Shi Jinmo's Case of Treating Acute Nephritis
The Zhu-Selected Medical Cases of Shi Jinmo includes a case in which Shi Jinmo treated a 9-year-old boy for acute nephritis. At presentation the child had facial edema from acute kidney inflammation, back pain so severe he could not turn over, oliguria, and dark-red urine. Shi planned treatment with pain-relieving, anti-inflammatory, and diuretic methods. This therapeutic principle is interesting: it does not belong to any TCM terminology but uses Western medical terms, which highlights Shi Jinmo's emphasis on integrated Chinese-Western medicine.
Shi Jinmo's first-visit prescription: Xueyu tan (carbonized human hair, 血余炭) 3 qian (wrapped together with Yiyuan San 4 qian), Cheqiancao (Plantago herb) and Hanliancao (Eclipta) 3 qian each, Chao Duzhong (fried Eucommia) 3 qian, Chifuling (Red Poria) 3 qian, Chixiaodou (Red Phaseolus) 6 qian, Chuan Bixie (Dioscorea septemloba) 3 qian, Haijinsha (Lygodium spores) and Haifushi (Pumice) 3 qian each, Chao Zexie (fried Alisma) 2 qian, Qumai sui (Dianthus) 2 qian, Yun Fuling (Poria) 3 qian, Dongguazi (Winter Melon seed) and Dongkuizi (Malva seed) 4 qian each, Chuan Huangbai (Phellodendron) 1.5 qian, Zhi Gancaoshao (honey-fried Licorice tip) 1 qian, Bai Tongcao (Tetrapanax pith) 1.5 qian, Da Shudi (prepared Rehmannia) 3 qian (pounded together with Xixin Asarum 2 fen), Kuishaoyao (White Peony) 4 qian.
In this formula, Hanliancao and Xueyu tan stop bleeding, and while stopping bleeding also promote diuresis; Hanliancao, Chuan Huangbai, Shudi, and Baishao also nourish yin and downbear fire; Duzhong, Baishao, Gancaoshao, and Xixin all relieve pain; Cheqiancao, Hanliancao, Duzhong, Fuling, Chixiaodou, Bixie, Haijinsha, Haifushi, Zexie, Qumai, Dongguazi, Dongkuizi, Gancaoshao, and Bai Tongcao all promote diuresis. Thus the formula is strongly targeted at the child's clinical symptoms.
The combination of Hanliancao and Cheqiancao in this formula is a famous ancient prescription for urinary obstruction and hematuria called Ercao Dan (Two-Herb Elixir). Chen Shiduo of the Qing Dynasty liked to use this formula for hematuria and edema—i.e., today's nephritic edema. Chen liked large doses; if following his habit, one might use only these two herbs, 1-3 liang of each, with good effect.
After taking the medicine, the child's back pain lessened, urination opened up, the urine was still red, urinalysis showed hematuria, and the facial edema receded somewhat. At the second visit, seeing the first prescription had basically worked, Shi Jinmo followed the same method with slight modifications.
The new formula was: Dan Zhuling (light Polyporus) 2 qian, Chifuling and Baifuling 3 qian each, Chuan Huangbai 1.5 qian, Fei Zhimu (Anemarrhena) 2 qian, Huainuxi (Achyranthes) 2 qian, Xiao Shengdi (raw Rehmannia) 3 qian, Kuishaoyao 3 qian, Gancaoshao 1 qian, Xiao Mutong (Akebia) 1 qian, Chao Zexie 3 qian, Xueyu tan 3 qian (wrapped with Yiyuan San 3 qian), Ejiaozhu (processed Asini Corii Colla bead) 3 qian, Cheqiancao and Hanliancao 3 qian each, Chao Duzhong 2 qian.
The second visit added Ejiaozhu and Zhimu on top of the first, changing Shudi to Shengdi, forming a combination of Ziyin Jianghuo Tang (Yin-Nourishing Fire-Draining Decoction) and Fuling Tang, further strengthening the effect of supplementing blood, stopping bleeding, clearing heat, and cooling blood.
After taking the medicine, the child's symptoms further improved: his back ached only occasionally and slightly, urination was open, and edema resolved. Shi Jinmo then switched to pill medicine for consolidation, instructing the child to take Qing'e Wan 2 qian morning and evening, and Jinkui Shenqi Wan 3 qian before bed, all swallowed with plain water, for a total of twenty days.
This nephritis case treated by Shi Jinmo may be a reference for kidney disease patients. Modern treatment of nephritis and renal injury basically follows the same principles: nourish yin and drain fire, reduce inflammation and discharge heat, promote diuresis, and stop bleeding. But the pill medicines Shi chose afterward seem a bit complex; in my experience, patients with nephritis or renal injury showing hematuria and edema may be consolidated with Zhibai Dihuang Wan (Anemarrhena-Phellodendron Rehmannia Pill) for better results. If the patient still has hematuria and mild back pain, Erzhi Wan can be added.
Patients with nephritis may appear cured, but relapse easily upon slight overexertion or improper diet; they need a period of pill-medicine consolidation. If it relapses repeatedly, it easily becomes chronic nephritis, which patients must not take lightly. The diet should avoid spicy and greasy foods, and a low-salt diet should be maintained for one to two months.