Discussion on the treatment of chronic glomerulonephritis

: Chronic Glomerulonephritis (CGN) is a common disease in primary glomerular diseases, characterized by a protracted course of disease that is difficult to cure and easy to relapse. If not effectively controlled, chronic glomerulonephritis may eventually develop into renal failure. With the development of modern medicine, modern doctors have gradually deepened their understanding of the etiology and pathogenesis of chronic nephritis, and put forward many new treatment ideas, such as treating from damp-heat, treating from Yin fire, treating from liver, etc. Based on the literature, this article will discuss the treatment ideas of modern doctors on chronic nephritis In order to guide clinical practice, this paper summarized the four aspects of etiology differentiation, zang-fu differentiation, meridians and collaterals differentiation, and Weiqi yingblood differentiation.


Introduction
Chronic glomerulonephritis (CGN) is a group of multi-etiological chronic glomerulonephritis, characterized by occulted onset, prolonged course and slow progression, characterized by proteinuria, hematuria, hypertension and edema as the basic clinical manifestations.With the development of the disease, renal dysfunction, anemia, electrolyte disorders and other diseases may occur, and eventually progress to end-stage kidney.At present, Western medicine has no specific treatment for chronic nephritis, mainly symptomatic treatment [1], the overall effect is not ideal, single treatment, side effects, and does not pay attention to individualization.Traditional Chinese medicine treatment of chronic nephritis has its unique advantages.With the in-depth study and understanding of the pathogenesis, many modern doctors put forward different views on the treatment of chronic kidney disease.The following are four aspects of etiology differentiation, zang-fu differentiation, meridian differentiation, Weiqi Yingblood differentiation.

Treating from the wind
Chronic glomerulonephritis with edema as the main symptom, so the disease is mostly classified as "edema" category, also known as "kidney wind "" kidney water".The name "kidney wind" comes from "Suq Qi Disease": " The emperor said: the disease is watery, the pulse is tight, the body has no pain, the shape is not thin, can not eat, eat less, why the name of the disease?Qi Bo said: the disease is born in the kidney, called kidney wind.It can be seen that as early as in ancient times, people have recognized that chronic nephritis is related to wind evil."Su ask water heat point" cloud:" Kidney sweat in the wind for tarsus, this is in the kidney, called Feng shui."The relationship between feng shui and kidney is pointed out."Plain ask water heat point on" said :" kidney sweat out in the wind, inside shall not enter the viscera, outside shall not exceed the skin, guest in the Xuanfu, line in the skin, pass for swollen.This in the kidney, called Feng shui.The pathogenesis of chronic nephritis caused by external wind transmission is pointed out.Wang Hui et al. [2] believe that wind evil is often an important factor to induce chronic nephritis or aggravate chronic nephritis.Professor Ye Chuanhui [3] believes that evil wind is the main cause of chronic nephritis, which is mostly induced by external wind and transmitted by internal wind.Yu Manshu et al. [4] also held that wind evil disturbed kidney needed to distinguish external wind from internal wind.Chinese medical master Professor Guo Ziguang [5] believes that: lung qi deficiency, weak wei outside, easy to cause wind evil invasion; Spleen-kidney Yang deficiency, weak wei outside, easy to cause wind evil invasion, positive vacuity evil love; Yin deficiency of liver and kidney is easy to cause endogenous wind evil, common dizziness, elevated blood pressure and other manifestations of liver wind internal movement, so Professor Guo Ziguang proposed that chronic nephritis should be treated from wind, summed up the effect of wind medicine in the treatment of chronic nephritis not only has the effect of dispelling wind, but also has the effect of dampness, blood circulation and promoting vitality.

Treatment from rheumatism
"Syndrome and Treatment Key" and "on the source of diseases" are divided into "swollen face for wind, swollen feet for water, is caused by rheumatism "" Fengshui and rheumatism fight, so cloud fengshui also."It is suggested that rheumatism is related to edema.In addition, a total of 37 prescriptions for the treatment of low back pain were prescribed in "Outer Taiwan Secret", which were used to tonifying liver and kidney, strengthening muscles and bones, and dispelling wind and dampness.Many of the symptoms related to low back pain were similar to chronic nephritis.The wind is Yang evil, the number of good deeds changes, the wet is Yin evil, its nature is heavy turbid sticky greasy, although the two are opposite, but can borrow their potential, disturb the kidney.Xu Zhengjin [6] believed that the body body of the spleen deficiency, water and dampness stopped in the kidney, although it did not stop the kidney, if the wind evil, the wind evil can invade the kidney with the dampness evil, and cause disease, similar to the combination of antibody and non-renal antigen outside the kidney, forming a circulating immune complex, deposited in the kidney with the blood circulation, causing kidney lesions.Zhao Jisheng [7] believed that chronic nephritis was caused by the inherent deficiency of spleen and kidney and the internal invasion of rheumatism, and the pathogenesis of rheumatism ran through the whole course of chronic kidney disease.Liu Tongtong et al. [8] believed that chronic nephritis was caused by the combination of wind, cold and dampness as arthralgia, causing blood obstruction and stasis.The medicine used to clear futongalthralgia, complemented by dispelling wind and dispelling evil, clearing heat and dampness, promoting blood circulation and removing blood stasis, laid a good foundation for the clinical application of treating chronic nephritis from rheumatism.

Treatment from damp-heat
Dampness-heat syndrome in patients with chronic nephritis is very complicated, including external sensation, internal injury, internal and external pathogenic factors and drugs, and its symptoms are complicated and changeable and difficult to diagnose.Director Yu Chenghui [9] believed that chronic nephritis belonged to traditional Chinese medicine diseases such as edema, lumbago, blood in urine, asthenia and fatigue, and that rheumatism, dampness-heat toxin invasion was the basic cause of the disease.Dampness-heat toxic evil accumulates and damages the kidney, and the kidney collateral stasis is a basic link in the pathology of nephritis."Medical prescription Examination" "The disease of lower jiao is due to dampness-heat "," Clinical Guide Medical records "" The initial disease of dampness-heat in the meridian, and the long-term stasis heat into the collages".Director Yu Chenghui stressed that "rheumatism interferes with kidney" is also an important cause of chronic nephritis pathogenesis, wind is the long disease, its good behavior and the number of changes, gently open drainage, the opening of the wind to interfere with the kidney's sealing function, so that the sealed fine with urine leakage, proteinuria.Dampness is Yin evil, easy to attack Yin position.Kidney is the little Yin in Yin, located in the lower jiao, and is the place where dampness evil is easy to invade [10]."Su question to really big on" said:" moisture big, soil victory, cold water by evil, kidney disease how."Wind, dampness and heat compound evil invade the kidney, which will inevitably affect the operation of the kidney meridians, qi and blood, and lead to proteinuria and repeated hematuria.Ye Kepingan [11] believed that the treatment of dampheat syndrome of chronic nephritis had important clinical significance in reducing proteinuria.

Treatment from heat toxin stasis
"Golden Chamber Essentials Heart Code" said:" poison, evil gas accumulation is called incomprehensible."Fire, heat also; The poison, the heat gradually also.There is a saying of "chronic disease entering collaterals as stasis" in "Medical Forest Correction".Chronic nephritis has blood stasis from beginning to end, which is an important reason for the sustained development of the disease and the progressive decline of renal function [12].Modern pharmacological studies have confirmed that Huoxue Huayu drug can improve renal microcirculation, inhibit platelet aggregation, clear antigen, inhibit antibody formation, reduce inflammatory exudation, inhibit inflammatory cell proliferation, and thus alleviate pathological damage of kidney [13][14].According to traditional Chinese medicine, heat often transforms poison, and poison often contains heat, and poison and heat are most closely related.Professor Wang Chen [15] believed that the cause of modern proteinuria was mostly fire toxin stasis caused by exogenous heat evil, and the pathogenesis was incandescency of heat toxin, blockage of kidney collateral or interlock of heat stasis, resulting in the inability of qi to flow freely, extravasation and subtle discharge resulting in proteinuria.In the treatment of "heat is not clear, poison does not understand, stasis is not removed, proteinuria is difficult to eliminate".

Treatment from lung
The two viscera of lung and kidney are closely related physiologically.First of all, the lung is the main qi, which is located in the upper jiao.Kidney main water, in the lower jiao, and arm dim mutual exterior, adjust and maintain the role of water and liquid balance in the body, so it is the source of water.Gao Shizong in the "Medical Canon biography" has "kidney for water viscera, combined with bladder water fu-organs, with the sun's gas, out of the fur to be combined with the lung, the lung of the day also, water day a qi, running ceasing."Therefore, there is a saying that "Qi water is a family" and "gold water is a source".Secondly, from the point of view of the five viscera, the lung belongs to gold, the kidney belongs to water, and gold can generate water, which helps the kidney to play its role of sealing and storage, so that fine substances do not leak to form proteins.Pathologically, chronic nephritis patients are often induced or aggravated by external sensation.Patients suffering from chronic nephritis for a long time have low immunity and are prone to cold and cold [16].Chen Jian et al. [17] summarized the experience of Mr. Tong Shabo in the treatment of chronic nephritis, and proposed that the method of supplementing lung and supplementing lung had ideal effects in the treatment of edema, hematuria, proteinuria and hypertension in chronic nephritis.Zhu Jingjing et al. [18] put forward the treatment of renal edema by "releasing lung qi, promoting water dampness", "lowering lung Qi, purging dampness turbidity", "warming lung cold, promoting water qi", "clearing lung heat, eliminating phlegm dampness".Shi Zhensheng [19] proposed four methods to treat chronic nephritis proteinuria: "tonifying lung, releasing lung, clearing lung and moistening lung".

Treatment from the spleen and stomach
"Plain question to really big essay" said:" All the dampness and swelling, all belong to the spleen ", Jin Yuan period "Dongyuan Ten books" pointed out:" the spleen and stomach qi weak, cannot transport fine, and cause water and grain to gather and not disperse ", the skin is swollen, gathered in the abdomen is full, fine wagons appear thin stool, proteinuria.Professor Li Xueming [20] believes that in chronic nephritis patients, most of them have the polybody spleen deficiency, or enjoy fat, thick and greasy, or live in wetlands for a long time, or due to long-term treatment, take a large number of hormones, immunosuppressants, antibiotics and other drugs.It is inevitable that the spleen and stomach will be damaged, so the clinical syndrome should pay attention to the care of the spleen and stomach.Liang Qiongfang et al. [21] discussed the treatment of hypertension, proteinuria and hematuria from the spleen respectively, and believed that the spleen was not healthy, the phlegm was turbiditic, and the liver wind interfered with the clearing of the body to form hypertension.Kidney loss of seal, spleen loss of control, subtle leakage can cause proteinuria; Spleen does not regulate blood, blood does not return to the meridian, can cause hematuria.Ma Congyi et al. [20] put forward corresponding treatment methods for different syndrome types from the aspects of invigorating the spleen and regulating water, invigorating the spleen and lung, warming the spleen and kidney, and invigorating the spleen and stomach.
Ancient doctors have the view that "spleen and stomach failure is a hundred diseases", and the emergence of "Yin fire" is no exception.Li Dongyuan put forward the theory of "Yin fire disease" in his book On the Spleen and Stomach, arguing that damage to the spleen and stomach leads to the dysfunction of the viscera, among which the theories of "true qi flowing down", "wet earth qi flowing under the umbilical cord", "massive pulse and headache" are similar to albuminuria and hypertension of chronic nephritis [22].Therefore, Pan Feixiang et al. [23] proposed that the treatment principles of chronic nephritis should be supplementating qi to raise Yang and dispersing fire.

Treatment from liver
Liver storing blood, kidney storing essence, liver blood depends on the nourishment of kidney essence, kidney essence depends on the supplement of liver blood, so it is feasible to treat kidney disease from liver.The liver is the main drainage, the main storage of blood, is an important organ of regulating qi machinery, when the liver is not the drainage, qi machinery disorders, there will be "qi down ", that is, modern medicine said proteinuria.Yun Kezheng et al. [24] put forward that the treatment of chronic nephritis proteinuria and other syndromes from the perspective of soothing the liver, tonifying the liver, clearing the liver, leveling the liver, searching the liver and warming the liver can often get twice the result with half the effort.Yi LAN et al. [25] proposed that Professor Zou Yanqin often treated chronic nephritis with liver function abnormalities in combination with hepatocholecystitis (such as fatty liver and chronic cholecystitis), renal hypertension induced by chronic nephritis (such as focal sclerosing nephritis and membranous proliferative nephritis), and hypertension caused by water and sodium retention during hormone therapy in chronic nephritis, and would be commonly used.The treatment methods are summarized as clearing liver and detoxifying, nourishing liver and nourishing Yin, flattening liver and suppressing Yang, soothing liver and collaterals.

Differentiation of six channels
The dialectical thought of the Six classics is one of the core ideas of Treatisis of Cold Disease, which contains many experiences in the treatment of CGN and has clinical guiding significance for modern doctors in the treatment of CGN.Professor Wu Bingcai [26] believed that the evolution of chronic glomerulonephritis was consistent with the law of the six classics of Treatises on Febrile Diseases.At the beginning of the disease, the sun surface syndrome is the main, and the treatment is to remove the evil and solve the surface, the surface syndrome is insoluble, and the Shaoyang cardinal is to reconcile the Shaoyang; The stage of Yangming disease is characterized by excessive dryness and heat, and the treatment is to expel heat and water.The stage of Taiyin disease is characterized by spleen deficiency and water stasis.Shaoyin disease stage is characterized by Yang deficiency and unfavorable gasification, and the treatment is to warm Yang and promote water; Disease to Jue Yin deficiency, mixed cold and heat, should be careful to observe the pathogenesis, flexible treatment.Tian Zihe [27] found that in the pathogenesis of CGN, the six channel diseases are mainly single channel diseases, and the frequency of occurrence is Shaoyin heat conversion syndrome, Shaoyin cold conversion syndrome, Jueyin disease, Taiyin disease, Yangming disease and Shaoyang disease in order from high to low, with the total proportion of three Yin diseases >90%.Among the three Yin diseases, the incidence of Taiyin disease was positively correlated with the level of urea, the incidence of Shaoyin heat conversion syndrome was positively correlated with the levels of red blood cells and triglycerides, and the incidence of Jueyin disease was positively correlated with the duration of the disease and the level of uric acid.Huang Yiting [28] analyzed the etiology of CGN dialectically from the six channels.First, the lung was affected by the evil and the kidney was affected by the evil.The second is the dysfunction of lung function caused by evil, resulting in dampness, phlegm, blood stasis and other pathological products, affecting the function of the kidney, and gradually developing into CGN.Third, it can be due to kidney Qi deficiency in the inside, and the lung deficiency is susceptible to outside, because the kidney is water, the lung is gold, gold and water phase, the kidney water shortage will lead to the deficiency of lung gold; CGN was treated from lung based on six channels dialectics.

Treatment according to collaterals
The theory of collaterals disease first appeared in the Huangdi Neijing, and put forward the characteristics of the choroidal vein as deficiency and stasis as solid.Ye Tianshi put forward the view of "long disease into the collaterals", and led to the difference and connection between the collaterals and meridians: "Where the meridians go straight, the collaterals run amokay, the meridians injection collaterals, collaterals are also the usual degree", that the collaterals start slowly, lingering and repeated, the beginning of the evil feeling, the evil qi stagnation in the qi, the qi and blood injury and blood collaterals over time, the collaterals disease is revealed, the collaterals disease from shallow to deep, from the qi and blood transmission law.Although chronic nephritis with proteinuria, hematuria, hypertension, edema as the basic manifestations, but early disease patients only fatigue, lumbar acid, increased nocturia and other discomfort, with the progress of the disease gradually appeared the above symptoms, this process is in line with the disease from shallow to deep development law, and modern medicine believes that the kidney glomerulus contains a rich capillary network, which is consistent with the structure of the network distribution.Professor Guo Enmian [29] put forward a new idea of "treating chronic glomerulonephritis from collaterals", thinking that the disease of chronic glomerulonephritis is based on kidney deficiency and collaterals damage, and the treatment idea is to create kidney tonifying and nourishing collaterals, removing dampness and activating blood circulation and clearing collaterals.Professor Tan Jinchuan [30] also believed that CGN mainly focuses on the spleen and kidney, especially the kidney, and focuses on the kidney collaterals because the disease has been entering the collaterals for a long time.The clinical experience of treating CGN by stage is consistent with the idea of "treating CGN by collaterals".

Syndrome differentiation of Wei Qi and blood
The theory of Wei Qi Ying blood, founded by Ye Tianshi, has important guiding value in the understanding and treatment of external febrile disease.Wei, qi, ying and blood are the four stages of transmission in the progression of chronic glomerulonephritis.Evil qi enters from Wei, passes through qi, permeates ying and enters blood, and gradually aggravates.The maltreatment and mistreatment of the Chronic glomerulonephritis lead to the entry of evil qi into the qi stage, that is, the stage of the initiation of acquired immunity and the excessive activation of inherent immunity.At this time, the clinical manifestations are cough, expectoration, sore throat, thirst and so on.The difference between wei and qi indicates that the pathogenic factors are confused, and the internal influent ying exerts the maximum effect of acquired immunity [31,32].The patients showed symptoms such as body heat, tiredness and thirst, red tongue and thin pulse, and clinical urine test showed positive occult blood.There is a saying in the Treatise on Warm Heat: "When the camp is heated, the blood is robbed."Yingzhi evil gas is very easy to spread into the blood, "entering the blood may consume blood and move blood", and the body is in the stage of severe immune system imbalance and low active immunity in blood stage [31,32], and patients can often see gross hematuria.Yang Jie et al. [33] believed that although chronic nephritis was atypical of exogenous fever, there was also an obvious process of wei-qi-yin blood transmission in the course of the disease.Chronic nephritis begins with the evil of lung wei and the internal transmission of blood.Therefore, the treatment can be applied to the syndrome differentiation of Weiqi ying blood, pay attention to the diffusion of lung Wei, Qingying cool blood.
Chronic glomerulphritis belongs to the categories of "edema", "kidney wind", "exhaustion" and "lumbago" in traditional Chinese medicine.The pathogenesis is often based on lung, spleen and kidney deficiency, with wind-cold dampness-heat turbidity-poison invasion and blood stasis as the standard, and the treatment is based on specimen consideration.The Plain Question, the True Great Theory, says: "We must fall before the Lord, and before the cause.""Three causes of the pole one disease prescription" also cloud: "Where the treatment, first must identify the cause, do not know the cause, the disease source without eyes."Reviewing the etiology and pathogenesis of diseases and conducting targeted treatment is the key to clinical effectiveness.On the basis of in-depth understanding of the etiology and pathogenesis of diseases, modern doctors put forward the thinking mode of "examining the cause and treating the disease", which is based on the information differentiation and treatment of the four diagnoses of traditional Chinese medicine.The microcausation method, which includes the differentiation of pathological changes and laboratory indicators in Western medicine, and the method of independent diagnosis and pathogenesis by grasping the main disease, can be applied alone or in combination, which is conducive to the accurate identification of complex and changeable clinical conditions, so as to improve the clinical efficacy of TCM treatment of CGN.From the perspective of etiology differentiation, the main pathogenic factors of chronic nephritis are wind, dampness, heat, poison and blood stasis, and the treatment is to dispel wind and overcome dampness, clear heat and detoxify.From the perspective of differentiation of zang-fu organs, chronic nephritis is mainly related to lung, spleen, liver and kidney.The main treatment methods are to promote lung, strengthen spleen, soothe liver and strengthen kidney.From the dialectical point of view of Wei Qi Ying blood and six channels, if we can master the law of chronic nephritis in the process of transmission, we can apply the idea of "prevention before disease" and "prevention after disease" to prevent its further development.TCM takes "holistic concept" and "syndrome differentiation and treatment" as the basic criteria, of which "syndrome differentiation and treatment" takes "holistic concept" as the premise.So these dialectical methods are all different explanations of the same disease from different perspectives.The clinical manifestations of chronic nephritis are edema, proteinuria, hematuria, hypertension and so on.In clinical diagnosis, we should first grasp the "disease" and "syndrome" corresponding to these clinical manifestations, and then choose the appropriate treatment method, or the combination of several treatment ideas, so as to improve clinical efficacy.