中医药研究论丛

233.15 末期肾病变(ESRD)病人洗肾前中医治疗历程
TJ TCM.23(3) : 197-210,2020
末期肾病变(ESRD)病人洗肾前中医治疗历程
The Traditional Chinese Medicine Treatment Intervention Before Kidney Dialysis of End-
Stage Renal Disease (ESRD) Patient 
蔡明谚1 戴有志1,2*
1 佛教慈济医疗财团法人台北慈济医院中医部,台北,台湾
2 慈济大学学士後中医学系,花莲,台湾
【摘要】
本文病患为72 岁女性,有疲倦、泡沫尿及贫血的现象,59 岁於西医就诊发现肾有萎缩情形和肌酸酐指数(Creatinine,Cre)偏高,诊断为慢性肾脏病(Chronic Kidney Disease,CKD),治疗期间肌酸酐指数仍持续上升没有缓和的迹象,至2018 年5 月时肌酸酐指数已高达9.2mg/dl,肾丝球过滤率(estimated Glomerular Filtration Rate,eGFR) 仅剩4.47ml/min/1.73m2,确诊为末期肾病变(End-Stage Renal Disease,ESRD),西医强烈建议血液透析,但病人拒绝,故至本院中医就诊,之後定时於中医与西医就诊,服药近一年,无出现肾功能持续恶化以及无体重减轻或其他副作用,肌酸酐指数逐渐下降至7.8-8.5mg/dl 范围(肾丝球过滤率为5.39-4.63ml/min/1.73m2),期间还可出国旅游,说明在中医师的诊治下服用符合药品优良制造作业流程(Good Manufacturing Practice,GMP)的科学中药不仅不会加剧损坏肾功能,更可以有效控制病情,维持ESRD 病人仅剩的肾功能,推迟洗肾时间,使病人及家属有更多时间可以清楚了解透析治疗的优、缺点,并与肾脏科医师讨论治疗的目标,建立良好的医病关系与共识。
【关键词】慢性肾脏病、末期肾病变、贫血、中医药
 
Ming-Yen Tsai1Yu-Chih Tai1,2*
1Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical
Foundation, Taipei, Taiwan
2School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
【Summary】
This case reports a 72-year-old woman with fatigue, foamy urine, and anemia. At the age of 59, she was found atrophic kidney and high Creatinine (Cre) value, diagnosed with chronic kidney disease (CKD) from nephrologists. During the treatment, the creatinine value continued to rise without easing. She was diagnosed ESRD in May 2018, the creatinine value had reached 9.2 mg/dl, and the estimated Glomerular Filtration Rate (eGFR) dropped to 4.47 ml/min/1.73m2. She saw a Chinese medicine doctor because she refused that western doctor strongly recommended hemodialysis. After that, she regularly consulted Chinese and Western medicine doctor. After taking the Chinese medicine for nearly a year, she could travel abroad during this period and did not appear continuous deterioration of kidney function, no weight loss and other side effects and the creatinine value gradually decreased to the range of 7.8-8.5 mg/dl (eGFR: 5.39-4.63 ml/min/1.73m2). This explains that taking qualified Good Manufacturing Practice (GMP) scientific Chinese medicine under the diagnosis and treatment of a Chinese medicine doctor will not only unlikely exacerbate the damage to kidney function, but also effectively control the condition, maintain the remaining kidney function of ESRD patients, delay the hemodialysis time, and allow patients and their families more time clearly understand the advantages and disadvantages of hemodialysis treatment, discuss the goals of treatment with nephrologists, and
establish a good relationship and consensus between doctors and patients.
【Keywords】Chronic Kidney Disease; End-Stage Renal Disease; Anemia; Chinese Medicine