关格2(尿毒症
李某，男，64岁，退休工人，1988年12月28日初诊。患者于两个月前发现纳差，乏力，心慌，恶心呕吐时作，检查尿蛋白(+-)，某医院以慢性肾炎，肾功能不全收入住院。入院后查尿素氮n2mg／dl.肌酐10mg／dl.血色素6 5g／dl.诊断为肾功能衰竭、尿毒症期，继发性贫血。经输液及中医结合药物治疗一月余，疗效不明显，并渐增皮肤搔痒，小便减少，浮肿，大便不畅，症状日益加重，检查尿素氮124mg／dl，肌酐17，4mg／dl.血色素6，2g／dl.且合并高血压、冠心病、心房纤颤。因而无法行血液透析疗法，西医束手无策，嘱其回家准备后事。其家属在绝望之际，试求中医一治，邀请赵老会诊。
会诊时患者面色皓白，周身浮肿较甚，呕吐频怍，气喘吁吁，手足发冷，舌质红苔白厚腻，脉濡软且滑，沉取三五不调，按之有力。询问之，尽食膏梁厚味。全是湿热积滞互阻，三焦不畅之象，先M芳香化浊，疏调气机、清热凉血方法，并嘱其清淡饮食。方药：荆芥6克，防风6克，藿香10克(后下)，佩兰10克(后下)，黄连2克，苏叶10克(后下)，生地榆10克，茜草10克，白鲜皮10克，地肤于10克，草河车10克，灶心土60克，大黄3克。服药5剂，呕吐减轻，又进5剂，病情大转，恶心呕吐、皮肤作痒皆止，浮肿见轻，略有食欲，精神转佳。
1989年元月9目又请会诊，舌红苔白且干，脉滑数，沉取不稳，虽有转机，仍中阳不足，病势较重，用清化湿热，凉血化瘀，佐雌甘寒益气养阴之品。处方：荆芥炭10克，防风6克，白芷6克，大黄5克，生地榆10克，赤芍10克，丹参10克，茅芦根各10克，小蓟10克，沙参10克，西洋参3克(单煎另眼)，麦冬10克。服药10剂，复查尿素氮54，4mg／dl.肌酐6 5mg／dl.出院来门诊治疗。
3月8日因感冒咳嗽发热，而出现胸水，肺水肿，喘促不能平卧，脉滑数，舌白苔喊，先用宣肃化痰方法，方药：苏叶子各10克，前胡6克，浙贝母10克，麻黄2克+荆芥穗6克，防风6克，白芷6克，生地榆10克，桑白皮10克，地骨皮10克，大黄2克。服药7剂，感冒愈，喘平咳嗽止。
4月3日查尿素氮46，3mg／dl.肌酐5mg／dl.血色素9，6g，下肢浮肿见轻，饮食二便正常，仍以前方加减。处方：苏叶子各10克，浙贝母10克，荆芥6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，赤芍10克，大黄5克，焦三仙各10克，水红花子10克。以此方为主加减服药1月余，病情稳定，查尿素氮34 5mg／dl.肌酐4，6mg／dl.血色素9，5g／dl。家人很高兴，于5月初由其女婿陪同乘飞机去广州等地旅游2周，安全顺利反京，并未反复。
[按]；此患者系尿毒症晚期，浮肿、尿少、肤痒、呕吐频作，并合并冠心病、心房纤颤。不能透析，西医畏之。经赵老治疗后，患者积极配合，以清淡饮食，绝对禁蛋白，下地活动，仅服5剂，病状大减，又进5剂，病情大转。中途因感冒出现肺水肿、胸水，又仅服药7制很快平息。前后共治疗半年，已能外出旅游。尿素氮由124mg1.d1.降至34 5mg／dl.肌酐由1 7，4mg／dl降至4，6mg朋1.，血色素由6 2mg／dl.上升为9，6g／dl，疗效满意。充分证明，中医能够治疗尿毒症，而并非透析一途。其治疗方法，先以菏香化浊，清热凉血。湿浊已去，再以凉血清热，括血化瘀，佐以甘寒益气养阴而取效甚佳。
关格3(尿毒症)
周某，男，75岁，退休工人，于1989年6月28日初诊。患慢性肾炎已23年，二年前圜全身浮肿、气喘、憋气等，某医院以尿毒症、心包积液入院抢救一次。1989年2月又因感冒复发急诊入院抢救，现已好转，出院求赵老医治。刻诊时，全身浮肿，咳嗽有痰，头晕乏力，皮肤作痒，大便干结，面色苍白，舌红苔白厚腻，口中秽浊，脉弦滑且数，查血肌酐8mg／dl.尿素氪87mg／dl.尿蛋白(+++)，血压170／l00mmHg，血色素8g／dl。证属湿阻气分，热郁血分，湿热积滞互阻，三焦不畅，关格已成。治以清化湿热，凉血化瘀方法。处方：荆芥炭10克，防风6克，白芷6克，生地榆10克，炒槐花10克，赤芍10克，茜草10克，白鲜皮10克，地丁草10克，茅芦根各10克，大腹皮10克，槟榔10克，大黄6克。嘱其清淡饮食，配合走路锻炼。服药7剂，症状减轻，尿蛋白(+，)，又以上方加减服药20余利，查尿素氮57mg／dl.肌酐3.4mg／dl.尿蛋白(+)，浮肿消失，肤痒已止，咳嗽已愈。再以前方为基础加减服药近半年，于1989年12月4目查尿素氮24 5mg／dl.肌酐2 5mg／dl.血色素11g／dl.血压130／90mmHg，尿蛋白(+)，舌红苔腻，脉濡软且数，饮食二便正常，无其他不适。仍以前方，改每周三剂。每日瘦肉2两，牛奶1磅(或鸡蛋1个)，每月来门诊取药一次，又半年后，满面红润，精神较佳，从未感冒，病情稳定。
[按]：患者有23年慢性肾炎史，发展为尿毒症已2年，曾两次医院抢救。转诊赵老治疗后，服中药月余，化验指明显下降，症状消失+不足半年，化验检查均近正常值，朱再反复，几年来尿素氮维持在25mg／dl左右，肌酐维持在2 Smg／dl左右。一直接坚持以服药为辅，以饮食调养为主，配合走路锻炼，病情非常稳定。
关格4(尿毒症)
董某，男，47岁，于1993年3月15日初诊。患者慢性肾炎已9年，自1990年开始肾功能不全，于1991年12月8日开始血液透析，每周三次至今。专程自老家来京求赵老医治。
现浮肿、腰痛、尿少、心烦、恶心、呕吐时作，大便干结，舌红苔黄厚腻，脉弦滑且数，尿素氮(透前)55mg／dl.肌酐(透前)5，5mg／dl.尿蛋白(-+)，血色素5g／dl.血压180／l20mmHg。证属湿热蕴郁，深入血分，络脉瘀阻。治以清化湿热，凉血化瘀方法。方药：荆芥6克，防风6克，白芷6克，独活6克，丹参6克，茜草10克，生地榆10克，炒槐花10克，大腹皮10克，槟榔10克，半夏10克，黄连2克，灶心土30克，大黄3克。服药4周，肿势减轻，呕吐未作，精神较佳，二便正常，查尿素氮364mg／dl.肌酐3，5mg／dl.血色素6 5g／dl.尿蛋白(¨)，仍用前法，再以上方去半夏、黄连、灶心土，改透析每周2次。又服药4周，病情稳定，查尿素氮27，1mg／d[，肌酐3，69mg／dl.尿蛋白(十)，血色素8 2g／dl.继服前方，改透析每周1次。于1993年9月12日，服中药治疗已近半年，查尿素氮16mg／dl.肌酐1.6mg／dl.血色素9 8g／dl.透析已近2年，开始停止透析。在停透1月时，因感冒而发生喘促不能平卧，全身浮肿，先治其标邪，改用宣肺利湿平喘方法。方用荆芥6克，防风6克，白芷6克，独活6克，葶苈子10克，桑白皮10克，地骨皮10克，大愎皮10克，槟榔10克，冬瓜皮30克，茯苓皮30克，焦三仙各10克，水红花子10克。服药7剂，肿消喘平，查尿素氮19.3mg／dl.肌酐2，1mg／dl.血色素10g／dl.尿蛋白(+-)，大便略干，舌红苔白，脉濡细，以上方加黄芪60克，大黄4克，又服2周。至n月28目停透已2月余，病情稳定，未复发，查尿素氮18mg／dl.肌酐2mg／dl，血色素9，6g／dl。尿蛋白(+-)，B超双肾大小形态结构正常，无其他不适，尿毒症恢复期，用凉血化瘀、益气养阴方，方药：荆芥6克，防风6克，丹参6克，茜草10克，生地榆10克，凤尾草10克，鬼箭羽10克，黄芪80克，沙参10克，麦冬10克，大黄6克，焦三仙各10克，水红花子10克。服药7剂，感觉很好，又以此方带药30剂，回老家休养，其后每月来京复查带药一次，一直未复发。
[按]：此患者肾病已9年，发现慢性肾衰已近3年，并血液透析1年余。经赵老治疗后，随症状改善而减透析，由每周3次递减为每周2次、1次，最后停止透析。停透析1月后，因感冒而反复1次，但很快平息。化验指征均降至正常范围，又以凉血化瘀、益气养阴为法以巩固疗效。
关格5(尿毒症)
李某，女，34岁，于1989年10月29日初诊。
患慢性肾炎(间质性)已10年，近半年来恶心呕吐，烦躁不安，小便增多，后赴县医院医治，诊断为尿毒症，肾性尿崩症。经中西医结合治疗效果不明显，专程从外地来京求赵老医治。诊时见：面色暗滞，口干且渴，时恶心呕吐，腰酸乏力且痛川、便频数而量较多，大便干结、舌黄苔白且干，脉濡滑且数；化验尿素氮106mg／dl.肌酐10mg／dl，血糖空腹250mg／dl.尿蛋白(+++)，尿糖(++++)，血压180／l10mmHg。证属湿热蕴郁，蓄久化热，深入血分，气阴受损。治应先以清化湿热、凉血化瘀方法，饮食当慎，防其恶化。
处方：荆芥6克，防风6克，生地榆10克，赤芍10克，丹参10克，茜草10克，半夏10克，白芷6克，茅芦根各10克，大黄2克。服药10剂，症状见轻，又服10剂，化验检查尿素氨51mg／dl.肌酐5，1mg／dl.尿蛋白(+++)，尿糖(++++)，恶心呕吐未作，腰痛乏力消失，仍心烦梦多，头晕目眩，血压偏高，舌红苔黄且干，脉弦精且数，再以原方加赭石10克，竹茹10克。
服上方20余剂，查尿素氮38.2mg／dl.肌酐3 6mg／dl.血糖(空腹)180mg／dl.尿蛋白(+)，尿糖(+++)，口干且渴，尿量仍多，脉舌如前，改用益气养阴、凉血化瘀方法。
处方：黄芪30克，沙参10克，五味子10克，茯苓10克，山药10克，荆芥炭10克，防风6克，白芷6克，生地榆10克，茜草10克，茅芦根各10克，半夏10克，大黄2克。服药30剂，原有症状基本消失，饮食二便正常，精神较佳，面色红润，每日早晨1磅牛奶，清淡饮食，仍每日坚持慢步行走2小时，并已半日工作。查尿素氮30mg／dl.肌酐3，7mg／dl.尿蛋白(+-)，尿糖(+-)，血糖100mg／dl.血色素10g／dl.仍用前法，改上方黄芪为50克，加补骨脂10克，继续服。于1990年5月30日，又来京复诊，查尿素氮31 2mg／dl.肌酐3，7mg／dl.尿蛋白(一)，尿糖(一)。血糖80g／dl.血色素9，5mg／dl.血压120／80mmHg。又观察治疗半年余，病情稳定，恢复全日工作，无其他不适感。以后定期来京复查取药。
[按]：此患者尿毒症较重，又合并有糖尿病，二者在治疗上互相矛盾，颇难下手，尿毒症当以清化湿热、凉血化瘀为主；而糖尿病则应以益气养阴，扶正补虚为主。赵老根据患者的脉、舌、色、症能及化验指标，综合分析认为；邪气实为主要矛盾，因此先以清化湿热、凉血化瘀去除邪气汴}病情稳定后，又以益气养阴、凉血化瘀、分途调理为大法，相互兼顾，取效甚佳，使尿毒症、糖尿病这两个顽症均获得比较满意的疗效。
Guan Ge 2 (Uremia)
Li, male, 64 years old, retired worker, first consulted on December 28, 1988. Two months prior, the patient noticed poor appetite, fatigue, palpitations, and intermittent nausea and vomiting. Urine protein was (+/-). He was admitted to a certain hospital with diagnoses of chronic nephritis and renal insufficiency. Upon admission, blood urea nitrogen (BUN) was 22 mg/dl, creatinine (Cr) 10 mg/dl, and hemoglobin (Hb) 6.5 g/dl. The diagnosis was renal failure, uremic stage, and secondary anemia. After more than one month of intravenous fluids and integrated Chinese and Western medicine treatment, the efficacy was not obvious. Symptoms gradually worsened, including pruritus cutis, oliguria, edema, and constipation. Subsequent tests showed BUN 124 mg/dl, Cr 17.4 mg/dl, and Hb 6.2 g/dl. Comorbidities included hypertension, coronary heart disease, and atrial fibrillation. Consequently, hemodialysis was contraindicated. Western medicine had no effective measures, and he was advised to go home and prepare for the end. In despair, his family sought traditional Chinese medicine (TCM) treatment and invited Professor Zhao Shaoqin for consultation.
During consultation, the patient’s complexion was pale, general edema was severe, vomiting was frequent, breathing was labored, hands and feet were cold. The tongue body was red with a thick, greasy white coating. The pulse was soft and slippery (Ru Mai), and irregular upon deep pressure (Chen Qu), yet forceful upon pressing. Inquiry revealed a history of consuming rich, fatty foods. This presentation indicated mutual obstruction by damp-heat and stagnation, with unsmooth Qi mechanism in the San Jiao (Triple Burner). The initial treatment method employed aromatic transformation of turbidity, regulation of Qi mechanism, clearing heat, and cooling blood. A light diet was prescribed. Formula: Jingjie (Schizonepetae Spica) 6g, Fangfeng (Saposhnikoviae Radix) 6g, Huoxiang (Agastaches Herba) 10g (added later), Peilan (Eupatorii Herba) 10g (added later), Huanglian (Coptidis Rhizoma) 2g, Zisu Ye (Perillae Folium) 10g (added later), Sheng Di Yu (Sanguisorbae Radix) 10g, Qiancao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Baixianpi (Dictamni Cortex) 10g, Difuzi (Kochiae Fructus) 10g, Caoheche (Arnebiae Radix seu Rhizoma) 10g, Zaoxin Tu (Furnacis Terra) 60g, Dahuang (Rhei Radix et Rhizoma) 3g. After 5 doses, vomiting decreased. After another 5 doses, the condition significantly improved; nausea, vomiting, and pruritus ceased, edema lightened, appetite returned slightly, and spirit improved.
Consulted again on January 9, 1989. Tongue was red with dry white coating; pulse was slippery and rapid (Hua Shu Mai), unstable upon deep pressure. Although there was a turning point, Middle Yang deficiency remained, and the disease severity was still high. The method used was clearing and transforming damp-heat, cooling blood and resolving stasis, assisted by sweet-cold herbs to tonify Qi and nourish Yin. Prescription: Jingjie Tan (Carbonized Schizonepetae Spica) 10g, Fangfeng 6g, Baizhi (Angelicae Dahuricae Radix) 6g, Dahuang 5g, Sheng Di Yu 10g, Chishao (Paeoniae Radix Rubra) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Ma Gen (Puerariae Radix) and Lu Gen (Phragmitis Rhizoma) 10g each, Xiaoji (Cirsii Herba) 10g, Shashen (Glehniae Radix) 10g, Xiyangshen (Panacis Quinquefolii Radix) 3g (decocted separately), Maidong (Ophiopogonis Tuber) 10g. After 10 doses, re-examination showed BUN 54.4 mg/dl, Cr 6.5 mg/dl. The patient was discharged and continued outpatient treatment.
On March 8, due to a cold with cough and fever, pleural effusion and pulmonary edema occurred, causing dyspnea preventing supine position. Pulse was slippery and rapid; tongue had white dry coating. The initial method was diffusing and descending to transform phlegm. Formula: Su Ye (Perillae Folium) and Xing Ren (Armeniacae Semen Amarum) 10g each, Qianhu (Peucedani Radix) 6g, Zhe Beimu (Fritillariae Thunbergii Bulbus) 10g, Mahuang (Ephedrae Herba) 2g, Jingjie Sui (Schizonepetae Spica) 6g, Fangfeng 6g, Baizhi 6g, Sheng Di Yu 10g, Sangbaipi (Mori Cortex) 10g, Digupi (Lycii Cortex) 10g, Dahuang 2g. After 7 doses, the cold resolved, wheezing stopped, and cough ceased.
On April 3, BUN was 46.3 mg/dl, Cr 5 mg/dl, Hb 9.6 g. Lower limb edema lightened; diet and bowel/bladder functions were normal. The previous formula was modified. Prescription: Su Ye and Xing Ren 10g each, Zhe Beimu 10g, Jingjie 6g, Fangfeng 6g, Baizhi 6g, Sheng Di Yu 10g, Chao Huaihua (Stir-fried Sophorae Flos) 10g, Danshen 10g, Qiancao 10g, Chishao 10g, Dahuang 5g, Jiao Sanxian (Charred Three Immortals: Shenqu, Maiya, Shaoyao) 10g each, Shuihonghuazi (Hydrocotylis Fructus) 10g. With this formula as the main basis, modified over one month, the condition stabilized. BUN was 34.5 mg/dl, Cr 4.6 mg/dl, Hb 9.5 g/dl. The family was pleased. In early May, accompanied by his son-in-law, he flew to Guangzhou and other places for a 2-week trip, returning safely without recurrence.
[Commentary]: This patient was in the late stage of uremia, presenting with edema, oliguria, pruritus, and frequent vomiting, complicated by coronary heart disease and atrial fibrillation. Hemodialysis was not possible, and Western medicine was hesitant. After treatment by Professor Zhao, the patient cooperated actively, adhering to a light diet, absolute protein restriction, and ambulation. After only 5 doses, symptoms greatly reduced; after another 5 doses, the condition significantly turned. Mid-treatment, pulmonary edema and pleural effusion occurred due to a cold, but were quickly resolved with only 7 doses of medication. Total treatment lasted half a year, allowing travel. BUN dropped from 124 mg/dl to 34.5 mg/dl, Cr from 17.4 mg/dl to 4.6 mg/dl, and Hb rose from 6.2 g/dl to 9.6 g/dl. The curative effect was satisfactory. This fully proves that TCM can treat uremia, not just via dialysis. The treatment method initially used aromatic transformation of turbidity, clearing heat and cooling blood. Once damp-turbidity was removed, the method shifted to cooling blood, clearing heat, activating blood and resolving stasis, assisted by sweet-cold herbs to tonify Qi and nourish Yin, yielding excellent results.
Guan Ge 3 (Uremia)
Zhou, male, 75 years old, retired worker, first consulted on June 28, 1989. He suffered from chronic nephritis for 23 years. Two years prior, due to general edema, asthma, and dyspnea, he was admitted to a hospital for emergency rescue with diagnoses of uremia and pericardial effusion. In February 1989, he was readmitted for emergency rescue due to relapse triggered by a cold. Now improved, he was discharged seeking treatment from Professor Zhao. Current examination showed general edema, cough with sputum, dizziness, fatigue, pruritus cutis, constipation, pale complexion, red tongue with thick greasy white coating, foul breath, wiry-slippery-rapid pulse (Xian Hua Shu Mai). Blood Cr was 8 mg/dl, BUN 87 mg/dl, urine protein (+++), blood pressure 170/100 mmHg, Hb 8 g/dl. The syndrome belonged to dampness obstructing the Qi level, heat stagnating in the Blood level, mutual obstruction of damp-heat and stagnation, unsmooth San Jiao, resulting in Guan Ge (Obstruction and Rejection). The treatment method was clearing and transforming damp-heat, cooling blood and resolving stasis. Prescription: Jingjie Tan 10g, Fangfeng 6g, Baizhi 6g, Sheng Di Yu 10g, Chao Huaihua 10g, Chishao 10g, Qiancao 10g, Baixianpi 10g, Dingcad (Violaris Herba) 10g, Ma Gen and Lu Gen 10g each, Dafupi (Arecae Pericarpium) 10g, Binglang (Arecae Semen) 10g, Dahuang 6g. He was advised to eat lightly and walk for exercise. After 7 doses, symptoms alleviated, urine protein became (+/-). Continuing modifications of this formula for over 20 doses, BUN dropped to 57 mg/dl, Cr to 3.4 mg/dl, urine protein to (+). Edema disappeared, pruritus stopped, and cough healed. Continuing base formula modifications for nearly half a year, on December 4, 1989, BUN was 24.5 mg/dl, Cr 2.5 mg/dl, Hb 11 g/dl, BP 130/90 mmHg, urine protein (+), tongue red with greasy coating, pulse soft-slippery-rapid, diet and excretion normal, no other discomfort. Continued with the same formula, changing to 3 doses per week. Daily diet included 2 liang of lean meat, 1 pound of milk (or 1 egg). Monthly clinic visits for medication. Half a year later, complexion was ruddy, spirit was good, never caught a cold, condition stable.
[Commentary]: The patient had a 23-year history of chronic nephritis, developing uremia 2 years ago, requiring two hospital rescues. After referral to Professor Zhao, taking Chinese herbal medicine for over a month, laboratory indicators dropped significantly, symptoms disappeared. Within less than half a year, lab tests approached normal values, with no recurrence. For several years, BUN maintained around 25 mg/dl, Cr around 2.5 mg/dl. Adherence to medication as auxiliary, dietary regulation as primary, combined with walking exercise, kept the condition very stable.
Guan Ge 4 (Uremia)
Dong, male, 47 years old, first consulted on March 15, 1993. Chronic nephritis for 9 years. Renal insufficiency started in 1990. Hemodialysis began on December 8, 1991, three times weekly until then. Came specially from hometown to Beijing for Professor Zhao's treatment.
Current symptoms: edema, lower back pain, oliguria, irritability, nausea, intermittent vomiting, constipation. Tongue red with yellow thick greasy coating; pulse wiry-slippery-rapid. Pre-dialysis BUN 55 mg/dl, pre-dialysis Cr 5.5 mg/dl, urine protein (-/+), Hb 5 g/dl, BP 180/120 mmHg. Syndrome: damp-heat accumulation, penetrating into the Blood level, collateral stasis. Treatment: clearing and transforming damp-heat, cooling blood and resolving stasis. Formula: Jingjie 6g, Fangfeng 6g, Baizhi 6g, Du Huo (Angelicae Pubescentis Radix) 6g, Danshen 6g, Qiancao 10g, Sheng Di Yu 10g, Chao Huaihua 10g, Dafupi 10g, Binglang 10g, Banxia (Pinelliae Rhizoma) 10g, Huanglian 2g, Zaoxin Tu 30g, Dahuang 3g. After 4 weeks, swelling reduced, no vomiting, spirit better, excretion normal. BUN 36.4 mg/dl, Cr 3.5 mg/dl, Hb 6.5 g/dl, urine protein (+/-). Continued previous method. Removed Banxia, Huanglian, Zaoxin Tu from the formula. Reduced dialysis to twice weekly. Another 4 weeks of medication, condition stable. BUN 27.1 mg/dl, Cr 3.69 mg/dl, urine protein (+), Hb 8.2 g/dl. Continued previous formula. Reduced dialysis to once weekly. On September 12, 1993, after nearly half a year of TCM treatment, BUN 16 mg/dl, Cr 1.6 mg/dl, Hb 9.8 g/dl. Dialysis had been ongoing for nearly 2 years; dialysis was stopped. One month after stopping, due to a cold, dyspnea preventing supine position and general edema occurred. First treated the exterior pathogen using diffusing Lung, promoting diuresis, and calming wheezing method. Formula: Jingjie 6g, Fangfeng 6g, Baizhi 6g, Du Huo 6g, Tinglizi (Descurainiae Semen seu Fructus) 10g, Sangbaipi 10g, Digupi 10g, Dafupi 10g, Binglang 10g, Dongguapi (Benincasae Exocarpium) 30g, Fulingpi (Poria Cum Mycelium Peel) 30g, Jiao Sanxian 10g each, Shuihonghuazi 10g. After 7 doses, swelling subsided, wheezing stopped. BUN 19.3 mg/dl, Cr 2.1 mg/dl, Hb 10 g/dl, urine protein (+/-), stool slightly dry, tongue red with white coating, pulse soft-thin. Added Huangqi (Astragali Radix) 60g, Dahuang 4g to the formula. Took for 2 more weeks. By November 28, 2+ months post-dialysis cessation, condition stable, no recurrence. BUN 18 mg/dl, Cr 2 mg/dl, Hb 9.6 g/dl, urine protein (+/-). Ultrasound showed normal bilateral kidney size, shape, and structure, no other discomfort. Uremia recovery phase. Used cooling blood, resolving stasis, tonifying Qi, nourishing Yin formula. Prescription: Jingjie 6g, Fangfeng 6g, Danshen 6g, Qiancao 10g, Sheng Di Yu 10g, Fengweicao (Pteridii Herba) 10g, Guijianyu (Eucommiae Ramulus cum Folio? Note: Usually refers to Eucommiae Ramulus or similar, here likely specific herb) 10g, Huangqi 80g, Shashen 10g, Maidong 10g, Dahuang 6g, Jiao Sanxian 10g each, Shuihonghuazi 10g. After 7 doses, felt very well. Took 30 doses home for rest. Monthly visits to Beijing for check-up and medication since then, no recurrence.
[Commentary]: This patient had kidney disease for 9 years, chronic renal failure diagnosed nearly 3 years ago, and hemodialysis for over 1 year. After Professor Zhao's treatment, dialysis frequency was reduced as symptoms improved: from 3 times/week to 2 times, then 1 time, finally stopped. One month after stopping, relapse occurred due to cold but was quickly resolved. Lab indicators dropped to normal range. Consolidation treatment used cooling blood, resolving stasis, tonifying Qi, and nourishing Yin.
Guan Ge 5 (Uremia)
Li, female, 34 years old, first consulted on October 29, 1989.
Chronic interstitial nephritis for 10 years. For the past half year, nausea, vomiting, irritability, polyuria. Diagnosed at county hospital with uremia and nephrogenic diabetes insipidus. Integrated treatment ineffective. Came specially from out of town to Beijing for Professor Zhao's treatment. Examination: dark and dull complexion, dry mouth and thirst, occasional nausea/vomiting, sore waist, fatigue and pain, frequent urination with large volume, constipation. Tongue yellow with dry white coating; pulse soft-slippery-rapid. Labs: BUN 106 mg/dl, Cr 10 mg/dl, fasting blood glucose 250 mg/dl, urine protein (+++), urine sugar (++++), BP 180/110 mmHg. Syndrome: damp-heat accumulation, long-standing heat generation, penetrating into Blood level, Qi and Yin damage. Initial treatment: clearing and transforming damp-heat, cooling blood and resolving stasis. Diet must be cautious to prevent worsening.
Prescription: Jingjie 6g, Fangfeng 6g, Sheng Di Yu 10g, Chishao 10g, Danshen 10g, Qiancao 10g, Banxia 10g, Baizhi 6g, Ma Gen and Lu Gen 10g each, Dahuang 2g. After 10 doses, symptoms lightened. Another 10 doses: BUN 51 mg/dl, Cr 5.1 mg/dl, urine protein (+++), urine sugar (++++). No nausea/vomiting, waist pain/fatigue disappeared. Still irritable, many dreams, dizziness, vertigo, high BP. Tongue red with dry yellow coating, pulse wiry-thin-rapid. Added Shizhi (Haematitum) 10g, Zhuru (Bambusae Caulis in Taenia) 10g to original formula.
After 20+ doses of above formula: BUN 38.2 mg/dl, Cr 3.6 mg/dl, fasting glucose 180 mg/dl, urine protein (+), urine sugar (+++). Dry mouth/thirst, polyuria persist. Pulse/tongue unchanged. Changed method to tonifying Qi and nourishing Yin, cooling blood and resolving stasis.
Prescription: Huangqi 30g, Shashen 10g, Wuweizi (Schisandrae Chinensis Fructus) 10g, Fuling 10g, Shanyao (Dioscoreae Rhizoma) 10g, Jingjie Tan 10g, Fangfeng 6g, Baizhi 6g, Sheng Di Yu 10g, Qiancao 10g, Ma Gen and Lu Gen 10g each, Banxia 10g, Dahuang 2g. After 30 doses, original symptoms basically disappeared. Diet and excretion normal, spirit good, ruddy complexion. Drank 1 pound milk daily, light diet, walked slowly for 2 hours daily, worked half-day. Labs: BUN 30 mg/dl, Cr 3.7 mg/dl, urine protein (+/-), urine sugar (+/-), glucose 100 mg/dl, Hb 10 g/dl. Continued previous method. Increased Huangqi to 50g, added Buguzhi (Psoraleae Fructus) 10g.
Re-consulted in Beijing on May 30, 1990. BUN 31.2 mg/dl, Cr 3.7 mg/dl, urine protein (-), urine sugar (-). Glucose 80 mg/dl, Hb 9.5 g/dl, BP 120/80 mmHg. Observed and treated for another half year. Condition stable, resumed full-time work, no discomfort. Regular monthly visits for check-ups and medication thereafter.
[Commentary]: This patient had severe uremia complicated by diabetes mellitus. These two conditions present contradictory treatment approaches: uremia requires clearing damp-heat and cooling blood/resolving stasis; diabetes requires tonifying Qi/nourishing Yin and supporting righteousness. Professor Zhao analyzed pulse, tongue, complexion, symptoms, and lab indicators, determining that excess pathogenic factor was the main contradiction. Thus, initially cleared damp-heat and cooled blood/resolved stasis to remove pathogens. After stabilization, used tonifying Qi/nourishing Yin, cooling blood/resolving stasis, and separate regulation methods, balancing both, achieving excellent results. Both uremia and diabetes, stubborn diseases, obtained satisfactory outcomes.