水肿4(慢性肾功能不全，双肾萎缩)
褚某，男，35岁，中国社会科学院某研究所科研人员。1982年患急性肾炎，未得根治，尿蛋白经常为++～+++，因其未至影响工作，故未重视治疗。1992年初发现血肌酐为3.1mg／dl.血尿素氮为24.7mg／d|，超出正常值不少，又作B超检查，结果显示双肾弥慢性病变，双肾萎缩，右肾缩小更甚，其左肾为9，2×4，1×3.7cm，右肾为7.7×3.8～4.1cm，遂确诊为慢性肾炎，继发慢性肾功能不全，氮质血症期。于1992年4月前来就诊。当时，尿蛋白为++，证见腰痛、乏力、恶心、纳呆、下肢浮肿。脉象濡滑数，按之有力，舌红苔白且腻根厚，练合脉、舌、色、证，辨为热入血分，络脉淤阻，湿郁不化冼用瘪血化瘀，疏风化湿方法。药用荆芥、防风、白芷、独活、苏叶、半夏、陈皮、生地榆、赤芍，丹参、茜草、焦三仙、水红花子、茅芦根，水煎服，每日一剂。并嘱其严格控制饮食，坚持进行走路锻炼，每甘不少于三小时。
二诊患者服上方一周后，湿郁已开，呕恶已除，精神转佳。但尿蛋白未减，余症仍在。遂于上方减去白芷、独活、苏叶、半夏、陈皮，加入小蓟、大腹皮、槟榔等。再服二周，自觉诸症皆减，身感有力，尿蛋白已降为¨，尿素氮降至正常范围，为14mg／dl.血叽酐降至2，3mg／dl.患者喜出望外，信心倍增，后依法坚持治疗一年余，尿蛋白维持在士～一之间，尿素氮和血肌酐也都维持在正常范围之内。最令人惊奇的是复查B超发现，患者的双肾均较治疗前明显增大，其左肾为9 2×4.9～3.7cm，右肾8.2×5.3×3.7cm。主检大夫对照前后两次B超结果，感到迷惑不解。因为本来已经萎缩了的肾脏竟又增大了，真令人不可思议。
[按]：本例为慢性肾小球肾炎长期不愈，发展为慢性肾功能不全+属于氧质血症期，按照现代医学的认识，其肾脏的病变将趋向于进行性恶化，并且是不可逆的。然而，经过赵师的精心治疗，在患者的密切配合下，获得了理想的治疗效果。不但血肌酐和尿素氮降到了正常范围，而且原已萎缩了的肾脏也有所增大。说明了在慢性肾功能衰竭阶段，其肾脏病变并非都是不可逆性的。中医药辨证论治，配合控制饮食和运动锻炼确实是治疗慢性肾病行之有效的方法。
水肿5(急性肾小球肾炎)
张某，男，5岁，于1990年1月31日初诊。患儿自1个月前因发热、浮肿去某儿童医院就诊，经化验检查尿蛋白抖，血白细胞13000／l.诊断为“急性肾小球肾炎”，住院治疗1月余，仍发热不退，尿蛋白不降，浮肿不消，遂请赵老会诊。但见发热不扬，咳嗽有痰，时有恶心呕吐，面目、眼睑及全身浮肿较甚，舌红起刺，苔黄根腻，脉滑数，化验检查：尿蛋白+++，血白细胞16000／mm3，体温38.5℃。证属热郁湿阻、肺气不宣，治拟芳香宣化，和胃止呕。药用苏叶3克，杏仁6克，佩兰6克，半夏6克，荆芥3克，茅芦根各10克，焦三仙各6克，水红花子6克。服5剂。热退，恶心呕吐未作，浮肿见消，仍咳嗽，大便干结，舌红苔白，尿蛋白+。用宣肺止咳，兼以清化方法，药用荆芥3克，防风3克，杏仁6克，前胡3克，浙贝母6克，茅芦根各10克，生地榆6克，茜草6克，瓜萎10克，焦三仙各6克，水红花子6克。又服药5剂，体温正常，咳嗽痰止，浮肿消失，食欲渐增，二便正常，精神转佳，舌红苔白，脉滑数，尿蛋白(一)。再以清热凉血化瘀治其本，药用荆芥3克，防风3克，生地榆6克，丹参6克，茜草6克，茅芦根各10克，焦麦芽10克。以此方服药5周，无其他不适，改每周7剂为每周服药3剂，又服5周未反复，而获痊愈。
[按]：急性肾小球肾炎属于中医“水肿”的范畴泳肿病是体内水液代谢功能紊乱，导致水液潴留，引起周身浮肿的病证。水肿的辨证，广义的可分为阳水与阴水两大类。阳水属实属表，包括风邪外袭，水锰浸渍，湿热蕴结，治疗多以祛邪为主；阴水属里属虐，包括脾肾阳虚或阴阳两虚，治疗多以扶正为主。本病案乃湿热内蕴，风邪外袭，肺气失宣，三焦不畅，故见发热不扬，咳嗽有痰，水肿较甚；三焦气化不利，中阳被水湿所困，可见恶心呕吐等，其主要矛盾是湿与热互结。对于湿热证的治疗，赵老认为，湿热证首当治湿，治湿必先化气，化气必当宣肺。盖肺主一身之气，肺气宣则一身气机通达，营卫调和，气化得行，湿乃自去，湿去热不独存。湿热去诸症自除。因此先以宣肺气化湿浊为法，取苏叶、杏仁、芦根宣展肺气，止咳化痰；苏叶、佩兰芳香化湿；半夏健脾和胃止呕，化湿去痰止咳；荆芥祛风胜湿，宣通气机；茅根利湿清热；焦三仙、水红花子消食导滞。服药5剂，热退肿消，湿去余热未清。又以前法加生地榆、茜草、瓜蒌等凉血清热之品；再服5剂，诸症皆除，而获痊愈。
水肿6(糖尿病性肾炎，慢性肾功衰竭)
粱某某，女，62岁
初诊
胰岛素依赖性糖尿病10余年，每日用胰岛素针剂，血糖得以控制。一年前发现尿中蛋白阳性，持续不降。诊断为糖尿病继发肾炎。半年前查出肌酐、尿素氮明显增高。近1个月来逐渐出现颜面及下肢浮肿，乏力殊甚，皮肤搔痒，恶心欲吐，脘腹胀满，不欲饮食等症。近查肌酐为5mg／dl，尿素氮54mg／dl.二氧化碳结合力38.脉象濡软，按之有力，舌胖苔白而腻，面色苍白浮肿，下肢水肿，按之官而不起小便短少色白，大便不畅，夜寐梦多，心炳急躁。此中阳不足，又兼血分郁热，益气行水，凉血化瘀，两兼顾之。
生黄芪30克，荆芥6克，苏叶10克，防风6克，白芷6克，生地榆10克，炒槐花r0克，丹参10克，茜草10克，茅芦根各10克，冬瓜皮30克，茯苓皮30克，大腹皮15克，槟榔10克，大黄2克，七付
二诊
药后小便增多，大便畅行，面肿已消，下肢肿消大半，呕恶减轻，搔痒尚存。脉仍濡软沉滑，舌白苔腻，继用前法进退。
黄芪30克，荆芥6克，苏叶10克，防风6克，白芷6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，地肤子10克，白鲜皮10克，草河车10克，冬瓜皮10克，大腹皮10克，大黄2克，七付
三诊
下肢浮肿全消，皮肤搔痒大减，微觉呕恶，脘腹稍胀，脉象濡滑，舌白苔润，再以疏调三焦方法。
黄芪30克，荆芥6克，苏叶10克，生地榆10克，炒槐花10克，丹参10克，茜草10克，青陈皮各10克，木香6克，焦三仙各10克，水红花子10克，大腹皮10克，槟榔10克，大黄3克，七付
四诊
胀消纳增，夜寐梦多，脉象濡滑，按之弦数，舌白苔腻，时觉心烦，肝经郁热未清，再以前法，参以清肝方法。
柴胡6克，黄芩6克，川楝子6克，荆芥6克，防风6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，炒枳壳6克，竹叶茹各10克，焦三仙各10克，大腹皮10克，槟榔10克，大黄3克，七付
五诊
药后眠安梦减，大便日二三行，小便如常。唯觉疲乏，余症全安。近查肌酐为3，2mg／dl.尿素氮28mg／dl.尿蛋白土。脉象濡软，舌白苔润，继用前法进退。
荆芥6克，防风6克，苏叶10克，白芷6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，茅芦根各10克，焦三仙各10克，大腹皮10克，槟榔10克，大黄3克，七付
后以上方加减，续服三个月，并以控制饮食，每日运动为配合，肌酐、尿素氨恢复正常水平，尿蛋白保持在士～+之间。
[按]：糖尿病继发肾炎肾衰，治疗较为困难。因为糖尿病屑气虚者多，肾炎肾衰则为郁热。补气则增热，清热恐伤气，故为两难。本案即是其例，其水肿的发生，既有气虚不适的一面，又有湿热蕴郁的一面。赵师在治疗中采服两顾之法，一方面重用黄芪补气，另一方面群集疏风化湿、凉血化瘀、利水消肿之品，使补气不碍邪，祛邪不伤正澈投之即收消肿之效。其后数诊，在大法不变的前提下，随症治之，如搔痒加地肤子、白鲜皮、草河车；腹胀满加青陈皮、木香，焦三仙；夜寐梦多加柴胡、黄芩、川楝子、竹叶茹等，药随症变，症随药消。既以不变应万变——其基本治法始终如一；又有应变之变——有是症则用是药。体现了在把握病机的前提下的辨证论治精神。这就是赵师独到经验的精华。
关格1(尿毒症)
孙某，男，47岁，1989年5月31日初诊。自1988年10月发现尿少、尿浊，下肢浮肿，未引起重视。于1989年1月7目突然晕倒昏迷，医院以一氧化碳中毒抢救10余天无效，后查尿素氨250mg／dl.血色素4g／dl，确诊为尿毒症，改血液透析疗法，每周2次至今。现求赵老诊治。刻诊时，患者面色褐浊，体质较差，口中秽浊较重，时恶心呕吐，皮肤作痒，大便干结，小便黄赤，周身乏力，腰酸嗜睡，下肢麻木，行走不利，舌红苔白厚腻。脉弦滑有力，查尿素氮110rag／dl.肌酐4mg／dl.尿蛋白(+)，血压140／90mmHg，证属湿热积滞互阻，湿阻气分，热郁血分，络脉瘀阻。治以清化湿热，消食导滞，活血化瘀，佐以通络方法。方药：荆芥6克，防风6克，生地榆10克，丹参10克，茜草10克，赤芍10克，藿香10克(后下)，佩兰10克(后下)，白芷6克，紫草10克，地丁草10克，自鲜皮10克，大黄2克。服药10剂，症状见轻，皮肤痒止，以上方去白鲜皮、地丁草、紫草，加半夏10克，竹茹6克，灶心土30克，又服药10余剂，腰酸嗜睡好转，恶心呕吐未作，饮食二便正常，唯下肢麻木，舌红苔白，脉滑数，查尿素氮14.4mg／dl.肌酐1.1rng／dl.尿蛋白+，改透析每周一次，用清化湿热、益气活血通络方法。方用荆芥炭10克，防风6克，丹参10克，茜草10克，生地榆10克，炒槐花10克，赤芍10克，黄芪30克，丝瓜络10克，桑枝10克，大黄2克。服药20余剂，无其他不适，停透析。停透1个月后，查尿素氮11.7mg／dl肌酐1.2mg/d1.血色素11.0g／dl.尿蛋白(一)，病情稳定。停透析半年后，复查肾功能、尿常规、血常规均在正常范围，未见复发，尿毒症痊愈，唯留下透析后下肢麻木行动不利后遗症。
[按]：此患者为尿毒症晚期，中毒症状较重，且已经血透，经赵老治疗后，不但临床症状全部消失，而且停止血透后化验指标全部正常，而获痊愈。充分证明尿毒证并非不可逆转，肾功能衰竭患者完全有可能恢复部分肾功能。但透析后的骨质疏松症而引起的下肢麻木等后遗症，则是今后待解决的新课题。
Edema Case 4 (Chronic Renal Insufficiency, Bilateral Renal Atrophy)
Patient Chu, male, 35 years old, a researcher at an institute of the Chinese Academy of Social Sciences. In 1982, he suffered from acute nephritis but did not receive radical treatment; urinary protein levels were frequently ++ to +++. As it did not affect his work, he did not attach importance to the treatment. In early 1992, blood creatinine was found to be 3.1 mg/dl and blood urea nitrogen (BUN) was 24.7 mg/dl, significantly exceeding normal values. An ultrasound examination showed diffuse lesions in both kidneys and bilateral renal atrophy, with the right kidney shrinking more severely; the left kidney measured 9.2 × 4.1 × 3.7 cm, and the right kidney measured 7.7 × 3.8–4.1 cm. He was subsequently diagnosed with chronic nephritis complicated by chronic renal insufficiency in the azotemia stage. He sought medical consultation in April 1992. At that time, urinary protein was ++. Symptoms included lower back pain, fatigue, nausea, poor appetite, and edema of the lower limbs. The pulse was soft, slippery, and rapid, feeling forceful upon pressure. The tongue was red with a white coating that was thick and greasy at the root. Synthesizing the pulse, tongue, complexion, and symptoms, the pattern was differentiated as heat entering the Blood level, collateral obstruction, and dampness stagnation failing to transform. The treatment method selected was promoting blood circulation to remove blood stasis and dispersing wind to resolve dampness. Herbs used included Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Baizhi (Angelicae Dahuricae Radix), Duhuo (Angelicae Pubescentis Radix), Ziyeh (Perillae Folium), Banxia (Pinelliae Rhizoma Praeparatum), Chenpi (Citri Reticulatae Pericarpium), Shengdiyue (Sanguisorbae Radix), Chishao (Paeoniae Radix Rubra), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Qiancao (Rubiae Cordifoliae Radix et Rhizoma), Jiao Sanxian (Fried Fructus Hordei, Fructus Triticum, and Fructus Crataegi), Shuihonghuazi (Polygoni Multiflori Caulis), and Maolugen (Imperatae Rhizoma and Phragmitis Rhizoma). Decocted in water, taken once daily. He was also instructed to strictly control his diet and persist in walking exercise for no less than three hours per day.
Second Visit: After taking the above prescription for one week, the dampness stagnation had resolved, vomiting and nausea ceased, and mental spirit improved. However, urinary protein had not decreased, and other symptoms persisted. Therefore, Baizhi, Duhuo, Ziyeh, Banxia, and Chenpi were removed from the original formula, and Xiaoji (Cibotii Rhizoma), Fudupi (Arecae Pericarpium), and Binglang (Arecae Semen) were added. After taking this modified prescription for another two weeks, he felt all symptoms had diminished, regained strength, urinary protein dropped to +, BUN decreased to the normal range at 14 mg/dl, and blood creatinine dropped to 2.3 mg/dl. The patient was overjoyed and his confidence increased significantly. He continued treatment according to this method for over a year. Urinary protein remained between ± and -, while BUN and blood creatinine were maintained within normal ranges. Most surprisingly, a follow-up ultrasound revealed that both kidneys had enlarged significantly compared to before treatment; the left kidney measured 9.2 × 4.9–3.7 cm, and the right kidney measured 8.2 × 5.3 × 3.7 cm. The chief examining doctor, comparing the results of the two ultrasounds, was puzzled. It was incredible that the already atrophied kidneys had actually enlarged.
[Commentary]: This case involves chronic glomerulonephritis that failed to heal for a long time, progressing to chronic renal insufficiency in the azotemia stage. According to modern medicine, the renal pathology tends toward progressive deterioration and is irreversible. However, through careful treatment by Master Zhao and close cooperation from the patient, ideal therapeutic effects were achieved. Not only did blood creatinine and BUN drop to normal ranges, but the previously atrophied kidneys also enlarged somewhat. This indicates that renal lesions in the stage of chronic renal failure are not always irreversible. Differentiated syndrome treatment using Traditional Chinese Medicine (TCM), combined with dietary control and exercise, is indeed an effective method for treating chronic kidney disease.
Edema Case 5 (Acute Glomerulonephritis)
Patient Zhang, male, 5 years old, first consulted on January 31, 1990. One month prior, due to fever and edema, the child visited a children's hospital. Laboratory tests showed urinary protein ++ and white blood cell count 13,000/l. Diagnosed with "acute glomerulonephritis," he was hospitalized for over a month. Fever persisted, urinary protein did not decrease, and edema did not subside. Consequently, Old Master Zhao was invited for consultation. Signs observed included low-grade fever, cough with phlegm, occasional nausea and vomiting, severe edema of the face, eyelids, and whole body. The tongue was red with prickles, coated yellow and greasy at the root. The pulse was slippery and rapid. Laboratory checks showed: urinary protein +++, white blood cell count 16,000/mm³, body temperature 38.5°C. The pattern belonged to heat stagnation and dampness obstruction, with failure of Lung Qi to diffuse. The treatment principle was aromatic diffusion and transformation, harmonizing the Stomach to stop vomiting. Herbs used included Ziyeh (Perillae Folium) 3g, Xingren (Armeniacae Semen Amarum) 6g, Peilan (Eupatorii Herba) 6g, Banxia (Pinelliae Rhizoma Praeparatum) 6g, Jingjie (Schizonepetae Spica) 3g, Maolugen (Imperatae Rhizoma and Phragmitis Rhizoma) 10g each, Jiao Sanxian (Fried Fructus Hordei, Fructus Triticum, and Fructus Crataegi) 6g each, and Shuihonghuazi (Polygoni Multiflori Caulis) 6g. Taken for 5 doses. Fever subsided, nausea and vomiting did not recur, edema began to subside, but cough persisted, stools were dry, tongue was red with white coating, and urinary protein was +. The method of diffusing Lung Qi to stop coughing, combined with clearing and transforming, was used. Herbs included Jingjie (Schizonepetae Spica) 3g, Fangfeng (Saposhnikoviae Radix) 3g, Xingren (Armeniacae Semen Amarum) 6g, Qianhu (Peucedani Radix) 3g, Zhebeimu (Fritillariae Cirrhosae Bulbus) 6g, Maolugen (Imperatae Rhizoma and Phragmitis Rhizoma) 10g each, Shengdiyue (Sanguisorbae Radix) 6g, Qiancao (Rubiae Cordifoliae Radix et Rhizoma) 6g, Gualou (Trichosanthis Fructus) 10g, Jiao Sanxian (Fried Fructus Hordei, Fructus Triticum, and Fructus Crataegi) 6g each, and Shuihonghuazi (Polygoni Multiflori Caulis) 6g. After another 5 doses, body temperature normalized, cough and phlegm stopped, edema disappeared, appetite gradually increased, urination and defecation were normal, mental spirit improved, tongue was red with white coating, pulse was slippery and rapid, and urinary protein was (-). To treat the root with clearing heat, cooling blood, and removing blood stasis, herbs included Jingjie (Schizonepetae Spica) 3g, Fangfeng (Saposhnikoviae Radix) 3g, Shengdiyue (Sanguisorbae Radix) 6g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 6g, Qiancao (Rubiae Cordifoliae Radix et Rhizoma) 6g, Maolugen (Imperatae Rhizoma and Phragmitis Rhizoma) 10g each, and Jiao Maiya (Fried Fructus Hordei Germinatus) 10g. Taking this prescription for 5 weeks without other discomforts, the dosage was changed from 7 doses per week to 3 doses per week. After another 5 weeks without recurrence, full recovery was achieved.
[Commentary]: Acute glomerulonephritis belongs to the category of "Edema" in TCM. Edema disease refers to a condition where dysfunction in the metabolism of body fluids leads to fluid retention, causing generalized edema. Broadly, edema differentiation can be divided into Yang Edema and Yin Edema. Yang Edema is excess and exterior, including external invasion of wind pathogen, immersion by water-dampness, and accumulation of damp-heat; treatment mainly focuses on expelling pathogens. Yin Edema is interior and deficiency, including Spleen-Kidney Yang deficiency or Yin-Yang dual deficiency; treatment mainly focuses on supporting healthy Qi. This case involved internal accumulation of damp-heat, external invasion of wind pathogen, loss of Lung Qi diffusion, and unsmooth Triple Burner, resulting in low-grade fever, cough with phlegm, and severe edema; unfavorable Qi transformation in the Triple Burner and Middle Yang trapped by water-dampness led to nausea and vomiting, etc. The main contradiction was the intermingling of dampness and heat. Regarding the treatment of damp-heat patterns, Old Master Zhao believed that treating dampness should come first; transforming dampness requires regulating Qi, and regulating Qi must involve diffusing Lung Qi. Since the Lung governs the Qi of the whole body, when Lung Qi diffuses, the Qi mechanism of the whole body becomes unobstructed, Ying and Wei harmonize, Qi transformation proceeds, and dampness naturally disappears; once dampness is gone, heat cannot exist alone. With the removal of damp-heat, all symptoms naturally disappear. Therefore, the initial method was diffusing Lung Qi to transform damp-turbidity, using Ziyeh (Perillae Folium), Xingren (Armeniacae Semen Amarum), and Lugen (Phragmitis Rhizoma) to diffuse Lung Qi, stop cough, and resolve phlegm; Ziyeh (Perillae Folium) and Peilan (Eupatorii Herba) to aromatically transform dampness; Banxia (Pinelliae Rhizoma Praeparatum) to strengthen the Spleen, harmonize the Stomach, stop vomiting, and transform dampness/phlegm; Jingjie (Schizonepetae Spica) to dispel wind and overcome dampness, diffusing the Qi mechanism; Maogen (Imperatae Rhizoma) to promote diuresis and clear heat; Jiao Sanxian (Fried Fructus Hordei, Fructus Triticum, and Fructus Crataegi) and Shuihonghuazi (Polygoni Multiflori Caulis) to digest food and guide out stagnation. After 5 doses, fever subsided, swelling reduced, dampness went, but residual heat remained. Using the previous method plus Shengdiyue (Sanguisorbae Radix), Qiancao (Rubiae Cordifoliae Radix et Rhizoma), Gualou (Trichosanthis Fructus) and other blood-cooling and heat-clearing herbs; after another 5 doses, all symptoms were eliminated, achieving full recovery.
Edema Case 6 (Diabetic Nephropathy, Chronic Renal Failure)
Patient Liang, female, 62 years old.
First Visit
Insulin-dependent diabetes for over 10 years, using insulin injections daily, blood sugar controlled. One year ago, positive urinary protein was discovered, persistently not decreasing. Diagnosed with diabetic secondary nephritis. Half a year ago, creatinine and BUN were found to be significantly elevated. Over the past month, gradual onset of facial and lower limb edema, severe fatigue, skin itching, nausea with desire to vomit, abdominal distension and fullness, and lack of desire to eat. Recent checks showed creatinine 5 mg/dl, BUN 54 mg/dl, CO2 combining power 38. Pulse was soft and weak, feeling forceful upon pressure. Tongue was fat with white greasy coating. Complexion was pale and puffy. Lower limb edema, indentation remaining after pressure. Urine was scanty and white, bowel movements were unsmooth, sleep was disturbed with many dreams, heart was irritable and impatient. This indicated insufficient Middle Yang, combined with stagnant heat in the Blood level. The method was tonifying Qi to move water, cooling blood and removing blood stasis, addressing both aspects.
Sheng Huangqi (Astragali Radix) 30g, Jingjie (Schizonepetae Spica) 6g, Ziyeh (Perillae Folium) 10g, Fangfeng (Saposhnikoviae Radix) 6g, Baizhi (Angelicae Dahuricae Radix) 6g, Shengdiyue (Sanguisorbae Radix) 10g, Chao Huaihua (Fried Flos Sophorae Immaturus) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qiancao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Maolugen (Imperatae Rhizoma and Phragmitis Rhizoma) 10g each, Dongguapi (Benincasae Exocarpium) 30g, Fulingpi (Poria Cum Mycelium Peel) 30g, Fudupi (Arecae Pericarpium) 15g, Binglang (Arecae Semen) 10g, Dahuang (Rhei Radix et Rhizoma) 2g. Seven doses.
Second Visit
After medication, urine volume increased, bowel movements flowed smoothly, facial swelling subsided, lower limb swelling reduced by more than half, nausea and vomiting alleviated, itching still present. Pulse remained soft, weak, deep, and slippery. Tongue had white greasy coating. Continuing the previous method with adjustments.
Huangqi (Astragali Radix) 30g, Jingjie (Schizonepetae Spica) 6g, Ziyeh (Perillae Folium) 10g, Fangfeng (Saposhnikoviae Radix) 6g, Baizhi (Angelicae Dahuricae Radix) 6g, Shengdiyue (Sanguisorbae Radix) 10g, Chao Huaihua (Fried Flos Sophorae Immaturus) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qiancao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Difuzi (Kochiae Fructus) 10g, Baixianpi (Dictamni Cortex) 10g, Caoheche (Radix Arisaomatis cum Bile) 10g, Dongguapi (Benincasae Exocarpium) 10g, Fudupi (Arecae Pericarpium) 10g, Dahuang (Rhei Radix et Rhizoma) 2g. Seven doses.
Third Visit
Lower limb edema completely resolved, skin itching greatly reduced, slight nausea, slight abdominal distension. Pulse was soft and slippery. Tongue had white moist coating. Again using the method of smoothing and regulating the Triple Burner.
Huangqi (Astragali Radix) 30g, Jingjie (Schizonepetae Spica) 6g, Ziyeh (Perillae Folium) 10g, Shengdiyue (Sanguisorbae Radix) 10g, Chao Huaihua (Fried Flos Sophorae Immaturus) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qiancao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Qingchenpi (Citri Reticulatae Pericarpium Viride and Citri Reticulatae Pericarpium) 10g each, Muxiang (Aucklandiae Radix) 6g, Jiao Sanxian (Fried Fructus Hordei, Fructus Triticum, and Fructus Crataegi) 10g each, Shuihonghuazi (Polygoni Multiflori Caulis) 10g, Fudupi (Arecae Pericarpium) 10g, Binglang (Arecae Semen) 10g, Dahuang (Rhei Radix et Rhizoma) 3g. Seven doses.
Fourth Visit
Distension resolved, appetite increased, sleep disturbed with many dreams. Pulse was soft and slippery, feeling wiry and rapid upon pressure. Tongue had white greasy coating, occasional feeling of vexation. Liver Meridian stagnant heat not yet cleared. Again using the previous method, supplemented with clearing Liver heat.
Chaihu (Bupleuri Radix) 6g, Huangqin (Scutellariae Radix) 6g, Chuanlianzi (Toosendan Fructus) 6g, Jingjie (Schizonepetae Spica) 6g, Fangfeng (Saposhnikoviae Radix) 6g, Shengdiyue (Sanguisorbae Radix) 10g, Chao Huaihua (Fried Flos Sophorae Immaturus) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qiancao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Chao Zhike (Fried Fructus Aurantii) 6g, Zhuyerujia (Folium Bambusae in Templa Preparatum and Fructus Phyllostachydis Henonis) 10g each, Jiao Sanxian (Fried Fructus Hordei, Fructus Triticum, and Fructus Crataegi) 10g each, Fudupi (Arecae Pericarpium) 10g, Binglang (Arecae Semen) 10g, Dahuang (Rhei Radix et Rhizoma) 3g. Seven doses.
Fifth Visit
After medication, sleep was peaceful, dreams reduced, bowel movements 2-3 times daily, urination normal. Only felt fatigue, other symptoms fully relieved. Recent checks showed creatinine 3.2 mg/dl, BUN 28 mg/dl, urinary protein ±. Pulse was soft and weak. Tongue had white moist coating. Continuing the previous method with adjustments.
Jingjie (Schizonepetae Spica) 6g, Fangfeng (Saposhnikoviae Radix) 6g, Ziyeh (Perillae Folium) 10g, Baizhi (Angelicae Dahuricae Radix) 6g, Shengdiyue (Sanguisorbae Radix) 10g, Chao Huaihua (Fried Flos Sophorae Immaturus) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qiancao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Maolugen (Imperatae Rhizoma and Phragmitis Rhizoma) 10g each, Jiao Sanxian (Fried Fructus Hordei, Fructus Triticum, and Fructus Crataegi) 10g each, Fudupi (Arecae Pericarpium) 10g, Binglang (Arecae Semen) 10g, Dahuang (Rhei Radix et Rhizoma) 3g. Seven doses.
Subsequently, based on the above formula with modifications, continued taking for three months, combined with dietary control and daily exercise. Creatinine and BUN returned to normal levels, urinary protein remained between ± and +.
[Commentary]: Treatment of diabetic secondary nephritis leading to renal failure is relatively difficult. Because diabetes often involves Qi deficiency, while nephritis and renal failure involve stagnant heat. Tonifying Qi may increase heat, while clearing heat may damage Qi, making it a dilemma. This case is an example. The occurrence of edema here has both the aspect of Qi deficiency and the aspect of damp-heat accumulation. Master Zhao adopted a method of addressing both aspects in treatment: on one hand, heavily using Huangqi (Astragali Radix) to tonify Qi; on the other hand, gathering herbs to disperse wind, transform dampness, cool blood, remove blood stasis, and promote diuresis to reduce swelling. This ensures tonifying Qi does not hinder pathogens, and expelling pathogens does not damage healthy Qi, achieving immediate effect in reducing swelling. In subsequent visits, under the premise of unchanged major principles, treatment was adjusted according to symptoms: e.g., adding Difuzi (Kochiae Fructus), Baixianpi (Dictamni Cortex), Caoheche (Radix Arisaomatis cum Bile) for itching; adding Qingchenpi (Citri Reticulatae Pericarpium Viride and Citri Reticulatae Pericarpium), Muxiang (Aucklandiae Radix), Jiao Sanxian (Fried Fructus Hordei, Fructus Triticum, and Fructus Crataegi) for abdominal distension; adding Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Chuanlianzi (Toosendan Fructus), Zhuyerujia (Folium Bambusae in Templa Preparatum and Fructus Phyllostachydis Henonis) for disturbed sleep with many dreams. Medication changes with symptoms, symptoms dissipate with medication. This reflects responding to myriad changes with constancy—the basic treatment method remains consistent; and adapting change with change—using specific herbs for specific symptoms. This embodies the spirit of differentiated syndrome treatment based on grasping the pathogenesis. This is the essence of Master Zhao's unique experience.
Guan Ge Case 1 (Uremia)
Patient Sun, male, 47 years old, first consulted on May 31, 1989. Since October 1988, he noticed oliguria, turbid urine, and lower limb edema, which he did not pay attention to. On January 7, 1989, he suddenly fainted and fell into a coma. The hospital treated him for carbon monoxide poisoning for over 10 days without success. Subsequent tests showed urea ammonia 250 mg/dl and hemoglobin 4 g/dl. Diagnosed with uremia, he switched to hemodialysis therapy, twice weekly until now. He now seeks treatment from Old Master Zhao. Current diagnosis shows dark and turbid complexion, poor physical constitution, strong foul odor in the mouth, occasional nausea and vomiting, skin itching, dry stools, yellow-red urine, general fatigue, sore lower back, drowsiness, numbness in lower limbs, difficulty walking. Tongue was red with thick white greasy coating. Pulse was wiry, slippery, and forceful. Tests showed BUN 110 mg/dl, creatinine 4 mg/dl, urinary protein (+), blood pressure 140/90 mmHg. The pattern belonged to mutual obstruction of damp-heat and food stagnation, dampness obstructing the Qi level, heat stagnating in the Blood level, and collateral obstruction. The treatment method was clearing and transforming damp-heat, digesting food and guiding out stagnation, promoting blood circulation to remove blood stasis, assisted by unblocking collaterals. Prescription: Jingjie (Schizonepetae Spica) 6g, Fangfeng (Saposhnikoviae Radix) 6g, Shengdiyue (Sanguisorbae Radix) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qiancao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Chishao (Paeoniae Radix Rubra) 10g, Huoxiang (Agastaches Herba) 10g (added later), Peilan (Eupatorii Herba) 10g (added later), Baizhi (Angelicae Dahuricae Radix) 6g, Zicao (Lithospermi Radix) 10g, Dingcaoye (Solani Caulis et Folium) 10g, Baixianpi (Dictamni Cortex) 10g, Dahuang (Rhei Radix et Rhizoma) 2g. After taking 10 doses, symptoms lightened, skin itching stopped. From the above formula, Baixianpi (Dictamni Cortex), Dingcaoye (Solani Caulis et Folium), and Zicao (Lithospermi Radix) were removed, and Banxia (Pinelliae Rhizoma Praeparatum) 10g, Zhuru (Folium Bambusae in Templa Preparatum) 6g, Zaoxintu (Terra Cinereus) 30g were added. After taking another 10+ doses, sore lower back and drowsiness improved, nausea and vomiting did not recur, diet and excretion were normal, only lower limb numbness remained. Tongue was red with white coating, pulse was slippery and rapid. Tests showed BUN 14.4 mg/dl, creatinine 1.1 mg/dl, urinary protein +. Dialysis was changed to once weekly. The method used was clearing and transforming damp-heat, tonifying Qi, promoting blood circulation, and unblocking collaterals. Prescription: Jingjie Tan (Carbonized Schizonepetae Spica) 10g, Fangfeng (Saposhnikoviae Radix) 6g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qiancao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Shengdiyue (Sanguisorbae Radix) 10g, Chao Huaihua (Fried Flos Sophorae Immaturus) 10g, Chishao (Paeoniae Radix Rubra) 10g, Huangqi (Astragali Radix) 30g, Sigualuo (Luffae Fructus Retinervus) 10g, Sangzhi (Mori Ramulus) 10g, Dahuang (Rhei Radix et Rhizoma) 2g. After taking 20+ doses, no other discomforts, dialysis stopped. One month after stopping dialysis, tests showed BUN 11.7 mg/dl, creatinine 1.2 mg/dl, hemoglobin 11.0 g/dl, urinary protein (-), condition stable. Six months after stopping dialysis, follow-up tests of renal function, routine urine, and routine blood were all within normal ranges, no recurrence seen, uremia cured, leaving only sequelae of lower limb numbness and difficulty walking caused by post-dialysis conditions.
[Commentary]: This patient was in the late stage of uremia with severe toxic symptoms and had already undergone blood dialysis. After treatment by Old Master Zhao, not only did all clinical symptoms disappear, but laboratory indicators were all normal after stopping blood dialysis, achieving full recovery. This fully proves that uremia is not irreversible, and patients with renal failure have the possibility of recovering partial renal function. However, sequelae such as lower limb numbness caused by osteoporosis after dialysis are new issues to be solved in the future.