The concept of kidney diseases is belonging to western medicine. The common procedure of its history is: kidney deficiency→acute or chronic nephritis→acute or chronic renal failure→uraemia. Uraemia is the common turnover. To understand the mechanism of this development, we must know the TCM pathogenesis of kidney firstly.
Kidney takes charge of water, corresponding to Kan. It was named as “officer acting with skills” in ancient TCM books. Jing was stored in kidney, being the basis of duration of life. Kidney has its outer sign in hair, corresponding Fu at bladder, storing water and acting on the basis of gasification. Waist is the outer Fu-organ of kidney; ear is the administrating officer, etc. More details:
The Yin and Yang in kidney include different pairs, such as: water between Heaven One and Earth Six; Kan and Chien which represent kidney Yin and kidney Yang respectively. It is taken charge by Zu Shao Yin kidney meridian and ordered by Li. Li represents heat and brightness and is always compared to moon. Moon has the image of Kan and brightness of Li. Li in heart meridian is compared to sun. Moon get brightness from sun, so Zhi belongs to spirit of heart. The brightness of moon can bring silence and calm to people to disperse their restlessness. Trigram Kan in kidney Jing is correspondence with Li of heat. We can probe the profoundity of kidney by comparing with moon. The full moon turns to be bright while the tide on earth was agitated by the heat of sun, accordingly a person will have sufficient Jing and Qi so that he could eject and discharge. Shao Yin meridian has the image of Kan but is dominated by Li. There is also image of Kan in kidney, so there is growth and decline between Kan and Li. If Li is excess but Kan is deficiency, water could not constrain fire, the fire would roar and induce wind like incomplete moon will bring breeze.
The first step of kidney diseases is kidney deficiency. The manifestations could be heat (Li excess of Kan) or cold (Kan excess of Li). The image of Li is usually reflected on bladder, its abnormal change will bring changes of urine, such as frequent micturition or urgency.
Kidney is dominated by the God named Xuanwu in north direction. What could represent Xuanwu are Guiban and Fuzi, so the two drugs are commonly used. Acute nephritis is the disease of Chien for its characteristic as wind and water breaking through; chronic nephritis is the disease of Kan for its characteristic as water rush forth from a pipe; uremia is the disease of Chen for its characteristic like disappearance of dragon and exhaustion of water.
If the deficiency of kidney is coming from the stagnation of renal meridian, Shenzhuo Decoction should be given to disperse the cold and dampness. Similarly, Jinkuishengqi Pill could be given to deficiency of renal Yang; Erzhi Pill could be given to deficiency of renal Yin. There are many changes of Liweidihuang which was made by Zhang Zhongjing. They are Zhibaidihuang and Qijudihuang, etc. I recommend a very useful formula here which could be used to reinforce all kinds of kidney deficiency. The prescription is Jinkuishengqi minus Fuzi and plus Wuweizi and Huangbai (formula 1). Patients could take this formula for a long time.
Acute nephritis could be cured by many strategies. The best one is using my patrimonial acupuncture plus small Lung-gold grass (commonly called Qucao). Activating Qi and diuretic method and strengthening earth to control water method could be used alternatively. To severe disease, removing wind, detoxication and activating blood methods could be added. During the convalescence stage, some nutrition formula could be used to prevent its recurrence. The basic principle in this stage is to strengthen defense of Chien. We can use Zhengwu Decoction plus Duhuo, Fangji and Huangqi (formula 2). Duhuo could search dampness and wind in kidney; Fangji could let dampness and heat out of the organ by urine; Huangqi could strengthen Qi to defend wind.
There are many kinds of chronic nephritis, with or without edema. The common mechanism is that kidney loses its mount, leading refined substances out. It is easy to disperse edema, but hard to disappear the plus sign in urine protein. In a word, the root is Kan. The principle is, when we dredge water course we should cultivate Kan at the same time. Jiajiebawei could be used to cultivate Kan. The prescription is Shudi, Zexie, Shanzuyu, Danpi, Shanyao, Fuling, Rougui and Wuweizi. After the disappearance of water, we need to use Guiban, Duanlonggu and Caopuhuang to treat urine protein (formula 3). Guiban plus Rougui could reinforce the kidney Yang so that refined substances not get out. Duanlonggu could reduce the pulse of liver and slippage of kidney. Caopuhuang could stop bleeding and diuresis. The formula is used to treat kidney deficiency with fire in blood. The forementioned formula with Duhuo is used to treat wind and dampness flowing down. We will have to give the two formulas with syndrome differentiation. Common nephritis could be controlled by the use of Huanniuxi and Cheqianiz in diuresis, Huangbai in strengthening renal Yin and Xuansheng in dealing with blood heat. If there are dermatitis glandularis erythematosa or irritability, Zhigancao could be added to calm the middle-Jiao , as well as Shanzi to purge pathogenic fire. The most important drug in this formula is Rougui, which could not only aid kidney water but also prevent the harm of too cold (formula 4).
The radical pathogenesis of uremia is dragon out with water exhaustion. Ken will lose its master without Chen, so stagnation of damp earth is excess. Water has no way to get out, the whole water in kidney is like flood. The vessel of Jueyin could not spread, so nitrogen and phosphorus will accumulate in blood. There is no fire in Ming Men, so fire of Chen lose its master and float on blood, inducing hypertension. The principles are: firstly getting the dragon back; secondly ditching water course, breaking through dampness and dispersing Xun. The patient usually is very faint, so any purgation agents should be forbidden. We will have to give warm reinforcement and slow permeation. In addition, the vital opportunity could be gained by hemodialysis. The basic formula is also Jingkuishengqi Pill, but Shudi should be changed into Shengdi to help permeation. Xuansheng could be used to moistening lung and kidney and astringe floating fire. Huangbai strengthens renal Yin and restrain assistant fire. Shanzhi disperses fire in liver and Shanjiao6. Zhigancao is helpful for the changes of Qi. Huanniuxi and Cheqianzi let dampness out, with the assistance of Ming Men. Guiban could hide the dragon which was led back by Fuzi. Fuzi is the eye of the formula (formula 5). In addition, Duzhong could treat waist soreness. If the patient is young, he could be cured by this formula. If he is old with severe condition such as liver and kidney failure with heavy dampness in spleen and stomach- poor appetite, Daizheshi could be added. In order to decrease creatinine and urea nitrogen, calcium tablet, Huashi, Yimucao, Wangbuliuxing, Yinchen and Zelan could be added when the urinary volume is restored (formula 6). Whether the patient could be cured or not is usually determined by the degree of liver and kidney failure. If the patient had black countenance and dead kidney pulse, he would inevitably be incurable. Liver cancer and uremia are extreme condition of Zang-organ, some of them are impossible cured.
Main prescriptions:
Formula 1: Jingkuishengqi Pill (minus Fuzi plus Wuweizi)
Formula 2: Duhuo 6g, Fangji 6g, Huangqi 9g, Fuling 9g, Shaoyao 9g, Baizhu 6g, Shengjiang 9g, Paofuzi 9g.
Formula 3: Shudi 24g, Zexie 9g, Shanzhuyu 12g, Danpi 6g, Shanyao 12g, Fuling 9g, Rougui 3g, Wuweizi 3g, Guiban 6g, Duanlonggu 6g, Caopuhuang 6g.
Formula 4: Shengdi 18g, Zexie 9g, Shanzhuyu 12g, Danpi 6g, Shanyao 12g, Fuling 9g, Rougui 3g, Wuweizi 3g, Huanniuxi 6g, Cheqianzi 6g, Xuansheng 9g, Huangbai 6g, Shanzhi 3g, Zhigancao 3g.
Formula 5: Shengdi 18g, Zexie 9g, Shanzhuyu 12g, Danpi 6g, Shanyao 12g, Fuling 9g, Rougui 3g, Fuzi 3g, Duzhong 9g, Zhiguiban 6g, Huanniuxi 6g, Cheqianzi 6g, Xuansheng 9g, Hangbai 6g, Shanzhi 3g, Zhigancao 3g.
Formula 6: Calcium tablet 6g, Huashi 6g, Yimucao 9g, Wangbuliuxing 9g, Yinchen 12g, Zelan 9g.

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