2022年4月7日星期四

(二) How to deal with the hypofunction of the middle-aged and the elderly, such as a slight decrease in the estimated glomerular filtration rate (eGFR) of renal function?

(二) How to deal with the hypofunction of the middle-aged and the elderly, such as a slight decrease in the estimated glomerular filtration rate (eGFR) of renal function? 


The estimated glomerular filtration rate (eGFR) is a test that measures your level of kidney function and determines your stage of kidney disease. It is a normal and natural phenomenon that the function of middle-aged and elderly people gradually declines. The renal function of many middle-aged and elderly people, such as eGFR, is slightly decreased, and other renal function indicators are normal without clinical symptoms. Even the family doctor will not notice and talk to the patient. How does traditional Chinese medicine deal with and solve this problem? Mr. Zhao Shaoqin (1918-2001) (born in the family of three generations of imperial physicians in Beijing, tenured professor of Beijing University of Chinese Medicine, famous contemporary Chinese medicine doctor, Chinese medicine educator). Zhao Shaoqin Professor has three monographs on academic achievements, "Theory of Nephritis is Not Simple Kidney Deficiency", "New Theory of Chronic Kidney Disease", and "Experience of Treating Uremia with Traditional Chinese Medicine". Zhao Shaoqin Professor believes that "the problem of diet for patients with nephritis: should not take all spicy and fragrant and rich in fat and protein products, and at the same time emphasise the control of diet to reduce the burden on the kidneys. Generally, the daily main food should not exceed 250g, supplemented by fresh vegetables. Sweet and greasy food, it helps to increase dampness and produce phlegm, while spicy and pungent, fragrant and dry frying food, it turns into fire and damages yin, aggravates the generation of qi stagnation and accumulated heat, and hinders the smooth flow of qi. From the perspective of modern medicine, protein is a nitrogen-containing compound, and most of these substances are excreted through glomerular filtration. If the patient eats too much fat and protein, it will cause increasing the production of nitrogen and waste and will increase the burden on the sick kidneys, not only can't they get enough proper nutritional supplements, but it is not good for the recovery of the disease. In addition, strengthening exercise, such as walking for two hours a day, promotes nitrogen excretion from the kidneys. Facts have proved that limited dietary and balanced exercise play an important role in adjuvant drug treatment." "Chinese medicine cools blood and removes blood stasis, the diet without fat and protein, and insisting on exercise are three key methods for treatment of chronic kidney disease.Those three methods must be used together and can not lack one of them. With the close cooperation of the patient, the treatment will be able to achieve good results. Chronic kidney disease can be radically cured and chronic kidney function damage can be reversed. This conclusion has been confirmed in clinical practice.” There are more middle-aged and elderly people around us with hypofunction. What should we do to treat them? According to Mr. Zhao's article, I propose that if there is a slight decrease in the renal function like eGFR in the middle-aged and elderly people, the total intake of fat and protein should be reduced, the burden on the kidneys should be reduced then, and exercise should be strengthened, such as walking for two hours a day, which helps the kidneys excrete nitrogen. Walk for half an hour after breakfast, half an hour after lunch, and an hour after dinner. I think this plan is more moderate and workable. It is good for the recovery of body function and also easy to come true.


 (二)如何对待中老年人机能减退如肾功能肌酐清除率轻微下降?


评估肾小球滤过率(eGFR)是一项测量肾脏功能水平和确定肾脏疾病阶段的测试。

中老年人机能逐渐减退,这是很正常的一个自然现象。很多中老年人的肾功能,如肌酐清除率有轻微的下降,其他肾功能指标正常的,而无临床症状,西医认为是轻度的肾功能的减退,也只能作为观察处理。甚至家庭医生都不会注意到,更不会告诉检查者。中医如何看待和解决这问题?


赵绍琴先生(1918-2001)(出生于北京三代御医之家,北京中医药大学终身教授,当代著名中医学家,中医教育家)。赵绍琴先生有三篇有关学术成就专论,《肾炎非单纯肾虚论》,《慢性肾病新论》,《中医药治疗尿毒症的体会》。先生认为 “肾炎患者的饮食调养问题:应禁食一切辛辣香燥和富含脂肪,蛋白质之品,同时强调控制饮食量,以减轻肾脏负担。一般每日不超过250g主食,辅以新鲜蔬菜。甘甜肥厚,有助于增湿生痰,辛辣香燥每多化火伤阴,加重郁热生成,阻碍气机通畅。从现代医学讲,蛋白质是含氮化合物,这些物质排泄大多要从肾小球滤过排出,食用多了,氮及废物产生增加,就要加重已病肾脏的负担,机能不仅得不到应有的营养补充,反不利于病情恢复。另外,加强锻炼,每日散步两小时,有助于肾脏排氮功能的恢复。事实证明,饮食禁忌和功能锻炼在辅助药物治疗中起着重要的作用。” “中药凉血化瘀,饮食忌食蛋白,坚持运动锻炼是治疗慢性肾病的三大法宝。治宜三者并行,缺一不可。在患者的密切配合下如法治疗,必能收到良好的效果。慢性肾病可以根治,慢性肾功能损害可以逆转,这一结论必能在临床实践中获得证实。”


我们周边更多的是中老年人机能减退的,对待他们,我们应该如何怎么办?

据赵先生文章所示,我提出对待中老年人如有肾功能肌酐清除率有轻微的下降,应该减少脂肪和蛋白质的摄入总量,减轻肾脏负担,加强锻炼,比如说每天散步两个小时,有助于肾脏排氮功能。早饭后散步半小时,中饭后散步半小时,晚饭后散步是一小时。我觉得这个方案是比较适中可行的。对身体有好处。也容易实施。