Chinese medicine believes that chronic nephritis mostly falls under the categories of "edema," "hematuria," and "lumbago," and in the late stage [third stage], it can belong to the category of "deficiency fatigue." Its onset is often due to "deficiency in origin and excess in manifestation," "spleen and kidney deficiency, invasion of external pathogens," and insufficient function of the zang-fu organs, leading to stagnation of dampness turbidity and internal obstruction of static blood. Dampness-heat and stasis toxins, in turn, exacerbate the injury to healthy qi, resulting in a deficiency-type pathogen and excess, mutually causal, and intertwined, making the disease persistent and difficult to cure. The disease cause and pathology are briefly described as follows:

1. Deficiency of healthy qi: Improper diet, overstrain causing internal damage, injury to the spleen and kidney; or living in damp environments, leading to internal invasion of dampness and spleen-kidney qi deficiency, qi failing to promote water transformation, resulting in internal retention of water-dampness. Prolonged spleen-kidney qi deficiency leads to yang deficiency, causing spleen-kidney yang deficiency; spleen yang deficiency fails to transform water-dampness, and kidney yang deficiency leads to dysfunction of qi transformation, resulting in water-dampness overflow. Chronic illness progresses from yang to yin, or excessive use of warm-dry substances damages yin, or indiscriminate use of clearing and draining substances depletes yang, leading to insufficient kidney yang, water failing to nourish the root, resulting in liver-kidney yin deficiency; spleen deficiency fails to generate qi and blood, kidney deficiency leads to essential qi deficiency, causing deficiency of both qi and yin, and insufficient nutrient-blood; spleen-kidney qi deficiency leads to gradual lung qi deficiency, weakened defensive exterior, and susceptibility to external pathogens.
2. Excess of pathogens: External pathogens include wind, cold, dampness, and heat, while internal pathogens mainly include water turbidity, dampness-heat, and static blood. Internal retention of water-dampness has the tendency to transform into cold or heat. If the body's yang qi is insufficient, it transforms into cold-dampness; if the body's yang is exuberant, it transforms into dampness-heat. Prolonged stagnation of dampness is prone to transform into heat, and the combination of dampness-heat becomes stubborn and difficult to resolve, leading to persistent illness. Dampness-heat scorches the blood, which over time coagulates into stasis, presenting as static blood. If external pathogens invade due to deficiency, they can trigger internal excess pathogens, leading to acute attacks or sudden worsening of the condition. Wind, cold, dampness, and heat can only cause this disease on the basis of deficiency of healthy qi.

bubble_chart Modern Research

Chronic glomerulonephritis, abbreviated as chronic nephritis, is a common chronic sexually transmitted disease caused by various factors, predominantly affecting adults. Clinically, it is typically manifested by proteinuria, hematuria, cylindruria, edema, and hypertension; the disease has a progressive development tendency and is the most significant clinical cause of chronic kidney failure.

The onset of chronic nephritis is significantly influenced by autoimmune reactions, with lesions affecting most of the glomeruli in both kidneys. Under the influence of various antigens (such as bacteria, viruses, and renal or non-renal antigens), the body may undergo immune reactions, forming antigen-antibody complexes that deposit on the glomerular basement membrane, activating the complement system, coagulation system, and kinin system, leading to a series of pathological reactions. Additionally, the onset of chronic nephritis is closely related to hemorheology and water-electrolyte imbalances. Based on clinical characteristics, it can be classified into three types: common type, hypertensive type, and acute attack type. The pathological types of chronic nephritis include minimal change disease, mesangial proliferative type, membranous type, membranoproliferative type, focal sclerosis, IgA nephropathy, among others. These types are closely related to the prognosis of chronic nephritis and usually require renal biopsy for determination.

[Diagnosis]

1. The onset is slow, with a protracted course, fluctuating severity, and gradual decline in renal function. In the late stage [third stage], anemia, retinal membrane lesions, and uremia appear.
2. There are varying degrees of proteinuria, hematuria, edema, and hypertension.
3. During the course of the disease, acute attacks may be triggered by respiratory infections, presenting symptoms similar to acute nephritis. Some cases may also spontaneously enter a stage of remission.
4. Based on clinical manifestations, it can be further differentiated into:
   1. Common type: exhibits various symptoms of nephritis but without prominent manifestations.
   2. Hypertensive type: in addition to general nephritis symptoms, there are prominent hypertension manifestations.
   3. Acute stage of attack: during the chronic course, acute nephritis syndrome manifestations appear.

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bubble_chart Pattern Analysis

1. Spleen-kidney Qi Deficiency︰The complexion is pale or slightly yellow, with mild grade I edema, often worsening after fatigue or a common cold. Symptoms include soreness and pain in the lower back and knees, dizziness, lack of strength, poor appetite, loose stools, and scanty urine. The tongue appears pale or slightly swollen with a thin white coating, and the pulse is thin and weak. This condition is commonly seen in ordinary or latent nephritis. Treatment focuses on strengthening the spleen and tonifying the kidneys, supplemented by eliminating dampness and reducing swelling. Modified Major Original-Qi Tonifying Decoction is used, consisting of: Codonopsis Root 10g, White Atractylodes Rhizome 10g, Astragalus Root 20g, Poria 15g, Chinese Yam 15g, Prepared Rehmannia Root 15g, Asiatic Cornelian Cherry Fruit 10g, Dodder Seed 15g, Eucommia Bark 10g, Coix Seed 15g, Chinese Angelica 10g. For cases leaning more toward spleen qi deficiency, increase the dosage of Codonopsis Root and Astragalus Root. For those with pronounced kidney deficiency, add Morinda Root 10g and Dipsacus Root 12g. If accompanied by fever, cough, or sore throat, add Mulberry Leaf 6g, Chrysanthemum Flower 6g, and Paris Root 10g. For severe throat swelling and pain, add Scrophularia Root 10g, Platycodon Root 10g, Great Burdock Achene 10g, and Belamcanda Rhizome 10g.
2. Spleen-kidney Yang Deficiency︰Generalized severe edema, especially pronounced below the waist with pitting upon pressure, accompanied by mental fatigue, cold limbs, abdominal distension and fullness, scanty urine, cough with dyspnea, and inability to lie flat. The tongue appears pale and tender or with tooth marks, coated with white and slippery fur, and the pulse is deep, thin, and weak. This condition is commonly seen in the nephrotic type. Treatment involves warming yang and excreting water, using modified True Warrior Decoction combined with Five-Peel Decoction: Prepared Aconite Lateral Root 10g, Morinda 10g, Dried Ginger 6g, Peony Root 10g, White Atractylodes Rhizome 6g, Tuckahoe Peel 10g, Areca Peel 15g, Tangshen 5g, Astragalus Root 15g, Polyporus 10g, Alisma 10g, Pricklyash Seed 10g, Chinese Date 6 pieces. For severe kidney yang deficiency, add Cassia Bark 6g. After edema subsides, urine output increases, and appetite improves, continue with Life-Relieving Kidney Qi Pill.
3. Liver-kidney Yin Deficiency︰Dizziness, tinnitus, palpitations, insomnia, feverish sensation in the palms and soles, or mild grade I edema, red tongue with scant coating, and thin pulse. Commonly seen in hypertension type or long-term use of steroids. Nourishing water to moisten wood, pacifying the liver and subduing yang, modified Wolfberry and Chrysanthemum Rehmannia Pill: Barbary Wolfberry Fruit 15g, Chrysanthemum Flower 10g, Unprocessed Rehmannia Root 15g, Asiatic Cornelian Cherry Fruit 15g, Chinese Yam 15g, Achyranthes Root 10g, Eucommia Bark 10g, Salvia 10g. For restlessness and insomnia with scanty dark urine, add Gardenia 10g, Bamboo Leaf 6g; for hematuria, replace Unprocessed Rehmannia Root with charred Unprocessed Rehmannia Root 15g, and add Large and Small Thistle 10g each, Lalang Grass Rhizome 15g; for ascendant hyperactivity of liver yang, add Antelope Horn Powder 2g (taken separately), Uncaria 10g, Nacre 10g.
4. Deficiency of Both Qi and Yin︰Dull complexion, irritability, insomnia, mental fatigue, lack of strength, low-grade fever in the afternoon or at night, or feverish sensation in the palms and soles, dry mouth and throat, reddened throat. The tongue is reddish with scant coating, and the pulse is thin and weak. Treatment involves tonifying qi, nourishing yin, and tonifying blood. Modified Four Gentlemen Decoction combined with Six-Ingredient Rehmannia Decoction. Codonopsis Root 10g, Raw Astragalus Root 15g, Raw Rehmannia Root 15g, Asiatic Cornelian Cherry Fruit 15g, Chinese Yam 15g, Moutan Bark 10g, Poria 10g, Alisma 10g, White Atractylodes Rhizome 10g, Liquorice Root 6g. Modifications: For severe heart qi deficiency, combine with Pulse-Engendering Drink; for severe kidney qi deficiency, add Dodder Seed 10g, Eucommia Bark 10g; for liver yin deficiency, add Raw Peony Root 10g, Glossy Privet Fruit 15g, Yerbadetajo Herb 15g; for prolonged sore throat, add Coastal Glehnia Root and Scrophularia Root; for anorexia, abdominal distension, and fullness, add Submature Bitter Orange 10g, Germinated Rice and Germinated Barley 10g each.
5. External Contractionwind-cold︰Headache, chills, fever without sweating, puffy face. Thin white tongue coating, floating and tight pulse. Release the exterior and dissipate cold. Modified Nine-Ingredient Notopterygium Decoction: Notopterygium 10g, Saposhnikovia Root 10g, Atractylodes Rhizome 10g, Asarum 3g, Sichuan Lovage Rhizome 10g, Dahurian Angelica 10g, Astragalus Root 6g, Liquorice Root 6g, Rehmannia 10g. For fever with mild sweating, add Cinnamon Twig 6g and Peony Root 6g; for nasal congestion with clear discharge, add Magnolia Flower 10g and Fistular Onion Stalk 3 pieces.
6. Wind-heat External Contraction︰Sore throat, fever, headache, turbid nasal discharge, facial puffiness, scanty dark urine. Thin yellow greasy tongue coating, floating rapid pulse. Release the exterior with pungent-cool. Modified Lonicera and Forsythia Powder. Lonicera 10g, Forsythia 10g, Lophatherum Herb 6g, Schizonepeta 10g, Great Burdock Achene 10g, Mentha 6g, Liquorice Root 6g. For red swollen painful eyes, add Chrysanthemum Flower 6g; for severe constipation, add Hemp Seed 15g, Rhubarb Rhizoma 6g (to be decocted later).
7. Dampness-heat︰Sore throat, epigastric fullness, anorexia, scanty and painful urination, loose stools with difficulty in defecation. Red tongue with yellow greasy coating, slippery and rapid pulse. Clearing heat and draining dampness, modified Eight-Ingredient Rectification Powder combined with Sweet Dew Detoxicating Pill: Akebia Stem 10g, Plantain Seed 10g, Grass of Common Knotgrass 10g, Talc 12g, Cardamom Seed 10g, Coptis Rhizome 6g, Rhubarb Rhizoma 6g, Immature Orange Fruit 10g. For oral ulcers, add Lotus Plumule 10g; for severe poor appetite, abdominal distension, and fullness, combine with Xiangsha Liujunzi Pill.
8. Static Blood︰The lumbago is fixed and immobile, with dark and dull facial skin or subcutaneous petechiae, and scanty urine. The tongue is dark, and the pulse is thin and choppy. The treatment involves invigorating blood and resolving stasis, as well as unblocking collaterals. Modified Sudden Smile Powder is used: Trogopterus Dung 12g, Typha 12g, Chinese Angelica 10g, Red Peony Root 10g, Peach Kernel 15g, Carthamus 6g, Achyranthes Root 10g, Submature Bitter Orange 10g, Sichuan Lovage Rhizome 10g, dried Earthworm 6g. For severe phlegm-dampness, add Pro Formula Pinellia 10g and Bile Arisaema 10g; for kidney deficiency, add Barbary Wolfberry Fruit 15g and Dodder Seed 10g.