment to avoid delaying their condition. ■
[Source: China Traditional Chinese Medicine News, content compiled from: "China Traditional Chinese Medicine News" December 8, 2021 Fifth Edition, Author: Jiao Jian, Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine]