The Study Of The Syndrome And Treatment Laws Of Traditional Chinese Medicine For Chronic Renal Failure

Chronic renal failure (CRF) is the performance of later period of a variety of kidney disease.It has a lingering course and seriously affects the quality of life of patients. With very expensive medical care of dialysis and renal transplantation in later period,it has brought great pain and burden to patients and society. There is no specific therapeutic measure of western medicine for this disease in early and mid period, however Traditional Chinese Medicine (TCM) has certain advantages and characteristics. By retrospective analysis of clinical data this study applies data mining such as cluster analysis and association rules analysis to explore the TCM syndrome characteristics of CRF and conclude my supervisor's idea and methods of treatment of CRF and experience of prescriptions and then put it into popularization and application in clinic.In addition, according to my supervisor's experience and following the principle of evidence-based medicine,this study respectively carries out methodological quality assessment and clinical efficacy systematic review of the clinical literature of randomized controlled trials (RCT) of Shenqidihuang decoction and the methord of regulating Spleen and Stomach in treatment of CRF.It objectively evaluates the efficacy of Shenqidihuang decoction and the methord of regulating spleen and stomach in treatment of CRF, thus provides evidence-based medical evidence for clinical treatment of CRF of TCM. This study has two innovations as following:①TCM syndrome characteristics and underlying rules of prescriptions are mined from a abundant and fuzzy database by cluster analysis and association rules analysis;②Systematic review on RCT of Shenqidihuang decoction and the methord of regulating Spleen and Stomach in treatment of CRF is carried out by Revman 5 Meta-analysis software provided by Cochrane Collaboration.The Overview of Experience of Diagnosis and Treatment of TCM MastersThrough the collation and analysis of the literature,the experience of 22 modern TCM masters is summarized and overviewed from such areas as the name of disease, etiology and pathogenesis, diagnosis and syndrome differentiation, treatment and recuperation. CRF attributes to "Guange" and other areas in TCM.It is rooted defficiency-symptomed excess and mixed with deficiency and excess.Dual deficiency of qi and yin is the most common TCM syndrome and is often mixed with dampness-heat and blood stasis, etc. The treatment principle is differential treatment from different points of view.The General Characteristics of CasesThe cases are CRF patients diagnosed and treated by my supervisor during January 2003 to October 2009, a total of 486 cases,580 clinic times. Male to female ratio 1.08:1, with an average age of 54.14±16.05 years. In primary disease,unknown causes account for 37.45%, followed by chronic glomerulonephritis 19.14%,11.93% of diabetic nephropathy, chronic interstitial nephritis 9.26%. Laboratory examinations, hemoglobin 101.30±24.77 g/l, blood urea nitrogen 47.96±27.87 mg/dl, serum creatinine 386.36±281.83μmol/l, creatinine clearance rate 25.81±17.66 ml/min. Periods of chronic renal failure, the period of decompensation accounts for the most 194 cases, followed by 103 cases of the period of renal dysfunction, the period of compensation 78 cases, the period of uremia or end-stage renal failure 58 cases. CKD staging, stage 5 accounts for the most 178 cases, followed by stage 3 143 cases, stage 4 139 cases, stage 1 and 2 have less cases.Study of The Law of TCM Syndrome Based on Cluster AnalysisThe symptoms of which the frequency is more than 20% in this study are in order:fatigue, anorexia, constipation, back soreness, easy to cold, sallow complexion, insomnia, edema, nausea, back pain, dizziness, dry mouth, pink tongue, pale dark tongue, thin white fur, yellow greasy fur, white greasy fur, deep thin pulse. According to the 1987 National TCM syndrome types criteria of chronic renal failure,dual deficiency of qi and yin is the most common in the main syndrome, up to 57.76%, followed by 23.62% for the spleen and kidney qi deficiency, rare liver and kidney yin deficiency, spleen and kidney yang deficiency,yin and yang deficiency; Dampness-heat is the most common in the accompany syndrome, accounting for 42.76%, followed by dropsy 23.79%, blood stasis 15.34%, dampness 13.45%, rare phlegm-heat, wind dryness, exogenous and wind-driven.By cluster analysis the syndrom types and its frequency of this study are as follows, the stage of disease:Deficiency stage 36.72-75.42%, Guange stage 20.28-63.28%. Syndrome type:spleen and kidney qi and yin deficiency 36.72-60.69%, spleen and kidney qi and yin deficiency inclined to heat 19.14-36.38%, inclined to cold 19.83-22.41%, spleen and kidney qi deficiency 16.38-17.07%, liver and kidney yin less than 17.07%; Middle impedance of dampness (dampness-heat, cold-dampness) 22.24-63.28%, water and dampness (dropsy) 16.38 17.07%,downward flow of dampness-heat 5.34- 5.52%, and blood stasis (heart vessel stagnation, blood stasis and dropsy) 13.1%.It is explained that this disease is deficiency of healthy energy and sthenia of evil and intertwist of cold with heat. Deficiency of healthy energy is the root while sthenia of evil is the tip. Spleen and kidney qi and yin deficiency is mainly in deficiency of healthy energy, followed by spleen and kidney qi deficiency, liver and kidney yin deficiency;Dampness (dampness-heat, cold-dampness) and dropsy is mainly in sthenia of evil,while blood stasis,wind-heat, phlegm-heat is rare.With intertwist of cold with heat, heat syndrome is more than cold syndrome.Mining of The Treatment Experience of My Supervisor Based on Association Rules AnalysisThe prescriptions of which the frequency is more than 10% in this study are in order:Shenqi Dihuang decoction(40.52%),Huanglian Wendan decoction(17.93%), Shengmai drink(17.76%), Xiangsha Liujunzi decoction(13.79%). The herb of which the frequency is more than 50% is as follows:Poria (Fuling) (83.1%),Radix Pesudostellariae(Taizishen) (46.38%),Flos Lonicerae(Jinyihua) (60.52%),Radix et Rhizoma Rhei (Daihuang) (58.45%), Radix Astragali seu Hedysari (raw) (Shenghuangqi) (57.93%),Radix Angelicae Sinensis (Danggui) (56.9%),Radix Salviae Miltiorrhizae(Danshen)(51.9%).By association rules analysis, I conclude the experience of my supervisor in treating CRF:①Syndrome differentiation and treatment in different phase, the main treatment in chronic deferral phase (deficiency stage)to strenthen the root vital qi. Strenthening qi and tonifying yin is the most common method while Shenqi Dihuang decoction and and Shengmai drink is most commonly used. Using tonic method,stomach qi should be payed attention to. The main treatment in acute attack phase(guange stage) is to eliminate the tip pathogen.The pathogen should be given a way.It is emphasized that elimination of pathogen do not be excess and should be stopped just right so as to prevent damage of heathy qi. In deficiency stage the main treatment is to strenthen the vital qi while elimination of pathogen should be payed attention to simultaneously and vice versa in guange stage.②With spleen and kidney as the root, the treatment is overall.To treat kidney,modified Liuwei Dihuang decoction is commonly used. Regulation of spleen and stomach is payed attention to and also heart,liver and lung simultaneously.③Correspondence of syndrome and prescription. To select formula through grasping the main symptoms. One typical symptom is enough for symptom differentiation which can greatly improve the efficiency and accuracy of clinical diagnosis and treatment.④Herb modification with symptoms,calm,light and agile,which avoids too hot and fragrant to damage fluid and too bitter and cold to hurt spleen and stomach,all for the clinical effect.⑤Agile method and prescription, exquisite herb compatibility.Relationship between qi, blood, yin and yang is payed attention to.Tonifying is combined with dredging and eliminating the pathogen, with no stagnation.By the use of association rules to analyze the law of syndrome differenciation and prescription of my supervisor will help to found the law of clinical treatment and to promote effective herbs. That will help to conclude the experience of old famous TCM doctors further scientificly and systematicly,then to inherit and carry forward.Systematic Review of Domestic Randomized Controlled Trials Literature of Shenqi Dihuang Decoction and Method of of Regulating Spleen and Stomach in Treatment of CRFThis study aims to assess the efficacy and safety of Shenqi Dihuang Decoction and the method of of regulating spleen and stomach in treatment of CRF.By retrieving the domestic biomedical journals, RCTs of that Shenqi Dihuang Decoction and the method of of regulating spleen and stomach is separately added on the basis of treatment of western medicine and simple wstern medicine treatment of CRF are chosed.The quality of included studies is evaluated and Meta analysis is conducted.9 randomized controlled clinical trials of Shenqi Dihuang Decoction are included in and 587 patients meet the inclusion criteria but their methodological quality is low. Compared with the control group with simple western medicine,western medicine-based therapy combined with Shenqi Dihuang Decoction in the treatment of CRF has a certain effect in the overall efficacy, reducing serum urea nitrogen and creatinine and increasing hemoglobin.8 randomized controlled clinical trials of the method of regulating spleen and stomach are included in and 516 patients meet the inclusion criteria but their methodological quality is low.Compared with the control group with simple western medicine, western medicine-based therapy combined with the method of regulating spleen and stomach in the treatment of CRF has a certain effect in the overall efficacy, reducing serum urea nitrogen and creatinine and increasing creatinine clearance rate and hemoglobin.Thus it is concluded that Shenqi Dihuang Decoction and the method of of regulating spleen and stomach may be effective in the treatment of CRF, but the interpretation of the result needs to be considered carefully. Methodological issues about evaluation of efficacy of TCM by evidence-based medicine is still worth considering and research.