Professor Liu Ximing's Clinical Summary On The Treatment Of Proteinuria In Diabetic Nephropathy

Objective This study aimed to explore the Chinese medicine therapy on DKD patients,furthermore to evaluate its efficacy.Meanwhile researchers summarized Professor Liu Ximing’s empiric knowledge about the traditional Chinese medicine treatment on DKD and its proteinuria.Methods This study was mainly a clinical observation on DKD patients in out-patient clinic during the period from 1th Oct 201 7 to 31th Dec 2019.We collected cases’medical materials at initial visit(0 w),4th w visit(4 w),8th w visit(8 w)and 12th w visit(12 w).Through self-control study we investigated a series of laboratory test indexes relating to urinary protein contents,renal function,glucose metabolism,score of symptoms.Results1.General information:31 cases were included in this study in which the gender ratio of male to female was 2.1:1.The results indicated that the age between 55s to 75s was in peak incidence and the proportion of these patients to total was 67.74%.We also found a positive correlation rather than the linear relationship between the length of DKD and DM.2.Reducing proteinuria:The treatment could reduce high UACR,making UACR on A2 and A3 stage decrease but not on A1 stage.After 12 weeks’ treatment the level of UACR on A2 stage dropped,from 159.50±98.43 mg/g to 81.22±81.83 mg/g(P<0.05).After 12 weeks’treatment the level of UACR on A3 stage dropped,from 922.55±521.21 mg/g to 361.15±95.21 mg/g(P<0.01).Besides,the treatment reduced 24h-UTP significantly.After 12 weeks’ treatment the level of 24h-UTP on A3 stage dropped,from 3989.43±2835.28mg/24h to 1743.69± 1532.78mg/24h(P<0.01).3.Improving renal function:The treatment reduced Scr and improved eGFR.There was significant difference in both Scr and eGFR between the initial visit and 12th week visit.Scr decreased from 144.98±81.65μmol/l to 116.22±54.76μmol/l(P<0.01)and eGFR rose from 58.17±3 1.30 mL/(min·1.73m2)to 70.64±32.65 mL/(min·1.73m2)(P<0.01)after 12 weeks’treatment.4.Glucose metabolism:After 12 weeks’ treatment HbAlc averagely decreased by 0.6%,from(7.64±1.94)%to(6.98±2.01)%(P<0.01).However the treatment had no similar effect on FPG and PPG5.Improving symptoms:There had been a dramatic improvement in symptoms.The score of symptoms decreased by 77.04%,from 16.03 to 3.68.There were five main symptoms including fatigue(52.42%),frequent urination(34.68%),edema(29.03%),lots of foam in the urine(28.23%),numbness on limb(22.58%).6.Major syndromes:The major syndromes were qi and yin deficiency syndrome,yin deficiency and blood stasis syndrome,splendid weakness and overabundant internal dampness syndrome,kidney essence deficiency syndrome,original qi deficiency syndrome,qi and blood deficiency syndrome.The syndrome elements varied in different stages.The major syndrome elements were qi deficiency and yin deficiency at A1 and A2 stage,while the major syndrome element was blood stasis which was followed by qi deficiency and yin deficiency at A3 stage7.Prescription characters:The top ten of Chinese medicine prescribed in frequency were Danshen,Huangqi,Shanyao,Shihu,Maidong,Fuling,Beishashen,Duzhong,Shudi,Yuzhu.There were matching Chinese medicine groups for different syndromes.Chinese medicine group for qi and yin deficiency syndrome included Huangqi,Taishen,Maidong,Yuzhu.There were two Chinese medicine groups for yin deficiency and blood stasis syndrome.The one included Beishashen,Maidong,Shihu,Danshen,while the other included Shudi,Shihu,Shanyao,Danshen,Niuxi.There were two Chinese medicine groups for splendid weakness and overabundant internal dampness syndrome as well.The one included Huangqi,Dangshen,Baizhu,Fuling,Chenpi and the other included Beishashen,Baibiandou,Yiren,Banxia,Chenpi.Chinese medicine group for kidney essence deficiency syndrome included Shudi,Shanzhuyu,Shanyao.Chinese medicine group for original qi deficiency syndrome included Huangqi in large amount,XiyangshenConclusions1.Reducing proteinuria:The treatment generally reduced proteinuria but its effects varied depending on albuminuria stage.The most significant effect was reduction of 24h-UTP at A3 stage.Besides the treatment also turned 30%of patients at A2 stage to A1 stage and kept all the patients at A1 stage steady.2.Syndromes and syndrome elements:The major syndromes were qi and yin deficiency syndrome,yin deficient and blood stasis syndrome,kidney essence deficiency syndrome The major syndrome elements were qi deficiency and yin deficiency at A1 and A2 stage while the major syndrome element was blood stasis at A3 stage which was followed by qi deficiency and yin deficiency.3.Therapy characters:Both tonifying qi and nourishing yin counted at the early stage.Tonifying qi and shengqing was stressed at the clinical stage,either was nourishing yin That supplementing original qi and warming yang counted at the end stage.Keep tonifying qi,nourishing yin and removing blood stasis throughout the treatment.