慢性肾衰竭 (Kidney failure)

我这是写给住在海外,没法请教郑医师的肾衰竭 (Kidney failure)患者而写,没什么灵丹妙药,希望能有些帮助.

尿毒症 (urinaemia)祗是症状,引起尿毒症是因为肾衰竭 , 造成肾衰竭的一个原因是肾小球硬化(glomerulosclerosis) ,肾小球硬化是肾脏纤维化 (fibrosis)的一部份.

高血压,高血糖,免疫损伤炎症反应及血管内凝血都能促成肾小球硬化 (glomerulosclerosis)蛋白尿能损伤肾小球毛细管壁肾小球系膜细胞而致肾小球硬化;此外, 脂质代谢紊乱损伤内皮细胞及基底膜诱导单核巨噬细胞浸润 ,导致系膜细胞增生和系膜外基质聚集.

慢性肾衰竭患者由于肾实质破坏导致200 多种代产物难以排泄 和某些激素不能降解,于是在体内蓄积,其中物质具有毒性作用,能引起尿毒症状,代谢紊乱和多种系统功能失调.

基本上,肾纤维化,是不可逆的,中西医都没办法还原.目前,祗有透析疗法和换肾是比较可行的选项.这个带子是好几年前的.不知透析疗法在中国还是那么遥不可及吗? 在其他地方,多由慈善机构包办,公众募捐,协助负担部分肾病患者的洗肾费用.透析疗法减低肾病患者尿中毒的风险.中国也完全有能力制造价格低廉又实用的洗肾机,以便普及,让病人更方便,惠及百万,甚至千万有肾病的病黎.

如果你是慢性肾衰竭患者,以下的验方希望能苟延宝贵生命,延缓病情进展,和增强免疫力,预防尿毒症, 可在专属医师指导下应用.

缓衰方(王丽,占永力)黄芪.太子参.茯苓.泽泻各15克,当归.川芎.赤芍.白芍.益母草各

12克.车前草15克,黄芩.焦大黄9克

加减: 若腹胀.纳呆.恶心者,加藿香梗.紫苏梗.法半夏.陈皮各9克;呕吐明显者,加旋覆花9克,代赭石12克,肢麻身痒者加鸡血藤15克,地肤子12克,贫血者加重当归至18克,阿胶珠15克.腰酸膝软者加桑寄生.牛膝12克.尿少,浮肿明显者,加大腹皮20克,车前子16克;心悸气短者,加麦冬15克.五味子9克.腹胀便秘者,加火麻仁12克,全瓜篓15克;抽搐者,加煅龙骨.煅牡蛎各12克

方义:在慢性肾衰竭的进程中正虚邪实,往往贯穿病程始终,正虚是脾与肾虚,邪实是指六淫,或内生水湿,湿浊.湿热,瘀血.治法应益气降浊,活血利湿.

方中黄芪,太子参健脾益气养阴,茯苓.泽泻.车前草利水渗湿. 当归.川芎.赤芍.白芍.益母草能活血化瘀,养血和血. 益母草兼能利水解毒.焦大黄能通腑泻浊,黄芩清热利湿,清中上焦湿热,车前草清下焦湿热.

黄芪有减少蛋白尿,改善肾功能的作用,是一种免疫调节剂,大黄可改善氮质血症,抑制残余组织代偿性肥大,降低残余肾的高代谢状态,并可以纠正脂代谢紊乱.慢性肾功能在慢性肾功能衰竭大多存在血液流变学异常肾脏血流动力学改变及肾脏微循环障碍应用活血养血药如当归,白芍等,即能降血粘度,提高肾小球滤过率.同时还能降低血脂,减少蛋白尿,从而延缓了慢性肾功能慢性肾功能衰竭的进展.

我代替慢性肾功能衰竭患者感谢王丽.占永力.周静媛的处方,他们的统计38例中,显效21例,有效9例,稳定5例,无效3例.我的看法是不妨长期吃,建立有效的免疫力,给已衰竭的肾一个稳定的环境.提高生命质量.有时间以后再提供更好的方给诸位患者.

如果出现关格现象,伤寒论说"关则不得小便,格则吐逆" 不得小便中医也叫癃闭.小便点滴而少病势较缓叫癃,点滴不通,病势较急,叫闭.这时,出现尿闭.呕吐.腹胀.纳呆.嗜睡.抽搐.昏迷.就是快要向阎王报到.赶快送院治疗.如果您住的偏远,来不及到医院,中医有云"大便动,小便自通"可自备大黄灌肠,用大黄来灌肠使粪氮排出量增加,还能阻止氨基氮从肠道吸收.如果没大黄,其它肛门泻剂也可用来暂时解急.最好还是去医院血液透析.

得了慢性肾功能衰竭很无耐但要正面对待,积极的过每一天,死亡并不可怕;我最近看了一本耶鲁大学教授谢利.卡根写的书,书名就叫"死亡",有中译本,我现在不那么怕死了.情志调养对疾病很重要,要努力做心理的调适,预防感染,避免过劳,适当的性生活,谨慎妊娠.在饮食上,要低蛋白,高热量,如果有低血钠现象,不必忌盐,尿多时,更不能忌盐.以免血容量不足,而减少肾血流,加重肾功能的损坏.水肿,血压升高,要低盐饮食.最好饮食习惯是完全素食,饥饿疗法,限盐限水.

本文是评论中华医药节目“绿豆降血压--魔芋挽救功能衰竭的肾”的全录，希望对慢性肾功能衰竭患者有益

Ebola virus, Can Chinese medicine be more effective? (Revised)

The pathology:  The particle consists of a genome wrapped up in two layers of protein. When the virus infects a cell the polymerase makes copies of genome and the cells is tricked into using these to make the proteins that the virus needs. Particularly, VP35 and VP24 prevent interferon, a class of molecule that alerts the immune system from being made. The sugars on the virus’s outside make it hard for other parts of the immune system to get to grips with; the virus makes infected cells produce more glycoprotein than it needs for its coats, with the surplus simply secreted into the bloodstream. Antibodies which would otherwise attack the virus stick to this decoy protein instead.

Immune cells which the virus attacks in the bloodstream early on carry attacks in the blood stream early on carry the infection to the liver, the spleen, and lymph nodes. Symptoms may manifest themselves in a day or two or may wait weeks. Eventually the virus’s spread triggers an immune overreaction known as a cytokine storm. Blood vessel walls become leaky, blood pressure and core temperature drop, organs fail and the body goes into shock. Some of the sick weather the storm, but most who survive infection do so by never getting to its direst straits. Some do not succumb at all. Some infected but never fallen ill.

The epitome of Ebola symptoms: Ebola’s patient can feel like the flu or other illnesses. Symptoms show up 2 to 21 days after infection and usually include:

•           High fever

•           Headache

•           Joint and muscle aches

•           Sore throat

•           Weakness

•           Stomach pain

•           Lack of appetite

As the disease gets worse, it causes bleeding inside the body, as well as from the eyes, ears, and nose.  Some people will vomit or cough blood, have bloody diarrhoea, and get a rash.

In Chinese Medicine theory, it is categorized as 热毒疫，Bleeding is corresponding to the theory of 热入血分, 迫血妄行  (heat invaded the blood phase, forcing blood off course).  TCM diagnoses it as a combination of  endotoxin derived from heat(热毒), internal stasis of dampness heat（湿热）, blood stasis（血瘀） ;As the virus attacks immune system, particularly, It further weaken spleen（脾） and kidney（肾）, in TCM terms, resulting deficiency in Yin and Yang（阴阳两虚）. The following prescription is in accordance with the rules of treatment of the diagnosis above:

鲜马齿苋1两 (Fresh Purslane herb)   川黄连5钱(Golden thread)    生大黄3钱（后下）(Rhubarb)制附子3 钱 (Prepared common monkshood daughter root))  硫黄2 分(Sulfur)   灶心土1 两(Furnace Soil)     川厚朴3 钱 (Officinal magnolia bark)    佩兰3钱(Fortune eupatorium herb)   乌梅6钱  (Smoked plum)   肉豆蔻3 钱  (Semen Myristicae)   漂白术5 钱 (Largehead Astractylodes Rhizome)    淮山药5 钱  (Common yam rhizome)  京赤芍3 钱 (Red Peony root)     淡干姜3 钱(Zingiber Dried Ginger)     粉葛根5 钱  (Kudzuvine Root) 单桃仁3钱 (Peach seed)      晚蚕砂3钱 (Silkworm Shit)    东阿胶5 钱(烊化)(Gelatin)( melting by heat)    牡丹皮3 钱  (Tree peony bark)   净连翘5 钱 (Weeping forsythia capsule)和   杭白芍 6 钱,(White peony root)

I posted the prescription on social media, but was given short shrift and brushed aside. I think there are several reasons for what happens the way it is.

One, we all pedestal authority, worship mainstream institution preponderantly as beyond doubt, other non-mainstream sources are slighted.

Two, culture differences on taking risk: The American culture to taking drug (Medicine) is more conservative; prefer FDA approval by rigorously tested and yielding positive results. It is good, but comes at a high price.

Three, the prevalent trends is towards discovery of new vaccine, seeing this path as the only way out of taming the epidemic.

There is nothing egregiously bad for the reasons I mentioned. It is all about choices we have, and the circumstances we are in. For example, WHO allowed untested drug for use, it is the circumstances determine the choices at hand and calibrated a seemingly unethical decision hopefully to ameliorate the situation.

We makes grave mistake without spanning the full gamut if we are obstinate to rule out every possibility of finding viable solution passing through the crucible.  This can happen to us because we have little knowledge of certain treatments; we have warped opinion of it, we disregard every avenue in the experiments in the discovery process. All those are not science. Many of the time, these kinds of behavioural distortions imbue our thinking; it becomes hindrance to great discovery due to our ignorance.

Why I think my prescription worth a second look?

It is a credible choice among current treatments. Mainstream medical treatments have yet come out with anything proclaimed efficacious; it is worth spending the resources on something may serendipitously cut the mustard.

The solution is relatively cheap and affordable to many Africans compared to many Western drugs.

At present, there is an ethical conundrum that too many patients chasing for paucity of unproven drugs available. To whom are to give first? (The situation may change soon, but most vaccine are untested) With this prescription, there is a ready source of supplies to go round for all patients. Restriction of human movements is futile to resolve the root cause but just control the spread and it elicits incessant other social and economic problems, It is hell-bent to quickly finding an efficacious solution,  key to preventing things run amok.

I don’t claim it is hundred per cent efficacious, there is no perfect drug even proven by authority, those who study medicine probably assent to this point. Much of the drawing from this prescription is: it is based on thousand years of empirical experiments and also I have no skin in the game.