| Chronic renal failure (CRF) is a syndrome consisting of a series of symptoms and metabolic disorder caused by progressive renal lesions based on primary or secondary chronic kidney deseases. The annual incidence of CRF is about 98-198 per million of population among natural people, according to a statistics by International Academy of Nephropathy .There are about 130 thousands of people to develop into patients of CRF, and there is almost the same amount of patients of CRF to develop into urinemia and need the therapy of hemodialysis. Therefore, there is a considerable significance of society to prevent and cure CRF actively and to delay its developing. The clinical practice has proved that the traditional Chinese medicine(TCM) has a superiority on the treatment of CRF, having a effect of relieving symptoms and delaying its developing before the stage of urinemia.The superiority of traditional Chinese medicine lies in determining treatment on differentiating syndromes of TCM, and the basis of determining treatment lies in differentiating syndromes of TCM. Only when the TCM syndromes of CRF are understood, can the good curative effect be achieved.The treatment on CRF by TCM has a time of several decades since literatures about treatment of CRF were reported. Modern TCM has a great deal of cognition on differentiating TCM syndromes and determing treatment of CRF, but all the achievements which are gained are summaries of personal experiences and the curative effect reports of small samples, or the reviewing summaries of clinical case files. The study on TCM syndromes of CRF lacks a investigation of large sample and a scientific statistical analysis.The topic for study this time aims exactly at this condition.Derected by theories of TCM, based on review of literatures and by applying clinical epidemiological method, the general clinical datas, the TCM syndrome types of asthenia of healthy energy, the distributing features of TCM syndromes, the relationships of healthy qi and pathogen, interfering factors, the features of qi and yin asthenia syndrome of CRF had all been studied. The influencece on CRF patients' nephric tubulointerstitial functions by advisor's empirical formula 'granula of invigorating the kidney and dispersing the poison' had also been studied. The results which had been gained are objective and are consistent with clinical practice. Research of literatures of CRFThe ancient literatures of TCM have no the name of CRF. But some descriptions about deficiency of energy, edema, renal wind syndrome, retention of urine, frequent vomiting and dysuria, urine poison are similar to CRF. The ancient TCM doctors considered that the etiological factors of CRF consist of exogenous pathogenic factors and internal damage, the pathological property consists of asthenia and sthenia, the pathogenesis include asthenia in origin causing sthenia in superficiality and sthenia in superficiality causing asthenia in origin, the pathological locations mainly include spleen, kidney and triple warmer.The study on CRF by moderm TCM began in 1950s. Now the etiological factors, the pathological property, the pathogenesis, pathological locations, and therapeutical principal and method of CRF are recognized in common. That is, the etiological factors of CRF consist of exogenous pathogenic factors and internal damages, and exogenous pathogenic factors are six evils, the internal damages include deficiency of spleen and kidney in normal time, defatigation, having a bad mood and will being unable to come true. The pathological property is asthenia and sthenia to exist in the same time, but unsymmetrically. The pathogenesis is asthenia in origin and sthenia in superficiality, asthenia in origin causing sthenia in superficiality. The pathological locations include spleen, kidney, liver, involing heart and lung. To cure CRF must strengthen healthy qi and elimilate pathogens.Research of literatures of modern medicine on CRF tells us that the mechanism of CRF to happen and to develop progressively is unknown wholly, but parts of mechanisms are discovered. There is no great progress in treatment of CRF. Now the study on mechanisms of CRF is focus on cell biology, molecular biology, molecular immunology.Research of general clinical data of 360 cases of CPU7In order to study the general clinical data, the TCM syndrome types of asthenia of healthy energy, the distributing features of TCM syndromes, the relationships of healthy qi and pathogen, interfering factors, the features of qi and yin asthenia syndrome of CRF, a questionnaire about the distribution of TCM syndromes on CRF had been designed, including gender, age, condition of body in normal time, history of illness, family history, basic desease of CRF, course of desease, symptoms associated with differetiation of TCM syndromes on CRF, also the physical and chemical examinations related to diagnosis. 360 cases of CRF which are qualified had been collected in two years from February, 2004 to February, 2005.Result:Among 360 patients, male patients are 157 cases and female patients are 203 cases, male: female is 1:1.3. Patients in age 40-50, 50-60, 60-70, 70- years old cover a large part of 81.9% in all while patients in age under 40 years old cover a small part of 18.1% in all. Patients in age 14-20 years old cover the smallest part of 1.11% while patients in age 60-70 years old cover the biggest part of 24.17%. This indicates that the incidence of CRF is associated with age. The distribution of basic deseases of CRF: chronic glomerulonephritis: 154 cases, cover 42.78%;chronic interstitial nephritis: 54 cases, cover 14.4%;diabetic nephropathy: 43 cases, cover 11.9%;hypertensive nephropathy: 41 cases;cover 11.4%;IgA nephropathy: 20cases cover 5.56%;the other nephropathy cover 13.06%. The distribution of cases at phases of CRF: compensative phase of renal function: 106 cases;cover 29.4%;decompensated phase of renal function 147 cases;cover 40.8%;exhaustion phase of renal function: 68 cases;cover 18.9%;urinemia phase of renal function: 39 cases;cover 10.9%. Condition of body in normal time: afraid of coldness: 184 cases, cover 51.1%;easy to get fatigued: 176 cases, cover 48.9%;easy to get a cold: 87 cases, cover 24.1%;easy to sweat: 61 cases, cover 16.9%;afraid ofhotness: 54 cases, cover 15%;night sweat: 15 cases, cover 4.1%. This indicates that many patients of CRF are in the condition of qi deficiency in normal time, only a few patients of CRF are in the condition of yin deficiency in normal time.Research of features of syndromes of deficiency in origin over CRF Based on past TCM clinical practice of nephropathy, throught an investigation over a sample of 360 patients of CRF, and by applying the theory of Factor Analysis, a study on the features and types of syndromes of deficiency in origin had been done. Through this investigation of questionnaires, all the 360 patients' information of symptoms, conditions of tongue and pulse were collected. Among the information, all those indicating deficiency in origin were selected as variables, there are 41 in all. These variables were analyzed with statistical method of factor analysis. When five factors were extracted, the results are consistent with clinical practice best. Results:Fl taking a smaller amount of food, deficient and short breath, lassitude and hypodynamia, gastric and abdominal distention, etiolating complexion, panicky and having a palpitation, sore and painful waist, thirsty but not want to drink, pulsus parvusF2 cool in hands and feet, being chilly, cold and painful in waist, pale complexion, clear and long urine, painful heel, light taste in the mouse, thin and loose stoolF3 infrequent pulse, wiry pulseF4 frequent pulse, tinnitus, dizziness, night sweat, dry and hard stool, dry and unsmooth in the eyes, feverish palms and soles, thin and yellow lingual fur, red body of the tongue F5 light red body of the tongue, thin and small body of tongue, thin and white lingual fur According to theory of TCM, Fl indicates qi deficiency syndrome of the spleen and kidney, F2 indicates yang deficiency syndrome of the spleen and kidney, F4 indicates yin deficiency syndrome of the liver and kidney, F3 is a group of typical pulse among patients of CRF, indicating stagnation of liver-qi with deficiency of the spleen and stagnation of pathogenic damp, F5 is a group of symptoms about picture of the tongue, indicating deficiency of qi and yin.So a conclusion can be obtained that the three basic syndromes of deficiency in origin are qi deficiency of the spleen and kidney, yang deficiency of the spleen and kidney, yin deficiency of the liver and kidney, that three basic constituents of deficiency in origin are qi deficiency, yang deficiency and yin deficiency. Research of distributing features of TCM syndromes over CRFThrough the study above, three basic syndromes of deficiency in origin and three basic constituents of deficiency in origin of CRF have been obtained. But actually, the syndromes are inclusive each other. According to theory of TCM and clinical practice, five syndromes of deficiency in origin of CRF can be obtained, based on three basic syndromes of deficiency in origin and three basic constituents of deficiency in origin. They are qi deficiency of the spleenand kidney, yang deficiency of the spleen and kidney, yin deficiency of the liver and kidney, deficiency of both qi and yin, deficiency of both yin and yang. In order to understand the constituent ratio, a standard to differentiate the TCM syndromes of CRF was made, based on the results of factor analysis and the past standard. The information of 360 patients was analyzed again. The results were obtained as below:Results:The constituent ratio of TCM syndromes of deficiency in origin of CRF: deficiency of both qi and yin 197 cases, cover 54.7%;deficiency of both yin and yang 74 cases, cover 20.6%;qi deficiency of the spleen and kidney, 59 cases, cover 16.4%;yin deficiency of the liver and kidney, 23 cases, cover 6.4%;yang deficiency of the spleen and kidney, 7 cases, cover 1.9%. So the center of gravity of deficiency syndromes in origin of CRF is deficiency of both qi and yin.The constituent ratio of basic constituents of deficiency in origin of CRF: qi deficiency, 256 cases, cover 71.1%;yin deficiency, 297 cases, cover 81.7%;yang deficiency, 81 cases, cover 22.5%. So the center of gravity of basic constituents of deficiency in origin of CRF is yin deficiency and qi deficiency, with a constituent ratio far more than yang deficiency.The relationships of healthy qi and pathogen, interfering factors: Each TCM syndrome of deficiency in origin of CRF can conclude all sorts of pathogen, interfering factor, but the ratio is different. Humid heat, wind dryness, wind moving cover a high ratio in syndromes including deficiency of yin, pathogenic damp, water vapor, stagnant blood cover a high ratio in syndromes including deficiency of yang.Dependablity of syndromes of deficiency in origin and gender, age, each phase of renal function of CRF: according to the statistics, the distributing of syndromes of deficiency in origin in gender, age, each phase of renal function of CRF have no significant difference, the distributing is almost equal.Research of syndrome of deficiency of both qi and yin of CRF The study above shows that the syndrome of deficiency of both qi and yin covers a large proportion of 54.7% in the syndromes of deficiency in origin of CRF. So it is necessary to make a study on the feature of syndrome of deficiency of both qi and yin, mainly to observe the proportion of qi deficiency and yin deficiency. All the 197 patients' information of symptoms, conditions of tongue and pulse were collected. Among the information, all those indicating deficiency in origin were selected as variables, there are 35 in all. These variables were analyzed with statistical method of factor analysis again. When three factors were extracted, the results are consistent with clinical practice best.Results:Fl: the principal index (to rank according to the size of load coefficient) red body of the tongue, thin and yellow lingual fur, frequent pulse, upset and disturbed, feverish palms and soles, dizziness, tinnitusThe econdary index:dry and hard stool, painful heel,lassitude and hypodynamia, sore and painful waist, etiolatingcomplexion, wiry pulse, dry and unsmooth in the eyesF2: the principal index:deficient and short breath, taking a smaller amount of food, thirsty but not want to drink,gastric and abdominal distention, lassitude and hypodynamia, pulsus parvus, dry and hardstoolThe secondary index:dry and unsmooth in the eyes, sore and painful waist, etiolating complexion, thin and whitelingual fur, frequent urination at night, panicky and having a palpitationF3 the principal index:not flushing in complexion, sweat while in slight moving, easy to catch a cold, feeble pulse,cool in hands and feet, easy to catch a cold,The secondary index:panicky and having a palpitation, light red body of the tongue, deficient and short breath,being chilly, taking a smaller amount of food, thin and white lingual fur, dry and unsmooth inthe eyes, sore and painful waist, lassitude and hypodynamiaFl indicates the syndrome of deficiency of both qi and yin, but mainly deficiency of yin. F2 indicates the syndrome of deficiency of both qi and yin, and the deficiency of both qi and yin is equal. F3 indicates the syndrome of deficiency of both qi and yin, but mainly deficiency of qi. Fl: 53cases, cover 26.9%;F2: 69cases, cover 35%;F3 75 cases, cover 38.1%o So in all the syndromes of deficiency of both qi and yin of CRF, the proportion of deficiency of qi is larger than the proportion of deficiency of yin. This shows that it is important to invigorate qi in treatment of syndromes of deficiency of both qi and yin of CRF.In this study, 11 symptoms which have the highest frequency of occurrence were extracted. They are: not flushing in complexion, etiolating complexion, deficient and short breath, taking a smaller amount of food, lassitude and hypodynamia, sore and painful waist, dry and hard stool, frequent urination at night, dizziness, light red body of the tongue, wiry and parvus pulseResearch of influencece of 'granula of invigorating the kidney and dispersing the poison' on CRF patients' renal tubule functionObjective: The recent study of modern medicine on CRF showed that nephric tubulointerstitial pathological changes is more closely correlate to renal function injury and prognosis than glomerular pathological changes. So effective drug must be found to prevent or delay nephric tubulointerstitial lesion, so as to prervent or delay the progress of CRF. Modern medicine has no effective drug to treat chronic nephric tubulointerstitial lesion. In this study, advisor Nielifang's empirical formula 'granula of invigorating the kidney and dispersing the poison' was observed to treat nephric tubulointerstitial lesion of CRF.Object: In the study, three indexes of 45 patients of CRF were observed. 45 patients of CRF are all in compensative phase and decompensated phase of renal function. The indexes are urine NAG, urine a j-MG, urine 3 2-MG.. 45 patients were devided into treatment group and control group in random. There were 25 patients in treatment group, and 20 patients in control group.Method: the treatment group was given 'granula of invigorating the kidney and dispersing the poison', 15g every time, twice a day, taken with warm water after meals.The control was given Coated Aldehyde Oxystarch Capsules, 5g every time, twice a day, taken with warm water after meals. The ourse of treatment was two month.Results: before treatment, the mean of urine NAG, urine a ,-MG, urine 3 2-MG has no significant difference in two group(P>0.05). After treatment, not only the mean of urine NAG, urine a ,-MG, urine 3 2-MG in control group is higher than the mean before treatment, but also higher than the mean in treatment group after treatment. There are significant differences(P<0.05,or P<0.01). The mean of urine NAG in treatment group before treatment is higher than the mean after treatment. There is significant difference(P<0.05, or P<0.01). The mean of urine a rMG, urine 3 2-MG in treatment group after treatment is lower than the mean before treatment, but there are no significant differences(P>0.05). Conclusion: 'Granula of invigorating the kidney and dispersing the poison' has a satisfactory curative effect on the nephric tubulointerstitial lesion of CRF.In the study above, we had design a questionnaire to investigate the features and distribution of TCM syndromes of CRF with clinical epidemiological method. We have analyzed the collected data with modern statistical method such as frequency distribution, rate, constituent ratio and factor analysis. All these above are the first time in the research of CRF and are very significant in the study of TCM syndromes of CRF. We also find that 'Granula of invigorating the kidney and dispersing the poison' has a satisfactory curative effect on the nephric tubulointerstitial lesion of CRF.
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