Az inzulinrezisztencia és diabétesz a HKO szerint
A hagyományos kínai gyógyászat lehet a leghatékonyabb fegyver a 2-es típusú diabétesz elleni harcban - derül ki egy nemzetközi kutatásból.
A PLOS One szakfolyóiratban megjelent kontrollált kísérlet során nyolcszáz, 2-es típusú diabéteszben szenvedő felnőttet vizsgáltak. A glibenclamid önálló alkalmazását hasonlították össze a glibenclamid és a hagyományos kínai gyógyászat ötvözésével. Az eredmények azt mutatták, hogy a hagyományos kínai orvoslással is kezelt betegek harmadával kisebb valószínűséggel tapasztaltak hipoglikémiát, vagyis veszélyesen alacsony vércukorszintet, mint azok, akiket csak glibenclamiddal kezeltek.
Forrás: Természet Gyógyász Magazin
Egy kutatás szerint a világ felnőtt lakosságának 8,3%-a szenved cukorbetegségben, a számuk pedig 2035-re az 592 milliót is elérheti. A betegek élete jóval nagyobb veszélyben forog, mint az áltagos embereké. Mi is pontosan a cukorbetegség? Milyen hatással van az emberi szervezetre? A hagyományos kínai orvoslás hogyan kezeli ezt a betegséget? Mai Zhang Qingbinnel, a Hagyományos Kínai Orvoslás Magyarországi Egyesületének elnökhelyettesével készített interjúnkat hallhatják és olvashatják a cukorbetegség korai felismeréséről és kezelési módszereiről.
Az emberek többségének nincsenek átfogó ismeretei a cukorbetegségről. Elmondaná, kérem, pontosan miről is van itt szó?
Először vegyünk néhány általános jellegzetességet. Régen a hagyományos kínai orvoslás "xiao ke"-nek nevezte a cukorbetegséget, amihez három altípust társított: a felsőt, középsőt és alsót. A hagyományos kínai orvoslás szerint a diabéteszre a "három sok és egy kevés" jellemző, azaz a páciens sokat iszik, sokat eszik, sokat vizel, mégis kevés a testsúlya. Ezen kívül a vizelete füstös és édeskés illatú. Ha ezek a tünetek felütik a fejüket, valószínűleg cukorbetegségről van szó. Ez a hagyományos kínai orvoslás diagnózisa, amely szerint a gyenge yin a betegség legfőbb jellemzője.
A hagyományos kínai orvoslás milyen kezelést alkalmaz?
A cukorbetegség krónikus betegség, így a kezelése is hosszú időt vesz igénybe. Nem csak gyógyszert, de fizikoterápiát is bevetünk, illetve átalakítjuk a beteg étkezési szokásait és életvitelét, vagyis átfogó kezelést alkalmazunk.
Cukorbetegség esetén a hagyományos kínai orvoslás elsősorban a yin táplálására, a forróság enyhítésére, valamint a máj, lép, vese és tüdő megerősítésére összpontosít. A hagyományos kínai gyógyszereken kívül akupunktúrával is kezelünk egyes akupunktúrás pontokat és csatornákat. A masszázs is jótékony hatású lehet.
A diabéteszből nehéz kigyógyulni, ezért más terápiát is bevetünk, pl. a nyugati és a hagyományos kínai orvoslás elegyéből álló integrált gyógymódot. A beteg kezelése során a diagnózis felállítása a legfontosabb. Az efféle integrált kezelés során a nyugati orvoslás kvantitatív és objektív diagnózisa nagy jelentőséggel bír, hiszen ennek segítségével a kínai orvosok pontosabb kezelési technikákat dolgozhatnak ki, amiket előbb is kezdhetnek alkalmazni.
Az étkezés terén mit kell szem előtt tartania a betegeknek?
A diabéteszes betegeknek nem javasolt a magas kalória- és
zsírtartalmú élelmiszerek, mint pl. rizs és gyümölcsök fogyasztása,
ahogy nem fejezhetik be az étkezést egy cukros desszerttel sem. Hogy mit
ehetnek? A legalkalmasabb táplálékot a teljes kiőrlésű gabonák és
babfélék jelentik a számukra. Néhány zöldség is jót tesz, például a
sütőtök vagy a keserű dinnye. Létezik egy édes élelmiszer is, amit
bátran fogyaszthatnak: a propolisz, más néven méhszurok.
Forrás: CRI ONLINE
TCM & Diabetes
Traditional Chinese Medicine (TCM) refers to diabetes as Wasting-Thirst syndrome. The root of Wasting-Thirst is said to be a deficiency of Yin in the body and the presence of a Heat pathogen affecting the Lungs, Stomach, and Kidneys. When Yin is deficient, Heat from deficiency is produced; likewise, when Heat is present, it "burns up" Yin.
It is common for people diagnosed with diabetes to have a constitutional Yin Deficiency, but the deficiency may develop over time as well. Frequent causes are a diet that includes too many spicy and drying foods, insufficient rest, overwork, and sexual over indulgence. Deficiency of Yin and the presence of the Heat Pathogen lead to the symptoms of diabetes.
Traditional Chinese Medicine Categories of Diabetes
The most common manifestations of diabetes are excessive thirst, hunger, and urination, associated, respectively, with the upper, middle, and lower aspects of the body (known as the Triple Burners in TCM), so the disorder is commonly categorized as Upper Burner, Middle Burner, and Lower Burner Wasting-Thirst Patterns of Disharmony.
- Upper Burner: Known as Heat in the Lungs, the primary symptom of this pattern is excessive thirst. The pulse is usually rapid and may be thin; the tongue is red and dry, possibly with a thin yellow coat.
- Middle Burner: Related to Stomach Fire, the primary symptom of this pattern is excessive hunger. The pulse usually is forceful and rapid; the tongue is red with a yellow coat.
- Lower Burner: Related to Kidney Yin Deficiency, the primary symptom of this pattern is excessive urination. The pulse is usually rapid and thin; the tongue is red with little coating.
Yin Deficiency and Heat can consume Qi and Fluids in the body and even lead to a "thickening" of Blood. Hence, Patterns of Disharmony such as Qi Deficiency, leading to symptoms of fatigue, and Blood Stasis, leading to circulatory disorders, may accompany these Patterns of Disharmony.
Patients who have been given a conventional diagnosis of diabetes, but who do not fall into these patterns, are diagnosed in TCM according to their particular signs and symptoms and are treated accordingly.
Traditional Chinese Medicine Treatment of Diabetes
Traditional Chinese Medicine treatments for diabetes focus on nourishing Yin, clearing the Heat, and resolving the Patterns of Disharmony in each of the Triple Burners. Because it is common for more than one Burner to be affected at the same time, treatment may be complex. While resolving the underlying condition, secondary treatment strategies for accompanying patterns such as Qi deficiency and Blood Stasis are carried out as well.
Traditional Chinese Medicine does not offer a cure for diabetes, and it
is necessary for patients with diabetes to continue taking their
medication and follow the diet prescribed by their physician. However,
in many cases, TCM can help lower glucose levels in the body and thus
reduce the need for medication. This reduction must be monitored
carefully in a joint effort by conventional physicians and practitioners
of TCM. Of the three modalities, herbal medicine is the modality of
choice and offers the most potential benefit. Acupuncture and Qi Gong
also may offer some benefit to diabetes patients.
Forrás: https://www.healthcommunities.com/type-2-diabetes/alternative-medicine/traditional-chinese-medicine-and-diabetes.shtml
Syndrome Differentiation of Diabetes by the Traditional Chinese Medicine according to Evidence-Based Medicine and Expert Consensus Opinion
Jing Guo, Hongdong Chen, Jun Song, Jia Wang, Linhua Zhao, and Xiaolin Tong
Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
Received 10 April 2014; Accepted 2 July 2014; Published 14 July 2014
Academic Editor: Zhao-Xiang Bian
Copyright © 2014 Jing Guo et al.
This
is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly
cited.
Abstract
In Chinese medicine, diabetes belongs to the
category of "Xiaoke disease (disease with symptoms of frequent drinking
and urination)"; in the traditional sense, its pathogenesis is "Yin
deficiency and dryness-heat." However, over time, changes in the social
environment and lifestyle have also changed the use of traditional
Chinese medicine (TCM) in diabetes. In this study, we performed diabetes
syndrome differentiation using TCM according to evidence-based medicine
and expert consensus opinion.
1. Introduction
Diabetes
mellitus (DM) is often caused by the consumption of a high fat and
calorie diet. It has a high prevalence and can often lead to
complications that seriously affect the quality of life of sufferers. In
2013, according to the latest statistics of the International Diabetes
Federation (IDF), the global prevalence of diabetes among adults aged
20-79 was 8.3%. The total number of patients with diabetes worldwide was
estimated to be 382 million, which was predicted to rise to nearly 592
million by 2035. Therefore, research on the prevention and treatment of
diabetes is critical and represents a great challenge for the medical
profession.
In recent years, Chinese medicine has made great progress
toward the prevention and the treatment of diabetes, and its curative
effects have been widely recognized. The clinical effects of the
kai-yu-jiang-zhuo decoction [1] are the same as metformin; therefore,
the kai-yu-jiang-zhuo decoction could be recommended clinically. In one
study [2] assessing the ability of the Chinese herbal medicine Tianqi
to reduce progression from impaired glucose tolerance to diabetes, there
was a significant difference in the number of subjects who had normal
glucose tolerance at the end of the study between the Tianqi (63.13%)
and placebo groups, respectively (46.60%). Cox's proportional hazards
model analysis demonstrated that Tianqi reduced the risk of diabetes by
32.1% compared with placebo. Similarly, tang-min-ling pills [3] could
effectively reduce glycosylated hemoglobin levels and fasting blood
glucose (FBG) and improve islet β cell function. As the main ingredient
in Coptis, Berberine [4, 5] also has good hypoglycemic effects and
improves insulin resistance.
Treatment based on syndrome
differentiation is the basic principle of illness and treatment in
traditional Chinese medicine (TCM). To improve symptoms, individualized
treatment plans are more scientific and superior. A previous study [6]
suggested that the Chinese medicinal dialectical treatment of patients
with diabetes was highly effective. In addition, dialectical treatment
is relatively flexible, causes less adverse reactions, and is safe and
reliable. These characteristics can effectively improve the quality of
life of diabetic patients and are worth assessing clinically. However,
due to the inadequate international understanding of the culture of TCM,
syndrome differentiation is often avoided or disregarded, which reduces
the potential benefits of TCM.
In TCM [7], the diagnoses and
treatment of Xiaoke disease were traditionally based on "three excessive
and one loss" symptoms, excessive fluid drinking, excessive
food-consumption, excessive urination, and weight loss and its core
pathogenesis is "Yin deficiency and dryness-heat." However, 80% of type 2
diabetes patients do not have these three typical symptoms, so are very
different form Xiaoke. Approximately 85% of type 2 diabetes patients
are overweight or obese, suggesting that these obese diabetes patients
form the majority of the diabetic population. In addition, compared with
prior living environments, the modern diet has changed significantly,
which has resulted in a significant increase in the diabetic population.
Fewer individuals are thin, and an increasing number of people are
obese. Thus, physicians gradually realized that the typical SanXiao
symptoms (three types of diabetes that, resp., involving the upper-jiao,
middle-jiao, and the lower warmer) usually develop later during the
pathogenesis of diabetes, and so most people with diabetes do not
present with these symptoms. The traditional TCM theory of Yin
deficiency and dryness-heat is more difficult to obtain a satisfactory
curative effect during the treatment of diabetes; therefore, novel
theories have been proposed. Diabetes symptoms are complex, and
physicians do not have unified opinions regarding the pattern
identification based the syndrome differentiation of diabetes.
Guidelines of Prevention and Treatment of Diabetes by TCM, the first
guidelines for diabetes, which was issued in 2007 as a project funded by
the State Administration of Traditional Chinese Medicine, promoted the
diagnosis and treatment of diabetes and its complications. The
guidelines were proposed and revised repeatedly by members of the
standing committee of diabetes branch of the China Association of
Chinese medicine and were confirmed by the domestic renowned diabetes
experts Linlan, Zhang Farong, Li DeLin, and Cheng Yichun. With the
unification of TCM and Western medicine terminologies related to
diabetes and its complications, diabetes-related terminology gradually
became normalized and standardized. In this study, we perform diabetes
syndrome differentiation of TCM based on the guidelines (2007) and
evidence-based medicine.
2. Syndrome Differentiation
"TCM
syndrome differentiation and evaluation standard of DM", "Guidelines of
Prevention and Treatment of Diabetes by TCM, 2007," and "DM treatment
using integrated traditional Chinese and Western medicinal therapy" have
all been proposed for the TCM-mediated differentiation of the clinical
stages of DM [8, 9]. In one study [10], stagnancy, heat, deficiency, and
damage were thought to be the four stages of diabetes, and collateral
damage existed through the course of the disease even before the
diagnosis. The collateral damage in different degrees could be defined
as "collateral qi obstruction, collateral qi stagnation, collateral
blockage, and collateral damage." The study also suggested that the
TCM-mediated differentiation with the clinical stages of DM is
indispensable. Therefore, we performed syndrome differentiation based on
the clinical stages of diabetes.
2.1. Syndrome Differentiation of DM
2.1.1. QI Stagnation due to Liver Depression
According
to modern medical research [11], patients with diabetes often exhibit
aggravated emotional tension, which is consistent with the theory of TCM
that negative emotions could lead to diseases. Liver depression could
lead to qi stagnation and result in some emotional symptoms. This was
the first stage of diabetes, and the characteristic was stagnancy.
Therefore, soothing the liver and adjusting qi are the main therapeutic
principles. This type of diabetic patients shows some emotional symptoms
such as depressed mood, like frequent sighing, nervousness, distention,
and fullness in the chest and rib-side. The patients usually have a
pale tongue with thin white moss and a stringy pulse. Modified Xiao
Chaihu decoction, a classic Chinese ancient prescription, was commonly
used to treat this type of diabetic patients; some herbs like Bupleurum,
Scutellaria baicalensis, Pinellia ternata, and Ginseng were included in
this decoction [12-15].
2.1.2. Liver and Stomach Heat Stagnation
A
symptom analysis of 2518 obese patients with type 2 diabetes [16]
demonstrated that there were 1332 cases of liver and stomach heat
stagnation syndrome, accounting for 52.9% of all the cases, suggesting
that it was an important type in diabetes syndrome differentiation.
Liver and stomach heat stagnation belong to the stagnancy and heat
stages of diabetes. The patients of this type showed some emotional and
digestive symptoms such as irritability, distention and fullness in the
chest and rib-side, drinking too much fluids and the production of
increased urine, eating too much food, hunger, experiencing a bitter
taste, dry mouth, and constipation. And patients usually have a red
tongue, and a rapid and stringy pulse. Clearing stagnation-heat of liver
and stomach is an important therapeutic principle for this type. A
modified Da Chaihu decoction, one of classic Chinese ancient
prescriptions recorded in Treatise on Cold Pathogenic and Miscellaneous
Diseases, was used to treat such diabetic patients. Some Chinese herbs
like Bupleurum, Chinese rhubarb, Scutellaria baicalensis, Citrus
aurantium, Radix Paeoniae Rubra, and so forth were included in this
formula [17, 18].
2.1.3. Phlegm and Heat Stasis
A
study by Gan et al. [19] showed that phlegm and heat stasis syndrome
was a common type in the early and middle stages of diabetes and
accounted for more ratios particularly in patients who smoked and drank
alcohol. Zhou et al. [20] investigated 344 patients with type 2 diabetes
and found that 101 cases (29.4%) belonged to phlegm and heat stasis
syndrome. This syndrome often appears in the "heat" stage of diabetes,
and the patients are relatively obese because in the theory of Chinese
medicine, "obese people tend to have copious phlegm." Patients with this
type may have some symptoms such as abdominal obesity, a sense of chest
suppression, abdominal distention, and dry mouth. They might also
prefer cold drinks, drink much more fluids, and be irritable and have a
bitter taste in their mouth as well as constipation. Patients also have a
red and fat tongue with yellowish greasy moss, yellow urine, and a
stringy and smooth pulse. Reducing heat and removing phlegm is the
therapeutic principle in this syndrome, and a modified Xiao Xianxiong
decoction, a classic Chinese ancient prescription, is used to treat such
diabetic patients. Some Chinese herbs like rhizoma coptidis, Pinellia
ternata, snakegourd seed, and so forth are included in this formula
[21-24].
2.1.4. Excess Heat in the Stomach and Intestine
Both
Tong and Wang's studies [16, 25] demonstrated that "excess heat in the
Stomach and intestine" was one of main syndromes of diabetes. This
syndrome generally occurs in the diabetic middle stage or in the "heat"
stage. In the middle stage of diabetes, patients eat large amounts of
food, which stagnate and form heat in the stomach and intestine. As
such, its principal symptoms are abdominal fullness and distention,
constipation, a bitter taste and dry mouth, halitosis, thirst with a
desire for cool water, drinking and eating too much, and hunger.
Patients usually have a red tongue with yellow moss and a rapid strong
pulse. To remove the heat, a modified Dahuang Huanglian Xiexin Decoction
is regarded as the main prescription which includes Chinese rhubarb and
rhizoma coptidis and so forth [25-27].
2.1.5. Intestinal Damp and Heat Syndromes
According
to the findings of Zhao et al. [28] in a study using classical
prescriptions to treat different diseases, the Gegen Qinlian decoction
could be used to treat type 2 diabetes with concurrent intestinal damp
and heat syndromes, with a good clinical efficacy. An additional study
[29] showed that Gegen Qinlian decoction could significantly improve the
intestinal damp and heat syndrome scores of patients with type 2
diabetes and could effectively control blood glucose with a success rate
of 88.6%. Another study [30] revealed that the morbidity of type 2
diabetes with damp and heat syndrome was 30.7% and that the location of
disease was in Fu-organs. In addition, this syndrome has unique
features. The intestinal damp and heat syndromes always appear in the
diabetic middle stage or during the heat stage. Its principal symptoms
are thirst with no desire to drink, hunger with no desire to eat, a
bitter taste, a sticky and greasy sensation in the mouth, and abdominal
distention. Patients also show a red tongue with yellow and greasy moss
and a slippery pulse. When damp and heat affect the large intestine,
smelly greasy stools might also form. To reinforce the spleen and
stomach and remove the heat and dampness, a modified Gegen Qinlian
decoction, one of classic Chinese ancient prescriptions, is used to
treat such diabetic patients. Some Chinese herbs like kudzuvine root,
Scutellaria baicalensis, rhizoma coptidis, and so forth are included in
this formula [29, 31].
2.1.6. Deficiency of Body Liquid due to Excessive Heat Syndrome
A
study by Gan and Chen [32] suggested that excessive heat injuring
liquid syndrome was a principle syndrome of diabetes. Consistent with
this, Zhang et al. [33] reached the same conclusion after investigating
1490 cases of type 2 diabetes using clinical syndrome differentiation.
The deficiency of body liquids due to excessive heat syndrome is more
commonly found in the diabetic middle-late stage or the heat and
deficiency stages. Impacted by the fire and heat pathogens from the
early and middle stages of diabetes, qi is consumed and liquids are
injured gradually. As such, its principle symptoms are dry throat and
mouth, thirst with a desire for cool water, overeating and hunger,
frequent micturition volume, irritability, bitter taste, red urine, and
constipation. Patients also commonly have a red tongue with yellow fur
and a rapid pulse. To sooth the heat and promote fluid production, a
modified Xiaoke Wan or Baihu Tang, belonging to classic Chinese ancient
prescriptions recorded in Treatise on Cold Pathogenic and Miscellaneous
Diseases, is used to treat such diabetic patients. Some Chinese herbs
like Gypsum, Rhizoma Anemarrhenae, Liquiritia Glycyrrhiza, and so forth
are included in this formula [34-36].
2.1.7. Dual Deficiency of Qi and Yin
Based
on her 40 years of clinical experience, Lin and Ni [37] proposed a
theory called III-type differentiation, which proposes that the dual
deficiency of qi and yin syndrome was one of basic syndromes of
diabetes. Many other professors, including Xu et al. [38], Mao et al.
[39], and Li et al. [40] also concluded that the dual deficiency of qi
and yin syndrome was a common syndrome of diabetes. The dual deficiency
of qi and yin syndrome occurs in the late diabetic or the deficiency
stage. The fire and heat pathogens further dissipate the primordial qi
of zang-fu organs, and then the generalized qi is consumed. In addition,
fire and heat pathogens scorch liquids and damage yin. Therefore, the
main symptoms are dry throat and mouth, thirst with a large intake of
fluid, fatigued spirit and lack of strength, shortness of breath and
reluctance to speak, emaciation of the body, limp aching lumbus and
knees, spontaneous and night sweats, feeling palm and arch fever, upset,
palpitations, insomnia, a red tongue with scant liquids and thin white
dry tongue fur, and a fine rapid pulse. Boosting qi and nourish yin is
one of the important therapeutic principle in this type, and a modified
Shengmai Yin decoction, a classic Chinese ancient prescription, is used
to treat such diabetic patients. Some Chinese herbs like, Ophiopogon
japonicas, Schisandra chinensis, ginseng, and so forth are included in
this formula [41, 42].
2.2. The Stage of Diabetes Complications
During
the diabetic complications stages, treatment requires the combination
of disease and syndrome differentiation due to its complexity. In
general, the deficiency is increasingly aggravating, and so
qi-blood-liquid deficiency and the function of internal organs decline.
It belongs to late stage of diabetes; liver and kidney insufficiency and
deficiency in both yin and yang are its endpoints. The main syndromes
in this stage include insufficiency of the liver and kidney and
detrimental yin and yang [10, 15].
2.2.1. Insufficiency of the Liver and Kidney Syndrome
The
main symptoms are urinary frequency, turbid unctuous, and limp aching
and lumbus and knees, which are accompanied by additional symptoms
including blurred vision, dizziness, tinnitus, red tongue with some fur,
and a fine rapid pulse. Modified Qiju Dihuang Wan, which includes the
fruit of Chinese wolfberry, chrysanthemum, Chinese yam, and Cornus
officinalis, is used to treat these diabetic patients by enriching the
liver and kidney with essence and increasing blood supply [43-45].
2.2.2. Dual Deficiency of Yin and Yang Syndrome
Patients
with this syndrome exhibit symptoms including urinary and nocturia
frequency, which can be accompanied by feeling palms and arches fever,
being upset, dry throat or mouth, limp aching lumbus and knees, fear of
the cold, icy cold limbs, and a forceless fine sunken pulse. Enriching
yin and supplying yang is an important therapeutic principle; modified
Jingui Shenqi decoction, which includes the Chinese herbs adhesive
rehmannia dried root, Chinese yam, Fructus Corni, cassia twig, and
monkshood, is commonly used to treat these diabetic patients [46-49].
Studies [50]
have shown that the characteristic pathophysiological mechanism of
chronic diabetic complications is root deficiency and tip excess.
Deficiency and static blood occur throughout several complications. The
dual deficiency of qi and yin, phlegm turbidity, and static blood
obstructing the network vessels form the common pathological basis of
diabetic chronic complications. Studies [51] using the collateral
disease theory have determined that static blood obstructing the
collateries is the pathological basis for diabetic microangiopathy;
therefore, treatment should be aimed to promote blood circulation and
remove obstruction in vessels throughout the whole process. A large
number of clinical observations and scientific studies have confirmed
that capillaries can be protected and diabetic microvascular
complications prevented and treated using drugs that accelerate blood
flow during early-mid diabetes.
Generally, treatments for diabetic
complications should target phlegm, static blood, and additional
pathological factors, except for insufficiency of the liver and kidney
and dual deficiency of qi and yin, for more comprehensive and thorough
evidence-based medicine.
3. Diabetic Patterns and Correlation Indices
3.1. Pattern Types according to the Function of Insulin
Studies
[52-54] have demonstrated that diabetic syndrome differentiation is
closely correlated with insulin function, which provides an objective
basis for syndrome differentiation using TCM. During the pathogenesis of
diabetes, islet β-cell function changes from the compensatory period to
the mildly decompensated period, severe decompensated period, and
decompensated with structure damage, which correspond to the different
stages of diabetes. Concurrently, during early diabetes, qI stagnation
occurs due to liver depression and other syndromes. In the middle stage,
intestinal dampness-heat and other syndromes occur. Finally in the
middle and late stages the dual deficiency of qi and yin and the dual
deficiency of yin and yang and other syndromes are present; islet
β-cells are increasingly damaged. As a result, insulin secretion
gradually declines as symptoms evolve. Varying degrees of insulin
resistance occur with different symptoms and commonly first increase and
then decline as symptoms evolve. This might be because, in the late
stages of diabetes whereas the number of islet β-cells gradually decline
and the number of insulin receptors on target organs relative
increases.
3.2. Diabetic Patterns of Inflammatory Markers
Studies
[55] have shown that CRP, IL-6, and other cytokines mediate insulin
metabolic pathways, weaken insulin receptor signal transduction, induce
disorders of glucose metabolism, and stimulate type 2 diabetes.
Additional studies [56, 57] assessing the long-term risk factors for
type 2 diabetes revealed that the levels of CRP, IL-6, IL-8, and TNF-α
were higher in diabetic populations than the normal population. These
indexes levels increase gradually as syndromes evolve; in particular,
the levels of those indexes of the dual deficiency of yin and yang
symptom are higher than those of any other symptoms. Consequently, IL-6,
IL-8, and TNF-α can be used as objective indicators during the
TCM-mediated syndrome differentiation of DM [58].
3.3. Diabetic Patterns of Biochemical Indicators
Fasting
plasma glucose, postprandial blood sugar, and glycosylated hemoglobin
were significantly higher in diabetic populations than normal
individuals, but there were no significant differences among different
syndromes [59, 60].
When combined with high uric acid (UA) hematic
disease, the UA levels of type 2 diabetic patients with dual deficiency
yin and yang syndrome were higher than those of other syndromes, which
suggested that the dual deficiency of yin and yang might be a factor
leading to elevated blood UA levels [61].
Compared with normal
individuals, obvious lipid metabolic disorders occur in patients with
type 2 diabetes, including increased triglycerides (TG), total
cholesterol (TC), low density lipoprotein (LDL), and decreased high
density lipoprotein (HDL). Phlegm and heat stasis changed the most with
an increased severity of symptoms. As the course of the disease
lengthened and TC and LDL-C increased, the lipid metabolism disorders of
phlegm and heat stasis symptom became most serious [62, 63].
3.4. Diabetic Pattern Types of Hemorheology
Studies
[58, 64] have shown that significant changes occur between the
hemorheological performances of normal and type 2 diabetes populations.
The levels of blood specific viscosity, fibrinogen, hematocrit,
erythrocyte sedimentation rate (ESR), and other indicators of dual
deficiency of qi and yin symptom were significantly higher than those of
normal populations. This suggested that the occurrence of diabetes was
associated with increased blood viscosity, and that the dual deficiency
of qi and yin was the pathological basis for the change of blood
rheology.
3.5. Diabetic Patterns of Related Genes
Studies
[65] on the relationship between syndrome differentiation of diabetes
by TCM and the level of calcitonin gene related peptide (CGRP) showed
that the levels of CGRP of every syndrome of diabetes are significantly
lower than normal people, and the dual deficiency of yin and yang has
the lowest level of CGRP. Another study [66] to explore the relation
between Chinese medicine syndrome and the gene polymorphism of
peroxisome proliferator-activated receptor delta (PPARD)-87C>T, the
genotype frequencies of T/C and C/C at PPARD-87C>T are higher in the
dual deficiency of yin and yang syndrome in newly diagnosed type 2
diabetes patient. Newly diagnosed type 2 diabetes patients with these
alleles have higher levels of plasma glucose and lipids. This suggests
that the PPARD-87C>T polymorphism might be a factor that affects the
progression of type 2 diabetes.
An additional study [67] on the
substance of dual deficiency of qi and yin from the molecular level used
a diabetes gene array (Superarray Bioscience) containing 96 key
diabetes-related genes to identify that 43 differentially expressed
genes between normal and diabetic dual deficiency of qi and yin
patients. Compared with the gene levels of normal people, 35 were
upregulated and eight were downregulated. And further RT-polymerase
chain reaction (RT-PCR) and Western-blotting measurement confirmed Fork
head box C2 (FOXC2) and IRS-2 mRNA are specific genes of diabetic
patients with dual deficiency of qi and yin syndrome.
4. Summary
The
TCM emphasizes individualized treatment and pay attention to yin-yang
balance and a holistic approach. Deep understanding of diabetes'
clinical manifestation and symptom differentiation from different
aspects are very important to improve the clinical effects, such as
uncomfortable symptoms, blood glucose, blood lipids, and diabetes
complications. Though symptom differentiation of TCM is relatively
difficult to understand, with the development of modern medicine and
researcher's efforts on it, people will get familiar with it and make
TCM play an important role in diabetic fields.
Conflict of Interests
All authors declare that there is no conflict of interests regarding the publication of this paper.
Acknowledgment
This work was financially supported in part by the 973 Project (no. 2010CB530601).
References
F. M. Lian, Z. X. Wei, X. F. Lv et al., "Clinical study on reducing
sugar effect of Kaiyu Qinre-Jiangzhuo prescription on T2DM," World
Journal of Integrated Traditional and Western Medicine, vol. 3, pp.
32-35, 2008. View at Google Scholar
F. Lian, G. Li, X. Chen et
al., "Chinese herbal medicine Tianqi reduces progression from impaired
glucose tolerance to diabetes: a double-blind, randomized,
placebo-controlled, multicenter trial," The Journal of Clinical
Endocrinology and Metabolism, vol. 99, pp. 648-655, 2014. View at
Publisher · View at Google Scholar
X. L. Tong, S. T. Wu, F. M.
Lian et al., "The safety and effectiveness of TM81, a Chinese herbal
medicine, in the treatment of type 2 diabetes: a randomized double-blind
placebo-controlled trial," Diabetes, Obesity and Metabolism, vol. 15,
no. 5, pp. 448-454, 2013. View at Publisher · View at Google Scholar ·
View at Scopus
W. H. Liu, Z. Q. Hei, H. Nie et al., "Berberine
ameliorates renal injury in streptopzotocin-induced diabetic rats by
suppression of both oxidative stress and aldose reductase," Chinese
Medical Journal, vol. 121, no. 8, pp. 706-712, 2008. View at Google
Scholar · View at Scopus
Y. S. Lee, W. S. Kim, K. H. Kim et al.,
"Berberine, a natural plant product, activates AMP-activated protein
kinase with beneficial metabolic effects in diabetic and
insulin-resistant states," Diabetes, vol. 55, no. 8, pp. 2256-2264,
2006. View at Publisher · View at Google Scholar · View at Scopus
L. Y. Ma, "The clinical observation on the syndrome differentiation by
TCM in the treatment of diabetes," China Healthy Industry, vol. 10, p.
135, 2013. View at Google Scholar
X.-L. Tong, L. Dong, L. Chen,
and Z. Zhen, "Treatment of diabetes using traditional Chinese medicine:
past, present and future," The American Journal of Chinese Medicine,
vol. 40, no. 5, pp. 877-886, 2012. View at Publisher · View at Google
Scholar · View at Scopus
J. X. Zhao, S. D. Wang, J. Li et al.,
"Studies on TCM syndrome differentiation and evaluation standards of
diabetes," World Journal of Integrated Traditional and Western Medicine,
vol. 8, pp. 504-506, 2013. View at Google Scholar
J. P. Wei, R.
Wu, and L. Lan, "Review on the study of diabetes syndromes," The Journal
of Medical Research, vol. 40, pp. 7-10, 2011. View at Google Scholar
X. L. Tong, W. K. Liu, J. Wang, Q. Ni, and J. P. Wei, "Key points of
syndrome differentiation and practical application of stagnation, heat,
deficiency and damage, four stages of diabetes," Jilin Journal of
Traditional Chinese Medicine, vol. 32, pp. 442-444, 2012. View at Google
Scholar
H. Q. Cheng, J. Cheng, and Z. X. Wei, "The Theory study
on the relationship between Qi stagnation due to liver repression and
xiaoke disease," Journal of Jiangsu Traditional Chinese Medicine, vol.
18, pp. 35-36, 1997. View at Google Scholar
J. P. Chen, A. C.
Wang, L. Yin, and Z. F. Zhao, "Dispensable symptoms to diagnose Qi
stagnation due to liver depression syndrome and its relationship with
depression," Journal of Liaoning Traditional Chinese Medicine, vol. 32,
pp. 19-22, 2005. View at Google Scholar
G. Z. Wang, L. M. Duan,
S. B. Sun, Y. J. Shen, Y. J. Chen, and H. B. Zhao, "The clinical
Observation of the treatment of type 2 diabetes by coursing liver and
regulating Qi," Journal Traditional Chinese Medicine, vol. 22, pp.
336-337, 2000. View at Google Scholar
T. Y. Liu, "The treatment
of coursing liver and regulating Qi for 63 cases of T2DM," Zhong Yi Han
Shou Tong Xun, vol. 19, p. 51, 2000. View at Google Scholar
X. L.
Tong, Q. Ni, and J. P. Wei, "Standards of diagnosis and treatment of
diabetes by TCM," World Jounal of Integrated Traditional and Western
Medicine, vol. 6, pp. 540-547, 2011. View at Google Scholar
X. L.
Tong, G. Z. Bi, Zh. Zhen et al., "TCM syndrome differentiation of 2508
T2DM cases," World Journal of Intergrated Traditional and Western
Medicine, vol. 3, pp. 26-28, 2008. View at Google Scholar
W. L.
Li, K. Song, and X. J. Zhang, "The application of Da Chaihu decoction in
T2DM," Journal of Henan Traditional Chinese Medicine, vol. 33, pp.
336-337, 2013. View at Google Scholar
X. Deng and W. J. Wang, "Da
Chaihu decoction in the treatment of 39 patients with obesity
diabetes," Journal of Shananxi Traditional Chinese Medicine, vol. 32,
pp. 171-172, 2011. View at Google Scholar
J. R. Gan, X. L. Liu,
L. Li, and Y. Zhang, "The report of 1492 cases of type 2 diabetes
syndrome epidemilogical survey in Kunming," Yunnan Journal of
Traditional Chinese Medicine and Materia Medica, vol. 34, pp. 26-27,
2013. View at Google Scholar
L. P. Zhou, J. P. Wei, F. Liu et
al., "Sthdy on the TCM pathology and syndrome characteristic of first
attack diabetes," Journal of Sichuan of Traditional Chinese Medicine,
vol. 26, pp. 34-36, 2008. View at Google Scholar
G. F. Liu, W. K.
Liu, H. Y. Ji, J. Song, and X. L. Tong, "Thought of diagnosis and
treatment of T2DM by TCM," Journal of Traditional Chinese Medicine, vol.
52, pp. 1243-1245, 2011. View at Google Scholar
Y. F. Gu and Q.
Fu, "Study on Xiao Xianxiong decoction in the treatment of diabetes
from," Phlegm, Heat and Qi Stagnation, Global Traditional Chinese
Medicine, vol. 3, pp. 136-137, 2010. View at Google Scholar
M. S.
Jin, X. Y. Chen, and H. Y. Ji, "Analysis on dialectical points about
Xiao Xianxiong Decoction in the treatment of T2DM according to Professor
Tong experience," Journal of Yunnan University of Traditional Chinese
Medicine, vol. 34, pp. 40-43, 2011. View at Google Scholar
H.
Wang and Q. Zhou, "Professor Tong's experience on Xiao Xianxiong
decoction in the treatment of T2DM," Chinese Journal for Clinicians,
vol. 41, pp. 68-70, 2013. View at Google Scholar
H. M. Wang, M.
Chen, H. Wang, and J. Xia, "TongFu Runzao decoction in the treatment of
oral hypoglycemic drugs in uncontrolled stomach-intestine excessive heat
type 2 diabetes 60 cases," Chinese Journal of Experiment Traditonal
Chinese Medicine Formula, vol. 19, pp. 273-276, 2013. View at Google
Scholar
X. L. Tong, "Application of a series of classical
prescriptions with rhizoma coptidis being monarch drug in the syndrome
differentiation of diabetes," Journal of Traditional Chinese Medicine,
vol. 54, pp. 209-221, 2013. View at Google Scholar
X. Sun,
"Application of Xie Xin decoction and likewise decoctions in the
treatment of diabetes," Journal of Traditional Chinese Medicine, vol.
51, pp. 114-116, 2010. View at Google Scholar
L. H. Zhao, H. Y.
Ji, B. W. Ji, J. Song, and X. L. Tong, "Exploration of Gegen Qinlian
decoction's effect on diabetes mellitus in theory," Chinese Journal of
Traditional Chinese Medicine and Pharmacy, vol. 27, pp. 280-283, 2012.
View at Google Scholar
N. P. Huang, "Clinicial effects of Gegen
Qinlian decoction combined with metfom infor treatment on patients with
type 2 diabetes of dampness heat syndrome, seek medical and aslc," The
Medicine, vol. 10, pp. 229-300, 2012. View at Google Scholar
S.
M. Li, Y. C. Li, W. G. Li, and Z. G. Wang, "Investigtion on
characteristics of diabetic Dampness Heat Syndrome and evolving
regulation," Journal of Hunan University of Traditional Chinese
Medicine, vol. 27, pp. 65-68, 2007. View at Google Scholar
Y. H.
Wang, "The TCM treatment of dampness heat syndrome of diabetes," Journal
of Fujian College of TCM, vol. 13, pp. 32-33, 2003. View at Google
Scholar
J. R. Gan and Y. Q. Chen, "Study on syndrome
differentiation of TCM," Journal of Yunnan University of Traditional
Chinese Medicine, vol. 35, pp. 41-45, 2012. View at Google Scholar
Q. M. Zhang, Z. Q. Chen, Y. Z. Liu et al., "A survey on the pattern
differentiation of type 2 diabetic mellitus and its complications,"
Journal of TCM University of Hunan, vol. 24, pp. 33-36, 2004. View at
Google Scholar
X. Y. Zhou, "A part of Li Zhuo's experience about
Baihu Renshen decoction in the treatment of Xiaoke disease," Journal of
Practical Traditional Chinese Internal Medicine, vol. 17, p. 161, 2003.
View at Google Scholar
L. Xin, F. S. Fu, L. K. Liao, and L. Q.
Deng, "Clinical research of Xiaoke Fang in the tretment of oral
glucose-lowering drugs controlled type 2 diabetes," China Journal of
Chinese Medicine, vol. 28, pp. 1215-1217, 2013. View at Google Scholar
H. Liu, K. K. Wei, J. P. Li, and S. W. Ma, "Xiaoke Fang in the
treatment of diabetes 200 cases," Journal of TCM of Shanxi, vol. 26, pp.
1322-1323, 2005. View at Google Scholar
L. Lin and Q. Ni, Theory of Practice of III-Type Differentiation of T2DM, Scientific Chinese, 2011.
C. X. Xu, W. C. Ye, and Y. G. Hu, "Syndome differentiation and
correlative analysis of 120 cases of type 2 diabetes mellius," Shanghai
Journal of Traditional Chinese Medicine, vol. 41, pp. 34-36, 2007. View
at Google Scholar
Z. J. Mao, Y. Dong, J. Luan et al.,
"Investigation of TCM symptoms and syndrome in 180 patients with T2DM,"
Chinese Journal of Traditional Chinese Medicine and Pharmacy, vol. 24,
pp. 1064-1067, 2009. View at Google Scholar
Z. Li, S. D. Wang, T.
Tan et al., "Exploration on distribution regulation of TCM syndromes in
2735 cases of type 2 diabetes and pathogenesis of vigorous fire
consuming Qi," World Chinese Medicine, vol. 8, pp. 488-490, 2013. View
at Google Scholar
X. C. Tang, "Jiawei Shengmai decoction in the
treatment of 60 patients with T2DM," Henan Traditional Chinese Midecine,
vol. 27, pp. 52-53, 2007. View at Google Scholar
P. Wang and Y.
Wang, "Application of Shengmai decoction in the treatment of diabetes,"
Journal of Tianjin University of Traditional Chinese Medicine, vol. 30,
pp. 127-128, 2011. View at Google Scholar
B. Dai and Z. Y. Ou,
"Study on Qiju Dihuang decoction in the treatment of insufficiency of
the liver and kidney syndrome of the old with diabetes," Clinical
Journal of Traditional Chinese Medicine, vol. 17, pp. 544-545, 2005.
View at Google Scholar
W. T. Zhang, "Qiju Dihuang decoction in
the treatment of diabetic retinopathy in 36 cases," Chinese Community
Doctors, vol. 15, p. 68, 2013. View at Google Scholar
B. L. He,
Y. P. Tang, G. B. Zhuang, and J. N. Chen, "Observation of the nearly and
long-term clinical effects of Qiju Dihuang decoction in the treatment
of diabetic retinopathy," China Medical Herald, vol. 6, pp. 83-118,
2009. View at Google Scholar
Y. E. Lu, "Jingui Shenqi decoction
combined with western drugs in the treatment of DN in 60 cases," Journal
of Shaanxi College of Traditonal Chinese Medicine, vol. 32, pp. 29-31,
2009. View at Google Scholar
X. M. Yang, "Jingui Shenqi decoction
in the treatment of T2DM in 120 cases," Chinese Journal of Experimental
Traditional Medicine Formula, vol. 17, pp. 261-263, 2011. View at
Google Scholar
H. Z. Wu, "Clinical observation of Jingui Shenqi
decoction in the treatment of T2DM," Pharmacology and Clinics of Chinese
Materia, vol. 29, pp. 191-193, 2013. View at Google Scholar
D.
H. Liu, "Observation of Jingui Shenqi Decoction in the treatment of 62
patients with Dual Deficiency of Yin and Yang Syndrome of T2DM," Journal
of New Chinese Medicine, vol. 36, pp. 31-32, 2004. View at Google
Scholar
G. M. Gong, L. G. Yuan, J. Li et al., "Epidemiology of
chronic diabetic complications and research of syptoms of traditional
chinese medicine of newly-diagnosed type 2 diabetes," Journal of
Liaoning Traditional Chinese Medicine, vol. 39, pp. 26-30, 2012. View at
Google Scholar
X. L. Tong, Y. Zhao, G. Z. Bi et al., "Research
on application of preventive "Treatment of Disease" and "Collateral
Disease" theories in diabetic microvascular complications," Journal of
Traditional Chinese Medicine, vol. 48, pp. 485-486, 2007. View at Google
Scholar
Y. Zhao, X. L. Tong, and L. Chen, "Relationship between
the Function evolving of β-cell and TCM syndrome differentiation of
diabetes," Journal of Shandong Traditional Chinese Medicine, vol. 25,
pp. 3-5, 2006. View at Google Scholar
J. Q. Zhang, K. Ma, and S.
G. Lv, "Relationship between TCM syndrom differentiation and insulin
resistance of type 2 diabetes," China of Shandong Traditional Chinese
Medicine, vol. 25, p. 3, 2006. View at Google Scholar
Z. Y. Gao,
S. P. Qian, X. M. Yi, X. P. Luo, and X. D. Huang, "Relationship between
TCM syndrome differentiation and the function of β-cell and Insulin
sensitivity," Chinese Journal of Integrative Medicine on Cerebravasoular
Disease, vol. 1, p. 58, 2003. View at Google Scholar
S.
Wassmann, M. Stumpf, K. Strehlow et al., "Interleukin-6 induces
oxidative stress and endothehal dysfunction by overexpression of the
angiotensin ii type 1 receptor," Circulation Research, vol. 94, no. 4,
pp. 534-541, 2004. View at Publisher · View at Google Scholar · View at
Scopus
F. B. Hu, J. B. Meigs, T. Y. Li, N. Rifai, and J. E.
Manson, "Inflammatory markers and risk of developing type 2 diabetes in
women," Diabetes, vol. 53, no. 3, pp. 693-700, 2004. View at Publisher ·
View at Google Scholar · View at Scopus
R. Bouhaha, T. Baroudi,
H. Ennafaa et al., "Study of TNFα-308G/A and IL6 -174G/C polymorphisms
in type 2 diabetes and obesity risk in the Tunisian population,"
Clinical Biochemistry, vol. 43, no. 6, pp. 549-552, 2010. View at
Publisher · View at Google Scholar · View at Scopus
J. Y. Xu, Z.
Q. Chen, N. Y. Hu, and C. H. Chen, "Investigation of the relationship
between the syndrome patterns in TCM differentiation diagnostics and the
levels of plasmatic IL-6, IL-8 and TNF-a in diabetes mellitus
patients," China Journal of Modern Medicine, vol. 13, pp. 66-67, 2003.
View at Google Scholar
L. Y. Zhao, L. F. Bi, H. H. Zhao et al.,
"Correlation between syndrome types and clinical indexes in 147 patients
with type 2 diabetes," Journal of Beijing University of Traditional
Chinese Medicine, vol. 36, pp. 480-483, 2013. View at Google Scholar
H. Li and J. Peng, "Study on relationship between TCM syndrome
differentiation of T2DM and dyslipidemia, blood glucose and body mass
index," Chinese Journal of Basic Medicine in Traditional Chinese
Medicine, vol. 11, pp. 925-926, 2005. View at Google Scholar
Y.
Gong and H. Wang, "Distribution of blood uric acid level in dual
deficiency Qi and Yin of T2DM," Xinjiang Journal of Traditional Chinese
Medicine, vol. 25, pp. 15-16, 2007. View at Google Scholar
X.
Wang, L. Zhao, and X. R. Xu, "Study on correlation among stagnated heat
syndrome of type 2 dibetes liquid metabolic and disease course," Journal
of Liaoning University of TCM, vol. 15, pp. 5-6, 2013. View at Google
Scholar
L. B. Zhou, M. Li, L. Dong, and X. L. Tong, "The clinical
study of the relationship between T2DM syndrome differentiation by TCM
of young obese patients and lipid metabolism," Jiangsu Journal of
Traditional Chinese Medicine, vol. 40, pp. 43-45, 2008. View at Google
Scholar
L. X. Zhong and Y. Q. Tu, "Change of blood rheology
markers in II type diabetes patients," Zhejiang Medical Education, vol.
4, pp. 41-43, 2005. View at Google Scholar
Z. Y. Li and L. Q.
Zhang, "Study on TCM syndrome differentiation of T2DM, plasma endothelin
and calcitonin gene related peptode," Journal of Fujian College of
Traditional Chinese Medicine, vol. 11, pp. 1-4, 2001. View at Google
Scholar
Ch. Ren, F. T. Geng, and J. W. Qian, "Relation between
Chinese medicine Syndrome and PPARD-87C>T gene polymorphism in newly
diagnosed type 2 diabetes patients," Journal of Traditional Chinese
Medicine, vol. 53, pp. 1397-1400, 2012. View at Google Scholar
K.
F. Chai, X. L. Huang, and J. W. Qian, "Gene expression study of type 2
diabetes mellitus belong to defficiency of both Qi and Yin," Chinese
Archives of Traditional Chinese Medicine, vol. 27, pp. 1351-1354, 2009.
View at Google Scholar