Case 3: Mr. Gao, male, 45 years old

Case 3: Mr. Gao, male, 45 years old

Initial Consultation: May 8, 2018
Chief Complaint: Chronic nephritis for 8 years, renal failure. During this period, he had used Huangkui capsules, Jinshuibao, Shenfukang capsule preparations, and prednisone treatment. Although his condition stabilized, urinary protein remained persistently (++), without any reduction. Recently, due to a traumatic injury resulting in lumbar contusion, he developed hematuria, low back pain, leg pain, lower limb edema, dizziness, palpitations, nausea, vomiting, aversion to cold, and chills. His tongue was red with thick yellow greasy coating, and his pulse was deep, slow, and weak.
Physical Examination: Urea nitrogen 28 mmol/L, serum creatinine 600 µmol/L, urinary protein (+++), urinary occult blood (+++). 24-hour urine protein quantification: 3.5 g; triglycerides 3.8 mmol/L; total cholesterol 4.6 mmol/L; blood pressure 140/90 mmHg.
Western Medical Diagnosis: Renal failure, azotemia.
Traditional Chinese Medicine Syndrome Differentiation: Post-traumatic blood stasis obstructing the collaterals, damp-heat accumulating in the lower burner, kidney yang deficiency, turbid qi rising upward.
Treatment Principle: Clear heat and remove dampness, activate blood circulation and resolve stasis.
Prescription: Xuefu Zhuyu Tang, Guizhi Fuling Wan, Xiaoji Yinzi with modifications.
Ingredients: Peach kernel 10 g, safflower 6 g, Rehmannia glutinosa 10 g, Angelica sinensis 10 g, White peony root 10 g, Ligusticum chuanxiong 6 g, Bupleurum chinense 10 g, Cortex Moutan 6 g, Lotus rhizome 15 g, Coptis chinensis 15 g (decocted separately), Aristolochia fangchi 15 g (decocted separately), Akebia quinata 10 g, Sichuan lovage 10 g, Dipsacus asper 10 g, Salvia miltiorrhiza 10 g, Glycyrrhiza 6 g, Magnolia officinalis 10 g, Poria cocos 10 g, Citrus aurantium peel 10 g, Platycodon grandiflorus 20 g, Licorice 6 g, Gardenia jasminoides 10 g, Bamboo leaves 10 g, Imperata cylindrica 30 g, Cypress leaves 10 g, Panax notoginseng 3 g (added later), Leech 10 g (added later), Salvia miltiorrhiza 20 g, Acorus tatarinowii 10 g (added later), Amomum villosum 10 g. Decoct in water and take twice daily, one dose every other day, for a total of 14 doses.

Second Consultation: After taking the medication, low back pain and hematuria both alleviated, edema disappeared, aversion to cold and chills subsided, and blood pressure dropped to 130/80 mmHg. Urinary protein (+++) and urinary occult blood (+) persisted, but the tongue was red with thin yellow coating, and the pulse was deep, slow, and strong. The syndrome was attributed to kidney deficiency, damp-heat, and blood stasis, so Shiwai Pipa Heji was prescribed for treatment.
Prescription: Stonecrop 10 g, Loquat leaf 10 g, Dryopteris crassirhizoma 10 g, Equisetum arvense 10 g, Papilionaria 10 g, Houttuynia cordata 15 g, Bombyx mori 10 g, Cistanche deserticola 10 g, Morinda officinalis 10 g, Cornus officinalis 10 g, Angelica sinensis 10 g, Rehmannia glutinosa 12 g, Fenugreek 10 g, Epimedium 10 g, Polygonum multiflorum 10 g, Polygonum multiflorum 10 g, Eucommia ulmoides 10 g, Mulberry 10 g, Deer antler glue 10 g, Cinnamon 6 g, Aconite 6 g, Wine-processed Rheum palmatum 6 g (added later), Oyster shell 30 g (decocted first), Su stem 20 g, Cicada slough 6 g, Motherwort 15 g, Panax notoginseng powder 3 g (added later), Leech powder 10 g (added later). Total of 14 doses, one dose per day.
Explanation: Stonecrop, Equisetum, Motherwort, Loquat leaf, Dryopteris, and Papilionaria all have the effects of clearing heat, removing dampness, and detoxifying. Loquat leaf and Houttuynia cordata descend lung qi to elevate kidney qi; Cistanche, Morinda, Fenugreek, Epimedium, Mulberry, Deer antler glue, Cinnamon, and Aconite are powerful tonics that replenish kidney yang and restore kidney qi, thus nourishing the source of fire to dispel yin shadows. As stated in the "Plain Questions": "Yang qi is like heaven and the sun; if it loses its proper place, life will be shortened and its brilliance diminished." Replenishing kidney yang can restore kidney qi and enable water to be properly governed. Rehmannia, Angelica, Polygonum multiflorum, and Cornus officinalis nourish yin and tonify the kidneys, strengthening the master of water to control the sunlight. Panax notoginseng and leech activate blood circulation and resolve stasis, improving glomerular blood flow. Cinnamon, Aconite, oyster shell, and Rheum palmatum warm yang and reduce turbidity, unblocking the bowels to detoxify, thereby reducing the burden on the kidneys and improving renal function. Su stem, Cicada slough, and Motherwort dispel wind and reduce swelling, alleviating proteinuria. This formula has shown remarkable efficacy in treating renal failure. In the third consultation, urinary occult blood (-), urinary protein (++), urea nitrogen 18 mmol/L, serum creatinine 200 µmol/L—all indicators decreased. The patient’s low back pain, hematuria, edema, dizziness, and palpitations all improved. Since the treatment was effective, another 14 doses were prescribed to observe the effect. The patient continued to take this formula with adjustments, totaling over 60 doses, and all indicators—urea nitrogen, creatinine, urinary protein, and urinary occult blood—returned to normal ranges. The patient was instructed to continue taking this formula to consolidate the therapeutic effect and prevent recurrence.