III. Hepatic-Renal Syndrome

III. Hepatic-Renal Syndrome

As cirrhosis progresses to a certain stage, liver function deteriorates, metabolic waste products accumulate, blood ammonia levels remain high, false neurotransmitter levels rise, and albumin levels decrease—these factors all significantly impact and increase the burden on the kidneys. Over time, kidney function is damaged, leading to impaired excretion of non-protein nitrogen in the blood, with serum urea nitrogen exceeding normal levels (5.9 mmol/L) and serum creatinine levels also surpassing normal values (96 mmol/L). Furthermore, a decline in carbon dioxide binding capacity (below the normal range of 21–30 µmol/L) indicates that renal failure has progressed to acidosis. While Western medicine and conventional treatments for renal failure include the routine administration of large doses of albumin and dialysis therapy, there are no alternative approaches available. Dialysis is only a temporary solution, capable of providing relief only for a short period and easily leading to systemic infections and other complications—ultimately, it does not guarantee a cure. Some people even say, “Dialysis has no return path.” Traditional Chinese medicine and herbal remedies also show promise in treating hepatic-renal syndrome. Through long-term observation and experience, I’ve found that employing methods that soothe the liver and tonify the kidneys can help some patients with hepatic-renal syndrome improve. Below, I share the commonly used main formulas: 10g of angelica sinensis, 10g of white peony, 10g of atractylodes macrocephala, 10g of poria, 10g of alisma, 12g of rehmannia root, 6g of cornus officinalis, 10g of Dioscorea opposita, 10g of rhubarb, 6g of processed aconite, 10g of cinnamon twig, 20g of motherwort, 10g of red peony, 10g of plantain seeds, 10g of two flowers, 20g of white flower snake tongue grass, 10g of three-edged polygonum, 10g of curcuma, 6g of leeches (mixed for use), decocted in water, one dose per day, taken in several portions. Among the herbs in this formula—such as three-edged polygonum, curcuma, motherwort, leeches, and other blood-removing herbs—play a key role in treating renal failure. Particularly, leeches possess the power to break down walls and restore balance, making them indispensable in this context. The formula combines Xiaoyao San and Gui Fu Ba Wei to soothe the liver, tonify the kidneys, and strengthen the body’s fundamental defenses. I once reviewed the “Comprehensive Collection of Prescriptions from Famous Modern Doctors in China” (Hebei Science and Technology Press), where the prescription by Zhejiang’s renowned old Chinese medicine practitioner Pan Chenglian, Xu Changqing’s formula, was considered a well-structured and effective remedy. This formula consists of 15g of Xu Changqing, 10g of white reed root, 6g of wood gourd, 10g of winter melon seeds, 10g of Qumai, 10g of Areca catechu, 10g of talc, decocted in water and taken once daily. This formula had been tested in clinical practice and proved effective. In March 2000, Mr. Wang, a 52-year-old man, was hospitalized for more than three months due to hepatic-renal syndrome. He underwent long-term treatments including liver protection, diuretic therapy, and infection prevention; his ascites subsided, and his liver function returned to normal. However, his urea nitrogen level remained at 11.2 mmol/L, and his serum creatinine level reached 208 µmol/L. After taking the above formula for 10 doses, his urea nitrogen dropped to 9.2 mmol/L, and his serum creatinine fell to 182.5 µmol/L. Since then, the patient continued to take this formula alongside standard treatments for decompensated cirrhosis, and he was eventually discharged, able to manage his daily activities independently. This formula originated from “Jufang,” originally designed to treat qi stagnation and obstruction, urinary retention, and lower abdominal discomfort. Mr. Pan Chenglian possessed a keen insight and successfully applied it to treat renal failure—its efficacy proved true, demonstrating that ancient prescriptions can be revived and adapted for modern use. My experience shows that patients with renal failure often experience disruptions in gastrointestinal endocrine function and exocrine function. Given this, the digestive and absorptive functions of the gastrointestinal tract are often severely disrupted. Therefore, while taking traditional Chinese medicine, it is advisable to also administer 10mg of metoclopramide three times a day and 150mg of ranitidine three times a day—only in this way can we ensure that the traditional Chinese medicine reaches the stomach.