Chronic nephritis is and allergic disease caused by a wide variety of etiological factors. Only a small percentage of cases are obviously due to the progression of acute nephritis. The majority of patients with chronic nephritis have no history of acute nephritis. The disease is common in young adults and middle aged people. Its course is long and the prognosis is unfavorable. In TCM, this disease is categorized as "shui zhong" (edema), "xu lao " (consumptive diseases), "yao tong" (lumbago), etc.  

Main Points of Diagnosis

There are three types of chronic nephritis according to the clinical features.

1. Common type: The course of this type is persistent. The quantitative examination of urinary protein is at a range between 1.5g and 3.5g per day. Patients may have hypertension, hematuria, cylinduria and decrease of renal function.

2. Nephrotic type: In addition to the features of the common type, quantitative examination of urinary protein is greater than 3.5g per day, the serum albumin is less than 3.5g percent. Marked edema is the characteristic feature of this type.

3. Hypertensive type: A persistent hypertension is the predominant manifestation of this type of chronic nephritis besides the features of the common type. 

Differentiation and Treatment of Common Syndromes     

1. Deficiency of the Spleen-Yang and Kidney-Yang

Main Symptoms and Signs: Pale complexion, lassitude, listlessness, aversion to cold, cold limbs, high-grade edema, abdominal distension, anorexia, soreness of the waist, oliguria, thin and whitish coating of the tongue, deep and fine pulse.

Therapeutic Principle: Warming yang  of the spleen and kidney to promote diuresis

Recipe: Modified Decoction for Reinforcing the Spleen.

astragalus root

codonopsis root

white atractylodes rhizome

poria

prepared aconite root

cinnamon bark

shell of areca husk

water-plantain tuber

plantago seed (wrapped in a piece of cloth before decoction)

All the above herbs re to be decocted in water for oral administration.

If the edema is mile but persistent, it suggests the deficiency of spleen-qi, the treatment should be aimed at replenishing qi and invigorating the spleen to induce diuresis. Modified Tetrandra and Astragalus Decoction is preferred for the treatment. The compositions are: tetrandra root 10g, astragalus root 15g, white atractylodes rhizome 15g, codonopsis root 15g, poria 15g, umbellate pore-fungus 12g, water-plantain tuber 12g, tangerine peel 10g, prepared licorice root 3g. All the above herbs are to be decocted in water for oral administration.

2. Hyperactivity of Yang due to Deficiency of Yin

Main Symptoms and Signs: Indistinct edema, headache, dizziness, tinnitus, dry mouth, irritability, feverish sensation in the palms and soles, palpitation, insomnia, red tongue, taut and thready pulse.

Therapeutic Principle: Nourishing yin and suppressing hyperactive yang.

Recipe: Bolus of Six Ingredients Including Rehmannia and Adding Wolfberry and Chrysanthemum with additional ingredients.

wolfberry fruit

chrysanthemum flower

fresh rehmannia root

prepared rehmannia root

dogwood fruit

moutan bark

Chinese yam

poria

water-plantain tuber

tortoise plastron

uncaria stem with hooks

eucommia bark

abalone shell

All the above ingredients are to be decocted in water for oral administration.

3. Retention of Damp-Heat in the Body

Main Symptoms and Signs: Flushed face, obesity, edema, distension of head, headache, dry mouth, irritability, constipation, prolonged hormonotherapy, thin and yellowish or yellowish and greasy coating of the tongue, taut and rapid or slippery and rapid pulse.

Therapeutic Principle: Clearing away pathogenic heat and dampness.

Recipe: Modified Decoction of Gentian for Purging Liver-Fire.

gentian root

scutellaria root

capejasmine fruit

water-plantain tuber

plantago seed (wrapped in a piece of cloth during decocting)

dried rehmannia root

phellodendron bark

dandelion 

cogongrass rhizome

All the above herbs are to be decocted in water for oral administration.  

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