中医治疗糖尿病的优势与进展.ppt

　　国医节----1929年3月17日

　　The Therapeutic Effect and Advantages of Chinese Medicine for the Treatment of Diabetes Mellitus 中医治疗糖尿病的优势与进展 Prof.Hu Zhen Wenzhou Medical College huzhen998@yahoo.com.cn

　　巴西库利提巴市1993

　　纳米比亚1996-1998年

　　东方大学孔子学院 Confucius Institute at Burapha University Thailand

　　泰国 2005--2012

　　2023/11/6

　　13

　　美国

　　2023/11/6

　　18

　　In this book, the authors emphasize certain key principles commonly applied in clinical practice. Numerous case studies and classical quotes are included to assist the reader in understanding the profound concepts involved in diagnosis and treatment.

　　The Basic Knowledge and Advances in The Research糖尿病的基本知识和研究新进展

　　EpidemiologyThe diabetes mellitus is geographically widespread, occurring throughout the world. At least 171 million people are currently affected with diabetes (According to the International Diabetes Federation)

　　Epidemiology

　　26 million diabetes cases in the United State. 79 million Americans with prediabetes. Diabetes affects 8.3% of Americans of all ages 11.3% of adults aged 20 years and older, About 27% of those with diabetes(7 million ) Americans—do not know the fact that they have the disease. Prediabetes affects 35% of adults aged 20 years and older. A 2011 Centers for Disease Control and Prevention (CDC) report (USA)

　　The top 10 countries (in the number of people with diabetes)

　　India, China, the United States, Indonesia, Japan, Pakistan, Russia, Brazil, Italy, and Bangladesh.

　　The Basic Knowledge and Advances in The Research糖尿病的基本知识和研究新进展

　　One of the leading causes of morbidity and mortality The major cause of blindness in adults aged 20-74 years The leading contributor to end-stage of renal disease (ESRD) The leading cause of nontraumatic lower limb amputations

　　TheBasic Knowledge and Advances in The Research糖尿病的基本知识和研究新进展

　　Diabetes mellitus is a group of metabolic disorders with one common manifestation: hyperglycemia. Chronic hyperglycemia causes damage to the eyes, kidneys, nerves, heart and blood vessels. The etiology and pathophysiology leading to the hyperglycemia, however, are markedly different among patients with diabetes mellitus, dictating different prevention strategies, diagnostic screening methods and treatments.

　　(1) The occurrence and development of diabetes mellitus糖尿病的发生与发展

　　Pancreatic β-cells ↓ Insulin Resistance

　　Insulin deficiency (defective insulin secretion, insulin action )

　　Abnormal Metabolism(hyperglycemia )

　　Oxidative Stress

　　diabetes mellitus ↓ diabetic complications (damage, dysfunction and failure ) kidney, eye, nerves, heart and blood vessels

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　　Simplified scheme for the pathophysiology of type 2 diabetes mellitus

　　(2)Criteria for the diagnoss of diabeters mellitus and impaired glucose homeostasis糖尿病诊断标准(WHO 和IDF 标准)

　　①Classic symptoms of diabetes mellitus ： polyuria、polydipsia、polyphagia、weight loss ②Fasting plasma glucose FPG ≥7.0mmol/L(126mg/dL) ③2hr postprandial plasma glucose ≥11.1mmol/L(200mg/dL) DM:hemoglobin A1c diagnostic tests ( HbA1c)≥6·5%(ADA: 2010)

　　美国糖尿病协会(ADA)， 在2003 年11 月，则将IFG 的诊断标准从6.1mmol/L (110mg/dL) 下调为5.5mmol/L(100mg/dL)。 2010年ADA :hemoglobin A1c diagnostic tests ( HbA1c)≥6·5%列为糖尿病诊断标准之一,并将HbA1c≥5·7%作为糖尿病筛查标准之一。

　　(2)Criteria for the diagnoss of diabeters mellitus and impaired glucose homeostasis糖尿病诊断标准(WHO 和IDF 标准)

　　④Impaired fasting glucose IFG: fasting plasma glucose FPG ≥6.1mmol /L(110mg/dL) <7.0mmol/L(126mg/dL) ⑤Impaired glucose tolerance IGT : 2hr postprandial plasma glucose ≥7.8mmol/L(140mg/dL <11.1mmol/L(200mg/dL)

　　Classification

　　Type 1 diabetes (insulin-dependent diabetes mellitus IDDM) pancreatic beta-cell destruction ketoacidosis autoimmune process type 2 diabetes (non-insulin-dependent diabetes mellitus NIDDM) insulin resistance inadequate insulin secretion due to pancreatic beta cells.

　　(3)The treatment for diabetes mellitus糖尿病的治疗

　　No effective treatments have been identified Lowering blood sugar (hemoglobin A1c ) Reducing the blood pressure Lowering blood lipids Controlling the risk factors (a program of diet and exercise -- risk reduction about 25%)

　　Rational administration of drugs for DM (OAD)

　　Prof Ralph DeFronzo advocate The treatment based on the etiology Early diagnosis Combined Therapy ( the β-cell proliferation ) Approaches: Life style intervention Three Drugs Combined Therapy Troglitazone TZD(噻唑烷二酮)、 Metformin(二甲双胍) Exenatide(依克那肽)

　　Other treatment approaches

　　Gastric bypass(GBP) 胃旁路手术 Stem cells 干细胞技术

　　The Advantages of Chinese Medicine for the Treatment of Diabetes Mellitus中医治疗糖尿病优势

　　Treating the human body as a whole Individualized treatment a treatment for a patient Prevention and cure of complications

　　(1) Treating the human body as a whole整体调节

　　Treatment based on differentiation of symptom-complex? 1 Selecting acupoint along channel (循经取穴) 三焦经穴外关为主穴 2 Selecting acupoint based on differentiation of symptom-complex(辩证论治取穴) 肺脾肾 3 Biological holographic theory (生物全息理论取穴) 耳穴

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　　Effects of multi-targets 多靶点作用

　　Protect β-cells and stimulate insulin secretion Increase insulin receptors and affinity Inhibit glucagon secretion Enhance the ability of utilization of sugar in target organs and tissue Correct metabolic disturbance of carbohydrate, fat and protein Improve microcirculation

　　Dazhui(大椎) moxibustion Shenque(神阙) moxibustion Reduce the level of fasting blood glucose ， Increase the capacity response of glucose load of Pancreatic lslet Beta Cells， Increase the excretion of insulin

　　The comprehensive therapy 综合性治疗

　　Alimentary therapeutics饮食、 Cinesiatrics 运动、 Message 推拿、 Acupuncture and moxibustion 针灸、Pharmacotherapy药物

　　(2) Individualized Treatment 个体化治疗

　　To identify the nature and location of a disease 辨性定位 To infer the cause and judge the pathogenesis of a disease 求因审机 To differing conditions in terms of locality, time, and persons involved 因人、因地、因时制宜

　　辨证分型Clinical Stage and Type

　　三消论治Triple diabetes diabetes involving the upper warmer----lungs 上消：肺 diabetes involving middle warmer ----spleen 中消：脾 diabetes involving the lower warmer----kidney 下消：肾

　　Three types 《the Chinese herbal medicine new medicine clinic research guideline 》三型《中药新药消渴病(糖尿病)临床研究指导原则》

　　extreme heat due to deficiency of yin in an early stage(阴虚热盛--早期) deficiency of both qi and yin in a middle stage(气阴两虚--中期) yin-yang deficiency in a Late stage(阴阳两虚--晚期) accompanying symptoms(兼证) stagnant blood and blood stasis(血瘀脉络) dampness and heat in spleen(湿热困脾)

　　Five stages and five types(五期五型论治)Chinese Diabetes Association diagnosis criteria of diabetes mellitus in 19911991年全国糖尿病学会辩证标准

　　Preclinical(糖尿病前期) Prodrome period(糖尿病症状期) Early complications糖尿病合并症早期 Middle complications糖尿病合并症中期 Late complications糖尿病合并症重危期

　　脏腑论治

　　differentiation of diseases according to pathological changes of the viscera and their interrelations

　　The Prescriptions of TCM

　　White Tiger Decoction(白虎汤) Shanghan Lun (treatise on Exogenous伤寒论) Shigao(石膏)(Gypsum Fibrosum) 50g Zhimu (知母)( Rhizoma Anemarrhenae)18g Gancao(甘草)(Radix Glycyrrhizae)6g Jingmi(粳米) (Semen Oryzae Sativae)9g Actions: Clearing away heat Promoting the production of body fluid Clinical Application: High fever,polydipsia, profuse perspiration ,large pulse

　　The Prescriptions of TCM

　　Yunu Jian (玉女煎) Jingyue Quanshu (jingyue’s Complete Works) 景岳全书 Shigao (石膏Gypsum Fibrosum) 50g Dihuang (地黄Radix Rehmanniae )6g Maimendong (麦门冬Radix Ophiopogonis)6g Zhimu(知母 Rhizoma Anemarrhenae)5g Niuxi(牛膝Radix Achyranthis Bidentatae)5g Actions: Clearing away stomach-heat nourishing yin of stomach Clinical Application: syndrome of stomach-heat and yin deficiency

　　The Prescriptions of TCM

　　Shenqi Wan(肾气丸) Jingui Yaolue (synopsis of prescriptions of the Golden Cabinet) Shengdihuang(Radix Rehmanniae)240g Shanyao (Rhizoma Dioscoreae)120g Shanzhuyu(Fructus Corni)120g Zexie(Rhizoma Alismatis)90g Fuling(poria)90g Mudanpi(Cortex Moutan Radicis)90g Guizhi ( Ramulus Cinnamomi) 30g Fuzi(Radix Aconiti)30g Actions: Warming and invigorating kidney- yang polyuria、polydipsia

　　The disease patteren defined in the Internal Canon of Medicine 《内经》消渴发病模式

　　Xiaoke was first mentioned in the Internal Canon of Medicine 消渴之名首见于《内经》

　　The disease patteren defined in the Internal Canon of Medicine 《内经》消渴发病模式

　　Etiologic factors deficiency of the spleen and stomach(脾胃虚弱) “脾脉微小为消阐” 《灵枢?邪气脏腑病形篇》 heat formation due to food stagnation (食滞化热) “脾阐，此肥美之所发也，此人必数食甘美而多肥也，肥者令人内热，甘者令人中满， 故其气上溢，转为消渴” 《灵 枢?奇病论》 functional injury of the spleen by medicine (药物伤脾) “夫石药之气悍，适足滋热，与热气相合，必内伤脾，此药石之渴也”。张子和在《儒门事亲》

　　The disease patteren defined in the Internal Canon of Medicine 《内经》消渴发病模式

　　甘美 中满 脾虚 + 数食 —— 令人 —— 消渴 多肥 内热 deficiency of the spleen a large number of food --------internal heat------- Xiaoke (sweet + fat ) food stagnation

　　A formula for Xiaoke recorded in the Internal Canon of Medicine 《内经》消渴的治方

　　“治之以兰(佩兰eupatorium) ，除陈气也”

　　The treatment based on Spleen消渴从脾论治

　　Nourishing Spleen Yin： 玉竹yuzhu(radix polygonati officinalis )、石斛shihu(dendrobe) Reinforcing Spleen Qi： 黄芪huangqi(Astragalus mongholicus )、山药shanyao(Chinese yam) Eliminating Spleen Dampness： 白术baizhu(bighead atractylodes rhizome )、茯 苓fuling(Poria cocos )

　　The treatment based on Spleen消渴从脾论治

　　Clearing Spleen Heat： 黄连huanglian(the rhizome of Chinese goldthread); 知母zhimu(rhizoma anemarrhenae ) Promoting Spleen Yang： 葛根gegen(the root of kudzu vine) 、升麻shengma(rattletop ) Warming Spleen Yang： 桂枝guizhi(cassia twig )、 附子fuzi(monkshood )

　　Experimental Research on SQ-Complex Prescription升清降糖合剂实验研究1.材 料 与 方 法Materials and methods

　　1.1 laboratory Animal实验动物： Male clean degree SD rats 45，with a body mass from 200g to 240g 1.2 Test Drug ： SQ-Complex Prescription(升清降糖汤) 葛根the root of kudzu vine ，黄芪Astragalus mongholicus

　　2.实验方法Experimental Method

　　2.1 Establishment of rat model and group division 2.2 Dose and Administration 2.3 Sample Collection 2.5 Data Analysis (by statistical package )

　　3.实 验 结 果Experimental results

　　3.1升清降糖合剂对糖尿病大鼠一般状况的影响 effect of SQ-Complex Prescription on the general status of diabetic rats Normal group(正常组) : normal drinking and food intake ，a silky coat , flexible mobility ，bowel acting properly 。 Model group(糖尿病模型组): polydipsia, polyphagia, polyuria ，lost weight ，fur lackluster ，decrease in activity ， Treatment group: Better in the general status ，

　　3.2升清降糖合剂对糖尿病大鼠血糖值的影响Effects of SQ-Complex Prescription on the levels of blood glucose of diabetic rats

　　The results fasting serum glucose (Treatment lasting 60 days ): Model group: before and after the treatment no obvious difference (P>0.05) in blood glucose ， Treatment group and model group: significant difference after treatment (P<0.05) in both groups and the treatment group was effective 。

　　3.3 升清降糖合剂对糖尿病大鼠胰腺病理的影响(见附图)Effect of SQ-Complex Prescription on Pathology of Pancreas of DiabeticRats

　　Normal group (正常对照组)：

　　Model group(模型对照组)：loose in the pancreatic islets structure ，islet cell atrophy fibrosis were formed in islets，

　　Treatment group(升清降糖合剂组):normal pancreatic islets,A tiny amount of islet cell atrophy

　　结论Conclusion

　　1)The results show that SQ-Complex Prescription improves the status of diabetic rats, reducing the level of blood glucose 2)The results show that SQ-Complex Prescription improves the number of Pancreatic Islet β Cells in rat and protects diabetic rats’ pancreas

　　(3)Prevention and Cure of Complications防治并发症

　　The disorders are characterized by hyperglycemia associated with microvascular (ie, retinal, renal, possibly neuropathic), macrovascular (ie, coronary, peripheral vascular), neuropathic (ie, autonomic, peripheral) complications.

　　Diabetic Enteropathy

　　Diabetic enteropathy ' is a condition in which patients suffer episodes of diarrhea and watery stool , or constipation and diarrhoea appear alternately . The effects on diabetic control, physical health and emotional quality of life are severe. Patients do not respond reliably to general supportive management or conventional medications. Surgical options have disappointing results. The need for more effective treatment is acknowledged universally Treatment by Chinese herbs Acupuncture and moxibustion Herbal coloclysis

　　Buzhong Yiqi Tang(补中益气汤)

　　黄芪Huangqi (radix astragali seu hedysari)18g 甘草Gancao (radix glycyrrhizae)9g Renshen(radix ginseng)6g Danggui(radix angelicae sinensis)3g Jupi(pericarpium citri reticulatae)6g Shengma(rhizoma cimicifugae)6g Chaihu(radix bupleuri)6g Baizhu(rhizoma atractylodis macrocephalae)9g

　　Zengye Chengqi Tang(增液承气汤)purgative decoction for increasing fluid

　　玄参Xuanshen(radix scrophulariae)30g 麦门冬Maimendong(radix ophiopogonis)25g 生地黄Shengdihuang(radix rehmanniae)25g 大黄Dahuang(radix et rhizoma rhei)9g 芒硝Mangxiao(natrii sulfas)5g

　　Neutrogenic bladder

　　The normal function of the urinary bladder is to store and expel urine in a coordinated, controlled fashion. This coordinated activity is regulated by the central and peripheral nervous systems. Neurogenic bladder is a term applied to a malfunctioning urinary bladder due to neurologic dysfunction or insult emanating from internal or external trauma, disease, or injury. Treatment by Chinese herbs Acupuncture and moxibustion

　　Shenqi Wan(肾气丸)

　　Jingui Yaolue (synopsis of prescriptions of the Golden Cabinet) Shengdihuang(Radix Rehmanniae)240g Shanyao (Rhizoma Dioscoreae)120g Shanzhuyu(Fructus Corni)120g Zexie(Rhizoma Alismatis)90g Fuling(poria)90g Mudanpi(Cortex Moutan Radicis)90g Guizhi ( Ramulus Cinnamomi) 30g Fuzi(Radix Aconiti)30g Actions: Warming and invigorating kidney- yang polyuria、polydipsia

　　Diabetic Nephropathy

　　Diabetic nephropathy is the leading cause of chronic kidney disease. It is also one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Diabetes is responsible for 30-40% of all end-stage renal disease (ESRD) cases in the United States. Diabetic nephropathy is a clinical syndrome characterized by the following: Persistent albuminuria (>300 mg/d or >200 μg/min) that is confirmed on at least 2 occasions 3-6 months apart Progressive decline in the glomerular filtration rate (GFR) Elevated arterial blood pressure Treatment by Chinese herbs

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