Patient's question:
6-month-old boy, pneumonia, hydrops of the thyroid cartilage, excessive sputum, has been sick for a month, suddenly found blood in urine this morning, is it nephritis?Doctor's answer:
You can first undergo a urinalysis to check if the red blood cell count is elevated and the morphology of the red blood cells. You can register for the appointment through Nanjing's unified registration platform. It is possible to get an appointment in the morning. Suggestions: According to the clinical characteristics of acute nephritis, such as its rapid onset, rapid changes, initial swelling in the upper body accompanied by surface symptoms and predominantly heat-related signs, traditional Chinese medicine (TCM) considers this condition to fall under the category of edema (Yangshui). Its etiology is associated with wind, cold, dampness, heat, and toxicity. The occurrence of this disease is often due to external pathogens such as wind-cold or wind-heat invading the lungs, leading to impaired lung function and disrupted Qi transformation in the three, or due to exposure to rain or water, resulting in dampness invasion through the skin or internal invasion of skin sores. Cold-dampness or heat-dampness can then obstruct the spleen's Yang Qi, impairing its ability to transport fluids, leading to impaired fluid regulation, fluid retention, and subsequent overflow into the skin, causing edema. Alternatively, wind-heat invasion can leave behind residual heat, which damages the lower Jiao's meridians, causing blood to flow uncontrollably and resulting in hematuria. Dysfunction of the lungs, spleen, and kidneys can accumulate heat, gradually transforming into heat-dampness stagnation.In the recovery phase of acute nephritis, residual heat-dampness persists, and some patients may gradually develop kidney Yin deficiency alongside lingering heat-dampness. Some patients may experience fever, excessive sweating, polyuria, or nocturia after swelling subsides, which is a sign of self-resolving heat-dampness and should not be treated with tonics. Instead, aromatic and diuretic methods should be used to promote its resolution. For patients with lingering heat-dampness and insufficient vital Qi, a balanced approach is necessary, focusing on eliminating pathogens without harming the body and tonifying the body without obstructing pathogen elimination.
How does TCM treat acute nephritis? Based on its etiology, pathogenesis, and clinical manifestations, TCM treatment for acute nephritis primarily involves the following methods:
(1) Wind-dispelling and diuresis, with internal and external differentiation. Indications: Early stage of onset with chills, aversion to wind, fever, cough, headache, decreased urine output, and prominent edema above the waist. Thin white tongue, floating or deep and fine pulse. Common prescriptions include modified Yuebi Decoction combined with Wupi Decoction.
(2) Wind-dispelling and heat-clearing, with blood-cooling and detoxification. Used for patients with wind-heat symptoms: fever without chills, sore throat, decreased urine with red color, and gross hematuria. Slender and rapid or fine and rapid pulse, red tongue with thin yellow coating. Common prescriptions include Yinqiao Decoction with cicada, white silkworm, red peony root, and peony root.
(3) Heat-clearing and dampness-drying or heat-clearing and detoxification. Suitable for patients with skin infections or resolved external symptoms, where dampness transforms into heat, leading to fever, dry mouth with bitter taste, preference for cold drinks, decreased urine with red color, and unresolved edema. Thin yellow or yellow greasy tongue, slender and rapid pulse. Common prescriptions include modified Wushi Xiaodu Decoction.
How does TCM treat edema in acute nephritis? For patients with edema as the primary symptom, diuresis and edema reduction are the top priorities, as uncontrolled edema can lead to complications such as lung and heart involvement, worsening the condition. Common methods for diuresis include:
(1) Lung-ventilating and diuresis: Suitable for short-term courses with lung symptoms, primarily facial edema or concurrent fever. Examples: Mahuang Guipi Decoction (Ephedra 6g, Cinnamon twigs 10g, Tangerine peel 10g, Cloudy Poria bark 30g, Mulberry bark 15g, Large abdominal tangerine peel 15g, Ginger bark 6g) for wind-cold; Yuebi Wupi Decoction (Ephedra 6g, Gypsum 30g, Tangerine peel 10g, Cloudy Poria bark 30g, Mulberry bark 15g, Large abdominal tangerine peel 15g, Ginger bark 6g) for wind-heat.
(2) Spleen-tonifying and diuresis: Suitable for prolonged courses with edema extending to limbs or, poor appetite, abdominal distension, chest tightness, body heaviness, nausea, or vomiting. Pale red tongue with deep pulse. Common prescriptions include Fangji Huangqi Decoction combined with Fangji Lingzhi Decoction with additions (Astragalus 15g, Han Fangji 30g, White Atractylodes 10g, Cinnamon bark 6g, Poria 30g, Licorice 6g, Huaixi 10g, Plantain 30g, Ginger 6g, Jujube 6g).
(3) Heat-clearing and diuresis: For patients with prominent heat signs, where heat combines with dampness, leading to facial redness, acne, bitter mouth, sticky mouth, red and greasy urine, unsatisfactory bowel movements, or skin sores. Red tongue with yellow greasy coating, wiry and slippery pulse. Common prescriptions include Wushi Xiaodu Decoction combined with Wupi Decoction (Silver flower 30g, Dandelion 15g, Purple flower root 15g, Chrysanthemum 15g, TCM gentian 10g, Mulberry bark 15g, Large abdominal tangerine peel 15g, Tangerine peel 10g, Ginger bark 6g, Cloudy Poria bark 30g).
How does TCM treat hematuria in acute nephritis? For patients with hematuria as the primary symptom, stopping bleeding is crucial. Methods include:
① Heat-clearing and blood-cooling to stop bleeding: Due to heat injuring blood vessels, common prescriptions include Xiaoji Yin Decoction with modifications (Xiaoji 30g, Rehmannia 10g, Bamboo shoot 10g, Slender stone 10g, Licorice 3g, Lotus leaf 20g, Whiteroot 30g, Motherwort 15g, Stonevine 15g, Peony root 6g, Horsetail 15g, Side pine needle 15g).
② Yin-nourishing and heat-clearing to stop bleeding: Due to deficiency fire injuring vessels, common prescriptions include Zhi Bai Di Huang Tang with modifications (Anemarrhena 12g, Coptis 9g, Rehmannia 12g, Cornus 12g, Dioscorea 15g, Peony root 12g, Poria 15g, Alisma 9g, TCM 3g, to be taken with hot water).
What is the prognosis for acute nephritis? Acute nephritis is a self-limiting disease with generally good prognosis. With timely removal of the cause and appropriate treatment, about 85–90% of children and 60–75% of adults can fully recover. Elderly patients have a lower incidence but the worst prognosis among acute nephritis cases. Most cases show urinary changes resolving within 3–6 months. Some patients may have transient symptoms after the acute phase with normal renal function but lingering red blood cells and minimal protein in urine for 1–2 years. A few cases may recover after 1–2 years of delayed progression, while others may relapse into chronic nephritis. Rarely, severe complications during the acute phase may lead to death. However, with improved prevention and treatment, mortality has decreased to 1–2% or even zero.
How can acute nephritis be prevented? The key is to prevent and treat other diseases that can lead to nephritis (also called pre-nephritic diseases), especially those caused by hemolytic streptococcal infections, such as upper respiratory infections, acute tonsillitis, pharyngitis, scarlet fever, and impetigo. After infection with these diseases, it takes a latent period (1–2 weeks for upper respiratory infections/tonsillitis, 2–3 weeks for scarlet fever, 2–4 weeks for impetigo) before nephritis develops. Timely treatment during this latent period can prevent immune reactions. Clinical observations show that recurrent tonsillitis, pharyngitis, or chronic infection foci can lead to acute nephritis and its progression to chronic nephritis. If acute nephritis is confirmed to be caused by tonsillitis, tonsillectomy may be considered at the right time to aid recovery and prevent recurrence. Other bacteria, viruses, and parasites can also cause nephritis, so active and timely prevention of pre-nephritic diseases is crucial for preventing acute nephritis and its progression to chronic nephritis.