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The Therapeutic Effect and Advantages of Chinese Medicine for the Treatment of Diabetes Mellitus

Prof.Hu ZhenWenzhou Medical Collegehuzhen998@yahoo.com.cn

1993

1996-1998

Confucius Institute at Burapha UniversityThailand2005--2012

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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 ResearchEpidemiology The 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 ) Americansdo 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

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 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

Pancreatic -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

Simplified scheme for the pathophysiology of type 2 diabetes mellitus

(2)Criteria for the diagnoss of diabeters mellitus and impaired glucose homeostasisWHO IDF

Classic symptoms of diabetes mellitus polyuriapolydipsiapolyphagiaweight lossFasting plasma glucose FPG 7.0mmolL126mgdL2hr postprandial plasma glucose 11.1mmolL200mgdLDM:hemoglobin A1c diagnostic tests HbA1c65%(ADA: 2010)

ADA 2003 11 IFG 6.1mmolL 110mgdL 5.5mmolL100mgdL2010ADA :hemoglobin A1c diagnostic tests HbA1c65%,HbA1c57%

(2)Criteria for the diagnoss of diabeters mellitus and impaired glucose homeostasisWHO IDF

Impaired fasting glucose IFG: fasting plasma glucose FPG 6.1mmol L110mgdL7.0mmolL126mgdLImpaired glucose tolerance IGT : 2hr postprandial plasma glucose 7.8mmolL140mgdL 11.1mmolL200mgdL

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 mellitusNo 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 etiologyEarly diagnosis Combined Therapy ( the -cell proliferation )Approaches:Life style interventionThree Drugs Combined Therapy Troglitazone TZD() Metformin() Exenatide()

Other treatment approaches Gastric bypass(GBP) Stem cells

The Advantages of Chinese Medicine for the Treatment of Diabetes Mellitus

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

Treatment based on differentiation of symptom-complex 1 Selecting acupoint along channel () 2 Selecting acupoint based on differentiation of symptom-complex() 3 Biological holographic theory

Effects of multi-targets

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

Dazhui() moxibustion Shenque() moxibustionReduce the level of fasting blood glucose Increase the capacity response of glucose load of Pancreatic lslet Beta CellsIncrease the excretion of insulin

The comprehensive therapy

Alimentary therapeutics Cinesiatrics Message Acupuncture and moxibustion Pharmacotherapy

(2) Individualized Treatment

To identify the nature and location of a disease To infer the cause and judge the pathogenesis of a disease To differing conditions in terms of locality, time, and persons involved

Clinical Stage and TypeTriple diabetes diabetes involving the upper warmer----lungsdiabetes involving middle warmer ----spleendiabetes involving the lower warmer----kidney

Three types the Chinese herbal medicine new medicine clinic research guideline

extreme heat due to deficiency of yinin an early stage(--

deficiency of both qi and yinin a middle stage--yin-yang deficiencyin a Late stage--accompanying symptoms stagnant blood and blood stasis() dampness and heat in spleen()

Five stages and five types()Chinese Diabetes Association diagnosis criteria of diabetes mellitus in 19911991

Preclinical()Prodrome period()Early complicationsMiddle complicationsLate complications

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

The Prescriptions of TCMWhite Tiger Decoction(Shanghan Lun (treatise on ExogenousShigao(Gypsum Fibrosum) 50gZhimu ( Rhizoma Anemarrhenae18gGancao(Radix Glycyrrhizae)6gJingmi( Semen Oryzae Sativae)9gActions: Clearing away heat Promoting the production of body fluidClinical Application: High fever,polydipsia, profuse perspiration ,large pulse

The Prescriptions of TCMYunu Jian (Jingyue Quanshu (jingyues Complete Works)Shigao (Gypsum Fibrosum) 50gDihuang (Radix Rehmanniae )6gMaimendong (Radix Ophiopogonis)6gZhimu( Rhizoma Anemarrhenae)5gNiuxi(Radix Achyranthis Bidentatae)5gActions: Clearing away stomach-heat nourishing yin of stomachClinical Application: syndrome of stomach-heat and yin deficiency

The Prescriptions of TCMShenqi Wan()Jingui Yaolue (synopsis of prescriptions of the Golden Cabinet)Shengdihuang(Radix Rehmanniae)240gShanyao (Rhizoma Dioscoreae)120gShanzhuyu(Fructus Corni)120gZexie(Rhizoma Alismatis)90gFuling(poria)90gMudanpi(Cortex Moutan Radicis)90gGuizhi ( Ramulus Cinnamomi) 30gFuzi(Radix Aconiti)30gActions: Warming and invigorating kidney- yangpolyuriapolydipsia

The disease patteren defined in the Internal Canon of Medicine

Xiaoke was first mentioned in the Internal Canon of Medicine

The disease patteren defined in the Internal Canon of Medicine

Etiologic factorsdeficiency of the spleen and stomach() heat formation due to food stagnation () functional injury of the spleen by medicine ()

The disease patteren defined in the Internal Canon of Medicine

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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

eupatorium

The treatment based on Spleen

Nourishing Spleen Yin yuzhu(radix polygonati officinalis )shihu(dendrobe) Reinforcing Spleen Qi huangqi(Astragalus mongholicus )shanyao(Chinese yam)Eliminating Spleen Dampness baizhu(bighead atractylodes rhizome ) fuling(Poria cocos )

The treatment based on SpleenClearing Spleen Heat huanglian(the rhizome of Chinese goldthread); zhimu(rhizoma anemarrhenae )Promoting Spleen Yang gegenthe root of kudzu vine shengma(rattletop )Warming Spleen Yang guizhi(cassia twig ) fuzimonkshood

Experimental Research on SQ-Complex Prescription 1. Materials and methods

1.1 laboratory Animal Male clean degree SD rats 45with a body mass from 200g to 240g1.2 Test Drug SQ-Complex Prescription() the root of kudzu vine Astragalus mongholicus

2.Experimental Method 2.1 Establishment of rat model and group division 2.2 Dose and Administration2.3 Sample Collection 2.5 Data Analysis (by statistical package )

3. Experimental results

3.1effect of SQ-Complex Prescription on the general status of diabetic ratsNormal group() : normal drinking and food intake a silky coat , flexible mobility bowel acting properly Model group(): polydipsia, polyphagia, polyuria lost weight fur lackluster decrease in activity Treatment group: Better in the general status

3.2Effects 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

3.3 ()Effect of SQ-Complex Prescription on Pathology of Pancreas of DiabeticRats Normal group()

Model group()loose in the pancreatic islets structure islet cell atrophy fibrosis were formed in isletsTreatment group():normal pancreatic islets,A tiny amount of islet cell atrophy

Conclusion

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

(3)Prevention and Cure of Complications

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 EnteropathyDiabetic 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 moxibustionHerbal coloclysis

Buzhong Yiqi Tang(

Huangqi (radix astragali seu hedysari)18gGancao radix glycyrrhizae)9gRenshen(radix ginseng)6gDanggui(radix angelicae sinensis)3gJupi(pericarpium citri reticulatae)6gShengma(rhizoma cimicifugae)6gChaihu(radix bupleuri)6gBaizhu(rhizoma atractylodis macrocephalae)9g

Zengye Chengqi Tang(purgative decoction for increasing fluidXuanshen(radix scrophulariae)30gMaimendong(radix ophiopogonis)25gShengdihuang(radix rehmanniae)25gDahuang(radix et rhizoma rhei)9gMangxiao(natrii sulfas)5g

Neutrogenic bladderThe 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()

Jingui Yaolue (synopsis of prescriptions of the Golden Cabinet)Shengdihuang(Radix Rehmanniae)240gShanyao (Rhizoma Dioscoreae)120gShanzhuyu(Fructus Corni)120gZexie(Rhizoma Alismatis)90gFuling(poria)90gMudanpi(Cortex Moutan Radicis)90gGuizhi ( Ramulus Cinnamomi) 30gFuzi(Radix Aconiti)30gActions: Warming and invigorating kidney- yangpolyuriapolydipsia

Diabetic NephropathyDiabetic 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 g/min) that is confirmed on at least 2 occasions 3-6 months apartProgressive decline in the glomerular filtration rate (GFR)Elevated arterial blood pressure Treatment by Chinese herbs

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