The Treatment of Modern Western - Biblio.nhat-nam.ru

20CHRONIC RENAL FAILUREAlso called uremia and end stage renal disease (ESRD),chronic renal failure (CRF) may evolve from chronicglomerulonephritis or any other major cause of renal dysfunction.This clinical condition results from chronicderangement and insufficiency of renal excretory and regulatoryfunction. Its most common causes are diabeticnephropathy and hypertensive nephroangiosclerosis. Patientswith mild to moderate renal insufficiency may only havevague symptoms accompanied by marked nocturia. The firstsymptoms of uremia are usually lassitude, extreme fatigueeven after a good night’s sleep, decreased mental acuity, difficultysleeping, itching and dry skin. Neuromuscular featuresinclude coarse muscular twitches, peripheral neuropathies,muscle cramps, and convulsions which tend toworsen at night. Other symptoms include anorexia, nausea,vomiting, stomatitis, and an unpleasant taste in the mouth.In case of chronic uremia, there is usually generalized tissuewasting due to malnutrition. In advanced CRF, GI ulcerationand bleeding are common. Hypertension is present inmore than 80% of patients with advanced CRF.Chronic renal failure should be suspected when serum creatinineconcentration is more than 1.5-2mg/dL. The definitiveWestern medical diagnostic tool for CRF is renal biopsy.However, this is contraindicated when ultrasonographyshows that the kidneys are small and fibrotic. Usually moderateacidosis and anemia are also characteristic. The Westernmedical treatment of this condition primarily revolvesaround treatment of the primary disease, such as diabetes orhypertension. In particular, ACE inhibitors and angiotensinreceptor blockers are used to decrease the rate of decline incases of diabetic nephropathy. Other factors, such as heartdisease and infections, should also be treated specifically.Maintaining proper fluid and electrolyte levels are an importantaspect of management. Chronic metabolic acidosis isusually treated with sodium bicarbonate. The tendency tobleeding is lessened by RBC, platelet, or cryoprecipitateinfusions. Pruritus may respond to ultraviolet phototherapy.If uremia results from a progressive and untreatable disorderand conventional therapy is no longer effective, dialysis andtransplantation are required. The prognosis of this conditiondepends on the nature of the underlying disorder and superimposedcomplications.CHINESE DISEASE CATEGORIZATION: Inhibitionof urination is called guan or block, while vomiting is calledge, repulsion. Therefore, this condition is most commonlycategorized as guan ge, block and repulsion, based on its main,end stage clinical manifestations. Fatigue is called pi ji, lack ofstrength is called shi li, anorexia is na dai, torpid intake,insomnia is shi mian, and pruritus is simply yang, itching.DISEASE CAUSES: Enduring disease and bodily vacuitydue to aging, possible contraction of external evilsDISEASE MECHANISMS: This disease is mainly causedby yang vacuity and yin congelation. Due to congestion andexuberance of stasis and turbidity, the triple burner qi transformationloses its normalcy. The clear qi is not able to riseand be upborne, while turbid qi is not able to obtain precipitationand be downborne. Damp depression may give rise todamp heat. If damp heat binds with blood stasis, there willbe stasis heat. If enduring heat damages yin, there will be qiand yin or yin and yang vacuities. Thus, the root of this conditionis vacuity, while its branch is repletion.TREATMENT BASED ON PATTERNDISCRIMINATION:VACUITY DETRIMENT STAGE:1. QI & YIN VACUITY PATTERNMAIN SYMPTOMS: A lusterless, sallow yellow facial complexion,fatigue, generalized lack of strength, shortness ofbreath on movement, low back and knee soreness and limp-