Type 2 Diabetes Tcm Dialectical Staging

Background:Great attention has been paid to the researches in Traditional Chinese Medicine (TCM) about the syndrome differentiation types of Diabetes Mellitus and its complications. Previous researches had shown that they were usually studied altogether, without clear diagnosis and stage recognition. Many researchers have introduced a great many of different kinds of syndrome differentiation types that depend on their clinical experiences. Thus, it is really hard to come into an agreement, which becomes a great barrier for further investigation.Objective:Approach to the method of syndrome differentiation types of type 2 Diabetes Mellitus (T2DM), with modern statistic technique and based on clear diagnosis and stage recognition, in order to standardize the syndrome differentiation types of Diabetes mellitus and its complications in the TCM clinical researchMethod:This research is part of the content of the National Science Foundation of China project "the Correlation of TCM Body Constitution Susceptibility and the Polymorphism of Gene TGF-β1 T869C (Leu10pro) in Diabetic Nephropathy". The research proceeds the questionnaire of T2DM established according to task group, collecting the T2DM patients came from Dozhimen Hospital affiliated to Beijing University of Chinese Medicine and Hangzhou Red Cross Society Hospital. All of the patients chosen in this clinical trail had been clearly diagnosed in T2DM and its complications, and accorded with the internalize standard. All the cases had been collected basic data about general physical condition, information form TCM four diagnoses and correlative laboratory indices. We chose those cases with complete data and proceeded statistics analysis. We use the method of chi-square test with SPSS13.0 statistical package and the cluster analysis with SAS8.2 statistical package.Result:We finally investigated 131 cases of T2DM patients, in which,80 cases are accorded with the diagnosis of Diabetic Nephropathy (DN). Though the traditional study method of syndrome differentiations, it is discovered that, with the symptoms of which frequency are above 50%, the T2DM patients without any complications are most likely to appear to have Qi deficiency and Yin deficiency, with internal heat and phlegm dampness, while the DN patients of stageⅢ(stage diagnosis according to Mogenson) are most likely also to have Qi deficiency and Yin deficiency, and the stageⅣand stageⅤappear to have Yang deficiency beside Qi deficiency and Yin deficiency, and Internal heat, Phlegm dampness, Blood stasis, and Qi stagnation may all appear.At the same time, we use cluster analysis with the T2DM symptoms which are without complications and DN symptoms. And we get 9 clusters for the T2DM and 8 clusters for DN. Finally we conclude them into 7 differentiation types each, which demonstrate that the theory of professor Lv Renhe.Conclusion:According to the results, we can conclude that:Firstly, within the methods of clustering analysis, it is possible to proceed research on TCM syndrome differentiation in T2DM under clear diagnosis and stage recognition. It is convinced the standpoint of Professor Lv Renhe that "the differentiation types are determined by the fundamental deficiency, while the pathogenic factors determined the symptom complexes." And so is the Professor Zhao Jinxi's, that syndrome differentiation method of distinguishing superficiality and origin, based on the stage recognition. And it also suggests that according to the theory and method of clinical epidemiology, with the help of modern statistic technique, strictly following the DME design, we can perform further researches on TCM syndrome complexes.Secondly, for the cases of T2DM without complications, in terms of deficiency in origin, Qi deficiency and Yin deficiency, Yin deficiency and Yang deficiency are usually exist together. While, there are simple Qi deficiency and simple Yin deficiency, too. In terms of excess in superficiality, internal heat syndrome is generally existed besides blood stagnation. These internal heat included heat retention, humid heat, stagnated heat, and phlegm fire. And the location of lesion mostly relied in Zang-organ of liver, kidney, and spleen.Thirdly, for the cases of DN, in terms of deficiency in origin, Qi deficiency and Yin deficiency, Yin deficiency and Yang deficiency are also likely to exist together. There is simple Yin deficiency, too. While, in terms of excess in superficiality, stagnation of Qi, Blood, Water, and heat can all be seen in complex. And the lesion is mostly lies in the Zang-organ kidney, involving Zang-organ liver, spleen, heart, and lung.Finally, the research can only reflect the syndrome differentiation types of the sample, for its deficiency in the number of cases. In order to a more practical result, further clinical epidemiology researches with bigger sample and multicentre is needed.