Appreciation of Professor Zhang Qi's Case: Treating Chronic Renal Failure
Professor Zhang Qi (1922-2019) was, before his passing, a doctoral supervisor at Heilongjiang University of Chinese Medicine and was awarded the title of National Medical Master in 2009. Professor Zhang Qi had rich teaching and clinical experience and made unique achievements in treating kidney diseases. This article reprints his case of treating chronic renal failure using the TCM approach of Hua Zhuo Yin (Turbidity-Transforming Beverage), for readers' reference.
The patient, surnamed He, male, 65 years old, first sought treatment from Professor Zhang Qi on May 9, 2003. He had a history of more than 5 years of chronic glomerulonephritis. In the preceding half year he developed poor appetite and nausea, with occasional ammoniacal taste in the mouth, abdominal distension, constipation, a dry tongue with a yellow greasy coating and scant fluids. Blood tests showed serum creatinine 545 umol/L, urine protein +++, urea nitrogen 25.4 mmol/L, carbon dioxide combining power 20 mmol/L, and hemoglobin 100 g/L.
Professor Zhang Qi differentiated the patient as having dampness evil transforming into heat and attacking the stomach, and planned to treat by clearing heat and draining dampness. The first-visit prescription was: Cu Zhi Dahuang (vinegar-processed Rhei Radix) 10 g, Huangqin (Scutellariae Radix) 10 g, Huanglian (Coptidis Rhizoma) 10 g, Caoguo (Tsaoko Fructus) 5 g, Huoxiang (Agastaches Herba) 15 g, Cangzhu (Atractylodis Rhizoma) 10 g, Zisu (Perillae Folium) 10 g, Chenpi (Citri Reticulatae Pericarpium) 5 g, Banxia (Pinelliae Rhizoma) 15 g, Shengjiang (Zingiberis Rhizoma Recens) 15 g, Yinchen (Artemisiae Scopariae Herba) 15 g, Gancao (Glycyrrhizae Radix) 10 g. After taking 10 doses of the above formula, the nausea and abdominal distension resolved, and the stools were once or twice daily and formed.
At the second visit, Professor Zhang Qi felt that since the first-visit approach was already effective, it should not be radically changed, so he only made slight adjustments. The prescription was: Cu Zhi Dahuang 10 g, Huangqin 10 g, Huanglian 10 g, Caoguo 1 g, Huoxiang 15 g, Cangzhu 10 g, Zisu 10 g, Chenpi 5 g, Banxia 15 g, Shengjiang 15 g, Yinchen 15 g, Gancao 10 g, Sharen (Amomi Fructus) 15 g, Shudihuang (processed Rehmanniae Radix) 20 g.
After continuously taking the medicine for 3 months, the patient returned for follow-up: serum creatinine and urea nitrogen had dropped significantly; serum creatinine had fallen to 200 umol/L, urea nitrogen to 10 mmol/L, and hemoglobin to 110 g/L. The patient reported acceptable appetite, good spirit and energy, and the tongue coating had become thin.
Professor Zhang Qi's prescription was formed by combining San Huang Xiexin Tang (Three-Yellow Heart-Draining Decoction, consisting of Dahuang, Huanglian, and Huangqin) and Ping Wei San (Calm the Stomach Powder, consisting of Cangzhu, Chenpi, Houpo, Banxia, Huoxiang, and Gancao), then modifying the herbs. San Huang Xiexin Tang clears heat and drains fire, dries dampness and resolves toxin, mainly treating exuberant fire in the triple burner with frenetic movement of evil heat; Ping Wei San dries dampness and strengthens the spleen, harmonizes the stomach and stops vomiting, mainly treating the middle jiao obstructed by dampness with gastric and epigastric fullness, nausea, and vomiting. Caoguo, Zisu, and Sharen are aromatic dampness-resolving herbs that assist Ping Wei San in strengthening the spleen, transforming dampness, and downbearing counterflow to stop vomiting, and can also prevent San Huang Xiexin Tang from being bitter-cold and damaging the stomach. Yinchen belongs to the dampness-draining jaundice-relieving category and can assist San Huang Xiexin Tang in clearing heat and draining dampness. Shudihuang nourishes kidney yin; when dampness-draining herbs are used for a long time, one must guard against the drawback of excessive diuresis damaging yin, so Shudihuang, which nourishes kidney yin, is used to balance things slightly.
Professor Zhang Qi's compositional approach fully demonstrates the depth of his TCM theoretical foundation. His formula is both highly targeted, hitting the mark and effectively relieving the patient's clinical symptoms, and fully considerate of the pros and cons of each herb, with thoughtful and balanced medication. The causes of kidney disease are relatively complex; this patient's kidney disease had already become chronic kidney disease, and whether treated with TCM or Western medicine, a long treatment course is needed. Treatment must consider both efficacy and drug side effects, so prescribing is extremely difficult. Professor Zhang Qi's prescription looks ordinary, but at the fine points it shows great attention to measure.
In addition, in this treatment, Professor Zhang Qi used vinegar-processed Dahuang for more than three months, and the patient's body was not harmed but rather improved. This case of Professor Zhang Qi sufficiently proves that the view recently put forward by some doctors-that chronic kidney disease cannot use purgatives like Dahuang-is untenable. In TCM treatment, "if the pattern is present, use the corresponding herb"; one should not be bound by too much echoing of others.