| Objective:Through the literature research on the method of warming the middle and strengthening the spleen,it provides more detailed information for the historical research on the method of warming the middle and strengthening the spleen;search and collect relevant literature on the clinical application of Fuzi Lizhong Decoction in the treatment of diabetic gastroparesis(DGP),and understand its effectiveness and safety through data analysis and quality evaluation.Combined with medical records,the clinical experience of my teacher in the treatment of DGP was discussed from the aspects of applicable population,medication characteristics and clinical application of modified Fuzi Lizhong decoction in the treatment of DGP,in order to provide reference for the prevention and treatment of DGP by traditional Chinese medicine.Methods: 1.Using the method of literature research,taking China National Knowledge Infrastructure(CNKI)and ’ Chinese Medical Classics ’ as the retrieval platform,the literature related to the method of warming middle and invigorating spleen was collected,the origin and development process of the method of warming middle and invigorating spleen were sorted out,and its development and evolution were studied.To explore the connotation and compatibility form of warming spleen method;organize the common prescriptions and indications of warming spleen method.2.Evidence-based medicine systematic review part based on the results of clinical studies,the main research formula Fuzi Lizhong Decoction in the treatment of DGP clinical efficacy meta-analysis.According to the inclusion and exclusion criteria,6 randomized controlled trial studies were finally included for literature quality evaluation,and Rev Man 5.4 was used for meta-analysis,heterogeneity test,and risk of bias assessment of the clinical efficacy of the literature.3.The experience analysis and summary part selected my teacher to use Fuzi Lizhong Decoction to treat typical DGP patients for in-depth discussion,combined with medical records from Fuzi Lizhong Decoction applicable population,medication characteristics and clinical application to summarize my teacher’s clinical experience in the treatment of DGP.Results: 1.By searching the ancient literature and CNKI in the Chinese Medical Dictionary,it is suggested that the method of warming the middle and invigorating the spleen originated from the ’ Yellow Emperor ’s Internal Classic ’,based on the ’ Treatise on Febrile and Miscellaneous Diseases ’,inherited from the Tang and Song Dynasties,developed in the Jin and Yuan Dynasties,and improved in the Ming and Qing Dynasties.2.Evidence-based medicine systematic review included 6literatures of clinical randomized controlled trials of Fuzi Lizhong Decoction that met the requirements,all of which were Chinese literatures,with a total of 496 patients.Meta-analysis showed that relative to the control group treated with western medicine alone,the overall response rate of Fuzi Lizhong Decoction in the treatment of DGP(RR=1.30,95% CI [1.19,1.42],P<0.00001)was better than that in the control group,and the recurrence rate(RR=0.33,95%CI [0.15,0.75],P=0.008),gastric emptying time(MD=-1.45,95% CI [-1.73,-1.16],P<0.00001),fasting blood glucose(MD=-0.74,95%CI [-1.23,-0.24],P=0.004),and 2-hour postprandial blood glucose(MD=-0.96,95% CI[-1.56,-0.36],P=0.002)were lower than those in the control group,and the differences were statistically significant;In subgroup analysis,the overall clinical response rate(RR=1.25,95%CI[1.10,1.42],P=0.0005)of Fuzi Lizhong Decoction alone for DGP was higher than that of the control group;the overall clinical response rate(RR=1.35,95%CI [1.19,1.54],P<0.00001)of Fuzi Lizhong Decoction combined with prokinetic drugs for DGP was higher than that of the control group.In the risk assessment of excursion,the literatures were mostly distributed in the middle part of the funnel,relatively tight,and the left and right scatter points were asymmetric,suggesting that there was publication bias in the included literatures.3.Modified Fuzi Lizhong Decoction is suitable for patients with DGP of spleen and stomach deficiency cold type.It mainly improves the symptoms of DGP by warming spleen yang,paying attention to warming kidney,eliminating food and resolving accumulation,promoting blood circulation and removing blood stasis,regulating liver and spleen,and treating mind and body together.Conclusions:1.The method of warming the middle and strengthening the spleen sprouted in the ’ Yellow Emperor ’s Internal Classic ’,based on the ’ Treatise on Febrile and Miscellaneous Diseases ’,inherited in the Tang and Song Dynasties,developed in the Jin and Yuan Dynasties,and perfected in the Ming and Qing Dynasties.2.Fuzi Lizhong Decoction can shorten the gastric emptying time of DGP patients;it is superior to western medicine alone in reducing fasting blood glucose and 2-hour postprandial blood glucose;Fuzi Lizhong Decoction can improve the treatment efficiency,reduce the recurrence rate after 1 month of treatment,and improve clinical symptoms.However,due to the low quality grade of the original articles included in the six articles,there are heterogeneity and methodological defects that may affect the meta-analysis results of the clinical efficacy of Fuzi Lizhong Decoction in the treatment of DGP.3.My teacher believes that diabetes for a long time,yin damage and yang,spleen and stomach yang deficiency,transport has no right,for diabetes stomach cramps pathogenesis of the main cause.The clinical application of Fuzi Lizhong Decoction in the treatment of spleen and stomach deficiency cold type of diabetes stomach cramps is effective,can be appropriately combined with Xiaoshi Huaji,qi and blood stasis products,for the future use of Fuzi Lizhong Decoction in the treatment of DGP to provide a useful reference. |
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