Combined TCM & Western Medicine Treatment for
Chronic Kidney Disease
by Dr. Jiun-Liang Chen
Center for Traditional Chinese Medicine, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
Patients with chronic kidney disease (CKD) initially are without specific symptoms. As the kidney function decreases, they begin to have symptoms such as foamy urine, edema, sore lower back, hypertension, and anemia. This occurs at an early stage of CKD. People should be cautious if the following long-term symptoms are observed, as they are early warning of kidney disease: lower limb or eyelid edema, severe frequent nocturnal enuresis, and foamy urine after waking up in the morning.
The causative risk factors of CKD are:
Metabolic disorders: Such as diabetes, gout, and amyloidosis; among these, diabetic nephropathy is the most common cause of chronic renal failure.
Various types of primary glomerulonephritis.
Various types of secondary glomerulonephritis, such as secondary nephritis caused by lupus or a tumor. Renal failure caused by lupus is more commonly seen.
Nephrosclerosis caused by long term hypertension and arteriosclerosis.
Autosomal dominant polycystic kidney disease.
Obstructive nephropathy: Long-term urinary tract blockage causes damage to kidney tissues. Once it reaches the stage of chronic renal failure, even if the cause of the blockage can be removed, normal kidney function can never be resumed.
Chronic interstitial nephritis: Possibly due to long-term intake of analgesics or renal tuberculosis.
Diagnosis of CKD
[Western Medicine Diagnosis]
CKD is classified into the following five stages:
Stage I: (Follow-up once every 6 months) Normal kidney function with traces of proteinuria. GFR: ≥ 90 ml/min/1.73 m2.
Stage II: (Follow up once every 6 months) Mild chronic renal failure. GFR: 60-89 ml/min/1.73 m2.
Stage III: (Follow up once every 3 months) Moderate chronic renal failure. GFR: 30-59 ml/min/1.73 m2.
Stage IV: (Follow up once every 3 months) Severe chronic renal failure. GFR: 15-29 ml/min/1.73 m2.
Stage V: (Follow up once every 2-4 weeks) End-stage renal disease. GFR: < 15 ml/min/1.73 m2.
[TCM Symptom Diagnosis]
TCM classifies CKD into the following patterns by pattern differentiation:
1. Spleen-kidney Yang deficiency
Symptoms: Pale complexion, fatigue and lack of strength, small appetite, bloated abdomen, fear of cold with cold limbs, cold pain of low back and knees, long clear nighttime urination, impotence, diarrhea with undigested food, or diarrhea before dawn. The tongue is swollen, pale with teeth marks with a thin tongue coating. The pulse is thin, weak or deep.
2. Liver-kidney Yin deficiency
Symptoms: Red cheeks, vexing heat in the five centers, dizziness and headache, dry eyes, deafness or tinnitus, dry mouth and throat, weak sore low back and knees, insomnia with profuse dreaming. The tongue is red with a scanty coating. The pulse is thin, wiry, and rapid.
3. Qi and blood deficiency
Symptoms: Withered-yellow complexion, respiratory weakness and laziness to talk, fatigue and lack of strength, spontaneous sweating, dizziness, pale lips, numbness of the limbs, and palpitations and insomnia. The tongue is pale and tender. The pulse is thin and weak.
4. Yin and Yang deficiency
Symptoms: Edema, fear of cold with cold limbs, dull dark complexion, loose stool or constipation, clear long nighttime urination or scanty yellow urination, feverish feeling in the palms and soles, and insomnia with night sweating. The tongue is pale, swollen with very little saliva and teeth marks. The pulse is thin or rapid.
5. Cold-turbidity encumbering the spleen
Symptoms: Respiratory weakness and lack of strength, dull complexion, nausea and vomiting, aversion to food and a bloated abdomen, full body edema, scanty urination and loose stool. The tongue is big swollen and pale (jade-pale) with a thin greasy coating. The pulse is deep thin or soggy thin.
6. Heat-turbidity invading the stomach
Symptoms: Fatigue and lack of strength, nausea and retching or frequent vomiting, poor appetite and digestion, bloated abdomen, and constipation. The tongue is red with a yellow greasy or dry rough tongue coating. The pulse is either thin rapid or wiry rapid.
7. Kidney water pathogen attacking the heart
Symptoms: Palpitations and chest tightness, shortness of breath and unable to lie flat, cold body and limbs, dripping with a lot of sweat, and loss of consciousness. Yin deficiency symptoms with vexing heat in the five centers and flushing red cheeks. The tongue is pale with a thin coating. The pulse is faint, thin, feeble or hidden, deep.
8. Heat-turbidity trapping the heart
Symptoms: Loss of consciousness, irritable and restless, bleeding nose and gingival atrophy, bloody urine and stool, purple spots on the skin, stiff tongue and not talking, and anuria in severe cases. The tongue is red with char-yellow coating. The pulse is thin, rapid or knotted, intermittent.
9. Heat-turbidity invading the liver
Symptoms: Anuria, trembling fingers, trembling or curled tongue, headache and dizziness, skin that is atrophying, irritable and restless, loss of consciousness in severe cases, and convulsions of the limbs. The tongue is either red and dry or yellow and dry without saliva. The pulse is thin, wiry, and rapid.
10. Phlegm-turbidity clouding the orifices
Symptoms: Sullied and stagnant complexion, dementia, distorted or unclear speech, deep coma in severe cases, mostly there is no fever, silent without vexation, gurgling phlegm noise, and nausea and vomiting. The tongue has either a white greasy or grey greasy coating. The pulse is deep and slippery.
The above patterns may include different symptoms of the different stages of CKD.
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