Treating Chronic Kidney Disease from the Perspective of Blood Stasis Syndrome Using the"Six Differentiations"Framework
Chronic kidney disease(CKD)is characterized by a complex mix of deficiency and blood stasis,with blood stasis running throughout the disease progression.Treating CKD from the perspective of blood stasis is critical,but clinical practice should not rely solely on activating blood and removing stasis when signs of stasis appear.Instead,treatment should follow the principle of"six differen-tiations":differentiation of mechanism,location,tendency,constitution,timing,and manifestations.Differentiation of mechanism refers to understanding the disease mechanism.The formation of stasis in CKD is due to both deficiency and excess.When stasis arises from defi-ciency,treatment should focus on tonifying deficiency and resolving stagnation based on qi,blood,yin and yang deficiency conditon,u-sing such formulas as Yang-Supplementing and Five-Returning Decoction,Four Substances Decoction,Effective Integration Decoction,or drugs such as Huangqi(Radix Scutellariae),Danggui(Radix Angelicae Sinensis),Jixueteng(Caulis Spatholobi),etc.When stasis ari-ses from excess,the nature of the pathogenic factor and concurrent symptoms must be identified,using formulas such as Chinese Angeli-ca Frigid Extremities Decoction,Rhinoceros Horn and Rehmannia Decoction,Trichosanthes and Chinese Chive and Pinellia Decoction combined with Salvia Beverage,etc.Differentiation of location identifies the site of the disease.In CKD,the primary location is the kid-ney,with kidney deficiency and collateral blood stasis as the core pathology.Treatment follows the principle that"old stagnation should be removed,and stasis in the collaterals is dispersed by acrid agents"and adopts the"acrid and moistening dispersion"method.Differ-entiation of tendency examines the prognosis of the disease.In acute cases,expelling the pathogen takes precedence,while in chronic ca-ses,harmonizing yin and yang and strengthening healthy qi are emphasized.Differentiation of constitution refers to classifying body types based on Professor Kuang Diaoyuan's typology,including normal,turbid-sticky,dry-red,slow-cold,and fatigued-pale types,with individ-ualized treatments provided for each.Differentiation of timing aligns treatment with seasonal changes,following the principles of"spring birth,summer growth,autumn harvest,and winter storage,"and adjusts proper formulas based on the severity of stasis according to the current season.Differentiation of manifestations focuses on identifying specific clinical signs,including symptoms,physical signs,and modern physical and chemical examinations,to determine stasis patterns and select appropriate formulas and drugs.
chronic kidney disease(CKD)stasis syndrome"six differentiations"differentiation of mechanismdifferentiation of loca-tiondifferentiation of tendencydifferentiation of constitutiondifferentiation of timingdifferentiation of manifestations
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