Shao-Qing Zhang, Li-Ming Ma, Jun Zhang

Department of Pediatrics, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110000, Liaoning

Keywords:Purpuric nephritis Children Traditional Chinese medicine therapy Experience of famous doctors Zhang Jun

ABSTRACT Based on the theory of children's TCM constitution “children are Zhi yang wei chong, and Zhi yin wei zhang”, combined with the etiology and pathogenesis of TCM in children with purpuric nephritis, Professor Zhang Jun uses The four methods of "Clearing heat, dampness, tonicity, and stasis" are used to treat children with purpuric nephritis, and it is advocated that the method of "resolving blood stasis" runs through the entire treatment process, and the clinical results are quite good.

Purpuric nephritis, as a common generalized small vessel vasculitis in children, a serious complication of allergic purpura, mostly occurs within half a year of continuous purpura symptoms on the skin. Purpuric kidney damage can directly lead to a poor prognosis and seriously threaten the life of children [1-2]. Although the motherland medicine does not have the concept of purpuric nephritis, according to clinical manifestations such as skin purpura, hematuria, and edema, it is classified into the categories of "purpura", "hematuria", and "muscle crest". Wet, poisonous, and blood stasis are closely related to actual evils [3]. In addition, based on the physiological characteristics of TCM constitution of children, the body is incomplete, incomplete and not strong. Therefore, the children's internal organs are weak and vulnerable, which is also an important pathological basis for the occurrence of this disease [4]. Professor Zhang Jun, as the sixth batch of instructors to inherit the academic experience of the famous Chinese medicine practitioners in the country, has gained insightful and fruitful achievements in the field of traditional Chinese medicine treatment and academic research in children with allergic purpura and related nephritis within 30 years of his practice. The four methods of clearing heat, dampening dampness, tonifying stasis and removing blood stasis have achieved good results in the clinical treatment of purpuric nephritis. The author is fortunate to attend the clinic, and now summarizes the four methods of Professor Zhang Jun in the treatment of children with purpuric nephritis.

1. Method of dredging and clearing heat

Traditional Chinese medicine believes that "wind is the strength of all diseases" and "wind is the evil". Its pathogenicity is characterized by a number of changes in good deeds and initiative. The "Clinical Manual of Clinical Practice" also states that "with the six qis, wind is all Wuqi, if it is cold, it means wind cold ... and fire is wind and fire. " Most children with purpuric nephritis are transmitted by allergic purpura. From the etiology and pathogenesis of allergic purpura and the laws of transmission, the onset is mostly related to exogenous wind and heat [5]. The etiology and pathogenesis are: exogenous wind evil invades the fur and causes pharyngitis, sore throat, cough, etc .; evil qi travels through the meridians, immersed in the blood network without penetration, dredging, and blood sees on the muscle surface Skin purple spots and itching; Fengxie further seeks menstruation and enters, the kidney seal is damaged, subtle and solid, and the wind-heated evil burns the kidneys, so I see foam, hematuria, and edema around the body. Purpuric nephritis is in accordance with the theory of "Essays on the Sources of Diseases", "Wind evil enters Shaoyin but hematuria." From the perspective of pediatric TCM constitution, Zhu Danxi said in the "Gezhiyulun · Ciyoulun" Zeng Yun "before the child was sixteen years old, he had pure yang, and he had more heat." Pure Yang's hot body is more likely to induce the occurrence and development of purpuric nephritis under the invasion of wind evil [6]. Therefore, Professor Zhang Jun advocates the method of "relieving wind and clearing heat" as the main rule for treating purpuric nephritis in children caused by wind and heat, supplemented by the method of promoting blood circulation and removing blood stasis.

When children with swelling and sore throat, purpuric skin, reddish mild itching (small amount, mostly limited to the lower extremity), thin white or yellow tongue coating, floating pulse and other clinical manifestations of wind and heat, Professor Zhang Jun mostly used Yinqiao Sanshu Ningluo Zhixue Recipe is added and subtracted, and medicinal honeysuckle, forsythia, lisianthus, licorice, burdock, nepeta spike, black ginseng, small thistle, white grass root, madder root, salvia root, chicken blood vine, windproof, white fresh skin and so on. Among them, honeysuckle and forsythia are the princes of "Xinliangping agent", which can play the role of dispersing wind and heat and clearing heat and poison; and the Chinese bellflower and burdock can release lungs, expel phlegm, and detoxify the throat, and can play the role of lifting the pot and covering it. Effectively recovers wind-heated lungs caused by "wounded by the wind, first affected by it", and kidney damage caused by infusion of water and fluid caused by kidney infusion; The function of diarrhea and hemostasis is to cure the skin purpura. Ningluo Zhixue formula uses blood thistle, blood stasis medicine such as thistle, white grass root, madder root, salvia, chicken blood vine and so on. Healing blood and self-extinguishing blood "to alleviate the symptoms of non-menstrual blood such as skin purpura, hematuria, and so on. At the same time, take the functions of" Xinyin Qingre "and licorice" relief, reconcile medicine "in the formula to ease The dryness of the medicine for treating wind and hemostasis is related to the various medicines for purging fire and injuring the yin; the windproof is the "moisturizer in the wind", which is longer than expelling wind and dissolving the table, and can overcome dampness, analgesics and ascension; The wind relieves itching, and Yunbai Xianpi of "Medicine Fu" cures all hot poisonous winds; The "throat, tongue-folding" route, redness, swelling, and purulence in the throat can cause the wind-heat poison to be injected into the kidney through the meridian, aggravating the damage to the kidney's blood network and aggravating the hematuria symptoms. Therefore, Professor Zhang Jun paid special attention during his visit Purulent throat congestion in children with purpuric nephritis, including old-fashioned grass, Chonglou, Houttuynia cordata, Hedyotis diffusa, wild chrysanthemum and other drugs to clear the throat and purify the throat, as appropriate. The combined use of various medicines to treat purpuric nephritis caused by windheat in children with the method of "relieving wind, clearing heat, and resting blood to stop bleeding" makes the clinical effect quite good.

2. Methods of removing dampness and diarrhea

Professor Zhang Jun believes that when the child's skin purpura is not seen in the upper limbs, chest and abdomen, but only in the bilateral lower limbs and more fused into a film, accompanied by purpuric nephritis symptoms such as edema, hematuria, proteinuria, etc. When the tongue is fat, with white teeth or yellow greasy moss, according to the theory of "Empty Wet Evil" in "The Yellow Emperor's Canon", you can consider the body's wet evil to stagnate and heat up, and the kidneys will be burned by immersion. , Is a purpura affected by wet poison. In addition, the course of the disease is prolonged and the disease is lingering repeatedly. It is also related to the pathological characteristics of "sticky and heavy turbidity" of wet evil, and it is often associated with the real and evil phases of wind and heat [7]. If the damp and hot turbidity is in the throat, then the child's throat is red and swollen (the swelling is slightly slower than the wind and hot evil). It seems to have sticky sputum and wheezing is not smooth. Sanjiao water liquid loses its gasification function and appears edema; if the damp and hot turbidity hurts the kidney blood network and the blood is forced, the hematuria can be seen; if the damp and hot evil enters and hurts the air, the spleen and stomach are transported Loss of sputum, phlegm and turbidity, can also be seen in children with foam (proteinuria). From the perspective of pediatric TCM constitution, Wanquan of the Ming Dynasty pointed out that "the spleen is rustic, the child is born ... the spleen is not used, and its qi is weak." Therefore, children's physical characteristics of traditional Chinese medicine can make their disease more prolonged and unhealed than adults' resistance to damp, hot and turbid evils [8-9]. Therefore, Professor Zhang Jun advocates the method of "dispelling dampness and reducing turbidity" as the main rule for treating purpuric nephritis in children caused by dampness, supplemented by the method of promoting blood circulation and removing blood stasis.

When children with purpuric nephritis are accompanied by symptoms such as abdominal fullness, loss of appetite, stickiness in the mouth, and soreness of limbs, such as scorching dampness and heat poisoning, Professor Zhang Jun mostly uses dampness and Chinese medicine with cooling and hemostatic drugs. Use Artemisia spp., Scutellaria baicalensis, Patchouli, Stone Calamus, White Kernel Kernel, Amomum villosum, Purple Grass, Agrimony and so on. Among them, Yin Chenhao and Scutellaria baicalensis are king medicines, which play the functions of clearing heat, dampness, purging fire, and detoxifying, which is the same as the pathogenesis of dampness, heat, turbidity, and evil; because dampness, heat, turbidity, and evil suppress the middle coke machine, so patchouli, stone The four medicines of calamus, Baikouren and Amomum villosum are responsible for the aroma, turbidity, dampness, and the qi and spleen pleasure. At the same time, cool blood and hemostatic drugs such as purple grass and celestial grass are added to restore the hot and hot evil burns the blood network. Purpura and hematuria. In addition, when children with purpuric nephritis are accompanied by clinical symptoms of scorching dampness fever such as frequent urination, turbidity, and hematuria, Professor Zhang Jun mostly applies the Shimiao Pills in combination with Qi and blood activating drugs in the manner of eliminating and eliminating dampness. , Sichuan Achyranthes bidentata, raw barley kernel, motherwort, red scallion, salvia and so on. Among them, Cangzhu and Huangbai are king medicines. The two medicines take bitterness and dryness, and can effectively remove the hot and humid heat; Chuanxius angustifolia promotes blood circulation, directs the medicine down (directly to the lower coke), and can nourish liver and kidney, making a large number of bitter cold medicines used. Bitter but not dry; meanwhile, it is supplemented with barley kernels, spleen and water, and promotes the function of organs in organs; motherwort, red scallion, salvia and other drugs for promoting blood circulation and promoting qi to promote stagnation of dampness in the body; Profit. The combination of various medicines is closely related to the pathogenesis of damp heat and turbidity, seeking the solid source, removing dampness without helping heat, reducing turbidity, and not getting wet. The method of "removing dampness and turbidity" is used to treat children with purpuric nephritis caused by dampness, so Obtained clinical efficacy.

3. The method of tonic and solid foundation

Traditional Chinese medicine summarizes the physiological relationship between qi and blood with "qi as the handsome of blood" and "mother as the mother of qi". The operation of blood is inseparable from the immobilization and promotion of qi. [10-11]. For children with purpuric nephritis, the body is not secure, external evils enter the space, change through the meridian, and cause deficiency due to reality, which in turn induces and aggravates damage to the vital organs such as the lung, spleen, and kidney [12- 13], as described in "Lingshu · The Beginning of the 100 Sickness", "Wind and cold, not cold, evil cannot hurt alone." The lung is a canopy, and the energy of Jiaozhu is the source of the body's water. The "golden water phase" is the mother of kidney water. If the lung qi is deficient, it will regulate the waterway function loss, mother disease and the child, which will affect the main water function of the child's internal organs and kidneys; the child's body is weak, and the purpuric nephritis is prolonged and repeated. No blood is taken, and the kidney qi is not solid and has not been sealed. From the perspective of children's TCM constitution, Chao Yuanfang stated in his "Essays on the Sources of Diseases and Children's Theory" that "the viscera of children is weak", pointing out that children's viscera functions are not yet mature, and their ability to resist external feelings and endogenous evil qi is poor. When encountering lingering incurable diseases such as "purple spots", it is easier to consume gas and yin, further aggravating the deficiency of righteousness [14]; In addition, "the spleen is rustic, the firstborn of the child ... the spleen is not used, and its qi is weak. ", Which indicates that the spleen is the source of acquired blood and biochemistry of qi and blood, and that the function of the spleen and stomach is often the key to the progression of disease. Professor Zhang Jun believes that when children with recurrent generalized skin purpura, rashes are faint, short urine and red blood are trapped in hematuria and foam, accompanied by spontaneous sweating, redness on both sides, five upset fever, limb fatigue, tongue When red deficient nephropathy such as red shaojin and moss is manifested, this is the body's deficiencies, the kidney is not solid, plus the lingering illness, drug overdose caused by Qi deficiency and deficiency, blood stagnation purpura. Therefore, Professor Zhang Jun advocates the method of "tonicity and solidity" as the main rule for the treatment of purpuric nephritis in children caused by evidence of deficiency, supplemented by the method of cooling blood to stop bleeding and nourishing yin and nourishing.

When children with purpuric nephritis develop unresolved disease, dark reddish whole body purpura color, persistent hematuria and proteinuria, etc., Professor Zhang Jun uses Liu Wei Di Huang Wan He Er Zhi Wan as the basic formula, with nourishing yin and nourishing blood. , Cooling blood hemostatic drug addition and subtraction, medicinal cooked rehmannia, yam, yam meat, paeonia pelt, Alisma orientalis, Poria cocos, Ligustrum lucidum, Eclipta grandis, raw Dihuang, Xuanshen, Astragalus, Radix Pseudostellariae, Radix Ginseng, etc. Liuwei Dihuang Wan is the essential medicine of "tonicate the five internal organs in the kidney". Among them, Rehmannia glutinosa replenishes the kidneys and nourishes the yin, fills the essence and solids, and uses the "lord of strong water" as the remedy in the prescription [16]; Entering the heart, sour taste into the liver, from the left to the kidney, can achieve liver and kidney tonic, and yam white into the lung, sweet taste into the spleen, from the right to the kidney, can lung and spleen tonic, the two flavors are common medicine, That is, it has a clear and harmonious scent, and plays a role in nourishing the kidneys to converge and solidify the root; Danpi can clear blood and detoxify heat, can cool blood to stop bleeding, and can also restrict the temperature and tenderness of mandible meat; Alisma can clear bladder heat, prevent kidney essence Qi is shaken by the phase fire, which has the effect of dampness and turbidity; Poria cocoon enters the spleen, lightly infiltrates the spleen and dampness, can clear the air and divide heat, and prevents the essence of water valley from being spread by the body's phase fire. ; Astragalus yang supplements qi, fixes antiperspirant, and can quickly replenish patients' internal weakness and vitality, which is the "top quality" medicinal material of the "Book of Classics"; Taizishen belongs to the spleen and lung meridians, which is a vital medicine for qi and vitality, and is used for purpura Nephropathy in children with late weakness, thirst, lack of diet and other performances have good relief; Ligustrum lucidum and Eclipta nourishing liver and kidney The essential medicine can also cool the blood and stop bleeding, and it can have a good relief effect for those who have purpuric nephritis and hot blood. The prescription is supplemented with drugs such as Shengdihuang, Xuanshen, and Lithospermum to nourish the yin and clear the heat while strengthening the deficiency, Cooling blood stasis. As the socalled "Wu Yihui Lecture" states, "The five internal organs can be incorporated into the Tibetan possession." The whole prescription is based on tonic, and it is clear that it is not to be tired. The clinical effect is quite good.

4. Methods of activating blood and removing blood stasis

Purpuric nephritis belongs to the "blood syndrome" and its derivative diseases in the medicine of the motherland. The skin purpura and renal collateral hemorrhage (hematuria) are separated menstrual blood for forced blood and belong to stasis. Blood stasis has the characteristics of stagnant astringency and hinders normal blood flow. It is the pathological product and pathogenic factor of the disease, and it is also the main reason that causes the disease to be repeated and prolonged [17]. Just as the "Blood Syndrome" states that "everything has roots ... the roots of blood loss, the stagnation is also the root, so those who repeatedly occur, multivolt stasis", Professor Zhang Jun pays special attention to promoting blood circulation in the clinical treatment of children with purpuric nephritis The method of treating blood stasis. She believes that blood stasis runs through purpuric nephritis caused by various causes. The pathogenesis is that wind and heat and qi flow through the skin and fur through the surface of the skin. Blood stasis caused by burns and blood stasis prevents normal blood from running; the dampness of the blood is severe, which hinders the operation of qi, blood, and body fluids. When wet for a long time, it becomes a stasis, causing a vicious cycle of increased blood stasis symptoms; lungs, spleen Deficiency of viscera, kidneys and other organs results in a substantial weakening of qi-fixation and impetus, qi deficiency does not promote blood flow, and impaired blood flow causes intravenous stasis; in addition, as the major serious complication of allergic purpura, purpuric nephritis There are different degrees of blood network damage at the beginning of the illness, and the children's physical constitution gradually tends to "blood stasis", which is one of the fundamental reasons for the increasingly severe symptoms of blood stasis [18]. From the perspective of children's TCM constitution, "Lingshu · Nishun Fat and Thin" mentioned that children have the characteristics of "brittle, weak blood, and weak gas", indicating that children, as a group with weak blood and weak gas, are more likely to be stimulated by external evils. Endogenous stasis [19]. Therefore, Professor Zhang Jun advocates the method of "blood circulation and removing blood stasis" as the main rule for purpuric nephritis in children caused by blood stasis syndrome.

Professor Zhang Jun followed the law of the disease "Weiqiyingxue" to treat the disease of children with blood stasis. When the children had extremities, chest and abdomen with densely packed patches of purpura, itching was seen, accompanied by fever and bad wind. Symptoms such as fatigue, limb fatigue, light sweating, and slow red tongue can be considered as stasis in the camp. If the child's whole body skin purpura is bright red, with different degrees of fever, dizziness, upset, hematuria, Clinical manifestations such as constipation, ecchymosis, pulse strings, etc. can be regarded as blood stasis. Professor Zhang Jun usually added and subtracted Guizhi Decoction and Siwu Decoction for children with blood stasis in the camp and used Guizhi, Shaoyao, Jujube, Ginger, Chuanxiong, Angelica, and Rehmannia glutinosa; for In children with blood stasis, the rhizome dihuang decoction is the main formula for addition and subtraction. If the blood stasis is not enough for a long time, astragalus supplementation and qi can be taken. Guizhi Decoction as the "Zhong Jingqun Fang Zhikui" has a good effect on the evidence that the camp is not tuned and unreasonable; Siwu Tangzhongchuanxiong, Angelica sinensis, Rehmannia glutinosa and Paeonia lactiflora are combined with Buzhong, and not warm. Dryness, nourishment but not greasy, can be effective for children with purpuric nephritis to manage blood stasis and difficult blood flow; Xijiao Dihuang Decoction takes its effect of clearing heat and detoxifying, cooling blood and removing blood stasis. For children with purpuric nephritis with hot blood Through the bitter coldness of the rhino horns and the bitter coldness of the raw land, it can restore the lost yin blood while cooling the blood to stop bleeding [20]. According to the identification of the disease position, convergence and hemostasis without leaving evil spirits, cooling blood to stop bleeding and nourishing yin and nourishing blood are simultaneously used.

5. Summary

Affected by the children's TCM constitution of "Children's immature yang is not filled, but immature yin is not long", children with purpuric nephritis have complicated pathogenesis and lingering conditions. In the face of the disease, a comprehensive diagnosis and treatment of the disease is carried out, and the method of "resolving blood stasis" is used throughout the treatment process. The clinical results are quite good. Its clinical experience is worthy of promotion and reference.