Chronic Pyelonephritis
Chronic pyelonephritis (CPN), also known as chronic upper urinary tract infection, may present with symptoms such as abnormal urination, flank pain, low-grade fever, and pyuria. It is primarily associated with recurrent episodes of acute pyelonephritis over a period of more than six months. Supporting investigations may show repeatedly positive clean-catch midstream urine cultures or microscopy; persistent tubular dysfunction even after symptoms resolve with treatment; or imaging findings such as deformity of the renal pelvis or calyces, irregular renal contours, or even reduced kidney size. Chronic pyelonephritis with ongoing infection is considered active, while localized sterile scars remaining from previous infection indicate inactive chronic pyelonephritis. In TCM, this condition falls within the categories of “Lin syndrome” (painful urinary dysfunction), “low back pain,” and “deficiency taxation.”
TCM Pattern Identification and Medication Reference
| Common Symptoms
Clinical description:
Scant, dark-yellow urine; dribbling and painful urination; urgency and frequency; soreness and pain in the lower back; a feeling of heaviness and distension in the lower abdomen; dry mouth and throat; a red tongue with a yellow, greasy coating; and a rapid pulse
In everyday terms:
- Urine is scant and yellowish-red. Urination may be dribbling and incomplete, with a stinging or painful sensation; the urge comes on suddenly and occurs more often, making urination generally uncomfortable and difficult.
- The lower back feels sore and achy, with discomfort that may be noticeable during activity or after sitting for a long time.
- The lower abdomen feels distended and heavy, with a dragging sensation that may become more uncomfortable when walking or standing.
- The mouth and throat feel dry, with an uncomfortable dryness when speaking or swallowing.
- The tongue appears redder than usual.
- The tongue is coated with a yellow, sticky-looking layer.
- The pulse feels faster than usual.
| Treatment Approach
Clinical description:
Clear heat and promote the resolution of dampness
In everyday terms:
- Aims to clear internal heat and ease discomfort such as feverishness, restlessness, thirst, or a dry throat.
- Aims to help resolve dampness and turbidity in the body and ease sensations such as heaviness, scant dark urine, or swelling in the lower limbs.
| Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
| Common Symptoms
Clinical description:
Recurrent urinary frequency, urgency, painful urination, or dribbling and difficulty urinating; lower-back soreness and pain; reduced appetite; fatigue and lack of energy; low-grade fever or heat in the palms and soles; dry mouth and tongue; teeth marks along the tongue edges; a scant coating or a yellow, greasy coating at the root of the tongue; and a fine, weak pulse or a fine, rapid, weak pulse
In everyday terms:
- Urination is more frequent and urgent, and may be painful; there may also be dribbling or difficulty passing urine. These urinary symptoms tend to recur.
- The lower back feels sore and achy, sometimes more noticeably during activity or after sitting for a long time.
- Appetite is reduced, with less interest in eating.
- It is easy to feel tired and weak, with low energy and limited improvement after resting.
- There may be a slight fever, or a sensation of heat in the palms of the hands and soles of the feet.
- The mouth and tongue feel dry, with an uncomfortable dryness when speaking or swallowing.
- Indentations from the teeth may be visible along the edges of the tongue, giving them a scalloped appearance.
- The tongue may have very little coating, or a yellow, sticky-looking coating at its root.
- The pulse may feel fine and weak, or fine and rapid but lacking strength.
| Treatment Approach
Clinical description:
Tonify Qi and nourish Yin; clear and drain damp-heat
In everyday terms:
- Aims to replenish Qi and nourish Yin, easing discomfort such as fatigue, shortness of breath, dry mouth and throat, or hot flashes and night sweats.
- Aims to clear damp-heat in the body and ease sensations such as heaviness, scant dark urine, or swelling in the lower limbs.
| Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
| Common Symptoms
Clinical description:
Recurrent urinary frequency, urgency, painful urination, or dribbling and difficulty urinating; dizziness and tinnitus; soreness and weakness of the lower back and knees; occasional low-grade fever or a sensation of heat and irritability in the palms, soles, and chest; restless sleep, sometimes with night sweats; or blood in the urine; a red tongue with scant coating or a yellow, greasy coating at the root; and a fine, rapid pulse or a rapid, weak pulse
In everyday terms:
- Urination is more frequent and urgent, and may be painful; there may also be dribbling or difficulty passing urine. These urinary symptoms tend to recur.
- You may feel dizzy or lightheaded and hear ringing or buzzing in the ears, even when it is quiet.
- The lower back and knees feel sore and weak, and may feel lacking in strength when walking or sitting for a long time.
- There may sometimes be a low-grade fever or a feeling of heat and restlessness in the palms, soles, and chest.
- Sleep may be restless; in more severe cases, sweating during sleep may wake you or dampen your clothes.
- There may sometimes be blood in the urine, making it appear reddish.
- The tongue may look red with very little coating, or have a yellow, sticky-looking coating at its root.
- The pulse may feel fine and rapid, or weak and rapid.
| Treatment Approach
Clinical description:
Nourish Kidney Yin, clear heat, and transform dampness
In everyday terms:
- Aims to nourish Kidney Yin and ease discomfort such as soreness and weakness in the lower back and knees, dizziness, tinnitus, or hot flashes and night sweats.
- Aims to clear internal heat and resolve dampness, easing sensations such as heaviness, scant dark urine, or swelling in the lower limbs.
| Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
| Common Symptoms
Clinical description:
Recurrent urinary frequency, urgency, painful urination, yellow urine, or dribbling and difficulty urinating; distending pain in the flanks and ribs that is worse with pressure; nausea and poor appetite; aversion to greasy foods; dry, bitter mouth; a red tongue with a greasy coating; and a deep, slippery, rapid pulse
In everyday terms:
- Urination is more frequent and urgent, and may be painful; the urine may be yellow, or urination may be dribbling and difficult. These symptoms may recur.
- There may be distending discomfort and pain along the flanks and ribs, which worsens when pressed.
- Nausea and poor appetite may occur, with little interest in food.
- Greasy foods may be unappealing and may cause more discomfort.
- The mouth may feel dry and bitter.
- The tongue may appear red with a sticky-looking, heavy coating.
- The pulse may be felt more clearly when pressed deeply, and may feel slippery and rapid.
| Treatment Approach
Clinical description:
Course and regulate Liver and Gallbladder function; clear heat and promote the resolution of dampness
In everyday terms:
- Aims to regulate Liver and Gallbladder Qi and ease discomfort such as distending pain along the flanks and ribs, bitter taste, dry throat, or low mood.
- Aims to clear internal heat and promote the resolution of dampness, easing sensations such as heaviness, scant dark urine, or yellowing of the eyes and skin.
| Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
| Common Symptoms
Clinical description:
Urinary frequency, urgency, painful urination, or dribbling and difficulty urinating, especially after exertion; soreness and weakness of the lower back and knees; poor appetite and fatigue; a dragging, distended sensation in the lower abdomen; in more severe cases, aversion to cold and cold limbs, facial and limb swelling; a pale tongue with a thin, white, moist coating; and a deep, fine, weak pulse
In everyday terms:
- After exertion, urination may become more frequent and urgent, painful, or dribbling and difficult.
- The lower back and knees feel sore and weak, with a sense of reduced strength when walking or standing for a long time.
- Appetite may be reduced, with fatigue and low energy.
- The lower abdomen feels distended and heavy, with an uncomfortable dragging sensation during activity.
- In more severe cases, there may be sensitivity to cold, with cold hands and feet that are slow to warm up.
- The face and limbs may appear swollen, with noticeable puffiness when pressed.
- The tongue may look pale, with a thin, white, moist coating.
- The pulse may be felt more clearly when pressed deeply and feel fine and weak.
| Treatment Approach
Clinical description:
Strengthen the Spleen and benefit the Kidneys; clear and drain dampness and turbidity
In everyday terms:
- Aims to support Spleen function and nourish Kidney Qi, easing discomfort such as poor appetite, fatigue, or soreness and weakness in the lower back and knees.
- Aims to help resolve dampness and turbidity in the body and ease sensations such as heaviness, a foggy feeling in the head and body, or difficulty urinating.
| Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
| Common Symptoms
Clinical description:
Recurrent urinary frequency, urgency, painful urination, or dribbling and difficulty urinating; stabbing, sore, distending pain in the flank and lower back; distending pain in the lower abdomen; a purplish-dark tongue or purple spots and patches; and a fine, choppy pulse
In everyday terms:
- Urination may be more frequent and urgent, and may be painful, or may be dribbling and difficult to complete. These urinary symptoms may recur.
- There may be a localized stabbing pain with soreness along the flanks and lower back.
- The lower abdomen may feel distended and painful, with discomfort whether moving or still.
- The tongue may look dark purple, with purple spots or patches on its surface.
- The pulse may feel fine and uneven or rough.
| Treatment Approach
Clinical description:
Clear and drain damp-heat; unblock Yang and resolve blood stasis
In everyday terms:
- Aims to clear damp-heat in the body and ease sensations such as heaviness, scant dark urine, feverishness, or restlessness.
- Aims to promote Yang circulation and resolve stagnation, easing discomfort such as painful areas of bruising, localized swelling or hardness, or difficulty bending and straightening the joints.
| Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
References
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- Editorial Group of the 2nd Academic Conference on Nephrology. Standards for the Treatment of Urinary Tract Infections [J]. Chinese Journal of Nephrology, 1985, 1(4): 13.
- Wang Haiyan. Nephrology [M]. 3rd ed. Beijing: People’s Medical Publishing House, 2008: 1280-1281.
- Editorial Committee for the National Essential Medicines Clinical Application Guidelines. National Essential Medicines Clinical Application Guidelines (Chinese Patent Medicines) [M]. Beijing: People’s Medical Publishing House, 2012: 148-150.
- Chinese Pharmacopoeia Commission. Clinical Medication Guide to the Pharmacopoeia of the People’s Republic of China: Chinese Medicine Patent Preparations [M]. Beijing: China Medical Science Press, 2010: 162, 185-197, 202.
- Chinese Pharmacopoeia Commission. Pharmacopoeia of the People’s Republic of China [M]. Beijing: China Medical Science Press, 2010: 632, 992, 1132.
- Zhang Liwei. Clinical efficacy of Sanjin Tablets combined with levofloxacin in treating 60 cases of acute pyelonephritis [J]. China Journal of Ethnomedicine and Ethnopharmacy, 2014, 23(4): 38-39.
- Shi Jiangeng. Study of the efficacy of integrated traditional Chinese and Western medicine in treating acute pyelonephritis [J]. Electronic Journal of Cardiovascular Diseases of Integrated Traditional Chinese and Western Medicine, 2015, 3(5): 98-99.
- Kang Ping, Zhang Hongbo, Jiang Guohong, et al. A controlled clinical study of treatment for chronic pyelonephritis [J]. Chinese Journal of Modern Drug Application, 2009, 3(13): 68-68.
- Li Menglin, Liang Bin, Tang Jingwen, et al. Pharmacodynamic study of Relinqing Granules in rats with a pyelonephritis model [J]. China Journal of Chinese Materia Medica, 2006, 31(2): 153-155.
- Tao Xiaofen, Zhang Hongying. Shenshu Granules for 48 cases of chronic pyelonephritis with damp-heat accumulation [J]. Shaanxi Journal of Traditional Chinese Medicine, 2013, 34(10): 1344-1345.
- Duan Yuanzhi, Yu Guizhi. Treatment of 56 cases of chronic pyelonephritis with dual Qi and Yin deficiency using Qi-tonifying and Yin-nourishing therapy combined with antibiotics [J]. Chinese Medicine Modern Distance Education of China, 2013, 11(23): 63-64.
- Liu Zixiang. Clinical observation of Buzhong Yiqi Tang in the treatment of chronic pyelonephritis [J]. Heilongjiang Medical Journal, 2003, 27(5): 398-398.