Section 10 New Perspectives on Chronic Kidney Disease
Chronic kidney diseases such as chronic nephritis, nephrotic syndrome, and chronic renal failure are recognized worldwide as difficult-to-treat conditions. Currently, both traditional Chinese medicine (TCM) and Western medicine lack effective radical treatments for these diseases. Through years of clinical practice, the author has found that the poor efficacy of traditional treatments for chronic kidney disease is mainly due to misunderstandings in the comprehension of the disease. Therefore, it is necessary to conduct an in-depth exploration of the etiology, pathogenesis, and treatment of chronic kidney disease, break through old theories, and propose new ones to open new paths and improve therapeutic outcomes. With this spirit, after repeated discussions and practical verification, the author guides clinical practice with new theories, using traditional Chinese medicine as the main treatment alongside dietary regulation and exercise, achieving satisfactory results in treating chronic kidney disease. The new theory can be summarized into four aspects, collectively named the New Theory of Kidney Disease, which is now presented to the public for verification by peers.
(1) The Theory that Chronic Kidney Disease Is Not Deficiency
It is a longstanding traditional view that chronic kidney disease is essentially kidney deficiency. Under this view, treatment mostly focuses on tonifying the kidney, with formulas such as Liuwei Dihuang Wan and Bawei Dihuang Wan being commonly used. Some adopt the principle of addressing deficiency first and then excess, primarily supporting the root. This concept that chronic kidney disease is kidney deficiency is clearly influenced by the ancient medical theory that “kidney governs deficiency,” equating the TCM concept of the kidney with the anatomical kidney in Western medicine. The ancient reference to “kidney governs deficiency” is limited to the kidney’s role in reproduction and development, while the Western anatomical kidney is an organ of the urinary system; these are not interchangeable. Chronic kidney disease is not a reproductive disease but a urinary system disease, with its pathological location in the renal parenchyma anatomically. Hence, the ancient TCM theory of “kidney governs deficiency” should not be applied to the pathogenesis of chronic kidney disease; instead, clinical analysis should be the focus.
Clinically, chronic kidney disease indeed presents some deficiency-like symptoms such as pale or sallow complexion, fatigue, and soreness in the lower back and knees. The presence of these weakness symptoms is one reason people perceive chronic kidney disease as kidney deficiency. However, the appearance of deficiency symptoms does not equate to the disease being essentially deficient. The Inner Canon (Nei Jing) states, “For what is present, seek it; for what is absent, seek it; for deficiency, hold it responsible; for excess, hold it responsible,” clearly indicating that any symptom can have both deficiency and excess causes. The ancients said, “Great excess may appear as emaciation; extreme deficiency may show signs of excess,” showing the inconsistency between symptoms and the essence of the disease. Therefore, Nei Jing emphasizes that “treatment must seek the root of the disease.” Clinically, it is necessary to analyze symptoms comprehensively to find the root cause of the disease.
A comprehensive analysis of pulse, complexion, tongue, symptoms, and medical history of chronic kidney disease reveals: First, from the medical history, chronic kidney disease mostly develops from acute nephritis, initially caused by external pathogens that are not eradicated, and often aggravated repeatedly by colds or infections, indicating old pathogens not removed and new pathogens invading, becoming deeper and more severe over time – a sign of pathogen excess. Second, symptomatically, patients often exhibit restlessness, irritability, frequent dreams at night, dry stools, reddish urine, and itchy skin, all signs of excessive heat. Third, complexion shows pale, yellow, or sallow faces, invariably dull and turbid, worsening as the disease progresses — indicating blood stasis and circulation disorders. Fourth, tongue examination often reveals a red and dry tongue with greasy, thick coating at the root, and purple-black veins on the tongue back, typical signs of heat and blood stasis in the nutritive level. Fifth, pulse characteristics in kidney disease patients include slippery, wiry, thin yet rapid pulses with deep and strong feeling. In cases of uremia, the six pulses become wiry, slippery, flooding, and rapid, worsening upon palpation, indicating accumulation of toxic pathogens. With such pulses and signs, how can one claim deficiency?
From a Western medical perspective, the persistent positivity of protein and cells in urine, elevated serum creatinine and blood urea nitrogen reflect invasion of pathogens into the nutritive blood level. Microvascular spasms, obstruction, microcirculatory disorders, inflammation, swelling, damage, sclerosis, and even atrophy of renal parenchyma are all related to pathogenic invasion and vascular stasis. In summary, the basic pathogenesis of chronic kidney disease is penetration of wind, dampness, and heat pathogens into the nutritive blood, resulting in vascular stasis. The disease is one of excess rather than deficiency, with prevalent heat and stasis. Warm tonic treatments are contraindicated; treatment should primarily focus on clearing heat, cooling blood, and resolving stasis, combined with individualized therapy in accordance with manifestations. Such an approach is consistent with the pathogenesis and is expected to achieve better therapeutic results.
(2) The Theory that Protein Should Be Avoided in Chronic Kidney Disease
Persistent positive protein in urine is one of the characteristics of chronic kidney disease. Particularly in nephrotic syndrome patients, massive protein loss occurs in urine, with qualitative tests frequently showing +++ to ++++, and daily protein loss often exceeding 10 grams. Western medicine’s response to such massive protein loss is to encourage patients to consume a high-protein diet, summarized as the principle “replace lost protein with protein,” considered an essential treatment measure for kidney disease. Both Western and traditional Chinese medicine firmly believe in this, and patients commonly regard it as a lifesaving approach. This principle has been followed for a long time without reconsidering its error. The author applied this method for 30 years before the 1960s and repeatedly encountered failure, realizing that the “replace lost protein with protein” approach was not only ineffective but harmful. In the early 1960s, while treating many kidney disease patients, it was discovered that those on high-protein diets mostly failed to recover long-term or died, while those on low-protein diets often surprisingly improved. From this arose the insight that the dietary principle should be reversed: “Avoid protein when protein is lost.” Extensive clinical practice has proven that a protein-restricted diet combined with herbal differentiated treatment can control urinary protein in a relatively short time and gradually return it to normal, significantly improving treatment effectiveness.
The rationale behind protein avoidance in chronic kidney disease is that a low-protein diet helps reduce the burden on the kidney and favors the repair of damaged renal tissue. This can be likened to a leaking kettle bottom — pouring more water only results in more leakage; sealing the leak is the solution. Protein supplementation is like adding water, while protein avoidance is like plugging the leak, with the latter being obviously superior. The viewpoint that low-protein diets help eliminate proteinuria was reported internationally as early as the 1980s, supporting the “avoid protein in chronic kidney disease” theory.
(3) The Theory that Chronic Kidney Disease Requires Movement, Not Rest
Western medicine advocates rest as the primary principle for nurturing chronic kidney disease patients. General cases are required to stay in bed, and severe cases demand absolute bed rest. This has become clinical routine without question. The author, based on TCM fundamental theory and extensive clinical verification, summarizes the new perspective that “chronic kidney disease requires movement, not rest.”
Bed rest is detrimental to kidney repair and might promote renal atrophy, while appropriate exercise supports recovery of renal function, facilitates repair of damaged renal tissue, and prevents renal atrophy. TCM theory holds that constant movement is a fundamental law of nature, from celestial bodies to the internal environment of the human body, all in constant motion. Ancient physicians taught “movement that is moderate leads to ‘life generating life’,” and modern sayings claim “life lies in movement,” all highlighting that movement is an expression of life and a physiological necessity. The fundamental pathogenesis of chronic kidney disease is blood stasis. Whether it is microcirculatory disorders in the kidney or sclerosis and atrophy of renal parenchyma, in TCM terms, all represent blood stasis and vascular obstruction. One basic therapeutic principle is to activate blood and resolve stasis. Daily care for patients should follow this principle. Rest causes blood stasis; movement promotes blood flow—an unchanging truth, explaining why chronic kidney disease requires movement rather than rest.
Traditional Chinese medicine herbal therapies activating blood and resolving stasis represent only part of comprehensive treatment; patients must actively cooperate, persist in self-directed physical exercises to promote smooth flow of qi and blood in the organs, giving full play to medicinal effects, removing stasis from the blood, accelerating toxin elimination, and promoting repair of damaged kidneys while preventing atrophy. Excessive bed rest inevitably worsens blood stasis, making recovery difficult. Clinical evidence shows that patients who persistently exercise combined with treatment achieve better results. Thus, the theory that chronic kidney disease requires movement, not rest, is by no means empty talk.
(4) The Theory that Chronic Renal Functional Damage Is Reversible
Once chronic kidney disease progresses to the stage of renal failure, it is almost equivalent to a death sentence. Western medicine believes that chronic renal failure is inevitably irreversible, progressively worsening, with lost kidney units unable to regenerate; compensatory kidney units decrease continuously, eventually resulting in death due to total renal function loss. This means that chronic renal functional damage is irreversible—a conclusion that can be disputed.
According to the author’s new perspective on chronic kidney disease, using internal administration of herbal medicine to clear heat, cool blood, and resolve stasis, combined with dietary regulation, protein avoidance, and continued exercise, comprehensive treatment of chronic renal failure can maintain long-term stability of the disease, and some patients can achieve renal function recovery approaching or reaching normal levels. For example, patient Wang from Shandong was initially diagnosed with serum creatinine of 442 μmol/L and urea nitrogen of 17.5 mmol/L. After more than a month of treatment, symptoms relieved; he took the prescription home and adhered to the regimen for 10 months. Subsequent tests showed complete normalization of creatinine and urea nitrogen. Patient Li, with bilateral renal cysts and severe renal dysfunction, showed a straight right kidney image on scintigraphy. After more than a year of treatment, the right kidney image nearly returned to normal. Patient Chu had right renal atrophy with ultrasound dimensions 7.7 cm × 3.9 cm × 4.1 cm. After one year of treatment, repeat ultrasound showed enlargement to 8.1 cm × 5.3 cm × 3.7 cm, astonishing the examining physician, who considered this unthinkable. These cases demonstrate that renal function damage is not irreversible, and TCM treatment for chronic kidney disease including renal failure has significant utility.
The key is to be guided by correct theories. The author believes that cooling blood and removing stasis with Chinese medicine, protein-restricted diet, and persistent exercise are the three major treasures in treating chronic kidney disease. These three should be applied concurrently and none can be omitted. With close patient cooperation and proper treatment, good results are assured. Chronic kidney disease can be fundamentally cured, and chronic renal functional damage can be reversed—a conclusion that will be confirmed in clinical practice.