Clinical Data Of TCM Outpatients With Diabetes And Chronic Renal Failure

ObjectiveThrough the analysis of Professor Tong outpatient data,to explore traditional Chinese medicine(TCM)in the treatment of diabetes with chronic kidney failure patients in demographic characteristics(gender,age,address,etc,),treatment information(treatment frequency,treatment time,follow-up frequency,follow-up time),disease diagnosis(complications),the main symptoms and signs(fatigue,agrypnia,edema),laboratory indexes(serum creatinine,blood urea nitrogen,glomerular filtration rate,etc.)and other information,and to study the treatment of this disease core prescription and rules in drug application(the frequency of use,dosage,pharmaceutic rules,etc.),to evaluate clinical efficacy of TCM treatment of this disease.Through the analysis of these data,summarize rules in drug application and syndrome differentiation experience of Professor Tong on diabetes with chronic kidney failure.MethodsDiabetes with chronic kidney failure patients were identified by searching professor Tong's outpatient cases database.According to the data mining methods,the scale-free complex network method was applied to excavate core prescriptions.Trend chart was applied to study the trend of laboratory indexes.Chi-square test was performed to compare effective rate.Results(1)Basic information:the study included the period from 2005 to March 2015 to Professor Tong outpatient diabetes with chronic kidney failure patients with renal failure in 160 cases(1433 diagnosed times).There were 106 male patients and 54 female patients.In February of the year,the number of diagnosed times was the least(only 90 times),and the number of diagnosed times in the most in March(146 times).The age of the patients mainly concentrated in 40-70 years old,mainly in the middle aged and elderly people.(2)Disease types:In the 160 cases patients;there are 3 patients with type 1 diabetes,the remaining 157 patients for type 2 diabetes.With this disease and at the same time with diabetes complications which most frequently appear are diabetic retinopathy,diabetic peripheral neuropathy and diabetic autonomic neuropathy.And most frequent of comorbid diabetes complication's disease categories are endocrine system and nutrition metabolic disease,circulatory system disease and digestive system diseases.In the aspect of single disease,five of the most common diseases were hypertension,dyslipidemia,high uric acid hematic disease,metabolic syndrome,and fatty liver.(3)Symptoms and signs:the most common symptoms are fatigue,edema,loose stools,agrypnia,body numbness,constipation,body pain,urine bubble,blurred vision,dry mouth.The most common signs(tongue diagnosis and pulse-taking)are taut pulse,greasy coating on the tongue,yellow coating,deep pulse,thick coating,smooth pulse,rapid pulse,red tongue,sublingual varices and hard pulse.(4)Syndrome element:diversity and compositeness of symptom type is not suitable for the use of the computer for statistical analysis.We need to find out the "minimum unit" of TCM syndrome differentiation which can independently and accurately express the meaning.Therefore,referencing the concept of "syndrome factor",we have figured out TCM syndrome differentiation.Three of the most common disease location syndrome factors are main and collateral channels,spleen and stomach and large intestine,the most common nature of disease syndrome factors are blood stasis and turbidity toxin,followed by heat,phlegm,stagnation of the circulation of vital energy,deficiency of vital energy and deficiency of yin.(5)Prescription and medicine:the number of herbal medicines in a prescription which with 8-9 kinds is the most commonly used,and the least of which is 3 kinds,the most of which is 30 kinds.The average prescribed daily dose is 230.5±91.2g,and at least 45g,at most 870g.Commonly used drugs are rheum officinale,astragalus root,leech,salvia miltiorrhiza,rhizoma coptidis,fresh ginger,poria cocos,monkshood,red kojic rice,clematis root.The core prescription drug is rheum officinale.The core couplet medicines are rheum officinale and astragalus root.The core prescription is rheum officinale,astragalus root and leech.(6)Curative effect and effective drugs mining:Overall,the Scr is declining,the effective drugs of which are monkshood,astragalus root,salvia miltiorrhiza,leech,fresh ginger,rheum officinale.The BUN shows a trend of fluctuant decline,the effective drug of which is rhizoma coptidis.The GFR remains stable generally,the effective drugs of which are pinellia,epimedium,fresh ginger,rhizoma coptidis,motherwort,salvia miltiorrhiza.The blood uric acid remains stable generally,the effective drugs of which are clematis root and salvia miltiorrhiza.The 24hUTP is declining,the effective drugs of which are leeches and rheum officinale.The HbAlc is declining,the effective drug of which is rhizoma anemarrhenae.The FBG is on the decline,there is no statistical significance of the single drug effectively.Overall,the SBP shows a slight decline,DBP remains stable generally;the effective drug of SBP and DBP is leech.The CHO is on the decline,there is no statistical significance of the single drug effectively.The TG is declining,the effective drug of which is astragalus root.The LDL-C is on the decline,there is no statistical significance of the single drug effectively.ConclusionDiabetes with chronic kidney failure pathogenesis is mainly collaterals blood stasis resistance,and turbidity toxin accumulation.The clinical common symptoms are fatigue,edema,loose stools,agrypnia,body numbness,etc.The common tongue and pulse signs are taut pulse,greasy coating,yellow coating,deep pulse,thick coating,etc.The core prescription is rheum officinale,astragalus root and leech.Through the analysis of outpatient data,astragalus root,salvia miltiorrhiza,leech,fresh ginger,rheum officinale on Scr,rhizoma coptidis on BUN,pinellia,epimedium,fresh ginger,rhizoma coptidis,motherwort,salvia miltiorrhiza on GFR,clematis root and salvia miltiorrhiza on blood uric acid,leeches and rheum officinale on 24hUTP,rhizoma anemarrhenae on HbAlc,leeches on BP(especially SBP),astragalus root on TG,it may produces positive effects for laboratory indexes on the above drugs.