bubble_chart Concept

This disease falls under the category of "edema" in Chinese medicine, often caused by external pathogenic invasion, improper diet and lifestyle, and overstrain internal damage. The location of the disease is in the lungs, spleen, and kidneys, affecting the bladder and triple energizer. Due to congenital deficiency or inherent weakness, after being affected by external pathogens (wind, dampness, heat toxin, etc.), the pathogens lurk within the body, and the disease manifests after approximately 1 to 4 weeks. The disease cause and mechanism of disease are briefly described as follows:

1. Invasion of wind-cold, conflict of wind and edema: If it is wind-cold, then lung qi is depressed; if it is wind-heat, then lung qi fails in purification and dispersion, unable to distribute fluids upwards or dredge and regulate water passages downwards to the bladder, leading to wind blocking water and conflict of wind and edema, internally invading zang-fu organs and meridians, externally soaking the limbs and skin, resulting in this disease.
2. Internal retention of water-dampness, dysfunction of spleen in transportation: Damp climate or exposure to rain and water leads to internal invasion of water-dampness, obstructing spleen yang, causing dysfunction of spleen in transportation, unable to ascend lucidity and descend turbidity, leading to water-dampness not descending, overflowing the skin and causing edema; dampness-heat pouring down, injuring the lower energizer blood vessels, can lead to hematuria.
3. Internal invasion of sore toxins, affecting zang-fu organs: Skin sores, internal invasion of pathogenic toxins, zang-fu organs are harmed, leading to lung's failure in regulation, spleen's failure in transportation, kidney's inability to govern water, dysfunction of body fluids metabolism, obstruction of water-dampness movement, soaking and overflowing the skin to form edema; if heat toxin injures the lower energizer blood vessels, it can lead to hematuria.

Additionally, heat toxin stagnates in the liver meridian, depleting liver yin, leading to ascendant hyperactivity of liver yang, which can cause headache, vertigo, and even convulsions, unconsciousness; water pathogen obstruction, attacking the heart and lungs, can lead to panting, palpitation, and even cyanosis; if damp pathogen is internally excessive, spleen and renal failure, triple energizer qi movement is blocked, ascending and descending are dysfunctional, it can lead to oliguria, anuria, nausea, vomiting, and even unconsciousness, etc., pattern of internal block of water toxin.

bubble_chart Modern Research

Acute glomerulonephritis, abbreviated as acute nephritis, has a sudden onset and a short course, and is one of the common glomerular diseases. It is most commonly seen in school-age children, with a higher incidence in males than in females. Its onset is closely related to antecedent infections, with symptoms typically appearing 2-3 weeks after the antecedent infection, characterized by edema, hypertension, hematuria, and proteinuria, and even azotemia as typical manifestations. Most cases show improvement or even recovery after 4-8 weeks of treatment, but some may progress to chronic nephritis.

Modern medicine believes that most cases of acute nephritis are related to infections, mainly affecting the glomeruli, and are classified as immune-mediated diseases. The pathogenic microorganisms causing the infections are mostly bacteria (most commonly streptococci, with a few being staphylococci, pneumococci, cold-damage disease bacilli, etc.), viruses (such as influenza, chickenpox, measles, etc.), and protozoa (mainly malaria parasites). Acute nephritis is not a direct infection of the kidneys by these pathogens, but rather an immune complex nephritis caused by immune reactions following infection. The most common is type hemolytic streptococcal infection. The antecedent infections are often pharyngitis (tonsillitis), skin pustules, otitis media, scarlet fever, etc., where nephritogenic streptococci, through enzyme action or their products, bind to the body's Ig, altering the chemical composition or antigenicity of Ig, and then form immune complexes. The deposition of antigen-antibody complexes in the glomerular basement membrane and the resulting diffuse injury (which may present as diffuse capillary endothelial proliferation or mesangial proliferation) are the main links in the pathogenesis of acute nephritis. After glomerular capillary endothelial injury, fibrin deposition and platelet aggregation can form microthrombi, exacerbating glomerular ischemia and hypoxia, and further aggravating glomerular inflammation.

[Diagnosis]

1. The onset is acute, with varying severity of the condition, and most cases have a good prognosis, generally recovering within several months to a year.
2. There is proteinuria, hematuria, and cast urine, often accompanied by edema, hypertension, or transient azotemia, with no reduction in kidney size on B-ultrasound examination.
3. Some cases have a history of acute streptococcal infection, usually occurring 1-4 weeks after the infection.

bubble_chart Pattern Analysis

1. Wind-cold Obstructing the Lung︰The onset is rapid, with swelling of the eyelids first, followed by edema in the limbs and the whole body, especially prominent on the face. The skin appears shiny and does not pit upon pressure. There is scanty urine, slight aversion to wind and cold, or accompanied by fever, joint soreness, nasal congestion, or cough with shortness of breath. The tongue is pale with a thin white coating, and the pulse is floating and tight. Treatment involves dispersing wind and dissipating cold, unblocking yang, and promoting diuresis. Modified Spleen-Qi Effusing Decoction combined with Five Ingredients with Poria Powder is used. Ingredients include Ephedra 6g, Bitter Apricot Seed 10g, Saposhnikovia Root 10g, Cinnamon Twig 10g, Poria 15g, Polyporus 12g, White Atractylodes Rhizome 6g, Alisma 10g, Raw Gypsum 15g, and Fresh Ginger Rhizome 3 slices. For severe cough, add White Mulberry Root-Bark 10g, Pepperweed Seed 10g, Dried Tangerine Peel 6g, and Cultivated Purple Perilla Fruit 10g. If there is sweating with aversion to wind, dysuria, and persistent edema with a heavy voice, this indicates deficiency of the exterior qi and retention of water-dampness. Modified Stephania and Astragalus Decoction is used instead.
2. Wind-heat Invading the Lung︰Sudden swelling of the eyelids and face, fever with sweating, sore throat, dry mouth with thirst, scanty dark urine. Slightly red tongue edges and tip with thin yellow coating, floating rapid pulse. Dispersing wind and diffusing the lung, clearing heat and promoting diuresis. Modified Five Ingredients with Poria Powder. Tuckahoe peel 6g, Polyporus 12g, Alisma 10g, White Atractylodes Rhizome 10g, Dried Tangerine Peel 6g, Areca Peel 10g, White Mulberry Root-Bark 10g, Cinnamon Twig 6g. For severe swelling in the upper body accompanied by cough, add Ephedra 6g, Bitter Apricot Seed 10g, Cultivated Purple Perilla Leaf 6g; for severe swelling in the lower body with fatigue, bland taste in mouth, abdominal distension and fullness, remove White Mulberry Root-Bark and add Magnolia Bark 10g, Stephania Tetrandra 10g, Pricklyash Seed 6g; for cold body and limbs with deep slow pulse, add Prepared Aconite Lateral Root 6g, Dried Ginger 6g.
3. Internal Stirring of Liver Wind︰Headache, vertigo, dysphoria, bitter taste in mouth, dark urine, even convulsions, unconsciousness, red tongue with yellow rough coating, wiry pulse. Pacify the liver and purge fire, subdue yang and extinguish wind, promote diuresis and open orifices. Modified Antelope Horn and Uncaria Decoction: Antelope Horn 3g (ground into powder and taken with decoction), Uncaria 15g, Poria with Pine 10g, Chrysanthemum Flower 10g, Mulberry Leaf 10g, Unprocessed Rehmannia Root 12g, Abalone Shell 12g, Raw Peony Root 10g, Raw Liquorice Root 6g, Light Bamboo Shavings 6g, Plantain Seed 10g, Nacre 5g, Alisma 10g. Take with one pellet of Purple Snow Bolus.
4. Water Rising of Qi Flooding, Pathogen Attacking He︰Edema of the limbs, coughing and shortness of breath, palpitation, chest tightness, dysphoria, inability to lie flat, cyanosis of the lips, and purple nails. Drain the lungs and promote diuresis, tranquilize the mind and calm the spirit, modified Jijiao Rehmannia Pill: Stephania Tetrandra 15g, Pricklyash Peel 6g, Pepperweed Seed 15g, White Mulberry Root-Bark 15g, Alisma 10g, Rhubarb Rhizoma 6g, Ginseng 10g, Fossil Bone 15g, Carthamus 6g.
5. Dampness-heat Stagnation in the Triple Energizer︰(dampness turbidity retention, water toxin internal stagnation, triple energizer obstruction) generalized edema, scanty urine or anuria, dizziness, nausea and vomiting, somnolence, or even unconsciousness. Pale and swollen tongue with greasy coating, wiry or rapid pulse. Promote bowel movement and descend turbidity. Modified Gallbladder-Warming Decoction combined with Aconite Heart-Draining Decoction. Dried Tangerine Peel 6g, Pinellia Tuber 12g, Poria 12g, Bamboo Shavings 6g, Immature Orange Fruit 10g, Prepared Aconite Lateral Root 10g, Dried Ginger 6g, Skullcap Root 10g, Coptis Rhizome 6g, Rhubarb Rhizoma 6g.
6. Incomplete Resolution of Dampness-heat with Spleen︰Fatigue, lack of strength, lower limb edema, sore lower back, scanty urine, poor appetite, loose stool. Red tongue with thin yellow greasy coating, soggy and thin pulse. Clearing heat and draining dampness, benefiting the spleen and tonifying the kidneys, modified Three Marvel Pill combined with Six-Ingredient Rehmannia Decoction: Atractylodes Rhizome 10g, Achyranthes Root 10g, Astragalus Root 6g, Phellodendron Bark 6g, Coix Seed 15g, White Atractylodes Rhizome 6g, Unprocessed Rehmannia Root 10g, Chinese Yam 15g, Asiatic Cornelian Cherry Fruit 10g, Moutan Bark 6g, Alisma 10g, Poria 10g, Glossy Privet Fruit 10g, Yerbadetajo Herb 10g. For low-grade fever, add Sweet Wormwood 10g and Turtle Carapace 10g; for severe qi deficiency, add Codonopsis Root 12g and Astragalus Root 15g; for abdominal distension and fullness, add Radish Seed 10g.