Clinical observation of Huang Qi Bai Zhu Tang for early diabetic nephropathy
Wei Jing, Endocrine Specialist, Jinan Hospital of Traditional Chinese Medicine
Abstract: OBJECTIVE: To observe the efficacy of the self-prepared traditional Chinese medicine formula Huangqi Baijutang in the treatment of early diabetic nephropathy. METHODS: 35 cases of early diabetic nephropathy were treated with the self-prepared traditional Chinese medicine formula Huangqi Baijutang, and a control group was set up with the application of valsartan to observe the efficacy of both groups, the changes of urea nitrogen, blood creatinine and microurinary protein. RESULTS: The clinical symptoms of the treatment group improved significantly after treatment, and the urea nitrogen, blood creatinine and microurinary protein decreased significantly, and the efficiency was significantly higher than that of the control group (P<0.05). CONCLUSION: The self-prepared traditional Chinese medicine formula Huangqi Baijutang has better efficacy in treating early diabetic nephropathy, especially in reducing proteinuria, which is more effective than the treatment with western medicine alone.
Keywords: Huangqi Baijutang, early diabetic nephropathy, proteinuria
Diabetic nephropathy is the most common and serious microvascular complication of diabetes mellitus, and one of the most important causes of death and disability in diabetic patients. In our department, we applied self-prepared Huangqi Baijiao Tang to treat early diabetic nephropathy in the three years from March 2009 to March 2012, and achieved satisfactory results, which are reported as follows.
1. Clinical data
1. 1. Inclusion criteria: according to the 2007 diagnostic criteria of diabetes mellitus, and reached the stage III of Mogensen stage.
1．2．Exclusion criteria: patients with primary renal disease, patients with acute complications of diabetes mellitus, and patients with other causes of urinary protein such as pregnancy, heart failure, urinary tract infection, and stones.
1.3 General data: The 70 patients in this group were all outpatients and inpatients of the endocrinology department of our hospital and were randomly divided into 2 groups. In the treatment group, there were 35 cases, 25 males and 10 females, aged 37-70 years, with a mean age of 53.6 years. In the control group, there were 35 cases, 23 males and 12 females, aged from 40 to 70 years old, with a mean age of 54.2 years. The clinical data of the two groups were statistically not significantly different in terms of gender, age, disease, disease duration and symptom distribution (P＞0.05) and were comparable.
2. Treatment methods
Patients in both groups were provided with diabetes education, diet control, high-quality low-protein diet (protein intake 0.6-0.8g/kg.d), exercise therapy, and oral hypoglycemic drugs or subcutaneous insulin injection according to their conditions. On the basis of controlling blood glucose, blood pressure and blood lipids, the treatment group applied self-prepared Astragalus and Atractylodes soup (Astragalus 60g, Atractylodes 15g, Angelica 20g) for one dose daily with water decoction. The control group was given valsartan 80mg/dose orally once a day. Both groups were rechecked for symptoms and laboratory indexes after 6 weeks of treatment.
3. Efficacy criteria
3.1. Effective: clinical symptoms disappeared or improved significantly, renal function was normal or improved significantly, proteinuria disappeared or reduced by more than 50%.
3．2．Effective: clinical symptoms improve, renal function improves or is stable, proteinuria is reduced by more than 20%.
3．3．Ineffective: clinical symptoms and renal function are not significantly improved or aggravated, and proteinuria is reduced by less than 20% or increased.
4．Treatment results
4.1. efficacy results: treatment group: 18 cases with significant effect, 12 cases with effective effect and 5 cases with ineffective effect. The total effective rate reached 85.7%. Control group: 12 cases with significant effect, 10 cases with effective effect, and 13 cases with invalid effect, with a total effective rate of 62.8%. The total effective rate of the two groups was P < 0.05.
4.2. Comparison of laboratory indexes before and after treatment between the two groups of patients (see Table 1).
Table 1 Changes of laboratory indexes before and after treatment in the two groups
Examination items
Treatment group (35 cases)
Control group (35 cases)
Before treatment
After treatment
Before treatment
After treatment
BUN(mmol/L)
9.32
7.25
9.36
8.07
Cr(umol/L)
121.46
96.72
122.32
116.55
u-Alb(mg/L)
157
38
157
62
5. Discussion
The development of diabetic kidney damage can be divided into 5 stages, of which stage I is the glomerular hyperfiltration stage, without any clinical symptoms, with only an increase in kidney volume, an increase in glomerular filtration rate, dilatation of small glomerular inlet arteries, and an increase in glomerular internal pressure. Stage II is the stage of renal damage without clinical manifestations, with thickening of the glomerular capillary basement membrane and most of the urinary albumin excretion rate in the normal range or intermittently increased. Stage III is the early stage of nephropathy with microalbuminuria and a persistently high urinary albumin excretion rate (1). The development of diabetic nephropathy can be slowed down or even reversed if effective interventional treatment is carried out in stage III. In Western medicine, the treatment of early diabetic nephropathy and reduction of proteinuria is mainly about controlling blood glucose, controlling protein intake, controlling blood pressure, improving renal metabolism and circulation, etc. There are no more effective methods.
In Chinese medicine, diabetic nephropathy can be categorized as achalasia, edema, etc. Its basic pathogenesis is Yin deficiency, dryness and heat, and deficiency of all five organs, of which Spleen Qi deficiency and Kidney Yin deficiency are the main causes. The weakness of spleen qi and the inability to transport blood can lead to qi deficiency and blood stasis. Huang Qi is sweet and warm, belongs to the spleen and lung meridians, good at nourishing the qi of the spleen and lung, benefiting the vital energy and nourishing the three jiao, the spleen is the source of biochemistry, the lung is the master of the qi of the body, the spleen and lung qi is sufficient, the qi of the body is flourishing. Atractylodes macrocephala is bitter, sweet and warm, and belongs to the spleen and stomach meridians, which can nourish the qi and strengthen the spleen. Radix Angelicae Sinensis is sweet, pungent and warm, and belongs to the three meridians of the liver, heart and spleen, which can nourish the blood and invigorate it, dispel blood stasis without harming the righteousness. Modern pharmacological studies have also confirmed that Astragalus and Angelica have improved early hyperperfusion, hyperfiltration and reduced proteinuria in rats with diabetic nephropathy (2). Astragalus can also inhibit glomerular hypertrophy, basement membrane thickening, and thylakoid zone enlargement in diabetic rats by inhibiting aldose reductase activity, which has a protective effect on the kidney (3).
We treated early diabetic nephropathy based on Western medicine treatment, together with the application of the self-prepared traditional Chinese medicine formula Huangqi Baijutang for internal use, which led to significant improvement in clinical symptoms of patients, especially in reducing proteinuria, and achieved better results than Western medicine treatment alone. This formula is refined and can be used to treat patients according to their clinical symptoms and add flavors according to their symptoms, which is convenient for clinical application.
References
(1) Liu Xinmin, Qi Jinwu, Yang Xiaofeng, et al. Differential diagnosis and therapeutics of endocrine diseases. Beijing: People’s Military Medical Publishing House, 2009.
(2) Hu Renming. New clinical techniques for endocrine metabolic diseases. Beijing: People’s Military Medical Publishing House, 2002.
(3) Xu Xiangjin, Zhang Liqun, Wang Qingbiao, et al. The protective effect of quercetin on the kidney of diabetic rats. Chinese Journal of Endocrine Metabolism, 2001,17(5):316~319.