7. Warmly Tonify and Reverse the Trend

The "Classical Compendium with Supplementary Wings, Seeking Correct Records, True Yin Theory" says, "When the original yang is insufficient... the Ming Men fire declines, unable to produce earth, leading to spleen and stomach deficiency, reduced food intake, or vomiting, bloating, or reverse stomach heat... or loose stools, frequent diarrhea, or involuntary urination... or cold in the lower jiao, causing water to float and swell." This indicates that insufficient kidney yang can lead to a series of digestive symptoms. As previously mentioned, the fundamental pathogenesis of chronic nephritis is kidney yang deficiency. When this deficiency progresses to a severe stage, the spleen and stomach cannot digest food properly, and dampness and turbidity accumulate in the middle jiao, resulting in vomiting, bloating, reverse stomach heat, frequent diarrhea, involuntary urination, and other symptoms of imbalance in ascending and descending qi. Further progression can lead to coma, weak pulse, cold limbs, and other signs of complete yang depletion. These symptoms are very similar to the clinical manifestations of uremia in Western medicine. In treating such cases, traditional Chinese medicine should adhere to the principle of "warmly tonify the kidney to treat the root, and reverse the trend to treat the manifestation." Warmly tonify the kidney using fu pian and cinnamon. Reverse the trend using da huang, sheng zhe, ginger, and ban xia, with fu pian and da huang working particularly well together.

III. Case Examples

[Case 1] Wang ××, male, 18 years old, sent-down youth, first visited in early October 1976. The patient

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Two years ago, facial edema, fatigue, and generalized joint pain appeared after a cold. The Second Affiliated Hospital of Lanzhou Medical College admitted the patient with a diagnosis of acute nephritis. After more than 20 days of Western medicine treatment, the edema subsided, and urinary protein decreased from (+++) to trace amounts. Following discharge, recurrent colds and tonsillitis caused relapse of edema, with urinary protein reaching (+++). Subsequently, the edema progressively worsened, leading to a second hospitalization at this institution six months ago. Diagnosis: chronic nephritis (nephrotic type). During hospitalization, treatments included antibiotics, prednisone, cyclophosphamide, and dihydroergotamine. The condition improved for a period, but recent recurrences prompted the patient to request discharge and seek traditional Chinese medicine treatment at our clinic.

Physical examination: Temperature 36.6°C, pulse 72 beats/min, blood pressure 16.0/12.0 kPa (120/90 mmHg), normal development but poor nutrition. Pale complexion, pitting edema throughout the body, most pronounced in the lower legs. Heart and lungs (-), liver and spleen (-), abdominal distension, ascites sign (+), pulse: deep, fine, and weak. Tongue: pale, plump, with tooth marks, thin white coating. Laboratory tests: Urinalysis: protein (+++). Red blood cells 2–5 per low-power field, white blood cells 1–2 per low-power field, few hyaline casts. Routine blood test: Hemoglobin 10 g%, white blood cells 11,200/mm³, neutrophils 66%, lymphocytes 34%. Cholesterol: 490 mg/mL, NPN 40 mg/mL, serum total protein 4.5 g/L, albumin 2.1 g/L, globulin 2.4 g/L. Western medical diagnosis: Chronic nephritis, nephrotic type.

TCM differentiation: The patient presents with a pale face, shortness of breath, lethargy, dizziness, tinnitus, lumbago, leg weakness, aversion to cold with spontaneous sweating, generalized edema, and poor appetite. Pulse is deep and fine, particularly weak in both cun positions. Tongue is pale, plump, with tooth marks and a thin white coating. Syndrome belongs to deficiency of spleen and kidney yang with excessive water-dampness; treatment principle is to warm the kidneys and strengthen the spleen while promoting urination and reducing edema. Prescription: Jisheng Shenqi Tang with modifications: Rehmannia root 10 g, Cornus fruit 6 g, Chinese yam 10 g, Phellodendron bark 6 g, Poria 12 g, Alisma 10 g, Cinnamon 10 g, Aconite slices 10 g, Plantago seeds 10 g, Achyranthes root 10 g, Codonopsis 10 g, Astragalus 20 g, Ephedra 10 g, Gypsum 20 g, Licorice 6 g, Motherwort 30 g, Perilla stem 10 g, Cicada slough 10 g. Decoction taken once daily for over a month; edema largely resolved, but urinary protein remains (+++), red blood cells 0–1 per low-power field, white blood cells 0–1 per low-power field. Patient’s spirits and appetite have improved compared with before, and aversion to cold with spontaneous sweating has also improved. Pulse remains deep and fine, with both cun positions still weak. Tongue is plump, pale, with tooth marks and a thin white coating. The original formula was adjusted by removing Ephedra and Gypsum, adding Bupleurum, Curcuma, Seaweed, and Kelp, each 6 g. After taking over 150 doses of this modified formula, the patient feels energetic and physically strong. In September 1977, follow-up examination showed normal urinalysis and cholesterol level at 200 mg%. Subsequent follow-ups from 1979 to 1980 revealed good general condition, with only occasional presence of 0–1 white blood cells per low-power field in urinalysis.

[Case 2] Liu ×, female, 43 years old, cadre. First visit on November 21, 1980. One year ago, the patient began experiencing generalized edema accompanied by urgency, frequency, and dysuria. At Lanzhou Railway Central Hospital, she was diagnosed with chronic pyelonephritis and hospitalized for over a month. Purulent cells in urine disappeared, but protein remained around (++). After discharge, her condition fluctuated between mild and severe. Four months ago, she developed a cold with fever and sore throat, immediately followed by worsening edema. Gansu Provincial Hospital of Traditional Chinese Medicine admitted her with a diagnosis of chronic nephritis (acute exacerbation). During hospitalization, combined TCM and Western medicine treatment was administered, but edema never subsided, and urinary protein remained (+++). One month ago, the patient voluntarily discharged herself, after which edema further worsened, accompanied by sore throat, cough, poor appetite, reduced urine output, and dysuria. Consequently, she sought TCM treatment at our clinic.

Physical examination: Temperature 37°C, pulse 90 beats/min, blood pressure 17.6/13.1 kPa (132/98 mmHg), normal development but poor nutrition, pale complexion, moderate generalized edema, red pharynx, grade II enlarged tonsils, heart border not markedly enlarged, a grade II systolic blowing murmur audible at the apex, lungs (-), abdominal distension, ascites sign (++). Pulse: all six pulses are wiry, slippery, and rapid, with both cun positions slightly weak. Tongue: red body, slightly yellow and greasy coating.

Laboratory tests: Urinalysis shows protein (++++) and red blood cells (++), pus cells (+), and 1–2 granular casts per low-power field. Blood routine: red blood cells 3.1 million/mm³, hemoglobin 9 g%, white blood cells 10,000/mm³, neutrophils 79%, lymphocytes 21%. Blood cholesterol 660 mg%, serum total protein 3.8 g%, globulin 2.2 g%, albumin 1.6 g%. Ascites examination: clear appearance, protein (±).

Western medical diagnosis: Chronic nephritis, nephrotic type, complicated by upper respiratory tract infection.

TCM differentiation: The patient presents with a pale face, generalized edema, lumbago, leg weakness, dizziness, bitter taste in mouth, sore throat, cough, chest fullness, reduced urine output with reddish color, slight chills and fever. Combined with pulse and tongue findings, it indicates kidney deficiency with water excess and wind-heat invading the interior. Prescription: Jisheng Shenqi Tang combined with heat-clearing and detoxifying herbs, with modifications: Rehmannia root 10 g, Cornus fruit 6 g, Chinese yam 10 g, Moutan bark 6 g, Poria 10 g, Alisma 10 g, Cinnamon 10 g, Aconite 10 g, Plantago seeds 10 g, Achyranthes root 10 g, Honeysuckle 15 g, Forsythia 15 g, Dandelion 15 g, Patrinia 15 g, Prunella 15 g, Summer Solstice Grass 15 g, Stone Fern 20 g, White Reed Root 20 g, Ephedra 10 g, Gypsum 30 g, Cicada slough 10 g, Perilla stem 10 g, Motherwort 30 g. After taking 10 doses, cough gradually subsided, generalized edema slightly reduced, and ascites sign (+) disappeared. Urinalysis: protein (+++), red blood cells (+), granular casts 1–2 per low-power field. However, the patient still appears pale, with generalized edema, lumbago, leg weakness, tinnitus, and aversion to cold. Pulse remains deep and weak, tongue is red with white greasy coating. Syndrome belongs to kidney yang deficiency with water overflow. Modified prescription: Jisheng Shenqi Tang combined with Baoyuan Tang with modifications: Rehmannia root 12 g, Cornus fruit 6 g, Chinese yam 6 g, Moutan bark 6 g, Poria 12 g, Alisma 10 g, Cinnamon 10 g, Aconite 10 g, Codonopsis 10 g, Astragalus 20 g, Licorice 6 g, Psoralea 10 g, Epimedium 10 g, Morinda 10 g, Eclipta 10 g, White Reed Root 30 g. After taking over 30 doses, urinalysis shows no abnormalities. Blood routine: hemoglobin 15 g%, red blood cells 4.8 million/mm³, white blood cells 9,800/mm³, neutrophils 68%, lymphocytes 32%. Blood cholesterol 220 mg%, patient’s physical strength recovered, energy restored, and able to return to work.

[Case 3] Chen ××, male, 48 years old, cadre. First visit in June 1978. Ten years ago, he was diagnosed with chronic nephritis at a local hospital due to edema, back pain, and high blood pressure. After hospitalization, his condition improved, but in recent years, he has repeatedly experienced edema along with hypertension and proteinuria, being repeatedly admitted to local hospitals with diagnoses of chronic nephritis. For the past six months, edema has persisted without remission, urine output has been consistently low, accompanied by poor appetite, lumbago, leg weakness, spontaneous sweating with aversion to cold, fatigue, nausea, loose stools, dizziness, and blurred vision. Recently, these symptoms have worsened, and blood pressure remains persistently high, prompting him to seek treatment at our clinic.

Physical examination: Temperature 36.4°C, pulse 74 beats/min, blood pressure 24.0/13.3 kPa (180/100 mmHg). Patient is alert but expressionless, with generalized edema most pronounced on the face and lower legs. A grade II systolic blowing murmur audible at the apex, liver (-), spleen (-), abdomen distended, ascites sign (++). Pulse: wiry, slippery, and rapid. Tongue: red body, plump with tooth marks, thin white coating.

Laboratory tests: Urinalysis shows protein (+++), red blood cells (++), white blood cells 0–2 per low-power field, hyaline casts 1–2 per low-power field. Blood routine: hemoglobin 12.5 g%, white blood cells 11,200/mm³, neutrophils 72%, lymphocytes 27%, monocytes 1%. Blood cholesterol 390 mg%, NPN 146 mg%, CO₂ binding capacity 25 volume percent, serum total protein 5.5 g%, albumin 2.1 g%, globulin 3.4 g%. Western medical diagnosis: Chronic nephritis complicated by uremia.

TCM differentiation: The patient presents with edema, dizziness, lumbago, leg weakness, aversion to cold with spontaneous sweating; also poor appetite, fatigue, nausea, loose stools. Syndrome belongs to deficiency of spleen and kidney yang with dampness stagnating in the middle jiao and impaired ascending-descending function. Treatment principle is to warm the kidneys, reverse the rebellious qi, strengthen the spleen, and promote urination. Prescription: Jisheng Shenqi Tang combined with Da Huang, Sheng Zhe Shi, and Xiao Ban Xia with modifications: Rehmannia root 10 g, Cornus fruit 10 g, Chinese yam 10 g, Moutan bark 6 g, Poria 10 g, Alisma 10 g, Cinnamon 10 g, Aconite 10 g, Plantago seeds 10 g, Achyranthes root 30 g, Da Huang 12 g, Ginger 6 g, Ban Xia 6 g, Cicada slough 10 g, Earthworm 12 g, Raw Dragon and Oyster shells 15 g each, Sheng Zhe Shi 15 g, Raw White Peony 15 g, Raw Turtle Shell 15 g, White Reed Root 30 g, Stone Fern 20 g, White Atractylodes 15 g, Pig Polyporus 10 g. After taking 10 doses, vomiting gradually subsided, appetite slightly improved, urine output increased, and generalized edema slightly improved. Blood pressure dropped to 20.0/12.0 kPa (150/90 mmHg). Urinalysis: protein (++), red blood cells 2–5 per low-power field, hyaline casts 1–2 per low-power field. NPN 122 mg%. The original formula was adjusted by removing Raw Turtle Shell and Ginger, adding Codonopsis 10 g, Citrus Peel 6 g, and Agarwood 3 g. After continuous use of 43 doses, spirits and diet improved, edema significantly subsided, blood pressure dropped to 18.7/12.0 kPa (140/90 mmHg), urinalysis: protein (+), blood NPN 39 mg%, CO₂ binding capacity 57 volume percent, blood cholesterol 310 mg%, total protein 5.7 g%, albumin 3.1 g%, globulin 2.6 g%. Blood routine: hemoglobin 13.5 g%, white blood cells 9,000/mm³, neutrophils 68%, lymphocytes 32%. Patient still exhibits pallor, fatigue, dizziness, lumbago, and aversion to cold. Therefore, Jisheng Shenqi Tang combined with Xiangsha Liujun Tang was used, taking over 90 doses, until all symptoms were completely alleviated, and urinary protein became negative.

(From “Gansu Medicine” 1982, Supplement)

Experience in TCM Treatment of Chronic Pancreatitis

Pei Zhengxue

Chronic pancreatitis is a progressive digestive disease characterized by abdominal pain, abdominal masses, and steatorrhea; some cases may also present with jaundice, diabetes, and wasting. Due to its recurrent nature and prolonged course, clinical prognosis is often suboptimal. Over the years, the author has treated this condition with TCM and accumulated some experience, which is shared here for reference. Any shortcomings are welcome to be criticized and corrected.

I. Etiology and Pathogenesis

The abdominal pain in this disease is usually located in the left upper quadrant and radiates to the left chest and left flank, often accompanied by bitterness in the mouth, dry throat, and irritability—indicative of liver qi stagnation. Diarrhea (steatorrhea or meaty diarrhea) is attributed to spleen-stomach deficiency-cold, reflecting liver qi stagnation and transverse invasion of the stomach. Prolonged liver stagnation leads to heat, while long-term spleen deficiency results in dampness; when dampness and heat combine, jaundice occurs. Mild liver stagnation causes pain that shifts unpredictably between the two flanks, indicating involvement of the qi level; severe stagnation results in persistent pain localized to the left chest and epigastrium, suggesting involvement of the blood level. If blood stagnation persists, it can coalesce into masses, leading to abdominal masses. In summary, liver qi stagnation is the root cause of this disease, and diarrhea, abdominal masses, and jaundice all arise from this root.

II. Treatment Principles