Meta-Analysis Of Tonifying Kidney And Activating Blood Circulation Therapy In Treating Adult Primary Nephrotic Syndrome And The Study Of Professor Zhang Daning's Medication Rules

Objective: This study evaluates the clinical efficacy and safety of tonifying Kidney and activating blood circulation therapy in the treatment of adult primary Nephrotic Syndrome through meta analysis,and explores the medication rules of Professor Zhang Daning,a master of traditional Chinese medicine,in order to provide reliable clinical basis and experience for Chinese medicine in the treatment of adult primary Nephrotic Syndrome from the perspective of evidence-based medicine and inherit the academic thought of famous doctor of traditional Chinese Medicine.Method:1.The RCT literatures of adult primary Nephrotic Syndrome treated by tonifying Kidney and activating blood circulation therapy were searched in CNKI,VIP,Wanfang,CBM,Pub Med,EMBASE and Cochrane library by computer.According to the inclusion and exclusion criteria,and according to the quality evaluation table provided by Cochrane cooperation network,the quality of the included literatures was evaluated,and the statistical analysis was carried out by revman5.3 and stata12 software.2.The prescriptions of the adult patients who were treated by Professor Zhang Daning for primary Nephrotic Syndrome from January 2014 to October 2019 were collected.Then after standardized,the data was input in "auxiliary platform of traditional Chinese Medicine Inheritance v2.5" to build a database,and used some Data mining methods such as“ frequency statistics ”,“improved mutual information”,“ entropy clustering of complex systems” and“unsupervised entropy hierarchical clustering ”to deeply find the medication rules and the characteristics of the prescriptions of Professor Zhang Daning.Result:1.This study included 18 articles,1231 adult patients with primary Nephrotic Syndrome.The results of meta analysis showed that the treatment based on the therapy of tonifying Kidney and activating blood circulation had advantage not only on improving clinical efficacy,but also increasing plasma albumin,reducing 24-hour urinary protein excretion,reducing total cholesterol and triglyceride,reducing blood creatinine,reducing theincidence of adverse reactions,while there was no significant difference in reducing urea nitrogen compared with clinical medicine.2.There are 31 patients in this study,including 21 males and 10 females.The average age of them is 53.03 ± 17.36,with the ratio of males to females was 2.1: 1.Among them,8patients aged 20 to 40,12 patients aged 41 to 60,9 patients aged 61 to 80,and 2 patients aged over 80.The age distribution of patients was relatively average.There are 135 prescriptions of traditional Chinese medicine,involving 98 kinds of Chinese medicine,with 2687 times of use.The Chinese medicine used more than 50 times is Astragalus membranaceus,Rhizome of chuanxiong,Salvia miltiorrhiza,Smilax glabra,Amomum villosum,Atractylodes macrocephala,Schisandra chinensis,Cherokee rose fruit,Curcuma zedoary,Radix Pseudostellariae,Cohosh,Dendrobium,Wax gourd skin,Psoralea,Poria cocos,Chicken's gizzard-membrane,Raspberry,Poria cocos peel,Gorgon fruit.The most frequently used drugs are tonic drugs,astringent drugs,blood activating and stasis removing drugs,heat clearing drugs,and water and moisture promoting drugs;the most commonly used drugs are warm,calm and cold drugs,and the most commonly used drugs are sweet and bitter drugs.The meridians of drug mainly related to the liver,spleen and kidney.According to the analysis of association rules,Professor Zhang's commonly used drugs for the treatment of the disease are:Astragalus membranaceus,Rhizome of chuanxiong,Salvia miltiorrhiza,Smilax glabra,Amomum villosum,Atractylodes macrocephala,Schisandra chinensis,Cherokee rose fruit,Curcuma zedoary,Radix Pseudostellariae.Six pairs of core combinations and six new prescriptions were obtained.Conclusions:1.The treatment based on the therapy of tonifying Kidney and activating blood circulation has a good effect on adult primary Nephrotic Syndrome,which can alleviate the symptoms of patients,and has a positive impact on some laboratory indicators.2.Through the analysis of Professor Zhang Daning's medication law,this study discusses his understanding of the etiology and pathogenesis of the disease and the treatment concept.Professor Zhang Daning thinks that adult primary Nephrotic Syndrome is based on deficiency of spleen and kidney,and takes "blood stasis,water dampness and damp heat" as pathological factors.During treatment,attention should be paid to nourish the spleen and kidney,clearingheat and removing dampness,promoting “qi” and “water”,removing blood stasis and dredging collaterals,and increasing convergence.Professor Zhang Daning makes accurate differentiation of symptoms and signs,using the drugs properly and flexibly during the treatment,and he established the three-dimensional coordinate of modern kidney disease diagnosis and treatment.With the help of TCM inheritance assistant platform,we can objectively,efficiently and multi-dimensionally analyze and explore the clinical experience of famous doctor of TCM,and provide new ideas and valuable methods for further clinical diagnosis and treatment of primary Nephrotic Syndrome.