| Objective:Combined with the method of literature research,this paper discusses the idea of reasonable diagnosis and differentiation of patients with positive urinary occult blood from the point of view of renal physicians,in order to improve the efficiency of clinical reception,so as to make accurate triage of patients with positive urinary occult blood.further diagnosis and treatment of patients with renal hematuria can avoid misdiagnosis and missed diagnosis,resulting in the delay of the disease.The rule of traditional Chinese medicine in the treatment of chronic glomerulonephritis hematuria was studied by the way of data mining,and the clinical diagnosis and treatment of chronic glomerulonephritis hematuria was analyzed combined with the tutor’s clinical experience.to provide a new reference for the treatment of chronic glomerulonephritis hematuria with traditional Chinese medicine.Method:1.By reading and looking up the eighth edition of Internal Medicine,the eighth edition of Diagnostics,the third edition of Nephrology,and the third edition of Nephrology,published by the people’s Health Publishing House,on hematuria and diseases related to hematuria,write reading abstracts,and summarize the main points of diagnosis of various diseases.To explore the preliminary clinical diagnosis of patients with positive urinary occult blood from the point of view of nephrologists.2.The data of patients with chronic glomerulonephritis diagnosed as chronic glomerulonephritis with hematuria as the main clinical manifestation from November 1,2018 to November 30,2020 were collected.A total of 61 medical records and 264 prescriptions of traditional Chinese medicine were collected.The patient information was inputted by Excel form,and the general situation and the distribution characteristics of TCM syndromes were statistically analyzed.After data standardization,the name of traditional Chinese medicine and its four qi,five flavors,meridian tropism and efficacy classification were recorded in the Excel table respectively,the database was established,and the frequency of use of each drug was counted,and it was concluded that the high frequency drugs(the cumulative frequency of use was more than 60 times),that is,the core drug,the core drug table was established by using Excel table,and the classification of nature,taste and efficacy of each drug were statistically described,and charts were drawn.The core drug list was imported into SPSSModeler18.0 software and SPSSStatistics26.0 software respectively,and the correlation analysis and cluster analysis were carried out respectively,and the TCM medication rules and clinical syndrome differentiation ideas of Director Jiao Jian in the treatment of chronic glomerulonephritis hematuria were summarized.Result:1.Through the analysis of the literature,the diseases closely related to the occurrence of hematuria are as follows:(1)Primary glomerular diseases,including acute glomerulonephritis,rapidly progressive glomerulonephritis,chronic glomerulonephritis,asymptomatic hematuria and / or proteinuria(occult glomerulonephritis),nephrotic syndrome.According to pathological classification,it mainly includes Ig A nephropathy,Mesangial proliferative glomerulonephritis,minimal change nephropathy,membranous nephropathy,focal segmental glomerulosclerosis,membranous proliferative glomerulonephritis,crescentic glomerulonephritis and so on.(2)Secondary nephropathy,including lupus nephritis,Henoch-Schonlein purpura nephritis,endocapillary proliferative glomerulonephritis,ANCA-associated vasculitis,hepatitis B virus-related glomerulonephritis,hypertensive nephropathy,obesity-related nephropathy and so on.(3)acute interstitial glomerulonephritis.(4)hereditary nephropathy,including Alport syndrome,thin basement membrane nephropathy,polycystic nephropathy and so on.(5)Urological diseases,including urinary tract infection,urinary tract tumor,urinary tract stone,renal tuberculosis and so on.In addition,as a result of taking some drugs or food with pigment,it can lead to false gross hematuria;because of severe trauma or blood transfusion reaction,it can lead to hemoglobinuria and myoglobinuria;factors such as strenuous exercise,sexual intercourse or female menstruation can lead to transient hematuria before urine examination;hematuria can be caused by the use of anticoagulant drugs or kidney damage drugs.2.In this study,a total of 61 medical records were collected,with a total of 264 consultations,including 26 males(42.6%)and 35 females(57.4%).The ratio of male to female was 1.35.The age distribution showed that the maximum age was 82 years old,the minimum age was 22 years old,the average age was 49.52 ±15.98 years old,and the median was 48 years old.The statistical results of the distribution of TCM syndromes show that the most common clinical symptoms are "fatigue","sore waist and knees","red tongue" and "yellow greasy fur",and pulse mainly "weak pulse" and "stringed veinlets".This deficiency syndrome is mainly "spleen and kidney qi deficiency syndrome",and the standard syndrome is mostly "damp-heat syndrome".A total of 169 traditional Chinese medicines were involved in this study,of which 20 were used more than 60 times,followed by Radix Astragali 220 times,Schisandra chinensis 174 times,Poria cocos 166 times,Salvia miltiorrhiza 138 times,Ligusticum chuanxiong 133 times,Atractylodes macrocephala 118 times,dandelion 97 times,Ligustrum lucidum 94 times,licorice 92 times,golden cherry 89 times,Ligustrum lucidum 89 times,Ramie root 82 times,honeysuckle 74 times,Scutellaria barbata 71 times,Angelica sinensis 68 times.There were 67 times of moutan bark,67 times of Cornus officinalis,65 times of small thistle and 62 times of Crane grass.The statistical results of the efficacy of traditional Chinese medicine showed that there were 7 kinds of drugs that were used more than 200 times,namely,deficiency medicine,heat-clearing medicine,promoting blood circulation and removing blood stasis medicine,hemostatic medicine,astringent medicine,diuresis and dampness medicine,and surface-relieving medicine,with a total frequency of3638 times,accounting for about 81.4% of the total frequency.The statistical results of four qi show that the frequency of cold drugs is the highest,accounting for 43.9% of the total frequency,followed by warm,flat,cool and hot.The statistical results of the five flavors show that the order according to the number is sweet,bitter,pungent,salty,sour,astringent and light,and according to the frequency of use,it is sweet,bitter,pungent,sour,astringent,light and salty.The results of meridian tropism showed that the six most frequently used channels were liver meridian,lung meridian,spleen meridian,stomach meridian,kidney meridian and heart meridian.Through the drug correlation analysis,it is concluded that the basic prescriptions commonly used by mentors are: Radix Astragali,Salvia miltiorrhiza,Ligusticum chuanxiong,Poria cocos.Through cluster analysis,it is concluded that there are five groups of drug combinations commonly used by mentors,namely,Ligustrum lucidum,Moxa lotus,Ramie root,fairy crane grass;honeysuckle,licorice;dandelion,Scutellaria barbata;Radix Astragali,Poria cocos,Salvia miltiorrhiza,Ligusticum chuanxiong,Schisandra;cohosh,Atractylodes macro.Conclusion:1.From the point of view of renal physicians,when a patient sees a doctor with positive urinary occult blood,the clinical history should be collected first,and the source of hematuria should be preliminarily identified by symptoms and signs;secondly,the false positive should be excluded by urinary sediment microscopic examination.pass combined with urine phase contrast microscope examination to distinguish renal hematuria from non-renal hematuria;imaging examination of patients with suspected urological diseases and timely referral.For patients with renal hematuria,further systematic examination,if necessary,renal biopsy to confirm the diagnosis,in order to carry out the next step of treatment.2.The basic pathogenesis of hematuria in chronic glomerulonephritis is deficiency and excess.In clinical treatment,teachers of Jiaojian mainly take tonifying drugs for deficiency,especially pay attention to the application of tonifying qi drugs.According to different syndromes,combined with heat-clearing drugs,drugs for promoting blood circulation and removing blood stasis,hemostatic drugs,etc.,tonifying and reducing drugs,cold and temperature are used at the same time,expelling pathogens without forgetting to strengthen the upright.Through this study,it is found that the most common deficiency syndrome of this disease is spleen and kidney qi deficiency syndrome,and damp-heat syndrome is the most common syndrome.Jiao Jian teacher often takes tonifying spleen and kidney,clearing heat and promoting dampness as the basic treatment.Because kidney deficiency and blood stasis often run through the disease all the time,in clinical treatment,Jiao Jian teacher often uses the products of promoting blood circulation and removing blood stasis. |
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