Exploring The Characteristics Of TCM Differentiation And Treatment Of 3-5 Elderly Patients With Chronic Kidney Disease

Objective:Through the investigation of TCM syndrome differentiation and treatment in the elderly patients with CKD stage3-5,summarize the TCM syndrome distribution,the treatment principles and the characters of application of Chinese herbal medicine,as well as explor the certain relationship between primary syndrome type and the laboratory parameters,as the guideline for the clinical diagnosis and treatment for nephrology Department of integrated traditional and western medicine Hospital of Beijing.At the same,proposing the basis of theory and pratice on the clinical diagnosis and treatment of CKD.Method:Using the methods of retrospective survey and real-time recording,then,we chose 122 cases of Geratologous CKD stage3-5 in nephropathy Department in integrated traditional and western medicine Hospital of Beijing to take the primary statistics about the gender,age,the primary affection,the stage of CKD,the TCM syndrome type etc.Result:122 cases of the elderly patients with CKD in 3-5 stage,mainly due to diabetes nephropathy with 44 cases,secondly,the unknown reason of primary affection occupies 25 cases,18 patients with chronic glomerular nephritis,16 patients with hypertensive renal impairment,8 patients with gouty nephropathy.TCM syndrome type distribution features:Qi-Yin deficiency syndrome(46 cases)is the first,this was followed by Yang deficiency in spleen and kidney(43 cases),deficiency of vital energy of spleen and kidney(17 cases),Kidney asthenia(10 cases),deficiency of liver-yin and kidney-yin(6 cases).The emergence of thepoison-blood stasis(87 cases)is the highest,this was followed by damp syndrome(38 cases),dampness-heat(15 cases),bloodstasis(13 cases)is the least.At the same time,top 10 in the rank of total number all are occupied by Astragalus,salvia miltiorrhiza,radix cyathulae,cogongrass rhizome,Ligustrum lucidum,Hedyotis diffusa,Codonopsis,Cicada,Baizhu.Serum creatinine,serum β2-MG and blood’s uric acid in diagnosis of Yang deficiency in spleen and kidney have a certain value(AUC=0.681,95%CI:0.582,0.799;AUC=0.837,95%CI:0.753,0.921;AUC=0.427,95%CI:0.310,0.545)Conclusions:Of all the cases with CKD stage3-5 of the elderly,deficiency of both energy and Yin is more than each other,Yang deficiency in spleen and kidney rankssecond,as well asThe emergence of the poison-blood stasis is the most commonone.In the process of treatment,seizing the essence of its pathology and the key to pathogenesis,advocates the treatment should be strengthen to not only Supplement vital energy,but also eliminate unhealthy influences.The basic principle for treating CKD is to supplement spleen and kidney,to promot blood circulation to remove meridian obstruction,to dredge intestines and descend turbid substance,to clear heat and eliminate damp.Astragalus、Codonopsis pilosula、Rhizoma atractylodis macrocephalae、Epimedium、Ligustrum lucidum Ait、salvia、salviae miltiorrhizae、radix cyathulae、Hirudo、Cogongrass rhizome、Oldenlandia、Dandelion、Herba pyrrosiae、sanguisorba、rhubarb are always chosen to be used in clinical treatment.Serum β2—MG has some close relationships with Yang deficiency in spleen and kidney with CKD,to provide evidence for syndrome standardization study and guide the clinical treatment.