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六味地黄汤加减治疗早期糖尿病肾病,连续治疗56d,未有不适,血糖可控。女,75岁,糖尿病19年,伴腰痛2年,空腹血糖6.15mmol/L,腰痛加重1月余;拜糖平50mg TID、睡前皮下注射长秀霖12U,控制血糖;乏力,口干口苦,双目干涩、视物模糊,迎风流泪,右眼睑下垂,右侧面部麻木不适,腰部隐痛,呈阵发性,疼痛可忍,偶有头晕头痛,耳鸣耳聋,无咳嗽咳痰,无心慌胸闷,平素怕热汗多,双下肢轻度凹陷性水肿,四肢无麻木,偶有抽筋,纳可,眠可,小便频数、色黄,尿中有泡沫,大便偏干,两三日一行,舌质暗红,苔少,脉沉细;尿微量白蛋白:41.30mg/L;尿常规:葡萄糖(+++),尿蛋白(+);葡萄糖:15.2mmol/L;糖化血红蛋白:10.9%;肌酐:3457umol/L,符合早期糖尿病肾病诊断。治以滋补肝肾、活血通络,六味地黄汤加减,山药~炒15g,山萸肉20g,白术30g,茯苓30g,熟地黄15g,黄芪45g,麦冬30g,五味子9g,芡实~炒20g,决明子、枸杞各30g,苍术、薏苡仁各15g,川牛膝、续断各20g,泽泻、泽兰各15g,3剂,水煎服,早晚饭后温服。嘱糖尿病低盐、低脂、优质低蛋白饮食,并予前列地尔改善微循环,肾康注射液降逆泄浊、益气活血,葡萄糖酸钙注射液补充钙质,速尿利水消肿,口服拜糖平、睡前皮下注射长秀霖控制血糖。连续14d为1疗程,每疗程后根据临床表现及生化指标,辨证加减用药,连续治疗4疗程,症状基本消失,尿微量白蛋白:20.5mg/L;尿常规:葡萄糖(+),尿蛋白(-)。继7剂巩固治疗,避风寒,适度运动,糖尿病低盐、低脂、优质低蛋白饮食。2周后复查,未述特殊不适,血糖控制可。
Liu Wei Di Huang Decoction for the treatment of early diabetic nephropathy, continuous treatment 56d, no discomfort, blood glucose control. Female, 75 years old, diabetes 19 years, with low back pain for 2 years, fasting blood glucose 6.15mmol / L, lower back pain more than 1 month; Bai Pingping 50mg TID, Changshulin 12U subcutaneous injection before going to bed to control blood sugar; Bitter, binocular dry, blurred vision, wind and tear, right eyelid ptosis, right facial numbness, waist pain, paroxysmal, painful, occasional dizziness, headache, tinnitus and deafness, no cough and sputum, no heart panic Chest tightness, usually afraid of hot sweat, mild depression of both lower extremity edema, limbs numbness, occasionally cramps, can be satisfied, sleep may, frequent urination, color yellow, urine bubble, stool dry, two or three days his party, Urinary albumin: 41.30mg / L; Urinary routine: Glucose (+++), Urine protein (+); Glucose: 15.2mmol / L; Glycosylated hemoglobin: 10.9% ; Creatinine: 3457umol / L, in line with the diagnosis of early diabetic nephropathy. Governance to nourish the liver and kidney, Huoxuetongluo, Liu Wei Di Huang Decoction, yam ~ fried 15g, cornus 20g, Atractylodes 30g, Poria 30g, Rehmannia 15g, Astragalus 45g, Radix 30g, Schisandra 9g, , Cassia, Chinese wolfberry 30g, herb, Yiyiren 15g, Achyranthes, continued off the 20g, Alisma, Zeeland the 15g, 3, Shuijianbi, sooner or later after meal warm clothes. Prompt diabetes low salt, low fat, high-quality low-protein diet, and to the alprostadil to improve microcirculation, Shen Kang injection Jiangni Xiezao, Qi and blood, calcium gluconate injection of calcium, furosemide diuresis, Oral oral sugar level, before going to bed subcutaneous injection Changxiu Lin control blood sugar. Continuous 14d for a course of treatment, according to the clinical manifestations and biochemical indicators after each course of treatment, plus or minus medication differentiation, continuous treatment for 4 courses, the symptoms disappeared, urinary albumin: 20.5mg / L; urine: glucose (+ (-). Following the seven agents to consolidate the treatment, avoid cold, moderate exercise, diabetes, low salt, low fat, high-quality low-protein diet. 2 weeks after the review, did not describe the special discomfort, blood glucose control can be.