| Chronic renal failure is a series of clinical symptom complex of metabolic disorder because of renal function lesion induced by primarily or acquired chronic nephrosis.It is the final termination of various kinds of kidney disease.Uraemia is the advanced stage of chronic renal failure, the severity patients is alwaysdepend on blood purification to survive ? The adverse effect of thigh blood pressure for cardiovascular system and central nervous system severityly affect the prognosis. Therefore,the favourable blood pressure control is very important, however most of the patients are not so.Now the Chinese medical science therapeutics of maintenance hemodialysis hypertensive patient is fewer and lack the systemic syndrome research.The topic that study the Chinese medical science to cure complication of haemodialysis, promote the survival rate and the quality of life of the uraemia patient has been widely concerned, and the determination of treatment based in pathogenesis obtained throu-gh differentiation of symptoms and signs is the most important. So to study the maintenance hemodialysis patient symptom rule has the great theory and clinic value.We studyed the Chinese medical science symptom rule through the 105 patients of maintenance hemodialysis hypertensive disease to support the Chinese medical science determine the treatment based on differentiation of symptoms and signs.Primary part Documents research1. The current research situation on maintenance hemodialysis hypertensionReseach the Chinese medical science and west medical science documents on the maintenance hemodialysis high blood pressure and summarize them.we find that west medical science treatment such as dialyze ultrafiltration and dyazide has certain limitations, modern medicine will have further research about the mechanism and therapeutic measure of maintenance hemodialysis high blood pressure. At the same time the Chinese medical science therapeutics of maintenance hemodialysis hypertensive patient is fewer and lack the systemic syndrome research, determination of treatment based in pathogenesis obtained throu-gh differentiation of symptoms and signs is the fundamental Chinese medical science cure method, evidence is the foundation determination of treatment based in pathogenesis obtained throu-gh differentiation of symptoms and signs. So to study the maintenance hemodialysis patient symptom rule has the great theory and clinic value.2. Uraemia Chinese medical science symptom rule systema analysisStudy the uraemic Chinese medical science documents through the evidence medical science method from Chinese medical science symptom, differentiation of symptoms and signs and basic prescription. Find the most common asthenia of healthy energy of uraemia is asdthenic splenonephro-yang,others is deficiency of both vital energy and yin, hepatic and renal yin deficiency, asthenia of both yin andyang;deficiency of both yin and yang, deficiency of kidney-qi spleen, insufficiency of qi of the lung and kidney, state of evil domination, the frequent state of evil domination is pathogenic damp> liquid cease ^ haemostasis, wet heat.3. Maintenance hemodialysis Chinese medical science symptom rule systema analysisStudy the maintenance hemodialysis Chinese medical science documents through the evidence medical science method from Chinese medical science symptom, differentiation of symptoms and signs and basic prescription. Find the most common asthenia of healthy energy of maintenance hemodialysis is deficiency of kidney-qi spleen,others is deficiency of both vital energy and yin, hepatic and renal yin deficiency, asthenia of both yin and yang;deficiency of both yin and yang, spleen deficiency of kidney-qi, insufficiency of qi of the lung and kidney, state of evil domination, the frequent state of evil domination is pathogenic damp, liquid cease, haemostasis. wet heat.4. Primary hypertension Chinese medical science symptom rule systema analysisStudy the maintenance hemodialysis Chinese medical science documents through the evidence medical science method from Chinese medical science symptom, differentiation of symptoms and signs and basic prescription. Find the most common Chinese medical science type of syndrome of primary hypertension is type of deficiency of yin leading to hyper activity of yang, excessive rising of liver-yangjhyperactivity of liver- yang, hepatic and renal yin deficiency, phlegmatic hygrosis , overabundant liver-fire, deficiency of both yin and yang.others is deficiency of vital energy blood stasis type, deficiency of both qi and blood, asdthenic splenonephro-yang.the frequent is haemostasis.Second partMaintenance hemodialysis hypertension Chinese medical science symptom research------105 patients clinical research papers1. Object and method1. 1 Case of a particular disease sourceChina Academy of Chinese Medicine Wangjing Hospital > Guanganmen Hospital. Capitalairport Hospital. Janary 2005-June 2005 1. 2 Case of a particular disease election1.2.1 Hypertension diagnostic criteria: apply WHO high blood pressure diagnostic criteria of 19991. 2. 2 Case of a particular disease internalize criteria: accordding with high blood pressure diagnostic criteria;patient that accomplished stage of induction dialyze and successfully enter stable and regularity hemodialysis1.2.3 Case of a particular disease remove criteria: Severityly primarily illness with heart> brain, liver, hemopoietic system disease;psychotic;pero-data means 1. 3 Symptom research methodApply symptom count differentiation of symptoms and signs method(ZHU Wen-feng), formulate clinical observation chart, cumulate symptom score, identifyevidence diagnose.1. 4 Statistics methodApply SPSS 13.0, test-t for measurement data, test-X2 for numeration data, significance discrepancy while PO.05.2. Consequence and Analysis2. 1 General data meansSex distribution information: 50 male patients account 47.62%, 55 female patients account 47.62%.the proportion is 1: 1.1, no significant deviation.Age distribution information: the smallest age of onset is the age of 26, the biggest age of onset is the age of 84, concentrate age of onset is 30-80, account 93.33 %, mean age is 57.89±13.7.Protopathy distribution information:the major reason lead to renal failure protopathy is chronic glomerulonephritis,the others are diabetic nephropathy and high blood pressure nephrosis.Dialyze frequency distribution information: dialyze 3 times / week , account 50.48%;dialyze 2 times / week, 10.48%High blood pressure grade distribution information: 3 grade and 2 grade are the major, account 84.76%.Dialyze age distribution information: shortest: 3 months, longest 16 years, average 3.41±0.36 years. 2. 2 Syndrome research 2.2. 1 Symptom distributionInvestigation 105 patients of maintenance hemodialysis high blood pressure,the consequence according to the symptom recorded in "the traditional Chinese medicine to cure chronic renal function failure"and"the traditional Chinese medicine to cure hypertensive disease clinical research direct principle"but also some symptom such as urine smell in mouth, skin tickle, anuresis, skin pigmentation, talagia, gonyalgia, eye circuit darkness ect.Investigation 105 patients and statistics clinical symptom, the consequence suggest that the most frequency of occurrence is urine smell in mouth, the symptom before the tenth is asthenia of healthy energy, the accumulated points of deficient syndrome exceed the sthenia syndrome, sugest that pathogenesis characteristic of maintenance hemodialysis patient are asthenia of healthy energy and state of evil domination. The major state of evil domination symptom is urine smell in mouth, frequency is 100%, indicate that the pathology essence of patient with uraemia. 2. 2. 2 differentiation of symptoms and signs elemental definition85 patients yin asthenia accumulated points achieve threshold value, 58 patients yang asthenia accumulated points achieve threshold value, 77 patients syndrome of deficiency of qi accumulated points achieve threshold value, 94 patients syndrome of hemopenia accumulated points achieve threshold value, 17 patients syndrome of cold accumulated points achieve threshold value, 35 patients syndrome of stagnation of blood accumulated points achieve threshold value, 44 patients syndrome of syndromeof stagnation of qi accumulated points achieve threshold value, 85 patients syndrome of liver accumulated points achieve threshold value, 44 patients syndrome of spleen accumulated points achieve threshold value, 105 patients syndrome of kidney accumulated points achieve threshold value. 2.2. 3 Evidence name definitionAsthenia of healthy energy type of syndrome: 2 patients / syndrome of deficiency of qi, 1 patients / spleen and syndrome of deficiency of kidney-qi;18 patients /yang asthenia, 9 patients /asdthenic splenonephro-yang, 9 patients /syndrome of deficiency of kidney-yang;24patients /hepatic and renal yin deficiency;21 patients /deficiency of both vital energy and yin, Bpatients /liver and kidney disease, 8patients/liver ,spleenand kidney disease;40patients/deficiency syndrome of both yin and yang,26patients/liver ,spleenand kidney disease, 14patients /liver and kidney disease.State of evil domination type of syndrome:77patients/pathogenic damp, 6patients/damp-heat syndrome, 14patients/cold-damp syndrome;44patients/syndrome of stagnation of qi;35patients/stagnation of blood;17patients/liquid blockage. 2. 2. 4 Syndrome feature researchAsthenia of healthy energy syndrome distribution feature: significant deviation in various kinds of asthenia of healthy energy, the most frequent is deficiency syndrome of both yin and yang,the second frequent is syndrome with yin astheniaN deficiency of both vital energy and yi.ru yang asthenia,the third is syndrome of deficiency of qi.Asthenia of healthy energy syndrome distribution feature in different sexes :there is no significant deviation.Asthenia of healthy energy syndrome distribution feature in different ages:there is no significant deviation.Asthenia of healthy energy syndrome distribution feature in different dialyze frequencies: deficiency syndrome of both yin and yang in patients with 1 times/week;deficiency syndrome of both yin and yang in patients with 2 times/week;syndrome with yin asthenia in patients with 3 times/week.Asthenia of healthy energy syndrome distribution feature in different protopathy.the patients with chronic glomerulonephritis are deficiency syndrome of both yin and yang and yang asthenia;the patients with diabetic nephropathy are deficiency of both vital energy and yin syndrome with yin asthenia;the patients with high blood pressure nephrosis syndrome with yin asthenia and deficiency syndrome of both yin and yang.Asthenia of healthy energy syndrome distribution feature in different dialyze ages: yang asthenia major with dialyze ages less than 1 year, syndrome with yin asthenia major with dialyze ages more than 1 year, there is no significant deviation in different ages patients with deficiency syndrome of both yin and yang and deficiency of both vital energy and yin.Asthenia of healthy energy syndrome distribution feature in patients with different high blood pressure grades: 3grade with deficiency syndrome of both yin and yang, 2grade with syndrome with yin asthenia, 1 grade with yang asthenia,butthere is no significant deviation.State of evil domination distribution feature in patients: there is significant deviation, turbid damp;pathogenic damp is the first,then the syndrome of stagnation of qh syndrome of blood stasis,stagnation of blood> water cease.State of evil domination distribution feature in patients with different dialyze frequencies :patients with 1 time/week are water cease and pathogenic damp;patients with 2 times/week are blood clot and pathogenic damp;the frequency of patients with 3 times/week is low. there is no significant deviation in syndrome of stagnation of qi.The relationship between asthenia of healthy energy and state of evil domination: pathogenic damp and water cease major show in deficiency syndrome of both yin and yang,the less is yang asthenia;blood clot major show in deficiency syndrome of both yin and yang;there is no significant deviation of syndrome of stagnation of qi in asthenia of healthy energy distribution.The comparison between the accumulated points of deficient syndrome and the accumulated points of sthenia syndrome: the accumulated points of deficient syndrome exceed the sthenia syndrome.3. Discussion3. 1 Fundamental syndrome featureThe clinical situation of maintenance hemodialysis patients mainly is asthenia of healthy energy, combining state of evil domination;the patients with high dialyse frequency easily appear syndrome with yin asthenia, state of evil domination in patients with 3 times/week is low;the frequency of syndrome of stagnation of qi is less than pathogenic damp.3. 2 Comparison between patients with maintenance hemodialysis hypertension and uraemia, maintenance hemodialysisThe frequency is different in various types of syndrome.Patients with uraemia mainly appear yang asthenia,but patients with maintenance hemodialysis mainly appear deficiency of qi asthenia, and patients with maintenance hemodialysis mainly appear deficiency syndrome of both yin and yang mainly appear and syndrome with yin asthenia.3. 3 Comparison between patients with maintenance hemodialysis hypertension and primary hypertension.Their syndrome distribution is different suggest that their Chinese medical science cure is different. 3. 4 Treatment discussionWe should pay attention to patients with yin-yang supply, sap negative, dissipating hygrosis, descending the turbid,regulate pneuma, promoting blood flow and using diuretic of hydragogue to alleviate water retention. In addition, maintenance hemodialysis patients with 3times/week should pay attention to sap negative, maintenance hemodialysis patients with 2times/week should pay attention to yin-yang supply, maintenance hemodialysis patients with ltime/week should pay attention to yin-yang supply, using diuretic of hydragogue to alleviate water retention,dissipatinghygrosis, descending the turbid. Maintenance hemodialysis patients with dialyze age less than 1 year should pay attention to warming yang, Maintenance hemodialysis patients with dialyze age more than 1 year should pay attention to sap yin. Maintenance hemodialysis high blood pressure patients with chronic glomerulonephritis should pay attention to yin-yang supply or warming yang, protopathy patients with diabetic nephropathy should pay attention to supply-qi sap-yin, protopathy patients with high blood pressure nephropathic should pay attention to sap-yin or yinyang supply. 3. 5 Merit and defectThis research apply symptom count differentiation of symptoms and signs method(Wen-feng Zhu), formulate clinical observation chart, cumulate symptom score according to ({Common Symptom Chinese Medical Science Discrimination Diagnose And Treat )) for clear diagnose. Merit: differentiation of symptoms and signs cover extensively, less subjective interference, diagnostic accurately.Investigate only 105 patients because of limited time and energy.Not mentioned the comparision between the patients with syndrome translation rule and non-hypertension maintenance hemodialysis,still need further research. |
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