Chronic nephritis & acupuncture

Townsend Letter for Doctors and Patients, Oct, 2005 by Honora Lee Wolfe

Keywords: Chinese medicine, acupuncture, nephrology, chronic nephritis

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Chronic nephritis is also known as chronic nephritic-proteinuric syndrome and chronic glomerulonephritis (CGN). Chronic glomerulonephritis is more aptly named slowly progressive glomerular disease. It is marked by chronic inflammation and gradual destruction of the glomeruli. Lesions are focused on the glomerular region but may spread to other structures.

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In Chinese medicine as practiced in China, chronic nephritis is usually treated with internally administered Chinese herbal formulas based on Chinese medical pattern discrimination with acupuncture used adjunctively. In the West, acupuncture may also be used adjunctive to standard Western medical treatments for this disease. In that case, it may help to more effectively control the symptoms of this condition. Thus it may also help lower the necessary doses of Western medicines as well as make one or more of those medicines unnecessary. Acupuncture may also be used to treat the side effects of Western medicines used in the treatment of chronic nephritis. For those interested in the possibilities of the adjunctive use of acupuncture in the management of this disease, the following article shows three things: 1) how Chinese medical practitioners reframe chronic nephritis into its traditional Chinese medical disease correspondences, 2) how Chinese medical practitioners then discriminate the patterns associated with chronic nephritis, and 3) how acupuncture points may be selected based on those patterns. I hope this information is helpful for those of you treating patients with symptoms of chronic nephritis.

Symptoms: Most patients with CGN remain asymptomatic for years. Eventually, symptoms of blood in the urine or dark and foamy urine may appear. This may be combined with nonspecific symptoms of weight loss, malaise, general malaise, headaches, itching, oliguria, easy bruising, nosebleeds, and decreased mental clarity. Hypertension is also a common finding.

Chinese medical disease categorization: In Chinese medicine, the clinical signs and symptoms of chronic nephritis correspond to the following traditional disease categories: dribbling urinary block (long bi), bloody urine (niao xue), water swelling (shui zhong), kidney taxation (shen lao) or vacuity taxation (xu lao) and taxation wind (lao feng), phlegm rheum (tan yin), lumbar pain (yao tong), abdominal distention (fu zhang), and dizziness (xuan yun).

Treatment based on pattern discrimination: Protein only in the urine

1. Spleen-kidney qi vacuity

Signs & symptoms: Fatigue, heart palpitations, shortness of breath, no appetite, loose stool, a pale facial complexion, low back and knee soreness and limpness. The tongue is pale with thin, white fur and the pulse is weak and slow or fine and weak.

Treatment principles: Supplement the center and boost the qi

Acupuncture: Pi Shu (Bl 20)

Shen Shu (Bl 23)

Qi Hai (CV 6)

Zhong Wan (CV 12)

Guan Yuan (CV 4)

Zu San Li (St 36)

San Yin Jiao (Sp 6)

Tai Xi (Ki 3)

Additions & subtractions: If there are heart palpitations, add Jue Yin Shu (Bl 14), Xin Shu (Bl 15), Dan Zhong (CV 17), Nei Guan (Per 6), and Shen Men (Ht 7). If there are loose stools, add Wei Shu (Bl 21), Da Chang Shu (Bl 25), and Tian Shu (St 25).

2. Spleen-kidney yang vacuity

Signs & symptoms: Feeling cold, cold hands and feet, fatigue, no appetite, water swelling (ascites). The tongue is pale and puffy with thin, white fur, and the pulse is deep, fine, and forceless.

Treatment principles: Fortify the spleen, warm the kidney, and transform water

Acupuncture: Needle and moxa or simply moxa:

Pi Shu (Bl 20)

Shen Shu (Bl 23)

Ming Men (GV 4)

Guan Yuan (CV 4)

Qi Hai (CV 6)

Zhong Wan (CV 12)

Zu San Li (St 36)

San Yin Jiao (Sp 6)

Yin Ling Quan (Sp 9)

Tai Xi (Ki 3)

3. Kidney yin & yang vacuity

Signs & symptoms: Feeling cold during the day, cold hands and feet, pale face, fatigue, low appetite; feeling hot during the night with night sweats. The tongue is pale red and puffy, and the pulse is bowstring but fine and forceless.

Treatment principles: Supplement yin and yang and secure the essence

Acupuncture: Needle and moxa or simply moxa:

Pi Shu (Bl 20)

Shen Shu (Bl 23)

Zhi Shi (Bl 52)

Ming Men (GV 4)

Qi Hai (CV 6)

Guan Yuan (CV 4)

Zhong Wan (CV 12)

Tai Xi (Ki 3)

Additions & subtractions: If there is are night sweats and feeling hot at night, add Zhao Hai (Ki 6) and San Yin Jiao (Sp 6) and use less or no moxa.

Protein, blood & casts in the urine

4. Spleen-kidney qi & yang vacuity with damp heat

Signs & symptoms: Fever, dry mouth with a bitter taste, desire for cold drinks. These are in addition to fatigue, heart palpitations, shortness of breath, no appetite, loose stools, a pale facial complexion, low back and knee soreness and limpness, feeling cold, cold hands and feet, and edema. The tongue is red and the pulse is floating and fast.

Treatment principles: First, clear and eliminate dampness and heat and quicken the blood; secondly, supplement yang and qi.

Acupuncture: Choose points to needle from: Zhi Gou (TB 6) for dry mouth, desire for cold drinks, constipation