This document discusses how traditional Chinese medicine approaches chronic kidney disease. It provides an overview of nephrology's cultural development and some nephrotoxic herbs. Traditional Chinese medicine treatments for kidney disease include acupressure, acupuncture, single herbs like Cordyceps sinensis and Salvia miltiorrhiza, and herbal formulas like Chai Ling Tang and Jin Gui Shen Qi Wan. Each treatment modality is described along with its benefits for conditions like fatigue, proteinuria, and slowing kidney disease progression. The document concludes with references.
2. Overview
Cultural Development of Nephrology
Aristolochic Acid and Chinese Herbal
Nephropathy
Nephrotoxic over the counter herbs
Traditional Chinese medicine’s treatment of
kidney disease
Acupressure
Acupuncture
Single Herbs
Formulas
2
14. Nephrotoxic Over the Counter Herbs
14
Pyrrolizidine Alkaloid Containing Species6
• Borage (Borago officinalis)
• Comfrey (Symphytium species),
• Coltsfoot (Tussilago farfar),
• Liferoot (Senecio aureus).2
Chinese herbs that contain pyrrolizidine alkaloids are:
• Kuang Dong Hua (Flos Tussilaginis farfarae),
• Pei Lan (Herba Eupatorii fortunei),
• Qian Li Guang (Senecio scandens),
• Zi Cao (Radix Arnebiae seu Lithospermi)3
15. Nephrotoxic Over the Counter Herbs
15
Herbal Aquaretics2
• Tian Men Dong (Tuber Asparagi cochinchinensis)
• Gan Cao (Radix Glycyrrhizae uralensis),
• Horseradish(Radix Armoracia rusticana),
• Juniper berry(Fructus Juniperus communis),
• Lovage root (Radix Levisticum officinale),
• White sandalwood (Santalum album),
• Watercress (Nasturtium officinale)
16. Nephrotoxic Over the Counter Herbs
16
Licorice (Radix Glycyrrhizae uralensis) 2,4,5
Commonly given in formulas
and as a single herb.
Excessive licorice consumption
can lead to pseudoaldosterism
17. Nephrotoxic Over the Counter Herbs
17
Ephedra (Herba ephedra) 2,4,7
Increases blood pressure
Potentially contributes to kidney
stones
18. Nephrotoxic Over the Counter Herbs
18
St. John’s Wort (Hypericum perforatum) 4,8
Competes with immunosuppressive
Drugs
Also changes how immunosuppressive
drugs are broken down and their
byproduct
20. Acupressure
20
Acupressure is the manual administration
of force to an acupuncture point or channel
by a finger, hand, elbow, or other
instrumentation.
29. 29
Cordyceps sinensis
Inhibits Inflammatory Pathway of Kidney Disease31
Prevents Nephrotoxicities31,32,33,34,35,36,37
Slows Progression of Chronic Kidney Disease38,39,40
Ameliorates Damage from ischemia reperfusion41,42,43
30. 30
Tryptergerium Wilfordii
• Acts a potent Immunosuppressant
• Decreases Proteinuria in multiple forms of chronic kidney disease 48
Nephrotic Syndrome 44,45
IgA Nephropathy 46
Potential therapy for renal transplant 47
31. 31
Salvia miltiorrhiza
Decreases proteinuria, glomerular sclerosis, and tubular interstitial lesions by inhibiting
TGF-Beta 49,50,51,52
Lowers BUN and Scr in CKD patients49,50,51,52
Inhibits ROS by Increases serum SOD and catalase49,50,51,52
Lowers blood pressure, via ACEi, atrial natriuretic peptide, eNOS 53,54
Increases renal blood flow51
Acts as a xanthine oxidase inhibitor, prevent gout55
37. 37
Chai Ling Tang
Reduces autoimmune response in diseases such as rheumatoid arthritis 66
Reduces chances of acute rejection in kidney transplant. Every herb in this formula
is important in it’s anti-rejection capability 84
Reduces proteinuria in acute glomerulonephritis (Lupus and IgA) 49,63,64,65
Decreases proliferation of mesangial cells and inhibits progression of renal damage
during acute kidney diseases 49,63,64,65
Alters immune function – prevents alloimmune and autoimmune spontaneous
abortion 67
38. 38
Jin Gui Shen Qi Wan
Decreases Renal Oxidative Stress and dyslipidemia 68,69,70,71,72
Decreases Blood Pressure 73,74
Ameliorates diabetic nephropathy 75,76,77,78,79,80,81,82,85
Decrease renal hypoxia damage 83
39. 39Dang Gui Bu Xue Tang
Decreases glomerular tubulointerstitial injury via inhibition of TGF-Beta86
Decreases Extra Cellular Matrix precursors via activation of VEGF 87
Increases renal protective effect of enalopril88
Decreases vasopressin does not act as a ACEi 88
Induces EPO expression via HIF pathway 89
Decreases hyperlipidemia and proteinuria in nephrotic syndromes50,90
Unique preparation accounts for bioactivity of formula (5:1) 91,92
Thereby disease of the kidney are available, schistosomiasis very common. As is hieroglyphic description of urinary diseases
Jade stone -
Ruling kingdom grew all species of medically usefully plants near temples
Balkan Endemic Nephropathy
Aristilochia species was growing in wheat fields
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Herbs that contain pyrrolizidine alkaloids (PA) have potential to cause veno-occlusive liver damage. Usually reported as a potent carcinogen because of animal studies, no clinical associations have been found in humans.204 Commonly found PA containing herbs are borage (Borago officinalis) comfrey (Symphytium species), coltsfoot (Tussilago farfar), and liferoot (Senecio aureus).66 Chinese herbs that contain PA’s are Kuang Dong Hua (Flos Tussilaginis farfarae), Pei Lan (Herba Eupatorii fortunei), Qian Li Guang (Senecio scandens), and Zi Cao (Radix Arnebiae seu Lithospermi).205
Certain herbs are aquaretics, which causes polyuria without excretion of metabolites. Volatile essential oils of aquaretics cause irritation of the epithelial lining in the kidney. This irritation decreases reabsorption of water in the renal tubules. The following herbs are aquaretics and should be avoided with CKD
Gan Cao (Radix Glycyrrhizae uralensis) contains a chemical compound called glycyrrhizin, which is converted to glycyrrhetinic acid (GA) within the intestines. GA allows excessive cortisol to bind to mineralocorticoid receptors resulting in a pseudoaldosterism. Observable symptoms include high blood pressure and hypokalemia. Very high amounts would need to be taken to be lethal but in patients with CKD this threshold is much smaller.66,196,197
Ma Huang (Herba Ephedra) contains an alkaloid ephedrine, which increases blood pressure. 66,196 Ephedrine can also a contributor to kidney stones with the compound being found in examination of 166,466 stones.198
St. John’s Wort (Hypericum perforatum) competes with medications because it is metabolized by the same enzymatic pathway in the liver (CP450). Patients who are on life saving immunosuppressive drugs cannot risk the chance of their medication not working.196 Cyclosporin A (CSA), often used as a immunosuppressant in transplant patients, when combined with St. John’s Wort was found to not only cause CSA concentration to decreased in the person but the active metabolites were altered thereby changing it’s pharmacokinetics.196,199
Fatigue: Using acupuncture points KD-1 (Yongquan), St-36 (Zusanli), GB-34 (Yanglingquan), and SP-6 (Sanyinjiao) in ESRD patients acupressure was able to decrease and manage patients fatigue. Treatment protocol required acupressure of each point for 3 minutes, 3 times a week, for 4 weeks.37 In a different protocol, Englence, R et al.,190 used the same point set but with hemodialysis patients. Rather than using manual manipulation of the points they used a TENS unit. Outcomes showed that overall pain was decreased after 4 weeks of treatment while the control groups, who received no acupressure, pain was worsened. Same was found to be true for fatigue using the PFS
Insomnia: Sleep disturbances are frequent and common in patients with ESRD. Being reported in up to 80% of patients. The range of symptoms vary from difficulty falling asleep, staying asleep, waking early, restless legs, and jerking legs.248 Decreased quality of sleep can lead to lower quality of life and decreased pain tolerance during the day.251 Acupressure on HT-7 (Shenmen), Shenmen point in the ear, and KD-1 (Yongquan). Three minutes of acupressure per point. Results indicated that sleep issues started to improve after the first treatment then throughout treatment. Improvement is speculated to have been caused by the decrease in cortisol and the increase in serum serotonin levels.247,68
Pruritus: Itching can be so severe that multiple suicide reports have been documented or the loss of life by the discontinuation of dialysis.250 Acupressure (actually TENS) on the acupoints LI-11 (Quchi), SP-10 (Xuehai), ST-36 (Zusanli), and SP-6 (Sanyinjiao), 3 times a week for 6 weeks. This treatment was effective in reducing frequency and severity of uremic pruritus in hemodialysis patients. The positive effects lasted up to 18 weeks after the initial treatment. Treatment group was also found to have taken less medication than the control.179
Diabetic Neuropathy: Acupressure was applied by a trained professional for 90 minutes, 4-6 times a week, for 3 years. 249
Bob Wong Acupuncturist Sydney Australia
Amrit Singh Tonronto Canada
Decrease Blood Pressure3
Slow progression of Kidney Disease4,77,131
Pruritus135,
Diabetic Neuropathy253
Decreases sympathetic nerve activity
in kidney78,134,189,
Pain Management109,132,
Alters Blood Flow to Kidney133,194
7 steps and die – folk name
Unique preparation accounts for bioactivity of formula (5:1) 88,101
Story of APOL-1
“Infectious disease is a major force of natural selection in humans, often resulting in a high frequency of genetic variants that are protective against infection but that might also cause disease. J.B.S Haldane phrased evolutionary adaptation of this kind as “temporarily successful acquisitions of immunity” owing to its cost to carriers’ health.”162
A genetic sweep occurred 3 to 10 thousand years ago in Eastern African populations.144 The parasitic protozoa, Trypansoma brucei rhodesiense, that causes sleeping sickness (a fatal disease) was epidemic in scope. Luckily a small proportion of the population had a genetic variant in which their DNA produced a unique protein called apolipoprotein L1 (APOL-1). This protein was adaptive because it caused the lyses of trypansoma brucei rhodesiense. Thereby sparing the persons life but at a cost. There was trade off for this protection. An increased susceptibility to chronic kidney disease.162
This genetic feature was first found in 2008. It was previously known that people of African ancestry have an increased chance of kidney disease and an even greater increase in severity and progression of kidney disease. A percentage of this population did not respond to preventative angiotensin converting enzyme inhibitor (ACEi) therapy intended to lower blood pressure, inhibit transcription growth factor beta (TGF-B), and decrease mean arterial pressure in the kidney.144 The cause of this slow progression of kidney disease was found to be a variation in chromosome 22, G1 and G2 alleles. This unique genetic sequence caused the podocytes in the kidney to produce APOL-1. Even though the exact mechanism on how APOL-1 leads to progressive nephropathy growing consensus believes it has some relation to the podocytes.177
Similar to how sickle cell anemia creates immunity to malaria. APOL-1 genetic factor gives immunity to sleeping sickness. When treating people with kidney disease understanding that profound genetic variances occur in CKD could drastically change a Chinese medical treatment. For instance, up to 20% of African Americans have this genetic sequence yet Apol-1 is virtually absent European or Asian ancestry.177 Traditional Chinese medicines that have been shown to be beneficial for the kidney and lower blood pressure may not have the same effect in a person from recent African ancestry.
