Chronic Renal Failure

Chronic renal failure (CRF) is a clinical syndrome in which the renal parenchyma is severely damaged against a background of chronic kidney disease (CKD) of various causes, leading to a gradual, progressive decline in kidney function and eventual failure. Clinically, it is characterized mainly by a decreased glomerular filtration rate, retention of metabolic waste, and disturbances in water and electrolyte balance and acid-base balance. Based on its symptoms and signs, chronic renal failure falls within the categories of “Niao Du” (urinary toxin), “Guan Ge” (urinary retention and vomiting), “Shen Lao” (kidney taxation), and “Xu Lao” (deficiency taxation) in traditional Chinese medicine (TCM). The National Standard of the People’s Republic of China, Terminology of Clinical Diagnosis and Treatment in Traditional Chinese Medicine: Diseases, defines this condition as “chronic renal failure.”

TCM Pattern Differentiation and Medication Reference

Spleen and kidney deficiency with qi and yin deficiency
Spleen and kidney deficiency with yin deficiency and internal heat
Lung and kidney deficiency with insufficiency of essence and qi
Spleen and kidney deficiency with internal accumulation of dampness and turbidity
Impaired spleen transformation with obstruction by stasis and turbidity
Spleen and kidney yang deficiency with obstruction by dampness and stasis
Spleen deficiency with exuberant dampness and internal blood stasis
Declining kidney yang with impaired warming function
Liver and kidney yin deficiency
Liver and kidney deficiency with spleen qi weakness
Kidney yin and yang deficiency
Exuberant internal damp-heat
Failure of yang to transform qi with internal retention of water and dampness
Internal obstruction by blood stasis

|Common Symptoms

Clinical description:

Mental fatigue and lack of energy, soreness and weakness in the lower back and legs, facial and limb edema, dizziness and tinnitus, proteinuria, hematuria, pale tongue, deep and thin pulse

Plain-language explanation:

You may feel mentally and physically tired and lack the energy to get things done; rest may not bring much relief.
Your lower back may feel sore and your legs weak, making it difficult to stand or walk with strength.
Your face and limbs may look swollen, with a noticeable indentation after pressing.
You may feel dizzy or lightheaded, with ringing in the ears that may also be noticeable in quiet surroundings.
Urine may contain protein, as indicated by a urine test.
Blood may be present in the urine, making it look red or blood-tinged.
The tongue may appear pale, with less color than usual.
The pulse may feel deep and thin, and may be difficult to detect without firm pressure.

|Treatment Approach

Clinical description:

Boost qi and nourish yin; tonify the kidney and strengthen the spleen

Plain-language explanation:

Support replenishment of qi and nourishment of yin, with the aim of easing fatigue, shortness of breath, dry mouth or throat, and symptoms such as tidal fever and night sweats.
Support the kidney and spleen, with the aim of easing soreness and weakness in the lower back and knees, poor appetite, or loose stools.

|Related Products

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|Common Symptoms

Clinical description:

Fatigue and lack of energy, soreness and weakness in the lower back and knees, dry mouth and throat, vexing heat in the palms, soles, and chest, clear and copious urination at night, pale tongue with teeth marks, thin and rapid pulse

Plain-language explanation:

You may tire easily and feel weak, with little energy for daily activities; rest may not restore you fully.
Your lower back may feel sore and your knees weak, especially after walking or standing for a long time.
Your mouth and throat may feel dry, causing discomfort when speaking or swallowing.
Your palms, soles, and chest may feel hot, accompanied by restlessness and an internal sensation of heat.
You may urinate frequently at night, with relatively large amounts of pale, clear urine.
Your tongue may look pale, with teeth marks along its edges.
Your pulse may feel thin and rapid.

|Treatment Approach

Clinical description:

Boost qi and nourish yin; clear heat and promote the production of fluids

Plain-language explanation:

Support replenishment of qi and nourishment of yin, with the aim of easing fatigue, shortness of breath, dry mouth or throat, and symptoms such as tidal fever and night sweats.
Support clearing internal heat and generating fluids, with the aim of easing restlessness, thirst, dry throat, or hard stools.

|Related Products

|Common Symptoms

Clinical description:

Mental fatigue and lack of energy, soreness and weakness in the lower back and knees, edema of the limbs, menstrual irregularity, erectile dysfunction or premature ejaculation, chronic cough and weak breathing, enlarged tongue, white coating, deep and weak pulse

Plain-language explanation:

You may feel mentally and physically tired and lack energy; rest may not fully restore you.
Your lower back and knees may feel sore and weak, especially after walking or standing for a long time.
Your limbs may become swollen, with noticeable puffiness and a feeling of swelling during movement.
Your menstrual cycle may be irregular, with changes in cycle timing and flow.
You may have difficulty achieving or maintaining an erection, or ejaculate sooner than intended, affecting sexual activity.
You may have a persistent cough, shortness of breath, and weakness, with a feeling that breathing is difficult.
Your tongue may look enlarged and thick.
A white coating may cover the surface of your tongue.
Your pulse may be difficult to detect unless pressed deeply and may feel weak.

|Treatment Approach

Clinical description:

Supplement the lung and kidney; secure essence and boost qi

Plain-language explanation:

Support the lung and kidney, with the aim of easing shortness of breath, cough, soreness and weakness in the lower back and knees, or fatigue.
Support the securing of essence and replenishment of qi, with the aim of easing seminal emission, fatigue, or a pale complexion.

|Related Products

|Common Symptoms

Clinical description:

Nausea and vomiting, heaviness of the limbs, poor appetite, fullness and distention in the epigastrium and abdomen, sticky sensation in the mouth, red tongue with a thick, greasy coating, soggy and rapid pulse

Plain-language explanation:

You may feel nauseated and may vomit, with recurring discomfort in the upper abdomen.
Your body and limbs may feel heavy, with less strength during movement and increased fatigue.
Your appetite may be poor, and you may eat less or have little interest in food.
Your upper abdomen and abdomen may feel full, distended, and uncomfortable.
Your mouth may feel sticky and unpleasant, including when speaking or swallowing.
Your tongue may look red with a thick, greasy coating.
Your pulse may feel soft and somewhat rapid.

|Treatment Approach

Clinical description:

Transform turbidity and dispel dampness; strengthen the spleen and tonify the kidney

Plain-language explanation:

Support transforming internal turbidity and dispelling dampness, with the aim of easing bodily heaviness, a dull or heavy sensation in the head and body, or difficulty urinating.
Support the spleen and stomach and nourish kidney qi, with the aim of easing poor appetite, fatigue, or soreness and weakness in the lower back and knees.

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Xiang Sha Liu Jun Zi Tang

|Common Symptoms

Clinical description:

Low back pain, fatigue, sallow complexion, nausea and vomiting, poor appetite, difficulty urinating, sticky stools, dull complexion, skin bruising, visible distended veins, rough scaly skin, pale tongue, white greasy or white slippery coating, or pale-purple tongue with stasis spots, deep and moderate, deep and weak, or choppy pulse

Plain-language explanation:

Your lower back may be painful or uncomfortable, particularly during activity or after sitting for a long time.
You may feel tired and weak, with little energy; rest may provide only limited relief.
Your face may look yellowish and dull, with a sallow appearance.
You may feel nauseated or retch, and in more severe cases may vomit.
Your appetite may be poor, and you may eat less or have little interest in food.
Urination may be difficult or not flow freely.
Your stools may feel sticky and difficult to pass, with a sense of incomplete evacuation.
Your complexion may look dark and lack its usual brightness.
Bruise-like purplish marks may appear on your skin.
Veins beneath the skin may be prominent and clearly visible.
Your skin may feel dry and rough, with an uneven texture or fine scaling.
Your tongue may look pale, with less color than usual.
Your tongue coating may appear white and greasy, or white and slippery.
Your tongue may also look pale purple, with dark stasis spots or patches.
Your pulse may be felt only with deeper pressure and may be slow, weak, or choppy.

|Treatment Approach

Clinical description:

Boost qi and strengthen the spleen, invigorate blood and resolve stasis, unblock the bowels and discharge turbidity

Plain-language explanation:

Support replenishment of qi and healthy spleen function, with the aim of easing fatigue, poor appetite, or loose stools.
Support blood circulation and resolve stasis, with the aim of easing painful bruising, localized swelling or hardness, or menstrual irregularity.
Support bowel movement and elimination of turbidity, with the aim of easing constipation, abdominal distention, or bodily heaviness.

|Related Products

|Common Symptoms

Clinical description:

Edema, aversion to cold with cold limbs, fatigue and lack of energy, shortness of breath and reluctance to speak, soreness and weakness in the lower back and knees, poor appetite, pale and enlarged tongue with a slight purplish tinge, thin white moist coating, deep and weak or deep and thin pulse

Plain-language explanation:

You may have swelling, with a puffy, tight appearance and discomfort from the edema during activity.
You may be sensitive to cold, with cold hands and feet that are slow to warm up.
You may feel tired and weak, with little energy; rest may provide only limited relief.
You may become short of breath easily and feel reluctant to talk, with a quiet, weak voice.
Your lower back may feel sore and your knees weak, especially after walking or standing for a long time.
Your appetite may be poor, and you may have little desire to eat.
Your tongue may look pale and enlarged, with a slight purplish tinge.
Your tongue coating may look thin, white, and moist.
Your pulse may be difficult to detect unless pressed deeply and may feel weak or thin and weak.

|Treatment Approach

Clinical description:

Tonify the spleen and warm the kidney; drain dampness and invigorate blood

Plain-language explanation:

Support healthy spleen and stomach function and warm kidney qi, with the aim of easing poor appetite, sensitivity to cold, or soreness and weakness in the lower back and knees.
Support the elimination of dampness and turbidity and promote blood circulation, with the aim of easing bodily heaviness, edema, or painful bruising.

|Related Products

|Common Symptoms

Clinical description:

Body edema, especially below the waist, with pitting that resolves slowly, epigastric and abdominal distention, reduced appetite and loose stools, poor appetite, dull complexion, fatigue and cold limbs, scanty urine, stabbing pain, interrupted urination, skin bruising, visible distended veins, rough scaly skin, pale tongue, white greasy or white slippery coating, or pale-purple tongue with stasis spots, deep and moderate, deep and weak, or choppy pulse

Plain-language explanation:

You may have swelling, especially in the lower body; pressing the skin may leave an indentation that is slow to disappear.
Your upper abdomen and abdomen may feel distended and uncomfortable.
Your appetite may be reduced, and your stools may be loose and poorly formed.
Your complexion may look dull and lack its usual brightness.
You may feel tired and weak, with cold hands and feet and sensitivity to cold.
You may pass small amounts of urine, with stinging pain or an interruption in the urine stream.
Purplish bruises may appear on your skin, and veins beneath the skin may be prominent.
Your tongue may look pale, with a white greasy or slippery coating; it may also appear pale purple with stasis spots or patches.
Your pulse may be detectable only with deeper pressure and may be slow, weak, or choppy.

|Treatment Approach

Clinical description:

Unblock the bowels and direct turbidity downward; strengthen the spleen and drain dampness; invigorate blood and resolve stasis

Plain-language explanation:

Support bowel movement and direct turbidity downward, with the aim of easing constipation, abdominal distention, or heaviness in the head and body.
Support spleen and stomach function and promote the elimination of dampness, with the aim of easing poor appetite, bodily heaviness, or difficulty urinating.
Support blood circulation and resolve stasis, with the aim of easing painful bruising, localized swelling or hardness, or menstrual irregularity.

|Related Products

|Common Symptoms

Clinical description:

Edema, especially below the waist, with pitting that does not rebound, palpitations, shortness of breath, cold aching and heavy soreness in the lower back, pale or dull-gray complexion, pale and enlarged tongue, white coating, deep and thin or deep, slow, and weak pulse

Plain-language explanation:

Swelling may be more pronounced in the lower body. Pressing the skin may leave an indentation that does not quickly rebound, and the area may look puffy and tight.
You may feel your heart pounding or fluttering, with palpitations that do not easily settle even when resting.
Your breathing may be rapid or difficult, with shortness of breath after activity or fatigue after talking for a long time.
Your lower back may feel cold, painful, sore, and heavy, with discomfort worsening after prolonged sitting or standing, or exertion.
Your face may look pale or gray and dull, without its usual color or luster.
Your tongue may look pale and enlarged, appearing thick and swollen.
A white coating may cover your tongue and look moist.
Your pulse may be detectable only with deeper pressure and may feel thin or slow and weak.

|Treatment Approach

Clinical description:

Warm and tonify kidney yang; promote the transformation and movement of water and dampness

Plain-language explanation:

Support warming kidney qi and yang, with the aim of easing sensitivity to cold, cold limbs, soreness and weakness in the lower back and knees, or fatigue.
Support the movement and transformation of fluids, with the aim of easing difficulty urinating, swelling in the lower limbs, or bodily heaviness.

|Related Products

Ji Sheng Shen Qi Wan

|Common Symptoms

Clinical description:

Dizziness, headache, soreness and weakness in the lower back and knees, dry mouth and throat, vexing heat in the palms, soles, and chest, red tongue with scant coating, thin pulse

Plain-language explanation:

You may feel dizzy or lightheaded, especially when standing or walking, as if unsteady.
You may have a persistent headache, which may worsen with thinking or prolonged visual tasks.
Your lower back may feel sore and your knees weak, especially during activity or after sitting for a long time.
Your mouth and throat may feel dry, especially when speaking or swallowing.
Your palms, soles, and chest may feel hot, with episodes of internal heat and restlessness.
Your tongue may look red, with very little coating on its surface.
Your pulse may feel thin and weak.

|Treatment Approach

Clinical description:

Nourish and tonify the liver and kidney

Plain-language explanation:

Support nourishment of liver blood and kidney yin, with the aim of easing dizziness, soreness and weakness in the lower back and knees, tinnitus, or forgetfulness.
Support the liver and kidney, with the aim of easing blurred vision, fatigue, or symptoms such as tidal fever and night sweats.

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Liu Wei Di Huang Wan

Qi Ju Di Huang Wan

|Common Symptoms

Clinical description:

Sallow complexion, fatigue, poor appetite, soreness and pain in the lower back and knees, red tongue with scant coating, thin and weak pulse

Plain-language explanation:

Your face may look yellowish and dull, with a sallow appearance.
You may feel tired and weak, with a poor appetite and little interest in eating.
Your lower back and knees may feel sore and painful, especially with activity or prolonged sitting.
Your tongue may look red, with very little coating.
Your pulse may feel thin and weak.

|Treatment Approach

Clinical description:

Tonify the liver and kidney; strengthen the spleen and boost qi

Plain-language explanation:

Support the liver and kidney, with the aim of easing dizziness, soreness and weakness in the lower back and knees, tinnitus, or forgetfulness.
Support healthy spleen and stomach function and replenish qi, with the aim of easing poor appetite, fatigue, or loose stools.

|Related Products

|Common Symptoms

Clinical description:

Sensitivity to cold with cold limbs, vexing heat in the palms, soles, and chest, dry mouth and throat, soreness and weakness in the lower back and knees, pale tongue with teeth marks, deep and thin pulse

Plain-language explanation:

You may feel cold, with cold hands and feet that are slow to warm up.
Your palms, soles, and chest may feel hot, and you may feel restless and unable to relax.
Your mouth and throat may feel dry, especially when speaking or swallowing.
Your lower back may feel sore and your knees weak, making walking or prolonged sitting difficult.
Your tongue may look pale, with tooth marks along its edges.
Your pulse may be detectable only with deep pressure and may feel thin and weak.

|Treatment Approach

Clinical description:

Tonify the kidney and replenish essence; boost qi and strengthen yang

Plain-language explanation:

Support the kidney and replenish essence, with the aim of easing soreness and weakness in the lower back and knees, tinnitus, forgetfulness, or memory difficulties.
Support qi and yang, with the aim of easing sensitivity to cold, cold limbs, fatigue, or reduced sexual function.

|Related Products

|Common Symptoms

Clinical description:

Restlessness and oppression in the chest and epigastrium, epigastric and abdominal distention, poor appetite and nausea, bitter and sticky taste in the mouth, dark yellow or turbid urine, or hematuria, sticky stools, red tongue with yellow greasy coating, soggy and rapid or slippery and rapid pulse

Plain-language explanation:

Your chest and upper abdomen may feel oppressed and uncomfortable, with noticeable abdominal fullness and distention that may not ease with activity.
Your appetite may be poor, and you may feel nauseated or as if you might vomit.
Your mouth may taste bitter and feel sticky or unpleasant.
Your urine may look dark yellow or reddish, or cloudy; in more severe cases, it may contain blood.
Your stools may feel sticky and difficult to pass, with a sense of incomplete evacuation.
Your tongue may look red with a thick, yellow, greasy coating.
Your pulse may feel soft and rapid, or slippery and rapid.

|Treatment Approach

Clinical description:

Clear and drain damp-heat; resolve toxins and reduce swelling

Plain-language explanation:

Support clearing internal damp-heat, with the aim of easing bodily heaviness, a bitter taste, dark urine, or difficulty urinating.
Support resolving toxins and reducing swelling, with the aim of easing red, swollen sores, sore throat, or skin lumps.

|Related Products

|Common Symptoms

Clinical description:

Edema of the face and limbs, heaviness of the limbs, chest oppression, abdominal distention, nausea, vomiting, and diarrhea, thirst without desire to drink, pale and enlarged tongue, white greasy coating, soggy and moderate pulse

Plain-language explanation:

Your face and limbs may become swollen, with noticeable puffiness and tightness.
Your body may feel heavy and tired, with heavy limbs and less strength during activity.
Your chest may feel tight and uncomfortable, with a sense of restricted breathing or movement.
Your abdomen may feel full and distended, especially after eating or sitting for a long time.
You may feel nauseated or vomit and may also have diarrhea, with more frequent bowel movements.
Your mouth may feel dry or thirsty, but you may not want to drink, and drinking may not relieve the thirst.
Your tongue may look pale and enlarged, appearing thick and swollen.
A white, greasy coating may cover your tongue.
Your pulse may feel soft and relatively slow.

|Treatment Approach

Clinical description:

Warm yang and transform qi; drain dampness and promote urination

Plain-language explanation:

Support warming yang and promoting qi transformation, with the aim of easing sensitivity to cold, cold limbs, soreness and weakness in the lower back and knees, or fatigue.
Support the elimination of dampness and movement of fluids, with the aim of easing difficulty urinating, swelling in the lower limbs, or bodily heaviness.

|Related Products

Wu Ling San

|Common Symptoms

Clinical description:

Abdominal masses or fixed lumps, dull complexion, low back pain, numbness or stabbing pain in the limbs, rough scaly skin. Dark-purple tongue with stasis spots or patches, purplish and distended sublingual veins, choppy or thin and choppy pulse

Plain-language explanation:

You may feel a hard lump or mass in your abdomen that persists and does not easily go away.
Your complexion may look dark and dull, without its usual brightness.
Your lower back may hurt, especially with activity or prolonged sitting, and the pain may interfere with bending or turning.
Your limbs may feel numb or have a pins-and-needles or stabbing sensation.
Your skin may feel dry and rough, with an uneven, scale-like appearance.
Your tongue may look dark purple and dull.
Purple stasis spots or patches may be visible on the tongue.
The veins beneath your tongue may look dark purple, enlarged, and prominent.
Your pulse may feel choppy, or thin and choppy, rather than smooth.

|Treatment Approach

Clinical description:

Invigorate blood and dispel stasis

Plain-language explanation:

Support blood circulation and resolve stasis, with the aim of easing painful bruising, localized swelling or hardness, or difficulty with menstrual flow.
Support healthy blood circulation, with the aim of easing a dull complexion or joint pain.

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References

Ge Junbo, Xu Yongjian. Internal Medicine [M]. 8th ed. Beijing: People’s Medical Publishing House, 2014: 524–525.
Zhi-Hong Liu. Nephrology in China [J]. Nature Reviews Nephrology, 2013, 9(9): 523–528.
He Liqun. Interpretation of the TCM Clinical Diagnosis and Treatment Guidelines: Kidney and Bladder Volume [M]. Beijing: China Press of Traditional Chinese Medicine, 2015: 149–152.
Lai Weijing, Liu Fang, Fu Ping. Interpretation of clinical practice guidelines for the evaluation and management of chronic kidney disease—from K/DOQI to KDIGO [J]. Chinese Journal of Practical Internal Medicine, 2013, 33(6): 448–453.
Nephrology Committee of the Chinese Association of Integrative Medicine. Guidelines for the integrated traditional Chinese and Western medicine diagnosis and treatment of chronic renal failure [J]. Chinese Journal of Integrated Traditional and Western Medicine, 2015, 35(9): 1029–1033.
Ministry of Health of the People’s Republic of China. Guiding Principles for Clinical Research on New Traditional Chinese Medicines [M]. Beijing: People’s Medical Publishing House, 2002: 163–166.
Medical Administration Department, National Administration of Traditional Chinese Medicine. TCM Clinical Diagnosis and Treatment Plans for 95 Diseases in 22 Specialties [M]. Beijing: China Press of Traditional Chinese Medicine, 2010: 203–217.
Chinese Medical Association. Clinical Diagnosis and Treatment Guidelines: Nephrology Volume [M]. Beijing: People’s Medical Publishing House, 2011: 219–221.
Zhao Jing, Liu Baoli, Zhang Shengrong, et al. Analysis of the current status of Chinese patent medicines for chronic renal failure [J]. Beijing Journal of Traditional Chinese Medicine, 2014, 33(5): 368–370.
Tian Peng, Wang Quan, Li Lu, et al. A systematic review of Niaoduqing for the treatment of chronic kidney disease [J]. Journal of Liaoning University of Traditional Chinese Medicine, 2010, 12(3): 63–67.
Li Yanfeng, Li Jun, Li Qi. Clinical study of Haikun Shenxi Capsules for chronic renal failure with the dampness-turbidity pattern [J]. Pharmacology and Clinics of Chinese Materia Medica, 2015, 31(4): 273–274.
Liu Zehui, Zhang Yatong, Hu Xin. A systematic review of the efficacy of Bailing Capsules for chronic renal failure [J]. Journal of Clinical Drug Therapy, 2017, 15(2): 37–42.