A Case of Restoring Renal Function in a Myeloma Patient with Herbal Decoctions and Patent Medicines

The patient, Ms. Xiong, female, a myeloma patient born in 1955, from Guangxi. She was diagnosed at the First Affiliated Hospital of Guangxi Medical University (admission no. 1508503) with multiple myeloma (IgG-kappa type, with myeloma bone disease), pulmonary infection, hyperlipidemia, chronic gastritis, gallbladder polyps, senile cataracts, lumbar vertebral compression fracture (L1 vertebral body), thoracic vertebral compression fracture (T12 vertebral body), internal hemorrhoids, bilateral renal cysts, thyroid nodules, and other conditions. Because a colleague of her daughter was a lymphoma patient I had treated for many years, her daughter also hoped to seek my help.

When the patient first sought consultation in July 2020, she was anemic, with renal insufficiency, dysuria, lower limb edema, low back and leg pain, long-term bed rest, poor appetite, anal heaviness, and difficult defecation. Because of the COVID-19 pandemic she could not come in person; after a video consultation I suggested she first take decoctions and a Chinese patent medicine to address the most pressing problems of dysuria and lower limb edema.

Prescription: Lysimachia (Jinqiancao) 30 g, Poria (Fuling) 10 g, Polyporus (Zhuling) 10 g, Alisma (Zexie) 10 g, Raw Atractylodes (Sheng Baizhu) 20 g, Motherwort (Yimucao) 30 g, Lalang Grass Rhizome (Baimaogen) 30 g, Plantain Seed (Cheqianzi) 20 g. One dose each in the morning and evening, decocted in water; she was told to take only the first decoction to ensure the medicinal strength. In addition, she took Zhibai Dihuang Wan produced by Tong Ren Tang, according to the package insert.

After taking the medicine, the patient's urination increased markedly, the edema resolved, and her condition improved. Her appetite was still poor and she remained anemic. The prescription was then adjusted as follows:

Raw Astragalus (Sheng Huangqi) 30 g, Dry-fried Atractylodes (Chao Baizhu) 15 g, Codonopsis (Dangshen) 15 g, Angelica (Danggui) 10 g, Aucklandia (Muxiang) 10 g, Honey-fried Licorice (Zhi Gancao) 10 g, Processed Pinellia (Fa Banxia) 6 g, Tangerine Peel (Chenpi) 6 g, Eucommia (Duzhong) 10 g, Teasel (Xuduan) 10 g, Polygala (Yuanzhi) 10 g, Longan Aril (Longyanrou) 6 g, Sour Jujube Seed (Zaozaoren) 3 g, Poria (Fuling) 10 g, Cibotium (Gouji) 10 g, Morinda (Bajitian) 15 g, Epimedium (Xianlingpi) 10 g.

In addition, she continued taking Zhibai Dihuang Wan from Tong Ren Tang according to the package insert, and was told to keep taking it until the leg edema had completely resolved before stopping.

After taking the second prescription, her appetite recovered somewhat. Thereafter the patient also took antitumor drugs, but the anticancer effect was poor, so she was readmitted for Western antitumor therapy. At the end of the Lunar year, her renal function worsened again, with creatinine rising above 150. She then independently resumed taking the first decoction and pills. After taking them, the edema resolved again and creatinine dropped rapidly, with obvious effect.

The first prescription I wrote was given to me by the family of an elderly TCM physician from Xiantao, Hubei; it was a family ancestral formula for treating nephritis. It is said that when this old physician was alive, he commonly used this formula, combined with modifications of Zhibai Dihuang Wan, to treat acute nephritis patients who had not received hormone therapy, and all recovered fully.

The second formula was modified Guipi Decoction, whose main action is to fortify the spleen and supplement the kidney, and tonify qi and blood; it also contains herbs that supplement the kidney and strengthen bone and that promote diuresis and relieve edema. This was because I considered the patient's original qi to be deficient and declining, urgently needing tonification of qi and blood; but since the pathogen still lingered, the tonifying force should not be too great, so I used modified Guipi Decoction and replaced Ginseng with Codonopsis. Later, when the patient received Western treatment again, her renal function became insufficient once more, and she independently went back to the first prescription, which remained effective. This shows that this old physician's empirical formula is also effective for restoring renal function.