In the majority of medical disciplines, the pattern is quite obvious:
- When a patient is in less than optimal health or at the early stages of disease, and Western diagnostic indices are normal, TCM diagnostic methods may reveal bodily imbalances, thus positioning it as a preventive care leader.
- In a short and very efficient intervention, a disaster or a severe emergency case, Western medicine always comes out on top.
The essence of it is typically conveyed as: “TCM prevents disease, Western medicine treats established disease.”
Nonetheless, nephrology flips this position in the most interesting way:
Phase 1: Early-Stage Kidney Disease
Western Medicine’s Dominance
On the initial diagnosis, most kidney patients have normal renal function but show proteinuria.
Western treatments usually consist of:
- Corticosteroids and immunosuppressants
- Antihypertensives (ACE inhibitors, ARBs)
- SGLT2 inhibitors (e.g., dapagliflozin)
- MRAs (e.g., finerenone)
- For nephrotic syndrome: diuretics, lipid-lowering agents
Traditional Chinese Medicine (TCM) prescriptions can lower proteinuria by approximately 50%, but this is the same level of reduction that one Western drug can achieve. The combination of Western drugs usually leads to additive effects, and in some regimens, the reduction of protein can be more than 90% (although with more side effects) is possible.
One
Global nephrology research is largely devoted to proteinuria reduction. The drug regulators (FDA, EMA, etc.) approve new kidney drugs mainly on the basis of proteinuria results, thus they accept trials with delayed hard renal endpoints indirectly.
Phase 2: Advanced Renal Failure
TCM’s Therapeutic Advantage
The events of renal failure are:
- Pathologically: Occlusion of millions of renal microvessels (5μm diameter)
- Clinically: Toxin accumulation (creatinine, BUN) causing systemic illness
The situation is quite different from that of the coronary arteries where stents work, and hence microvascular occlusion is not suitable for such method but for TCM’s approach only: - Herbal formulas promoting blood circulation
- Collateral vessel activation
- Clinical evidence shows partial renal function recovery
In this way comes the unique reversal of nephrology:
Western medicine prevents progression, TCM treats established renal failure.
(Note: For end-stage cardiovascular complications—the leading cause of death—Western emergency care is still the first line of treatment.)
Collaborative Opportunities
The advantages of the physician’s role reversal are not simply good or bad but encompass a range of possibilities:
For TCM Practitioners:
- Adopt Western diagnostic precision (e.g., molecular biomarkers)
- Develop targeted herbal combinations for proteinuria pathways
- Advance objective treatment efficacy measures
For Western Nephrologists:
- Invest in macrovascular/interventional approaches
- Investigate various physical therapies for treating microvascular occlusion
- Create renal-specific revascularization surgical procedures
Once these two mechanisms consider their downsides, we shall witness such a drop in the incidence of ESRD that will be very pronounced.
About the Author
Dr. Shi Wei
- Chief Physician & Medical Director
- Professional Affiliations:
1) Committee Member, Chinese Society of Nephrology
2) Executive Committee, Hebei Association of Traditional Chinese Medicine Nephrology - Research Focus:
- Herbal formulations for chronic kidney disease
- Acupuncture point therapies for polycystic kidney disease
For appointments, email Dr. Shi at shiwei.tcm@gmail.com.
Key Adaptations for American Readers:
- Substituted bureaucratic references (Chinese FDA) with global equivalents
- Decremented the complexity of TCM technical terms without losing the essential core
- Converted measurement units (μm instead of “1/200 mm”)
- Omitted China-specific contact methods
- Highlighted the evidence-based part of TCM
- Kept all the original visuals with added explanations to help readers understand the cultural context
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