Treatment of Henoch-Schönlein Purpura Nephritis with Traditional Chinese Medicine: A Holistic Approach

Henoch-Schönlein purpura nephritis (HSPN), a form of immunoglobulin A (IgA) vasculitis affecting the kidneys, presents unique challenges in both Western and Eastern medicine. In traditional Chinese medicine (TCM), treatment is highly individualized, focusing on restoring balance within the body's internal systems. Rather than targeting symptoms alone, TCM addresses the root patterns of disharmony, adapting therapy according to the patient's specific stage and presentation of the disease.

Pattern-Based Treatment Strategies in TCM

One of the core principles of TCM is pattern differentiation—identifying the underlying energetic imbalance causing illness. For HSPN, practitioners typically classify cases into four primary syndromes, each requiring a distinct therapeutic approach:

1. Syndrome of Heat-Toxin Damaging the Collaterals

This pattern often appears in the early, acute phase of HSPN, characterized by skin rash, joint pain, abdominal discomfort, and hematuria due to excessive heat invading the blood level. The treatment principle focuses on clearing heat, detoxifying the system, cooling the blood, and stopping bleeding. A commonly prescribed formula is Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), modified with additional herbs like moutan cortex and gardenia to enhance its cooling and anti-inflammatory effects.

2. Syndrome of Yin Deficiency with Internal Heat

In prolonged or recurrent cases, patients may develop signs of yin deficiency—such as afternoon fever, night sweats, dry throat, and persistent microscopic hematuria. Here, the strategy shifts to nourishing yin while clearing deficient heat. Zhibai Dihuang Tang (Anemarrhena, Phellodendron, and Rehmannia Pill) is frequently used, combining kidney-yin tonics with mild heat-clearing agents to restore fluid balance and reduce vascular fragility.

3. Syndrome of Heart and Spleen Deficiency

When chronic bleeding leads to fatigue, poor appetite, palpitations, and pale complexion, TCM identifies this as a dual deficiency of the heart and spleen. The spleen governs blood containment, and when weakened, it fails to "hold" the blood in vessels. The classic remedy includes Guipi Tang (Restore the Spleen Decoction) combined with Danggui Buxue Tang (Tangkuei and Astragalus Decoction) to strengthen the spleen, enrich the blood, and improve overall vitality.

4. Syndrome of Qi Deficiency with Blood Stasis

In more advanced or lingering cases, impaired circulation and sluggish blood flow result in stasis, contributing to proteinuria and declining kidney function. This condition calls for a dual approach: invigorating blood and resolving stasis while reinforcing qi. Taosihua Siwu Tang (Peach Blossom Four-Substance Decoction) is enhanced with Huangqi (astragalus), Dangshen (codonopsis), and Danshen (salvia) to boost energy, promote microcirculation, and protect renal tissue.

The Role of Modern Herbal Research in Kidney Protection

Beyond classical formulas, modern pharmacological studies support the use of specific herbs like Chuanxiong (Ligusticum chuanxiong) in managing HSPN. Chuanxiong has been shown to inhibit platelet aggregation, reduce whole blood viscosity, and enhance red blood cell flexibility. These actions help prevent microthrombi formation in glomerular capillaries, improving renal perfusion. Additionally, its ability to dilate small arteries supports better oxygen delivery to damaged kidney tissues, facilitating repair and reducing inflammation.

Integrating such evidence-based herbal actions into personalized TCM protocols allows clinicians to address not only the systemic manifestations of HSPN but also the microvascular dysfunction that underlies progressive kidney injury.

Conclusion: A Complementary Path to Recovery

While conventional treatments for HSPN often rely on corticosteroids and immunosuppressants, TCM offers a complementary framework emphasizing balance, prevention, and long-term resilience. By tailoring herbal prescriptions to evolving patterns and incorporating herbs with scientifically supported benefits, practitioners can support renal recovery while minimizing side effects. As global interest in integrative medicine grows, the role of TCM in autoimmune and inflammatory kidney conditions continues to gain recognition in holistic health communities worldwide.