尿浊(运动性蛋白尿)
臧某某，女，25岁
初诊
近3个月来，经常发现小便混浊，排尿时并无异常感觉。经尿常规化验，蛋白++。后多次验尿，发现晨尿蛋白阴性，日间常为强阳性。经某医院检查，怀疑为运动性蛋白尿，嘱其卧床休息，避免体力活动。行之月余，愈感疲乏无力，验尿蛋白仍为+++。诊脉濡滑且数，舌红苔黄且腻，夜寐梦多。热在血分，先用清化方法。并嘱其每日运动锻炼，散步为主，不可依赖卧床。
荆芥6克，防风6克，白芷6克，独活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，大黄1克，七付
二诊
药后验尿蛋白已减为+，夜寐转安，精神体力明显好转，每日遵医嘱早晚各散步1～2小时，散步后自觉身体舒适，信心因之大增。脉象仍属弦滑，舌红苔腻，湿热蕴郁，仍用清化方法。
荆芥6克，防风6克，白芷6克，独活6克，生地榆10克，赤芍10克，丹参10克，茜草10克，茅芦根各10克，大黄1克，焦三仙各10克，七付
三诊
昨日尿常规检验结果，蛋白+，白细胞0～2。每目早晚坚持散步2小时，自觉体力增加。脉仍弦滑，舌红苔白，继用前法进退。
荆芥6克，防风6克，苏叶6克，独活6克，生地榆10克，炒槐花10克，丹参10克，赤芍10克，茅芦根各10克，焦三仙各10克，水红花子10克，大黄1克，七付
四诊
药后尿蛋白转阴。活动后也未出现阳性。脉象濡滑，舌红苔薄，仍用前法加减。饮食禁忌与运动锻炼，仍须坚持，不可半途而废。
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，赤芍10克，茅芦根各10克，大黄1克，焦三仙各10克，水红花子10克，七付
后以上方加减治疗三个月，尿蛋白始终保持阴性。遂停药观察，未见复发。
[按]：本案值得探讨处是运动锻炼与治疗慢性肾病的关系。按照传统的观点，慢性肾炎、慢性肾功能衰竭等都要注意休息，尽量避免体力活动，病情严重时必须绝对卧床休息。这几乎成了一条约定俗成的规则，多少年来，临床医生都是这样要求患者的，至今仍然如此，从未有人对此提质疑。赵师通过大量的临床观察，发现一味地卧床休息不但无助于肾病的治疗和康复，而且易加剧肾病恶化的发展速度。这是因为慢性肾病的病机的一个重要方面是络脉瘀阻，在现代病理学上表现为微血管的痉挛、堵塞等，中医认为此属血瘀。在长期卧床休息的状态下，气血的瘀滞会日趋严重。这就说明了为什么临床有上些病例绝对卧床休息反而迅速恶化。根据中医的基本理论，世界是恒动的，人体也是恒动的。生命在于运动的道理不仅适用于健康人的养生，也同样适用于多数疾病的治疗和康复。对于慢性肾病尤其适合。因此，赵师在临床上治疗慢性肾病的一个重要措施就是要求病人坚持以散步为主要形式的运动锻炼。通过坚持不懈的走步锻炼以促进周身气血的流通，改善肾脏的血液循环促进肾脏病灶的修复。实践证明，这一理论是正确的。凡是能够坚持运动锻炼的病人都尝到了运动的甜头，感到精神振奋，体力增强，自觉症状和体征都得到改善，化验指标也髓之好转。本案就是一个明显的例子。患者被确定为运动性蛋白尿，这种病的特点是只要稍有活动就会出现大量的蛋白蛋，而在安静状态下却十分正常。对这种病西医的方法很简单，那就是限制患者活动，令其卧床静养。然而几个月的静养并未能阻止其运动后蛋白尿的出现。赵师根据动静的辩证关系，反其道而行之，令其坚持运动，配合治疗。仅仅几个星期的功夫，运动性蛋白尿就得到了控制，使其恢复了正常的工作学习。这个病例启示我们，适度的运动在治疗慢性肾病的过程中起到了举足轻重的作用。应当予以足够的重视。
皮肤搔痒(尿毒症)
陈某某，女，49岁
初诊
自述患慢性肾小球肾炎1u余年，时轻时重，近2年发现肾功能不全，肌酐、尿素氮日渐增高。近半月来皮肤搔痒严重，夜不能寐。伴有精神不振，嗜睡，一身疲乏，双下肢无力尤甚，心烦急躁，大便于结小便短少，恶心欲吐。诊脉弦滑且数，按之有力，舌红苔黄垢厚。化验血肌酐7，4mg／dl.尿素氯82mg／dl。西医建议透析，患者晨惧，遂来就诊。证属湿热蕴郁成毒，深入血分，将成关格之证，急蚪凉血化瘀解毒之法治之。
荆芥炭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，焦三仙各10克，地肤子10克，白鲜皮10克，草河车10克，大黄3克，七付
二诊
药后大便通而未畅，皮肤搔痒减轻，已能入眠，仍感梦多。脉仍弦滑数，舌红苔黄根厚。继用前法进退。
荆芥炭10克，防风6克，白芷6克，独活6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，赤芍10克，茅芦根各10克，地肤子10克，白鲜皮10克，草河车10克，大黄5克，七付
三诊
药后大便畅行，每日2～3次，腹部舒适，精神转佳，嗜唾消失，皮肤搔痒显著减轻。脉仍弦滑，舌红苔黄厚，热郁虽减未清，仍用清化方法。饮食寒暖，诸宜小心，每日散步，不可懈怠。
荆芥炭10克，防风6克，白芷6克，独活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，地肤子10克，白鲜皮10克，草河车10克，大黄5克，七付
四诊
皮肤搔痒已愈，二便通畅，纳食有增，每日散步2～3小时而不觉疲劳，近日查血肌酐降至4 1mg／dl.尿素氮降为38mg／dl。脉仍弦滑，按之略数，舌红苔白，三焦虽畅，郁热未得全清，仍用凉血化瘀方法。
荆芥6克，防风6克，白芷6克，独活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，水红花子10克，大腹皮10克，槟榔10克，大黄5克，七付
后以此方加减治疗半年，血肌酐降为3mg／dl.尿素氮降为29mg／dl.临床症状基本消失，已能恢复半日工作。
[按]：本案患者属于典型的家族发病，其姐妹共5人，其中一人已死于尿毒症，另一人因慢性肾衰作了肾移植，另有一小妹为慢性肾小球肾炎。追踪其父母并无肾病，但其祖父母去世较早，其死因虽未明确，但其所述症候似与肾病尿毒症有关。象这种姐妹数人同时或先后均患慢性肾病的例子在临床并不少见，还有母子同病，兄弟同病等，这一现象提示肾病的发生可能与遗传因素有关。根据临床上慢性肾病家族性发病较为常见的事实，赵师提出了慢性肾病可遗传的观点。根据中医理论推断热毒深伏于髓是本病得自先天的基本特点。毒发于髓而表现为血分瘀热。故治疗当咀凉血化瘀为主。大忌温补，并忌食高蛋白高热量和一切辛辣刺激性食物，目的就是为了防止由于饮食不慎而更增其热。凉血化瘀可用生地榆、炒槐花、赤芍、丹参、茜草、小蓟、紫草、地丁草、白头翁等。本例以皮肤搔痒为主要表现，是血分热毒聚于皮肤，更加地肤子、臼鲜皮、草河车清热解毒。肾衰尿毒症时，小便短少，或色白，机体代谢废物不能扶尿排出，故溢出皮肤为痒，重者有尿素结晶如白霜状。治疗必通其大便，使热毒从大便排出。本案大便干结，数日一行，舌苔黄腻垢厚，属三焦蕴热，初诊即用大黄3克，而力有不逮，故二诊以后皆增至5克，得大便畅行，热毒得泄，而诸症向安。凡治尿毒症，必令其大便通畅滑日二三行为最佳，此为要决。
喘逆(慢性肾功能衰竭合并胸腔积液)
程某，女，53岁
初诊
慢性肾小球肾炎10余年，慢性肾功能衰竭发现半年余，肌酐6.7mg／dl.尿素氮74mg／dl。血色素6.5克。经服包醛氧化淀粉，大便每日二次，诸症尚称平稳。近日困患感冒，自觉胸闷短气，渐至喘逆不能平卧。西医作肺感染用青霉素3日，未见明显好转，经×光透视，发现胸腔积液中量。建议行血液透析，患者惧之。前来就诊。面色晦暗，端坐呼吸，喘逆不止，脉象弦滑数。按之振指，舌白苔腻水滑小便量少，大便不畅。此尿毒重症，水饮射肺，勉拟泻肺行水，以救其急，若不效，宜急行透析。
桑白皮15克+地骨皮15克，苏叶梗各10克，前胡6克，杏仁10克，葶苈子20克，生地榆10克，赤芍10克，茜草10克，丹参10克，大腹皮15克，槟榔10克，炒枳壳6克，大黄3克。三付
二诊
药后大便畅行，小便增多，喘逆之势稍减，诊脉弦滑而数，舌白苔腻根厚，再以宣肃方法。
苏叶梗各10克，前胡6克，杏仁10克，浙贝母10克，桑白皮15克，地骨皮15克，葶苈子20克，生地榆10克，炒槐花10克，丹参10克，茜草10克，大腹皮10克，槟榔10克，大黄3克，冬瓜皮30克，茯苓皮30克，三付
三诊
小便明显增多，一日夜可达2500毫升，喘逆之势渐减，脉仍弦滑，舌白苔腻，再以疏调三焦方法。
苏叶梗各10克，前胡6克，杏仁10克，桑白皮15克，枇杷叶10克，葶苈于15克，生地榆10克，炒槐花10克，丹参10克，茜草10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
喘逆已平，二便畅通，纳食亦香，脉仍弦滑有力，舌白苔腻未变，仍属尿毒重症，未可掉以轻心，饮食寒暖，诸宜小心。再以凉血化瘀，疏调三焦方法。
苏叶梗各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，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
后以上方加减治疗3个月，治疗期间辅以饮食控制，并令其逐步增加散步式运动锻炼，精神体力日见好转，肌酐下降至4mg／dl.尿素氮稳定在40mg／dl以下。
[按]：慢性肾功能衰竭、尿毒症并发胸闷憋气，喘逆不得平卧，最为危急，往往是因胸腔积液较多，压迫肺泡所致，重者可有心包积液，缺氧症状明显。其症不同于一般喘咳。治疗亦颇为棘手。赵师认为，此症乃水饮不得下输而逆射心肺，故治疗急当泻肺行水，用泻白散合葶苈大枣泻肺汤，不用大枣，加疏利三焦之品，务令大小便通畅，使水饮有泄越之途，从二便排出体外。其葶苈子宜重用，一般15～30克，药后可见小便增多，喘逆势减，便有转机。若喘逆有增无减，速当透析，以免贻误病情。
经期发热(周期性发热)
于某，女，50岁
于1989年2月11日初诊
自1988年9月开始至今，每月经行前1～2天，自觉发冷发热，体温37℃～38℃，同时伴有尿频、尿急、尿痛等症状。去某医院检查，尿中有大量红白血球，诊断为“泌尿系感染。”曾用呋喃坦啶、抗菌素、中药等治疗，疗效不明显，随经净而发热以及泌尿系症状消失。现又临近行经，恐其又作，故请赵老医治。证见：胸胁中脘胀闷不舒，食欲不佳，心烦急躁，夜寐梦多，大便不畅，下肢轻度浮肿，舌红且暗，苔白腻，脉弦滑细数。
证属肝经郁热，气桃不畅。拟治疏调气所机、清泻肝经郁热之法。用药：柴胡6克，黄芩6克，川楝子6克，丹参10克，赤芍10克，生地榆10克，茜草10克，炒山栀6克，丹皮10克，防风6克，荆芥炭10克。服药7剂，精神愉快。
2月14日月经适来，量多有血块，略有腹痛，发热未作，余症亦减轻，仍以前法进退。方药：荆芥炭10克，防风6克，茅根10克，小蓟10克，丹参10克，生地榆10克，炒槐花10克，炒山栀6克，黄芩6克，丹皮10克，焦三仙各10克。服药3剂。月经干净，大便偏干，睡眠不实有梦，舌红且干，改用凉血清热养阴，疏调升降方法。药用；蝉衣6克，僵蚕10克，片姜黄6克，香附10克，黄芩6克，川楝子6克，炒枳壳6克，竹茹6克，生地10克，旱莲草10克，女贞子10克。服上方7剂，大便正常，夜寐较安。又服7剂，月经至，发热以及他症均未发作。
3个月后随访，未再复发。
[按]：此患者已50岁，时至绝经期，一般认为肾气渐衰，天癸将绝，应补益肾之阴阳为主。而赵老根据临床症状，辨证为肝经郁热之证。先用逍遥散加减，舒肝解郁清热，以畅气机。
郁热得清，发热则去，下移之热随之而解，改用凉血育阴之法以治其本。
臧某某，女性，25岁。
初诊：
近三个月来，经常发现小便混浊，排尿时并无异常感觉。经尿常规化验，蛋白为两个加号（++）。后来多次验尿，发现晨起尿液中蛋白为阴性，日间常呈强阳性。经某医院检查，怀疑为运动性蛋白尿，嘱咐其卧床休息，避免体力活动。实行一个多月后，反而感到更加疲乏无力，验尿蛋白仍为三个加号（+++）。诊脉象濡滑且数，舌质红，苔黄且腻，夜间睡眠多梦。辨证为热在血分，先用清化方法治疗。并嘱咐其每日进行运动锻炼，以散步为主，不可依赖卧床休息。
处方：荆芥6克，防风6克，白芷6克，独活6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，茅根与芦根各10克，大黄1克，共七剂。
二诊：
服药后验尿蛋白已减少为一个加号（+），夜间睡眠转为安稳，精神和体力明显好转。每日遵医嘱早晚各散步1～2小时，散步后自觉身体舒适，信心因此大增。脉象仍属弦滑，舌质红，苔腻，辨证为湿热蕴郁，仍用清化方法治疗。
处方：荆芥6克，防风6克，白芷6克，独活6克，生地榆10克，赤芍10克，丹参10克，茜草10克，茅根与芦根各10克，大黄1克，焦三仙各10克，共七剂。
三诊：
昨日尿常规检验结果，蛋白为+，白细胞0～2个。每天早晚坚持散步2小时，自觉体力增加。脉仍弦滑，舌质红，苔白，继续使用前法进行加减调整。
处方：荆芥6克，防风6克，苏叶6克，独活6克，生地榆10克，炒槐花10克，丹参10克，赤芍10克，茅根与芦根各10克，焦三仙各10克，水红花子10克，大黄1克，共七剂。
四诊：
服药后尿蛋白转阴。活动后也未出现阳性反应。脉象濡滑，舌质红，苔薄，仍用前法加减。饮食禁忌与运动锻炼，仍须坚持，不可半途而废。
处方：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，赤芍10克，茅根与芦根各10克，大黄1克，焦三仙各10克，水红花子10克，共七剂。
此后以上方加减治疗三个月，尿蛋白始终保持阴性。遂停药观察，未见复发。
[按语]：本案值得探讨之处是运动锻炼与治疗慢性肾病的关系。按照传统的观点，慢性肾炎、慢性肾功能衰竭等都要注意休息，尽量避免体力活动，病情严重时必须绝对卧床休息。这几乎成了一条约定俗成的规则，多少年来，临床医生都是这样要求患者的，至今仍然如此，从未有人对此提出质疑。赵绍琴老师通过大量的临床观察，发现一味地卧床休息不但无助于肾病的治疗和康复，而且易加剧肾病恶化的发展速度。这是因为慢性肾病的病机的一个重要方面是络脉瘀阻，在现代病理学上表现为微血管的痉挛、堵塞等，中医认为此属血瘀。在长期卧床休息的状态下，气血的瘀滞会日趋严重。这就说明了为什么临床上有些病例绝对卧床休息反而迅速恶化。根据中医的基本理论，世界是恒动的，人体也是恒动的。生命在于运动的道理不仅适用于健康人的养生，也同样适用于多数疾病的治疗和康复。对于慢性肾病尤其适合。因此，赵老师在临床上治疗慢性肾病的一个重要措施就是要求病人坚持以散步为主要形式的运动锻炼。通过坚持不懈的走步锻炼以促进周身气血的流通，改善肾脏的血液循环，促进肾脏病灶的修复。实践证明，这一理论是正确的。凡是能够坚持运动锻炼的病人都尝到了运动的甜头，感到精神振奋，体力增强，自觉症状和体征都得到改善，化验指标也随之好转。本案就是一个明显的例子。患者被确定为运动性蛋白尿，这种病的特点是只要稍有活动就会出现大量的蛋白尿，而在安静状态下却十分正常。对这种病西医的方法很简单，那就是限制患者活动，令其卧床静养。然而几个月的静养并未能阻止其运动后蛋白尿的出现。赵老师根据动静的辩证关系，反其道而行之，令其坚持运动，配合治疗。仅仅几个星期的功夫，运动性蛋白尿就得到了控制，使其恢复了正常的工作学习。这个病例启示我们，适度的运动在治疗慢性肾病的过程中起到了举足轻重的作用。应当予以足够的重视。
陈某某，女性，49岁。
初诊：
自述患慢性肾小球肾炎十余年，时轻时重，近2年发现肾功能不全，肌酐、尿素氮日渐增高。近半月来皮肤搔痒严重，夜不能寐。伴有精神不振，嗜睡，一身疲乏，双下肢无力尤甚，心烦急躁，大便于结，小便短少，恶心欲吐。诊脉弦滑且数，按之有力，舌质红，苔黄垢厚。化验血肌酐7.4mg/dl，尿素氮82mg/dl。西医建议透析，患者恐惧，遂来就诊。证属湿热蕴郁成毒，深入血分，将成关格之证，急拟凉血化瘀解毒之法治之。
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，丹参10克，茜草10克，焦三仙各10克，地肤子10克，白鲜皮10克，草河车10克，大黄3克，共七剂。
二诊：
药后大便通而未畅，皮肤搔痒减轻，已能入眠，仍感梦多。脉仍弦滑数，舌质红，苔黄根厚。继用前法进退。
处方：荆芥炭10克，防风6克，白芷6克，独活6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，赤芍10克，茅根与芦根各10克，地肤子10克，白鲜皮10克，草河车10克，大黄5克，共七剂。
三诊：
药后大便畅行，每日2～3次，腹部舒适，精神转佳，嗜睡消失，皮肤搔痒显著减轻。脉仍弦滑，舌质红，苔黄厚，热郁虽减未清，仍用清化方法。饮食寒暖，诸宜小心，每日散步，不可懈怠。
处方：荆芥炭10克，防风6克，白芷6克，独活6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，茅根与芦根各10克，地肤子10克，白鲜皮10克，草河车10克，大黄5克，共七剂。
四诊：
皮肤搔痒已愈，二便通畅，纳食有增，每日散步2～3小时而不觉疲劳，近日查血肌酐降至4.1mg/dl，尿素氮降为38mg/dl。脉仍弦滑，按之略数，舌质红，苔白，三焦虽畅，郁热未得全清，仍用凉血化瘀方法。
处方：荆芥6克，防风6克，白芷6克，独活6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，茅根与芦根各10克，焦三仙各10克，水红花子10克，大腹皮10克，槟榔10克，大黄5克，共七剂。
后以此方加减治疗半年，血肌酐降为3mg/dl，尿素氮降为29mg/dl，临床症状基本消失，已能恢复半日工作。
[按语]：本案患者属于典型的家族发病，其姐妹共5人，其中一人已死于尿毒症，另一人因慢性肾衰作了肾移植，另有一小妹为慢性肾小球肾炎。追踪其父母并无肾病，但其祖父母去世较早，其死因虽未明确，但其所述症候似与肾病尿毒症有关。象这种姐妹数人同时或先后均患慢性肾病的例子在临床并不少见，还有母子同病，兄弟同病等，这一现象提示肾病的发生可能与遗传因素有关。根据临床上慢性肾病家族性发病较为常见的事实，赵老师提出了慢性肾病可遗传的观点。根据中医理论推断热毒深伏于髓是本病得自先天的基本特点。毒发于髓而表现为血分瘀热。故治疗当以凉血化瘀为主。大忌温补，并忌食高蛋白高热量和一切辛辣刺激性食物，目的就是为了防止由于饮食不慎而更增其热。凉血化瘀可用生地榆、炒槐花、赤芍、丹参、茜草、小蓟、紫草、地丁草、白头翁等。本例以皮肤搔痒为主要表现，是血分热毒聚于皮肤，更加地肤子、白鲜皮、草河车清热解毒。肾衰尿毒症时，小便短少，或色白，机体代谢废物不能从尿排出，故溢出皮肤为痒，重者有尿素结晶如白霜状。治疗必通其大便，使热毒从大便排出。本案大便干结，数日一行，舌苔黄腻垢厚，属三焦蕴热，初诊即用大黄3克，而力有不逮，故二诊以后皆增至5克，得大便畅行，热毒得泄，而诸症向安。凡治尿毒症，必令其大便通畅滑润，日二三行为最佳，此为要决。
程某，女性，53岁。
初诊：
慢性肾小球肾炎10余年，慢性肾功能衰竭发现半年余，肌酐6.7mg/dl，尿素氮74mg/dl。血色素6.5克。经服包醛氧化淀粉，大便每日二次，诸症尚称平稳。近日困患感冒，自觉胸闷短气，渐至喘逆不能平卧。西医作肺感染用青霉素3日，未见明显好转，经×光透视，发现胸腔积液中量。建议行血液透析，患者惧之。前来就诊。面色晦暗，端坐呼吸，喘逆不止，脉象弦滑数。按之振指，舌白苔腻水滑，小便量少，大便不畅。此尿毒重症，水饮射肺，勉拟泻肺行水，以救其急，若不效，宜急行透析。
处方：桑白皮15克，地骨皮15克，苏叶梗各10克，前胡6克，杏仁10克，葶苈子20克，生地榆10克，赤芍10克，茜草10克，丹参10克，大腹皮15克，槟榔10克，炒枳壳6克，大黄3克。共三付。
二诊：
药后大便畅行，小便增多，喘逆之势稍减，诊脉弦滑而数，舌白苔腻根厚，再以宣肃方法。
处方：苏叶梗各10克，前胡6克，杏仁10克，浙贝母10克，桑白皮15克，地骨皮15克，葶苈子20克，生地榆10克，炒槐花10克，丹参10克，茜草10克，大腹皮10克，槟榔10克，大黄3克，冬瓜皮30克，茯苓皮30克，共三付。
三诊：
小便明显增多，一日夜可达2500毫升，喘逆之势渐减，脉仍弦滑，舌白苔腻，再以疏调三焦方法。
处方：苏叶梗各10克，前胡6克，杏仁10克，桑白皮15克，枇杷叶10克，葶苈子15克，生地榆10克，炒槐花10克，丹参10克，茜草10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，共七付。
四诊：
喘逆已平，二便畅通，纳食亦香，脉仍弦滑有力，舌白苔腻未变，仍属尿毒重症，未可掉以轻心，饮食寒暖，诸宜小心。再以凉血化瘀，疏调三焦方法。
处方：苏叶梗各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，茅根与芦根各10克，焦三仙各10克，大腹皮10克，槟榔10克，大黄3克，共七付。
后以上方加减治疗3个月，治疗期间辅以饮食控制，并令其逐步增加散步式运动锻炼，精神体力日见好转，肌酐下降至4mg/dl，尿素氮稳定在40mg/dl以下。
[按语]：慢性肾功能衰竭、尿毒症并发胸闷憋气，喘逆不得平卧，最为危急，往往是因胸腔积液较多，压迫肺泡所致，重者可有心包积液，缺氧症状明显。其症不同于一般喘咳。治疗亦颇为棘手。赵老师认为，此症乃水饮不得下输而逆射心肺，故治疗急当泻肺行水，用泻白散合葶苈大枣泻肺汤，不用大枣，加疏利三焦之品，务令大小便通畅，使水饮有泄越之途，从二便排出体外。其葶苈子宜重用，一般15～30克，药后可见小便增多，喘逆势减，便有转机。若喘逆有增无减，速当透析，以免贻误病情。
经期发热（周期性发热）
于某，女性，50岁。
于1989年2月11日初诊：
自1988年9月开始至今，每月经行前1～2天，自觉发冷发热，体温37℃～38℃，同时伴有尿频、尿急、尿痛等症状。去某医院检查，尿中有大量红白血球，诊断为“泌尿系感染。”曾用呋喃坦啶、抗菌素、中药等治疗，疗效不明显，随经净而发热以及泌尿系症状消失。现又临近行经，恐其又作，故请赵老医治。证见：胸胁中脘胀闷不舒，食欲不佳，心烦急躁，夜寐梦多，大便不畅，下肢轻度浮肿，舌红且暗，苔白腻，脉弦滑细数。
证属肝经郁热，气机不畅。拟治疏调气机、清泻肝经郁热之法。用药：柴胡6克，黄芩6克，川楝子6克，丹参10克，赤芍10克，生地榆10克，茜草10克，炒山栀6克，丹皮10克，防风6克，荆芥炭10克。服药7剂，精神愉快。
2月14日月经适来，量多有血块，略有腹痛，发热未作，余症亦减轻，仍以前法进退。方药：荆芥炭10克，防风6克，茅根10克，小蓟10克，丹参10克，生地榆10克，炒槐花10克，炒山栀6克，黄芩6克，丹皮10克，焦三仙各10克。服药3剂。月经干净，大便偏干，睡眠不实有梦，舌红且干，改用凉血清热养阴，疏调升降方法。药用：蝉衣6克，僵蚕10克，片姜黄6克，香附10克，黄芩6克，川楝子6克，炒枳壳6克，竹茹6克，生地10克，旱莲草10克，女贞子10克。服上方7剂，大便正常，夜寐较安。又服7剂，月经至，发热以及他症均未发作。
3个月后随访，未再复发。
[按语]：此患者已50岁，时至绝经期，一般认为肾气渐衰，天癸将绝，应补益肾之阴阳为主。而赵老根据临床症状，辨证为肝经郁热之证。先用逍遥散加减，舒肝解郁清热，以畅气机。
郁热得清，发热则去，下移之热随之而解，改用凉血育阴之法以治其本。
Turbid Urine (Exercise-induced Proteinuria)
Zang Moumou, Female, 25 years old.
First Visit:
For the past three months, she has frequently noticed turbid urine, with no abnormal sensations during urination. Routine urine examination showed protein (++). Subsequent multiple urine tests revealed that morning urine was negative for protein, while daytime urine was often strongly positive. After examination at a certain hospital, exercise-induced proteinuria was suspected, and she was advised to rest in bed and avoid physical activity. After more than a month of this regimen, she felt increasingly fatigued and weak, and urine protein remained (+++). The pulse was soggy, slippery, and rapid; the tongue was red with a yellow, greasy coating; and she had frequent dreams at night. The syndrome was identified as heat in the blood level (Xue Fen), so a method of clearing and resolving was used initially. She was also instructed to engage in daily exercise, primarily walking, and not to rely on bed rest.
Prescription: Jingjie (Schizonepetae Spica) 6g, Fangfeng (Saposhnikoviae Radix) 6g, Baizhi (Angelicae Dahuricae Radix) 6g, Duhuo (Angelicae Pubescentis Radix) 6g, Shengdiyü (Sanguisorbae Radix) 10g, Chao Huaihua (Sophorae Flos, stir-fried) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qiancao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Maogen (Imperatae Rhizoma) and Lugen (Phragmitis Rhizoma) each 10g, Dahuang (Rhei Radix et Rhizoma) 1g, total seven doses.
Second Visit:
After taking the medicine, urine protein decreased to (+), nighttime sleep became peaceful, and mental and physical energy improved significantly. She followed the doctor's advice to walk for 1-2 hours every morning and evening. She felt comfortable after walking, and her confidence increased greatly. The pulse remained wiry and slippery; the tongue was red with a greasy coating. The syndrome was damp-heat accumulation and stagnation (Shi Re Yun Yu); the method of clearing and resolving was continued.
Prescription: Jingjie 6g, Fangfeng 6g, Baizhi 6g, Duhuo 6g, Shengdiyü 10g, Chishao (Paeoniae Radix Rubra) 10g, Danshen 10g, Qiancao 10g, Maogen and Lugen each 10g, Dahuang 1g, Jiao Sanxian (Charred Sanxian) each 10g, total seven doses.
Third Visit:
Yesterday's routine urine test results showed protein (+), white blood cells 0-2. She persisted in walking for 2 hours every morning and evening and felt an increase in physical strength. The pulse remained wiry and slippery; the tongue was red with a white coating. The previous method was continued with modifications.
Prescription: Jingjie 6g, Fangfeng 6g, Suye (Perillae Folium) 6g, Duhuo 6g, Shengdiyü 10g, Chao Huaihua 10g, Danshen 10g, Chishao 10g, Maogen and Lugen each 10g, Jiao Sanxian each 10g, Shuihonghuazi (Hydrocotylis Fructus) 10g, Dahuang 1g, total seven doses.
Fourth Visit:
After taking the medicine, urine protein turned negative. No positivity appeared after activity. The pulse was soggy and slippery; the tongue was red with a thin coating. The previous method was continued with modifications. Dietary restrictions and exercise must be persisted in and not abandoned halfway.
Prescription: Jingjie 6g, Fangfeng 6g, Suye 10g, Baizhi 6g, Shengdiyü 10g, Chao Huaihua 10g, Danshen 10g, Qiancao 10g, Chishao 10g, Maogen and Lugen each 10g, Dahuang 1g, Jiao Sanxian each 10g, Shuihonghuazi 10g, total seven doses.
Subsequently, treated with modifications of the above prescription for three months, urine protein remained consistently negative. Medication was then stopped for observation, with no recurrence seen.
[Commentary]: This case is worth discussing regarding the relationship between exercise and the treatment of chronic kidney disease. According to traditional views, chronic nephritis and chronic renal failure require rest, avoiding physical activity, and absolute bed rest for severe cases. This has become a conventional rule followed by clinicians for decades without question. Through extensive clinical observation, Master Zhao Shaqin found that mere bed rest does not aid in the treatment and recovery of kidney disease but may accelerate its deterioration. A key aspect of the pathogenesis of chronic kidney disease is collateral stasis (Luo Mai Yu Zu), which manifests in modern pathology as microvascular spasm and blockage, corresponding to blood stasis (Xue Yu) in TCM. Prolonged bed rest exacerbates the stagnation of Qi and blood. This explains why some clinical cases deteriorate rapidly under absolute bed rest. According to basic TCM theory, the world is constantly moving, and so is the human body. The principle that "life lies in movement" applies not only to health preservation for healthy individuals but also to the treatment and recovery of most diseases, especially chronic kidney disease. Therefore, an important measure in Master Zhao's clinical practice for treating chronic kidney disease is requiring patients to persist in exercise, primarily walking. Unremitting walking promotes the circulation of Qi and blood throughout the body, improves renal blood circulation, and promotes the repair of renal lesions. Practice has proven this theory correct. Patients who persist in exercise experience the benefits: they feel spirited, physically stronger, their subjective symptoms and signs improve, and laboratory indicators also improve accordingly. This case is a clear example. The patient was diagnosed with exercise-induced proteinuria, characterized by significant proteinuria upon slight activity but normality at rest. Western medicine simply restricts activity and prescribes bed rest. However, months of rest failed to prevent post-exercise proteinuria. Based on the dialectical relationship between movement and stillness, Master Zhao acted contrary to convention, insisting on exercise combined with treatment. Within just a few weeks, the exercise-induced proteinuria was controlled, allowing her to resume normal work and study. This case inspires us that moderate exercise plays a pivotal role in treating chronic kidney disease and deserves sufficient attention.
Skin Pruritus (Uremia)
Chen Moumou, Female, 49 years old.
First Visit:
She reported suffering from chronic glomerulonephritis for over ten years, with fluctuating severity. Renal insufficiency was detected two years ago, with creatinine and urea nitrogen levels gradually rising. For the past half-month, skin pruritus has been severe, preventing sleep. Accompanied by listlessness, somnolence, general fatigue, severe weakness in both lower limbs, irritability, constipation, scanty urine, nausea, and vomiting. The pulse was wiry, slippery, and rapid, forceful upon pressure; the tongue was red with a thick, greasy, yellow coating. Laboratory tests showed serum creatinine 7.4 mg/dl and urea nitrogen 82 mg/dl. Western medicine suggested dialysis, but the patient feared it, so she sought consultation. The syndrome belongs to damp-heat accumulating into toxicity, penetrating the blood level, approaching the stage of Guan Ge (Obstruction and Reversal). Urgent treatment with cooling the blood, resolving stasis, and detoxifying is required.
Prescription: Jingjie Tan (Schizonepetae Spica, charred) 10g, Fangfeng 6g, Baizhi 6g, Shengdiyü 10g, Chao Huaihua 10g, Danshen 10g, Qiancao 10g, Jiao Sanxian each 10g, Difuzi (Kochiae Fructus) 10g, Baixianpi (Dictamni Cortex) 10g, Caoheche (Arisaematis Cum Bile) 10g, Dahuang 3g, total seven doses.
Second Visit:
After medication, bowel movements were unblocked but not smooth; skin pruritus lessened, allowing sleep, though dreams persisted. The pulse remained wiry, slippery, and rapid; the tongue was red with a thick yellow coating at the root. Continue the previous method with adjustments.
Prescription: Jingjie Tan 10g, Fangfeng 6g, Baizhi 6g, Duhuo 6g, Shengdiyü 10g, Chao Huaihua 10g, Danshen 10g, Qiancao 10g, Chishao 10g, Maogen and Lugen each 10g, Difuzi 10g, Baixianpi 10g, Caoheche 10g, Dahuang 5g, total seven doses.
Third Visit:
Bowel movements became smooth, 2-3 times daily, abdomen comfortable, spirit improved, somnolence disappeared, and skin pruritus significantly reduced. The pulse remained wiry and slippery; the tongue was red with a thick yellow coating. Heat stagnation has decreased but is not cleared; continue the clearing and resolving method. Be careful with diet and temperature regulation; walk daily without slackening.
Prescription: Jingjie Tan 10g, Fangfeng 6g, Baizhi 6g, Duhuo 6g, Shengdiyü 10g, Chao Huaihua 10g, Danshen 10g, Qiancao 10g, Maogen and Lugen each 10g, Difuzi 10g, Baixianpi 10g, Caoheche 10g, Dahuang 5g, total seven doses.
Fourth Visit:
Skin pruritus resolved, bowel and urinary passages smooth, appetite increased, walking 2-3 hours daily without fatigue. Recent labs showed serum creatinine dropped to 4.1 mg/dl and urea nitrogen to 38 mg/dl. The pulse remained wiry and slippery, slightly rapid upon pressure; the tongue was red with a white coating. Although the Triple Burner (San Jiao) is open, latent heat is not fully cleared; continue cooling the blood and resolving stasis.
Prescription: Jingjie 6g, Fangfeng 6g, Baizhi 6g, Duhuo 6g, Shengdiyü 10g, Chao Huaihua 10g, Danshen 10g, Qiancao 10g, Maogen and Lugen each 10g, Jiao Sanxian each 10g, Shuihonghuazi 10g, Dafupi (Arecae Pericarpium) 10g, Binglang (Arecae Semen) 10g, Dahuang 5g, total seven doses.
Treated with modifications of this prescription for half a year, serum creatinine dropped to 3 mg/dl, urea nitrogen to 29 mg/dl, clinical symptoms basically disappeared, and she could resume half-day work.
[Commentary]: This patient represents a typical familial onset. Among her five sisters, one died of uremia, another underwent kidney transplantation for chronic renal failure, and a younger sister has chronic glomerulonephritis. Her parents have no kidney disease, but her grandparents died early, and although the cause of death was unclear, the symptoms described seem related to kidney disease/uremia. Cases of multiple sisters suffering from chronic kidney disease simultaneously or sequentially are not uncommon in clinical practice, as are mother-child or brother-brother occurrences. This phenomenon suggests that kidney disease may be related to genetic factors. Based on the commonality of familial onset of chronic kidney disease in clinical practice, Master Zhao proposed the view that chronic kidney disease can be inherited. According to TCM theory, it is inferred that deep-seated heat-toxin in the marrow is the congenital characteristic of this disease. Toxin arising from the marrow manifests as blood-level stasis-heat. Therefore, treatment should focus on cooling the blood and resolving stasis. Warm tonification is strictly contraindicated, as well as high-protein, high-calorie, and all spicy/stimulating foods, to prevent dietary indiscretion from increasing heat. Cooling the blood and resolving stasis can use Shengdiyü, Chao Huaihua, Chishao, Danshen, Qiancao, Xiaoji (Cirsii Herba), Zicao (Arnebiae Radix et Rhizoma), Didingcao (Heterotrichii Herba), and Baitouweng (Pulsatillae Radix). In this case, skin pruritus was the main manifestation, indicating blood-level heat-toxin gathering in the skin; Difuzi, Baixianpi, and Caoheche were added to clear heat and detoxify. In renal failure/uremia, urine is scanty or colorless, and metabolic waste cannot be excreted via urine, so it overflows into the skin causing itching; in severe cases, urea crystals appear like white frost. Treatment must ensure patent bowels to allow heat-toxin to exit via stool. This case presented dry stools, once every few days, and a thick, greasy, yellow coating, indicating heat accumulation in the Triple Burner. Initially, Dahuang 3g was used, but its effect was insufficient, so it was increased to 5g from the second visit onwards. With smooth bowel movements, heat-toxin was discharged, and symptoms stabilized. For treating uremia, ensuring smooth, lubricated bowel movements, 2-3 times daily, is optimal and crucial.
Wheezing and Reverse Flow (Chronic Renal Failure Complicated with Pleural Effusion)
Cheng Mou, Female, 53 years old.
First Visit:
Chronic glomerulonephritis for over 10 years; chronic renal failure detected for over half a year. Creatinine 6.7 mg/dl, urea nitrogen 74 mg/dl. Hemoglobin 6.5 g. After taking Polystyrene Sulfonate Calcium (Baoquan Oxidized Starch), bowel movements occurred twice daily, and symptoms were relatively stable. Recently complicated by a cold, she felt chest tightness and shortness of breath, gradually progressing to wheezing and reverse flow unable to lie flat. Western medicine treated for lung infection with Penicillin for 3 days without obvious improvement. X-ray fluoroscopy revealed moderate pleural effusion. Hemodialysis was suggested, but the patient feared it. She came for consultation. Complexion was dull, breathing in a sitting position, continuous wheezing, pulse wiry, slippery, and rapid, striking the finger forcefully. Tongue coating was white, greasy, and watery; urine volume was low, bowel movements unsmooth. This is a severe uremic condition with fluid retention attacking the lungs. Tentatively prescribing draining the lungs and promoting water metabolism to save the emergency; if ineffective, urgent dialysis is necessary.
Prescription: Sangbaipi (Morus Cortex) 15g, Digupi (Lycii Cortex) 15g, Suyegeng (Perillae Caulis) each 10g, Qianhu (Peucedani Radix) 6g, Xingren (Pruni Semen) 10g, Tinglizi (Descurainiae Semen seu Lepidii Semen) 20g, Shengdiyü 10g, Chishao 10g, Qiancao 10g, Danshen 10g, Dafupi 15g, Binglang 10g, Chao Zhike (Aurantii Fructus Immaturus, stir-fried) 6g, Dahuang 3g. Total three doses.
Second Visit:
After medication, bowel movements were smooth, urine volume increased, and the trend of wheezing slightly decreased. Pulse wiry, slippery, and rapid; tongue coating white, greasy, thick at the root. Again using the method of diffusing and descending.
Prescription: Suyegeng each 10g, Qianhu 6g, Xingren 10g, Zhebeimu (Fritillariae Thunbergii Bulbus) 10g, Sangbaipi 15g, Digupi 15g, Tinglizi 20g, Shengdiyü 10g, Chao Huaihua 10g, Danshen 10g, Qiancao 10g, Dafupi 10g, Binglang 10g, Dahuang 3g, Dongguapi (Benincasae Exocarpium) 30g, Fu Ling Pi (Poriae Cortex) 30g, total three doses.
Third Visit:
Urine volume significantly increased, reaching 2500 ml per day and night; wheezing trend gradually decreased. Pulse still wiry and slippery; tongue coating white and greasy. Again using the method of regulating the Triple Burner.
Prescription: Suyegeng each 10g, Qianhu 6g, Xingren 10g, Sangbaipi 15g, Pipaye (Loquat Leaf) 10g, Tinglizi 15g, Shengdiyü 10g, Chao Huaihua 10g, Danshen 10g, Qiancao 10g, Jiao Sanxian each 10g, Shuihonghuazi 10g, Dafupi 10g, Binglang 10g, Dahuang 3g, total seven doses.
Fourth Visit:
Wheezing has subsided, bowel and urinary passages smooth, appetite good. Pulse still wiry, slippery, and forceful; tongue coating white and greasy unchanged. Still a severe uremic condition, do not let guard down; be careful with diet and temperature regulation. Again using cooling the blood, resolving stasis, and regulating the Triple Burner methods.
Prescription: Suyegeng each 10g, Jingjie 6g, Fangfeng 6g, Baizhi 6g, Shengdiyü 10g, Chao Huaihua 10g, Danshen 10g, Qiancao 10g, Maogen and Lugen each 10g, Jiao Sanxian each 10g, Dafupi 10g, Binglang 10g, Dahuang 3g, total seven doses.
Treated with modifications of the above prescription for 3 months, supplemented with dietary control and gradual increase in walking exercise. Mental and physical strength improved daily; creatinine dropped to 4 mg/dl, urea nitrogen stabilized below 40 mg/dl.
[Commentary]: Chronic renal failure and uremia complicated with chest tightness, stifling sensation, wheezing, and inability to lie flat are most critical, often caused by large amounts of pleural effusion compressing alveoli; severe cases may have pericardial effusion and obvious hypoxia. These symptoms differ from ordinary coughing and wheezing. Treatment is also quite tricky. Master Zhao believes this syndrome is due to fluid retention failing to descend and counter-flow attacking the heart and lungs. Therefore, urgent treatment should drain the lungs and promote water metabolism, using Xie Bai San combined with Tingli Da Zao Xie Fei Tang (without Da Zao), adding herbs to regulate the Triple Burner, ensuring patent bowel and urinary passages so that fluid retention has an outlet for discharge via stool and urine. Tinglizi should be used in heavy doses, generally 15-30g. After medication, increased urine output and reduced wheezing indicate a turning point. If wheezing increases rather than decreases, immediate dialysis is necessary to avoid delaying the condition.
Menstrual Fever (Periodic Fever)
Yu Mou, Female, 50 years old.
First Visit on February 11, 1989:
Since September 1988, one to two days before menstruation, she feels chills and fever, body temperature 37°C–38°C, accompanied by urinary frequency, urgency, and dysuria. Examination at a certain hospital showed numerous red and white blood cells in urine, diagnosed as "urinary tract infection." Treated with Furadantin, antibiotics, and Chinese medicine, but efficacy was not obvious. Fever and urinary symptoms disappeared after menstruation ended. Now approaching menstruation again, fearing recurrence, she sought treatment from Master Zhao. Signs include: distension and discomfort in the chest, hypochondrium, and epigastrium, poor appetite, irritability, frequent dreams, unsmooth bowel movements, mild edema in lower limbs, tongue red and dark, coating white and greasy, pulse wiry, slippery, fine, and rapid.
The syndrome belongs to constrained heat in the Liver Meridian with unsmooth Qi mechanism. The treatment plan is to regulate the Qi mechanism and clear/constrict constrained heat in the Liver Meridian. Medication: Chaihu (Bupleuri Radix) 6g, Huangqin (Scutellariae Radix) 6g, Chuanlianzi (Toosendan Fructus) 6g, Danshen 10g, Chishao 10g, Shengdiyü 10g, Qiancao 10g, Chao Shanzhi (Gardeniae Fructus, stir-fried) 6g, Danpi (Moutan Cortex) 10g, Fangfeng 6g, Jingjie Tan 10g. Took 7 doses, spirit became cheerful.
On February 14, menstruation arrived, abundant flow with blood clots, slight abdominal pain, no fever, other symptoms also alleviated. Continue with the previous method with adjustments. Prescription: Jingjie Tan 10g, Fangfeng 6g, Maogen 10g, Xiaoji (Cirsii Herba) 10g, Danshen 10g, Shengdiyü 10g, Chao Huaihua 10g, Chao Shanzhi 6g, Huangqin 6g, Danpi 10g, Jiao Sanxian each 10g. Took 3 doses. After menstruation ended, stools were slightly dry, sleep was restless with dreams, tongue red and dry. Changed to cooling the blood, clearing heat, nourishing Yin, and regulating ascending/descending methods. Medication: Chan Yi (Bombyx Batryticatus) 6g, Jiangcan (Bombyx Batryticatus) 10g, Pian Jianghuang (Curcumae Radix) 6g, Xiangfu (Cyperi Rhizoma) 10g, Huangqin 6g, Chuanlianzi 6g, Chao Zhike 6g, Zhu Ru (Bambusae Caulis in Taenia) 6g, Shengdi (Rehmanniae Radix) 10g, Hanliancao (Ecliptae Herba) 10g, Nvzhenzi (Ligustri Lucidi Fructus) 10g. Took the above prescription for 7 doses, stools normalized, nighttime sleep relatively peaceful. Took another 7 doses, menstruation arrived, fever and other symptoms did not recur.
Follow-up after 3 months showed no recurrence.
[Commentary]: This patient is 50 years old, at the menopausal age. It is generally believed that Kidney Qi is gradually declining, Tian Gui (menstrual essence) is about to cease, and treatment should mainly tonify Kidney Yin and Yang. However, based on clinical symptoms, Master Zhao differentiated the syndrome as constrained heat in the Liver Meridian. First, using modified Xiao Yao San to soothe the Liver, resolve constraint, clear heat, and smooth the Qi mechanism.
Once constrained heat is cleared, fever disappears, and downward-moving heat resolves accordingly. Then changed to cooling the blood and nourishing Yin to treat the root.