中西结合治疗慢性肾炎之台湾经验

Experience on Sino-Western Combination Therapy for

中国医药大学附设医院中医合作部之肾病特别门诊自88年开始对肌酸酐廓清率(Cre<70西西／分),肌酸酐(Creatinine)>1．5毫克,去除可逆因素后,其肌酸酐值仍不能下降者,进行中西结合治疗。91年至97年,我们对29位患者(14位男性,15位女性),其年龄由31岁至80岁,其肌酸酐值由1．5毫克至6．0毫克予三埔归地汤3个月,比较其使用前后之检查,取得统计学(P<0．05)有意义之疗效。因慢性肾炎在进行中,湿、热、瘀、毒(尿)是重要致病恶化因素,故98年后陆续加用蒲公英、忍冬藤、川芎、鸡血藤、丹参,而三黄泻心汤去黄连和黄柏,仅用大黄来排毒,陆续取得疗效,以治疗3个月后肌酸酐值下降0．4mg为有效。然对肌酸酐值超过6．0毫克以上者仍难以控制,故依中医理论本虚(肾虚、五脏虚、气血阴阳虚)而分为气阴两虚、肝肾阴虚、阴阳两虚分别施治,而标实(湿、热、瘀、毒)予以清热利湿活血排毒之药,用此补虚清热利湿活血排毒之大方复治法取得疗效,故提出来报告。上述患者若血压超过140／90毫米汞柱则予以西药(Monopril或Losartan)降压治疗,若携铁蛋白值(Ferritin)小于500ng则予输注铁剂,若血容比(Hct)值小于28％则予Epo．(促血红素形成素),血钙值低于10毫克则予碳酸钙(Ca．Carbonate)。

It is known that reducing cretinine and BUN is a standard treatment in western medicine for chronic nephritis patients.However, such a treatment may not always succeed even if some reversible factors have been removeAFrom 1991 to 1997,we collected 29 cases(14males and 15females aged from 31 to 80 years),whose cretinine levels were ranged from 1.5mg% to 6.0mg%,for a trial on study of the efficacy of sino-western combination therapy for chronic nephritis patients.All patients were treated with San-Pu-Guidi-Tong,which was composed of Sanhuang-Xicxin Tong,Pujiangen,Guipi Tong and Liuwei Dihuang Wan.For those patients whose creatnine value was reduced 0.4 mg% over 3 months duration,the treatment was effective. Nevertheless,for those whose cretinine levels above 6.0mg% the effect is not significant.Based on these results,we thus tried to add extra medicines such as Pu-kung-in,Zan-dong-tan,Gi-shei-tan,Dan-seng,and Ta-huang etc,to the treatment to lower the cretinine level.Western medicines were also given for the treated patients by their biochemical indices.If blood pressures were over 140/90mmHg,monopril or losartan were added.If Hematocrits were below 28%,Epo.was added.If serum Ca ievels were below 10mg,Calcium Carbonate was added.