NEPHROTIC SYNDROME

GENERAL

Clinical Manifestations	Nephrotic syndrome can be caused by a wide variety of glomerular diseases. It may follow bacterial or viral infection, malignant tumors and administration of some drugs. Some immune diseases, such as systemic lupus erythematosis, allergic purpura and diabetes mellitus can be complicated by nephrotic syndrome. This disease is included in the categories of "Shui Zhong" (edema), and "Xu Lao" (consumptive diseases) in TCM. Main Points of Diagnosis: 1. Heavy proteinuria, accompanied with edema and hypoproteinemia, are three major manifestations of this syndrome. There may also be high blood pressure. Urinary protein excretion exceeds 3.5g per day. The serum albumin is lower than 30g per liter. Severe edema may appear if serum albumin is lower than 15g per liter. 2. The alteration of blood pressure varies with different types of the disease. Hyperlipidemia is common, particularly increased cholesterol. 3. About 75 per cent of cases with nephrotic syndrome are caused by primary glomerular diseases. In children nearly 80 per cent of cases are nephrotic syndrome of minute lesion type. The rest are secondary to other diseases. Renopuncture biopsy is of much help in confirming the cases of the diseases and indicating treatment
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TAI YANG BIAO FU

Clinical Manifestations	Chills and fever Achiness Stiff neck and shoulders Anhidrosis Headache Stabbing joint pain Itchy throat Cough Asthma Aversion to Cold Maybe frozen shoulder * The Tai Yang symptoms remain for 2-3 days Thirst with no desire to drink May have vomiting immediately after drinking Difficult urination May have upper body edema T: Normal C: White P: Floating and slippery
Treatment Principle	Promote urination Dispel Dampness Expel Wind
Herb Formulas	Wu Ling San With indigestion and diarrhea: Si Ling San With jaundice and dysuria: Yin Chen Wu Ling San
Points	Moxa or moxa needle KI-3, LI-4, LU-7, REN-3, SP-6, SP-9, UB-13, UB-28 With indigestion and diarrhea: moxa ST-25, ST-36 With jaundice and dysuria: DU-9

SHAO YANG WITH WATER ACCUMULATION

Clinical Manifestations	Alternating chills and fever Thirst A bitter taste in the mouth Anorexia Edema Vomiting and diarrhea with water intake Dysuria Fullness and oppression in the chest and hypochondrium Diarrhea T: Pink C: White P: Superficial and wiry
Treatment Principle	Harmonize the Exterior and the Interior Relieve the Shao Yang Dispel Water Accumulation Resolve Phlegm Accumulation
Herb Formulas	Chai Ling Tang
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WIND AND WATER ACCUMULATION

Clinical Manifestations	Aversion to Wind and Cold Facial edema moving to generalized edema Slight fever or fever and chills Thirst Slight but continuous perspiration Sore, heavy limbs Decreased urination Headache Edematous orbits A red, swollen sore throat Belching Cough Asthma Dyspnea Bulging eyes Severe cough T: Normal C: White or Thin white P: Floating or Floating and big
Treatment Principle	Promote perspiration Disseminate Lung Qi Clear Heat Move water
Herb Formulas	Yue Bi Tang + Wu Pi San Yue Bi Jia Zhu Tang
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WEI QI DEFICIENCY

Clinical Manifestations	Soft, weak cough with clear thin sputum Physical and mental exhaustion Soft, weak voice Reluctance to speak Shortness of breath Pale face Spontaneous perspiration (daytime) Low resistance to the common cold Tendency to blocked nose T: Pale C: Thin and white P: Weak
Treatment Principle	Reinforce the Lungs Strengthen Qi.
Herb Formulas	Yu Ping Feng San
Points	UB-13, UB-43, ST-36, REN-17, LU-9

LUNG AND KIDNEY YIN DEFICIENCY

Clinical Manifestations	Calcaneus pain May be bone spur Unproductive cough or Scanty, sticky phlegm or Sometimes blood-streaked sputum Dry mouth Dry throat Low back and knees sore and weak "Steaming Bone" tidal fever Night sweats Malar flush Maybe hoarse voice Maybe pain in shin, foot, and heel Spermatorrhea Irregular menses T: Red C: Little or None P: Thready and rapid
Treatment Principle	Nourish and Reinforce the Lungs and Kidneys
Herb Formulas	Ba Xian Chang Shou Wan
Points	HT-6, KI-3, KI-6, LU-6, LU-9, UB-13, UB-23

SPLEEN DEFICIENCY EDEMA

Clinical Manifestations	Sallow complexion Physical and mental fatigue Anorexia Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools Shortness of breath Edema in limbs, especially lower limbs Maybe anasarca Maybe abdominal distention Shortness of breath Cough Urinary retention Lower abdominal fullness Extreme thirst Palpitations Lower abdominal distention Lower abdominal palpitations Dizziness Abdominal pain T: Pale C: White and moist P: Soft and even
Treatment Principle	Warm Yang Strengthen the Spleen Benefit Qi Move water
Herb Formulas	Wu Ling San
Points	SP-6, SP-9, REN-6, REN-9, UB-20, UB-22, UB-23, ST-28, ST-36

SPLEEN DEFICIENCY EDEMA LEADING TO URINARY BLADDER DAMPNESS

Clinical Manifestations	Loose stools Urinary difficulty Scanty urination T: Normal C: Slippery and white P: Floating and rapid
Treatment Principle	Regulate water circulation Drain Dampness Strengthen the Spleen
Herb Formulas	Si Ling San
Points	REN-6, REN-9, SP-6, SP-9, ST-28, ST-36, UB-20, UB-22, UB-23

SPLEEN YANG DEFICIENCY

Clinical Manifestations	Sallow complexion Anorexia (maybe with vomiting) Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools or watery stools containing undigested food Shortness of breath Pain in the epigastrium with cold sensations (pain is relieved by warmth) Cold limbs Feeling chilled Frequent, clear urination Mental fatigue Maybe scanty urine with edema Maybe clear, watery vaginal discharge T: Pale C: Thin and white P: Deep and weak
Treatment Principle	Warm the Center Dispel Cold
Herb Formulas	Shi Pi Yin With little or no edema Cold or no obvious symptoms: Bu Zhong Yi Qi Tang Chinese Patent Medicines: Fu Zi Li Zhong Wan Bu Zhong Yi Qi Wan
Points	DU-26, KI-7, LI-4, LU-7, REN-3, SP-6, ST-29, UB-22, moxa or moxa needle DU-20, REN-6, REN-9, UB-20, UB-23 Moxa LIV-13, REN-12, SP-3, SP-5, SP-6, ST-36, UB-20

SPLEEN YANG DEFICIENCY GENERATING PHLEGM STAGNATION

Clinical Manifestations	Fullness in the chest and hypochondrium Palpitations Shortness of breath Coughing up clear, watery sputum Dizziness Vertigo (when standing) Dyspnea Anxiety Tinnitus Difficult urination Mild edema Cold feet Headache Migraine Weak abdomen T: Pale and swollen C: White and slippery or greasy P: Slippery and wiry or soggy or Soft or Deep and tight
Treatment Principle	Warm and transforms Phlegm and congested Fluids Strengthen the Spleen Resolve Dampness
Herb Formulas	Ling Gui Zhu Gan Tang
Points	UB-20, ST-36, ST-40, SP-3, SP-5, SP-6, REN-12, PC-5, LIV-13

SPLEEN AND KIDNEY YANG DEFICIENCY

Clinical Manifestations	Sallow complexion or Complexion white and shiny Mental fatigue Cold extremities Bodily edema which is more severe in the region below the waist Anorexia Loose stools containing undigested food Weakness of the loins Oliguria Body cold Limbs icy Low back, knees and abdomen feel Cold and painful Lower abdomen feels Cold and painful “Cock-crow” diarrhea (occurs at about 5 am) Edema of face and limbs Dysuria T: Pale, moist and swollen C: Thin and white or White and greasy or Whitish smooth P: Deep, thready, weak and maybe slow
Treatment Principle	Warm the Kidneys Strengthen the Spleen Promote diuresis to reduce edema
Herb Formulas	Zhen Wu Tang + Wu Pi Yin Nephrotic Syndrome #1
Points	Moxa UB-20, UB-23, ST-36, SP-6, SP-9, REN-4, REN-12

HEART FIRE WITH QI AND YIN DEFICIENCY AND DAMP-HEAT IN THE LOWER JIAO

Clinical Manifestations	Restlessness Irritability Thirst Nocturnal emission Insomnia Dream disturbed sleep Lack of spirit Fatigue Low back pain Tinnitus Dysuria Depression Turbid urine Abnormal uterine bleeding Polyuria Enuresis Seminal emission Leukorrhea Blood tinged leukorrhea Anorexia Dry mouth Dry Tongue Five Sole Heat Fever Physical and mental overexertion T: Red C: Little or None P: Deep and rapid
Treatment Principle	Clear Heart Fire Disperse Damp-Heat Benefit Qi and Yin Promote urination
Herb Formulas	Qing Xin Lian Zi Yin modified
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HEART AND KIDNEY YIN DEFICIENCY

Clinical Manifestations	Insomnia with much dreaming Spermatorrhea with erotic dreams Premature ejaculation Irritability Easily startled Palpitations Poor memory Dizziness Tinnitus Low back soreness Legs weak Tidal fever Night sweats Dry mouth Red cheeks Urine short and red T: Red C: Little or None P: Thready and rapid
Treatment Principle	Nourish Yin Reduce Fire Make Heart and Kidney communicate.
Herb Formulas	Ba Xian Chang Shou Wan
Points	HT-7, KI-3, PC-6, PC-7, UB-15, UB-23

LIVER AND KIDNEY YIN DEFICIENCY

Clinical Manifestations	Facial complexion pale and sallow Both cheeks slightly red Dizziness Dry eyes Blurred vision Spots before the eyes Numbness of limbs Flaccid paralysis (Wei syndrome) Weakness Tinnitus Deafness Forgetfulness Five Sole heat Low-grade fever Night sweats Insomnia Stools difficult to pass Constipation Dry mouth and tongue Lower back and knee pain Urinary difficulty Weakness of the lower back, knees and extremities Steaming bones Light-headedness Vertigo Chronic dry, sore throat	Toothache Wasting and thirsting disorder (Xiao Ke) Muscular weakness Irritability Dry skin Spontaneous and nocturnal emissions Tidal fevers Loose teeth Dripping urine Thirst Swollen gums, painful and light red in color Numbness and weakness at the waist and knees Heel pain Urinary incontinence Pain at midline and in lower back Irregular menses or Scanty menses or Amenorrhea Vaginal discharge T: Red C: Little or None P: Thready and rapid (large at the Kidney positions)
Treatment Principle	Enrich Yin Nourish the Essence of the Liver and Kidneys Reduce Deficiency Fire
Herb Formulas	Zhi Bai Di Huang Wan Mai Wei Di Huang Wan Da Bu Yin Wan Chinese Patent Medicines: Liu Wei Di Huang Wan Zhi Bai Di Huang Wan Da Bu Yin Wan
Points	KI-3, LIV-3, SP-6, UB-18, UB-23 UB-18, UB-23, SP-6, LIV-3, KI-3

KIDNEY YIN DEFICIENCY

Clinical Manifestations	Dizziness Tinnitus or deafness Poor memory Aching, soreness or weakness of low back Spermatorrhea or premature ejaculation Aching in bones Aching in leg and heel Dry mouth Thirst Night sweats Five sole heat Malar flush Low grade fever in the afternoon Dry throat, maybe recurrent sore throat Dry stools and / or constipation Urine short and red Heightened libido T: Red C: Little or None P: Thready and rapid
Treatment Principle	Nourish Yin Reinforce the Kidneys
Herb Formulas	Liu Wei Di Huang Wan With Empty Fire Rising: Zhi Bai Di Huang Wan
Points	KI-1, KI-3, KI-6, REN-4, SP-6, UB-23 KI-2, KI-6, REN-4, ST-28, UB-23

KIDNEY YIN DEFICIENCY WITH EMPTY FIRE FLARING

Clinical Manifestations	Chronic cloudy, scanty, yellow urine or Opaque urine like rice-water Dizziness Tinnitus or deafness Poor memory Aching, soreness or weakness of the low back Spermatorrhea or Premature ejaculation Aching in the bones Aching in the leg and heel Dry mouth Thirst Night sweats Five Sole Heat Malar flush Low grade fever in the afternoon Dry throat, maybe recurrent sore throat Dry stools and/or Constipation Urine short and red Heightened libido If Heart Fire also Flares: Insomnia Frequent dreams Palpitations If Liver Yang also Rises: Dizziness Blurred vision T: Red C: Little or None P: Thready and rapid
Treatment Principle	Nourish Yin Subdue Fire
Herb Formulas	Zhi Bai Di Huang Wan Da Bu Yin Wan Chinese Patent Medicines: Liu Wei Di Huang Wan Zhi Bai Di Huang Wan Da Bu Yin Wan
Points	KI-2, KI-6, REN-4, ST-28, UB-23 KI-1, KI-2, KI-3, KI-6, KI-9, KI-10, REN-4, SP-6, UB-23 If Heart Fire also Flares: HT-7, PC-7, UB-15 If Liver Yang also Rises: LIV-3, UB-18

KIDNEY YANG DEFICIENCY

Clinical Manifestations	Low back and knees feel cold, weak and aching Feeling chilled Aversion to Cold Cold limbs General debility Pale or waxy pale complexion Urinary frequency with abundant, clear urine or Oliguria with edema Maybe nocturia Maybe incontinence Frequent cloudy, milky urination Maybe greasy urine Thick, white vaginal discharge The urge to urinate may increase with exposure to Cold The urge to urinate is worse with prolonged standing and lifting Lower abdominal distention Lassitude Listlessness Fatigue Withdrawn, subdued behavior Knees feel cold and aching Dizziness Tinnitus Impotence Spermatorrhea Premature ejaculation Low libido Female infertility ("uterus cold and infertile") Maybe anorexia Maybe loose stools or Constipation Maybe chronic diarrhea or "cock crow" diarrhea T: Pale and swollen or Pale, moist and swollen C: Thin and white P: Deep and thready - maybe slow or Slow and weak or Deep, slow and weak
Treatment Principle	Warm the Kidneys Reinforce Kidney Yang Astringe fluids With turbid urine: Separate the turbid from the clear Drain Dampness
Herb Formulas	Jin Gui Shen Qi Wan (Ba Wei Di Huang Wan) You Gui Wan modified Sang Piao Xiao San modified Lu Rong Bu Se Wan Ji Sheng Shen Qi Wan With turbid urine: Bei Xie Fen Qing Yin With less or no Cold and evidence of Heart involvement (frequent and cloudy urination, forgetfulness and disorientation: Sang Piao Xiao San With Wind-Cold: Ma Hua Fu Zi Xi Xin Tang modified For severely deficient Kidney Yang with "Water Toxin" (very scanty urination, or anuria, dizziness, vomiting of clear Fluids, anorexia, restlessness): Fu Zi Li Zhong Wan + Wu Zhu Yu Tang modified Chinese Patent Medicines: Jin Gui Shen Qi Wan Ren Shen Lu Rong Wan Ge Jie Bu Shen Wan Ning Xin Bu Shen Wan Jin Suo Gu Jing Wan * The last formula is usually taken with one of the first four.
Points	DU-26, KI-7, REN-3, SP-6, moxa or moxa needle DU-4, REN-6, REN-9, UB-23, UB-53 Moxa or moxa needle DU-4, KI-3, REN-4, UB-23 DU-26, KI-3, KI-11, SI-3, SP-6, moxa or moxa needle DU-4, REN-4, UB-23 For enuresis in children: SI-3 is usually enough. With turbid urine: REN-6, REN-9, UB-20, UB-22, UB-23, UB-39, ST-28, ST-36, SP-6, SP-9, KI-7

KIDNEY YANG DEFICIENCY WITH WATER FLOODING

Clinical Manifestations	Aversion to Cold Edema of whole body particularly at and below the waist Cold extremities Scanty urination Abdominal distention with full sensations Edema of the legs Cold sensations in the lower body Sensory numbness Low back pain, aching and heaviness Severe pitting edema Fatigue Feeling nervous and cold with mental weariness Face gray and congested or pale Urinary difficulties Oliguria Severe: Ascites Edema of scrotum T: Pale and swollen with teethmarks C: White and slippery or Thin and white or Thick, white and sticky P: Deep and wiry or Deep and thready
Treatment Principle	Warm Yang TonifY the Kidneys Aid water transformation Promote urination Reduce edema
Herb Formulas	Ji Sheng Shen Qi Wan Zhen Wu Tang Jia Wei Shen Qi Wan
Points	REN-6, REN-9, UB-20, UB-22, UB-23, UB-39, ST-28, ST-36, SP-6, SP-9, KI-7

KIDNEY QI DEFICIENCY

Clinical Manifestations	Pale complexion General debility with a desire for sleep Aversion to Cold Pitting edema Hydrops in the scrotum or Hydrothorax Ascites Frequent urination at night (with profuse proteinuria) T: Pale and swollen with teeth marks C: Whitish P: Deep and slow
Treatment Principle	Strengthen the Kidneys Stop proteinuria
Herb Formulas	Ba Wei Di Huang Wan modified
Points	Moxa or moxa needle UB-23, DU-4, REN-4, needle KI-1, KI-3, SP-6

KIDNEY JING DEFICIENCY

Clinical Manifestations	Exhaustion from long-term illness Low energy Lethargy Aversion to Cold Coolness of the extremities Impotence Spermatorrhea Aching and weakness of the lower back and knees Infertility Premature ejaculation Seminal emission Loose stools (sometimes with undigested food) Incontinence of urine Edema of the lower extremities Pale face Spontaneous perspiration Dizziness Enuresis T: Pale P: Deep, slow and weak
Treatment Principle	Warm and tonify the Kidney Yang Replenish the Jing Tonify the Blood
Herb Formulas	You Gui Wan
Points	DU-4, KI-3, REN-4, UB-23 For bones: Moxa UB-11 For poor memory: HT-7, UB-15

YANG DEFICIENCY WITH INTERNAL COLD-DAMP

Clinical Manifestations	Lower abdominal pain and Cold Abdomen feels chilled Aching bones and joints Muscle ache Whole body pain Aversion to Cold, especially at the back Cold limbs No Thirst Lower abdominal pain and Cold Abdomen feels chilled Maybe fever No thirst T: Normal C: White and slippery P: Deep and faint or Forceless or Choppy and slow or Wiry
Treatment Principle	Dispel Cold Warm the channels Assist Yang Dispel Dampness Relieve pain
Herb Formulas	Fu Zi Tang
Points

BLOOD STAGNATION WITH WATER ACCUMULATION

Clinical Manifestations	Continuous cramping pain in the abdomen Pain is not severe Pain is relieved by pressure Edema of the feet Urinary difficulty Slight edema (primarily of the lower limbs) Symptoms generally occur during pregnancy Pale face Fatigue Heaviness of head Lassitude Lower abdominal pain Dizziness Tinnitus Lumbago Edema Abdominal pain with edema during pregnancy due to Blood Deficiency and abnormal water circulation Oliguria	Palpitations Cold feet Extreme coldness of the hands and feet Vertigo Weakness and numbness of lower back and legs during pregnancy or postpartum Mal position of the fetus Dysmenorrhea Irregular menstruation Right upper quadrant pain Hepatomegaly Anemia Lack of energy Sore back Thirst with no desire to drink T: Pale or pink maybe petechiae on margin C: Thin or Greasy white P: Deep and weak or Soft, floating, small and slow or Wiry and small or Wiry and rough
Treatment Principle	Nourish Liver Blood Soften the Liver Spread Liver Qi Strengthen the Spleen Resolve Dampness
Herb Formulas	Dang Gui Shao Yao San + Wu Pi San Gui Zhi Fu Ling Wan + Wu Pi San
Points

TAN YIN

Clinical Manifestations	Anorexia Edema Abdominal distention Chest and hypochondriac distention Dizziness Nausea Vomiting Vertigo Thirst with no desire to drink Maybe no thirst Palpitations Shortness of Breath T: Normal C: Thick and slippery P: Slippery, full and maybe wiry
Treatment Principle	Warm and Dissolve Tan Yin
Herb Formulas	Ling Gui Zhu Gan Tang Wu Ling San With indigestion, diarrhea and decreased urination: Si Ling San With jaundice and dysuria: Yin Chen Wu Ling San
Points	PC-6, SJ-6, SP-6, SP-9, ST-40, UB-13, UB-20, UB-23

YI YIN

Clinical Manifestations	Heaviness Swollen extremities Pain in the extremities Sluggish urination Aversion to Cold Fever Anhidrosis Cough Asthma with Phlegm T: Swollen C: Greasy and white P: Tight and wiry
Treatment Principle	Warm Yang Benefit water Dispel exogenous pathogens
Herb Formulas	Wu Ling San With indigestion, diarrhea and decreased urination: Si Ling San With jaundice and dysuria: Yin Chen Wu Ling San
Points	Moxa only PC-6, SJ-6, SP-6, SP-9, ST-40, UB-13, UB-20, UB-23

XUAN YIN

Clinical Manifestations	Cough with sharp pain in the chest and hypochondrium Hypochondriac distention and pain Hard focal distention in the epigastrium Dry heaves Shortness of breath Headache Abdominal distention Wheezing Fullness in the chest Dyspnea caused by extreme chest and back pain Dizziness Vertigo Asthma Rapid breathing Generalized edema which is worse in the lower body Difficult urination and defecation T: Normal or Dark C: Thick, greasy and white P: Deep and wiry
Treatment Principle	Attack and Dispel water
Herb Formulas	Shi Zao Tang
Points	KI-3, LI-4, LI-11, PC-6, REN-11, REN-12, ST-36, UB-13, UB-20, UB-23

ZHI YIN

Clinical Manifestations	Cough Asthma Shortness of breath which is worse when lying down Abdominal distention with water retention Edema in the lower extremities Facial edema T: White bubbles C: Thick, greasy and white P: Thready
Treatment Principle	Regulate the Lungs Purge Yin
Herb Formulas	Wu Ling San Xiao Qing Long Tang
Points	LU-7, SP-6, SP-9, UB-13

YANG EDEMA

Clinical Manifestations	Generalized edema Wheezing Dyspnea Restlessness Anuria Irritability Thirst Constipation Urinary obstruction
Treatment Principle	Drain downward Drive out water Expel Wind Release the Exterior
Herb Formulas	Shu Zao Yin Zi
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