Academic Thought Of Professor Zhao Ji-sheng's Treatment In Chronic Renal Failure With Determining Treatment By Patterns Identified And His Clinical Research Of Fortifying Spleen, Boosting Kidney, Resolving Toxin, And Transforming Stasis

Introduction to Tutor:Zhao Ji-sheng, male, born in1946, CPC member, is from Nanchang city, Jiangxi province. He is the professor from Jiangxi Medical College, traditional Chinese physician director, doctorial tutor of Nanjing University of Traditional Chinese Medicine, and is also one of the instructors of the third and the forth batch national work, which is inheriting academic experience from famous and veteran traditional Chinese medicine and pharmacy experts. Meanwhile, he is the member of the standing committee of the nephropathy branch of the Jiangxi Medical Association, deputy director of the nephropathy group of internal medicine of Jiangxi Traditional Medicine Association. What's more, he is famous as a traditional Chinese medicine practitioner in Jiangxi province. Professor Zhao graduated in TCM purpose from Jiangxi Medical Collage in1969. He has been chosen to be an apprentice of professor Lu Zhi-zheng, an elder TCM physician, in China Academy of TCM for further study from1979to1982. During the time, he studied assiduously, treated the patients carefully, fully inherited the academic thoughts, and familiar with all treatments of diseases, especially good at treating nephropathy. Since professor Zhao has been worked in the clinical Chinese medicine for more than40years, he has accumulated vast of perfect medical-skill, made an evident effect in treatment, and earned a great honor from colleagues and patients. Professor Zhao is good at treating many diseases, chronic glomerulonephritis, nephrotic syndrome, purpuric nephritis, hypertensive nephropathy, lupus nephropathy, diabetic nephropathy, hepatitis B virus associated-glomerulonephritis, urinary tract infection, chronic renal insufficiency and so on, that with insightful experience, which effect is obvious. Professor Zhao has compiled and published3monographs about medicine, published more than40academic theses, masterminded and took part in4province-level research subjects.This research is composed by two parts, the first part is about professor Zhao Jing-sheng's experiences in treating chronic renal failure (CRF), including the understanding of etiology and pathogenesis of CRF from professor Zhao, discussion of the rule for diagnosis and treatment. determine treatment by patterns identified and all kinds of identity patterns and pharmacy feature that will render CRF. The second part is about the method of fortifying spleen, boosting kidney, resolving toxin, transforming stasis in clinical study, including the discussion of the academic thought and clinical observation of the method of fortifying the spleen, boosting kidney, resolving toxin, transforming stasis in treating CRF. Both of the two parts provide scientific evidence for using traditional Chinese medicine and pharmacy to prevent and treat CRF.1Experience of Professor Zhao Ji-sheng in treating CRF1.1Etiology and pathogenesisProfessor Zhao considers CRF is caused by the disease of edema, stranguria, lumbar pain, urinary retention, wasting-thirst syndrome and so on, which is in wrong treatment or invaded by exogenous pathogen repeatedly that make it a long course and hard to recovery. The weak function of the spleen and kidney will affects the lung, liver and heart, causes dampness, toxin and stasis aggressive, makes triple energizer stasis, yin and yang disorder, qi and blood destruction and other pathological changes. Each stage of CRF comprises2aspects, pathogenic factor prevailing while body resistance weakened. In early stage, the prevailed pathogenic factor chiefly is interaction of wind, dampness, heat, stasis and toxin, while weakened body resistance mostly is spleen-kidney qi deficiency and yang deficiency. Medium-term's manifestation is insufficiency of qi and yin. Characterizes in terminal stage are deficiency of construction-blood, destruction between yin and yang, combination with turbid damp, toxin and stasis. Diseases in causing CRF mainly are:chronic glomerulonephritis, chronic pyelonephritis, diabetic nephropathy, hypertensive nephropathy, polycystic kidney, lupus nephropathy, obstructive nephropathy, gouty nephropathy and so on.1.2Rules of Diagnosis and TreatmentThe rules of diagnosis and treatment include the judgment of patient's condition, through patient's facial, tongue, pulse, spirit, cold and urine; TCM pattern features; pathogenic level; diseases'prognosis and so on.1.3Treatment's rules according to pattern differentiationWeakened body resistance lays particular stress on yang, qi and blood:The essence of this disease is deficiency, and the mainly pathogenesis is the insufficiency of qi, yang and blood through the whole process. There are4patterns according to different stages of the disease, spleen qi deficiency pattern, spleen-kidney qi deficiency pattern, spleen-kidney yang deficiency pattern, liver-kidney yin deficiency pattern. Each pattern combines with blood insufficient, and appears deficiency with both yin and yang.Prevailed pathogenic factor lays particular stress on dampness, turbid and stasis: Damp-heat presents to the progress stage of the disease, while damp-turbidity or cold-damp internal retention appears to the patient whose yang-qi is deficient evidently. The pattern of internal stasis blood obstruction appears less independently, and the weaker the body resistance is, the more aggravating the internal stasis blood obstruction pattern is. It's hard to separate the two parts, and the weaker the body resistance is, the more prevailed the pathogenic factor is. The weakened body resistance towards to multiple levels, while the prevailed pathogenic factor towards to multiple factors in development. Bases on the regulations above, professor Zhao put his opinion forth to treat CRF by fortifying spleen, booting kidney, resolving toxin, and transforming stasis. The pattern identification, treatment principle, pharmacy regularities and features are as follows:Basic prescription:astragalus, morindae, psoralea, lingustici rhizoma, ranunculi ternati tuber, hedyotis, centella, rhubarb(1) Spleen-kidney qi deficiency:fortify the spleen and boost qi. Add codonopsis, cornus, dioscorea, herb pyrolae, radix saussureae, fructus amomi. tuckahoe, largehead atractylodes rhizome, dried orange peel and so on in the basic prescription.(2) Spleen-kidney yang vacuity:fortify the spleen and warm the kidney. Add herba cistanches, eclipta alba, fructus ligustri lucidi, dodder, rhizoma cyperi, rhizoma curculiginis, epimedium herb and so on in basic prescription.(3) Toxin and stasis combine together:resolve toxin and transform stasis. Add herb serissa, ramuli euonymi, Ilexcornuta, dandelion, rhizoma smilacis glabrae, safflower, peach seed, leech in the basic prescription.(4) Damp turbidity abstracts center: dispel dampness and resolve turbidity. Add goldthread, pinellia, orange peel, unripe bitter orange, tuckahoe, rhizoma alismatis, grifola. atractylis, coix seed, fructus amomi, rhubarb in the basic prescription.1.4Identity patterns and pharmacy character of those will cause CRFComprise ascertaining the cause and determining treatment of chronic nephritis, determining treatment of diabetic nephropathy's edema by stages, the features of the pattern and treatment of hepatitis B virus associated-glomerulonephritis, determining treatment of allergic purpura on the basis of pattern types, the prescription features and pharmacy of urolithiasis.1.5The TCM treatment of the complication after hemodialysis of CRFComprise the TCM treatment of hypotension, dialysis disequilibriumsyndrome, anemia, dialytic osteopathy, itch of skin, and pericarditiis after hemodialysis.2Clinical researches of fortifying the spleen, boosting the kidney, resolving toxin, and transforming stasis2.1Purpose:to investigate the clinical effectiveness of fortifying the spleen, boosting the kidney, resolving toxin, and transforming stasis in treating CRF.2.2Method:Cases are from outpatients and inpatients of our hospital's Urology Department from April2009to April2011.50males,44females, age rang20～80years, at (49.6±10.8) year of age.94cases of patients were divided randomly into treatment group (56cases) and control group (38cases). In the treatment group the ratio of male to female is1:1.3, age rang20-75years, at (49.6±12.1) year of age, the average course of CRF is8.02±6.25. Among treatment group there are22cases chronic glomerulonephritis,8cases diabetic nephropathy,3cases gouty nephropathy.1case lupus nephropathy,2cases polycystic kidney, lcase urolithiasis with obstructive nephropathy,10cases hypertensive nephropathy,1case hyperlipidemia with hypertensive nephropathy,1case cyst of kidney,1case right kidney transplant surgery,6cases unknown aetiology.15cases are in compensation stage, while21decompensation stage,15exhaustion stage,5uremia stage. In the control group the ratio of male to female is1:0.95, age rang21-80years, at (50.1±13.2) year of age, average course is9.54±1.25. Among this group, there are13cases chronic glomerulonephritis,6cases diabetic nephropathy,2cases gouty nephropathy,1case nephrotic syndrome,1case polycystic kidney, lcase urolithiasis with obstructive nephropathy,7cases hypertensive nephropathy,1case purpuric nephritis.1case obstructive nephropathy,1case surgery of abdominal aorta rupture,4cases unknown aetiology.9cases are in compensatory stage, while16decompensatory stage.9exhaustion stage.4uremia stage. It is comparable between the two groups in age. course of disease. Treatment group is treated according to pattern by professor Zhao's methods that fortify the spleen, boot the kidney, resolve toxin. and transform stasis. Decoction of the traditional Chinese medicine. entry400ml water. boiled to100ml, take juice; re-entry300ml water, boiled to100ml again, take juice, mix two juice together. Drink the juice100ml per time, twice a day. Control group will oral intake Shenshuaining capsule for treatment. Both two groups are continuous course treatment for2～6months.2.3ResultsThe results of the research show that professor Zhao's method, fortify the spleen, boot the kidney, resolve toxin, transform stasis, for CRF could achieve a total effective rate of2months is68%,6months is80%. Moreover, treatment in compensatory stage Ⅰ and decompensatory stage Ⅱ is effective, while the course in exhaustion stage Ⅲ and uremia stage Ⅳ could obvious meliorate the chiefly syndromes that shortness of breath, laziness to speak, fatigue and lack of strength, heavy cumbersome limbs, reduced eating and poor appetite, aching lumbus and knees, numbness of the limbs, dizziness and headache, which is seriously affect the patients' status, after6months. Compare with the control group after2months and6month, treatment group shows much better in reducing the BUN and scr level, decreasing the body toxin, delaying the progression of CRF, promoting kidney function (P<0.05,P<0.01), and improving hemoglobin level (P<0.05). Both of the treatment group and control group reveal significant difference better than before treatment after2months and6months (P<0.05).2.4ConclusionProfessor Zhao uses the methods that fortify the spleen, boot the kidney, resolve toxin, transform stasis for CRF treatment is better than the Shenshuaining control group, especially in compensatory stage Ⅰ and decompensatory stage Ⅱ is obvious effective. Compare with the disease course,6months shows much better than2months in meliorating the chiefly syndromes that shortness of breath, laziness to speak, fatigue and lack of strength, heavy cumbersome limbs, reduced eating and poor appetite, aching lumbus and knees, numbness of the limbs, dizziness and headache, which is seriously affect the patients'status, and reducing the BUN and scr level, decreasing the body toxin, delaying the progression of CRF, promoting kidney function.