中医针药并用辅助治疗糖尿病肾病变末期患者之病例报告

A Case Report on Acupuncture and Traditional Chinese Medicine Treatment for Diabetic Nephropathy

吴承家1林郁甯1龚彦纶1,2,3,*

1佛教慈济医院财团法人花莲慈济医院中医部，花莲，台湾

2慈济大学学士後中医学系，花莲，台湾

3慈济大学医学科学研究所，花莲，台湾

慢性肾脏病在台湾的盛行率逐年上升，其中糖尿病肾病变占了一半左右，随着疾病发展，最後会需要进行肾脏替代疗法，致使台湾透析的盛行率也高居世界第一，是一项严重威胁国人健康且消耗庞大医疗资源的重大疾病。近年来中医药治疗慢性肾脏病的实证越来越被世界看到，2020年卫生福利部中央健康保险署通过中医慢性肾脏病门诊加强照护计画，希望可以藉由中医对疾病不同的切入角度，协助缓解肾脏功能下降，并改善肾友的生活品质。本案为一位68岁女性，有高血压、糖尿病病史，109/06/19至本院新陈代谢科门诊就诊，经抽血检查意外发现肌酸酐（creatinine）6.3 mg/dL、eGFR：7.03 mL/min/1.73m2，诊断为第五期慢性肾脏病。病患因尚无法接受肾脏替代疗法，又出现体力变差、疲劳倦怠明显、慢步行走100公尺即腿酸、气短喘甚、食欲较差、纳减、下肢水肿等症状，遂於110/3/29至中医门诊求诊。诊断为脾肾阳虚，痰瘀阻络。藉由针灸与浓缩中药并用，以健脾补肾为治疗主轴，标本兼施，佐以活血化瘀、利湿化浊、清热解毒，经过8个多月的治疗，患者自觉体力和水肿改善明显，肠胃不适也有效的舒缓。血压较为平稳，肾功能维持稳定，且没有高血钾的副作用。希望本案可提供给临床中西医师做叁考。

【关键词】慢性肾脏病、糖尿病肾病变、针灸、浓缩中药

The prevalence of chronic kidney disease in Taiwan is increasing year by year, of which diabetic nephropathy acs for about half. As the disease progresses, renal replacement therapy will eventually be required. The prevalence rate of dialysis in Taiwan is also the highest in the world. It is a major disease that seriously threatens the health of the Chinese people and consumes huge medical resources. In recent years, the evidence of traditional Chinese medicine in the treatment of chronic kidney disease has been seen more and more by the world. In 2020, the Central Health Insurance Administration of the Ministry of Health and Welfare had strengthen the care plan for chronic kidney disease outpatient clinics of traditional Chinese medicine, hoping to use traditional Chinese medicine to treat diseases from different perspectives, and then relieve the decline of kidney function and improve the patient’s quality of life. This case is a 68-year-old woman with a history of hypertension and diabetes. She went to the Metabolism Department of our hospital on 2020/06/19. After a blood test, it revealed creatinine (Cre): 6.3 mg/dL, eGFR: 7.03 mL/min/1.73m^2, and was diagnosed as the fifth stage of chronic kidney disease. The patient was unable to accept renal replacement therapy, and suffered from poor physical strength, obvious fatigue, poor appetite, lower limbs edema. She felt leg pain and shortness of breath after walking 100 meters slowly. Therefore, she went to the Chinese medicine department on 2020/3/29 for consultation. The syndrome patterns were spleen and kidney yang deficiency, phlegm and blood stasis obstructing the collaterals. In order to treat both manifestation and root cause of disease, we planned to invigorate the function of the spleen and nourish the kidney by using acupuncture and herbal medicine. Then, we tried to promote blood circulation for removing blood stasis, promote diuresis for removing turbidity, and clear heat-toxin. After more than 8 months of treatment, the patient felt her physical strength and edema had improved significantly, and the gastrointestinal discomfort was also effectively relieved. Her blood pressure was relatively stable, and kidney function remained stable, moreover, she had no side effects of hyperkalemia. We hoped that this case can be used as a reference for clinical Chinese and Western physicians.

【Keywords】Chronic Kidney Disease； Diabetic Nephropathy； Acupuncture； Traditional Chinese Medicine； Herbal Medicine