中醫針藥並用輔助治療糖尿病腎病變末期患者之病例報告

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

吳承家1林郁甯1龔彥綸1,2,3,*

1佛教慈濟醫院財團法人花蓮慈濟醫院中醫部，花蓮，台灣

2慈濟大學學士後中醫學系，花蓮，台灣

3慈濟大學醫學科學研究所，花蓮，台灣

慢性腎臟病在台灣的盛行率逐年上升，其中糖尿病腎病變佔了一半左右，隨著疾病發展，最後會需要進行腎臟替代療法，致使台灣透析的盛行率也高居世界第一，是一項嚴重威脅國人健康且消耗龐大醫療資源的重大疾病。近年來中醫藥治療慢性腎臟病的實證越來越被世界看到，2020年衛生福利部中央健康保險署通過中醫慢性腎臟病門診加強照護計畫，希望可以藉由中醫對疾病不同的切入角度，協助緩解腎臟功能下降，並改善腎友的生活品質。本案為一位68歲女性，有高血壓、糖尿病病史，109/06/19至本院新陳代謝科門診就診，經抽血檢查意外發現肌酸酐（creatinine）6.3 mg/dL、eGFR：7.03 mL/min/1.73m2，診斷為第五期慢性腎臟病。病患因尚無法接受腎臟替代療法，又出現體力變差、疲勞倦怠明顯、慢步行走100公尺即腿酸、氣短喘甚、食慾較差、納減、下肢水腫等症狀，遂於110/3/29至中醫門診求診。診斷為脾腎陽虛，痰瘀阻絡。藉由針灸與濃縮中藥並用，以健脾補腎為治療主軸，標本兼施，佐以活血化瘀、利濕化濁、清熱解毒，經過8個多月的治療，患者自覺體力和水腫改善明顯，腸胃不適也有效的舒緩。血壓較為平穩，腎功能維持穩定，且沒有高血鉀的副作用。希望本案可提供給臨床中西醫師做參考。

【關鍵詞】慢性腎臟病、糖尿病腎病變、針灸、濃縮中藥

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