Chinese medicine believes that the main factors leading to the occurrence of this disease are:

1. congenital deficiency, weak constitution: congenital deficiency leads to low function of the zang-fu organs throughout the body, weak resistance to disease, and susceptibility to external pathogenic invasion; weak constitution makes it difficult to recover from illness, leading to a state of chronic illness that further depletes the yin-yang qi and blood of the zang-fu organs, causing damage to the five zang organs.
2. postnatal disharmony, damage to essential qi: the kidney stores essence, and kidney essence is the material basis of qi, blood, yin, and yang, and is continuously replenished by postnatal spleen and stomach fluid retention and food essence. If there is no restraint in sexual activity, excessive indulgence, or improper treatment after illness, kidney qi can be dissipated and kidney essence can be depleted. If overstrain is excessive, diet is irregular, hunger and satiety are not regulated, and the spleen and stomach are injured, the postnatal source of transformation becomes insufficient, kidney essence is not replenished, and the qi, blood, yin, and yang of the zang-fu organs gradually decline.
3. after major or chronic illness, lack of proper care leads to damage to qi, blood, yin, and yang, and weakness of the zang-fu organs. In summary, the main pathology of this disease is deficiency and damage to the qi of the zang-fu organs, with kidney deficiency being the primary factor. Kidney deficiency leads to insufficient qi of the five zang and six fu organs, resulting in systemic deficiency symptoms. Insufficient kidney qi and decline of life gate fire lead to kidney yang deficiency, and spleen yang is also insufficient, often manifesting as spleen-kidney yang deficiency; liver and kidney share the same source, and insufficient kidney essence leads to liver-kidney yin deficiency. In addition, due to the deficiency of organ qi being unable to generate blood, and qi deficiency being unable to promote blood circulation, this disease often presents with blood deficiency and blood stasis during its progression.

bubble_chart Modern Research

Addison's disease, also known as primary chronic adrenal cortical insufficiency, is a disorder of the adrenal glands themselves. It is caused by the destruction of the majority of the adrenal glands due to subcutaneous nodes, autoimmune disorders, tumors, leukemia, etc., leading to reduced secretion of cortical hormones. The majority of patients are middle-aged and young adults, mostly between 20 and 50 years old.

Modern medicine believes that any cause leading to the destruction of the majority of both adrenal glands can result in this disease. The disease causes can be summarized as:

1. Idiopathic adrenal atrophy: In recent years, this is considered the most common cause of the disease. Antibodies against adrenal microsomes and mitochondria can be detected in the patient's blood, suggesting an association with autoimmunity.
2. Subcutaneous nodes: Most commonly found in the adrenal glands.
3. Others: Such as surgical removal of most or all of the adrenal glands, fungal infections, tumor metastasis, congenital adrenal hypoplasia, etc., can also cause this disease.

Clinical manifestations

Skin and mucous membrane pigmentation is a characteristic symptom of this disease. The pigmentation is widely distributed, especially noticeable in exposed areas, frequently rubbed and pressured areas, as well as around the areola, nipple, perineum, anus, armpits, fingerprints, nail roots, and scars; the pigmentation appears in patches. Additionally, combined with weight loss, fatigue, low blood pressure, and a smaller heart, a preliminary diagnosis of this disease can be made.

Laboratory tests

1. Measurement of urinary 17-hydroxycorticosteroids and 17-ketosteroids: Patients with this disease have significantly lower 24-hour urinary excretion of 17-hydroxycorticosteroids and 17-ketosteroids than normal. If the 24-hour urinary excretion of both is <13.8 μmol/24 hours, it is definitely adrenal cortical insufficiency; if the former is 13.8～27.6 μmol/24 hours and the latter is 17.35～34.7 μmol/24 hours, it is suspicious for grade I adrenal cortical insufficiency; if the former is >27.6 μmol/24 hours and the latter is >34.7 μmol/24 hours, adrenal cortical function is normal. Patients with liver disease, malnutrition, and chronic wasting diseases may also have reduced excretion.
2. Plasma 17-hydroxycorticosteroid measurement: Often significantly reduced in patients with this disease.
3. ACTH stimulation test: This test can measure adrenal reserve function. In severe primary adrenal cortical insufficiency, there is no response after continuous stimulation for 2～5 days; in mild cases, there may be a low response early on, with a grade I increase in the first 8 days of a 5-day intravenous drip test, followed by a decrease in the last 2 days, indicating impaired cortical function. In secondary adrenal cortical insufficiency, the response is smaller on the first and second days, and gradually recovers after continuous stimulation for 3 days. This test can be used to differentiate between primary and secondary adrenal cortical insufficiency and is also a main indicator for diagnosing this disease.
4. Water load test: Empty the bladder at 7 AM, and urinate at 8, 9, 10, and 11 AM, recording the volume each time. If the total volume over 4 hours is >50%, it is negative. If <50%, repeat the test the next day after oral administration of 50 mg of cortisone. If the excretion volume significantly increases, it confirms adrenal cortical insufficiency.

bubble_chart Pattern Analysis

1. Spleen-kidney Yang Deficiency︰Complexion dark or dark all over, mental fatigue and lack of strength, drowsiness and desire to lie down, facial puffiness and limb swelling, poor appetite, or even vomiting, abdominal distension and fullness, loose and thin stools, clear and copious urine, soreness and pain in the lower back, fear of cold and cold limbs, dull and falling hair, decreased libido, vertigo and palpitations. Tongue texture pale and swollen-tender with white coating, pulse deep, faint and thin or weak and feeble. Warm and tonify kidney yang, tonify the spleen and replenish qi. Modified Fourteen-Ingredient Center-Fortifying Decoction. Aconite Lateral Root 10g, Cassia Bark 6g, Desertliving Cistanche 15g, Chinese Angelica 10g, White Atractylodes Rhizome 10g, Tangshen 15g, Liquorice Root 6g, Sichuan Lovage Rhizome 6g, Astragalus Root 30g, Prepared Rehmannia Root 15g, Indian Bread Tuckahoe 10g. For indigestion, add Chicken's Gizzard-Skin, Millet Sprout, Germinated Barley, and Hawthorn Fruit 10g each, Villous Amomum Fruit 6g; for chest and hypochondriac fullness, add Dried Tangerine Peel, Aucklandia Root, and Radish Seed 10g each; for severe diarrhea, add Evodia Fruit 6g, Dried Ginger 10g, and Nutmeg 10g.
2. Kidney Yang Deficiency︰The body is covered with black flags, the eye sockets are black, the waist and knees are sore and weak, lack of strength, fear of cold, cold limbs, especially cold pain in the back, clear and long urine, frequent nocturia, generalized edema, obvious swelling of the lower limbs, dizziness, emaciation; hair loss, sexual dysfunction, impotence and seminal emission in men, cold abdomen and excessive vaginal discharge leading to infertility in women. The tongue is pale with a white and slippery coating, and the pulse is faint, weak, or deep and weak. The treatment involves warming and tonifying kidney yang and nourishing the lower origin. Modified Right-Restoring Pill is used, consisting of Prepared Rehmannia Root 15g, Chinese Yam 15g, Cornus Officinalis 10g, Barbary Wolfberry Fruit 15g, Eucommia Bark 10g, Aconite Lateral Root 10g, Cassia Bark 6g, Dodder Seed 30g, Cervi Deer-Horn Glue 10g (melted), and Chinese Angelica 10g. For obvious generalized edema, Poria, White Atractylodes Rhizome, and Polyporus can be added to warm yang and promote diuresis while benefiting the kidneys. For severe soreness and weakness of the waist and knees, Chinese Taxillus Herb, Dipsacus, and Psoralea can be added to strengthen the waist and bones. For urinary incontinence and frequent nocturia, Lindera, Chinese Yam, and Sharpleaf Galangal Fruit can be added to benefit the kidneys, consolidate essence, and reduce urination. For impotence and seminal emission, actinolite, Songaria Cynomorium Herb, and Mantis Egg-Case can be added to tonify yang and consolidate the kidneys. For scanty menstruation or amenorrhea leading to infertility in women, Motherwort Herb and Human Placenta can be added to invigorate and nourish blood.
3. Liver-kidney Yin Deficiency︰The body is dark and black, with soreness and weakness in the waist and knees, dizziness and tinnitus, blurred vision or dark spots, irritability and insomnia, depressed mood, numbness and trembling in the hands and feet, feverish feeling in the palms and soles, or low-grade fever, night sweats, and menstrual irregularities in women. The tongue is red with little moisture and a thin coating, and the pulse is wiry and thin or thin, rapid, and weak. Nourish water to moisten wood and enrich blood to replenish essence. Modified All-Along Decoction combined with Four Ingredients Decoction. Glehnia 20g, Ophiopogon Tuber 15g, Unprocessed Rehmannia Root 15g, Barbary Wolfberry Fruit 15g, Chinese Angelica 10g, Chinaberry Fruit 10g, Sichuan Lovage Rhizome 6g, Prepared Rehmannia Root 15g, Peony Root 10g. For trembling hands and feet, vertigo, and tinnitus, add Gastrodia Tuber, Uncaria, and Abalone Shell. For empty pain in the head, tinnitus, and deafness, add human placenta and tortoise-plastron glue. For irritability and insomnia, add Schisandra Fruit, Milkwort Root, and Platycladi Seed. For night sweats, add glutinosae rice root and Smoked Plum. For low-grade fever or tidal fever, add Chinese Wolfberry Root-bark and Sweet Wormwood.
4. Deficiency of Both Qi and Blood︰Fatigue, lack of strength, poor appetite, dizziness, palpitations, insomnia, pale yellow facial skin gradually turning dark. Pale tongue with little coating, thin and weak pulse. Tonifying qi and nourishing blood. Modified Returning to Spleen Decoction. White Atractylodes Rhizome 10g, Poria with Pine 15g, Astragalus Root 15g, Longan Aril 10g, Sour Jujube 10g, Tangshen 10g, Aucklandia Root 6g, Prepared Liquorice Root 6g, Chinese Angelica 10g, Milkwort Root 10g. For blood stasis, add Sichuan Lovage Rhizome and Salvia; for yin deficiency, add Ophiopogon Tuber and Prepared Rehmannia Root.