Evaluation Of Curative Effect And Analysis Of Drug Use Rule In The Treatment Of Chronic Kidney Disease By Professor Yu Dajun

Background:Chronic kidney disease(CKD)is a disease of abnormal renal structure or function caused by a variety of causes,and the main manifestation is that it lasts for more than 3 months.With the development of science and technology in China,the significant improvement of medical and health level,the transformation of people’s lifestyle and the accelerating process of population aging society,the incidence of chronic kidney disease in China is increasing year by year.At present,the western medicine treatment for this disease is mainly to support treatment and symptomatic treatment,and combined with the stage of the disease to take the corresponding treatment measures.In the early stage of chronic kidney disease,it is mainly to treat the primary disease and delay the progression of the disease.In the middle stage of chronic kidney disease,on the basis of the above treatment measures,it is necessary to evaluate the complications of patients,and then take active intervention and treatment.In the advanced stage of chronic kidney disease,renal replacement therapy should be considered,and the corresponding symptomatic treatment and supportive treatment should be taken.However,the above treatment measures can only control the primary disease and complications of the patients,but cannot significantly improve the clinical symptoms of the patients.Traditional Chinese medicine intervention and treatment for this disease has significant advantages,not only improve the clinical symptoms of patients,but also can delay the progress of pathological changes of chronic kidney disease.It is of great significance for the inheritance and development of TCM to excavate the clinical experience of TCM masters in the diagnosis and treatment of chronic kidney disease.Professor Yu Dajun of Xiyuan Hospital,China Academy of Chinese Medical Sciences,has been engaged in the diagnosis and treatment of kidney diseases for more than 30 years,and has accumulated rich clinical experience in the diagnosis and treatment of chronic kidney diseases.Objective:With the help of data analysis and data mining software,multi-angle and multi-level mining analysis was carried out on the clinical cases of Professor Dajun in the diagnosis and treatment of chronic kidney disease,so as to evaluate the clinical efficacy of Professor Yu Dajun in the diagnosis and treatment of chronic kidney disease,and to explore the drug use rules for the diagnosis and treatment of chronic kidney disease.In this way,the academic thoughts and experience of Professor Yu Dajun in the diagnosis and treatment of chronic kidney disease are summarized comprehensively,and the reference of traditional Chinese medicine method is provided for the diagnosis and treatment of chronic kidney disease.Methods:Patients who were diagnosed with chronic kidney disease in the outpatient department of Professor Yu Dajun in Xiyuan Hospital,China Academy of Chinese Medical Sciences from January 2020 to January 2021 were collected.The main study was to study the medical records,prescriptions and auxiliary examinations of patients meeting the inclusion criteria.The basic information,primary disease,course of disease,complications,clinical symptoms,auxiliary examination,syndrome differentiation,prescription and so on of the patients were counted by using Excel database.SPSS Modeler18.0,SPSS Statistics 25.0 software and ancient and modern medical case cloud platform were used for data mining.Results:Basic information of patients and basic information of diseases:A total of 54 patients with chronic kidney disease were included in this study,among whom 33 were males,accounting for 61%of the total number.21 cases were female,accounting for 39%of the total.The youngest was 30 years old,the largest was 85 years old,and the average age was 57.91±15.56 years old.The number of patients aged 60-69 years was the largest,with 15 cases.Among 54 patients,29 cases(53.7%)had chronic glomerulonephritis,followed by 11 cases(20.37%)of nephrotic syndrome.There were 7 cases of metabolic disease,1 case of drug-induced kidney damage,3 cases of malignancy associated kidney disease,and 1 case of autoimmune disease.Hypertension and renal damage:2 cases.Among the 54 patients,the shortest course of disease was more than 1 year,while the longest was more than 30 years.The mean duration of disease was 7.54±0.81 years-Among them,24 cases(about 44.4%)had the disease course of 6-10 years.Complications mainly in 54 patients with primary hypertension,hyperlipidemia,high uric acid hematic disease,coronary atherosclerosis,heart disease and type 2 diabetes is given priority to,among them 39 cases of primary hypertension,hyperlipidemia,32 cases of high uric acid hematic disease,29 cases,25 cases of coronary atherosclerosis sex heart disease,11 patients with type 2 diabetes.Among the 54 patients,CKD-MBD and renal anemia were the main complications of chronic kidney disease,including 28 patients with complicated CKD-MBD and 18 patients with renal anemia.Before treatment,54 patients(27 cases,accounting for 50%of the included patients)were mainly in stage 3 CKD stage.Secondly,there were 15 patients with stage 2,accounting for 27.8%,7 patients with stage 4,accounting for 13%,and 5 patients with stage 5,accounting for 9.3%.The TCM name diagnosis of 54 patients was mainly deficiency and fatigue,a total of 19 cases,12 cases of hematuria,10 cases of urine turbidity and edema,and 3 cases of patients were diagnosed as low back pain.TCM syndrome differentiation and classification,among which the main syndrome is the deficiency of Qi and Yin,followed by the deficiency of spleen and kidney Qi,deficiency of liver and kidney Yin and deficiency of spleen and kidney Yang.The concurrent syndromes were mainly dampness and blood stasis mutual obstruction syndrome,followed by phlegm and turbidity intermediate obstruction syndrome,middle coke damp-heat syndrome and spleen-deficiency water dampness syndrome.The common symptoms of the patients before and after treatment were mainly fatigue,lack of food and tolerance,shortness of breath and lazy speech,abdominal distention,edema,nocturia and long clear,waist and knee soft.Result of curative effect evaluation:The scores of TCM syndrome before and after treatment were compared,which decreased from 21.52±7.55 before treatment to 10.26±4.20 after treatment,with statistically significant difference(P<0.01).The changes of serum creatinine and endogenous creatinine clearance before and after treatment were compared.The serum creatinine clearance decreased from 158.33±85.39 before treatment to 145.94±85.04,the difference was statistically significant(P<0.05).The endogenous creatinine clearance rate increased from 48.02±21.81 before treatment to 55.06±28.55,the difference was statistically significant(P<0.05).After 3 months of treatment with integrated traditional Chinese and western medicine,the symptoms of 54 patients changed and improved significantly in 13 cases,effective in 39 cases,and stable in 2 cases.The endogenous creatinine clearance rate before and after treatment was significantly effective in 15 cases,effective in 11 cases,stable in 20 cases and ineffective in 8 cases.Before and after treatment,serum creatinine showed obvious effect in 10 cases,effective in 9 cases,stable in 27 cases and ineffective in 8 cases.Data mining results:A total of 216 prescriptions were included in this study,involving 164 drugs in total.Astragalus membranaceus was the most frequently used drug,accounting for about 88.43%.There were 7 traditional Chinese medicines with a frequency of more than 50%,which were Astragalus membranaceus,Rehmanniae rehmanniae,Salvia miltiorrhiza,Chinese yam,Tangerine peel,Alisma orientalis and Coptis coptidis in order.The main effects of 164 traditional Chinese medicines included,in turn,nourishing water and reducing swelling,promoting blood circulation and removing blood stasis,nourishing water and oozing dampness,dryness and dampness to dissolve phlegm,and nourishing fluid and blood.Among the four drugs,the top four most frequently used ones were flat,warm,cold and mild,and the cumulative frequency of the above four kinds of drugs was up to 83%.The five flavors of medicine were mainly sweet,bitter,pungent and light,with a cumulative frequency of 89%.Less use of sour taste,astringent traditional Chinese medicine.The main drug channels were liver,spleen,lung,kidney and stomach,with a cumulative frequency of 81%.The complex network diagram of core drug combination was obtained by complex network analysis of 164 Chinese herbs in 216 prescriptions.Among them,the core drug components successively included Astragalus membranaceus,Rehmannia glutinosa,Salvia miltiorrhiza,Chinese yam,Tangerine peel,Coptis chinensis,Alisma orientalis,Dangshen,Zedoary rhizome and Morinda officinalis.Conclusion:1.Professor Yu Dajun integrated traditional Chinese and western medicine treatment of chronic kidney disease,can significantly improve the clinical symptoms of patients,for stage 2,3 patients with endogenous creatinine clearance rate and serum creatinine has a significant effect.For stage 4 and 5 patients,although there was no significant statistical difference in endogenous creatinine clearance rate and serum creatinine before and after treatment,the changes showed a trend of gradual improvement.The above results were related to older age,longer course of disease,shorter observation and treatment period,and more complications and complications in stage 4 and 5 patients.2.Through the data mining of 216 prescriptions of 54 patients above,it is concluded that the most commonly used high-frequency drugs used by Professor Yu in the treatment of chronic kidney disease are Astragalus membranaceus,Rehmannia glutinosa,Salvia miltiorrhiza,Chinese yam,Tangerine peel,Alisma alisma and Rhizoma coptis.Clinical prescription medication is relatively mild,mainly for tonifying and reducing.In the treatment of chronic kidney disease,Professor Yu Dajun mainly focuses on strengthening the spleen and tonifying the kidney while removing pathogenic factors.In clinical practice,Astragalus membranaceus,Dangshen Radix,Rehmannia glutinosa,Chinese yam and Atractylodonis root are commonly used to strengthen the spleen and tonifying the kidney.On the basis of nourishing qi and nourishing Yin,especially attention is paid to warming Yang,and commonly used halberd and so on.For patients with severe deficiency,use the products of flesh and blood,such as tortoisesha gum,antler gum and so on.Removing evil is mainly aimed at dampness and heat,phlegm and turbidity,blood stasis and qi stagnation.Commonly used lotus leaf,coix seed,coptis and so on heat and dampness;Atractylodes Atractylodes,Atractylodes Atractylodes,etc.Salvia miltiorrhiza,zedoary,ground dragon,ghost arrow feather and so on promote blood circulation,remove blood stasis and clear collaterals;Tangerine Peel,Su Terrier,etc.In addition to taking into account the virtual standard,especially pay attention to the evil to the outlet,commonly used rhubarb and other Fu Fu catharsis;Diuretic drainage of Alisma nalisma,Dioscorea septum,etc.In addition,according to the prescription test,the author summarized the common prescriptions used by Professor Yu Dajun in clinical diagnosis and treatment of chronic kidney disease.Often used Yiqi filling lung commonly used as jade screen powder,Yiqi solid table;Spleen-invigorating Spleen is commonly used such as Shengyang Yiwei Decoction,Shenling Baizhu Powder,Buzhong Yiqi Decoction;Kidney nourishing Yin warming Yang commonly used such as kidney qi pills,left to pills,right to pills,Guilu two Xian glue;Dihuang Decoction series such as Shenqi Dihuang Decoction and Maiwei Dihuang Decoction are commonly used for both lungs,spleen and kidney.For patients with a large amount of proteinuria,manifested as kidney deficiency and its fixation,use such as Jinsuogujing pills.For the evil of damp heat,belongs to the wet stagnation of the spleen and stomach commonly used Pingwei powder;The dampness and heat connotations often use Suye Huanglian Tang and Sanren Tang;Damp heat bet eight is scattered,four miao pills;For the evil of phlegm turbidity,Erchen soup and orange peel bamboo soup are often used.For the Qi stagnation often use Chaihu Shugan powder,Yue Ju pills,Pinellia magnolia decoction;Aimed at the evil of blood stasis,the homology of blood and water such as ghost arrow feather,Zanlan and Leonurus is often used.Or Salvia miltiorrhiza,Yanhusuo,turmeric and other Qi and blood harmonies;Or leech,earth dragon,pangshan dragon and other blood circulation.Secondly,we should attach importance to giving evil a way out.Urine often use prescription such as eight is scattered,Dongkui son Fu Ling powder;Common medicine such as plantain seed,white straw root;The stool commonly used cooked rhubarb,because of Qi Yin two injuries,intestinal loss of Run,often Wu pockmark kernel and other quality Run fatty products.3.Professor Yu Dajun often from the viscera in the treatment of chronic kidney disease cause treatment based on syndrome differentiation and treatment based on syndrome differentiation of zang-fu syndrome differentiation and treatment is mainly from the perspective of the lung,spleen,kidney three dirty,treated from lung,mainly due to pulmonary qi deficiency,who is not solid,the wind caused by heat toxin evil invading lung collaterals,at the beginning of the disease often is given priority to with wind heat meter empirical,long into the lung qi deficiency syndrome.Therefore,at the beginning of the disease to Shufeng Qingrejiedu pharynx mainly,and to yiqi solid table;The treatment from the spleen is mainly due to deficiency of spleen and the accumulation of dampness.Therefore,the clinical treatment is often based on invigorating the spleen and reducing dampness.Kidney treatment is mainly due to kidney deficiency,and it is necessary to distinguish between Yin deficiency and Yang deficiency,or Yin and Yang deficiency.The treatment is mainly to nourish the kidney and warm Yang,or to nourish Yin and Yang,and at the same time,it is necessary to take into account the mutual roots of Yin and Yang.The prescription for dispensing drugs in the presence of symptoms should bear in mind that nourishing Yin must be accompanied by warming Yang,and warming Yang should not forget nourishing Yin.Secondly,proteinuria is one of the common clinical manifestations of chronic kidney disease,traditional Chinese medicine that protein in the human body of fine matter,kidney fixation is one of the main reasons for the leakage of fine matter.Therefore,Professor Yu Dajun clinically commonly used tonifying kidney astringent essence method to treat proteinuria.The etiology and syndrome differentiation are mainly treated by dampness and heat,phlegm and turbidity,and blood stasis.Professor Yu Dajun believes that dampness and heat are evil throughout the chronic kidney disease.Therefore,clearing heat and reducing dampness is the basis of treating chronic kidney disease.And then according to the cause of the phlegm turbidities and blood stasis is different,and adopt different treatment.Professor Yu Dajun’s clinical medication has the following characteristics:First,clinical prescription medication is fine and gentle,and the dosage is light.Clinical use of gentle taste of the product.Secondly,Professor Yu Dajun believes that Yang Qi is the root of the whole body’s Qi.Warm and warm,it promotes the movement of the whole body’s Qi mechanism.If Yang Qi is deficient,the Qi mechanism stags,and for a long time,it produces dampness,turbidity,phlegm and blood stasis.Therefore,in the treatment of this kind of syndrome,we should pay special attention to warming Yang on the basis of strengthening Zhengquanxia.The compatibility of clinical formulations pays attention to regulating qi,giving evil spirits a way out,and making good use of "tongfa".The pathogenesis of chronic kidney disease is mainly the basic deficiency and the standard solid,and the standard solid is usually composed of dampness,turbidity,phlegm,blood stasis and other pathogenic factors,which are easy to block the Qi machine and cause disease.Therefore,it is appropriate to use the method of passing through,promoting the ventilation machine,regulating the Qi machine,and removing the evil.