Therapeutic Use of Traditional Chinese Herbal Medications for Chronic Kidney Diseases

Yifei Zhong; Yueyi Deng; Yiping Chen; Peter Y. Chuang; John Cijiang He


Kidney Int. 2013;84(6):1108-1118. 

In This Article

General Therapeutic Principles of TCM

The overarching principle in the practice of TCM is the focus on individual assessment and treatment to coordinate the natural balance of the Yin and Yang, which are two major opposing forces of the body represented in the ancient Chinese Taoism philosophy. TCM posits that disease of the body arises from an imbalance within the body and between the body and the nature, leading to an alteration in the entire body system.

The syndrome differentiation and treatment approach is a principle that has been used to understand, diagnose, and treat diseases based on the theories of TCM. The diagnostic procedure involves an analysis of the clinical data regarding symptoms, physical signs, and disease history, together with information obtained from application of the four diagnostic methods, which consist of inspection, auscultation and smelling, inquiry, and pulse-taking and palpation (see Table 1 ). These four diagnostic methods allow the differentiation of syndromes, which in turn dictates the approach to clinical treatment. The patient's response to a specific clinical treatment plan then informs the correctness of the deduced differentiation. These three key aspects of the syndrome differentiation and treatment approach form the basis of diagnosis and treatment in TCM.

In the practice of TCM, it is generally considered that multiple herbal medications are more effective than a single herbal agent. Therefore, prescriptions of TCHMs usually combine several herbs in which a few components contribute to the main effect of the prescription, and these herbs are referred to as 'ruler drugs.' In addition, another group of herbs known as 'minister drugs' provide an additive effect to the 'ruler drugs,' and the remaining constituents of the herbal prescription are called 'assistant drugs and messenger drugs.' Physicians practicing TCM usually prescribe formulas that combine several types of herbs or minerals, where one herb represents the principal component and others serve as adjunctive agents, assisting the effects or facilitating the delivery of the principal component. In China, more than 3200 herbs and 300 mineral and animal extracts are used in more than 400 different formulas.[5] Adjustment of individual components of the herbal prescription by the practitioner is based on patients' signs and symptoms, with an overall goal of restoring the balance of Yin and Yang. At each follow-up visit, physicians usually change either the herbal components or their relative percentage in the prescription.

Differences in the practice and principles of TCM and western medicine are summarized in Table 1 . These differences largely stemmed from their different historical backgrounds. Concepts of TCM related to organ function, disease pathogenesis, and treatment approach were formulated in the absence of our current molecular understanding of disease and were deeply influenced by social, religious, and cultural factors in these historical periods. One can debate the validity and scientific merits of the TCM approach. However, one should not immediately discount the empiric knowledge accumulated over centuries of treating patients with different decoctions of herbal mixtures. With recent integration of TCM and western medicine, diagnosis of CKD by practitioners of TCM has supplemented traditional diagnostic approach with western molecular and imaging diagnostic tools. The current treatment of CKD in TCM is often achieved by combining TCHMs and western pharmacologic agents. Owing to the rapid economic growth and scientific development over the past decade, the Chinese government has supported studies to examine the scientific basis of TCM using advanced cell and molecular biology approaches. A rapid development of TCM is expected over the next decade.