Discussion On The Diagnosis And Treatment Of Overweight And Obesity Type 2 Diabetes Mellitus Based On Structured TCM Hospital Medical Record Data

This study relies on the special projects of State administration of Traditional Chinese Medicine and Beijing municipal Science and Technology Commission.This article consist of two parts.The first part is the literature review of research progress of Chinese and western medicine to the obese patient with type 2 diabetes.The second part is the clinical studies.Objective:This study use the program of electronic medical record data in Guang’an Men Hospital.There are 1214 cases of obese patients with type 2 diabetes.We use this program to analyze the data of 1214 cases so that to find out the basic rules of diagnosis and treatment.Methods:This study is based on the program of electronic medical record data in our hospital.And the database is gam_detail_admin/database109. We use this program to find out 1214 cases of obese patients with type 2 diabetes which were accurately recorded from January 2006 to November 2014.Then all the cases were organized so to make it precise and standard.According to the level of BMI,these dates were divided into two groups,the overweight and the obese.And then we used the Spss19.0,FP-Growth and the complex networks to analyze the relationships among the symptoms.the type of syndrome, tongue, pulse,and traditional Chinese medicine.Results:(1)There are 1214 valid cases in this study,592 cases in the overweight and 622 cases in the obese.Among them,there are 593 male and 621 female.And 874 patients were with diabetes for more than 10 years.Most of them were also with coronary heart disease, high blood pressure, blood lipid disorders and insulin resistance.Almost half of them had a family history of diabetes and obesity.Therefore,in this study.the majorities are with the metabolic syndrome.Along with the increase of BMI, the risk of cardiovascular disease also increases accordingly.(2)The relationships among the syndromes,symptoms,tongue,pulse and Chinese medicine.① There are seven types of syndrome:the syndrome of deficiency of both qi and yin,the syndrome of hyperactivity of fire due to deficiency of yin. the syndrome of collateral retardation due to blood stasis,the syndrome of blood stasis and phlegm,the syndrome of dampness due to the deficiency of spleen.the syndrome of deficiency of liver-yin and kidney-yang,the syndrome of deficiency of yin and yang.The syndromes of deficiency of yin and yang is the most common syndrome.② The main symptoms with the the syndrome of deficiency of both qi and yin are as follow:thirst,restlessness,short of breath,dizziness,palpitation,insomnia,dry stool,aching and lassitude of loins and legs,numbness of extremities,red tongue with white fur or thin white dry fur,taut and deep pulse.The main prescriptions are Shenqi Dihuang Decoction,Pulse- activating Powder and Liuwei Dihuang Decoction.③The main symptoms with the syndrome of collateral retardation due to blood stasis are as follow:thirst,dieblausucht,palpitation,bosom frowsty chest pain, numbness of extremities, cold limbs,distending pain in hypochondrium,dizziness,headache,backache,dry stool,deep purle tongue with white fur and ecchymoses,taut and thready pulse,or thready and weak pulse.The main prescriptions are Decoction of Four Ingredients with Peach Kernel and safflower,Red Sage Decoction,and Decoction for Removing Blood Stasis.④The main symptoms with the syndrome of hyperactivity of fire due to deficiency of yin are as follow:polydipsi,polyphagia,dysphoria with feverish sensation in the chest,palm and soles,sweating,dry stool,temperamental tendency,aching and lassitude of loins and legs,red or dull-red tongue with white or yellow thin fur,thready and frequent pulse,or taut and frequent pulse.The main prescriptions are Zhibai Dihuang Decoction,and Liuwei Dihuang Decoction.⑤ The main symptoms with the syndrome of blood stasis and phlegm are as follow:polydipsi,fatigue,short of breath,bosom frowsty chest pain, palpitation, dizziness poor appetite,insomnia,cough with sputum,numbness of extremities,dry stool,light red tongue with yellow or gray fur,taut and slippery pulse,or taut pulse,or deep and thready pulse.The main prescription are Decoction of Trichosanthes,Macrostem and Pinellia,and Decoction for clearing away gallbladder-heat.⑥The main symptoms with the syndrome of deficiency of liver-yin and kidney-yang are as follow:thirst,fatigue,bitter taste, amnesia, dizziness, headache, insomnia,sweating,night sweating,temperamental tendency,numbness of extremities,aching and lassitude of loins and legs,blurred vision,red or dull-red tongue with fissure and white fur.taut and thready pulse,or taut pulse,or deep and thready pules.The main prescription are Decoction to claming the liver and subducing hyperactivity of the liver-yang, QiJu Dihuang Decoction.⑦The main symptoms with the syndrome of dampness due to the deficiency of spleen are as follow:thirst,sticky mouth,fatigue,short of breath,loose stool, retching,poor appetite,sour regurgitation,abdominal distension,facial edema,edema of the body and limbs,light red tongue with white or yellow thick fur,slippery pulse,or taut and slippery pulse,or thready and slippery pulse.The main prescriptions are Huopu Xialing Decoction and Decoction for reinforcing the spleen.⑧The main symptoms with the syndrome of deficiency of yin and yang are as follow:thirst,fatigue,short of breath,aversion to cold,palpitation,nausea,poor appetite, insomnia, cold limbs, numbness of extremities,facial edema,oliguria,turbid urine,dull-red tongue with white fur,thready and weak pulse.or thready pulse.The main prescription is Bolus for Tonifying the kidney-qi.The main herbs in this study are as follow:Poria,Chinese angelica,Water-Plantain tuber,Radix ophiopogonis root.Red sage root,Red paeony root,Chuanxiong rhizome,Red peony root,Safflower.,Radix Pseudostellariae,astragalus root, Prepared Rehmannia Root,Chinese yam,Dogwood,Suberect Spatholobus Stem,Peach seed,The root of bidentate achyranthes,pericarpium citric reticulatae,Pinellia ternata, White paeony root,Rhizoma anemarrhenae,fruit of immature citron and so on. These herbs are all related to inducing diuresis and excreting dampness,promoting blood circulation and removing blood stasis,resolving the phlegm and replenishing the qi and yin.(3)The physicochemical indexes is much higher in symptom with the the syndrome of deficiency of both qi and yin than any other symptoms.And the value of glycosylated hemoglobin is high in the syndrome of collateral retardation due to blood stasis,the syndrome of hyperactivity of fire due to deficiency of yin and the syndrome of blood stasis and phlegm.And the value of low density lipoprotein is high in the syndrome of collateral retardation due to blood stasis,the syndrome of blood stasis and phlegm,and the syndrome of hyperactivity of fire due to deficiency of yin.The value of triglyceride is high in the syndrome of dampness due to the deficiency of spleen.the syndrome of blood stasis and phlegm,and the syndrome of hyperactivity of fire due to deficiency of yin.The value of total cholesterol is high in the syndrome of hyperactivity of fire due to deficiency of yin,the syndrome of collateral retardation due to blood stasis.and the syndrome of blood stasis and phlegm.The value of uric acid is high in the syndrome of blood stasis and phlegm,the syndrome of collateral retardation due to blood stasis.and the syndrome of hyperactivity of fire due to deficiency of yin.Conclusion:According to the results of this study above,there are several risk factors which are related to the obese patients with diabetes:course of diabetes,past medical history,family history,age,smoking,drinking,coronary heart diseases,hyper-tension, lipid disorders, hyperuricemia and so on.(2)The main syndrome is the the syndrome of deficiency of both qi and yin.Others are the syndrome of hyperactivity of fire due to deficiency of yin, the syndrome of collateral retardation due to blood stasis,the syndrome of blood stasis and phlegm,the syndrome of dampness due to the deficiency of spleen,the syndrome of deficiency of liver-yin and kidney-yang,the syndrome of deficiency of yin and yang.(3)Thirteen recipes are widely used in this study:Shenqi Dihuang Decoction,Pulse-activating Powder,Liuwei Dihuang Decoction, Zhibai Dihuang Decoction,Qiju Dihuang Decoction,Decoction of Trichosanthes,Macrostem and Pinellia,Decoction for clearing away gallbladder-heat,Decoction to claming the liver and subducing hyperactivity of the liver-yang,Huopu Xialing Decoction, Decoction for reinforcing the spleen.Decoction of Four Ingredients with Peach Kernel and safflower,Red Sage Decoction, Decoction for Removing Blood Stasis, and Bolus for Tonifying the kidney-qi.(4)The main herbs in this study are as follow:Poria,Chinese angelica.Water-Plantain tuber,Radix ophiopogonis root,Red sage root,Red paeony root.Chuanxiong rhizome,Red peony root,Safflower,Radix Pseudostellariae,astragalus root, Prepared Rehmannia Root,Chinese yam,Dogwood,Suberect Spatholobus Stem,Peach seed,The root of bidentate achyranthes,pericarpium citric reticulatae,Pinellia ternata,White paeony root,Rhizoma anemarrhenae,fruit of immature citron and so on. These herbs are all related to inducing diuresis and excreting dampness,promoting blood circulation and removing blood stasis,resolving the phlegm and replenishing the qi and yin.According to the new study of pharmaceutical actions,these herbs can help to ameliorate insulin resistance.regulate the blood glucose,improve circulation,reduce blood lipid,prevent atherosclerosis and other cardiovascular diseases.