Research On TCM Syndrome And The Etiology And Pathogenesis Of Idiopathic Membranous Nephropathy Based On Evidence-based Medicine And Delphi Method

Objective To explore the characteristics of TCM syndrome,the etiology and pathogenesis,prescription of idiopathic membranous nephropathy,provid the traditonal chinese medicine theory basis for the formulation of "Standard for diagnosis and treatment of idiopathic membranous nephropathy with traditonal chinese medicine".Methods1.Literature retrieval and screening:Literatures about IMN were collected from electronic searches in datebases and manual retrieval in library.Retrieval time was from building to 2017.4.1.EndNote X6 software was used for document management.Screening the literature according to the inclusion and exclusion criteria.2.Extraction of etiology and pathogenesis syndrome:Extracting data from the literature that conform to the inclusion criteria,analyzing the content.Of all the literature of the etiology and pathogenesis of IMN using Microsoft Office2010 data sheet software to set up a original data table.Then we calculate the frequence of contents in the table,and conform statistical tables finally.3.Literature quality evaluation:We evaluate the quality of literatures whereby the scale such as AMSTAR scale,modified version of Jadad scale,and MINORS scale.Those with higher quality score were cited as research evidence.Expert experience literature is marked by "expert experience",then included in the study.4.Extraction of prescriptions and grade of evidence:The prescription and Chinese patent drug were extracted from the literatures with high quality.According to the Evidence Classification and Recommendation Level Reference,we grade the evidence of prescriptions.5.Expert questionnaire survey and expert argumentation:Based on the results of the literature research,draw up the expert questionnaire by the Delphi method.In the form of questionnaire,advisory opinion from 30 experts and professors of related fields in the country,preliminary sure the definition,etiology,pathogenesis and syndrome types of the IMN.Then we collected the questionnaire and analyzed the date using heat distribution method and Delphy statistical method.Results1.Literature researchA total of 162 qualified papers and 3 monograph were included.?1?The etiology of IMN were congenital inadequacy,emotional depression,exogenous pathogenic factors,damp-heat,protracted disease,fatigus,weakened body resistance and acquired disorders.?2?The pathogenesis were deficiency of spleen and kidney,qi-yin deficiency,qi deficiency of spleen and kidney,yang deficiency of spleen and kidney,blood stasis,damp-heat,water and dampness,kidney collateral stasis and turbid phlegm₃differentiation and symptom:?syndrome of Qi-Yin deficiency:fatigue,deficiency of Qi,light fever afternoon,dry mouth and throat,soreness-tired of waist and knee,red tongue,less fur,pulse is thin,and crack on tongue.?syndrome of yang deficiency of spleen and kidney:anorexia and abdorminal distension,cold chills,deep and thin pulse,slow and sunken pulse,stool loosed,fatigue,teeth print on tongue margin,white and greasy fur,pale tongue,pale complexion,frequency of micturition,legs edema,susceptible to exogenous pathogenic factors,lassitude in loin and legs.?syndrome of qi deficiency of spleen and kidney:anorexia and stool loosed,pale tongue,white and greasy fur,teeth print on tongue nargin,low and sunken pulse,thin pulse,soreness-tired of waist and knee,edema,fatigue:sallow complexion,abdominal distension.?syndrome of yin deficiency of liver and kidney:lassitude in loin and legs,dizziness and tinnitus,dry mouth,thready and thin pulse,burning sensation of five centres,red tougue and less fur,dryness in the eyes,edema,short urine,dry stool.?syndrome of damp-heat:thin and yellow fur,abdominal distention,edema.?syndrome of blood stasis:low back pain,dark tongue or petechial tongue,darkish complexion,stringy pulse.?syndrome of water and dampness:short urine,white fur or greasy fur,anasarca,slow and sunken pulse,pale tongue.?syndrome of turbid damp:deep thready pulse,abdominal distention and stool loosed,anorexia,edema of lower extremity,teeth print on tongue margin,white and greasy fur,thirsty but without desire of drinking,dry stool or loosed stool,short and yellow urine.?syndrome of dampness-heat due to spleen deficiency:edema of lower extremity,dry mouth,anorexia,dry stool,fatigue,red tongue,thin and yellow fur or yellow and greasy fur,soft pulse or soft and rapid pulse,bitter taste,facial acne or skin eczema,short urine.?4?traditional Chinese medicine of each syndrome type:?syndrome of Qi-Yin deficiency:Shenqi Dihuang decoction,applying dabuyuanjian,Ye Xiaobai Decoction No.4.?syndrome of yang deficiency of spleen and kidney:Jiangpi Yiqi Huoxue decoction,the prescription to nourish the kidney for membranous nephropathy respectively,Golden Chamber Pill for Reinforcing Kidney Qi and Erxian Tang,Zhenwu Tang and Linggui Zhugan Tang,ZhenwuTang and Wuling San,Membranous nephropathy No.1 decoction,Yishen particals,Bu Pi Yi Chang Pill.?syndrome of qi deficiency of spleen and kidney:Yishen Xiaobai Fang,Huangqi Dihuang decoction and Si Junzi Tang,Yiqibushen decoction,Shenjiu Fang,Huaiqihuang particals.?syndrome of blood stasis:Huoxue Qingli Fang,Yiqi Huoxue Huayu Tongmai Fang,Yang Supplementing Five Returning Decoction,Guizhi Fuling Pill,salvia injection,Shuxuetong injection,Fenqing Huazhuo capsule,Huoxue Tongmai capsule.?syndrome of damp-heat:Huoxue Qingli Fang,the prescription to clear away heat for membranous nephropathy,three Kernels decoction,Membranous nephropathy No.2 decoction,Huanglian Wendan Tang,Ye Xiaobai Decoction No.1,Qingre Moshen granule,Qizhu capsule.?syndrome of water and dampness:Shenling Baizhu San,Shipi Yin,Chunze Tang,Ye Xiaobai Decoction No.2,Yang Supplementing Five Returning Decoction.2.Expert questionnaire survey and expert argumentationReach a consensus on the following content:?1?The etiology of IMN:congenital inadequacy,deficiency of kidney,yang deficiency of spleen and kidney.?2?The pathogenesis:qi deficiency of spleen and kidney,yang deficiency of spleen and kidney,qi-yin deficiency,water and dampness,blood stasis.?3?differentiation and symptom:?syndrome of Qi-Yin deficiency:fatigue,deficiency of Qi,light fever afternoon,dry mouth and throat,soreness-tired of waist and knee,red tongue,less fur,pulse is thin,and crack on tongue.?syndrome of qi deficiency of spleen and kidney:fatigue,soreness-tired of waist and knee,anorexia and stool loosed,abdominal distension,edema,pale tongue,white and greasy far,teeth print on tongue margin,low and sunken pulse,thin pulse.?syndrome of yang deficiency of spleen and kidney:anasarca,pale complexion,anorexia and stool loosed,cold chills,pale tongue,teeth print on tongue margin,deep and thin pulse,slow and sunken pulse,wet fur.?syndrome of blood stasis:darkish complexion,dark tongue or petechial tongue,stringy pulse,sublingual vessel tortuosity.?syndrome of damp-heat:bitter taste or dry mouth,swelling of the face or limb,anorexia and abdominal distension,yellow urine,thick and yellow fur,soft pulse or soft and rapid pulse.?syndrome of water and dampness:swelling of the face or limb,palpitate,stool loosed,pale tongue,teeth print on tongue margin,white fur or greasy fur,slow and sunken pulse.?syndrome of turbid damp:fatigue,abdominal distention and anorexia,sticky slimy sensation in the mouth,nausea or vomiting,stool loosed,slippery pulse or string-like pulse.?4?traditional Chinese medicine of each syndrome type:?syndrome of Qi-Yin deficiency:Shenqi Dihuang decoction.?syndrome of qi deficiency of spleen and kidney:Huangqi Dihuang decoction and Si Junzi Tang,Bailing capsule,Renshen Jianpi pill.?syndrome of yang deficiency of spleen and kidney:Zhenwu Tang and Linggui Zhugan Tang,ZhenwuTang and Wuling San,Yougui pill,Golden Chamber Pill for Reinforcing Kidney Qi.?syndrome of blood stasis:Tiaohong Siwu Tang,Xuefu Zhuyu Tang,Xuefu Zhuyu capsule,Baoshenkang capsule.?syndrome of damp-heat:Simiao San,Huangkui Capsule,Yishen Huashi particle.?syndrome of water and dampness:Shipi Yin,Wuling San,Linggui Zhugan Tang.Conclusion1.The etiology of IMN:xongenital inadequacy,deficiency of kidney,yang deficiency of spleen and kidney.2.The pathogenesis:qi deficiency of spleen and kidney,yang deficiency of spleen and kidney,qi-yin deficiency,water and dampness,blood stasis.3.Differentiation and symptom:?1?syndrome of Qi-Yin deficiency:fatigue,deficiency of Qi,light fever afternoon,dry mouth and throat,soreness-tired of waist and knee,red tongue,less fur,pulse is thin,and crack on tongue.?2?syndrome of qi deficiency of spleen and kidney:fatigue,soreness-tired of waist and knee,anorexia and stool loosed,abdominal distension,edema,pale tongue,white and greasy fur,teeth print on tongue margin,low and sunken pulse,thin pulse.?3?syndrome of yang deficiency of spleen and kidney:anasarca,pale complexion,anorexia and stool loosed,cold chills,pale tongue,teeth print on tongue margin,deep and thin pulse,slow and sunken pulse,wet fur.?4?syndrome of blood stasis:darkish complexion,dark tongue or petechial tongue,stringy pulse,sublingual vessel tortuosity.?5?syndrome of damp-heat:bitter taste or dry mouth,swelling of the face or limb,anorexia and abdominal distension,yellow urine,thick and yellow fur,soft pulse or soft and rapid pulse.?6?syndrome of water and dampness:swelling of the face or limb,palpitate,stool loosed,pale tongue,teeth print on tongue margin,white fur or greasy fur,slow and sunken pulse.?7?syndrome of turbid damp:fatigue,abdominal distention and anorexia,sticky slimy sensation in the mouth,nausea or vomiting,stool loosed,slippery pulse or string-like pulse.4.Traditional chinese medicine of each syndrome type:?1?syndrome of Qi-Yin deficiency:Shenqi Dihuang decoction.?2?syndrome of qi deficiency of spleen and kidney:Huangqi Dihuang decoction and Si Junzi Tang,Bailing capsule,Renshen Jianpi pill.?3?syndrome of yang deficiency of spleen and kidney:Zhenwu Tang and Linggui Zhugan Tang,ZhenwuTang and Wuling San,Yougui pill,Golden Chamber Pill for Reinforcing Kidney Qi.?4?syndrome of blood stasis:Tiaohong Siwu Tang,Xuefu Zhuyu Tang,Xuefu Zhuyu capsule,Baoshenkang capsule.?5?syndrome of damp-heat:Simiao San,Huangkui Capsule,Yishen Huashi particle:?6?syndrome of water and dampness:Shipi Yin,Wuling San,Linggui Zhugan Tang.5.At present,the clinical trials of traditional chinese medicine are mostly small sample,and single center,the medical experts always emphasize "personal experience" in the clinical dialectics,the empirical formula lack clinical experimental research and other peer experts' clinical validation,which affects the formation of later evidence and the choice of questionnaire expert.