Study On The Medication Rules Of Zhao Jinxi's Staged Syndrome Differentiation Treatment For Diabetic Nephropathy Based On Data Minin

Background:With an aging population and changing lifestyle habits,there has been a dramatic increase in the number of people with diabetes worldwide,leading to a change in the etiologic spectrum of chronic kidney disease.Diabetic kidney disease(DKD)is now the leading single cause of end-stage renal disease(ESRD).Therefore,based on the actual clinical case data,it is important to conduct a deep excavation of Prof.Zhao Jinxi’s diagnosis and treatment experience.Objective:To summarize the diagnosis and treatment experience of Prof.Zhao Jinxi for different disease stages,symptoms,symptoms,complications,and combined disease conditions by analyzing and counting the cases of DKD treated by Prof.Zhao Jinxi in various aspects,so as to provide reference for the diagnosis and treatment of DKD in Chinese medicine.Methods:Outpatient cases of diabetic kidney disease of Professor Zhao Jinxi at Dongzhiman from September 1,2020 to December 31,2022 were selected.Western medicine staging was based on the CGA staging method proposed in the guidelines published by KDIGO in 2012,and Chinese medicine staging referred to the Chinese medicine three-stage staging scheme proposed in the "Diabetic Kidney Disease Staging Identification Standard and Efficacy Assessment Scheme and its Research".Base on Modern Medical Case Cloud Platform V2.3.5 developed by the Chinese Academy of Traditional Chinese Medicine to analyze the drug attribution,efficacy in the collected medical records,and to analyze the correlation,complex network,and point reciprocal information on the patterns of drug use for different stages,symptoms,symptoms,complications,and combined diseases of DKD.Results:In total,806 DKD patients were included in this analysis,of which 559 are male and 247 are female.The mean age of the patients in this study was 59,and most patients were distributed between 50 and 79 years old.In terms of CGA staging,there were 174 cases(21.59%)with early-stage DKD,248 cases(30.77%)with middle-stage DKD,and 384 cases(47.64%)with late stage DKD.In terms of symptoms,the frequency of DKD patients was,in descending order,weakness,swelling,shortness of breath,sleeplessness,dreaminess,chest tightness,abdominal distention,numbness in the extremities,bitterness in the mouth,fear of cold,purple-red lips,tingling in the nail,cold feet,and Qi rebellion when lying down,etc.In terms of symptoms,the frequency of Qi deficiency was the highest among patients with DKD,followed by Blood stasis,Dampness,Water-dampness,Qi stagnation,Drinking stoppage,Stagnant heat,Yin deficiency,Damp-heat,and Yang deficiency.The most commonly used herbs were Astragalus,Salvia,Poria,Dioscorea,Dioscorea,Diangshang,Shiwei,Angelica,Chuanxiong,Cicada,Turmeric,and Paeonia.The drugs more closely associated with blood stasis are Di Long,Chuan Xiong,Angelica,leech,etc.;the drugs more closely associated with dampness are Perilla stems,Cicada molasses,Dioscorea,etc.;the drugs more closely associated with water dampness are Poria,Dagger,Dahurian,etc.The drugs that are more closely related to water-dampness are Poria,Dagger’s bark,Safflower seed,Poria etc;the drugs that are more closely related to qi stagnation are Ziziphus stems,Aromatic herb,Mullein,Sharen,Chaihu,Wuhu,Guahu,Fa Xianxia,etc.;the drugs that are more closely related to drinking stagnation are Scapularia,Mullein,Shengma,Zhiwu,Guahu,etc.;The drugs more closely related to heat are Mulberry leaf,Chrysanthemum,Xia Ku Cao,Licorice,Chai Hu,Scutellaria,etc.;the drugs more closely related to yin deficiency are Ground bone bark,Di Huang,Lychee core,Licorice,Xian He Cao,Xia Ku Cao,etc.;the drugs more closely related to yang deficiency are Cinnamon,Huang Lian.The drugs that are more closely associated with Yang deficiency are Cinnamomum cassiae,Huanglian,Fried Atractylodes,Pueraria Mirifica,and Wu Yao.Early Stage core prescriptions are Danshen,Fu Ling,Dioscorea,Scutellaria,Astragalus,Angelica,Radix Angelicae Sinensis,Rhizoma Ligustici,Rhizoma Ligustici.Middle Stage core prescriptions are Astragalus,Angelica,Cicada,Rhizoma,Rhizoma,Salvia,Danshen,Dioscorea,Dioscorea,Pierced Mountain Dragon,and Shiwei,etc.Late Stage core prescriptions are Dioscorea,Dioscorea,Shiwei,Pierced Mountain Dragon,Danshen,Cicada,Rhizoma,Rhizoma,Jiang Huang,and Sclerotinia.For different amounts of proteinuria medications,the common drugs for moderate and large amounts of proteinuria include Astragalus,Panax notoginseng,Poria,Poria,Morinda citrifolia,Burdock,Asclepias,Rhizoma alba,Shivei,Fructus antibiotics,and Salvia,and the common drugs for trace and moderate amounts include Rhizoma alba,Coix lacryma,fried Atractylodes,Forsythia,and Huanglian.The characteristic drugs for large amount of proteinuria are Dagger’s bark,water saffron seed,leech,oyster,ripe rhubarb,turtle nail,scabbard seed,turmeric,stiff cicada,angelica,and the characteristic drugs for medium amount of proteinuria are guahu,tiger scepter,white atractylodes,red peony,windbreak,white peony,Chuanxiong,and piercing dragon;the characteristic drugs for trace amount of proteinuria are north saxifrage,lychee core,licorice,groundnut,ground bark,Fritillaria,senghuang,chicken blood vine,Mulberry leaf,mulberry saposhnikovia,Chuansuan,mulberry branch,Xia Ku Cao,and Pueraria lobata.Most of the patients with DKD in this study had a clear diagnosis of diabetic retinopathy,and nearly half had a diagnosis of diabetic peripheral neuropathy.The drugs more closely associated with diabetic retinopathy were Xia Ku Cao,Mulberry leaf,Chrysanthemum,Mimosa,Semen cassia,Cyperus rotundus,Bei Sha Shen,Panax ginseng,Chai Hu,Scutellaria baicalensis,Paeonia lactiflora,Mai Dong,Leech,Datura,and Lotus leaf.Drugs more closely associated with diabetic peripheral neuropathy include henbane,mucuna pruriens,rhizoma cibotii,achyranthes,wei ling xian,datura,peach kernel,cinnamon stick,safflower,green fungus vine,Sichuan achyranthes,yu zhu,dahurica dahurica,Chuan xian zhuan,di dragon,mulberry,mulberry branch,and rhubarb.Drugs more closely related with hypertension include Xia Ku Cao,Mulberry leaf,Chrysanthemum,Mimosa,Xuan Ginseng,Chuanxiong.The drugs more closely related with hyperlipidemia include lotus leaf,Yin Chen,yu zhu,fried coix seeds,raw rhubarb,tiger scepter,perilla seed,money grass,etc.Drugs closely related to hyperuricemia include Cyperus rotundus,Ulva lucidum,Cyperus rotundus,Qin Pi,Tu Fu Ling,Dioscorea,Qing Feng Vine,Niubizi,etc.The drugs more closely associated with coronary heart disease include Dracaena scabra Asclepias,Aromatic Herb,Psidium guajava,Astragalus,Zhi Mu,Morinda citrifolia.Conclusion:①DKD is characterized by the syndrome of Qi deficiency and Blood stasis,which presents differently at various stages.In the early stage,Yin and Qi deficiency with internal Heat,phlegm and stasis obstructing collaterals are the primary syndromes.In the middle stage,renal Yuan deficiency,dampness obstructing collaterals,and cessation of drinking are common,while dampness predominates,along with the presence of Yang deficiency,Blood deficiency,and Heat-toxin in the late stage.②Professor Zhao Jinxi uses drugs that tonify Qi,activate Blood,promote diuresis,and clear turbidity,expel wind,dispel pathogenic factors,and strengthen and protect the Spleen and Stomach to treat DKD.This approach reflects an understanding of the core pathological mechanisms of "formation of micro-lesions" and "wind pathogen obstructing collaterals" while emphasizing the importance of treating turbidity by harmonizing the Stomach.③Treatment for DKD is differentiated based on stages and syndrome differentiation.Clearing heat,tonifying Qi,activating Blood,and transforming stasis are the primary treatments for the early stage.For the middle stage,tonifying Qi,expelling wind,detoxifying,and draining turbidity,and activating Blood and transforming stasis are the main treatments.For the late stage,detoxifying and draining turbidity,tonifying Qi and protecting the Stomach,promoting diuresis,and activating Blood and transforming stasis are the main treatments.Treatment approaches and medication are flexibly adjusted for DKD patients with different concurrent diseases,based on their pathogenic mechanisms.④Professor Zhao Jinxi has inherited valuable experience from the Shi Jinmo school of medicine,including medicinal pairs and combinations.Commonly used medicinal combinations for treating DKD include stir-fried Atractylodes Rhizome and stir-fried White Atractylodes Rhizome,Rhizoma Polygoni Cuspidati and Lysimachia christinae,Semen Lepidii and Morus alba bark,Cortex Dictamni and Erythrina variegata seed,Poria and Poria cocos,Hirudo and Notoginseng,Carapax Trionycis and Ostrea gigas,Cortex Lycii and Litchi seed,Hedyotis diffusa and Semen Nelumbinis,Hedyotis diffusa and Coix seed,Coptis chinensis and Cinnamon twig,Os Draconis and Ostrea gigas,Linderae Radix and Chicken gizzard skin,and Kochiae Fructus and White mulberry bark.