The present invention discloses a traditional Chinese medicine preparation for lgA nephropathy, which is made from raw materials such as Huangqi, Codonopsis pilosula, Rehmannia glutinosa, stir fried Atractylodes macrocephala, Poria cocos, Yam, Coix seed, White beans, Goji berries, Cornus officinalis, Cistanche deserticola, Morinda officinalis, Eucommia ulmoides, Houttuynia cordata, Mulberry Parasitic, Epimedium, Zelan, Leonurus heterophylla, Polygonatum sibiricum, Cymbidium multiflorum, Chuanxiong, Achyranthes bidentata, Angelica sinensis, and safflower. According to the different characteristics of each traditional Chinese medicine, it is pre treated by washing and cutting into pieces, formulated in proportion, and made by a special method. It has the effects of tonifying the kidney and strengthening bones, nourishing essence and filling marrow, dispelling wind and dampness, promoting blood circulation and supplementing blood. The product combination and production method of this invention are unique. Through clinical verification, the therapeutic effect of this medicine is significant, the treatment cycle is short, the price is low, there are no adverse reactions or any toxic side effects, and it has broad market application prospects.
1、 This plan is suitable for the target audience
Traditional Chinese Medicine Diagnosis: The first diagnosis is renal wind (TCD code: A04.05.07).
Western medicine diagnosis: The first diagnosis is IgA nephropathy (ICD-10 code: N02.801).
2、 Diagnosis
（1） Disease diagnosis
1. Diagnostic criteria of traditional Chinese medicine
Refer to the "Diagnosis and Treatment Guidelines for Common Diseases in Traditional Chinese Medicine Internal Medicine" (ZYYXH/T100-2008) released by the Chinese Association of Traditional Chinese Medicine in 2008, and the "Practice Guidelines for Western Medicine Diagnosis and Traditional Chinese Medicine Syndrome Differentiation of IgA Nephropathy" developed by the Kidney Disease Professional Committee of the Chinese Association of Integrated Traditional Chinese and Western Medicine in 2013.
Urinary blood, or increased foam in urine, or eyelid, tarsal edema, or low back acid, low back pain, or conscious of no obvious discomfort.
2. Diagnostic criteria of Western medicine
Refer to the 2012 Clinical Practice Guidelines for KDIGO Glomerulonephritis, Clinical Diagnosis and Treatment Guidelines - Nephrology Volume (revised by the Nephrology Branch of the Chinese Medical Association, People's Health Press, 2011), and Nephrology (edited by Wang Haiyan, People's Health Press, 3rd edition, 2008).
The onset is slow, the course of the disease is prolonged, and the duration of illness exceeds 3 months; Some patients have acute onset and a short course of illness; Hematuria is mainly composed of irregular red blood cells, while proteinuria is mainly composed of medium molecules; Pathological diagnosis of IgA nephropathy by renal biopsy; Exclude secondary factors.
（2） Syndrome diagnosis
(1) Deficiency of both qi and yin: blood in urine, or excessive urine with foam, colorless complexion, mental fatigue, easy to catch cold, sore back and soft knees, dry mouth and eyes, dizziness and tinnitus, hot flashes and night sweats, and five heart upset heat. Tongue red or light red, thin or sparse coating, fine or numerous veins.
(2) Deficiency of lung and spleen qi syndrome: blood in urine, or urine with foam, tired and lazy, poor appetite, abdominal distention, easy to catch cold, spontaneous sweating, loose stool, or swollen eyelids and tarsals. The tongue is pale red, the tongue body is plump, or there are tooth marks on the edge of the tongue, the coating is thin and white, and the veins are thin and weak.
(3) Liver and kidney yin deficiency syndrome: blood in urine, or urine with foam, dry eyes, dizziness and tinnitus, dry throat and pain, sore waist and soft knees, hot flashes and night sweats, five heart upset heat, and dry stool. Red tongue with little saliva, thin coating, fine veins or strings.
(4) Kidney meridian stasis syndrome: hematuria, lower back pain, or prolonged illness; Their facial color may be dull or dark, their lips may be purple or have bruises, and their limbs may be numb. The tongue is dark, or there are bruises or spots on the tongue, or the sublingual veins are stagnant, with fine or astringent veins. (Referring to renal pathology, vascular loop occlusion, microthrombus formation, balloon adhesion, focal segmental glomerulosclerosis, etc.).
(5) Syndrome of internal disturbance of rheumatism: polyuria, foam or blood in urine, aggravated in a short time; There are newly appeared or aggravated drowsiness and edema, red or light red tongue, thin and greasy coating, and fine or heavy veins. (Reference renal pathology shows segmental capillary loop fibrinoid necrosis, cellular crescentic formation, etc.).
3、 Treatment methods
（1） Diagnosis and treatment based on syndrome differentiation
(1) Qi Yin deficiency syndrome
Treatment method: tonifying qi and nourishing yin
① Recommended prescription: Modified Shenqi Dihuang Decoction. Astragalus membranaceus, Codonopsis pilosula, Rehmannia glutinosa, Chinese yam, Angelica sinensis, Paeonia lactiflora, Chuanxiong, Ligustrum lucidum, Eclipta, Rosa laevigata, Euryale ferox, etc. Or traditional Chinese patent medicines and simple preparations with the same effect.
② Traditional Chinese Medicine Soaking and Washing: Select Qi tonifying and Yin nourishing Chinese herbs according to the characteristics of the patient's syndrome, and adjust accordingly. After orally decocting the residue of traditional Chinese medicine, immerse the skin below the knee joint in the medicine solution at a water temperature of 40-42 ℃, once a day or every other day, for 7 days as one course of treatment, each time lasting 15-30 minutes. The water temperature should not be too high to avoid burning the skin.
③ Dietary therapy: It is advisable to eat foods that nourish qi and yin, and avoid spicy, raw, cold, and greasy foods. You can choose foods such as lotus seeds, red dates, yams, and fungus.
(2) Lung spleen qi deficiency syndrome
Treatment method: tonify the lungs and spleen
① Recommended prescription: Yupingfeng Powder combined with Bu Zhong Yi Qi Tang, modified. Huangqi, Codonopsis pilosula, Dodder seed, Atractylodes macrocephala, Fangfeng, Huai yam, dried Rehmannia root, Angelica sinensis, Chenpi peel, Shengma, Chaihu, etc. Or traditional Chinese patent medicines and simple preparations with the same effect.
② Traditional Chinese Medicine Soaking and Washing: Select tonifying lung and spleen herbs or adjust according to the patient's syndrome characteristics. You can take the decoction residue of traditional Chinese medicine orally and then boil it again. Wash and press your feet once a day (using the same method as above).
③ Dietary therapy: It is advisable to eat foods that nourish the lungs and spleen, and avoid spicy, greasy, and cold foods. You can choose foods such as chestnuts, red dates, yams, astragalus, carrots, chicken, etc.
(3) Deficiency syndrome of liver and kidney yin
Treatment: Nourish the liver and kidneys
① Recommended prescription: Modified Liuwei Dihuang Decoction. Rehmannia glutinosa, Chinese yam, cornus officinalis, peony bark, tuckahoe, Alisma orientalis, etc. Or traditional Chinese patent medicines and simple preparations with the same effect.
② Traditional Chinese Medicine Soaking and Washing: Select nourishing liver and kidney herbs or adjust according to the patient's syndrome characteristics. You can take the decoction residue of traditional Chinese medicine orally and then boil it again. Wash and press your feet once a day (using the same method as above).
③ Dietary therapy: It is advisable to eat foods that nourish yin and clear heat. Avoid spicy and warm foods, and eat less fatty and rich foods. Silver ear, water chestnut, celery, raw lotus root, lily, pear, duck meat, fish, etc. can be selected.
(4) Kidney meridian stasis syndrome
Treatment: Promote blood circulation and unblock collaterals
① Recommended prescription: Xia Yu Xue Tang with modifications. Military equipment, ground turtles, snow covered grass, peach kernels, turmeric, etc. Or traditional Chinese patent medicines and simple preparations with the same effect.
② Traditional Chinese Medicine Soaking and Washing: According to the characteristics of the patient's syndrome, choose blood activating and meridian unblocking traditional Chinese medicine or adjust it according to the syndrome, or boil the herbal residue after oral Chinese medicine decoction and then soak and wash it (the same operation method as above).
③ Dietary therapy: It is advisable to eat foods that promote blood circulation, disperse lumps, and replenish qi, while avoiding foods that are astringent and cold. Hawthorn, shiitake mushrooms, seaweed, black beans, garlic, scallions, ginger, etc. can be selected.
(5) Rheumatoid internal disturbance syndrome
Treatment method: dispelling wind and removing dampness
① Recommended prescription: Modified Fangji Huangqi Decoction. Or add Han Fangji, Xu Changqing, and Gui Jianyu to the original syndrome differentiation prescription. Huangqi, Hanfangji, Xu Changqing, Fuling, Atractylodes macrocephala, Angelica sinensis, etc. Or traditional Chinese patent medicines and simple preparations with the same effect.
② Traditional Chinese Medicine Soaking and Washing: According to the characteristics of the patient's syndrome, select traditional Chinese medicine for dispelling wind and dampness or adjust according to the syndrome, or boil the residue of orally taken traditional Chinese medicine and then soak and wash it (the same operation method as above).
③ Dietary therapy: It is advisable to eat products that dispel wind and dampness, consume less fat, sweet, and rich flavors, and avoid overeating. You can choose Coix seed, winter melon, Poria cocos, luffa, radish, white beans, etc.
（2） Traditional Chinese patent medicines and simple preparations and hospital preparations: Huangkui capsule, Bailing capsule, Jinshuibao, Shenyan Kangfu tablet can be selected dialectically; hospital preparations can be selected dialectically from Yishen Jiedu mixture (composition: Poria cocos, astragalus, cornus, salvia miltiorrhiza, safflower, red peony, scutellaria baicalensis, etc.); main functions: invigorating the spleen and kidney, clearing away dampness and heat, removing blood stasis and detoxification, eliminating proteinuria); Wenshen Huaqi pills (composition: citronella, epimedium herb, Morinda officinalis, Dipsactus, Guji, etc.; main functions: warming the kidney and spleen, resolving qi and water); Qingzhong Huashi pills (composition:: Atractylodes Rhizoma Atractylodes, Magnolia officinalis, Pinellia ternata, Poria cocos, Scutellaria baicalensis, etc. Main functions: clearing away heat and dampness, regulating qi and harmonizing all kinds of diseases, which belong to the type of damp heat in the middle energizer), Tongfu Zhuyu mixture (composition: woody incense, zedoary turmeric, fructus aurantii immaturus, thick tonic, betel nut, fried malt, etc. Main functions: promoting qi and activating the fu organs, removing blood stasis and eliminating swelling) Waiting for medication
（3） Other traditional Chinese medicine characteristic therapies
1. Traditional Chinese Medicine Fumigation Bath: For patients with obvious edema or those whose edema does not subside satisfactorily after rest, salt restriction, and diuresis, exposed hot water medicinal baths can be given. Reference medicated bath prescription: floating duckweed, Su Ye, Feng Feng, Tu Fu Ling, Dan Shen, etc. The water temperature is 38-40 ℃, and it is recommended to do it in a specially designed bathtub or bathroom. Measure body temperature, pulse, respiration, blood pressure, weight, and oxygen saturation before taking a medicinal bath. During the medicinal bath, except for the head and neck area, all parts are immersed in the bath solution and covered with a thin film. The bath lasts for 2 hours each time, and the entire body is gently wiped with a bath ball to make the body sweat. The temperature, time, and duration of treatment are adjusted according to the patient's different treatment goals and tolerance levels.
2. Chinese medicine retention enema: Administer Chinese medicine enema solution (reference formula: rhubarb, elm, oyster, etc.) for retention enema, remove some urinary toxins, and significantly improve symptoms such as nausea, vomiting, abdominal distension, and constipation. Before treatment, it is necessary to understand and check for any medical history related to the lower gastrointestinal tract, and at the same time, perform intestinal cleaning. According to the condition, place the patient in a supine position, move their buttocks to the bedside, elevate them by 10cm, place a rubber sheet and treatment towel on top, and place the bent disc at the hip edge, paying attention to keeping warm. Lubricate the front end of the anal canal, use an enema device to draw the medicine and connect it to the anal canal, exhaust it, clamp the tube, and instruct the patient to perform bowel movements. Insert the anal canal into 10-15 cm. Release the water stop clamp, slowly pour in the medicine, complete the infusion, clamp the tube, and draw in the medicine again. Repeat this process, pour in all the medicine, and then pour in 5-10 ml of warm water. Raise the end of the anal canal so that all the medicine in the tube is poured in, clamp the tube, wrap the anal canal with toilet paper, gently pull it out, place it in a curved plate, and wipe the anus clean.
3. Moxibustion: Select acupoints such as Qi Hai, Guan Yuan, Yin Ling Quan, San Yin Jiao, Zu San Li, Tai Xi, Shen Shu, and Pi Shu to adjust according to the syndrome, and use a moxibustion box. Fully expose the moxibustion site, ignite the moxa stick and place the moxa box at the acupoint. During the moxibustion process, ask the patient if they feel any burning pain, adjust the distance, and prevent skin burns. Each session lasts about 20-30 minutes, once a day, with ten sessions constituting one course of treatment.
You can choose to use colon dialysis machines, meridian guided therapy devices, traditional Chinese medicine fumigation steam self-control therapy devices, fumigation beds, medical intelligent steam therapy devices, and other equipment. And you can choose the six qi acupuncture method.
（4） Western medicine treatment
According to the "Clinical Diagnosis and Treatment Guidelines - Nephrology Volume" (revised by the Nephrology Branch of the Chinese Medical Association, People's Health Press, 2011), the third edition of "Nephrology" (edited by Wang Haiyan, published by People's Health Press, 2008), and the 2012 "KDIGO Glomerulonephritis Clinical Practice Guidelines", ACEI (ARB) drugs can be used in combination with mild IgA nephropathy patients; For patients with moderate to severe IgA nephropathy, steroids and immunosuppressive drugs can be used in combination. Corresponding treatment measures should be taken for complications or infections such as renal hypertension, renal anemia, and renal bone disease.
（5） Key points of nursing adjustment
1. Dietary care: Manage protein intake according to the severity of the condition, avoid beef, and adopt a low salt, high-quality, and low protein diet. Avoid excessive salt intake, generally less than 6 grams per day. When presenting with nephrotic syndrome, salt intake should be limited to 3 grams per day, and stricter measures should be taken when accompanied by increased blood pressure, until edema and hypertension are controlled. The recommended protein intake for CKD1-2 stage is 0.8g/(kg · d); CKD stage 3 reduced to 0.6g/(kg · d); High quality protein intake (eggs, lean meat, chicken, milk, fish, etc.) with a content of over 60%.
2. Life care: Be cautious in daily life, be comfortable with work and rest, avoid fatigue, and prevent colds. Those with severe illness should rest in bed. Avoid intense physical activity. Strengthen daily care, maintain a clean environment, frequently open windows for ventilation, keep indoor air fresh, and promote the physical and mental recovery of patients. For patients with moderate to severe IgAN, it is advisable to avoid fatigue and advise against pregnancy and childbirth.
3. Psychological care: Maintain a relaxed mood and avoid negative emotions such as irritability and anxiety. Patients should be helped to understand the treatment goals at that time, strive for their cooperation, and avoid blind anxiety, tension, indiscriminate medical treatment, and medication, which can worsen the condition.
4. Health education: Through posters, brochures, the internet, and other means, educate patients on the scientific knowledge of IgA nephropathy, guide them to actively adopt traditional Chinese medicine measures for early treatment, and prevent the progression of the disease.
4、 Efficacy evaluation
Referring to the Clinical Research Guidelines for Traditional Chinese Medicine New Drugs in 2002 and the Diagnosis, Syndrome Differentiation, and Efficacy Evaluation of IgA Nephropathy (Trial Scheme) formulated by the Nephrology Branch of the Chinese Society of Traditional Chinese Medicine in 2007
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