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Long-term effects of tcm decoction in treatment of nephrotic syndrome
ABSTRACTS FROM THE JOURNAL OF TRADITIONAL CHINESE MEDICINE,
Long-term Effects of TCM Decoction in Treatment of Nephrotic Syndrome
This study describes the treatment of 114 cases of nephrotic syndrome over a period ofbetween 5 and 15 years. A treatment group of 57 were prescribed TCM decoctions tosupplement treatment with prednisolone and cyclophosamide. The control group wereprescribed the pharmaceuticals alone. Both groups were clinically similar, with more than3.5mg proteinuria in 24 hours, and hypoalbuminaemia ≤30g/L exhibiting 2 or 3 times within6 or 12 months after treatment. Both groups had an average age of between 28 and 29 years,and the mean disease duration was just over 25 years. In the treatment group there were 17cases of Spleen and Kidney yang deficiency, 11 cases of Spleen and Kidney qi deficiency, 23cases of yin deficiency and damp heat, and 6 cases of mutual obstruction of water and stasis.
In the control group the numbers were 20, 8, 24 and 5 respectively. Both groups wereadministered 1mg/kg/day prednisolone orally for 8 weeks. From the ninth week, the dosewas decreased weekly by 10% until a dosage of 0.5mg/kg/day was reached. 200mg ofcyclophosphamide was administered intravenously with 40ml of saline once every other day.
This dosage was reduced by 10% every week until the maintenance dosage of 0.4mg/kg wasreached and this was then taken every two days for 12-18 months. 50mg of persantine and50mg of vitamin E were administered 3 times a day. For the treatment group, TCM herbs wereprescribed according to one of four TCM patterns: 1. Spleen and Kidney yang deficiency; amodified Zhen Wu Tang
(True Warrior Decoction) was used to warm yang and strengthen theSpleen. The ingredients were Shu Fu Zi (Radix Aconiti Carmichaeli Praeparatae) 10g, Fu Ling(Sclerotium Poriae Cocos) 15g, Bai Zhu (Rhizoma Atractylodis Macrocephalae) 12g, Bai Shao(Radix Paeoniae Lactiflorae) 10g, Ze Xie (Rhizoma Alismatis Plantago-aquaticae) 12g, andBing Lang (Semen Arecae Catechu) unshelled 20g. 2. For Spleen and Kidney qi deficiency amodified Fang Ji Huang Qi Tang
(Stephania and Astragalus Decoction) was used to supple-ment qi and strengthen the Spleen. The ingredients were Sheng Huang Qi (Radix Astragali)30g, Fang Ji (Stephaniae Tetrandrae Radix) 12g, Bai Zhu (Rhizoma Atractylodis Macrocephalae)12g, Fu Ling (Sclerotium Poriae Cocos) 15g, Dang Shen (Radix Codonopsis Pilosulae) 15g,Shan Yao (Radix Dioscoreae Oppositae) 15g, Shan Zhu Yu (Corni Officinalis Fructus) 12g andYu Mi Xu (Stigma Maydis) 30g. 30g of Yin Yang Huo (Herba Epimedii) was added in caseswhere there was qi deficiency occurring as the prednisolone dosage was reduced, and 15g ofTu Si Zi (Semen Cuscutae) added where there were signs of yang deficiency when pred-nisolone was at maintenance dosage. 3. For yin deficiency and damp-heat, a modified Liu WeiDi Huang Wan
(Six-Ingredient Pill with Rehmannia) was prescribed to nourish yin, clear heatand remove damp. The ingredients were Sheng Di Huang (Radix Rehmanniae Glutinosae)15g, Shan Yao (Radix Dioscoreae Oppositae) 12g, Fu Ling (Sclerotium Poriae Cocos) 15g, MuDan Pi (Cortex Moutan Radicis) 12g, Ze Xie (Rhizoma Alismatis Plantago-aquaticae) 12g,Cang Zhu (Rhizoma Atractylodis) 12g, Zhi Mu (Radix Anemarrhenae Asphodeloidis) 12g, YiMu Cao (Herba Leonuri Heterophylli) 30g, and Ze Lan (Herba Lycopi Lucidi) 15g. 4. Formutual obstruction of water and stasis, a modified Da Huang Zhe Chong Wan
(Bolus of Rheiand Eupolyphaga seu steleophaga) was prescribed to activate the blood circulation andpromote diuresis. The ingredients were Da Huang (Rhizoma Rhei) 10g, Tu Bie Chong(Eupolyphagae seu Opistoplatiae) 15g, Shui Zhi (Hirudo seu Whitmaniae) 10g, Meng Chong(Tabanus) 10g, Tao Ren (Semen Persicae) 12g, Hong Hua (Flos Carthami Tinctorii) 12g, ChiShao (Radix Paeoniae Rubrae) 15g, and Yi Mu Cao (Herba Leonuri Heterophylli) 30g. For allsyndromes, where there is a susceptibility to catch cold, add Yu Ping Feng San
(JadeWindscreen Powder), and for reactions of the digestive tract, add Er Chen Tang
(Two-CuredDecoction). In the event of reduced production of bone marrow, add 15g of Gou Qi Zi (FructusLycii Chinensis), 12g of Dang Gui (Radix Angelicae Sinensis) and 30g of Ji Xue Teng (Radixet Caulis Jixueteng). The success of the therapies was measured according to the followingcriteria: complete remission - less than 0.2mg/24hr of proteinuria and normal or near normalserum albumin levels in 3 or more tests; partial remission - 0.2-3.5/24hr of proteinuria and noincrease of serum albumin; ineffective - no significant increase in either proteinuria or serumalbumen levels. In the treatment group, 48 cases (84.2%) achieved complete remission and 9(15.8%) achieved partial remission, whereas in the control group the figures were 25 (43.9%)and 21 (36.8%) respectively. Monitoring of these patients over the next 15 years showed thatof the 48 from the treatment group who achieved complete remission, 9 subsequently hadrepeat episodes: 7 within 5 years and 2 within 5-10 years; the remaining 39 were still inremission after 15 years, representing 68.4% of the original 57 cases in this group. In the controlgroup, of 25 who achieved complete remission 13 subsequently had repeat episodes: 10 within5 years and 3 within 5-10 years; meaning that only 12 cases were still in remission after 15 years,21.1% of the original 57 in the control group. The long term remission rates were thereforesignificantly better (P<0.01) in the treatment group than the control group, as was theincidence of adverse reactions to the pharmaceuticals used.
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