Professor Lu Renhe's Experience In Treating IgA Nephropathy Based On The Analysis Of Medical Records

Background:IgA nephropathy(IgAN)is the most common primary glomerular diseasewith various clinical symptoms,which must be diagnosed by immunofluorescence of renal biopsy.Its pathogenesis is still not clear,but is believed to be related to immunity,heredity,infection and environmental factors.Treatments mainly include blood pressure management,immunosuppressive therapy,tonsillectomy,etc.However,the effect isnot significant.Professor Lu Renhe,as a master of Traditional Chinese Medicine(TCM),has accumulated abundant and precious experience in diagnosis and treatment of nephropathy and endocrine diseases.Professor Lu advocates that chronic glomerulonephritis should be treated from the point of“Wind pathogen”,and proposes the pathogenesis theory of "Shen Luo Zheng Jia".Also,he advocates a comprehensive prevention and treatment system that combines diet,exercise,emotional regulation and medicine treatment,which plays a crucial part in chronic diseases management and is worth in-depth study.Objective and Methods:Typical medical records about Professor Lu’s treatment of IgAN were collected,parsed,normalized and then inputed into the Medical Record Data base System(MRDS)for frequency and correlation analysis.The purpose was to discover and verify Professor Lu Renhe’s views on the causes,pathogenesis,syndrome differentiation and treatment of IgAN.Also,relevance between syndrome differentiation and treatment and lab test indexes including pathology was explored.Results and Conclusions:Using MRDS,the frequency analysis of the "Cause" and "Incidence characteristics" of the 148 typical medical records included in the study was conducted.It was found that the causes were mainly related to "weakness due to chronic course" and "exogenous pathogens".Wind was the predominant pathogen,combining with Heat,Cold and Dampness pathogen,to invade the body.During the chronic course,acute exacerbations was caused by exogenous pathogens,mood swings,and fatigue.Conclusion:IgAN was a chronic disease that could be aggravated by exogenous pathogens invasion,which was consistent with Professor Lu’s opinion.In order to study the characteristics of symptoms and treatment of cases respectively caused by exogenous and non-exogenous factors,the frequency of "Symptoms" and"Medication Range" were inquired based on MRDS."Herb matching probability" was established based on correlation analysis to explore Herb Pairs commonly used by Professor Lu.The results showed that in cases caused by exogenous pathogens,symptoms like "fever and chills" were rare,but "cough,sore throat" indicating the problem of lung and throat were common.Compared with cases caused by non-exogenous factors,"Phlegm" and "Dizziness" were more severe in cases caused by exogenous pathogens.From the perspective of the tongue,the proportion of "dark" tongues was similar in both kinds of cases.But the proportion of "dark red tongue" in cases caused by exogenous pathogens was higher,while the proportion of "light dark tongue" in cases caused by non-exogenous pathogens was higher.As the medication of cases with exogenous manifestations,Flos Lonicerae,Fructus Forsythiae and Radix Scutellariae were commonly used to clear heat.Fructus Gardeniae was added when there was liver fire.Herba Schizonepetae,Adix Saposhnikoviae,Periostracum Cicadae and Fructus Gardeniae were used to remove Wind pathogen,clear heat,circulating blood and dredging collaterals.Besides the herbs mentioned above,the top 8 herbs of both kinds of cases were the same,including Radix Salviae Miltiorrhizae,Polyporus,Radix Astragali,Radix Angelicae Sinensis,Rhizoma Chuanxiong,Cortex Moutan,Radix Paeoniae Rubra Ganoderma.Conclusion:First,considering that the IgAN patients invaded by exogenous factors were in the condition of Zheng Qi deficiency,it was necessary to take the "Zheng Qi deficiency" "blood stasis" and "heat" into account while eliminating exogenous evils.Second,based on the first one,Professor Lu had always emphasized using the method of moving and cooling blood and nourishing Qi and blood as well.In order to study the symptoms,syndromes,disease position and the medication of IgAN in different renal function stages,the cases were divided into early stage and late stage according to the level of serum creatinine.The results revealed that as the creatinine increased,the symptoms and states of tongue showed that dampness and blood stasis became worse.The disease position changed from lung,spleen and kidney to heart and kidney.The medication showed that the frequency of herbs for clearing heat and cooling blood,promoting blood circulation and clearing dampness,and nourishing qi and blood increased.Conclusion:the consistency was found in symptoms,syndr omes,disease position and medication between cases of IgAN in early stages and late stages.And this was also consistent with Professor Lu Renhe’s opinion.In order to explore the relevancy between IgAN pathology and symptoms,syndrome differentiation and treatment,the cases were divided into two categories using IgAN pathology grade III as the cut-off point.The results revealed that the deterioration of the symptoms like nocturia,proteinuria,oedema,heart palpitations and insomnia suggested a worse condition in pathological grade,which was consistent with Professor Lu’s opinion.The syndrome of stasis-heat ran through the whole course.With the aggravation of pathological grade,the syndromes of Qi and Yin deficiency were converted into Yin and Yang deficiency,followed by the syndrome of blood stasis mixing up with phlegm coagulation.As for the treatment,herbs of promoting blood circulation and nourishing Qi and comforting mind,such as Ganoderma and Rhodiola Rosea,appeared more common.