| Diabetic Dephropathy(DN) is clinical common and intractable one of the microvascular complications about patients with Diabetes Mellitus(DM). With the change in people's way of life, life extension, the modern disease spectrum fundamental changes have taken place, Diabetes' incidence rate in the whole world is rising rapidly,the incidence rate of DN is also rising, DN has become the main reason that lead to death of end-stage renal patients.because of the high incidence and mortality rate of DN, there is no ideal drugs and method treating and delaying and retarding the development of DN at home and abroad at present,so now it has becomes the common concern hot spot of the medical profession about how to improving the patient's quality of life,reducing the mortality rate,preventing and treating DN effectively. However Traditional Chinese Medicine(TCM) not only has its unique advantages on combating DN, the protection of the kidney, disease control, etc,but also has made a good clinical effect. TCM is a great treasure house. Ancient and modern literature of TCM about DN include the valuable diagnosis and treatment experience which is worth to Mining.The paper from ancient and modern literature collation and analysis of prescriptions with theoretical study starts, concluded Ancient and Modem literature research Overview,syndromes and treatment regular of prescriptions of DN, with a view to provide a clinical useful reference.1 Relevant literature researched and differentiated of Traditional Medicine Chinese of Diabetic NephropathyIt is the key point with ancient things as modern reference, exploring flow and finding source. Although there is no the name of DN in the ancient Chinese Medicine books,its symptoms is consistency with diseases of TCM such as"shen-xiao","niao-zhuo","shui-zhong","shen-lao","guan-ge". DN also involve a lot of ancient disease names, but some paradoxical, some more controversial.For example"fei-xiao not relevant with DM","shi-yi,shi-ye,that is zhong-xiao""ge-xiao means wasting-thirst disease secondary to nephropathy? "identifing the precise meaning of these ancient disease names is very important for DN research. Through the collection,collation of the ancient medical source about DN.and researching and differentiating and analysis seriously,and we have a more objective recognise of this.It is found that the following disease names are more closely linked with DN:①Xiao-dan,could be a complication of DM (including DN), may also be hyperthyroidism and other diseases.②3-xiao, DN belongs to this area.3-xiao continues, there will be urine muddy,edema, superficial infection and other complications that have great relevance with modern DN.③Xia-xiao,xiao-shen, DN are under the scope of xia-xiao. xiao-shen belong to the more serious cases, the disease-site of its mainly in the kidneys, could also be secondary to edema, urine muddy, dilatate and full, Georgia, and others. xia-xiao,xiao-shen and DN have a close relationship.④Nei-xiao,ji-xiao,are more a title for some ancient doctors Experts under similar xia-xiao,xiao-shen.⑤Ke-li,shi-yi and DM with DN have a certain correlation.Therefore,there are close relevance among DN and xiao-dan, shen-xiao (xiao-shen),xia-xiao 3-xiao,which shen-xiao (xiao-shen) is most closely connected with.In addition, by researching and differentiating and analysis seriously,above controversial"fei-xiao" not only can not be completely ruled out its relevance with DM,but also could include the related diseases of wasting-thirst disease secondary to nephropathy;shi-yi,shiye,zhong-xiao, with near-term differences; "ge-xiao" means "ge-xiao",it is little relevance with wasting-thirst disease secondary to nephropathy. Defining the exact meaning of these ancient disease names for reseach of DN can play an important role of amendmenting nature and understanding origin.2 Study on the laws of syndrome differentiation and treatment of prescriptionsThrough analysis of statistical methods for the ancient and modern prescriptions, sum up the using condition and characteristics of these prescriptions treating DN, to explore the regularity of syndrome differentiation and treatment and removal of the drug group about DN, for clinical drug reference,and be benefit to the literature research and theoretical improvement on this disease.I The laws of syndrome differentiation and treatment study of ancient prescriptions(I) MethodsAncient prescriptions' choice as A dictionary of Chinese Medicine Prescriptions for the main Search goal, screened up to the Eastern Han Dynasty, down to the end of the Qing dynasty and republic prescription literature data about the treatment of DN.As the prescriptions in each history and dynasty about xiao-ke complications from kidney treatment for major research areas, to take means of differentiation,from symptoms,from herbs,testing syndromes to prescriptions, collected prescriptions in each history and dynasty about diseases and syndromes of "xia-xiao" "xiao-shen" "shen-xiao""xiao-ke complicating urine muddy". And standardize data, establish prescription database, and make analysis of 3-xiao typings frequency of use,cluster through the use of statistical methods, the Third Consumers type,to summing up its syndrome and treatment regularity of prescription.(II) ResultsIn the statistical analysis of prescription of results before the Song dynasty,xia-xiao as main symptoms among 3-xiao typing accounted for 80%; Medication to Poria,Radix Ginseng, Radix Paeoniae Alba; there is the larger proportion to replenishing drugs (37.22%),heat-clearing drugs(15.74%),drugs for arresting discharge(12.56%),diuretics for eliminating dampness(10.08%), cumulative frequency up to 75.60%. medication Partial to warm and bland; mainly to sweet taste; the drugs mainly into the kidney meridian (22.80%),the liver meridian(16.07%),the heart meridian(15.57%); in drug combinations by cluster analysis,to mainly treat 3-xiao(such as asthenia of Qi,imbalance between heart-yang and kidney-yin), xiao-ke with kidney deficiency, kidney deficiency following thirst, xiao-shen, xia-xiao,and find white muddy and sliding multi-urine,the virtual lack, polydipsia,and other symptoms.In the statistical analysis of prescription of results during the Jinyuan dynasty,xia-xiao as main symptoms among 3-xiao typing accounted for 77.36%; Medication to Poria,Radix Glycyrrhizae,Radix Ginseng; there is the larger proportion to replenishing drugs (29.55%),heat-clearing drugs(20.90%), diuretics for eliminating dampness (11.59%)drugs for arresting discharge (7.27%),drugs for relieving exterior syndrome (6.14%),cumulative frequency up to 75.45%.medication Partial to cold and cool,mainly to warm and cold; mainly to sweet taste; the drugs mainly into the lung meridian(18.59%),the spleen meridian(15.28%),the gastrin meridian(15.20%); in drug combinations by cluster analysis,to mainly treat xia-xiao,3-xiao(such as deficiency of both Qi and Yin,fire-heat filling internus,consumption of yin-fluid),kidney deficiency following thirst, xiao-shen, xia-xiao,and find drenching and muddy urine,thirst to drink, dryness-heat,and other symptoms.In the statistical analysis of prescription of results during the Ming dynasty,xia-xiao as main symptoms among 3-xiao typing accounted for 96.67%; Medication to Poria,Radix Paeoniae,Fructus Corni; there is the larger proportion to replenishing drugs(43.07%), diuretics for eliminating dampness (13.63%),drugs for arresting discharge(12.90%), heat-clearing drugs (10.46%), cumulative frequency up to 80.05%.medication Partial to warm,mainly to sweet taste; the drugs mainly into the kidney meridian(26.25%),the liver meridian (16.89%),the spleen meridian(16.17%); in drug combinations by cluster analysis, to mainly treat 3-xiao(such as yang asthenia, kidney deficiency),xiao-shen, kidney deficiency following thirstand find white muddy and frequent multi-urine, polydipsia,dryness-heat,and other symptoms.In the statistical analysis of prescription of results during the Qing dynasty,xia-xiao as main symptoms among 3-xiao typing accounted for 95.50%; Medication to Poria,Radix Paeoniae Alba,Rhizoma Dioscoreae; there is the larger proportion to replenishing drugs(42.29%),heat-clearing drugs (18.89%), diuretics for eliminating dampness (11.70%),drugs for arresting discharge (11.12%),cumulative frequency up to 84.01%. medication Partial to warm and bland; mainly to sweet and bitter taste; the drugs mainly into the kidney meridian(27.29%),the liver meridian(15.85%),the heart meridian (15.23%); in drug combinations by cluster analysis,to mainly treat xia-xiao and 3-xiao,and find thirst to drink,frequently and multi-urine,mastic and fat of urine.and other symptoms.(III) ConclusionAnalysis from syndrome differentiaton and treatment prescriptions' distribution of 3-xiao typing indicates that Song-Jin-Yuan dynasty (including the Song Dynasty ago) is at the early stages of 3-xiao typing.the Ming and Qing dynasties is in the development period of 3-xiao typing.From ancient prescription frequency analysis it is found that there is higher using proportion and frequency for heat-clearing drugs,diuretics for eliminating dampness,drugs for arresting discharge,mainly to replenishing drugs, medication Partial to warm and bland; mainly to sweet taste,the drugs mainly into the kidney meridian; in drug combinations by cluster analysis,often involves four drug category such as replenishing drugs,heat-clearing drugs, diuretics for eliminating dampness,drugs for arresting discharge,with invigorating and consolidating the kidney,heat-clearing and nourishing yin, promoting the production of body fluid to quench thirst,convergence to unsmooth, inducing diuresis for treating strangurtia,to hint that it can treat these syndromes such as 3-xiao,xia-xiao, shen-xiao, etc,reflects the feature of asthenia in origin and sthenia in superficiality and deficiency syndrome mingling with excess syndrome about cause and pathogenesis of disease and syndrome differentiation and treatment.Overall,about the concept of DN,prescription of syndrome differentiation and treatment and the development process,the conclusion is: from ((Emperor Classic)) ; expanding in the Han and Tang dynasties; maturing in the Song- yuan-jin dynasties; and improving and developing in the Ming and Qing Dynasties.II The laws of syndrome differentiation and treatment study of mordern prescriptions(I) Methods Modern prescriptions' choice as VIP database for the main search way, with manual retrieval of books,screened important magazines, journals with the relevant experts and important books in recent years by more than 20 reported in clinical literature of Chinese Medicine treatment of DN.To select prescriptions as "Diabetic Nephropathy","wasting-thirst disease secondary to nephropathy","shen-xiao","xiao-shen"for choosing standards, and standardize data,establish prescription database,and make analysis of syndromes typing,frequency of use,cluster through the use of statistical methods,to summing up its syndrome and treatment regularity of prescription.(II) ResultsIn the statistical analysis results of 352 prescriptions of DN,it involves the following major syndromes as deficiency of both qi and yin,82 cases,asthenia of the spleen and kidney,70 cases,accouts of 23.30%, 19.89% Respectively.Medication to Radix Astragall,Poria,Radix Salviae Miltiorrhizae; there is the larger proportion to replenishing drugs (35.82%),drugs activating blood circulation to dissipate blood stasis (13.78%), heat-clearing drugs(12.53%),diuretics for eliminating dampness (12.39%),cumulative frequency up to 74.52%.medication Partial to warm and bland,mainly to sweet taste; the drugs mainly into the liver meridian(19.35%),the kidney meridian(18.76%),the spleen meridian (17.56%); in drug combinations by cluster analysis,to mainly treat these syndromes of asthenia of both qi and yin,hepatic and renal yin deficiency,stagnation of blood stasis,phlegm and body fluid stayed internal about DN,and other symptoms.(III) ConclusionAnalysis from prescriptions about DN indicates that there is higher using proportion and frequency for drugs invigorating vital energy,drugs activating blood circulation to dissipate blood stasis,heat-clearing drugs,diuretics for eliminating dampness,medication partial to warm and bland; mainly to sweet taste,the drugs mainly into the liver,the kidney,the spleen meridian; in drug combinations by cluster analysis, mainly involves drug category such as replenishing drugs,heat-clearing drugs,activating blood circulation drugs,diuretics for eliminating dampness, qi-unobstructed drugs,with tonifing the liver and kidney and spleen,benefiting vital energy and nourishing yin, activating blood circulation to dissipate blood stasis,diureting for eliminating dampness, reflecting the feature of asthenia in origin and sthenia in superficiality,deficiency syndrome mingling with excess syndrome about cause and pathogenesis of DN,the laws of syndrome differentiation and treatment of replenishing healthy energy mainly and eliminating sthenia pathogenic factors. However,about the development and changes of ancient and modern prescriptions of the laws of syndrome differentiation and treatment,it is most significant that the using frequency of drugs activating blood circulation to dissipate blood stasis greatly increased.Additionally,the experience of instructors is also introduced about this study. Instructors often cited this ancient knowledges as modern reference, sum up experience, in the long-term clinical practice,the treatment of DN by using TCM achieves satisfactory effect,which may be better to improve the clinical symptoms and delay disease progression, deterioration,and some patients significantly improved of kidney function, it shows the strengths and potential of TCM in the treatment of DN.It also suggests its importance of with ancient things as modern reference, making the past serving the present. |
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