Nephrotic syndrome can be caused by a wide variety of glomerular diseases. It may follow bacterial or viral infection, malignant tumors and administration of some drugs. Some immune diseases, such as systemic lupus erythematosus, allergic purpura and diabetes mellitus can be complicated by nephrotic syndrome. This disease is included in the categories of "shui zhong" (edema), and "xu lao" (consumptive diseases) in TCM.  

Main Points of Diagnosis

1. Heavy proteinuria, accompanied with edema and hypoproteinemia, are three major manifestations of this syndrome. Urinary protein excretion exceeds 3.5g per day. The serum albumin is lower than 30g per liter. Severe edema may appear if serum albumin is lower than 15g per liter.

2. The alteration of blood pressure varies with different types of the disease. Hyperlipemia is common, particularly increased cholesterol.

3. About 75 per cent of cases with nephrotic syndrome are caused by primary glomerular diseases. In children nearly 80 per cent of cases are nephrotic syndrome of minute lesion type. The rest are secondary to other diseases. Renopuncture biopsy is of much help in confirming the cases of the diseases and indicating treatment.  

Differentiation and Treatment of Common Syndromes

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

Main Symptoms and Signs: Sallow complexion, mental fatigue, cold extremities, bodily edema which is more severe in the region below the waist, anorexia, loose stool, weakness of the loins, oliguria, pale or plump moist tongue with whitish smooth fur, deep, thready and weak pulse.

Therapeutic Principle: Warming the kidney, strengthening the spleen and inducing diuresis to alleviate edema.

Recipe: Modified Drink for Reinforcing the Spleen in combination with Diuretic Decoction for Strengthening Yang of the Spleen and Kidneys.

astragalus root

codonopsis root

white atractylodes rhizome

poria

coix seed

prepared aconite root

cinnamon bark

umbellate pore-fungus

aucklandia root

epimedium

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

2. Weakness of the Kidney-Qi

Main Symptoms and Signs: Pale complexion, general debility with desire for sleep, aversion to cold, pitting edema, hydrops in the scrotum or hydrothorax and ascites frequent urination at night (with profuse proteinuria), pale, swollen and teeth-printed tongue with whitish fur, deep and slow pulse.

Therapeutic Principle: Strengthening the function of the kidney to stop proteinuria.

Recipe: Kidney-Yang-Reinforcing Bolus with additional ingredients.

prepared rehmannia root

Chinese yam

dogwood fruit

wolfberry fruit

dodder seed

prepared aconite root

cinnamon bark

astragalus root

codonopsis root

lotus seed

Cherokee rose-hip

euryale seed

poria

unbellate pore-fungus

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

If the case is complicated with symptoms of dampness and heat, 10 grams of phellodendron bark 15 grams of tale and 20 grams of coix seed ought to be added to the recipe.

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