| ObjectiveThis study is to use ancient and modern literature research to sort out the ancient Chinese traditional external treatment for nephrogenic edema and analyze its modern clinical application profile and efficacy.Besides,by using retrospective case data from our department,to retrospectively analyze the clinical efficacy of the most commonly used modern clinical external treatment method of buckwheat package external application for nephrogenic edema,and to provide a basis for the overall efficacy evaluation of external Chinese medical treatment for nephrogenic edema.MethodsThis study was conducted step by step from ancient literature research to clinical application profile and efficacy analysis based on modern literature,and to retrospective efficacy analysis using case data from our department.1.Using the ancient literature search tool "Chinese medicine big data intelligent processing and knowledge service system" developed and provided by the big data team of Guangdong Hospital of TCM,we searched the ancient texts of external Chinese medical treatment for nephrogenic edema contained in the period of pre-Qin-Republic of China,standardized the description,and used Excel to sort out the texts,treatment methods,prescriptions,and sources as well as the frequency statistics.2.Using modern literature research methods,we searched modern literature on the treatment of renal edema by external treatment methods of Chinese medicine sorted out from ancient literature in four major Chinese databases,namely CNKI,Wanfang,cqivp and CBM.The ancient external treatment methods were analyzed in modern clinical applications in terms of types of external treatment methods,composition of drugs used,and sites of drug use.To evaluate the efficacy of external Chinese medical treatment for nephrogenic edema in terms of study population,interventions,treatment course,sample size,observed indicators,and study results.A retrospective review of the electronic medical records database of Guangdong Hospital of TCM was conducted to obtain an overview of the application of external Chinese medical treatment for nephrogenic edema in our department.3.A retrospective study was conducted to collect medical records of patients hospitalized in the Department of Nephrology of Guangdong Hospital of TCM between January 2017 and December 2019,and a total of 201 patients who met the inclusion criteria were obtained and divided into buckwheat package external application group(n=98)and no buckwheat package external application group(n=103)according to whether the patients applied buckwheat package external application during hospitalization,comparing the two groups of patients at admission,at discharge,at efficacy indicators and safety indicators at 3 months of discharge and 6 months of discharge.The data were analyzed using SPSS 22.0 statistical software.Results1.Ancient literature study:a total of 28 ancient texts documenting external Chinese medical treatment documenting nephrogenic edema were obtained,with 70 articles,43 drugs,31 groups of prescriptions,and 5 treatments.The treatment methods include external application,external washing,fumigation,foot massage and moxibustion,with external application as the main method.The external application sites are mainly the Shen Que points and abdominal points.The top 4 drugs in terms of frequency of external application were garlic,field snail,Gansui,and psyllium.As for the prescriptions,the two most frequently used prescriptions consisted of high-frequency drugs,namely,field snail,garlic,and psyllium,as well as di dragon,pig ling,needle sand,and glycyrrhiza.The external treatment method of Chinese medicine takes Xuan Tong as the main rule,and also uses the properties of the drugs themselves and the warming properties of the therapy to improve edema.2.Modern clinical application:the external Chinese medical treatment methods in ancient literature have the characteristics of inheritance and development in modern clinical application.Specifically,(1)from ancient times to the present,the external application of Chinese medicine has been the most commonly used external Chinese medical treatment for nephrogenic edema,confirming its practicality and effectiveness.However,the techniques applied to the external application method are constantly being improved.(2)In modern research reports,the external treatment prescriptions are still dominated by a large number of drugs with diuretic and heat-clearing,pungent and aromatic orifice opening and ligament-opening effects,but the grouping is more flexible and rich.(3)Although the external application part has been changed from the ancient one in which the umbilicus was commonly applied to the lower extremities to the modern one in which both lower extremities are commonly applied,it is still consistent with the ancient literature in which the acupuncture points of the spleen and kidney meridians of the lower extremities were mostly considered in the external treatment.(4)Ancient external Chinese medical treatment method to "Xuan Tong" as the main principle,including the effect of the drug itself and the warming effect of two aspects.The mechanism of external application of buckwheat packages for the treatment of renal edema in our department is to take into account the effectiveness of buckwheat itself to reduce swelling and toxicity and the warming effect.Clinical efficacy assessment:external Chinese medicine treatment of renal edema has the clinical efficacy of decongestion and diuresis.However,whether it can effectively improve renal function and other laboratory indicators is not clear.There is a lack of clinical research reports on the treatment of renal edema by external Chinese medicine.Buckwheat package applied externally to both lower extremities for the treatment of renal edema is the most commonly used external treatment of renal edema in recent years in our department,with sufficient case information,but there has been no formal clinical study to assess its efficacy.3.Retrospective efficacy analysis of buckwheat package applied externally for the treatment of renal edema.The results of the study suggest that,compared with the no buckwheat package externally applied group,patients in the buckwheat package externally applied group were discharged with a higher degree of weight loss than the no buckwheat package externally applied group(P<0.05);patients in the buckwheat package externally applied group had a greater improvement in the urine protein creatinine ratio before and after treatment(P>0.05);patients were better than the no buckwheat package externally applied group in terms of elevated serum albumin before and after treatment(P<0.05).The uric acid level was more stable in the buckwheat wrap topical group,while the uric acid rose faster in the no buckwheat wrap topical group,and the difference in uric acid at 3 months and 6 months after discharge was higher than that in the buckwheat wrap topical group(P<0.05).Fewer patients were treated with furosemide during hospitalization in the buckwheat package topical group(P<0.05),and their applied dose was lower(P<0.05).However,no significant difference was seen between the two groups in terms of improvement in renal function indicators.ConclusionThe treatment of nephrogenic edema with external Chinese medical treatment has developed from ancient to modern clinical practice in the course of inheritance and innovation in development.Although modern literature reports affirm its clinical efficacy of diuresis and decongestion,there is no conclusive evidence on whether it has the long-term efficacy of reducing urinary protein and improving renal function.The lack of modern clinical research reports affects the comprehensiveness of the assessment of the efficacy of external Chinese medicine.The retrospective efficacy analysis of buckwheat package topical treatment of nephrogenic edema provides a basis for the overall efficacy evaluation of topical external Chinese medical treatment of nephrogenic edema,but further prospective high-quality clinical studies are still needed. |
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