Tutor's Experience Of Chronic Renal Failure Treated By Chinese Medicine And Study On Quality Of Life Of Patients With Chronic Renal Failure In Early To Middle Stages

In recent years, the increasing incidence and prevalence rates of the chronic kidney disease(CKD) and which cause chronic renal failure(CRF) around the world, have become an overlooked medical and social problems.Therefore,it is necessary to enhance the early prevention and treatment of chronic renal failure.In early to middle stages of chronic renal failure,if patients of CRF were treated properly by Chinese medicine,their symptoms would be reduced or even eliminated, the renal function and quality of life would be improved,thus delay the process of CRF with varying degrees. And it was very important of the clinical experience of famous experts of Chinese medicine from long-term clinical practice.On clinical evaluation of chronic renal failure treated by Chinese medicine,based on clinical and biological indexes, the health-related quality of life(HRQOL) scale was combined,then it was more comprehensive for the effect evaluation of chronic renal failure.At present,there were lots of research on quality of life(QOL) of end-stage renal disease,but few research on early to middle stages of chronic renal failure.Therefore, the quality of life and its related factors of 124 cases with early to middle stages of CRF was investigated.At the same time, reinforcing Qi and nourishing Yin's effect on recent quality of life of early to middle stages of CRF's patients with syndrome of dual deficiency of qi and yin was observed which based on the my tutor's clinic experience of CRF. The innovations of my paper are two aspects:①The quality of life and its related factors of patients with early to middle stages of CRF was investigated by the cross-sectional survey;②Reinforcing qi and nourishing yin's effect on recent QOL of early to middle stages of CRF's patients with syndrome of dual deficiency of qi and yin was observed.1.My tutor's clinic experience of CRF by Chinese medicineAfter analyzing the complex pathogenesis and clinical manifestations of CRF by the theory of "tip and root"and"chronic and acute",my tutor put forward the view on TCM's clinic stages of CRF,including"deficiency stage" and "block and repulsion stage".The manifestations of "deficiency stage"were lots of deficiency symptoms due to the pathogenesis of healthy qi deficiency. The pathogenesis of "block and repulsion stage"was pathogenic qi excess mainly,and internal obstruction of dampness turbidity was key.My tutor thinked that the basic concept of treating CRF was the combination of "treating disease"and "treating person". And the basic principles of treating CRF by Chinese medicine was the combination of differentiating stages and differentiating syndromes was of very importance for the treatment of CRF by Chinese medicine.In contrast,the condition of "deficiency stage"was mild ralatively,so the principles of therapy was mainly reinforcing healthy qi and treating the root.(1) spleen-lung qi deficiency syndrome,treated by Buzhongyiqi decoction,or Shenlingbaizhu powder preparation;(2)spleen-kidney yang deficiency syndrome,treated by Baoyuan decoction,or Zhenwu decoction;(3) liver-kidney yin deficiency syndrome,treated by Qijudihuang decoction,or Majudihuang decoction,or Guishaodihuang decoction;(4) syndrome of dual deficiency of qi and yin,treated by Shenqidihuang decoction.The condition of block and repulsion stage"was heavier, so the principles of therapy was eliminating the pathogenic factors mainly, reinforcing healthy qi following.(1) syndrome of internal obstruction of cold-dampness,treated by Xiangshaliujunzi decoction;(2)syndrome of internal obstruction of dampness-heat,treated by Huanglianwendan decoction.In the course of CRF,if there were reversible factors (such as external contraction,edema,urination, water qi intimidating the heart and lung),they should be treated firstly to eliminating theose factors, namely treating the tip (acute) before the root (chronic).2. Quality of life in patients with chronic renal failure and its influencing factorsObjective:To analyze the quality of life (QOL) of patients with early to middle stages of CRF,and the influencing factors of the QOL.Methods:124 patients coming from Xiyuan Hospital of China Academy of Chinese Medical Sciences,Dongfang hospital affiliated Beijing university of TCM,the military general hospital of Bejing PLA.QOL were investigated by SF-36 health survey of Chinese version. Statistical analysis were completed by using SPSS13.0.Results:(1) The each scale's scores of SF-36 Health Survey were:GH:36.24±12.97,RP:37.74±31.20, VT:52.60±20.75,RE:55.34±30.06,MH:59.20±17.85,SF:59.88±18.05, PF:79.11±14.87,BP:79.60±19.14.They were worse than scores of general population,but higher than scores of patients with hemodialysis.(2) The influencing factors on PCS of patients with early to middle stages of CRF were gender,age and serum creatinine. The influencing factor on MCS of patients with early to middle stages of CRF was education. The influencing factor on total score of patients with early to middle stages of CRF was serum creatinine.The RP,BP,GH,VT and MH scores in male patients were higher than those in female patients.There was signifant difference(P<0.05).Among three age groups,the VT and PF scores'difference was significant (P<0.05).The age was lower,the score was higher. Among three education groups,the VT and MH scores'difference was significant (P<0.05).The education was lower, the score was higher. The scores of RP,GH,VT,PCS in stage 2 of CKD(eGFR was 60-89ml/min)were higher than those in stage 3 of CKD(eGFR was 30-59ml/min) (P<0.05 or 0.01).Conclusion:(1) The quality of life (QOL) of patients with early to middle stage of CRF was worse than general population.(2)The influencing factors were gender,age,education and Scr.3.The research on reinforcing qi and nourishing yin's effect on recent QOL of early to middle stages of CRF's patients with syndrome of dual deficiency of qi and yin.Objective:To evaluate the reinforcing qi and nourishing yin's effect on recent QOL of early to middle stages of CRF's patients with syndrome of dual deficiency of qi and yin.Methods:57 cases were divided into treatment group and control group.30 cases in treatment group from Xiyuan Hospital of China Academy of Chinese Medical Sciences,and 27 cases in control group from the military general hospital of Bejing PLA.Integrated treatment of chronic kidney disease was carried out in control group.Shenqidihuang decoction was carried out in treatment group based on symptomatic treatment of western medicine.The QOL were investigated by SF-36 health survey of Chinese version before treatment and 3 months after treatment respectively. Statistical analysis were completed by using SPSS13.0.The analysis of ITT was carried out.Results:the plan of treatment group could increase the scores of VT,RP,GH,RE and MH,and decrease the Scr.Compared with before treatment,there was a significant difference(P<0.01 or P<0.05).Thus the scores of physical component summary(PCS) and mental component summary(MCS) were increased,and compared with before treatment,there was very significantly difference(P<0.01).The plan of control group could increase the scores of VT,RP,GH,BP and MH.Compared with before treatment,there was a significant difference(P< 0.01 or P< 0.05) by ITT analysis.Thus the scores of PCS and MCS were increased,and compared with before treatment,there was very significantly difference(P<0.01) by ITT analysis.After treatment,there was no significant difference (P>0.05) except RP(P<0.05) between treatment group and control group.Conclusion:The effect on reinforcing qi and nourishing yin based on symptomatic treatment of western medicine was significant for the recent QOL of early to middle stages of CRF's patients with syndrome of dual deficiency of qi and yin.It can improve the patients'recent QOL(includingRP,GH,VT,MH,RE).But the effect between two groups for patients'recent QOL was no significant difference.