关格6(尿毒症)
包某，男，38岁，内蒙古某林场工人。1992年11月确诊为慢性肾功能衰竭，尿毒症期。1993年初来京医治，在某大医院作血液透析。1993年4月就诊于赵师。当时患者每周血透三次，已连续时行了三个多月。透前血肌酐为6 7mg／dl.尿毒氮54mg／dl.证见面色苍黄晦浊，神疲乏力，恶心欲吐，皮肤搔痒，下肢浮肿小便短步，大便干结，血色素为5克，舌质暗淡，舌苔垢厚且腻，脉象弦滑数，按之有力。合而观之，其证属邪蕴成毒，深入血分，络脉淤阻，三焦不畅，将成关格。用凉血化瘀，清泄邪毒方法。拟方如下：荆芥炭、防风、佩兰、藿香、生地愉、炒槐花、丹参、茜草、白鲜皮、地肤子、草河车、大腹皮、槟榔、灶心土、大黄，水煎服，每日一剂。每次少量，多次分服，以防其吐，并反复叮咛，一定要严格控制饮食，每天坚持走路锻炼2至3小时，上方服后，呕恶即止小便渐增，浮肿见消，大便通畅，患者自觉精神好转，气力有增。复查血肌酐和尿素氮也有所下降。此后治疗，均以凉血化瘀、琉风化湿、疏调三焦为基本大法，而随症灵活加减。在患者的密切配合下，治疗两周之后开始延长透析间隔时间，由开始治疗时的每周三次逐渐递减为每周两次、每周一次，直到1993年9月停止透析，完全用中药治疗。1993年12月复诊，停止透析已67天，面色较润，精神爽适，知饥欲食，二便如常，自觉气力增加，每天散步3至4小时，不觉疲劳。近日化验血肌酐为2.3mg％，尿素氮27mg％，血色素10.3g％。说明停透后病情基本稳定，未出现反复。患者要求携方返里。根据其病情现状分析，认为回去之后，只要能够按照既定的治疗方案进行综全调理，是可以逐渐好转的，于是为患者拟定下方：荆芥炭、防风、白芷、独活、生地榆、炒槐花、丹参、茜草、焦三仙、红花子、大腹皮、槟榔、大黄，水煎服，每日一剂。并再次谆谆叮嘱，务必谨慎饮食，坚持运动锻炼，不可松懈。患者遵嘱，遂携上方回家治疗。1994年3月，该患者介绍其同乡前来就诊，告之包某回去后身体较前强壮，已能干些轻活，仍在依法治疗云。
[按]：本例为慢性肾功能衰竭、尿毒症，且已进行血液透析三个多月。按一般规律推论，是不可能停止透析的。只能长期依赖透析，等待机会换肾而已。赵师以凉血化瘀、清泄邪毒为法进行治疗，并严格控制其饮食，有效地降低了血肌酐和尿素氮。又根据化验指标的改善情况，适时地逐渐拉长透析的间隔时间。这期间，随着患者坚持治疗和适度的运动锻炼，其肾功能也渐渐得到部分恢复，终于达到了完全停止透析的目的。
从这个病例的治疗过程中，我们可以看出，赵师对慢性肾病的治疗是综合性的，中医药辨证论治、患者注意饮食控制和运动锻炼，这三个方面缺一不可。这就是赵师治疗慢性肾病成功的秘诀。
关格7(尿毒症)
沈某，男，80岁初诊
患者长期患高血压、心脏病，已20余年，近几个月来逐渐出现进行性贫血，面色苍白，唇甲色淡，头晕心慌，一身乏力，遂住某医院治疗。经检查发现肌酐为6，4mg／dl.尿素氮为65mg／dl.确诊为慢性肾功能衰竭、尿毒症期。拟行血液透析疗法，但因其高血压心脏病，心功能欠佳，不宜作血透，姑且保守治疗，并请本院中医专家会诊，固当时患者身体极度衰弱，严重贫血，血色素仅为5.5克，会诊中医专家认为其属脾肾阳虚，气血大亏。遂用温补脾肾益气补血方法，药用红参、黄芪、鹿茸、枸杞、杜仲、熟地黄、巴戟天、阿胶等，服药半月，反致烦躁不安，恶心呕吐，口鼻出血，皮肤搔痒等，再查血色素降至4
1克，血肌酐上升至10 2rng／dl.尿素氮为10mg／dl。病情十分危急，医院连续两次发出病危通知。经人介绍，患者家属请赵师会诊。倾诊两脉弦滑而数，按之振指有力，舌红苔黄垢厚-恶心作吐，皮肤搔痒，鼻衄时作小便短步，大便干结?四日未行。
证属湿热积滞蕴积三焦，误服温补，热毒深入血分，尿毒重症，法在不治。先用通腑泄热凉血化瘀方法，冀其便通吐止为幸。
大黄10克，黄芩10克，黄连3克，荆芥炭10克，防风6
克，生地榆10克，炒槐花10克，丹参10克，茜草10克，茅芦根各10克，赤芍10克，五付
二诊
药后大便得下，鼻衄未作，呕恶稍减，肤痒亦轻。弥仍弦滑有力，舌苔黄腻垢厚，药既见效，病有转机，勿事更张，仍以前法。
荆芥炭10克，防风6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，小蓟10克，茅芦根各10克，大黄6克，七付
三诊
大便日2～3行，小溲较前增多，恶心呕吐已止，精神转佳，体力有增，已能下床活动。嘱其每日下床散步，以不疲劳为度，饮食素食为主，不得进食动物蛋白及植物高蛋白如豆制品，并不得进食补药及补品。药用凉血化瘀方法，兼肚疏调三焦。
荆芥炭10克，防风6克，白芷6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，赤芍10克，焦三仙各10克，水红花子10克，大腹皮10克，大黄6克，七付
四诊
一周来精力日渐增加，每日可散步1小时，并能步行出院前来门诊就医。近查血肌酐下降至8，6mg／dl.尿素氮下降为78mg／dl.血色素升至5.6mg／dl。脉仍弦滑数，舌黄苔厚，郁热日久，未可掉以轻心，仍用前法进退。
荆芥炭10克，防风6克，白芷6克，独活6克，生地愉10
克，炒槐花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，大腹皮10克，大黄6克。七付
后以上方加减治疗2个月，肌酐降至6mg，dI，尿素氮43mg／dl.患者出院回家疗养。
[按]：本案患者高龄久病，血色素极低，面色苍白，口唇无华，心慌头晕，倦怠乏力，一派虚象，无怪乎前医认为气血双亏，而用峻朴之剂。然而补之不效，病情陡然加重，呕恶作吐，鼻衄肤痒，二便不利，已成关格重症。是虚不受补乎?抑或补力不逮乎?二者皆非。盖此本非虚证，乃大实若赢之象。尿毒症乃血中蕴毒，不得排泄，故肌酐、尿素氮升高，其所伴贫血，乃肾性贫血，其血色素之降低与肌酐尿素氮之升高呈负相关，即肌酐、尿素氮愈高，血色素就愈低，反之肌酐、尿素氮下降，血色素就上升。可见这种贫血的原因在于血中毒素蓄积。也就是说种种虚弱的症侯皆源于体内邪毒不能排泄。这就是古人所说的大实若赢状，种种赢状是标象，是假象，邪实深伏才是病本。辨之之法，察舌与脉，舌苔的垢厚满布是邪气壅盛之标志，脉象弦滑有力，愈按愈盛，更是说明邪毒深伏于内，不得泄越，当此之时，再用补法，岂不是火上浇油，无异于输粮资寇。唯一的正确治法只能攻逐邪气，给邪气以出路。如本案初诊即用大黄10克以峻攻之，虽患者高龄久病，虚弱若甚，亦无所顾忌。盖邪盛之时，唯当取邪，邪不去则正不复，邪去刚正安。前贤张子和云“陈垄去而肠胃洁，痛瘕尽而营卫昌，不补之中有真补存焉。”在本案治疗中，随着攻邪治法的应用，肌酐尿素氮稳步下降，血色素随之上升。呕恶肤痒鼻衄等热毒症候丑速消退，神疲乏力头晕心慌等虚弱症状也得以改善。患者由卧床不起到下床行走，并能坚持锻炼，终于转危为安。这都得益于正确地使用了攻邪治病的原则。这一病案所反映的治疗原则具有普遍的指导意义。赵师认为慢性肾病，包括慢性肾炎、慢性肾衰、尿毒症，其本质决非虚证，邪毒久留而不去，深入血分，蕴郁化热成毒，以致脉络瘀阻，是慢性肾病的基本病机，因此治疗上大忌温补，必须以凉血化癀为主，佐以疏风胜湿，疏调三焦之法，务使内外上下一齐通调，邪气外出有路，则可收邪去正安之效。证之临床，确实如此。
关格6（尿毒症）
包某，男性，38岁，内蒙古某林场工人。1992年11月被确诊为慢性肾功能衰竭，处于尿毒症期。1993年初来到北京就医，在某大型医院接受血液透析治疗。1993年4月就诊于赵绍琴老师。当时患者每周进行三次血液透析，已连续进行了三个多月。透析前血肌酐为6.7mg/dl，尿素氮54mg/dl。症见面色苍黄晦暗浑浊，精神疲倦乏力，恶心欲吐，皮肤瘙痒，下肢浮肿，小便短少，大便干结，血色素为5克，舌质暗淡，舌苔垢厚且腻，脉象弦滑数，按之有力。综合观察，其证候属于邪气蕴结化为毒邪，深入血分，络脉瘀阻，三焦气机不畅，即将形成关格病。采用凉血化瘀、清泄邪毒的治疗方法。拟定方剂如下：荆芥炭、防风、佩兰、藿香、生地榆、炒槐花、丹参、茜草、白鲜皮、地肤子、草河车、大腹皮、槟榔、灶心土、大黄，水煎服，每日一剂。每次少量，多次分服，以防引起呕吐，并反复叮嘱，一定要严格控制饮食，每天坚持走路锻炼2至3小时。服用上方后，呕吐恶心得以停止，小便逐渐增多，浮肿消退，大便通畅，患者自觉精神好转，体力增加。复查血肌酐和尿素氮也有所下降。此后的治疗，均以凉血化瘀、疏风化湿、疏调三焦为基本大法，并根据症状灵活加减。在患者的密切配合下，治疗两周之后开始延长透析间隔时间，由开始治疗时的每周三次逐渐递减为每周两次、每周一次，直到1993年9月停止透析，完全用中药治疗。1993年12月复诊，停止透析已67天，面色较滋润，精神爽适，知饥欲食，二便正常，自觉气力增加，每天散步3至4小时，不觉疲劳。近日化验血肌酐为2.3mg%，尿素氮27mg%，血色素10.3g%。说明停透后病情基本稳定，未出现反复。患者要求携带方剂返回家乡。根据其病情现状分析，认为回去之后，只要能够按照既定的治疗方案进行综合调理，是可以逐渐好转的，于是为患者拟定下方：荆芥炭、防风、白芷、独活、生地榆、炒槐花、丹参、茜草、焦三仙、红花子、大腹皮、槟榔、大黄，水煎服，每日一剂。并再次谆谆叮嘱，务必谨慎饮食，坚持运动锻炼，不可松懈。患者遵嘱，遂携带上方回家治疗。1994年3月，该患者介绍其同乡前来就诊，告知包某回去后身体较前强壮，已能干些轻活，仍在依法治疗云。
[按语]：本例为慢性肾功能衰竭、尿毒症，且已进行血液透析三个多月。按一般规律推论，是不可能停止透析的。只能长期依赖透析，等待机会换肾而已。赵绍琴老师以凉血化瘀、清泄邪毒为法进行治疗，并严格控制其饮食，有效地降低了血肌酐和尿素氮。又根据化验指标的改善情况，适时地逐渐拉长透析的间隔时间。这期间，随着患者坚持治疗和适度的运动锻炼，其肾功能也渐渐得到部分恢复，终于达到了完全停止透析的目的。
从这个病例的治疗过程中，我们可以看出，赵绍琴老师对慢性肾病的治疗是综合性的，中医药辨证论治、患者注意饮食控制和运动锻炼，这三个方面缺一不可。这就是赵绍琴老师治疗慢性肾病成功的秘诀。
关格7（尿毒症）
沈某，男性，80岁初诊
患者长期患有高血压、心脏病，已有20余年，近几个月来逐渐出现进行性贫血，面色苍白，唇甲色淡，头晕心慌，一身乏力，遂住某医院治疗。经检查发现肌酐为6.4mg/dl，尿素氮为65mg/dl，确诊为慢性肾功能衰竭、尿毒症期。拟行血液透析疗法，但因其有高血压心脏病，心功能欠佳，不宜作血透，姑且保守治疗，并请本院中医专家会诊。当时患者身体极度衰弱，严重贫血，血色素仅为5.5克，会诊中医专家认为其属脾肾阳虚，气血大亏。遂用温补脾肾益气补血方法，药用红参、黄芪、鹿茸、枸杞、杜仲、熟地黄、巴戟天、阿胶等，服药半月，反致烦躁不安，恶心呕吐，口鼻出血，皮肤瘙痒等，再查血色素降至4.1克，血肌酐上升至10.2mg/dl，尿素氮为10mg/dl。病情十分危急，医院连续两次发出病危通知。经人介绍，患者家属请赵绍琴老师会诊。切诊两脉弦滑而数，按之振指有力，舌红苔黄垢厚，恶心作吐，皮肤瘙痒，鼻衄时作，小便短少，大便干结，四日未行。
证属湿热积滞蕴积三焦，误服温补，热毒深入血分，尿毒重症，法在不治。先用通腑泄热凉血化瘀方法，冀其便通吐止为幸。
处方：大黄10克，黄芩10克，黄连3克，荆芥炭10克，防风6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，茅根芦根各10克，赤芍10克，五付。
二诊
药后大便得下，鼻衄未作，呕恶稍减，肤痒亦轻。脉仍弦滑有力，舌苔黄腻垢厚，药既见效，病有转机，勿事更张，仍以前法。
处方：荆芥炭10克，防风6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，小蓟10克，茅根芦根各10克，大黄6克，七付。
三诊
大便日2～3行，小溲较前增多，恶心呕吐已止，精神转佳，体力有增，已能下床活动。嘱其每日下床散步，以不疲劳为度，饮食素食为主，不得进食动物蛋白及植物高蛋白如豆制品，并不得进食补药及补品。药用凉血化瘀方法，兼以疏调三焦。
处方：荆芥炭10克，防风6克，白芷6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，赤芍10克，焦三仙各10克，水红花子10克，大腹皮10克，大黄6克，七付。
四诊
一周来精力日渐增加，每日可散步1小时，并能步行出院前来门诊就医。近查血肌酐下降至8.6mg/dl，尿素氮下降为78mg/dl，血色素升至5.6g/dl。脉仍弦滑数，舌黄苔厚，郁热日久，未可掉以轻心，仍用前法进退。
处方：荆芥炭10克，防风6克，白芷6克，独活6克，生地榆10克，炒槐花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，大腹皮10克，大黄6克。七付。
后以上方加减治疗2个月，肌酐降至6mg/dl，尿素氮43mg/dl，患者出院回家疗养。
[按语]：本案患者高龄久病，血色素极低，面色苍白，口唇无华，心慌头晕，倦怠乏力，一派虚象，无怪乎前医认为气血双亏，而用峻补之剂。然而补之不效，病情陡然加重，呕恶作吐，鼻衄肤痒，二便不利，已成关格重症。是虚不受补乎？抑或补力不逮乎？二者皆非。盖此本非虚证，乃大实若羸之象。尿毒症乃血中蕴毒，不得排泄，故肌酐、尿素氮升高，其所伴贫血，乃肾性贫血，其血色素之降低与肌酐尿素氮之升高呈负相关，即肌酐、尿素氮愈高，血色素就愈低，反之肌酐、尿素氮下降，血色素就上升。可见这种贫血的原因在于血中毒素蓄积。也就是说种种虚弱的症侯皆源于体内邪毒不能排泄。这就是古人所说的大实若羸状，种种羸状是标象，是假象，邪实深伏才是病本。辨之之法，察舌与脉，舌苔的垢厚满布是邪气壅盛之标志，脉象弦滑有力，愈按愈盛，更是说明邪毒深伏于内，不得泄越，当此之时，再用补法，岂不是火上浇油，无异于输粮资寇。唯一的正确治法只能攻逐邪气，给邪气以出路。如本案初诊即用大黄10克以峻攻之，虽患者高龄久病，虚弱若甚，亦无所顾忌。盖邪盛之时，唯当取邪，邪不去则正不复，邪去则正安。前贤张子和云“陈莝去而肠胃洁，癥瘕尽而营卫昌，不补之中有真补存焉。”在本案治疗中，随着攻邪治法的应用，肌酐尿素氮稳步下降，血色素随之上升。呕恶肤痒鼻衄等热毒症候迅速消退，神疲乏力头晕心慌等虚弱症状也得以改善。患者由卧床不起到下床行走，并能坚持锻炼，终于转危为安。这都得益于正确地使用了攻邪治病的原则。这一病案所反映的治疗原则具有普遍的指导意义。赵绍琴老师认为慢性肾病，包括慢性肾炎、慢性肾衰、尿毒症，其本质决非虚证，邪毒久留而不去，深入血分，蕴郁化热成毒，以致脉络瘀阻，是慢性肾病的基本病机，因此治疗上大忌温补，必须以凉血化瘀为主，佐以疏风胜湿，疏调三焦之法，务使内外上下一齐通调，邪气外出有路，则可收邪去正安之效。证之临床，确实如此。
Guan Ge 6 (Uremia)
Patient Bao, male, 38 years old, a worker at a forest farm in Inner Mongolia. In November 1992, he was diagnosed with chronic renal failure, in the uremic stage. In early 1993, he came to Beijing for treatment and underwent hemodialysis at a major hospital. In April 1993, he consulted Master Zhao Shaoqin. At that time, the patient underwent hemodialysis three times a week, having continued this for over three months. Before dialysis, blood creatinine was 6.7 mg/dl, and blood urea nitrogen (BUN) was 54 mg/dl. Symptoms included a sallow, dull, and turbid complexion; mental fatigue and physical weakness; nausea with urge to vomit; pruritus of the skin; edema of the lower limbs; scanty urine; dry stools; hemoglobin level of 5 g/dl; dark and pale tongue body; thick, greasy, and dirty tongue coating; wiry, slippery, rapid pulse that is forceful upon pressure. Synthesizing these signs, the syndrome belongs to pathogenic factors accumulating into toxins, penetrating deeply into the Blood level, causing collateral stasis, and obstructing the San Jiao (Triple Burner), leading towards Guan Ge syndrome. The treatment method employed was cooling the Blood and resolving stasis, along with clearing and draining pathogenic toxins. The prescribed formula was as follows: Charred Schizonepetae Spica (Jingjie Tan), Saposhnikoviae Radix (Fangfeng), Pogostemonis Herba (Peilan), Agastaches Herba (Huoxiang), Sanguisorbae Radix (Diyu), Stir-fried Sophorae Flavescentis Flos (Huaisheng), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), Rubia Cordifolia Radix (Qiancao), Dictamni Cortex (Baixianpi), Kochiae Fructus (Difuzi), Akebiae Caulis (Caoheche), Arecae Pericarpium (Dafupi), Areca Seed (Binglang), Coccusturnalis (Zaoxintu), and Rheum Palmatum Rhizoma et Radix (Dahuang). Decocted in water, taken once daily. Taken in small amounts multiple times to prevent vomiting. Repeated instructions were given to strictly control diet and persist in walking exercise for 2 to 3 hours daily. After taking the above prescription, vomiting and nausea ceased, urine volume gradually increased, edema subsided, bowel movements became smooth, and the patient felt improved spirit and increased strength. Follow-up tests showed decreased levels of blood creatinine and BUN. Subsequent treatments primarily utilized the basic principles of cooling the Blood and resolving stasis, dispersing wind and drying dampness, and regulating the San Jiao, with flexible modifications based on symptoms. With the patient's close cooperation, after two weeks of treatment, the interval between dialyses began to be extended, gradually decreasing from three times a week to twice a week, then once a week, until dialysis was completely stopped in September 1993, with treatment relying entirely on Chinese herbal medicine. At the follow-up in December 1993, 67 days after stopping dialysis, the complexion was more lustrous, spirit was refreshed, appetite returned, bowel and bladder functions were normal, strength had increased, and the patient could walk 3 to 4 hours daily without fatigue. Recent lab results showed blood creatinine at 2.3 mg%, BUN at 27 mg%, and hemoglobin at 10.3 g%. This indicated that the condition was basically stable after stopping dialysis, with no recurrence. The patient requested to take the prescription back to his hometown. Based on an analysis of the current condition, it was believed that as long as comprehensive regulation followed the established treatment plan, gradual improvement would occur. Thus, the following formula was prescribed: Charred Schizonepetae Spica (Jingjie Tan), Saposhnikoviae Radix (Fangfeng), Angelicae Dahuricae Radix (Baizhi), Angelicae Pubescentis Radix (Duohuo), Sanguisorbae Radix (Diyu), Stir-fried Sophorae Flavescentis Flos (Huaisheng), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), Rubia Cordifolia Radix (Qiancao), Scorzonerae Radix, Cynanchum Atratum Radix, and Polygonati Rhizoma (Jiao Sanxian), Carthami Flos (Honghuazi), Arecae Pericarpium (Dafupi), Areca Seed (Binglang), and Rheum Palmatum Rhizoma et Radix (Dahuang). Decocted in water, taken once daily. Instructions were reiterated to be cautious with diet and persist in exercise without relaxation. The patient followed these instructions and took the prescription home. In March 1994, the patient introduced a fellow townsman for consultation, reporting that Bao had become stronger than before, able to perform light work, and continuing treatment according to the method.
[Commentary]: This case involves chronic renal failure and uremia, with hemodialysis already performed for over three months. By general rules, it is impossible to stop dialysis; one can only rely on long-term dialysis and wait for a kidney transplant opportunity. Master Zhao Shaoqin treated this with the method of cooling the Blood and resolving stasis, clearing and draining pathogenic toxins, while strictly controlling diet, effectively lowering blood creatinine and BUN. Furthermore, based on the improvement in laboratory indicators, the dialysis intervals were appropriately and gradually lengthened. During this period, with the patient's persistence in treatment and moderate exercise, renal function gradually recovered partially, ultimately achieving the goal of completely stopping dialysis.
From the treatment process of this case, we can see that Master Zhao Shaoqin’s treatment of chronic kidney disease is comprehensive. Traditional Chinese Medicine (TCM) syndrome differentiation and treatment, patient attention to dietary control, and exercise are indispensable. These three aspects constitute the secret to Master Zhao’s success in treating chronic kidney disease.
Guan Ge 7 (Uremia)
Patient Shen, male, 80 years old, first visit.
The patient had a long history of hypertension and heart disease, spanning over 20 years. In recent months, progressive anemia appeared, with pale complexion, pale lips and nail beds, dizziness, palpitations, and generalized weakness, leading to hospitalization. Examination revealed creatinine at 6.4 mg/dl and BUN at 65 mg/dl, confirming chronic renal failure and uremia. Hemodialysis was planned, but due to hypertension, heart disease, and poor cardiac function, hemodialysis was contraindicated. Conservative treatment was adopted, and TCM experts from the hospital were consulted for a joint conference. At that time, the patient was extremely weak with severe anemia, hemoglobin only 5.5 g/dl. The consulting TCM experts considered the syndrome to be deficiency of Spleen and Kidney Yang, with significant depletion of Qi and Blood. Therefore, a method of warming and tonifying Spleen and Kidney, benefiting Qi, and nourishing Blood was used, with herbs such as Red Ginseng Radix (Hongshen), Astragali Membranacei Radix (Huangqi), Deer Antler (Lurong), Lycii Fructus (Gouqi), Eucommiae Cortex (Duzhong), Prepared Rehmanniae Radix (Shudihuang), Morinda Officinalis Radix (Bajitian), and Donkey-hide Gelatin (Ejiao). After half a month of medication, the patient instead developed restlessness, nausea, vomiting, bleeding from mouth and nose, and pruritus. Re-examination showed hemoglobin dropped to 4.1 g/dl, blood creatinine rose to 10.2 mg/dl, and BUN was 10 mg/dl. The condition was critical, and the hospital issued critical illness notices twice consecutively. Introduced by others, the patient’s family invited Master Zhao Shaoqin for consultation. Palpation revealed wiry, slippery, and rapid pulses in both wrists, forceful upon pressure. Tongue was red with thick, yellow, greasy, and dirty coating. Symptoms included nausea and vomiting, pruritus, intermittent epistaxis, scanty urine, and dry stools, with no bowel movement for four days.
The syndrome belongs to accumulation and stagnation of Damp-Heat in the San Jiao. Due to the mistaken use of warming tonics, Heat-Toxin penetrated deeply into the Blood level. This is a severe uremic condition, generally considered untreatable. Initially, a method of purging the Fu organs, draining Heat, cooling the Blood, and resolving stasis was used, hoping for relief through bowel movement and cessation of vomiting.
Prescription: Rheum Palmatum Rhizoma et Radix (Dahuang) 10g, Scutellariae Radix (Huangqin) 10g, Coptidis Rhizoma (Huanglian) 3g, Charred Schizonepetae Spica (Jingjie Tan) 10g, Saposhnikoviae Radix (Fangfeng) 6g, Sanguisorbae Radix (Diyu) 10g, Stir-fried Sophorae Flavescentis Flos (Huaisheng) 10g, Salviae Miltiorrhizae Radix et Rhizoma (Danshen) 10g, Rubia Cordifolia Radix (Qiancao) 10g, Imperatae Rhizoma (Maogen) and Phragmitis Rhizoma (Lugen) 10g each, Paeoniae Radix Rubra (Chishao) 10g. Five doses.
Second Visit
After medication, bowel movement occurred, epistaxis did not recur, nausea and vomiting slightly decreased, and pruritus also lightened. Pulse remained wiry, slippery, and forceful; tongue coating was yellow, greasy, and dirty. Since the medicine was effective and the disease showed signs of turning, do not change the strategy; continue with the previous method.
Prescription: Charred Schizonepetae Spica (Jingjie Tan) 10g, Saposhnikoviae Radix (Fangfeng) 6g, Sanguisorbae Radix (Diyu) 10g, Stir-fried Sophorae Flavescentis Flos (Huaisheng) 10g, Salviae Miltiorrhizae Radix et Rhizoma (Danshen) 10g, Rubia Cordifolia Radix (Qiancao) 10g, Small Thistle Herb (Xiaoji) 10g, Imperatae Rhizoma (Maogen) and Phragmitis Rhizoma (Lugen) 10g each, Rheum Palmatum Rhizoma et Radix (Dahuang) 6g. Seven doses.
Third Visit
Bowel movements 2-3 times per day, urine output increased compared to before, nausea and vomiting ceased, spirit improved, strength increased, and the patient could get out of bed to move. Instructed to walk out of bed daily, stopping when not fatigued. Diet should be mainly vegetarian; animal protein and high plant proteins like soy products are prohibited; tonics and supplements are forbidden. Medication uses the method of cooling the Blood and resolving stasis, combined with regulating the San Jiao.
Prescription: Charred Schizonepetae Spica (Jingjie Tan) 10g, Saposhnikoviae Radix (Fangfeng) 6g, Angelicae Dahuricae Radix (Baizhi) 6g, Sanguisorbae Radix (Diyu) 10g, Stir-fried Sophorae Flavescentis Flos (Huaisheng) 10g, Salviae Miltiorrhizae Radix et Rhizoma (Danshen) 10g, Rubia Cordifolia Radix (Qiancao) 10g, Paeoniae Radix Rubra (Chishao) 10g, Scorzonerae Radix, Cynanchum Atratum Radix, and Polygonati Rhizoma (Jiao Sanxian) 10g each, Hygrophylla Seed (Shuihonghua Zi) 10g, Arecae Pericarpium (Dafupi) 10g, Rheum Palmatum Rhizoma et Radix (Dahuang) 6g. Seven doses.
Fourth Visit
Energy increased day by day over the past week; could walk for 1 hour daily and walked out of the hospital to attend the clinic. Recent labs showed blood creatinine decreased to 8.6 mg/dl, BUN decreased to 78 mg/dl, and hemoglobin rose to 5.6 g/dl. Pulse remained wiry, slippery, and rapid; tongue yellow with thick coating. Stagnant Heat has persisted for a long time; care must not be relaxed. Continue with the previous method, adjusting as necessary.
Prescription: Charred Schizonepetae Spica (Jingjie Tan) 10g, Saposhnikoviae Radix (Fangfeng) 6g, Angelicae Dahuricae Radix (Baizhi) 6g, Angelicae Pubescentis Radix (Duohuo) 6g, Sanguisorbae Radix (Diyu) 10g, Stir-fried Sophorae Flavescentis Flos (Huaisheng) 10g, Salviae Miltiorrhizae Radix et Rhizoma (Danshen) 10g, Rubia Cordifolia Radix (Qiancao) 10g, Imperatae Rhizoma (Maogen) and Phragmitis Rhizoma (Lugen) 10g each, Small Thistle Herb (Xiaoji) 10g, Scorzonerae Radix, Cynanchum Atratum Radix, and Polygonati Rhizoma (Jiao Sanxian) 10g each, Arecae Pericarpium (Dafupi) 10g, Rheum Palmatum Rhizoma et Radix (Dahuang) 6g. Seven doses.
Subsequently, the above prescription was modified and used for 2 months. Creatinine decreased to 6 mg/dl, BUN to 43 mg/dl. The patient was discharged home for recuperation.
[Commentary]: The patient in this case is elderly with a long-standing illness, extremely low hemoglobin, pale complexion, lackluster lips, palpitations, dizziness, lassitude, and weakness, presenting a picture of deficiency. No wonder the previous doctors considered Qi and Blood double deficiency and used strong tonifying agents. However, tonification was ineffective, and the condition suddenly worsened with vomiting, epistaxis, pruritus, and difficulty in urination and defecation, becoming a severe Guan Ge syndrome. Is it deficiency unable to accept tonification? Or is the tonifying power insufficient? Neither is correct. This is fundamentally not a deficiency syndrome, but a manifestation of "Great Excess appearing as Emaciation" (Da Shi Ruo Lei). Uremia is toxin accumulation in the Blood that cannot be excreted, hence elevated creatinine and BUN. The accompanying anemia is renal anemia; the decrease in hemoglobin is negatively correlated with the increase in creatinine and BUN. That is, the higher the creatinine and BUN, the lower the hemoglobin, and vice versa. It is evident that the cause of this anemia lies in the accumulation of blood toxins. In other words, all weak symptoms stem from the inability to excrete pathogenic toxins within the body. This is what the ancients called "Great Excess appearing as Emaciation." All emaciated signs are superficial phenomena, false appearances; deep-seated pathogenic excess is the root of the disease. The method of differentiation lies in observing the tongue and pulse. A thick, greasy, full tongue coating is a sign of abundant pathogenic qi. A wiry, slippery, and forceful pulse, becoming stronger with deeper pressure, further indicates that pathogenic toxins are deeply hidden internally and cannot vent outward. At this time, using tonification methods would be adding fuel to the fire, equivalent to supplying grain to the enemy. The only correct treatment method is to attack and expel pathogenic qi, providing an exit for the pathogens. For example, in the first visit of this case, 10g of Rheum Palmatum Rhizoma et Radix (Dahuang) was used for strong purgation. Although the patient was elderly, chronically ill, and seemingly very weak, there was no hesitation. When pathogenic excess is dominant, one must only target the pathogen; if the pathogen is not removed, Zheng Qi (Upright Qi) will not recover. Once the pathogen is gone, Zheng Qi is safe. The former sage Zhang Hezi said, "When old filth is removed, the intestines and stomach become clean; when masses and growths are exhausted, Ying and Wei flourish. Within non-tonification, true tonification exists." In the treatment of this case, with the application of pathogen-expelling methods, creatinine and BUN steadily decreased, and hemoglobin subsequently rose. Symptoms of Heat-Toxin such as vomiting, pruritus, and epistaxis rapidly subsided, and weak symptoms such as mental fatigue, weakness, dizziness, and palpitations also improved. The patient went from being bedridden to walking out of bed and persisting in exercise, finally turning danger into safety. This is all attributable to the correct use of the principle of attacking pathogens to treat disease. The treatment principle reflected in this case has universal guiding significance. Master Zhao Shaoqin believes that chronic kidney diseases, including chronic nephritis, chronic renal failure, and uremia, are fundamentally not deficiency syndromes. Pathogenic toxins remain for a long time without leaving, penetrating deeply into the Blood level, accumulating and transforming into Heat and Toxin, leading to collateral stasis. This is the basic pathogenesis of chronic kidney disease. Therefore, in treatment, warming and tonification are strictly taboo. The primary method must be cooling the Blood and resolving stasis, assisted by dispersing wind and overcoming dampness, and regulating the San Jiao. It is essential to ensure unobstructed circulation inside and outside, above and below, so that pathogenic qi has a way out, thereby achieving the effect of expelling pathogens and preserving Zheng Qi. Clinical evidence confirms this.