Research And Clinical Practise Of TCM Syndromes Differentiation And Treatment In Diabetic Nephropathy Based On Famous Doctors Clinical Experience

Diabetic Nephropathy is one of the common chronic microvascular complications of diabetes mellitus, because of its higher incidence, onset insidious, developed rapidly and has become the main reason for disability to death, its cause and pathgenesis is still unclear, clinical features of proteinuria, progressive renal damage, hypertension, edema, late severe renal failure, western medicine treatment of the limitations of the end of the irreversible Diabetic Nephropathy, and make it the leading cause of end-stage renal disease all over the world. However, treatment in traditional Chinese medicine has obvious therapeutic effect in improving the clinical symptoms, reducing the clinical biochemical indicators, easing kidney burden, slowing down disease progression, etc. Many of contemporary famous TCM doctors that use of traditional Chinese medicine in treating Diabetic Nephropathy has accumulated rich clinical experience. This study process the extraction of TCM for the diagnosis and treatment of Diabetic Nephropathy, summarizes the characteristics of etiology, pathogenesis and syndrome differentiation, forming for "spleen and kidney Yin deficiency and blood stasis" and "spleen and kidney Yang deficiency, wet stasis resistance" two kinds of comprehensive treatment, and enhance the level of clinical diagnosis and treatment and delay the progress of the kidney, improve the quality of life of patients.PurposeTo summary the TCM syndromes differentiation and treatment in diabetic nephropathy by analyzed the clinical experience of contemporary well-known TCM doctors, and explore the etiology and pathogenesis of DN and the regularity of syndrome differentiation, forming for "spleen and kidney Yin deficiency and blood stasis" and "spleen and kidney Yang deficiency, wet stasis resistance"two syndrome types of traditional Chinese medicine treatment, clinical curative effect bservation, to further verify the effectiveness of the traditional Chinese medicine intervention.MethodsTo search the data of DN treatment which is collected from30famous TCM doctors’130related literature, and then analyzed the TCM syndrome differentiations of DN and its frequency and correlation analysis of drugs by using frequency analysis method and System clustering method, and sums up the "spleen and kidney Yin deficiency and blood stasis"and"spleen and kidney Yang deficiency, wet stasis resistance"two syndrome types and two prescriptions and subtract syndrome differentiation, respectively, from September2012to April2014guangdong hospital endocrinology into standard of curative effect observation of60cases for4months, based on TCM symptoms, fasting and postprandial blood glucose, glycosylated hemoglobin, serum creatinine, blood urea nitrogen,24hurine trace albumin quantitative,24h urine protein quantitative indicators before and after its contrast, and establishing a database, for statistical analysis.Results1. We found that"congenital defect, improper diet, overstrain and emotional maladjustment "are the main etiological factors of DN in TCM, as deficiency of ben with excess syndrome of biao is the basic pathogenesis. The main syndrome types was Qi-Yin Deficiency and Blood Stasis, Spleen-Kidney Deficiency and Blood Stasis,Spleen-kidney Yang-asthenia,water-pathogen and blood stasis. Selecting of the treatment of DN mainly based on differentiation of syndrome, stages and disease. There were8common therapies of DN:regulating qi-blood and yin-yang, nourishing zang and fu organs, activating blood circulation and eliminating stasis, removing phlegm and resolving turbid, removing dampness and promoting diuresis, clearing away heat-evil, detoxication, suppressing hyperactive liver for calming endogenous wind. Application of frequency analysis results Selected4kinds of TCM drug use a higher frequency in DN treatment (a total of255herbal medicines):tonifying medicinal(34.79%), dampness-draining diuretic medicinal (13.54%), heat-clearing medicinal (12.26%), blood-activating and stasis-resolving medicinal (9.22%).The frequently used herbal medicine are poria, astragalus, chinese yam,dogwood, atractylodes, alisma, salvia, dried rehamnnia root.2. Through its contrast before and after the treatment, two groups total effective rate is over60%, significantly lower after treatment symptoms integral(P<0.05), fasting and postprandial blood glucose, glycosylated hemoglobin, serum creatinine, blood urea nitrogen,24h urine protein,24h urine trace albumin quantitative indicators such as the improvement of the situation is better than that before treatment(P<0.05).Conclusion1.The cause of DN is multifactorial, vital qi is deficient, and indicates the knot main pathogenesis. Most of the subject that all pay attention to the combination of disease and syndrome differentiation;Combined with clinical often witness, summed up the centralizer thrift, invigorate the circulation of water, expelling dampness turbidity comprehensive use of the most commonly used treatment. DN poria cocos, astragalus root, etc, is the most commonly used drugs belong to tonify deficiency, water moisture penetration, etc, and concludes that "spleen and kidney Yin deficiency and blood stasis","spleen and kidney Yang deficiency, wet stasis resistance" two syndrome types of ginseng and astragalus when, fairy stilbene when two prescriptions for clinical differentiation and subtract the application.2. By comparison with clinical observation, the two groups after treatment the blood sugar, kidney function, and24h urine protein quantitative earlier declined obviously, prompt treatment can significantly improve renal function, reducing urinary protein;The study found that the treatment of two groups of liuwei dihuang decoction prescriptions for cutting, medication on many tonic effect of spleen and kidney, confirm the DN treatment pays attention to strengthen the concept of benefit spleen and kidney; For the two groups in the numbness, lower limb swelling etc. The performance of blood stasis syndrome, YouYi strengthen promoting blood circulation to remove blood stasis. Dialectical application to add and subtract the two prescription treatment of DN efficacy, not only can regulate blood sugar, can effectively protect the kidney, delay the progress of the kidney.