Introduction: Key points in syndrome differentiation for kidney diseases and related medication in Traditional Chinese Medicine for treating kidney diseases.

Key Points in Syndrome Differentiation and Treatment of Kidney Diseases

The kidney is the foundation of innate constitution, thus kidney conditions only manifest as deficiency syndromes without excess syndromes. Both cold and heat patterns in the kidney are caused by deficiency syndromes, hence the pathogenesis of cold and heat in kidney diseases is that yin deficiency generates internal heat, while yang deficiency generates external cold.

Kidney yin deficiency syndrome can be roughly categorized into: pure kidney yin deficiency syndrome, such as low back pain and wasting-thirst; kidney yin deficiency generating internal heat syndrome, such as seminal emission, hematuria, and gum bleeding; and kidney yin deficiency with damp-heat manifestations, such as chyluria.

In clinical pattern differentiation, common manifestations include dizziness, blurred vision, tinnitus, soreness and weakness of the lower back and knees, fine pulse, and pale red tongue.

Yin deficiency with internal heat is additionally characterized by flushed cheeks, tidal fever and night sweats, heat sensation in the palms and soles, fine and rapid pulse, and red tongue. When combined with damp-heat, it may present with mild edema, soreness and pain in the lower back, chest tightness, dry throat, bitter taste in the mouth, scanty and dark urine, soggy and rapid pulse, and yellow greasy tongue coating.

Additionally, kidney qi deficiency commonly manifests as soreness and weakness in the lower back and knees, forgetfulness, deafness and tinnitus, dry and brittle hair, enuresis, and asthma; while kidney yang deficiency presents with a series of cold deficiency signs, such as cold limbs, shortness of breath, cold sensation in the back, aversion to wind, deep and slow pulse, and pale tongue coating. It may also affect spleen yang, leading to symptoms like diarrhea and dysentery.

In summary, it is essential to differentiate between spleen yang deficiency and kidney yang deficiency based on the prominent clinical symptoms and whether spleen yang is affected or both the spleen and kidneys have undergone pathological changes.

The kidneys are the foundation of innate constitution, and they form a unified whole with other organs. Therefore, pathological changes in the kidneys inevitably affect other organs.

For example, in cases of yin deficiency with effulgent fire, the pathological changes are related to the heart and liver. Similarly, liver-kidney yin deficiency and spleen-kidney dual deficiency should be differentiated based on the specific symptoms.

Classification of Medications for Kidney Disease

I. Classification by Drug Properties

Yin-Nourishing Drugs: American ginseng, Glehnia root, Dendrobium, Asparagus root, Ophiopogon root, tortoise plastron, turtle shell, Polygonatum odoratum, Cornus officinalis, Ligustrum lucidum, black sesame, bird's nest, polished round-grained rice, Rehmannia root, Scrophularia root

Yang-Tonifying Drugs: deer antler, deer antler glue residue, Cistanche deserticola, Eucommia bark, Dipsacus root, Psoralea corylifolia, Alpinia oxyphylla, Cordyceps sinensis, gecko, walnut, Epimedium, Morinda officinalis, Cibotium barometz, Cuscuta chinensis, Chinese chive seed, seal penis, stalactite, Chinese chive root and leaves, mulberry mistletoe, mutton, sheep kidney, sheep liver, sheep blood, fenugreek

Medicines for consolidating kidney qi: Schisandra chinensis, walnut meat, Psoralea corylifolia

Medicines for clearing heat and promoting diuresis: Viola yedoensis, Eclipta prostrata, Isatis indigotica, Phellodendron amurense, Taraxacum mongolicum

Diuretic medicines: Plantago asiatica, Talcum, Polygonum aviculare, Dianthus superbus, Dioscorea hypoglauca, Pyrrosia lingua, Lygodium japonicum, Malva verticillata, Coix lacryma-jobi, Vigna umbellata, Phaseolus radiatus, Poria cocos, Polyporus umbellatus, Alisma orientale, Benincasa hispida seed, Stephania tetrandra, Akebia quinata, Tetrapanax papyriferus, Juncus effusus, Lophatherum gracile, Kochia scoparia, Boehmeria nivea root

Medicines for arresting sweating and astringing essence: Ephedra sinica, light wheat, Os Draconis, Ostreae Concha, Schisandra chinensis, Rosa laevigata, Mantis egg-case, Rubus chingii, Euryale ferox

II. Medication Based on Kidney's Cold, Heat, Deficiency, and Excess Conditions

Kidney-Tonifying Medicinals: Prepared Rehmannia Root, Chinese Wolfberry Fruit, Epimedium Herb, Schisandra Fruit, Raw Rehmannia Root, Morinda Root, Fleeceflower Root, Eucommia Bark, Tortoise Plastron, Glossy Privet Fruit, Mung Bean Coat, Sea Cucumber

Kidney-Warming Medicinals: Psoralea Fruit, Deer Velvet, Deer Antler Glue Residue, Cornus Fruit, Mugwort Leaf, Dodder Seed, Star Anise

Kidney-Cooling Medicinals: Cuttlebone, Refined Mirabilite, Sophora Root, Raw Rehmannia Root, Moutan Bark, Anemarrhena Rhizome, Talc

Diuretic Kidney Medicines: Polyporus, Alisma, Anemarrhena, Red Poria, Coix Seed

III. Selecting Medicines According to Therapeutic Principles

Nourishing the Kidney: Raw Rehmannia, Prepared Rehmannia, Cornus, Polygonatum, Tortoise Plastron, Ligustrum, Lycium, Astragalus, Mulberry Fruit, Dried Mussel, Ox Bone Marrow, Pig Bone Marrow, Fish Maw Glue, Turtle Shell Glue

Warming the Kidney: Aconite, Cinnamon, Deer Antler, Morinda, Psoralea, Alpinia, Curculigo, Fenugreek

Diuresis: Poria, Red Poria, Polyporus, Alisma, Plantago Seed, Akebia, Wax Gourd Peel, Ricepaper Plant Pith, Cricket

Qi-moving: Lindera Root, Fennel

IV. Selecting Medicinals Based on Symptoms

Tidal fever and bone-steaming: Wolfberry Root Bark, Stellaria Root, Swallowwort Root

Low back pain and weak knees: Eucommia bark, Teasel root, Cibotium rhizome, Huai Achyranthes root, Chaenomeles fruit, Mulberry mistletoe

Deafness and tinnitus: Magnetite, Walnut kernel, Black sesame seed

Asthma: Gecko tail, Schisandra fruit, Psoralea fruit

Spermatorrhea: Mantis egg-case, Cherokee rose fruit, Lotus stamen, Euryale seed, Calcined dragon bone

Erectile Dysfunction: Seal Penis, Epimedium, Cynomorium, Sea Horse, Cnidium Monnieri, Chinese Chive Seed, Actinolite

Urinary Incontinence: Raspberry, Schisandra, Silkworm Cocoon

V. Chinese Herbal Medicine for the Urinary and Reproductive Systems

Diuretic: Polyporus Umbellatus, Poria, Alisma, Atractylodes, White Atractylodes, Plantago Seed, Akebia, Lophatherum, Amber, Knotweed, Dianthus, Lobelia, Scutellaria Barbata, Black Nightshade, Lygodium, Dioscorea Hypoglauca, Pyrrosia, Talc, Corn Silk, Imperata Rhizome, Reed Rhizome, Wax Gourd Peel, Prunella, Ephedra, Mosla, Duckweed, Commelina, Artemisia, Sophora Flavescens, Scutellaria, Kochia, Motherwort, Areca Peel, Stephania, Lepidium, Periploca, Tea Leaves, Astragalus, Loranthus, Cornus, Euphorbia Kansui, Daphne Genkwa, Phytolacca, Morning Glory, Orthosiphon

Increase urate excretion (with anti-gout effects): Fraxini Cortex, Clematidis Radix et Rhizoma, Gentianae Macrophyllae Radix, Rubiae Radix, Smilacis Glabrae Rhizoma, Plantaginis Semen

Expelling urinary tract stones: Lysimachia christinae, Lygodium japonicum, Pyrrosia lingua, Succinum, Polygonum aviculare, Dianthus superbus, Uncaria rhynchophylla, Corn silk, Orthosiphon aristatus

Eliminating chyluria: Dioscorea hypoglauca, Dianthus superbus, Capsella bursa-pastoris

Restoring renal function and eliminating proteinuria: Astragalus membranaceus, Panax ginseng, Codonopsis pilosula, Atractylodes macrocephala, Poria cocos, Trionyx sinensis, Dioscorea opposita, Angelica sinensis, Lycium barbarum, Mantis egg-case, Lotus stamen, Achyranthes bidentata, Eucommia ulmoides, Rehmannia glutinosa, Scrophularia ningpoensis, Ophiopogon japonicus, Cuscuta chinensis, Smilax glabra, Cicada slough (paired with Perilla frutescens, Leonurus japonicus), Rosa laevigata

Antidiuretic: Clematis chinensis, Panax ginseng, Acanthopanax gracilistylus, Mantis egg-case, Tribulus terrestris, Cuscuta chinensis, Psoralea corylifolia, Alpinia oxyphylla, Glycyrrhiza uralensis (in large doses), Citrus reticulata, Carthamus tinctorius (renal vasoconstriction), Triticum aestivum, Gallus gallus domesticus gizzard lining (acting on bladder sphincter)

Uterine stimulants: Citrus aurantium, Citrus aurantium (immature fruit), Cyrtomium fortunei, Leonurus japonicus, Leonurus japonicus (seed), fresh Portulaca oleracea, Vaccaria segetalis, Typha angustifolia pollen, Crataegus pinnatifida, Coix lacryma-jobi, Schisandra chinensis, Impatiens balsamina, Carthamus tinctorius, Rheum palmatum, Gleditsia sinensis, Dichroa febrifuga (side effects)

Inhibiting uterine contractions: Angelica sinensis, Ligusticum chuanxiong (in large doses), Cyperus rotundus (more pronounced during contractions), Eucommia ulmoides, Corydalis yanhusuo, Atractylodes macrocephala, Scutellaria baicalensis, Gentiana macrophylla, Citrus reticulata, Perilla frutescens, Aucklandia lappa

Promoting endometrial congestion: Paeonia suffruticosa, Rheum palmatum, Placenta hominis, Glycyrrhiza uralensis

Promoting semen production and secretion: Cervus nippon velvet antler, Placenta hominis, Epimedium brevicornum

Promotes development of mammary glands and female reproductive organs: Placenta Hominis, Dipsacus asper

Effects on the pituitary-adrenal cortex system: Aconitum carmichaelii, Aconitum kusnezoffii, Panax ginseng, Gentiana macrophylla, Stephania tetrandra, Tinospora sagittata, Glycyrrhiza uralensis, Schisandra chinensis, Bombyx mori, Bee venom, Royal jelly, Sinomenium acutum, Dioscorea nipponica, Lycoris radiata, Bubalus bubalis horn

Inhibits adrenal function: Codonopsis pilosula, Polygonatum sibiricum

Similar to adrenal cortical hormones: Glycyrrhiza uralensis, Dioscorea nipponica, Royal jelly, Astragalus membranaceus, processed Polygonum multiflorum, Polygonatum odoratum

Anti-Trichomonas vaginalis: Cnidium monnieri, Sophora flavescens, Pulsatilla chinensis, Melia azedarach bark, Agrimonia pilosa, Winter bud, Mint, Peach leaf, Scallion white, Garlic, Radish seed, Frankincense, Gleditsia sinensis

Anti-Escherichia coli: Chrysanthemum, Purslane, Euphorbia humifusa, Dandelion, Patrinia scabiosifolia, Verbena, Geranium wilfordii, Black nightshade, Scutellaria baicalensis, Rhubarb, Trichosanthes kirilowii, Polygonum aviculare, Aucklandia lappa, Agrimonia pilosa, Cirsium japonicum, Cirsium setosum, Salvia miltiorrhiza, White peony root, Garlic, Dark plum, Ophiopogon japonicus, Scutellaria barbata, Sophora flavescens