尿血2(狼疮性肾是)
毕某，女，1 2岁，吉林省人，病历号--001 764，于1990年7月5日初诊。患者自1989年11月因感冒发热之后10余天，出现双眼睑浮肿、血尿，查尿蛋白I}}1.尿中红血球满视野，当地县医院以“肾病综合征”收住入院，用激素治疗20余H无效，转院于北京某医院肾内科。查得狼疮细胞，确诊为狼疮性肾炎。用大剂量激素配合化疗(环磷酰胺每日0.15mg)治疗8个月仍无效，并出现高血脂，肝肾功能损害，特求赵老医治。刻诊时，全身浮肿，而色觥白，咽痛，恶心呕吐，失眠梦多，血尿不止，舌红苔白厚腻，脉滑细数。化验检查：尿蛋白1}I}；尿红血球30～50个／高倍视野，尿潜血+++，血胆固醇993～7526mg／dl.血尿素氨30mg／dl.血肌肝3，5mg／dl.血清GP，51iu／l.B超：肝脏肿大，双肾弥漫性病变。证属热郁营血、气机不畅。治拟清热凉血，活血通络方法。药用荆芥炭10克，防风6克，白芷6克，苏叶10克，丹参10克，茜草10克，茅芦根各10克，小蓟10克，焦三仙各10克，大黄1.5克。服药7剂，呕吐未作，浮肿见轻，血尿止，仍睡眠较差，尿化验：蛋白十+，潜血++，仍以前方加生地榆10克，炒槐花10克。服药20余剂，浮肿消失，尿化验转阴，仍用凉血化瘀方法。药用荆芥炭10克，防风6克，生地榆10克，炒槐花10克，丹参10克，赤芍10克，茜草10克，生地10克，茅芦根各10克，小蓟10克，焦三仙各10
克，大黄1.5克。又服药30剂，无不适感，尿检(一)，血生化检驻：血清谷——丙转氨酶24iu／l.尿素氮6 6mg／dl.肌酐O，7mg／dl.两对半(一)，血胆固醇205mg／dl。DNA及抗DNA抗体均阴性，激素已停，痊愈出院返回。
[按]：系统性红斑狼疮而致肾损害，是一比较难治的疾病，中西医对此病均感较棘手，此患者出现高度浮肿、严重血尿。用激素冲击疗法和化疗等治疗8个月余无效，并出现肝、肾功能损害、血脂增高等并发症，无奈转诊赵老。赵师用凉血清热，活血通络之法治疗，服药1周，尿蛋白开始下降，服药4
周，血尿止，浮肿消失，尿蛋白转阴，又服药30余剂临床症状消失，化验检查恢复正常指标内。本患者原治疗方法是采用绝对卧床休息、高蛋白、高营养。接受赵老治疗方案后，采用限制蛋白进入量，清淡饮食，走路锻炼等，配合治疗3个月，痊愈出院。半年后来京复查，未复发。一年后又来复查，化验指标全部正常。
尿血3(IgA肾病)
张某，男，30岁，于1993年2月4日初诊。患者自1988年患急性肾炎，经住院治疗2个月痊愈出院。出院后两周发现尿赤、腰痛，又去医院检查：尿蛋白+++，尿潜血+++，尿红血球10～15／高倍视野，住院治疗1月余，效果不明显，经肾穿刺确诊为IgA肾病(系膜增殖型)。以后尿常规化验时好时坏，有时出现肉眼血尿，曾多次住院治疗，均未彻底治愈。由一朋友介绍求赵老医治。刻诊时症见心烦梦雾，腰痛，尿赤，舌红苔白，脉弦滑且数，尿检验：尿蛋白++，尿潜血++，尿红细胞5～7／高倍视野。证属肝经郁热，深入血分，络脉瘀阻。治拟清泻肝经郁热，凉血通络止血。药用柴胡6克，黄芩6克，川楝子6克，荆芥炭10克，防风6克，生地榆10克，丹参10克，炒槐花10克，茜草10克，茅芦根各10克，小蓟10克，大黄1克。服药7剂，睡眠转安，尿赤见轻，尿蛋白士，尿潜血+，尿红细胞消失。又服前方7剂，尿蛋白转阴，唯腰痛。尿潜血士，改为活血通络，凉血育阴方法，药用：荆芥炭10克，防风6克，赤芍10克，丹参10克，茜草10克，生地榆10克，丝瓜络10克，桑枝10克，旱莲草10克，女贞子10克，小蓟10克，藕节10克，茅芦根各20克，大黄1克。服药20剂，腰痛消失，尿化验未觅异常，无其他不适。又观察治疗3个月，未再反复，而告获愈。
[按]；血尿是以小便中混有血液为其临床特征。在《内经》中又称为搜血、溺血。但辨证治疗时必须与血淋相鉴别，其主要是区别疼痛的有无，如小便出血时滴沥涩痛或疼痛难忍，为血淋，多属膀胱湿热；如小便出血时多无疼痛症状为溺血(或尿血)，多属血分郁热。此病案症见心烦梦多，尿赤，舌红，脉弦滑且数等，全是肝胆郁热深入血分之象。因此取柴胡、黄芩、川楝子等清泻肝胆郁热；生地榆、炒槐花、丹参、茜草凉血活血清热滂根、小蓟凉血止血；荆芥炭，防风既能疏调气机，又能止血；大黄凉血活血，推陈致新。初诊服七剂，症状即显著见轻，又服7剂，尿蛋白转阴，唯见腰痛，尿潜血(士)，改用凉血育阴方法，仅服药20剂，诸症皆去，化验检查亦未见异常。又以此方加减服药3个月以巩固疗效，并未再反复。病程达5年的IgA肾病，共治疗4个月而全愈。在治疗过程中，患者积极配合赵老的治疗方案，采用中药配合走路锻炼，限蛋白饮食等，疗效比较满意。
水肿1(肾病综合征)
王某某，女，68岁
初诊
患者病水肿已3年余，时轻时重，经某医院诊断为肾病综合征。服中西药无效，近2月来水肿加剧，下肢尤甚，几乎难以行走，由其女搀扶前来就诊。患者面目一身悉肿，按之盲而不起，下肢肿甚，面色眺白虚浮，眼睑难以开启，两眼如线状。肚腹肿胀如鼓，自觉胀满小便不利，大便艰涩难下。诊其两脉沉迟涩滞，如病蚕食叶状，关尺脉虚微若无，舌胖质嫩色淡，舌苔白腻滑润有液。一身关节沉重，动则作痛。检视其前所用方，不外五皮、五苓、肾气丸之类，然均无效验。综合脉、舌、色、证分析，其病本属中阳不足，真元大伤，寒湿阻络，失于温化，经脉闭阻，三焦不畅，其病已延久，阳擞阴盛，非大剂温通不足以解其寒凝。必俟寒解阳回，络脉疏通，方克有济。姑拟四遵加味温阳以散寒凝。
淡附片30克(先煎)，淡吴萸10克，淡干姜10克，肉桂6克，炒川椒6克，细辛6克，茯苓10克，三剂
二诊
4日后患者自已步行前来就诊，既不需人搀扶，也不需扶手杖。观其肿势已消之大半。患者自述服前方一剂后，至午夜腹痛作泄，下如稀水，连续三次，其势如注，总量约5000毫升。因其泻势甚猛，家人甚为担忧，意欲前来急诊，后因见其泻后自觉舒适，且精神尚佳，遂较放心观察。泄后安然入睡。次日服第二剂药后又泄3次，约3500毫升。第三剂服后又泄水二次，约2000毫升。三日之内，水肿日见消退，精神日增，饮食知味。已能自主活动。遂来复诊。
再诊其脉已由沉迟涩滞变为沉缓濡滑，按之已觉力增，舌白水滑之象已减。说明三进大剂温热，阳气已得振奋，驱逐阴寒水湿之邪由大便泄出，此为三焦畅通之象溢火之源以消阴翳，仍以前法继进，温阳益气，崇土制水之法。
淡附片30克，淡吴萸10克，淡干姜10克，川桂枝10克，炒川椒目6克，黄芪30克，党参20克，白术10克，茯苓10克，五剂
三诊
药后水肿全消，面色渐转红润，精神日增，饮食睡眠均佳，二便如常，行动自如，能协助家人干些轻活，脉象沉软濡滑，舌白苔润。寒湿虽去，恐其复来，为拟丸药处方，常服以资巩固。
黄芪60克，党参60克，附片60克，干姜20克，吴萸10克，肉桂10克，当归30克，白芍30克，熟地60克，川芎30克，白术30克，陈皮20克，茯苓60克，炙甘草30克，鹿角霜20克，鸡内金30克。
上药共研细面，炼蜜为丸，每丸重9克，每日早，午，晚各服1丸，白开水送下，如遇感冒发烧可暂停。
上药服完后，身体日渐强健，水肿未再反复。
[按]：此为阴水肿，缘于阳气衰微，阴寒内盛，闭阻络脉，气血不得流通，三焦不得通畅，水湿无由泄越，溢于肌肤而为水肿。仲景云：病痰饮者当以温药和之。概指此言。其证肤肿按之没指，富而不起，肌肤四肢沉重发凉，时时畏寒，口淡不渴，舌胖质嫩，苔白水滑，脉象沉微，接之无力。治疗此证当以温阳为先，使阳气振奋，则寒湿自去。观本案服温热回阳剂后，由大便泄水如注，其理即如《伤寒论》所云“由脾家实，腐秽当去故也。”其方用姨附片，淡干姜，淡吴萸，三者合用，名三淡汤，最善温阳散寒，是师门口授心传之经验方，为治疗阴寒内盛，元阳衰微之阴寒证之要方。再合辛甘大热之肉桂温阳化气，走窜行水之椒目，温经散寒之细辛，健脾利水之茯苓，故能振奋脾肾之阳气，而泄寒湿之壅盛。此证以温阳为急，故不可加入阴柔之药，若援引张介宾阴中求阳之例，加入熟地等补肾滋腻之药则误矣。故初诊，二诊皆不用之。水肿消退之后，以丸药善后调理则可用之。此间道理，细细揣摩，自可明之。
水肿2(肾病综合征)
房某，女，2 5周岁，于1989年10月30日初诊。患儿自1989年4月因感冒后全身浮肿去医院就诊，经检查发现尿蛋白忤H，并伴有大量管型，以肾病综合征收住入院治疗。用激素治疗后，浮肿见轻，尿蛋白仍持续在+～++，现症面色龇白，全身轻度浮肿，尿量较步，智力较差，激素已由每日30毫克减至每日7，5毫克，尿蛋白H，指纹色紫，舌红苔厚腻，脉滑数。证属湿热蕴郁于内，治拟清热化湿方法。药用荆芥2克，白芷2克，苏叶3克，丹参5克，生地榆5克，茅芦根各6克。服药7剂后，浮肿消失，尿蛋白(一)，夜啼不安，大便干结，舌红苔薄白，湿郁渐化，热郁未清，仍以前法，佐以凉血化瘀，递减激素。药用荆芥2克，防风2克，生地榆6克，丹参6克，赤芍6克，茜草6克，茅芦根各6克，焦三仙各6克。服药7剂，尿蛋白(一)，饮食二便正常。又接此方服药20余剂后，化验检查未见异常而停服激素。调整方药：荆芥3克，生地榆6克，焦麦芽6克，水红花子6克，改隔日一剂，连服4周。
[按]：肾病综合征是高度水肿，大量蛋白尿，以及高血脂症，低蛋白血症为其主要特征的一组临床症候群。属于中医水肿，虚劳的范畴。临床治疗多以利水I行水、甚至逐水等方法，治疗方剂如五苓散，五皮饮“及疏凿饮子等。而赵师从几十年临床观察和实践中，认为肾炎、慢性肾病的水肿，并非利水一途，因为利水的疗效不尽人意，往往是越利尿，水肿越甚，尿蛋白反复不降。其病的实质是湿热郁滞，邪气不去，正气难复，而用清化湿热的方法，往往收到经比较满意的疗效。治水肿不用利水剂，而收消肿之效，所谓不治之治是也，
水肿3(肾病综合征)
张某，男，22岁，某大学一年级学生。1988年秋季参加军训后出现浮肿，经多次检查确诊为肾病综合征。尿蛋白持续帅。住某医院治疗，先用激素冲击疗法，未见效果，反见严重的激素副作用症状。后加用环磷酰胺等免疫抑制剂，也无效。患者的父母都是医务工作者，深知肾病综合征大量尿蛋白流失的严重危害，同时，也深知丢蛋白补蛋白是肾病综合征的调养法宝。因此，他们为其于精心安排了高蛋白饮食谱，每天的饮食鱼、虾、肉、蛋、奶不断，平均每2～3天就要进食一只鸡，以补充营养，并强制其卧床休息，不得下床活动。他们为儿子做了他们认为应该做的一切，经此治疗一年有余，患者的病情更加严重，尿蛋白定性检查++++，24小时尿蛋白定量高达20多克，同时，其浮肿加剧，面色惨白，体力衰弱，几至不能下床行走。百般无奈之中，于1989年春请赵师会诊。视其舌红苔腻垢厚，切其脉濡滑数，接之有力，证属湿热蕴郁，热入血分，络脉瘀阻，困其食补太过，致使三焦不畅，气血壅滞。其诸般虚弱之症，非真虚也，乃“大实若赢”之象也，治当凉血化瘀、清化澎热、疏调三焦方法。遂令其停止进食一切蛋白食物，每天的主食也减量至3两。并要求患者进行户外活动，每天散步1至2
小时，逐渐增加到3至4小时，当患者和父母明确表示能够做到时，赵师始为疏方如下：荆芥、防风、白芷、独活、生地榆、炒槐花、丹参、茜草、焦三仙、水红花子、大腹皮、槟榔、大黄，水煎服，每日一剂。两周后，尿蛋白开始下降，浮肿也开始渐渐消退。继之依上方随症加减治疗三个月，在患者的密切配合下，其尿蛋白完全转阴，浮肿全消，体力也大大增加，继续巩固治疗半年，停药观察。至今未复发。
[按]：这个病例清楚地说明了补蛋白和禁蛋白对肾病综合征尿蛋白流失的不同影响。起初，患者大量进食高蛋白食物，但并未能纠正其低蛋白血症，相反确加剧了尿蛋白的流失；后来，由于采用了低蛋白饮食配合中药综合治疗，其尿蛋白很快就得到了控制。从而说明了忌食高蛋白食物对于治疗慢性肾病消除尿蛋白是多么重要。
尿血2（狼疮性肾炎）
毕某，女性，12岁，吉林省人，病历号001764，于1990年7月5日初次就诊。患者自1989年11月因感冒发热后10余天，出现双眼睑浮肿、血尿，检查发现尿蛋白（++），尿中红细胞满视野，当地县医院以“肾病综合征”收治入院，使用激素治疗20余天无效，转院至北京某医院肾内科。检查发现狼疮细胞，确诊为狼疮性肾炎。使用大剂量激素配合化疗（环磷酰胺每日0.15克）治疗8个月仍无效，并出现高血脂、肝肾功能损害，特来求赵绍琴老中医医治。诊察时，全身浮肿，面色㿠白，咽痛，恶心呕吐，失眠多梦，血尿不止，舌红苔白厚腻，脉滑细数。化验检查：尿蛋白（++）；尿红细胞30～50个/高倍视野，尿潜血（+++），血胆固醇993～7526mg/dl，血尿素氮30mg/dl，血肌酐3.5mg/dl，血清谷丙转氨酶51iu/l。B超显示：肝脏肿大，双肾弥漫性病变。证属热郁营血、气机不畅。治拟清热凉血，活血通络之法。药用荆芥炭10克，防风6克，白芷6克，苏叶10克，丹参10克，茜草10克，茅根、芦根各10克，小蓟10克，焦三仙各10克，大黄1.5克。服药7剂，呕吐未作，浮肿见轻，血尿止，仍睡眠较差，尿化验：蛋白（++），潜血（++），仍以前方加生地榆10克，炒槐花10克。服药20余剂，浮肿消失，尿化验转阴，仍用凉血化瘀方法。药用荆芥炭10克，防风6克，生地榆10克，炒槐花10克，丹参10克，赤芍10克，茜草10克，生地10克，茅根、芦根各10克，小蓟10克，焦三仙各10克，大黄1.5克。又服药30剂，无不适感，尿检（-），血生化检查：血清谷丙转氨酶24iu/l，尿素氮6.6mg/dl，肌酐0.7mg/dl，乙肝两对半（-），血胆固醇205mg/dl。DNA及抗DNA抗体均阴性，激素已停，痊愈出院返回。
[按语]：系统性红斑狼疮导致肾损害，是一比较难治的疾病，中西医对此病均感较棘手，此患者出现高度浮肿、严重血尿。用激素冲击疗法和化疗等治疗8个月余无效，并出现肝、肾功能损害、血脂增高等并发症，无奈转诊赵老。赵师用凉血清热，活血通络之法治疗，服药1周，尿蛋白开始下降，服药4周，血尿止，浮肿消失，尿蛋白转阴，又服药30余剂临床症状消失，化验检查恢复正常指标内。本患者原治疗方法是采用绝对卧床休息、高蛋白、高营养。接受赵老治疗方案后，采用限制蛋白进入量，清淡饮食，走路锻炼等，配合治疗3个月，痊愈出院。半年后来京复查，未复发。一年后又来复查，化验指标全部正常。
尿血3（IgA肾病）
张某，男性，30岁，于1993年2月4日初次就诊。患者自1988年患急性肾炎，经住院治疗2个月痊愈出院。出院后两周发现尿赤、腰痛，又去医院检查：尿蛋白（+++），尿潜血（+++），尿红细胞10～15/高倍视野，住院治疗1月余，效果不明显，经肾穿刺确诊为IgA肾病（系膜增殖型）。以后尿常规化验时好时坏，有时出现肉眼血尿，曾多次住院治疗，均未彻底治愈。由一朋友介绍求赵老医治。刻诊时症见心烦多梦，腰痛，尿赤，舌红苔白，脉弦滑且数，尿检验：尿蛋白（++），尿潜血（++），尿红细胞5～7/高倍视野。证属肝经郁热，深入血分，络脉瘀阻。治拟清泻肝经郁热，凉血通络止血。药用柴胡6克，黄芩6克，川楝子6克，荆芥炭10克，防风6克，生地榆10克，丹参10克，炒槐花10克，茜草10克，茅根、芦根各10克，小蓟10克，大黄1克。服药7剂，睡眠转安，尿赤见轻，尿蛋白（±），尿潜血（+），尿红细胞消失。又服前方7剂，尿蛋白转阴，唯腰痛。尿潜血（±），改为活血通络，凉血育阴方法，药用：荆芥炭10克，防风6克，赤芍10克，丹参10克，茜草10克，生地榆10克，丝瓜络10克，桑枝10克，旱莲草10克，女贞子10克，小蓟10克，藕节10克，茅根、芦根各20克，大黄1克。服药20剂，腰痛消失，尿化验未见异常，无其他不适。又观察治疗3个月，未再反复，而告获愈。
[按语]：血尿是以小便中混有血液为其临床特征。在《内经》中又称为溲血、溺血。但辨证治疗时必须与血淋相鉴别，其主要是区别疼痛的有无，如小便出血时滴沥涩痛或疼痛难忍，为血淋，多属膀胱湿热；如小便出血时多无疼痛症状为溺血（或尿血），多属血分郁热。此病案症见心烦多梦，尿赤，舌红，脉弦滑且数等，全是肝胆郁热深入血分之象。因此取柴胡、黄芩、川楝子等清泻肝胆郁热；生地榆、炒槐花、丹参、茜草凉血活血清热，茅根、小蓟凉血止血；荆芥炭、防风既能疏调气机，又能止血；大黄凉血活血，推陈致新。初诊服七剂，症状即显著见轻，又服7剂，尿蛋白转阴，唯见腰痛，尿潜血（±），改用凉血育阴方法，仅服药20剂，诸症皆去，化验检查亦未见异常。又以此方加减服药3个月以巩固疗效，并未再反复。病程达5年的IgA肾病，共治疗4个月而全愈。在治疗过程中，患者积极配合赵老的治疗方案，采用中药配合走路锻炼，限蛋白饮食等，疗效比较满意。
水肿1（肾病综合征）
王某某，女性，68岁
初诊
患者病水肿已3年余，时轻时重，经某医院诊断为肾病综合征。服中西药无效，近2月来水肿加剧，下肢尤甚，几乎难以行走，由其女搀扶前来就诊。患者面目一身悉肿，按之窅而不起，下肢肿甚，面色㿠白虚浮，眼睑难以开启，两眼如线状。肚腹肿胀如鼓，自觉胀满小便不利，大便艰涩难下。诊其两脉沉迟涩滞，如病蚕食叶状，关尺脉虚微若无，舌胖质嫩色淡，舌苔白腻滑润有液。一身关节沉重，动则作痛。检视其前所用方，不外五皮饮、五苓散、肾气丸之类，然均无效验。综合脉、舌、色、证分析，其病本属中阳不足，真元大伤，寒湿阻络，失于温化，经脉闭阻，三焦不畅，其病已延久，阳微阴盛，非大剂温通不足以解其寒凝。必俟寒解阳回，络脉疏通，方克有济。姑拟四逆汤加味温阳以散寒凝。
淡附片30克（先煎），淡吴茱萸10克，淡干姜10克，肉桂6克，炒川椒6克，细辛6克，茯苓10克，三剂
二诊
4日后患者自己步行前来就诊，既不需人搀扶，也不需扶手杖。观其肿势已消之大半。患者自述服前方一剂后，至午夜腹痛作泄，下如稀水，连续三次，其势如注，总量约5000毫升。因其泻势甚猛，家人甚为担忧，意欲前来急诊，后因见其泻后自觉舒适，且精神尚佳，遂较放心观察。泄后安然入睡。次日服第二剂药后又泄3次，约3500毫升。第三剂服后又泄水二次，约2000毫升。三日之内，水肿日见消退，精神日增，饮食知味。已能自主活动。遂来复诊。
再诊其脉已由沉迟涩滞变为沉缓濡滑，按之已觉力增，舌白水滑之象已减。说明三进大剂温热，阳气已得振奋，驱逐阴寒水湿之邪由大便泄出，此为三焦畅通之象。益火之源以消阴翳，仍以前法继进，温阳益气，崇土制水之法。
淡附片30克，淡吴茱萸10克，淡干姜10克，川桂枝10克，炒川椒目6克，黄芪30克，党参20克，白术10克，茯苓10克，五剂
三诊
药后水肿全消，面色渐转红润，精神日增，饮食睡眠均佳，二便如常，行动自如，能协助家人干些轻活，脉象沉软濡滑，舌白苔润。寒湿虽去，恐其复来，为拟丸药处方，常服以资巩固。
黄芪60克，党参60克，附片60克，干姜20克，吴茱萸10克，肉桂10克，当归30克，白芍30克，熟地60克，川芎30克，白术30克，陈皮20克，茯苓60克，炙甘草30克，鹿角霜20克，鸡内金30克。
上药共研细面，炼蜜为丸，每丸重9克，每日早、午、晚各服1丸，白开水送下，如遇感冒发烧可暂停。
上药服完后，身体日渐强健，水肿未再反复。
[按语]：此为阴水证，缘于阳气衰微，阴寒内盛，闭阻络脉，气血不得流通，三焦不得通畅，水湿无由泄越，溢于肌肤而为水肿。仲景云：病痰饮者当以温药和之。概指此言。其证肤肿按之没指，窅而不起，肌肤四肢沉重发凉，时时畏寒，口淡不渴，舌胖质嫩，苔白水滑，脉象沉微，按之无力。治疗此证当以温阳为先，使阳气振奋，则寒湿自去。观本案服温热回阳剂后，由大便泄水如注，其理即如《伤寒论》所云“由脾家实，腐秽当去故也。”其方用淡附片，淡干姜，淡吴茱萸，三者合用，名三淡汤，最善温阳散寒，是师门口授心传之经验方，为治疗阴寒内盛，元阳衰微之阴寒证之要方。再合辛甘大热之肉桂温阳化气，走窜行水之椒目，温经散寒之细辛，健脾利水之茯苓，故能振奋脾肾之阳气，而泄寒湿之壅盛。此证以温阳为急，故不可加入阴柔之药，若援引张介宾阴中求阳之例，加入熟地等补肾滋腻之药则误矣。故初诊、二诊皆不用之。水肿消退之后，以丸药善后调理则可用之。此间道理，细细揣摩，自可明之。
水肿2（肾病综合征）
房某，女性，25周岁，于1989年10月30日初次就诊。患儿自1989年4月因感冒后全身浮肿去医院就诊，经检查发现尿蛋白（++），并伴有大量管型，以肾病综合征收治入院治疗。用激素治疗后，浮肿见轻，尿蛋白仍持续在（+）～（++），现症面色㿠白，全身轻度浮肿，尿量较少，智力较差，激素已由每日30毫克减至每日7.5毫克，尿蛋白（++），指纹色紫，舌红苔厚腻，脉滑数。证属湿热蕴郁于内，治拟清热化湿方法。药用荆芥2克，白芷2克，苏叶3克，丹参5克，生地榆5克，茅根、芦根各6克。服药7剂后，浮肿消失，尿蛋白（-），夜啼不安，大便干结，舌红苔薄白，湿郁渐化，热郁未清，仍以前法，佐以凉血化瘀，递减激素。药用荆芥2克，防风2克，生地榆6克，丹参6克，赤芍6克，茜草6克，茅根、芦根各6克，焦三仙各6克。服药7剂，尿蛋白（-），饮食二便正常。又接此方服药20余剂后，化验检查未见异常而停服激素。调整方药：荆芥3克，生地榆6克，焦麦芽6克，水红花子6克，改隔日一剂，连服4周。
[按语]：肾病综合征是高度水肿，大量蛋白尿，以及高血脂症，低蛋白血症为其主要特征的一组临床症候群。属于中医水肿、虚劳的范畴。临床治疗多以利水、行水、甚至逐水等方法，治疗方剂如五苓散，五皮饮及疏凿饮子等。而赵师从几十年临床观察和实践中，认为肾炎、慢性肾病的水肿，并非利水一途，因为利水的疗效不尽人意，往往是越利尿，水肿越甚，尿蛋白反复不降。其病的实质是湿热郁滞，邪气不去，正气难复，而用清化湿热的方法，往往收到比较满意的疗效。治水肿不用利水剂，而收消肿之效，所谓不治之治是也。
水肿3（肾病综合征）
张某，男性，22岁，某大学一年级学生。1988年秋季参加军训后出现浮肿，经多次检查确诊为肾病综合征。尿蛋白持续（++）。住某医院治疗，先用激素冲击疗法，未见效果，反见严重的激素副作用症状。后加用环磷酰胺等免疫抑制剂，也无效。患者的父母都是医务工作者，深知肾病综合征大量尿蛋白流失的严重危害，同时，也深知丢蛋白补蛋白是肾病综合征的调养法宝。因此，他们为儿子精心安排了高蛋白饮食谱，每天的饮食鱼、虾、肉、蛋、奶不断，平均每2～3天就要进食一只鸡，以补充营养，并强制其卧床休息，不得下床活动。他们为儿子做了他们认为应该做的一切，经此治疗一年有余，患者的病情更加严重，尿蛋白定性检查（++++），24小时尿蛋白定量高达20多克，同时，其浮肿加剧，面色惨白，体力衰弱，几至不能下床行走。百般无奈之中，于1989年春请赵师会诊。视其舌红苔腻垢厚，切其脉濡滑数，按之有力，证属湿热蕴郁，热入血分，络脉瘀阻，困其食补太过，致使三焦不畅，气血壅滞。其诸般虚弱之症，非真虚也，乃“大实若羸”之象也，治当凉血化瘀、清化湿热、疏调三焦方法。遂令其停止进食一切蛋白食物，每天的主食也减量至3两。并要求患者进行户外活动，每天散步1至2小时，逐渐增加到3至4小时，当患者和父母明确表示能够做到时，赵师始为疏方如下：荆芥、防风、白芷、独活、生地榆、炒槐花、丹参、茜草、焦三仙、水红花子、大腹皮、槟榔、大黄，水煎服，每日一剂。两周后，尿蛋白开始下降，浮肿也开始渐渐消退。继之依上方随症加减治疗三个月，在患者的密切配合下，其尿蛋白完全转阴，浮肿全消，体力也大大增加，继续巩固治疗半年，停药观察。至今未复发。
[按语]：这个病例清楚地说明了补蛋白和禁蛋白对肾病综合征尿蛋白流失的不同影响。起初，患者大量进食高蛋白食物，但并未能纠正其低蛋白血症，相反确加剧了尿蛋白的流失；后来，由于采用了低蛋白饮食配合中药综合治疗，其尿蛋白很快就得到了控制。从而说明了忌食高蛋白食物对于治疗慢性肾病消除尿蛋白是多么重要。
Hematuria 2 (Lupus Nephritis)
Patient Bi, female, 12 years old, from Jilin Province, medical record number 001764, first consulted on July 5, 1990. More than ten days after a cold and fever in November 1989, the patient developed edema of both eyelids and hematuria. Examination showed urine protein (++), with red blood cells filling the field of view in urine. The local county hospital admitted her under the diagnosis of "Nephrotic Syndrome" (a clinical syndrome characterized by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia). Treatment with corticosteroids for over 20 days was ineffective, so she was transferred to the Department of Nephrology at a hospital in Beijing. Lupus cells were detected, confirming the diagnosis of Lupus Nephritis. Treatment with high-dose corticosteroids combined with chemotherapy (Cyclophosphamide 0.15g daily) for 8 months remained ineffective, and complications such as hyperlipidemia and liver and kidney function impairment appeared. She specially sought treatment from Master Zhao Shaoqin. At examination, there was generalized edema, pale complexion, sore throat, nausea and vomiting, insomnia with frequent dreams, persistent hematuria, red tongue with thick white greasy coating, and slippery, fine, rapid pulse. Laboratory tests: Urine protein (++); Urine RBC 30-50/high power field (HPF), Urine occult blood (+++), Blood cholesterol 993-7526 mg/dl, Blood urea nitrogen 30 mg/dl, Serum creatinine 3.5 mg/dl, Serum ALT 51 IU/L. Ultrasound: Hepatomegaly, diffuse lesions of both kidneys. The pattern was identified as Heat stagnating in Ying and Blood levels, with impaired Qi mechanism. The treatment principle was to clear heat and cool blood, invigorate blood and unblock collaterals. Prescription: Charred Schizonepetae Spica 10g, Saposhnikoviae Radix 6g, Angelicae Dahuricae Radix 6g, Perillae Folium 10g, Salviae Miltiorrhizae Radix et Rhizoma 10g, Rubia Cordifoliae Radix 10g, Imperatae Rhizoma and Phragmitis Rhizoma each 10g, Small Thistle Herb 10g, Scorch Sanxian (Charred Fructus Crataegi, Charred Fructus Diospyri, Charred Semen Ziziphus) each 10g, Rhubarb 1.5g. After 7 doses, vomiting ceased, edema lightened, hematuria stopped, but sleep remained poor. Urine test: Protein (++), Occult blood (++). The previous prescription was continued with added Sanguisorbae Radix 10g and Stir-fried Sophorae Flos 10g. After more than 20 doses, edema disappeared, and urine tests turned negative. The method of cooling blood and resolving stasis was maintained. Prescription: Charred Schizonepetae Spica 10g, Saposhnikoviae Radix 6g, Sanguisorbae Radix 10g, Stir-fried Sophorae Flos 10g, Salviae Miltiorrhizae Radix et Rhizoma 10g, Red Peony Root 10g, Rubia Cordifoliae Radix 10g, Rehmanniae Radix Preparata 10g, Imperatae Rhizoma and Phragmitis Rhizoma each 10g, Small Thistle Herb 10g, Scorch Sanxian each 10g, Rhubarb 1.5g. After another 30 doses, no discomfort was felt. Urine examination (-), blood biochemistry: Serum ALT 24 IU/L, Urea Nitrogen 6.6 mg/dl, Creatinine 0.7 mg/dl, Hepatitis B surface antigen panel (-), Blood cholesterol 205 mg/dl. DNA and anti-DNA antibodies were both negative. Corticosteroids were discontinued, and the patient was discharged cured.
[Commentary]: Renal damage caused by Systemic Lupus Erythematosus is a relatively difficult disease to treat, challenging for both Traditional Chinese Medicine (TCM) and Western medicine. This patient presented with severe edema and serious hematuria. After more than 8 months of ineffective treatment with hormone pulse therapy and chemotherapy, accompanied by complications like liver/kidney dysfunction and hyperlipidemia, she was referred to Master Zhao. Master Zhao treated her with methods to clear heat, cool blood, invigorate blood, and unblock collaterals. After 1 week of medication, urine protein began to decrease; after 4 weeks, hematuria stopped, edema disappeared, and urine protein turned negative. After another 30+ doses, clinical symptoms disappeared, and laboratory indicators returned to normal. The original treatment involved absolute bed rest and a high-protein, high-nutrition diet. Under Master Zhao's plan, protein intake was restricted, diet was light, and walking exercises were encouraged. After 3 months of combined treatment, she was discharged cured. Follow-up in Beijing half a year later showed no recurrence. One year later, all lab indicators were normal.
Hematuria 3 (IgA Nephropathy)
Patient Zhang, male, 30 years old, first consulted on February 4, 1993. In 1988, he suffered from Acute Glomerulonephritis, was hospitalized for 2 months, and recovered. Two weeks after discharge, he noticed reddish urine and lower back pain. Hospital examination showed: Urine protein (+++), Urine occult blood (+++), Urine RBC 10-15/HPF. He was hospitalized for over a month with little effect. Renal biopsy confirmed IgA Nephropathy (Mesangial Proliferative type). Subsequent routine urine tests fluctuated, sometimes showing gross hematuria. Multiple hospitalizations failed to achieve a complete cure. Introduced by a friend, he sought Master Zhao's treatment. Current symptoms included irritability with frequent dreams, lower back pain, reddish urine, red tongue with white coating, and wiry, slippery, rapid pulse. Urine test: Protein (++), Occult blood (++), RBC 5-7/HPF. The pattern was Liver Meridian Stagnant Heat penetrating into the Blood level, obstructing collaterals. The treatment principle was to purge stagnant heat from the Liver Meridian, cool blood, unblock collaterals, and stop bleeding. Prescription: Bupleuri Radix 6g, Scutellariae Radix 6g, Toosendan Fructus 6g, Charred Schizonepetae Spica 10g, Saposhnikoviae Radix 6g, Sanguisorbae Radix 10g, Salviae Miltiorrhizae Radix et Rhizoma 10g, Stir-fried Sophorae Flos 10g, Rubia Cordifoliae Radix 10g, Imperatae Rhizoma and Phragmitis Rhizoma each 10g, Small Thistle Herb 10g, Rhubarb 1g. After 7 doses, sleep improved, reddish urine lightened, urine protein (+/-), occult blood (+), RBC disappeared. Another 7 doses led to negative urine protein, except for lingering lower back pain and (+/-) occult blood. The method was changed to invigorating blood, unblocking collaterals, cooling blood, and nourishing Yin. Prescription: Charred Schizonepetae Spica 10g, Saposhnikoviae Radix 6g, Red Peony Root 10g, Salviae Miltiorrhizae Radix et Rhizoma 10g, Rubia Cordifoliae Radix 10g, Sanguisorbae Radix 10g, Luffa Fruit 10g, Mulberry Twig 10g, Ecliptae Herba 10g, Ligustri Lucidi Fructus 10g, Small Thistle Herb 10g, Lotus Node 10g, Imperatae Rhizoma and Phragmitis Rhizoma each 20g, Rhubarb 1g. After 20 doses, lower back pain disappeared, urine tests were normal, and no other discomforts were present. Observation for 3 months showed no recurrence, and recovery was declared.
[Commentary]: Hematuria is clinically characterized by blood mixed in urine. Known as "Sou Xue" or "Niao Xue" in the *Neijing*, it must be differentiated from Bloody Lin Syndrome during syndrome differentiation. The key distinction is the presence or absence of pain: dripping, astringent pain or unbearable pain during urination with blood indicates Bloody Lin Syndrome, often due to Damp-Heat in the Bladder; whereas bleeding without pain indicates Niao Xue (Hematuria), often due to Stagnant Heat in the Blood level. This case showed irritability, frequent dreams, reddish urine, red tongue, and wiry-slippery-rapid pulse, all indicating Liver-Gallbladder Stagnant Heat penetrating the Blood level. Thus, Chai Hu, Huang Qin, and Chuan Lian Zi were used to purge Liver/Gallbladder heat; Di Yu, Huai Hua, Dan Shen, and Qian Cao cooled blood, invigorated blood, and cleared heat; Mao Gen and Xiao Ji cooled blood and stopped bleeding; Jing Jie Tan and Fang Feng regulated Qi and stopped bleeding; Da Huang cooled blood, invigorated blood, and eliminated stale matter. Symptoms significantly improved after 7 doses. After another 7 doses, urine protein turned negative, leaving only lower back pain and (+/-) occult blood. The method shifted to cooling blood and nourishing Yin. After 20 doses, all symptoms resolved, and labs were normal. Maintenance with modified prescriptions for 3 months prevented recurrence. An IgA Nephropathy case lasting 5 years was fully cured in 4 months. The patient cooperated well, combining TCM with walking exercises and protein-restricted diet, yielding satisfactory results.
Edema 1 (Nephrotic Syndrome)
Patient Wang, female, 68 years old.
First Visit
The patient had suffered from edema for over 3 years, fluctuating in severity, diagnosed as Nephrotic Syndrome at a certain hospital. Chinese and Western medicines were ineffective. Edema worsened in the last 2 months, especially in the lower limbs, making walking nearly impossible; she was assisted by her daughter. Generalized edema of face, body, and limbs pressed deeply without rebound. Lower limb edema was severe, complexion pale and puffy, eyelids hard to open, eyes slit-like. Abdomen distended like a drum, feeling fullness, difficulty urinating, and constipation. Pulse was deep, slow, choppy, and stagnant, resembling silkworms eating leaves; Guan and Chi pulses were weak and faint. Tongue was fat, tender, pale, with white, greasy, moist coating. Joints felt heavy, painful upon movement. Previous prescriptions included Wu Pi Yin, Wu Ling San, or Shen Qi Wan, all ineffective. Analysis of pulse, tongue, color, and symptoms indicated deficiency of Middle Yang, severe depletion of True Yuan, Cold-Damp obstructing collaterals, failure of warming and transformation, meridian blockage, and San Jiao dysfunction. The disease had persisted long, with Yang deficiency and Yin excess. Only large doses of warming and unblocking agents could resolve the Cold coagulation. Once Cold resolves and Yang returns, collaterals will unblock, and relief may be achieved. Tentatively prescribed Si Ni Tang (Decoction to Restore the Prostrate Yang) with modifications to warm Yang and dissipate Cold coagulation.
Prepared Aconite Root 30g (decocted first), Evodia Fruit 10g, Dried Ginger 10g, Cinnamon Bark 6g, Sichuan Pepper 6g, Asarum Root 6g, Poria 10g. Three doses.
Second Visit
Four days later, the patient walked in independently, without assistance or cane. Most edema had subsided. She reported that after one dose, she experienced abdominal pain and diarrhea at midnight, passing watery stool three times, totaling about 5000ml. Family was worried due to the intensity, but seeing her comfort and good spirit afterward, they observed. She slept peacefully after diarrhea. The second dose caused 3 more episodes (~3500ml). The third dose caused two more episodes (~2000ml). Within three days, edema receded daily, spirit improved, appetite returned, and she could move independently.
Re-examination: Pulse changed from deep/slow/choppy to deep/slow/soft/slippery, strength increased upon pressing. Tongue moisture reduced. This indicated that three large doses of warming herbs had stimulated Yang, expelling Yin-Cold and Water-Damp via stool, signifying San Jiao patency. "Benefiting the source of Fire to eliminate Yin shadows," the same method was continued: warming Yang, benefiting Qi, strengthening Earth to control Water.
Prepared Aconite Root 30g, Evodia Fruit 10g, Dried Ginger 10g, Cassia Twig 10g, Sichuan Pepper Seed 6g, Astragalus Root 30g, Codonopsis Root 20g, Atractylodes Macrocephala Rhizome 10g, Poria 10g. Five doses.
Third Visit
Edema completely resolved, complexion turned ruddy, spirit improved, diet and sleep excellent, excretion normal, movement free, able to do light chores. Pulse deep/soft/soft/slippery, tongue white/moist. Although Cold-Damp was gone, fear of recurrence led to a pill prescription for maintenance.
Astragalus Root 60g, Codonopsis Root 60g, Prepared Aconite Root 60g, Dried Ginger 20g, Evodia Fruit 10g, Cinnamon Bark 10g, Angelica Sinensis Root 30g, White Peony Root 30g, Prepared Rehmannia Root 60g, Ligusticum Chuanxiong Rhizome 30g, Atractylodes Macrocephala Rhizome 30g, Tangerine Peel 20g, Poria 60g, Honey-fried Licorice Root 30g, Deer Antler Glue 20g, Chicken Gizzard Membrane 30g.
Grind to fine powder, make honey pills, 9g each. Take one morning, noon, and night with warm water. Pause if cold/fever occurs.
After finishing the medicine, health strengthened, edema did not recur.
[Commentary]: This is Yin Edema, caused by Yang decline and internal Yin-Cold excess, blocking collaterals, preventing Qi/Blood flow, obstructing San Jiao, causing Water-Damp to overflow into skin. Zhongjing said: "For patients with Phlegm-Fluid, use warm herbs to harmonize." This refers to this condition. Signs include deep-indentation edema, heaviness/coldness of limbs, aversion to cold, bland taste/no thirst, fat/tender tongue, white/wet coating, deep/faint pulse. Treatment prioritizes warming Yang to stimulate it, allowing Cold-Damp to dissipate. In this case, massive watery diarrhea after taking warm/Yang-restoring herbs illustrates the concept from *Shanghan Lun*: "When the Spleen recovers its vitality, foul matter is expelled." The formula uses Fu Pian, Gan Jiang, Wu Zhu Yu, known as "San Dan Tang," a master-disciple secret recipe for warming Yang and dispersing Cold, essential for Yin-Cold patterns with Yuan Yang decline. Combined with Cinnamon Bark (warming Yang/Qi), Pepper Seed (moving water), Asarum (warming meridians), and Poria (strengthening Spleen/drainaging damp), it stimulates Spleen/Kidney Yang and drains Cold-Damp. Warming Yang is urgent here; Yin-nourishing herbs should be avoided initially. Adding Shu Di Huang (as suggested by Zhang Jiebin for "seeking Yang within Yin") would be erroneous. Hence, omitted in visits 1 and 2. Pills can be used post-edema resolution for consolidation. This nuance requires careful contemplation.
Edema 2 (Nephrotic Syndrome)
Patient Fang, female, 25 years old, first consulted on October 30, 1989. Due to a cold in April 1989, she developed generalized edema. Tests showed Urine Protein (++), many casts. Admitted for Nephrotic Syndrome. Hormone therapy lightened edema, but proteinuria persisted at (+) to (++). Current signs: pale complexion, mild generalized edema, oliguria, poor intelligence. Hormones reduced from 30mg/day to 7.5mg/day. Urine Protein (++), purple finger vein, red tongue with thick greasy coating, slippery-rapid pulse. Pattern: Damp-Heat accumulating internally. Treatment: Clear Heat and transform Damp. Prescription: Schizonepeta 2g, Angelica Dahurica 2g, Perilla Leaf 3g, Salvia 5g, Sanguisorba 5g, Imperata and Phragmis each 6g. After 7 doses, edema vanished, urine protein (-). Night crying/restlessness, dry stool, red tongue/thin white coating indicated Damp resolving but Heat remaining. Continued method, added Cooling Blood and Resolving Stasis, tapered hormones. Prescription: Schizonepeta 2g, Saposhnikovia 2g, Sanguisorba 6g, Salvia 6g, Red Peony 6g, Rubia 6g, Imperata and Phragmis each 6g, Scorch Sanxian each 6g. After 7 doses, urine protein (-), diet/excretion normal. Continued for 20+ doses, labs normal, hormones stopped. Adjusted formula: Schizonepeta 3g, Sanguisorba 6g, Scorched Barley Sprout 6g, Hygrophylla Seed 6g. Alternate-day dosing for 4 weeks.
[Commentary]: Nephrotic Syndrome is characterized by severe edema, heavy proteinuria, hyperlipidemia, and hypoalbuminemia. It belongs to TCM categories of Edema and Deficiency Exhaustion. Clinical treatment often uses diuretic, moving-water, or purging-water methods, e.g., Wu Ling San, Wu Pi Yin, Shu Zao Yin Zi. However, Master Zhao, based on decades of practice, believes edema in nephritis/chronic kidney disease is not solely a water-retention issue. Diuretics often yield unsatisfactory results; excessive diuresis worsens edema and causes recurrent proteinuria. The essence is Damp-Heat stagnation; pathogens remain, Zheng Qi cannot recover. Clearing/transforming Damp-Heat often yields better results. Treating edema without diuretics yet achieving reduction exemplifies "treating by not treating."
Edema 3 (Nephrotic Syndrome)
Patient Zhang, male, 22 years old, freshman. Developed edema after military training in Autumn 1988, diagnosed as Nephrotic Syndrome. Persistent Urine Protein (++). Hospitalized, initial hormone pulse therapy failed, causing severe side effects. Cyclophosphamide and other immunosuppressants were also ineffective. Parents, being medical workers, understood the danger of protein loss and believed "replacing lost protein with dietary protein" was key. They arranged a high-protein diet (fish, shrimp, meat, eggs, milk constantly, chicken every 2-3 days) and enforced strict bed rest. After over a year, condition worsened: Urine Protein (++++) , 24h urine protein >20g, severe edema, pale complexion, extreme weakness, unable to walk. Desperate, they consulted Master Zhao in Spring 1989. Tongue: Red, thick greasy coating. Pulse: Soft, slippery, rapid, forceful. Pattern: Damp-Heat accumulation, Heat entering Blood level, collateral obstruction. Excessive dietary supplementation blocked San Jiao, causing Qi/Blood stagnation. The weakness was not true deficiency but "Great Excess appearing as Emaciation." Treatment: Cool Blood, Resolve Stasis, Clear/Transform Damp-Heat, Regulate San Jiao. Ordered cessation of all protein foods, reduced staple food to 150g/day. Prescribed outdoor activity: walking 1-2 hours daily, gradually increasing to 3-4 hours. Once compliance was assured, Master Zhao prescribed: Schizonepeta, Saposhnikovia, Angelica Dahurica, Angelica Pubescens, Sanguisorba, Sophora Flower, Salvia, Rubia, Scorch Sanxian, Hygrophylla Seed, Areca Peel, Betel Nut, Rhubarb. Decoct in water, once daily. After 2 weeks, proteinuria decreased, edema receded. Continued modification for 3 months. With cooperation, urine protein turned negative, edema resolved, strength increased. Consolidation for 6 months, then observation. No recurrence to date.
[Commentary]: This case clearly illustrates the different impacts of protein supplementation vs. restriction on proteinuria in Nephrotic Syndrome. Initially, high protein intake failed to correct hypoproteinemia and exacerbated protein loss. Later, low-protein diet combined with comprehensive TCM quickly controlled proteinuria. This highlights the importance of avoiding high-protein foods in treating chronic kidney disease to eliminate proteinuria.