V. Listing of Ancient and Modern Theories

V. Listing of Ancient and Modern Theories

Based on the clinical manifestations of this disease—oliguria or even anuria accompanied by nausea and vomiting—historical medical scholars’ discussions on similar conditions are mainly found in texts such as “Yinbi” and “Guange.” Regarding the location of the disease, its etiology, and pathogenesis, the “Plain Questions · Discussion on Water and Heat Points” states that the kidney is the gate of the stomach; when the gate is blocked, water accumulates and follows the same pattern. The “Plain Questions · Great Discussion on the Five Constants” records that when the disease is closed, evil forces injure the kidney. The “Plain Questions · Discussion on the Manifestation of the Five Qi” says that bladder dysfunction leads to urinary retention. The “Plain Questions · Discussion on the Transmission of Primary and Secondary Diseases” also mentions that bladder diseases cause urinary obstruction. The “Ling Shu · Chapter on the Main Channels” states: “The Triple Burner…when it is truly blocked.” The “Discussions on the Causes of Various Diseases · Discussions on Urinary Disorders” notes that urinary obstruction occurs because both the bladder and the kidney are hot. The “Qianjin Fang” believes that some people develop blockages after contracting certain illnesses, leading to fatal consequences, which should not be taken lightly. The “Qianjin Yifang” also records that this is often caused by weakness in the body and excessive heat in the lower burner. The “Lan Shi Mi Cang · Discussion on Urinary Retention” holds that when there is no outlet, it is always due to pathogenic heat. The “Jing Yue Quan Shu · Discussion on Urinary Retention” says: “There are cases where fire pathogen gathers in the small intestine and bladder, causing the water source to dry up and the airway to become hot and blocked; there are also cases where heat resides in the liver and kidneys, leading to either stagnant essence or blood blocking the waterways and preventing flow…there are also cases where true yin is exhausted, the primordial sea has no roots, and qi is weak and cannot transform, resulting in closure.” The “Zhengzhi Huibu · Discussion on Closure” recognizes that when heat accumulates in the lower burner and clogs the cells, the airway becomes obstructed; when there is hidden heat in the lungs and qi cannot be transformed. Clinically, the “Shanghan Lun” states that when the gate is closed, urination is impossible, and when the grid is closed, vomiting occurs. The “Qianjin Fang” says: “When urination is impossible, vomiting occurs, and food cannot enter.” The “Chongding Guangwen Bing Lun” adds: “Urinary toxins enter the bloodstream, and blood toxins affect the brain, causing headaches, dizziness, blurred vision, tinnitus, deafness, nausea, vomiting, breath with a urine-like odor, occasional sudden epileptic seizures, even loss of consciousness and convulsions, groping around the bed, empty gestures, tongue coating turning rotten, sometimes with black spots.”
Regarding the disease and prognosis, the “Ling Shu · Seventeen Chapters on Pulse Measurement” records that when yin and yang are both excessively strong, they cannot support each other, hence the term “gate and grid”; those who experience gate and grid cannot live out their full lifespan. The “Shanghan Lun” says: “…if there is no urination, abdominal distension makes treatment difficult.” The “Jing Yue Quan Shu · Discussion on Closure” records that when water cannot flow, it is considered closure, which is the most critical condition…if it remains blocked for several days, the situation becomes unbearable and may lead to danger. The “Zhengzhi Huibu · Discussion on Closure” states: “When both gate and grid occur, urination is impossible, and within a single day, vomiting suddenly increases dramatically. This is because turbid evil forces block the Triple Burner, preventing righteous qi from ascending and descending, so the gate must go down and urination stops, while the grid must go up and vomiting occurs. When yin and yang are completely closed, death can occur within a single day—this is the most dangerous scenario.”
Cai’s method of activating blood circulation and resolving stasis to treat one case of ARF caused by compression showed remarkable efficacy. Pan’s use of compound Da Chengqi Tang enema to treat 21 cases of traumatic ARF yielded results: 16 cases were cured, and 4 cases improved. Li’s use of Zhenwu Tang combined with Shibi Yin with modifications to treat patients with nephrotic syndrome and acute renal failure (those with spleen-kidney yang deficiency) resulted in relief for all 6 cases, with 5 achieving complete remission. Liu’s treatment of 36 elderly patients with acute renal failure believed that traditional Chinese medicine primarily works during the polyuria and recovery phases of acute renal failure, promoting recovery and strengthening the patient’s constitution. The main manifestation is qi-yin deficiency, so the treatment principle is to tonify qi and nourish yin, using Shengmai Yin combined with Zengye Tang (American ginseng 15 g, Ophiopogon japonicus 15 g, Scrophularia ningpoensis 15 g, Rehmannia glutinosa 15 g, cooked Rehmannia glutinosa 15 g, Adenophora stricta 15 g). This not only treated the primary disease but also increased survival rates and controlled severe gastrointestinal bleeding. Zhu Hong et al. pointed out that the interplay of blood stasis and heat runs throughout the entire process of acute renal failure; blood stasis and heat, internal dampness, and blockage of the Triple Burner are key pathological factors in acute renal failure.

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The focal points of treating acute renal failure to prevent complications and reverse the condition are expelling pathogenic factors, regulating qi and blood circulation, and restoring qi transformation.

Using the method of unblocking stasis and clearing heat to treat acute renal failure involves purging excess pathogenic factors, simultaneously breaking up stasis and dispersing it, detoxifying while transforming dampness, guiding the pathogenic factors outward according to their nature, allowing them to leave the腑 organs, eliminating stasis and heat so they cannot congeal, thereby facilitating smooth blood circulation, unblocking qi flow, ensuring that when blood flows, qi follows, and restoring qi transformation function. Shen Qingfa adopts a staged treatment approach for CRF. In the azotemia stage, the basic formula includes black soybeans, raw rhubarb, ginger pinellia, citrus aurantium, late silkworm excrement (wrapped), perilla leaves, ginger juice coptis, and honey-fried licorice. If patients experience severe vomiting during medication, a few drops of fresh ginger juice can be placed on the tongue before taking the medicine. In the uremia stage, the basic formula comprises prepared aconite root, black croton seed, white croton seed, realgar, magnolia bark, dried ginger, codonopsis, late silkworm excrement (wrapped), Poria with skin, soapberry, ginger pinellia, bamboo shavings, Acorus tatarinowii, costus root, Stephania tetrandra, stephania root, Sichuan pepper, and honey-fried licorice. Ye Rengao classifies chronic renal failure into primary and secondary syndromes, further subdividing them based on pattern differentiation for treatment. The primary syndromes include five types: spleen-kidney qi deficiency, treated by strengthening the spleen and tonifying the kidneys, using Shenling Baizhu San combined with Yougui Wan with modifications; spleen-kidney yang deficiency, treated by warming and tonifying the spleen and kidneys, using Zhenwu Tang with modifications; liver-kidney yin deficiency, treated by nourishing the liver and kidneys, using Liuwei Dihuang Wan combined with Erzhi Wan with modifications; qi-yin dual deficiency, treated by replenishing qi and nourishing yin, using Shenqi Dihuang Tang with modifications; and yang-yin dual deficiency, treated by tonifying both yang and yin, using Dihuang Yinzi or Jisheng Shenqi Wan with modifications. The secondary syndromes are divided into three types: damp-turbidity invading the stomach, treated by clearing heat and transforming dampness, harmonizing the stomach and descending turbidity, using Huanglian Wendan Tang with modifications; turbid yin ascending, treated by resolving phlegm, removing turbidity, and opening the orifices, using Ditang Tang with modifications; and liver yang hyperactivity, treated by nourishing yin and subduing yang, calming the liver and extinguishing wind, using Zhen Gan Xi Feng Tang with modifications. Clinically, he also frequently uses a self-formulated "Renal Failure Formula" to treat this disease, containing codonopsis, white atractylodes, northern astragalus, ophiopogon, raw oyster (decocted first), salvia miltiorrhiza, angelica sinensis, red peony, rhubarb (added later), and other herbs. Zhang Qi also adopts a staged treatment approach for this disease. During the compensated stage of renal insufficiency, the focus is on tonifying the spleen and kidneys, supplemented by promoting diuresis and reducing edema, activating blood circulation and removing stasis, with the main goal being to restore righteous qi, support the body's defenses while eliminating pathogenic factors, thus enabling renal function to recover. Commonly used formulas include those that tonify both the spleen and kidneys: astragalus, codonopsis, white atractylodes, angelica sinensis, Chinese yam, polygonum multiflorum, epimedium leaf, curculigo, dodder seed, ligustrum fruit, goji berry, cornelian cherry, prepared rehmannia, schisandra, salvia miltiorrhiza, angelica sinensis, motherwort, hawthorn, etc. In the decompensated stage of chronic renal insufficiency and the stage of renal failure, the treatment principle is to tonify the spleen and kidneys, drain damp-turbidity, detoxify, and activate blood circulation. The formula used is Fuzheng Huazhuo Huoxue Tang: red ginseng, white atractylodes, poria, dodder seed, prepared rehmannia, epimedium leaf, coptis, rhubarb, amomum villosum seeds, pinellia, peach kernel, safflower, red peony, licorice, salvia miltiorrhiza. Liu Baohou also divides chronic renal failure into four types for pattern-based treatment. For spleen-kidney qi deficiency with blood stasis, if the turbidity is transformed into heat, treatment focuses on strengthening the spleen and reversing the upward flow, harmonizing the stomach and clearing heat, using Wenpi Tang combined with Huanglian Wendan Tang with modifications; if the turbidity is transformed into cold, treatment focuses on strengthening the spleen and reversing the upward flow, warming the middle jiao and stopping vomiting, using Wenpi Tang combined with Wu Zhu Yu Tang or Xiangsha Liujunzi Tang with modifications. For liver-kidney yin deficiency and internal liver wind, treatment focuses on calming the liver and extinguishing wind, nurturing yin and subduing yang, using Da Ding Feng Zhu with modifications. For spleen-kidney yang deficiency and heart yang deficiency, treatment focuses on reviving yang and rescuing from collapse, using Si Ni Tang combined with Shen Fu Long Mu Tang with modifications. For qi-yin dual deficiency and chaotic blood heat, treatment focuses on cooling the blood and clearing heat, detoxifying and opening the orifices, using Xi Jiao Di Huang Tang with modifications. Additionally, Liu Baohou often uses his self-formulated Shenfukang No. 3 granules combined with nitrogen-lowering capsules to treat early and mid-stage chronic renal failure. Shenfukang No. 3 granules (sugar-free) consist of astragalus, codonopsis, prepared rehmannia, cornelian cherry, epimedium, morinda, pangolin, and zelkova, which have the effects of tonifying qi and kidney, strengthening the spleen, and activating blood circulation; the nitrogen-lowering capsules contain rhubarb, safflower, and other ingredients, which have the effects of draining turbidity, detoxifying, and activating blood circulation and removing stasis. Chen Yiping treats the stable phase of chronic renal failure by strengthening the spleen and kidneys, replenishing qi and nourishing blood, supplemented by promoting bowel movement and draining turbidity. The formula used is Chen's Urine A: codonopsis, salvia miltiorrhiza, goji berry, polygonatum, morinda, chicken blood vine, astragalus, angelica sinensis, polygonum multiflorum, meaty tuber, processed rhubarb; for the wet-heat syndrome of the secondary manifestation, treatment focuses on supporting righteousness and eliminating pathogenic factors, clearing dampness and heat, using Chen's Urine B: bupleurum, scutellaria, white atractylodes, white peony, goji berry, chrysanthemum, perilla, chuandong lian, pinellia, sandalwood, six-month snow, processed rhubarb; for blood stasis and renal hypertension, treatment focuses on activating blood circulation and removing stasis, using Chen's Urine C: astragalus, ligusticum, kudzu, eucommia, mistletoe, goji berry, motherwort, codonopsis, salvia miltiorrhiza, processed rhubarb, cortex of dictamnus, scutellaria, lotus seed meat, white atractylodes; for internal heat and toxic accumulation, external invasion syndrome, treatment focuses on clearing heat and detoxifying, activating blood circulation and promoting bowel movement, using Chen's Urine D: white flower snake tongue grass, honeysuckle vine, purple flower ground ivy, white pampas grass, salvia miltiorrhiza, raw rehmannia, red peony, betel nut, curcuma, processed rhubarb; for renal anemia, treatment focuses on Chen's kidney-tonifying and blood-generating formula: astragalus, angelica sinensis, epimedium, morinda, chicken blood vine, polygonatum, processed rhubarb. Nie et al.: Through investigation and analysis of 200 cases of chronic renal failure, they confirmed that the pathogenesis of chronic renal failure is characterized by deficiency in the root and excess in the manifestation, with mixed deficiency and excess, where deficiency in righteous qi is the root and excess in pathogenic factors is the manifestation. Deficiency in righteous qi is mainly qi-yin dual deficiency, followed by yang-yin dual deficiency and spleen-kidney qi deficiency. Pure spleen-kidney yang deficiency and liver-kidney yin deficiency are rare. The affected organs are the spleen, kidneys, and liver. The main pathogenic factors are damp-heat, followed by wind-dryness, wind movement, water qi, blood stasis, and damp-turbidity; a single case may simultaneously present several pathogenic factors. Chronic renal failure mostly occurs after the age of 40, with more female patients than male. Treatment of chronic renal failure should primarily focus on replenishing qi and nourishing yin, while also considering elimination of pathogenic factors; warming and drying herbs should be used with caution. Their experience suggests dividing chronic renal failure into two stages: the deficiency stage and the closure stage. During the deficiency stage, the main treatment is Shenqi Dihuang with modifications; during the closure stage, the main treatment is Su Ye Huang Lian Tang or Huanglian Wendan Tang with adjustments. Qiu Muyan et al.: Professor Zhao Shaoqin believes that the fundamental pathogenesis of CRF is deep-seated damp-heat invading the nutritive blood, causing stagnation and obstruction of the collateral vessels, which over time accumulates into toxicity. The main feature is excess pathogenic factors, with much heat and much stasis, so the treatment should consistently follow the basic principles of clearing damp-heat and cooling blood to remove stasis. Cheng Ruiling: Through research on the effect of Shen Shui Ning capsules on interstitial fibrosis in the kidneys of mice with unilateral ureteral obstruction (UU), it was found that the capsules can reduce the expression level of collagen type I in kidney tissue and decrease the expression of SMA, inhibiting the generation of fibroblasts and reducing ECM synthesis. They also inhibit the proliferation of mesangial cells and tubular epithelial cells, suppressing the number of MYOB in the tubulointerstitial space and the accumulation of collagen, thereby providing protective effects for the kidneys. Huo Changliang et al.: Using a traditional Chinese medicine foot bath formula consisting of ephedra, cinnamon twig, aconite, bone-penetrating herb, peach kernel, safflower, angelica sinensis, white flower snake tongue grass, and sophora with 30 grams of each ingredient, one can achieve the effects of inducing perspiration to drain turbidity, removing stasis, and detoxifying. Research shows that this herbal foot bath can eliminate proteinuria, lower creatinine levels, and produce quick results, with a short course of treatment, reliable efficacy, no toxic side effects, and simple operation. Zhang Leilei et al.: Through clinical observation of iontophoresis with kidney-tonifying liquid for treating chronic renal failure with kidney yang deficiency, significant therapeutic effects were observed. Analysis indicates that iontophoresis with kidney-tonifying liquid for CRF patients with kidney yang deficiency may exert its therapeutic effects mainly through the following aspects: ① regulating immune function, improving glomerular filtration rate, and adjusting protein metabolism; ② improving blood circulation, anti-inflammatory and anticoagulant effects, enhancing renal microcirculation; ③ promoting calcification of bones, providing good prevention and treatment for renal osteopathy; ④ stimulating proliferation, differentiation, and maturation of blood cells, playing an important role in hematopoiesis and improving renal anemia. Zhou Yuan et al.: Professor Wang believes that the fundamental pathogenesis of chronic renal failure is spleen-kidney qi deficiency with internal accumulation of dampness and stasis, where qi deficiency and blood stasis are important factors driving disease progression. Based on the theory of "qi and blood as mutually dependent roots," he treats this disease by warming yang and replenishing qi, nourishing yin and blood, removing stasis and draining turbidity, balancing pathogenic and righteous factors, coordinating qi and blood, achieving relatively good therapeutic effects. Li Ying: Observed the clinical efficacy of Yi Shen Huo Xue Tang in treating chronic renal failure (CRF). Seventy-two patients with chronic renal failure were randomly divided into two groups, with 36 patients in the treatment group and 36 in the control group. On top of standard treatment, the treatment group received Yi Shen Huo Xue Tang, while the control group received Urease Clear Granules. The treatment lasted for three months, after which the therapeutic effects of the two groups were compared. The results showed that the total effective rate in the treatment group was 83.33%, significantly higher than the 66.67% in the control group (P<0.05); the TCM symptom score in the treatment group was significantly lower than in the control group (P<0.05); all laboratory indicators—serum creatinine (Scr), blood urea nitrogen (BUN), and endogenous creatinine clearance rate (CCR)—showed statistically significant improvements compared with pre-treatment levels in the treatment group, and the degree of improvement in these indicators was also better in the treatment group than in the control group (P<0.05). The clinical efficacy of Yi Shen Huo Xue Tang in treating chronic renal failure is superior to that of Urease Clear Granules, effectively lowering serum creatinine and blood urea nitrogen while increasing endogenous creatinine clearance rate. VI. Conclusion Renal failure is often caused by kidney infections, poisoning, and allergies leading to ischemia and necrosis of the glomeruli, as well as renal artery sclerosis. Clinically, it is diagnosed by elevated blood urea nitrogen and creatinine levels, decreased glomerular filtration rate, azotemia, disturbances in water and salt metabolism, metabolic acidosis, and uremia. For acute renal failure, external pathogenic factors such as wind-cold invasion are treated with Yuebi Jia Shu Tang, Xiaoqinglong Tang, and Wuwei Xiaodu Yin with modifications; heat-toxin-induced kidney damage is treated with Xijiao Di Huang Tang, Qingying Tang, and Wuwei Xiaodu Yin with modifications; for kidney yang deficiency with ascending turbid toxins, treatment includes Taohe Chengqi Tang, Chaihu Guizhi Tang, and Shen Fu Long Mu Rescue Tang with modifications; for qi-yin dual injury, treatment includes Qiju Di Huang Tang, Gui Pi Tang, and Shen Mai Yin with modifications. For chronic cases, kidney yang deficiency with damp-turbidity and blood stasis is the main pathogenesis of chronic renal failure, with yang deficiency as the primary factor, related to dysfunction of the lung, spleen, and kidneys. For lung-spleen qi deficiency with internal damp-turbidity, use Shi He Ji with modifications; for spleen-kidney yang deficiency with blood stasis obstructing the collaterals, use Jisheng Shenqi Wan and Fu Fang Yi Shen Tang with modifications; for liver-kidney yin deficiency with stagnant collaterals, use Qiju Di Huang Tang and Guan Xin I Hao with modifications; for kidney yang deficiency with damp-turbidity and blood stasis, use Gui Fu Ba Wei Wan and Fu Fang Yi Shen Tang with modifications; for renal failure, when the condition progresses to the uremic stage, with continuous increases in BUN and creatinine, use Gui Fu Ba Wei Jiu and Ren Shuai He Ji with modifications.