Study On Treatment Rules Based On Syndrome Differentiation And Evaluation Of Therapeutic Efficiency Of Professor Zhang Qi On Treating Chronic Renal Failure

Through retrospective and prospective clinical study by the method of evidence-based medicine and epidemiology,the researcher summarized the treatment rules based on syndrome differentiation of Professor Zhang Qi on teating chronic renal failure(CRF), made an objective evaluation of therapeutic efficiency and summarized his academic thought.Through the retrospective study on 100 CRF cases,the researcher summarized the syndrome types,therapeutic methods and prescriptions of Professor Zhang Qi on teating CRF,and researched the relation between syndrome types and clinical phases of renal failure.The results show that the basic characteristic of CRF mechanism development is hypofunction of spleen and kidney,accumulation of noxious damp,blood stasis in superficial venules,deficiency of genuine qi and excess of pathogenic factor,deficiency complicated with excess.Deficiency syndrome as primary include deficiency of spleen-qi and kidney-qi, deficiency of spleen-yang and kidney-yang, deficiency of both qi and yin, deficiency of liver-yin and kiney-yin, deficiency of both yin and yang.Excess syndrome as secondary include blood stasis,damp-heat,damp,fluid and damp,wind srirring,wind-dryness.The compensatory phase of renal insufficiency is major in deficiency of spleen-qi and kidney-qi syndrome.The decompensatory phase of renal insufficiency is major in deficiency of spleen-yang and kidney-yang syndrome, deficiency of both qi and yin syndrome, deficiency of both yin and yang syndrome. The phase of renal failure is major in yin and yang syndrome, deficiency of spleen-yang and kidney-yang syndrome. Blood stasis,damp-heat,damp,fluid and damp can appear in any phase of renal failure. Wind srirring and wind-dryness mainly appear in phase of renal failure.The basictherapeutic method on CRF is tonifying spleen and kidney,purging damp,promoting blood circulation to remove blood stasis.The representative prescriptions include Shenqi Dihuang Tang,Zhenwu Tang,Guishao Liujunzi Tang,Qiju Dihuang Wan,Dihuang Yinzi,Wuling San,Wendan Tang,Huazhuo Yin,Jiawei Ganlu Yinjiedu Huoxue Tang.Through prospective clinical study on 61 CRF patients, the researcher researched the relation between CRF syndrome types and blood urea nitrogen (BUN), serum creatinine (Scr),quantity of urinary protein,serum Ca and P,vaso-active substance such as endothelin (ET)> Angiotensin II (Ang-II ),nitric oxide (NO)> 6-Keto-PGFia , and made an objective evaluation of therapeutic efficiency.The results show that in the CRF patients of deficiency of spleen-qi and kidney-qi syndrome, elevation of BUN,Scr and quantity of urinary protein , loss of RBC,Hb and serum Ca and P metabolism abnormality is lowest. In the patients of deficiency of both yin and yang syndrome, elevation of BUN,Scr and quantity of urinary protein , loss of RBC,Hb and serum Ca and P metabolism abnormality is most obvious.The vaso-active substance ET , Ang-II of CRF patients obviously elevate,and NO,6-Keto-PGFia obviously descend. In the patients of deficiency of spleen-qi and kidney-qi syndrome, elevation of ET , Ang-II and loss of NO,6-Keto-PGFia is lowest,which in the patients of deficiency of both yin and yang syndrome is most obvious.So the relation between CRF syndrome types and objective indexes can provide objective basis for clinical treatment based on syndrome differentiation.The therapeutic efficiency of TCM treatment base on syndrome differentiation on CRF is exact,which can obviously improve the clinical syptoms and life qulity of CRF patients,the total effective rate amount to 80.33%.Moreover, it can obviously descend BUN,Scr of CRF patients,reduce quantity of urinaryprotein,elevate RBC,Hb,adjust serum Ca and P metabolism abnormality,and it can also descend ET, Ang- II ,and elevate NO,6-Keto-PGFiaof patients,the improvement of which provide basis for objective evaluation of therapeutic efficiency.