Appreciation of Wang Shaohua's Case: Treating Nephrotic Syndrome Edema with Combined Medicinal and Dietary Therapy

Professor Wang Shaohua, a renowned senior TCM physician of Jiangsu Province, treated a case of edema caused by nephrotic syndrome using a combined medicinal and dietary approach. This treatment method is well worth learning from, and the author respectfully uses his case to explain this method in detail.

The patient in this case, surnamed Tan, sought treatment from Professor Wang Shaohua on February 28, 1982. The patient was 26 years old at the time. Having suffered from chronic kidney disease for nearly 2 years, with generalized edema and accompanying ascites, and having sought treatment everywhere without effect, the patient turned to Professor Wang Shaohua for TCM treatment. The patient had previously also used TCM, taking patent medicines such as Liuwei Dihuang Wan and Jinkui Shenqi Wan, but the effect was not ideal.

At the visit, the patient's urine protein was ++++, white blood cells 3-5, red blood cells 1-3, granular casts 0-1, plasma total protein 42 g/L, albumin 27 g/L, and globulin 15 g/L. Western medicine diagnosed nephrotic syndrome and treated with prednisone, cyclophosphamide, hydrochlorothiazide, and others for 2 weeks, without improvement. At the visit, the patient had a bright pale complexion, exhausted spirit, faint voice, generalized edema that pitted on pressure, a belly distended like a drum (abdominal circumference 88 cm), poor appetite, difficulty breathing, aching lower back and abdomen, cold extremities, scanty urine, loose stools, a deep weak pulse, and a pale tongue with a greasy coating.

Professor Wang Shaohua differentiated the patient as having injury to both the spleen and kidney. The root should be treated by strengthening the spleen and warming yang, and the branch by dispersing fluid and percolating dampness. He planned to treat with modified Shpi Yin (Solidifying the Spleen Beverage) combined with Fangji Fuling Tang (Stephania and Poria Decoction). First-visit prescription: Sheng Huangqi (raw Astragali Radix) 30 g, Chifuling (Poria Rubra) 30 g, Dong Baizhu (winter Atractylodis Macrocephalae Rhizoma) 20 g, Han Fangji (Stephaniae Tetrandrae Radix) 15 g, Zhuling (Polyporus) 10 g, Dafupi (Arecae Pericarpium) 10 g, Shanglu (Phytolaccae Radix) 10 g, Guizhi (Cinnamomi Ramulus) 6 g, Guang Muxiang (Aucklandiae Radix) 6 g, Fu Pian (processed Aconiti Radix) 5 g, Chuan Houpo (Magnoliae Officinalis Cortex) 5 g, Zhi Gancao (honey-fried Glycyrrhizae Radix) 3 g, Sheng Mahuang (raw Ephedrae Herba) 3 g. Three doses, decocted in water.

The patient was also instructed to stew together one 500-g carp, 100 g of Chixiaodou (Phaseoli Semen), and 10 g each of ginger and scallion until cooked, to be consumed within one day, for 3 consecutive days.

After three days of this combined medicinal and dietary therapy, the patient's urine volume increased greatly, facial edema had resolved, limb edema had decreased by about half, the abdominal circumference had dropped to 79 cm, appetite improved, breathing was no longer difficult, and the middle qi recovered. Professor Wang Shaohua then, based on the first visit, removed Mahuang and added Shengjiangpi (Zingiberis Rhizoma Crust) 1 g, prescribed another 5 days' worth, and instructed the patient to continue stewing carp with Chixiaodou for 3 more days.

After taking the medicine for another 5 days, the patient improved further and could get out of bed and walk. Wubeizi (Galla Chinensis), Dangshen (Codonopsis Radix), Shanyao (Dioscoreae Rhizoma), and Yimucao (Leonuri Herba) were then added to the previous formula, and the patient was instructed to simultaneously take Jisheng Shenqi Wan (the Jinkui Shenqi Wan produced by Tongrentang containing Cheqianzi and Niuxi, or the Japanese kampo Ni che Shenqi Wan, etc., are all made according to the Jisheng Shenqi Wan formula). After a total of 20 days of medication, the patient's edema completely resolved. Laboratory tests: urine protein +, white blood cells 0-2, plasma total protein 61 g/L. Professor Wang Shaohua instructed the patient to make the decoction formula into pills for follow-up consolidation.

In this case, the combined medicinal and dietary therapy used by Professor Wang Shaohua is also a method the author greatly admires for treating edema and ascites. Professor Wang stewed carp with Chixiaodou; the author has also seen an ovarian cancer patient whose ascites resolved and CA125 fell after stewing pork ribs with Xiaoji (Cirsii Herba). The author frequently recommends combined medicinal and dietary therapy to ascites patients, because it can indeed enhance the effect of reducing ascites. Besides Chixiaodou, Heidou (black soybean), Yumixu (corn silk), Donggua (wax gourd), Huz i (bottle gourd), and Bai luobo (white radish, including dried shredded white radish) all have strong diuretic and detumescent effects. A TCM doctor in the author's hometown in Hubei likes to stew 150-250 g of dried shredded radish with fish or meat as an adjunctive treatment for ascites or edema, with good results.

Compared with medicines, foods have far fewer toxic side effects, so when using food to assist in treating edema or pleural and ascites, one can use amounts that medicines dare not use without serious side effects. Stewing fish or meat with foods that have diuretic and detumescent effects can, besides promoting diuresis and reducing swelling, also supplement the patient with high-quality protein; such dietary therapy is very advisable. Of course, this combined medicinal and dietary method is only effective for some patients; for some refractory ascites, even using these methods, improvement is difficult.

Professor Wang Shaohua's formula is also well worth learning; its composition approach can actually be seen as Huangqi Fangji Tang (Astragalus and Stephania Decoction) plus Muxiang and Houpo. In the author's experience, Huangqi Fangji Tang has a very good diuretic and detumescent effect. Muxiang and Houpo are a commonly used herb pair of Professor Qian Ying for treating hepatic ascites; Professor Qian found in clinical practice that after adding Muxiang and Houpo, the patient's urine volume increased significantly, and removing these two herbs caused the urine volume to drop. These two herbs belong to the qi-regulating category of TCM and are strictly speaking not diuretics, but in practice they have a very good diuretic effect. So in this composition approach, the herbs playing the key role may be Huangqi, Han Fangji, Baizhu, Fuling, Zhuling, Muxiang, and Houpo.

In Professor Wang's case, the patient's ascites resolved rather quickly, which was actually somewhat risky; the reason is explained in the author's article "Qualitative and Quantitative Issues in the Treatment of Ascites (Intraperitoneal Effusion)," which explains this in detail. For safety, we should remind the patient to keep daily weight loss as much as possible within 1 kg and not to be overhasty.