柳红芳教授运用填精通络法治疗糖尿病肾脏病验案1则
A Case of Diabetes Kidney Diseas Treated by Professor LIU Hongfang with the Method of Filling Essence and Dredging Collateral
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1.北京中医药大学东直门医院肾病内分泌科,北京 100700
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蒋威, 柳红芳. 柳红芳教授运用填精通络法治疗糖尿病肾脏病验案1则[DB/OL].(2023-09-18)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=41907347&Fpath=home&index=0
JIANG Wei, LIU Hongfang. A Case of Diabetes Kidney Diseas Treated by Professor LIU Hongfang with the Method of Filling Essence and Dredging Collateral[DB/OL].(2023-09-18)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=41907347&Fpath=home&index=0
蒋威, 柳红芳. 柳红芳教授运用填精通络法治疗糖尿病肾脏病验案1则[DB/OL].(2023-09-18)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=41907347&Fpath=home&index=0 DOI:
JIANG Wei, LIU Hongfang. A Case of Diabetes Kidney Diseas Treated by Professor LIU Hongfang with the Method of Filling Essence and Dredging Collateral[DB/OL].(2023-09-18)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=41907347&Fpath=home&index=0 DOI:
病史摘要,2,患者男,57岁,主因“发现血糖升高7年,血肌酐升高10月余,双下肢水肿1月余”来诊。患者2013年出现口渴、多饮、多尿,就诊于铜仁华夏医院,诊断为2型糖尿病。2018年诊断为糖尿病性视网膜病变。2019年8月体检示血肌酐(Scr)130 umol/L(46~104 umol/L),于山东中医药大学第二附属医院诊断为“糖尿病肾脏病;慢性肾脏病3期”,予降糖、降压、纠正贫血等方案治疗,血糖、血压控制可。2019年12月27日于山东省中西医结合医院门诊部就诊,查血生化:Scr 125.5 umol/L,予益气养阴、通腑化浊中药治疗4月余,Scr在130~150 umol/L范围内波动。2020年5月8日因服中药后又出现双下肢水肿伴泡沫增多,认为疗效不佳,换用通腑化浊、祛邪利水中药治疗近1个月,病情未见改善。2020年6月10日,查血生化:Scr 158.5 umol/L,为求进一步治疗,寻余诊治。刻下症见:双下肢凹性水肿,活动时加重,休息后缓解,余无明显不适,纳可,眠欠佳,入睡困难,眠浅易醒。小便泡沫多,夜尿2~4次,大便可。舌红瘦,苔略黄腻,脉关弦,寸尺弱。中医诊断 消渴病肾病(肾精亏损,水、湿、瘀、热邪痹阻肾络证)西医诊断 慢性肾脏病3期;糖尿病肾脏病;2型糖尿病;糖尿病性视网膜病变;高血压3级 极高危组干预措施 中药方面:治以填补肾精,清热、利水、祛湿、化瘀以通络;西药方面:予降糖、降压及纠正贫血等方案不变。疗效转归 中药治疗三个半月后患者双下肢水肿消失,小便泡沫较前明显减少,眠好转,Scr由来诊时158.5 umol/L降至正常范围(血肌酐85.8 umol/L),尿素氮(UREA)9.93 mmol/L降为8.32 mmol/L,胱抑素C(Cysc)由3.24 mg/L降至1.80 mg/L,β2-微球蛋白(β2-MG)由5.38 mg/L降至4.76 mg/L,尿蛋白(PRO)由2+降至+-。2022年7月8日复查血生化提示:UREA 8.45 mmol/L,Scr 97.2 umol/L,UA 357 umol/L,Cysc 1.63 mg/L,β2-MG 5.58 mg/L;尿常规:PRO+-。
Summary of case history, The patient, a 57-year-old male, came to the clinic mainly because of "7 years of elevated blood sugar, elevated serum creatinine for more than 10 months, and edema of both lower extremities for more than 1 month." The patient developed thirst, polydipsia, and polyuria in 2013, and was diagnosed with type 2 diabetes at Tongren Huaxia Hospital. Diabetic retinopathy was diagnosed in 2018. In August 2019, the physical examination showed Scr 130 umol/L(46~104 umol/L), and was diagnosed as "diabetic kidney disease, Chronic kidney disease stage 3" at the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine. Control can be. On December 27, 2019, he went to the outpatient department of Shandong Provincial Hospital of Integrated Traditional Chinese and Western Medicine. Blood and biochemical tests: Scr 125.5 umol/L. He was treated with traditional Chinese medicine for nourishing qi, nourishing yin, clearing the intestines and removing turbidity for more than 4 months, and the Scr ranged from 130 to 150 umol/L. On May 8, 2020, due to the edema of both lower extremities accompanied by increased foam after traditional Chinese medicine, and it was considered that the efficacy was not good, and the treatment was changed to the the herbal medicines of clearing the intestines, removing turbidity, and Eliminate evil and dampness for nearly 1 month, and his condition did not improve. On June 10, 2020, blood biochemical examination: Scr 158.5 umol/L, for further treatment, he came to me for diagnosis and treatment. Current symptoms: concave edema of both lower extremities, aggravated during activity, relieved after rest, no obvious discomfort, good appetite, poor sleep, difficulty falling asleep, light sleep and easy awakening. Foamy urination, nocturnal urination 2 to 4 times, and stool. The tongue is red and thin, with a slightly yellow and greasy coating, the middle part of the pulse is like a qin string, and the upper and lower parts are weak.,TCM diagnosis, diabetic kidney disease(deficiency of kidney essence, water, dampness, blood stasis, heat pathogenic obstruction of kidney collaterals syndrome),Western medicine diagnosis, chronic kidney disease stage 3; diabetic kidney disease; type 2 diabetes; diabetic retinopathy; hypertension grade 3 very high risk group,Therapeutic methods, In terms of traditional Chinese medicine: the treatment is based on Filling kidney essence, clearing heat, diuretic water, removing dampness, removing blood stasis to dredging collaterals; in terms of western medicine: the programs for lowering blood sugar, lowering blood pressure and correcting anemia remain unchanged.,Clinical outcomes, After three and a half months of traditional Chinese medicine treatment, the edema of both lower extremities of the patient disappeared, the urination foam was significantly reduced compared with before, and the sleep was improved. Scr decreased from158.5 umol/L at the time of visiting to the normal range (serum creatinine85.8 umol/L), UREA9.93 mmol/L decreased to8.32 mmol/L, cystatin C decreased from 3.24 mg/L to 1.80 mg/L, β2-MG decreased from 5.38 mg/L to 4.76 mg/L, and urinary protein decreased from 2+ to +-. On July 8, 2022, the blood biochemical examination showed: UREA 8.45 mmol/L, Scr 97.2 umol/L, UA 357 umol/L, Cysc 1.63 mg/L, β2-MG 5.58 mg/L; urine routine: PRO +-.
糖尿病肾脏病填精通络法精损络痹
diabetic kidney diseasefilling essence and dredging collateralessence depletion and collateral impediment
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