CHEN Shijun，GU Di，L.J.TAY，Robert GRAY，JING Tao，CHEN Dingnan，ZHENG Shaobin，Peter THOMPSON

臨床研究

A history of tranditional Chinese medicine and its current role in urolithiasis

CHEN Shijun1，GU Di1，L.J.TAY2，Robert GRAY2，JING Tao3，CHEN Dingnan1，ZHENG Shaobin1，Peter THOMPSON2

1Department of Urology，Nanfang Hospital，Southern Medical University，Guangzhou 510515，China；2Department of Urology，King's College Hospital，London WC2R 2LS，UK；3Department of Urology，The Affiliated Hospital of Qingdao University，Qingdao 266003，China

Objective To trace the history of TCM，its concept and the evaluate its role in the management of renal stones. Methods References were retrieved following a thorough bibliographic search using OVID Medline，EMBASE，Cochrane Database.Keywords used included‘traditional chinese medicine'，'urolithiasis'，'calculi'，'herbal medicine'，'kampo'，'kidney'. Relevant review articles，case reports，books were considered along with resources from the Wellcome Trust Collection，Royal Society of Medicine，London.Results TCM has been in existence for over 2500 years.It broadly consist of acupuncture，herbal medicine，tuina（massage）and qi gong.The earliest documentation of Chinese herbal medicaments is in the‘Shen Nung Benchau Jing'，believed to be compiled during the Han Dynasty.Historically，it had an extensive role in treatment of chronic diseases，and has been widely used in China and Japan（known as Kampo）for 10 decades，until the introduction of Western medicine in the late 1800s.TCM is popular within urology，including herbal'ginseng'for the treatment of erectile dysfunction，acupuncture and herbal therapy for overactive bladder and renal stones.In TCM，dysfunction of Qi in the bladder causes damp-heat to diffuse downward and accumulate in the urinary system，over time causing calculus formation.Urolithiasis causing obstruction is believed to block the flow of Qi and therefore result in pain.Haematuria is attributed to the calculus injuries to the meridian.Currently，there is limited but growing evidence based literature on the role TCM in the prevention and treatment of stones.The Chinese State Medicine Administration Bureau issued guidelines in 1994 for management of urolithasis. It categorized it into four syndromes，each with different modes of treatment（Damp heat retention syndrome，qi-stagnation blood stasis syndrome，kidney ying deficiency syndrome and kidney yang deficiency syndrome）.Recent evidence showed that medicinal herbs are known to effectively increase the rate of calculus passage，decreased the complications of urolithasis，which indirectly reduces hospitalisation and cost.Conclusion From its primitive roots in China，TCM now has a global influence，and we need to recognise the complementary role it plays in urological practice.

urolithiasis；tranditional Chinese medicine；treatment

In China，traditional Chinese medicine（TCM）has been used more than thousands of years dealing with human treatment and prevention of diseases.This essay is going to briefly introduce the treatment of urolithiasis in TCM and its mechanism which has been proved under modern scientific research.

TCM is a unique，integral system which was generated through the experience of the Chinese people in their long struggle against diseases.Its theoretical system was greatly influenced by ancient Chinese materialism and dialectics.Briefly speaking，TCM takes the four diagnostic methods:inspection，auscultation and olfaction inquiry，pulse-taking and palpation as its principletechniques，usingthedifferentiationof syndromes which based on the theory of‘Zang-Fu'，‘Six-Meridian'and‘Wei，Qi，Ying and Xue'as its guideline and basic theories.Its therapeutic principles are‘treating aiming at its pathogensis'，‘strengthening vital Qi to eliminate pathogenic factor”，”coordinating yin and yang”and“treatment in accordance with seasonal conditions，local conditions and patients individuality”.

MATERIALS AND METHODS

References were retrieved following a thorough bibliographic search using OVID Medline，EMBASE，CochraneDatabase.Keywordsusedincluded ‘traditional chinese medicine'，‘urolithiasis'，‘calculi'，‘herbal medicine'，‘kampo'，‘kidney'.Relevant review articles，case reports，books were considered along with resources from the Wellcome Trust Collection，Royal Society of Medicine，London.

RESULTS

Urolithiasis is called“stone urinate”in TCM references.Symptoms of this disease include stone in urine，painful urination，and lower abdominal pain with radiation to the umbilical region.TCM believes that its pathogenesis is the dysfunction of Qi in bladder，making the damp-heat diffuse downward and accumulate in urinary system，and then affect the urine and gradually form the calculus in kidney，ureter and bladder.Whenthe urinary tract is blocked，the Qi-flowing is then obstructed and generate pain.When the calculus injury the meridian，the blood come out from the impaired meridian and cause hematuria.

In many Chinese societies，medicinal herbs are widelyusedinthepreventionandtreatmentof urolithiasis.In 28 Jun 1994，“State Chinese Medicine AdministrationBureau”inChinahasissuedthe guideline of“stone urinate”and classified it into four different sub-types as follows: Damp-heat Retention Syndrome

Clinical features:lumbago or lower abdominal pain，or interruption of urinary flow，urinary frequency，urgency，painful urination，cloudy urine or hematuria；can associated with aversion to cold，fever，thirsty，red tongue，yellow and greasy of tongue-coating，wiry and hasty pulse.

Management:clearing heat and draining damp，relieving strangury and removing calculus.

Representative prescription and formula:”Sanjing remove calculus decoction”（herbal composition can be adjusted according to syndrome differentiation）:Desmodium 60 g，Lygodium 60 g，Ventriculi galli mucosa 12 g，Plantago seed 12 g，Pyrrosia lingua 12 g，Chingma abutilon seed 9 g，Talcum（bag）15 g.

Qi-stagnation Blood Stasis Syndrome

Clinical features:Disease progress rapidly，lumbar and abdominal colic pain with radiation to the perineal region，urinary frequency，urgency，yellow or red urine，deep-red tongue or ecchymosis on the tongue，wiry or choppy pulse.

Management:regulatingtheflowofQiand activatingblood，relievingstranguryandremoving calculus.

Representativeprescriptionandformula:”Jinglingzi powder mix with Shiwei powder”:Chinaberry fruit 30 g，Corydalis tuber 30 g，Pyrrosia lingua 60 g，Zhai weat 30 g，Plantain seed 90 g，Chingma abutilon seed 60 g，Talcum 150 g.

Kidney Yin Deficiency Syndrome

Clinical features:lumbar and abdominal swelling pain or dull pain，dribbling and discomfortable urinate，yellow or red urine，associated with dizziness and tinnitus，insomnia and dreamful sleep，or dysphoria and chest plams-soles，dry eye，red tongue，thread and hasty pulse.

Management:nourishing yin and clearing heat，relieving strangury and removing calculus.

Representativeprescriptionandformula: “Zhibodihuang pill mix with Erzhi pill”:Fructus ligustri lucidi 30 g，herba celiptae 30 g，Rehmannia glutinosa libosach 15 g，Chinese yam 15 g，Asiatic cornelian cherry fruit 15 g，Rhizoma anemarrhenae 15 g，Poria cocos 15 g，Cassia twig15 g，The root of bidentate achyranrthes 15 g，Plantain seed 15 g，Tree peony bark 12 g，Licorice root 6 g. Kidney Yang Deficiency Syndrome

Clinical features:Urinary calculus with a long history，cannot be removed，lumbar swelling pain from time to time，exacerbation when overworked，uropenia，associated with lassitude and fatigue，or slight puffy swelling face，pale tongue，thin tongue-coating，thread and weak pulse.

Management:warming and recuperating kidney yang，relieving strangury and remove calculus

Representative prescription and formula:“Shenqi pill”:Desmodium 30 g，Lygodium 30 g，V entriculi galli mucosa 30 g，Astragalus membranaceus 30 g，Cuscuta chinensis 20 g，Pyrrosia lingua 20 g，fructus aurantii15g，Eucommiaulmoides15g，Salvia miltiorrhiza 15 g，Pangolin 15 g，Cistanche herba 15 g，Bighead atractylodes rhizome 15 g，Fructus psoraleae 10 g，Licorice root 6 g.

Intherecentyears，manymodernscientific researches，both in vivo or in vitro，have been applied to study the mechanism of how TCM's herbs work.For example，as a widely used herb for anti-urolithiasis，Desmodium can up-regulates urinary citrate excretion，promotes the formation of soluble calcium citrate which can consume calcium ions and therefore result in the reduction of urinary calcium.Also，its diuretic action can attenuate the concentration of Calcium and Oxalate andinhibitscrystalretention.Furthermore，the flavonoid in the extract of Desmodium can protect urinary epithelium cells against damage effect of ROS and the increased expression of Osteopontin［1］.We have abriefconclusionbelowaboutsomeofthe pharmacological actions of the medicinal herbs:（1）Desmodium styracifolium［2］，rhubarb［3］could increase ureteral peristalsis；（2）Desmodium styracifolium［4］，rhubarb［5］，the root of bidentate achyranthes［6］，bighead atractylodesrhizome［7］，Ericamultifloraflowers［8］，Cynodon dactylon rhizomes［9］，Poria cocos［10］have pharmacologic action of diuresis；（3）Plantain［11］，Alisma rhizome［12］，Desmodium styracifolium［13-14］，Orthosiphon stamineus and Cystone［15］could decrease calcium oxalatecrystallization；（4）Houttuyniacordata［16］，Sichuan lovage rhizome［17］，salviae miltiorrhizae［15］，Radix Paeoniae Rubra［16］，Desmodium styracifolium［1，17］possess pharmacologic action of antisepsis and anti-inflammation.

CONCLUSION

In the Chinese urology clinic，TCM's herbs are thought to be effectively increase calculi expulsion rate and decrease expulsion duration，complications，medical costs，and hospitalization rate.It currently plays as a synergistic role of the intracavitary minimally invasive surgery and ESWL in the treatment of urolithias.Since most of the active constituents of the medicinal herbs remain unclear，further research is needed to identify their biological activity and interaction.

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