The Summarization Of Xiwen Dai's Clinical Experiences In Treating Chronic Kidney Diseases

1.ObjectiveProfessor XiWen Dai is a famous senior nephrology expert working in Guang'anmen Hospital.In more than fourty years's clinical practice, she sets up some special methods to treat the Chronic Kidney Disease (CKD), which have been summarized, testified and explained. This study is intended to summarize and further explore the clinical experiences and CKD diagnosis and treatment laws of Prof Dai through Data Mining and analysing, the character of which is "Man-Computer Cooperation and mainly by man", so as to supplement and summarize her CKD academic ideology.2. MethodsThrough the Structural Clinical Information Collection System we made the database of Prof Dai and obtained the result by the technologies of on line analyze process (OLAP), free-scale network and pointwise mutual information(PMI).Then we analyzed and summarized Prof Dai's clinical experiences in treating CKD based on CKD stage and syndrome factors,such as symptom, syndrome, therapeutic method, prescription, herbal medicine-and so on.Then we got an interview with doctor Dai and make selections and explainations of the result. We summarized the thinking mode, clinical experiences and the learning point of view of Prof Dai combining with results of our past studies.3. Results—the clinical experiences of Prof Dai in treating CKD3.1 The view of symptomsThis study indicates that the most common tongue manifestations and the pulse manifestations were:dark or dark red tongue, bulgy tongue or teeth-printed tongue, with thin, yellow or greasy coating, thready pulse or slippery pulse; the most frenquent symptom are low back pain, lack of power, loose stool, edema, dry mouth, insomnia, foam urine, pharynx intumescence, sore throat, phlegm. The result reflect doctor Dai's experience that attach importance to these symptoms and take them as the basis of syndrome differentiation.3.2 The view of pathogenesisThis study reveals that the general pathogenesis of CKD is deficiency of vital qi and excess of pathogen.defiency of vital qi included the deficiency of lung qi, the deficiency of spleen qi and the deficiency of kidney qi, or accompanied with yin deficiency, blood deficiency. State of evil domination mainly included blood stasis, wind heat, damp toxin, or accompanied with turbid pathogen or water pathogen. Deficiency of qi,blood stasis and turbid damp are the central pathogenesis of CKD,they go through the whole process of CKD and tend to combine with other pathogens.Wind heat and toxin pathogen are the external cause which can aggravate the disease,and it is more obvious in the early stage of CKD.They are both the cause and the production of the disease. In the progress of CKD, water pathogen and turbid pathogen aggravate gradually, and further impair the healthy qi,and then become insufficiency of both qi and blood. The result accords with Prof Dai's view of pathogenesis.3.3 The application of therapeutic principle and theroputic methodsThe general therapeutic principle is to strengthen vital qi and dispel exogenous pathogen. The main therapeutic methods are to benefit vital qi and activate blood, clear away the heat evil and expel superficial evils and eliminate dampness, or combine with the methods such as inducing diuresis,check turbidity downward, nourishing yin, nourishing blood according to accompanied syndromes.According to different stages of CKD,their therapeutic methods are varies from each other. For stage 1-2 of CKD, the methods focus on strengthening qi and activating blood, clearing up heat,removing toxicity and draining dampness.For stage 3-4 of CKD, it's turning to strengthen qi and activate blood, clear up heat,inducing diuresis,check turbidity downward. For the last stage, the methods should focus on strengthening qi, nourishing and activating blood, clearing up heat,inducing diuresis,checking turbidity downward, or combining with regulating stomach.3.4 The application of prescriptionsThe most frequently used of prescriptions in this study are Honeysuckle Forsythia Powder, Jade-Screen Powder, Chinese Angelica and Peony Powder, Tetrandra and Astragalus Decoction and self-made prescription. The self-made prescription has the function of replenishing qi,promoting and nourishing the blood, dispersing the dampness and checking turbidity downward.Honeysuckle Forsythia Powder, aiming at Chronic pharyngitis and exogenous pathogens of wind heat, has been broadly used in various kinds of CKD;Jade-Screen Powder tends to be applied to hematuria, edema, lumbago and purpura, chronic nephritis and renal hypertension and so on; Chinese Angelica and Peony Powder and Tetrandra and Astragalus Decoction are used to treat TCM diseases,such as edema, consumption diseases and western medicine diseases like hypertensive nephropathy, renal hypertension and chronic renal failure; The self-made prescription is used to treat consumption diseases—chronic renal failure.For patients in CKD 1 or 2, Jade-Screen Powder and Honeysuckle Forsythia Powder are mainly used, when it came to stage3-5, Chinese Angelica and Peony Powder, Tetrandra and Astragalus Decoction are mainly used.The result accords with Prof Dai's experiences that using modified Honeysuckle Forsythia Powder and Jade-Screen Powder to replenishing qi to strengthen superficial defence,clearing away the heat evil and expelling superficial evils,dispelling external pathogens so as to treat chronic nephritis;using modified Chinese Angelica and Peony Powder, Tetrandra and Astragalus Decoction to activate blood and excrete the water so as to treat renal hypertension and renal edema; using prescriptions with functions of replenishing qi,promoting and nourishing the blood, dispersing the dampness and checking turbidity downward to treat chronic renal failure.3.5 Administration laws of chinese herbal drugsThe most frequently used of 15 chinese herbal drugs are:Shenghuangqi, Danggui, Lianqiao, Baihuasheshecao, Baishao,Chishao, Jinyinhua, Taizishen, Cheqiancao, Chuanshanlong, Fuling, Chaobaizhu, Daqingye, Chuanxiong, Fangfeng. These chinese herbal drugs are the core drugs in this research and reflect the therapeutic principle, which is strengthen vital qi and dispel exogenous pathogen and the therapeutic methods as replenishing qi,promoting and nourishing the blood, dispersing the dampness and checking turbidity downward.To the medication classification, the 10 kinds of chinese herbs which have been used most frequently are:heat-clearing herbs, tonic herbs, herbs that regulate the qi, herbs that promote urination and leach out dampness, herbs that release the exterior syndrome, herbs that eliminate the phlegm, herbs that promote blood circulation to remove stasis, herbs that arrest bleeding,herbs that calm the spirit,herbs that remove food stagnation and reduce mass;the 5 kinds of herbs which have been used most frequently are:tonic herbs, heat-clearing herbs, herbs that promote urination and leach out dampness, herbs that arrest bleeding, herbs that promote blood circulation to remove stasis.19 modification herb groups according to different syndromes:1.Focus on the dampness:These groups include Huangqin-Niuxi-Yimucao-Zexie, Zhuling-Shanglu-Hanfangji,Powdergbaipi-Dafupi,which have the function to promote blood circulation, promote urination and leach out dampness, and have been used to treat renal hypertention and renal edema.2.Focus on the syndromes like deficiency of yin and blood, stagnation of qi and blood:Zhimu-Huangbai, Nanshashen-Beishashen,which have the function of clearing heat-fire and can be used to treat the side-effect of glucocorticoid,chronic pharyngitis and hacking cough caused by the deficiency of lung yin; Nvzhenzi-Mohanlian have the function of nourishing yin of liver and kidney to eliminate tinnitus caused by yin deficiency of liver and kidney; Zhike-Yujin-Huangjing have the function of promoting qi, nourishing yin, activating blood and regulate qi,and to be used for Chest stuffiness. Danshen-Shengdi-Baixianpi, Shengdi-Shudi-Jixueteng-Daizheshi,Shengdi-Shudi-Xuduan-Xiangfu have functions of nourishing yin and blood, regulating menstruation, and to be used for endogenous wind caused by deficiency of blood and irregular menstruation.3.Focus on the syndrome of vessel injured by heat:Cebai-Xianhecao-Diyutan, Daji-Xiaoji are used to cooling blood for hemostasis.4.Focus on the damp obstruction in the middle or the lower jiao: Huanglian-Muxiang, Huanglian-Zhiwuzhuyu, Huanglian-Gualou-Zhishi,and Huogeng-Zisugeng are used to removing dampness for regulating stomach to treat the dampness stagnation of middle energizer, Chuanlianzi-Baijiangcao-Baitouweng have the efficacy of clearing heat toxicity and draining dampness to treat dampness heat of lower energizer. 5.Others:Tubeimu-Haigeke have the efficacy of softening and resolving hard mass, and be used to treat breast lump.Duanlonggu-Duanmuli have the efficacy of astringing and supplying calcium and can be used to treat spontaneous sweating and osteoarthropathy.medication laws in CKD 1-5:Modificating for stage1 or 2 of CKD,herbs that heat-clearing,promote urination and leach out dampness are mainly used; in stage 3 or 4, herbs that promote blood circulation to remove stasis, promote urination and leach out dampness are mainly used; in the 5th stage of CKD, therapeutic methods of nourishing blood and regulating qi have been further used.4. Academic ideology of Prof Dai4.1 Combining syndrome differenciation with differentiation of disease and integrating traditional and western medicineProf Dai advocates that syndrome differentiation should be combined with differentiation of disease in treating CKD.As some patients don't have typical symptoms, Prof Dai hold that syndrome differenciation should refer to the pathological mechanism of CKD, at the same time, the course and the prognosis of the disease should be thoroughly understood.4.2 Judging deficiency and excess of pathogen and vital qi, attaching importance to excess of pathogenProf Dai holds that the general pathogenesis of CKD is deficiency of vital qi and excess of pathogen. In the early stage of CKD, excess of pathogen dominates the disease, while in the later stage of CKD,deficiency of vital qi became more obvious. As dampness heat pathogen is throughout the course of CKD and tend to be accompanied by pathogens like blood stasis, turbidity, water and wind toxicity, which leading to the difficulty to cure the disease. Thus, the therapeutic methods of clearing heat and draining dampness are used throughout the course of CKD.4.3 Treating qi, blood and water pathogen at the same time to keep their dynamic equilibriumProf Dai considers that the morbidity of CKD is often accompanied by the unbalanced amone qi, blood and water pathogen. So she used to treat qi, blood and water pathogen at the same time to keep their dynamic equilibrium,especially for diseases like renal edema, ranal hypertension, etc.4.4 Differing therapeutic methods based on syndromes and applicating herbal medicine with proper laws4.4.1 Promoting vital qi without stagnation, eliminating pathogens in different ways: In treating CKD, Prof Dai persists in promoting vital qi, reinforcing yin, yang, qi and blood moderately. Keeping from Zi greasy herbs or pungent and warm herbs. Eliminating pathogens in different ways-expelling the superficial pathogens of wind heat, clearing heat and removing toxicity, inducing diuresis and excreting dampness, eliminating dampness of middle energizer, clearing heat and draining dampness of lower energizer, checking turbidity downward.4.4.2 Activating blood without impairing it, stanching blood without causing stasis: Blood stasis is the common pathogen of CKD.Prof Dai's therapeutic methods about it is based on the syndrome differenciation. For the syndrome of blood heat and stagnation, blood cooling and activating are used; for the syndrome of blood stasis and water stagnation, blood activating and diuresis inducing are used; nourishing blood and activating blood are used to treat the syndrome of blood deficiency and stasis; activating blood and regulating qi are used to treat the syndrome of qi stagnation and blood stasis. The therapeutic methods for hematuria are cooling blood,which have been always combined with astringent. Herbs with strong effects of removing blood stasis is avoided, nourishing and activating of blood are often used in hemostasis.4.4.3 Accurate application of herbal medicine and making full use of medication efficacy:Prof Dai attaches importance to the accurate application of herbal medicine and make full use of medication efficacy to obtain the satisfactory curative effect.4.5 Attaching importance to accompanied syndromes with tested medicationProf Dai holds that varies of infection are either pathogenic factors or aggravating factors of CKD, so she think highly of the treatment of these accompanied syndromes and takes good use of tested medication in treating them. Herbal medicines like Yinhua, Lianqiao, Dqqingye, Diding, Jingjiesui are used to expell the wind heat and remove the toxicity in treating syndrome of superficies attacked by wind-heat;Huangqin, Yuxingcao are used to clear the lung heat for removing phlegm in treating syndrome of accumulation of phlegm and heat in the lung. Treating syndrome of heat toxicity of upper energizer with Pugongying, Shemei to clear up the heat toxicity. To the dampness stagnation of middle energizer, Muxiang, Huanglian are used to climinate dampness and regulate qi.To the dampness heat of lower energizer, Baitouweng, Pugongying, Yuxingcao are used to drain dampness and promote urination. To the accompanied water pathogen,Prof Dai applied with Yimucao, Niuxi, Zexie, Zhuling to activating blood, inducing diuresis and eliminate edema. Jiaodahuang or Shengdahuang are used to discharge turbidity to treat syndrome of accumulation of turbid pathogen.4.6 Advocating long-term treatment with dietary therapy to obtain a favourable prognosisProf Dai hold that patients of CKD need long-term treatment. The goal of treatment for CKD patients of early stage is to eliminate proteinuria and hematuresis and keep from infections. While in the later stage, the goal is to slow down the progress of CKD, prevent and treat complications and improve the quality of life. At the same time, referring to the characteristic of different diseases, Prof Dai advocate the application of dietary therapy.