The Study On Revealing Of The Intervention Factors And Mechanism Of Medicated Bath Interfering The Chronic Kidney Disease Depend On Quantitative Differentiation Thought Of ZHANG Zhong-jing

Objective:1Confirm the effect of the medicated bath therapy on chronic kidney disease (CKD) and the best combination of intervention factors;2Making the process of technical operation standard on medicated bath;3Discuss the effect of medicated bath on the proliferation of HRMCs and immune inflammation in the development of CKD;4Reveal the scientificalness of quantitative differentiation thought of ZHANG Zhong-jing.Method:1.476patients with diagnosis of CKD3stage in Western Medicine and cold syndrome in TCM from outpatient and inpatient in five center (407cases completed, fall off in69cases)were randomly divided into six groups according to the three different concentrations of bath solution (containing placebo、0concentration), two different temperature levels, the treatment group adopted with medicated bath therapy based on modern medicine integrated treatment, the control group for the integration of modern medical treatment on the basis of matching the colour、smell of placebo water bath treatment,30ds for1course, for detection of GFR, Scr,24hours urine protein、serumβ2microglobulin, ESR, D-imer, C-reactive protein assay (CRP), complement assay (C3, C4), immunoglobulins (IgG, IgA, IgM), blood lipid (TC, TG, HDL-C), blood electrolyte (K+, Ca2+, P5+), CO2-CP before and after treatment respectively, takes GFR as the main evaluation index in subject;2. Monitoring of adverse bath process of shock,etc, combining with the relevant indexes of the immune system. RAS system, coagulation system(detection of hs-CRP, IL-6, renin, Ang Ⅱ, aldosterone, and D-dimer) Closely;3.234cases of chronic kidney disease with non dipper hypertension patients were randomly divided into6groups:morning low stimulus intensity group, morning high stimulus intensity group, morning control group, night low stimulus intensity group, night high stimulus intensity group, night control group, intervention in the same way, measured GFR、sCr、UA、BUN、24h UPr、ABPM respectively;4. Observe the multiplication of HRMCs by the Medicated serum and medicated bath reagent in vitro for the experimental research.Result: 1.GFR, Scr,24hours urine protein, serum β2microglobulin, ESR, D-dimer, C-dimer of C-reactive protein (CRP), complement assay (C3, C4), immunoglobulins (IgG, IgA, IgM), blood lipid (TC, TG, HDL-C) in patients is significant difference Before and after the medicated bath therapy between the level and the control group (P<0.05), with statistical significance;2.To GFR as the main evaluation index, low concentration (0.015g/ml) at37℃group has the best curative effect, thers is significant differences compared with the five other groups,(P<0.05), with statistical significance;3. sCr,p2-MG, D-dimer is consistent with the main evaluation index (GFR),24hour urinary protein, ESR, CRP, complement (C3, C4), immunoglobulins (IgG, IgA, IgM) has a relationship with GFR, but not consistent exactly, while the blood electrolyte (K+, Ca2+, P5+) and CO2-CP has no direct relationship with GFR;4.There were a significant difference in hs-CRP, IL-6, TNF-, renin, angiotensin, aldosterone and the level of D-dimer before and after adverse reaction of shock in the bath,,(P<0.05), with statistical significance;5. GFR、sCr、UA、BUN、24h UPr、 ABPM before and after the bath has significant difference (P<0.05), with statistical significance. Overall low stimulus intensity group is better than the high stimulus intensity group and control group, morning is better than night;6.The Medicated serum and medicated bath liquid all have effect on the multiplication of HMCs in vitro, Bcl-2, Bax, ECM (FN, LN, Col-Ⅳ), IL-1β, IL-6, TNF-α, TGF-β level of significant difference different before and after the intervention,(P<0.05), with statistical significance,and the serum is more obvious.Conclusion:1. Medicated bath has a moderating effect on the immune inflammation、RAS system、 coagulation system in CKD, this is one mechanism of "clean kidney", also an important pathological mechanism of the occurrence of adverse reaction;2.Low concentration (20.015g/ml) at37℃for medicated bath therapy is the best stimulation level in treatment of chronic kidney disease;3. GFR、sCr、UA、BUN、β2-MG、D-dime in important evaluation index of medicated bath treatment for CKD, the reference index is24hours urinary protein, ESR, CRP, complement (C3, C4), immunoglobulins (IgG, IgA, IgM); 4. Deterioration of renal function by the collapsion in the process of Medicated bath was related to the coagulation system、RAS system and immune system;5. Medicated bath can effectively regulate non dipper hypertension in patients with III stage chronic kidney disease;6. Prevention and treatment to renal fibrosis in CKD with medicated bath is related with the inhibition of the multiplication in HRMCs,the intervention on inflammation is one of the most important targets.7.The scientificalness of quantitative differentiation thought of ZHANG Zhong-jing is confirmed by the best stimulation level of medicated bath in treatment of chronic kidney disease and the mechanism.