Essential Research Of Diabetic Nephropathy (Deficiency Of Qi And Yin With Blood Stasis Syndromes) And Clinical Study On The Treatment With JiangTangYiShen Decoction

Objective: To investigate the prevalence rate of diabetic nephropathy(DN) in Changsha area and research the DN's distributing characteristics of the Chinese Medical syndrome types. To observe the clinical curative effect on DN by using Chinese Medical therapy of ZiYinYiQiHuoXue method ( nourishing Yin-invigorating Qi-activating the blood) and JiangTangYiShen decoction. To research the substantial foundations of the Chinese medical syndrome and the animal model with DN disease and syndromes. To search for a new way to make Chinese medical diagnosis based on syndromes and diseases by screening out the renal relative regulatory genes.Methods: 1718 cases of type 2 diabetes mellitus (T2DM ) inpatients in our hospital from 1994 to 2001 were selected and analyzed. (2)86 cases of DN patients with QiYinLiangXuJiaYu syndromes were divided into 3 groups, and were treated with JiangTangYiShen decoction, ZhongHuiTangMaiKang or perindopril respectively for 8 weeks in addition to gliquidone(60mg per day) as a basal treatment. Curative effect was observed. Moreover, urinary albumin excretion rate(UAER),blood creatinine(BCr), blood uria nitrogen(BUN), endothelin(ET), calcitonin-gene-related peptide (CGRP) were measured andcompared before and after treatment. In various period, uAlb, ET, Nitrogen monoxide(NO) and other items in model rats of DN induced by STZ were measured and compared. Moreover, gene chip was used to screen out the abnormal expressed gene in model rat's kidney.Results: The incidence of DN in Changsha is 9.02 %.The Chinese medical pathogenesis of DN is mainly Deficiency of Qi and Yin early, and Dificiency of Yin and Yang late.Blood stasis and turbid dampness exist all through.TThe total effective rate of JiangTangYiShen decoction was 86.2 % while Chinese medical syndromes improved rate was 96.6 %, and the results showed it had a cooperative effect with gliquidone. Moreover, the decoction could decrease the level of ET, increase the level of CGRP, so the ratio of ET/CGRP declined. (3) The level of blood sugar of diabetic model rats increased continuously, the UAER and CCr rise remarkably, the renal weight increased while the body weight decreased, the mean daily feed and water intake and the urine volume all increased obviously. The serum ET elevated , the NO increased early and decreased later. There were 252 abnormal expressed genes in these 8192 detected genes and 148 genes of them up-regulated while 104 down-regulated.Conclusions: The incidence of DN in Changsha area is lower than reported. The Chinese medical pathogenesis of DN is deficiency syndromes and redundancy syndromes mixed and reciprocal caused. Deficiency of Qi and Yin with blood stasis is prevalent in early DN. ZiYinYiQiHuoXue method is the effective therapy to it. As results showed, JiangTangYiShen decoction is an effective prescription for DN which can decrease the level of blood sugar cooperatively, protect the renal function and function of vascular endothelial cells. The diabetic model rats induced by STZ have the pathologic change and Chinese medical syndromes of deficiency of Qi and Yin with blood stasis inwhich decreased NO and abnormal secreted ET is the possible material foundation. Moreover, the renal abnormal expressed genes may show the relative change of Chinese medical syndromes of deficiency of Qi and Yin with blood stasis that provided a new idea for researching the essential of Chinese medical syndromes.