Discussion And Summary Of Clinicai Rule Of Professor Wang Dan In Treating Chronic Kidney Disease And Insomnia

ObjectiveRetrospective review of effective cases of chronic kidney disease insomnia treated by mentor,analyze the etiology and pathogenesis of chronic kidney disease and insomnia,and to investigate the characteristics of mentor’s medication.Summarize the medication patterns and clinical experience of the mentor in treating insomnia with chronic kidney disease.Provide effective ideas and methods for standardizing the treatment of insomnia with chronic kidney disease with Chinese medicine.Method1.There are 203 cases of patients with chronic kidney disease combined with insomnia were gathered in mentor’s outpatient clinic from March 2016 to October 2019.2.The cases that compliance with the inclusion criteria were sorted out and recorded the name,gender,age,main symptoms,tongue manifestation,pulse manifestation,laboratory examination,diagnosis of traditional Chinese and western medicine,pattern types and prescriptions into the clinical collection module.3.It was used the statistical report tables and system analysis modules to sort out the frequency of Chinese medicine,character taste and meridial distribution,commonly used medicine pairs and core drugs in the relevant prescriptions,and they were automatically generate new prescriptions.4.The characteristics and rules of the mentor’s clinical certificate were analyzed.5.The experience of the mentor was sorted out and summarized.Results1.This study included 203 cases of chronic kidney disease(CKD)combined with insomnia.There were 77 male patients and 126 female patients,the oldest being 82 years old and the lowest 30 years old.According to the statistics of primary disease,there were 68 cases of hypertensive kidney,53 cases of diabetic nephropathy,42 cases of chronic glomerulonephritis,33 cases of chronic interstitial nephropathy,and 7 cases of other diseases.There were 151 patients with chronic renal failure,52 patients with stage I-II and151 patients with stage III-V.According to the statistics of pattern,there were156 cases of deficiency of spleen and kidney and internal accumulation of dampness heat,27 cases of yin deficiency of liver and kidney,15 cases of disharmony of heart and kidney,5 cases of deficiency of heart and spleen.Among them,159 cases were accompanied by dampness and turbidity,and 178 with blood stasis.2.There were 229 Chinese herbal medicines involved in this study,among which the top ten Chinese herbal medicines with the highest frequency were Atractylodes macrocephala,licorice,Poria cocos,Polygala,Radix Astragali,Chinese yam,Coix seed,Pinellia ternate,Tangerine peel and Bamboo shavings.3.The order of frequency of use of medicinal properties,taste and meridian tropism in a unit as follows: 3,376 times of warm medicinal,2,463 times of cold medicinal,2,394 times of plain medicinal,376 times of cool medicinal and 31 times of hot medicinal.There were 5,081 times of sweet medicinal,3,812 times of bitter medicinal,2,481 times of spicy medicinal,1,184 times of sour medicinal,366 times of salty medicinal,and 352 times of astringent medicinal.The drugs were administered to the meridian of spleen4,075 times,meridian of liver 3,957 times,meridian of kidney 3,271 times,meridian of stomach 3,224 times,meridian of lung 3,084 times,and meridian of heart 2,656 times.4.It was generated the following commonly used drug pairs: Atractylodes macrocephala and licorice,Acorus calamus and Polygala,Bergamot and Citron,Astragalus adsurgens and Lycium barbarum,Pinellia ternata and tangerine peel,Pinellia ternate,Bamboo shavings and Fructus aurantii immaturus,stragalus membranaceus and Salvia miltiorrhiza.5.It was generated the following new prescriptions:Formula 1: Cooked Rehmannia glutinosa,Astragalus,Cornus officinalis,Alisma orientalis,Fructus Aurantii,Coix seed,Atractylodes macrocephala,Pinellia ternata,Bamboo shavings,Tangerine peel.Formula 2: Almond,Platycodon grandiflorum,Folium Isatidis_Loquat Leaf and Cynanchum stauntoni.Formula 3: Citron,licorice,Bergamot,Nutmeg,Toosendan and Myrrh.Conclusions1.The mentor treats chronic kidney disease insomnia with the principle of strengthening healthy qi to elimin ate pathogens and treating both cause and symptoms,using Codonopsis pilosula,astragalus,Atractylodes macrocephala,Chinese yam,Eucommia ulmoides to strengthen the spleen and kidney,relieving dampness,resolving phlegm,relieving depression and clearing heat to eliminate pathogenic factors,taking Wendan decoction as the main prescription,revise it with symptoms for nourishing the heart,calming the mind,and achieves good results.2.The mentor is good at using medicine in the treatment of chronic kidney disease combined with insomnia.It has remarkable curative effect and a lot of benefits.3.The mentor is skilled at using the method of ‘separation and elimination ’ to make the evil of dampness and heat of triple energizers separate and clear,and to remove dampness and heat,then sleep will be peaceful.4.The characteristics of the generated new prescription s are in line with the mentor’s clinical thinking.In clinical practice,the patients with nausea,vomiting and fatigue due to excessive phlegm and dampness should be treated with formula one,those who catch cold due to susceptibility to external pathogens should be treated with formula two,and those who have epigastric distension and abdominal distension due to disharmony between liver and stomach,especially after eating,should be applied with formula three.