Patient's question:
Description of the problem: I have a history of nephrotic syndrome for ten years, with recurrent episodes four times during this period. From 2005 to December 2008, all urine tests were negative, and I have been completely off medication for a year. In mid-December 2008, the urine test was positive with a quantitative value of 1.26 grams/24 hours. Currently, I am being treated with Tripterygium wilfordii, and the urine test has returned negative. In 2000, a kidney biopsy diagnosed minimal change type (mesangial proliferation type) nephropathy. I have not been married yet. Can I still be cured? When will this end?Doctor's answer:
1) Treatment for Spleen Deficiency and Dampness: Strengthen the spleen and invigorate qi, promote diuresis and resolve dampness. Prescription: 12-15g of Codonopsis pilosula, 15-20g of Astragalus membranaceus, 9-15g of Poria cocos, 9-12g of Atractylodes macrocephala, 9-15g of Alisma orientale, 9g of Tangerine peel, 15g of Dioscorea opposita, 15g of Coix lacryma-jobi, 15g of Plantago asiatica ( decocted separately), 12-15g of Magnolia officinalis, 15g of Bupleurum marginatum. Modifications: Poor appetite, add (Coptis chinensis) and Cardamom; Nausea and vomiting, add Rhubarb, Bamboo shoot, and Fresh ginger. Usage: 1 dose per day, decocted in water, taken twice. Common formulas: Si Jun Zi Tang combined with Wu Ling San, Wu Pi Yin, Fang Ji Ling Zhi Tang, Ling Gui Zhu Gan Tang, and Shen Ling Bai Zhu San (modified).(2) Treatment for Spleen-Kidney Yang Deficiency (Spleen-Kidney Qi Deficiency): Warm-tonify the spleen and kidney, transform qi and promote diuresis. Prescription: 15-20g of Prepared Aconite, 9g of Cinnamon twigs, 9-15g of Codonopsis pilosula, 15-30g of Astragalus membranaceus, 15g of Dioscorea opposita, 9-12g of Atractylodes macrocephala, 9-20g of Poria cocos, 9g of Alisma orientale, 15-20g of Epimedium brevicornum, 9g of Polygonum multiflorum, 9-12g of Cornus officinalis, 9-15g of Polygonum hydropiper, 15-30g of Plantago asiatica (decocted separately), 30g of Leonurus cardiaca, 6g of Licorice. Modifications: Reversed stomach qi, frequent vomiting and diarrhea, add (Baked ginger), Perilla frutescens, Roasted Artemisia argyi, Baked Atractylodes macrocephala, and Poria cocos; Severe Yang deficiency, add Cinnamon bark and Deer antler ash. Usage: 1 dose per day, decocted in water, taken twice. Common formulas: Zhen Wu Tang, Jin Gui Shen Qi Wan, Ji Sheng Shen Qi Wan, Shi Pi Yin, etc.
(3) Treatment for Damp-Heat Accumulation: Clear heat and resolve toxicity, promote diuresis and reduce swelling. Prescription: 9g of Anemarrhena asphodeloides, 9g of Phellodendron amurense, 9g of Scutellaria baicalensis, 20g of Taraxacum mongolicum, 12g of Lonicera japonica, 30g of Red bean, 30g of Poria cocos, 30g of Imperata cylindrica, 12g of Hydrangea arborescens, 9g of Bamboo leaves, 3g of Commelina communis. Modifications: Excess heart fire, add Coptis chinensis and Gardeniae fructus; Excess liver fire, irritability, add Gentiana scabra; Loose stools, add Dioscorea opposita; Poor sleep, add Polygonum multiflorum and Albizia julibrissin. Usage: 1 dose per day, decocted in water, taken twice. Common formulas: Huang Qin Si Shi Tang, Wu Cao Tang, Wu Wei Xiao Du Yin combined with Wu Pi Yin, Xuan Fei Li Shui Tang, etc.
(4) Treatment for Liver-Kidney Yin Deficiency: Tonify the liver and kidney, nourish yin and clear heat. Prescription: 15g of Rehmannia glutinosa and 15g of Rehmannia glutinosa root, 12-15g of Dioscorea opposita, 9-12g of Cornus officinalis, 9-15g of Alisma orientale, 9-15g of Polygonum multiflorum, 9-15g of Ligustrum lucidum, 9g of Goji berries, 15g of Eclipta prostrata, 15g of Achyranthes bidentata, 15g of Eucommia ulmoides, 9g of Ophiopogon japonicus, 6-15g of Moutan root bark, 15g of Polygonum multiflorum, 9g of Turtle shell, etc. Modifications: Dark red tongue with petechiae or blood stasis symptoms, add Persicae semen, Radix Paeoniae rubra, Salvia miltiorrhiza, Carthamus tinctorius, and Leonurus cardiaca; Hyperactivity of liver Yang and hypertension, add Euonymus alatus, Uncaria gambir, and Polygonum multiflorum. Usage: 1 dose per day, decocted in water, taken twice. Common formulas: Liu Wei Di Huang Wan combined with Er Zhi Wan, Da Bu Yin Wan, Qi Ju Di Huang Wan, and Zuo Gui Yin (modified).
(5) Treatment for Qi-Yin Deficiency: Tonify qi and strengthen the spleen, nourish the lungs and kidneys. Prescription: 15g of Rehmannia glutinosa, 15g of Sandalwood, 9g of Ophiopogon japonicus, 15g of Astragalus membranaceus, 9g of Atractylodes macrocephala, 9g of Dioscorea opposita, 9g of Polygonatum sibiricum, 9g of Goji berries, 9g of Eucommia ulmoides, 9g of Fructus mori, 9g of Poria cocos, 9g of Moutan root bark, 15g of Codonopsis pilosula. Usage: 1 dose per day, decocted in water, taken twice. Common formula: Da Bu Yuan Jiao.
Treatment for Nephrotic Syndrome Syndrome can be adjusted according to symptoms. If edema is significant and can be treated aggressively, enhance diuretic and anti-swelling herbs like Trichosanthes kirilowii, Bufo bufo, and Bupleurum marginatum. For large proteinuria or persistent proteinuria, add Hydrangea indica, Rosae rugosae, Euryale ferox, Sparganium stoloniferum, and Placenta serosa, and increase the dosage of Astragalus membranaceus. If plasma protein is low with persistent edema, add Turtle shell glue, Deer antler glue, and Collagen. Experimental studies suggest that Hei Liao Dou Wan (Hei Liao Dou, Astragalus membranaceus, Atractylodes macrocephala, and Dioscorea opposita) can improve plasma albumin. For high cholesterol, add Coptis chinensis, Polygonum multiflorum, Crataegus pinnatifida, Salvia miltiorrhiza, Radix Paeoniae rubra, and Angelica dahurica.
Efficacy: In clinical practice, treatment often combines hormones, immunosuppressants, and Chinese medicine. Additionally, after achieving efficacy in nephrotic syndrome, consolidation therapy is necessary to prevent recurrence. Long-term use of Yu Ping Feng San can enhance immune function. Among 815 patients, the overall effective rate was 94%, with 71.8% achieving complete remission. The combination of Chinese and Western medicine is indeed more effective than using either alone. Moreover, Chinese medicine can significantly alleviate toxic and adverse reactions caused by hormones and immunosuppressants. For example, high-dose hormones often cause Cushingoid syndrome-like symptoms, skin infections like acne, and persistent proteinuria. Using heat-clearing and damp-resolving Chinese medicine can increase the rate of proteinuria clearance from 34.1% to 83.3%.