Nephrotic syndrome falls under the category of "edema" in Chinese medicine. After the edema subsides, it often falls under the categories of "deficiency fatigue" and "lumbago." The internal causes are mainly yang deficiency and qi deficiency of the spleen and kidneys, while the external causes are triggered by the invasion of wind-cold dampness. The movement of water and dampness in the body relies on the regulation of lung qi, the transportation of spleen qi, and the opening and closing of kidney qi, enabling the triple energizer to perform its function of dredging, ensuring smooth bladder qi transformation and normal urination. Conversely, if there is dysfunction in the lung, spleen, and kidney triple energizer, the triple energizer loses its ability to dredge, and bladder qi transformation becomes impaired, leading to the occurrence of edema.

1. Internal invasion of water and dampness, spleen failing to transport and transform: The spleen governs transportation and transformation, prefers dryness and dislikes dampness. If one lives in a damp environment, or is exposed to rain and water, or if one indulges in excessive alcohol and cold foods, dampness accumulates internally, the spleen becomes overwhelmed by dampness, and its function of ascending lucidity and descending turbidity is impaired, causing water and dampness to fail to descend and instead overflow into the skin, resulting in edema.
2. Excessive overstrain, irregular eating habits: The spleen is responsible for transporting body fluids from the stomach, dispersing essence to the lungs, and distributing it throughout the body. If there is excessive overstrain and improper diet, leading to spleen qi deficiency, fluids cannot be transformed and transported, accumulating and overflowing, thus forming edema.
3. Excessive sexual activity, overwork damaging the kidneys: Unrestrained sexual desire and excessive sexual activity often lead to internal damage to kidney qi, gradually causing kidney qi deficiency. Kidney deficiency results in impaired opening and closing, inability to warm yang qi to promote diuresis, leading to the accumulation of fluids and their overflow into the skin, forming edema.
4. Prolonged accumulation of dampness-heat, damage to yin obstructing the collaterals: If one is affected by seasonal dampness, dampness stagnates and transforms into heat, or if one has an improper diet, leading to internal generation of dampness-heat, dampness and heat interact, consuming yin and blood, causing blood flow to become sluggish, leading to the internal generation of phlegm and blood stasis, obstructing the collaterals, resulting in poor water circulation and the development of swelling.

bubble_chart Modern Research

Nephrotic syndrome is not a single disease, but a clinical syndrome caused by various disease causes. It is characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia, and varying degrees of edema. These manifestations are all related to the increased filtration of plasma albumin by the glomerular filtration membrane and the massive loss of albumin in the urine. Massive proteinuria is a characteristic of glomerular disease, while hypoalbuminemia, hyperlipidemia, and edema are consequences of massive proteinuria. Therefore, massive proteinuria and the resulting hypoalbuminemia are essential conditions for the diagnosis of nephrotic syndrome. However, in cases of severe hypoalbuminemia, the amount of protein excreted in the urine often decreases and does not meet the above criteria, which should be noted in clinical diagnosis.

According to the Second National Nephrology Conference, nephrotic syndrome is divided into two types. Type I: no persistent hypertension, centrifugal urine red blood cells <10 per high-power field, no persistent renal insufficiency, highly selective proteinuria, normal urine FDP and C₃ values; Type II: often accompanied by hypertension, hematuria, renal insufficiency, non-selective proteinuria, positive urine FDP and C₃.

Any condition that can cause glomerular lesions can lead to nephrotic syndrome, usually resulting in injury to the glomerular capillary filtration membrane. Many scholars believe that its pathogenesis is related to immunity. Clinically, its disease causes are divided into primary (original lesion in the glomerulus) and secondary (secondary to systemic diseases). Secondary causes are complex, such as infections, drugs, toxins, allergies, tumors, and multi-system diseases. Primary nephrotic syndrome is pathologically classified into minimal change disease, mesangial proliferative glomerulonephritis, focal glomerulosclerosis, membranous nephropathy, membranoproliferative glomerulonephritis, etc. Among these, membranous nephropathy is more common in adults, while minimal change disease accounts for the majority in children, so the prognosis of nephrotic syndrome in children is better than in adults. According to domestic adult renal biopsy data, among primary nephrotic syndromes, mesangial proliferative glomerulonephritis is the most common, followed by focal segmental glomerulosclerosis and membranous nephropathy.

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Clinical manifestations

1. Generalized edema: In severe cases, it may be accompanied by pleural ascites and pericardial effusion. Edema can persist for weeks, months, or even the entire course of the disease, often recurring or worsening after infection, and may even lead to uremia.
2. Gastrointestinal symptoms: Due to gastrointestinal edema, symptoms such as poor appetite and nausea are common, and these symptoms worsen with azotemia.
3. Hypertension: This is not a major clinical manifestation of the disease, but with water and sodium retention and excessive blood volume, elevated blood pressure is often unavoidable.

Laboratory tests

1. Urinalysis: Massive proteinuria, more than 3.5 grams per day, and may include hyaline or granular casts.
2. Hypoalbuminemia: Mainly a decrease in plasma protein, the degree of which is significantly correlated with the degree of proteinuria, generally less than 3 grams/100 milliliters.
3. Hyperlipidemia: In severe cases, xanthomas may appear on the skin.
4. Protein electrophoresis: α₂ or (and) β-globulin may be significantly increased, while γ-globulin is often lower (increased in lupus erythematosus and amyloidosis).
5. Others: Erythrocyte sedimentation rate is often significantly increased. Selective measurement of urine FDP, urine C₃, and renal biopsy can help in clinical pathological classification.

bubble_chart Pattern Analysis

1. Spleen-kidney Yang Deficiency︰Cold limbs, pale complexion, edema of the limbs (especially the lower body), soreness and weakness in the lower back and legs, lack of strength, loose stool. The tongue is pale and swollen with tooth marks on the edges, thin white coating, and deep, thin pulse. Warm the kidneys, strengthen the spleen, and promote diuresis. Modified True Warrior Decoction or Life-Relieving Kidney Qi Pill. Prepared aconite root 6-10g, Common Curculigo Rhizome 9g, Epimedium Herb 9g, Poria 5g, Prepared Rehmannia Root 15g, Cornus 10g, Moutan Bark 10g, Chinese Yam 10g, Alisma 10g, Cassia Bark 4g. For lung qi stagnation, add Ephedra, Bitter Apricot Seed, and Pepperweed Seed; for dampness transforming into heat, add Phellodendron Bark, Pyrrosia Leaf, and Hedyotis; for qi stagnation, add Areca Peel, Cultivated Purple Perilla Leaf, and Cicada Slough; for static blood obstruction, add Motherwort Herb, Salvia, and Leech.
2. Spleen-kidney Qi Deficiency︰The complexion is pale or sallow and dull, with mental fatigue and lack of strength, poor appetite, abdominal distension and fullness, soreness and weakness in the lower back and knees, and recurrent swelling of the face and limbs that leaves indentations when pressed. The tongue is pale red with a thin white coating, and the pulse is soft and soggy. The treatment principle is to tonify qi, strengthen the spleen, unblock water, and disperse edema. Modified Stephania and Astragalus Decoction combined with White Atractylodes Powder is used. The prescription includes: Ginseng 10g, Poria 12g, White Atractylodes Rhizome 10g, Chinese Yam 15g, Hyacinth Bean 10g, Lotus Seed 10g, Coix Seed 15g, Villous Amomum Fruit 6g, Platycodon Root 6g, Liquorice Root 6g, Stephania Tetrandra 12g, Astragalus Root 20g. For stomach disharmony, add Pinellia Rhizome and Dried Tangerine Peel. For palpitations with qi rushing up to the chest and dysuria, add Cinnamon Twig and Poria.
3. Yin Deficiencydampness-heat︰Edema of the limbs, flushed face, aversion to heat, sweating, vexing heat in the chest, palms and soles, palpitation, insomnia, scanty and hesitant urination, constipation. The tongue texture is pale with thin yellow greasy coating, and the pulse is wiry and slippery. The treatment principle is to enrich yin, clear heat, and drain dampness. Modified Major Yin-Tonifying Pill combined with Polyporus Decoction. Ingredients: Prepared Rehmannia Root 12g, salt-fried Anemarrhena 15g, Phellodendron Bark 6g, processed Tortoise Carapace 10g, Pig Spinal Cord 10g, Polyporus 12g, Poria 12g, Alisma 6g, Donkey-hide Gelatin 12g, Talc 12g.
4. Stagnant Water Obstruction︰Dark complexion, ecchymosis on lips, tongue, and skin, oliguria, edema, anorexia. Purple-dark tongue texture, thready and choppy pulse. Invigorating blood and resolving stasis to promote diuresis. Modified Salvia Decoction combined with Shiny Bugleweed and Stephania Tetrandra Decoction. Salvia 15g, sandalwood 10g, Villous Amomum Fruit 6g, Shiny Bugleweed 6g, Stephania Tetrandra 12g, Red Peony Root 10g, Sichuan Lovage Rhizome 10g, Platycladi Seed 10g, Carthamus 6g, motherwort herb 10g. Modifications: for severe edema, combine with Five-Peel Decoction; for severe static blood, add Sparganium Rhizome and Zedoary Rhizome; for persistent hematuria, add Carbonized Typha, amber, Sanqi, etc.
5. Liver-kidney Yin Deficiency︰Flushed complexion, vexing heat in the chest, palms, and soles; soreness and pain in the lower back and knees; tidal fever and night sweats; dry mouth. The tongue texture is red or fissured, with scant and dry coating; the pulse is thin and rapid. Nourish yin and reduce fire, clear heat, and promote diuresis. Use Anemarrhena, Phellodendron, and Rehmannia Decoction combined with Two-Solstice Pill. Ingredients: Anemarrhena Rhizome 15g, Phellodendron Bark 6g, Unprocessed Rehmannia Root 15g, Eclipta Herb 15g, Asiatic Cornelian Cherry Fruit 15g, Chinese Yam 10g, Moutan Bark 10g, Alisma Rhizome 10g, Poria 10g. If serum albumin is low, consider adding blood-nourishing and essence-tonifying substances such as: Common Curculigo Rhizome 10g, Epimedium Herb 10g, Morinda Root 10g, Eucommia Bark 10g, Sharpleaf Galangal Fruit 12g, Dodder Seed 10g, Donkey-hide Gelatin 10g, Tortoise Shell Glue 10g. For yin deficiency with heat toxin, add Lonicera and Isatis Root. For phlegm accumulation, add Salvia and Peach Kernel.