【作者】 郭芝羽；

【导师】 龚丽娟；

【作者基本信息】 南京中医药大学 ， 中医内科， 2011， 硕士

【摘要】 慢性肾功能衰竭(Chronic renal failure简称CRF)是多种慢性肾脏疾患迁延日久或它脏影响损及于肾,使肾实质受到严重损伤所致。龚丽娟教授对慢性肾功能衰竭的治疗,强调中医辨证以正虚为纲,邪实为目,正虚则有脏腑气血阴阳亏损之异,邪实有外邪、水湿、湿浊、湿热、热毒之分,不论邪实或正虚均可出现气血瘀滞的血瘀证候。治疗上需注意错综复杂的病理变化,正确把握邪正虚实,轻重缓急的关系,或祛其邪,或培其本,或标本兼治,故在治疗上提出以“保肾气、健脾胃”为基本原则,兼以活血、排毒分期论治。从而达到缓解慢性肾功能衰竭(CRF)的主要症状,保护肾功能,提高患者的生存生活质量。目的：根据中医理论与临床观察,明确中药保肾健脾活血排毒法治疗慢性肾功能衰竭早、期患者,能缓解慢性肾功能衰竭(CRF)的主要症状,改善肾功能,提高患者的生存生活质量,从而提高中医药临床治疗早、中期慢性肾功能衰竭的疗效。方法：本研究以确诊为早、中期慢性肾功能衰竭患者进行临床研究,旨在通过服用中药方后自身对照试验研究,观察病例40例,予以中药基本方：生黄耆10～30g党参10～30g白术10g茯苓12g淮山药12g山萸肉10g熟地12g六月雪30g当归10g红花10g生大黄5～15g(后下),随证加减,每日一剂,水煎300ml,早晚分服。三个月为一个疗程。结果：总体疗效分析：治疗病例40例,有效34例(85%),无效6例(15%),患者治疗前后总疗效比较,有着明显差异。经统计学处理差异有统计学意义(P<0.005)。症状积分方面,治疗后均有下降,治疗前后比较差异有统计学意义(P<0.005)。肾功能中血肌酐(Scr)、内生肌酐清除率(Ccr)经过治疗后均有改善,治疗前后比较差异有统计学意义(P<0.005)。肾功能中尿素氮(Bun),多数患者在治疗后见明显下降,但治疗前后比较差异经统计学处理不具有统计学意义(P>0.005)。整个研究过程中未出现不良反应。结论：龚师所拟定“保肾健脾、活血排毒”法在治疗慢性肾功能衰竭早、中期的临床研究中获得较好的疗效,主要体现在改善临床症状,改善肾功能,降低血肌酐(Scr)指数,提高内生肌酐清除率(Ccr),能有效地提高慢性肾功能患者的生存生活质量。更多还原

【Abstract】 Chronic renal failure is the number of chronic kidney disease due course of time delay, or other organ damage in the kidney, the renal damage caused by severe. Professor Gong on the treatment of chronic renal failure, emphasizing the positive imaginary TCM as the key link, cult is indeed present, cult is indeed evils, wet, wet and dirty, humid, hot drug of the points, there are virtual blood and viscera of yin and yang Loss differences, whether real or positive imaginary cult can appear in the blood stasis of qi and blood stasis syndrome.Should pay attention to the complex treatment of pathological changes, correctly grasp the actual situation right from wrong, the relationship between priorities, or remove the evil, or the training of their book, or treating the symptoms, it is proposed in the treatment of "protecting kidney"as the basic principle, and to Blood circulation, detoxification stage of treatment. So as to achieve remission of chronic renal failure (CRF) of the main symptoms and protect renal function and improve survival in patients quality of life.Objective:To observe the clinical effects of the Chinese herb (Protect the kidneys and promoting blood circulation and detoxication method) in treating chronic renal failure(CRF). It is expected to improve the patients,signs and symptoms, the Kidney function tests, Improve the quality of life of patients, to Improve the clinical (Protect the kidneys and promoting blood circulation and detoxication method) treatment of the effects of chronic renal failure(CRF).Methods:40 patients with chronic renal failure patients, prescription medicine given to protect the kidneys chinese herb, Radix Astragali seu Hedysari 10～30 g, Radix Codonopsis 10～30 g, Largehead atractylodes rhizome 10 g, Poria 12 g, Common yam rhizome 12 g, Rehmannia 12 g, Shan Yu Meat 10g, safflower 10 g, Angelica 10 g, Serissa 30 g, Radix et Rhizoma Rhei 5～15 g(post below), and a day decoction 300 ml,morning and evening hours service.Both groups took for three months.Result:In treatment group,effective 34 cases(85%),no effective 6 case(15%). The total effect of patients before and after treatment compared with significant difference.The difference was statistically significant (P<0.005).Terms of symptom score, were decreased after treatment after treatment difference was statistically significant (P<0.005).Renal f unction in Scr、Ccr were decreased after treatment after treatment difference was statistically significant (P<0.005). Bun see most patients decreased significantly after treatment, but not by the statistical difference was not statistically significant (P> 0.005). There is no side effect in both groups. Conclusion:Protect the kidneys and promoting blood circulation and detoxication method treatment of chronic renal failure as early as the mid-clinical studies to obtain better efficacy, mainly in improving clinical symptoms, improve kidney function decreased serum creatinine (Scr) index, increased endogenous creatinine clearance rate (Ccr) can effectively improve the quality of life of patients with the methods of survival.更多还原