Post Date December, 03 2023
Application of Xiaochaihu Decoction in the Treatment of IgA Nephropathy
In "Treatise on Febrile Diseases", there are a total of 18 provisions on the use of Xiaochaihu decoction, which is the main prescription for Shaoyang disease. Teacher Xiao believes that the most essential characteristic of Shaoyang disease is that the positive qi has become insufficient, and both the positive and the evil are showing a declining trend.
As Zhang Zhongjing proposed in Article 96 that the main syndrome of Shaoyang disease is associated with cold and heat, he then explained it in Article 97: "The blood is weak and the qi is exhausted, the striae are opened, the evil qi enters due to it, and it combats with the positive qi, forming a knot under the threat, causing a division between the positive and the evil, causing the interaction between cold and heat, and stopping for a while.". The weakness of the blood and Qi, and the opening of the striae, clearly indicate that the weakness of the body's positive Qi precedes; The division between good and evil means that both good and evil are at a stalemate, with each other winning or losing.
When a less powerful qi encounters a less powerful evil qi, the qi that wants to dispel the evil cannot go out in one go, and the evil qi that wants to invade the human body cannot be driven in for a long time, resulting in a unique clinical manifestation of alternating cold and heat.
Another example is Article 265: "People with typhoid fever and a thin pulse, headache and fever, belong to Shaoyang.". The string belongs to Shaoyang, while the thin string refers to the deficiency of Zhengqi.
The treatment of fever caused by heat entering the blood chamber can be done with Xiaochaihu Decoction. The particularity of heat entering the blood chamber is that when a woman's menstrual cycle is comfortable and appropriate, the physical state of her menstrual cycle is obviously similar to that of blood weakness and qi. Therefore, the significance of using ginseng, licorice, and jujube in Xiaochaihu Tang, the main prescription of Shaoyang disease, can be understood.
Teacher Xiao believes that the most precious thing left by "Treatise on Febrile Diseases" is "specific prescription", and teaches us: What should we learn from "Treatise on Febrile Diseases"? Learn from the "specific prescriptions" that Zhang Zhongjing has established, and on this basis, expand the specific prescriptions according to his research field.
I am a graduate student in the Department of Nephrology. Today, I will discuss the application of Xiaochaihu Decoction in the treatment of IgA nephropathy based on the knowledge taught by Mr. Xiao in class and the experience of copying recipes from my tutor.
Knowledge of Western Medicine
IgA nephropathy is a group of primary glomerular diseases that are not accompanied by systemic diseases and are characterized by widespread deposition of IgA or IgA-based immunoglobulins in the mesangial region of the kidney by immunopathological examination of renal biopsy.
The clinical characteristics are: recurrent episodes of gross or microscopic hematuria, often induced by upper respiratory tract infections, accompanied by extensive IgA deposition, mesangial cell proliferation, matrix hyperplasia, and deposition of electronic dense substances in the mesangial region.
Understanding of IgA nephropathy in traditional Chinese medicine
According to its clinical manifestations, physical and chemical examination characteristics, and the development and prognosis of the disease, it can be classified into the categories of "blood in urine", "low back pain", and "asthenic fatigue" in traditional Chinese medicine.
In terms of its etiology and pathogenesis, domestic institutions have conducted multicenter clinical validation with a large sample, and it has been found that the TCM syndrome differentiation and typing scheme for chronic primary glomerular disease basically reflects the distribution characteristics of deficiency of qi and yin in IgA nephropathy, while excess of pathogenic factors is common in damp heat and blood stasis.
In general, IgA nephropathy is characterized by deficiency in origin and excess in origin, with positive deficiency as the basis and evil excess as the criterion. However, among the evil excess, the syndrome of excess in origin, such as wind heat, wind toxin, damp heat, damp toxin, and blood stasis, is more common. The evolution process often leads to deficiency due to excess, and on the basis of deficiency, there is also a mixture of evil and excess. In fact, diseases and pathogens often coexist, such as the intersection of damp heat and blood stasis.
Summary of follow-up knowledge
During the follow-up study, the tutor explained that the pathogenesis of IgA nephropathy is the synthesis of IgA1 in the oral cavity, stomach, and other mucous membranes. This substance is metabolized by the liver. If it cannot be metabolized by the liver, it will be deposited in the mesangial region of the glomerulus along with the blood circulation to stimulate immune activation, leading to the occurrence of the disease.
Therefore, the teacher proposed three steps for the treatment of IgA nephropathy: 1. protecting the mucosa; 2. Help the liver eliminate IgA1; 3. Reduce immune activation in deep deposits. In the first two of these three links, Xiaochaihu soup can be used.
1. Protect the mucous membrane.
The acute or paroxysmal stages of IgA nephropathy are often caused by exogenous factors, especially the recurrence and aggravation of the condition. Patients often experience pharyngalgia first, followed by symptoms of exogenous symptoms such as nasal congestion and runny nose, which are caused by exogenous factors.
"The pharynx belongs to Shaoyang, so Xiaochaihu Decoction can be used. The method of warming, tonifying, and clearing can be used. When clearing, it is not allowed to blindly chill and cool. Adding warming, tonifying, and further expelling pathogenic factors can be used. During a cold, using Xiaochaihu Decoction is the best time to turn the underlying pathogenic factors in the body out of the sun.".
At this time, Xiaochaihu Decoction not only treats colds and protects the mucous membranes of the respiratory tract, but also turns the internal evil into the sun, making it easier for us to treat this disease.
"The Internal Classic" states: "When the evil gathers, its qi will become deficient." The reason why the external evil causes the internal latent evil to occur indicates that the patient's body is currently deficient in positive qi; The reason why it is necessary for the internal evil to develop under the influence of external evil to indicate that the evil spirit is not too strong, which is consistent with Teacher Xiao's understanding of Shaoyang disease. The most essential feature of Shaoyang disease is that the positive spirit has become insufficient, and both the positive and the negative are showing a downward trend.
To cite a case: A patient, Li Mou, a female, 37 years old, was diagnosed with IgA nephropathy by renal puncture in a local hospital three years ago due to poor treatment for proteinuria and hematuria. For three years, she has been taking traditional Chinese medicine to treat hematuria and proteinuria in my tutor's outpatient clinic. Recently, she developed proteinuria due to a cold and fever, dry throat and sore throat, fat tongue with tooth marks, white fur, and thin pulse. She came to the outpatient clinic for treatment.
According to the principle of protecting the mucous membrane, the tutor gave the patient Xiaochaihu Decoction: 25 g of bupleurum chinense, 9 g of scutellaria baicalensis, 6 g of ginger, 9 g of jujube, 6 g of pinellia tuber, 15 g of radix pseudostellariae, and 9 g of raw licorice. After three doses of medicine, the patient's fever subsided, his throat did not ache, and his urinary protein decreased.
2. Help the liver eliminate IgA1.
"The metabolism of IgA1 is carried out in the liver. My tutor believes that the liver is referred to as Shaoyang in traditional Chinese medicine. If there is a problem with Shaoyang and IgA1 cannot be inactivated, it will enter the blood and deposit in the kidney along with the blood circulation, leading to disease.".
"Treatise on Febrile Diseases" states that Xiaochaihu Decoction is the main recipe for Shaoyang disease. Using the warm and nourishing ingredients in the recipe increases the elimination effect of Shaoyang on IgA1, while its warm and nourishing method can also drag the evil spirit trapped in Shaoyang out of the body. Therefore, using Xiaochaihu Decoction when patients have external symptoms is not only a link to treat pharyngalgia and protect the respiratory mucosa, but also a link to enhance the patient's resistance and help the liver eliminate IgA1.
Write after
The above is only what I have learned from Mr. Xiao in class and from my tutor after class. Perhaps due to my shallow knowledge, I cannot fully convey my tutor's views. I also request the teacher to criticize and correct me.
Teacher Xiao said, "Specific prescriptions" are the highest realm of medicine! We are encouraged to expand specific prescriptions based on Zhang Zhongjing's established "specific prescriptions" according to our own research field.
Teacher Xiao has expanded her field to include chronic renal failure, fever, and Xiaochaihu Decoction; For patients with chronic urinary fever, Xiaochaihu Decoction combined with Daochi Powder is the main treatment.
"I will continue to pay attention to the treatment of IgA nephropathy, and hope to combine what I have learned from Mr. Xiao and my mentor to conclude that" Xiaochaihu Decoction is mainly used for the first occurrence of exogenous pharyngalgia in IgA nephropathy ", and" Xiaochaihu Decoction is mainly used for the recurrence of proteinuria after exogenous IgA nephropathy ".".
Although I have used the names and symptoms of Western medicine to elaborate on the prescriptions I want to expand, it seems somewhat nondescript. However, with the progress of the times, the development of technology, and the introduction of modern medical examination equipment, our understanding of diseases has become more intuitive and detailed.
Therefore, I believe that expanding Zhong Jing's prescription can not only be limited to the concepts of syndromes and diseases in traditional Chinese medicine, but also be part of the so-called integration of traditional Chinese and Western medicine.
