A Case of Diabetic Nephropathy Treated by Traditional Chinese Medicine

Traditional Chinese medicine treatment of diabetic nephropathy 1 case

Proven case: Patient, female, 81 years old.

Chief complaint: abnormally high blood sugar for more than 30 years, accompanied by dizziness and fatigue aggravated for 2 days.

History of present illness: The patient found abnormally high blood sugar due to physical examination more than 30 years ago, and fasting blood sugar was measured 8 +mmol/L, after examination, he was diagnosed as “type 2 diabetes”, so he was given oral drug hypoglycemic treatment (the specific drug dosage is unknown), because the patient’s diet was uncontrolled and his blood sugar was not well controlled, so he switched to insulin for hypoglycemia 20 years ago For treatment, he is now taking “insulin glargine 16iu subcutaneous injection once a day, acarbose tablet 50mg orally, and Dapagliflozin tablet 10mg orally once a day three times a day” hypoglycemic treatment. Fuzzy went to the local hospital and was diagnosed with diabetic retinopathy and given symptomatic treatment. Two years ago, he experienced numbness in both lower limbs. He went to the local hospital and was diagnosed with diabetic peripheral neuropathy. Three times a day” and other symptomatic treatment.

2 days ago, the patient developed dizziness, fatigue, numbness of the right lower limb, pain and other symptoms without obvious incentives. In order to seek further treatment, he went to our hospital for treatment. “Xiake Type 2 Diabetes” was admitted to the hospital. During the course of the disease, the patient had dizziness, fatigue, blurred vision in both eyes, occasional palpitation, chest tightness, numbness of the right hand, soreness and discomfort at the back of the neck, numbness of both lower limbs, no headache, no nausea and vomiting, no abdominal pain and diarrhea, no chills and fever and other discomfort symptoms. Sleep well, normal urination, constipation, 3-5 days/time.

Traditional Chinese medicine engraved symptoms: engraved symptoms: dizziness, fatigue, blurred vision in both eyes, occasional palpitation, chest tightness, numbness in the right hand, soreness and discomfort at the back of the neck, numbness in both lower limbs, no Headache, no nausea and vomiting, no abdominal pain and diarrhea, no chills and fever and other discomfort symptoms, normal appetite and sleep, normal urination, constipation, 3-5 days/time. Red tongue, thin yellow fur with cracks, deep pulse.

Past history: past history of “cervical spondylosis, lumbar disc herniation” for more than 20 years; plaster fixation for patellar fracture 8 years ago, “right eye cataract surgery” “History of more than 4 years, with medical history of “cerebral infarction, thyroid cyst, left lung nodule, hysterectomy, coronary heart disease, knee arthritis”, denied other chronic diseases; denied history of hepatitis and tuberculosis; denied history of trauma; unknown blood transfusion; He denied any history of drug or food allergy.

Physical examination: T36.4oC, P90 times/min, R20 times/min, BP110 /70mmHg, refreshed and in good spirits, cooperation in physical examination. Light perception in the right eye, blurred vision in the left eye, no edema of the eyelids, no jaundice of the sclera, equal size and round pupils, normal light reflex, no abnormalities in the ears and nose, no cyanosis of the lips, no hyperemia of the pharynx, and no swelling of the bilateral tonsils big. The neck is soft, the neck has no resistance, the trachea is centered, the thyroid gland is not enlarged, and the jugular vein is not distended. Breath sounds in both lungs were clear, and dry and wet rales were not heard. The heart circle is normal, the heart rate is 90 beats/min, the rhythm is still regular, no extra heart sounds and pathological murmurs are heard. The abdomen was soft, without tenderness and rebound pain, the liver and spleen were not reached under the ribs, there was no percussion pain in the kidney area, and bowel sounds were normal. There was no edema in the lower limbs, no deformity in the spine and limbs, and tenderness in the back of the neck (+). The muscle strength and muscle tone of the limbs were normal, the sensation of needle pricking in both lower limbs was decreased, and the physiological reflex existed, but the pathological reflex was not elicited.

After the patient was admitted to the hospital, the relevant examinations were completed, and the electrocardiogram on 06.08: 1. Sinus rhythm 2. Low voltage 3. Complete right bundle branch block 4. Left axis deviation 5 Clockwise transposition 6. Poor R wave progression 7. Abnormal Q wave in the lower wall (please combine with clinical practice); Chest X-ray: No clear active lesions in both lungs, heart and diaphragm; Cervical spine anteroposterior and lateral X-rays: Cervical spine degenerative changes; Brain CT: 1. Multiple lacunar infarctions 2. Senile brain changes. 06.09 blood routine: Neu73.8%; coagulation five items + D-dimer: FIB5.72g/L, D-dimer 0.79ug/ml; renal function: Cr103.9umol/L, Cy1.22mg/L; Fasting blood glucose 6.96mmol/L; glycosylated hemoglobin 7.3%; fasting insulin: 2.59uIU/mL; fasting C-peptide 0.97ng/mL; five myocardial enzymes: HBDH290U/L; Viral nucleic acid test: negative; 06.10 urine routine: glucose + 3, white blood cells +; stool routine + OB: OB weakly positive; blood β2 microglobulin 4.47mg/L; 06.11 insulin antibody no abnormality; 06.14 new coronavirus nucleic acid test: negative .

Diagnosis: Traditional Chinese Medicine: Diabetes Disease (Qi Yin Deficiency and Stasis Syndrome)

Western medicine diagnosis: 1, type 2 diabetes, 2 type diabetic peripheral neuropathy, 2 type diabetic peripheral neuropathy, 2 type diabetic nephropathy, 2, cerebral infarction, 3, mixed cervical spondylosis, 4, coronary Atherosclerotic heart disease.

In terms of treatment, Western medicine provides symptomatic treatment such as hypoglycemic, anticoagulant, lipid-lowering, promoting blood circulation and removing blood stasis, as well as acupuncture treatment;

Chinese medicine provides Oral treatment with decoction of nourishing qi and nourishing yin, promoting blood circulation and dredging collaterals, calming the liver and suppressing yang, the prescription is as follows:

Pueraria 20g, Gastrodia elata 10g, Uncaria 6g, oyster 20g, raw land 12g, Ophiopogon japonicus 15g, Scrophulariaceae 10g, Trichosanthes 10g, Codonopsis 10g, Raw Atractylodes macrocephala 30g, Tangerine peel 8g, Baiziren 10g, Clematis 10g, Chuanxiong 10g 6 doses.

Recipe solution: Dangshen, Atractylodes invigorate the spleen and Qi; Shengdi, Ophiopogon japonicus, Radix Scrophulariae and Trichosanthes clear away heat and nourish yin, produce body fluid and quench thirst; Pueraria radiata and Clematis promote clearness, dispel wind and dredge collaterals; Liver yang and oyster calm the nerves; tangerine peel and stomach stagnation;

After taking the traditional Chinese medicine, the patient complained that dizziness and fatigue were better than before, appetite and sleep were also improved. Another 6 doses were given, and no abnormality was found in the reexamination of renal function; blood β2 microglobulin: 3.48mg/L. All symptoms improved and he was discharged from the hospital.

Thinking: In this case, there is no special medicine for treating kidney disease (the only one that may be related to it is the possibility of Polygonum cuspidatum), but it does have the effect of improving kidney function. I think this It is related to syndrome differentiation and treatment. The combination of four diagnostic methods can accurately identify the pathogenesis, use appropriate medication, improve the patient’s discomfort, and then restore the body’s self-healing ability.

Note: All kinds of prescriptions, proven prescriptions, folk prescriptions, etc. involved in this article are only for reference and study by professional Chinese medicine practitioners, and cannot be used as prescriptions. Please do not try them blindly. The platform and I do not assume any responsibility arising therefrom!

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