| BackgroundThe incidence of diabetes is rising worldwide with the economic level improving, lifestyle changing and the gradual ageing of population. Life expectancy has been shortened 5 to 10 years by Diabetes, and the microangiopathy caused by diabetes specifically is one of the most important reasons. Microangiopathy is the most common diabetic complication, mainly including diabetic nephropathy and diabetic retinopathy. Both of them are the most common causes of renal replacement therapy and blinding in people younger than 65 years. Once a microangiopathy is diagnosed, it will continue to advance. Although the per capita medical expense has reached 2834 euro, the progress of the diseases still can't be controlled, which is a great challenge for doctors. So it is the key for patients' prognosis to diagnose early and treat the diseases timely.There is a long history about the records of diabetes in Traditional Chinese Medicine, such as that in Huangdi's Canon of Medicine. There are lots of descriptions about the symptoms, pathogenesis and treatment therapies of diabetes and the microvascular complications. Contemporary chinese medicine scholars also have different views about the pathogenesis of diabetes and its microvascular complications. In a number of researches, deficiency of yin and stagnation of blood is commonly valued as the pivotal pathogenesis. Pioneers attached importance to the effect of deficiency of yin and believe dryness-heat due to yin dificiency is the key factor that passes through the process and development of diabetes, which is accepted by most scholars till now. Besides, the pathogenesis of blood stasis gradually became the hotspot of research after the founding of the state. Scholars studied the relationship between blood stasis syndrome and diabetic microangiopathy from both macroscopic and microscopic perspectives, and they have yielded heartening progress. It will greatly enhance the effect, delay and even block the progress of diseases and improve the prognosis of patients that having the correct understanding that deficiency of yin and stagnation of blood is the key pathogenesis from the early stage of the disease, using nourishing yin and activating blood therapy with western medicine to prevent and treat the disease. It has an important actual significance on reducing the burdens of patients, their families and the society.ObjectiveTo study the evolution of syndromee of yin deficiency and blood stasis in diabetes and the microangiopathy through a retrospective study, a prospective study and a system evaluation of the literature under the pathogenesis theory of yin deficiency and blood stasis; To explore the objective assessment indicators of syndrome of yin deficiency and blood stasis and the base of the relationship between the syndrome and diabetic microangiopathy; To evaluate literature of treating diabetic microangiopathy with combination of Chinese and western therapy, and analyze its scientificalness and creditability. MethodsPart one:We made a retrospective analysis on 214 inpatients who were diagnosed type 2 diabetes and without chronic complications or only with minor microangiopathies. We recorded patients' age, course of the disease, length of stay, lifestyle, symptom score of chinese medicine, syndrome pattern of TCM; blood pressure, blood sugar, blood lipid. urinary microalbumin indicators and conditions of the complications. Patients who had yin dificiency syndrome and yin deficiency and blood stasis syndrome were devided into two groups, with microangiopathy and without. Statistical analysis was made by software SPSS 17.0. T test was used in measurement data normally distributed, Nor-parametric test was used in measurement data non-normal distributed,and Chi-square test was used in count data. There are sgnificant differences when p≤0.05.Part two:We made a prospective analysis on 136 patients who were diagnosed type 2 diabetes and without chronic complications or only with minor microangiopathies. Patients were devided into group of yin deficiency syndrome, group of yin deficiency and blood stasis syndrome, simple diabetes group and microangiopathy group. The demographic indicators, physical examination, family history, lifestyle, chemical indicators and related indicators of diabetic vascular complacations were observed. Statistical analysis was made by software SPSS 17.0 with the methods of T test, nor-parametric test or chi-square test. Correlation analysis and multiple regression analysis were made between urinary microalbumin and risk factors. There are sgnificant differences when p≤0.05. Part three:We searched The Cochrane Library, MEDLINE, CNKI, VIP and CBM. Literature conforming to the inclusion criteria of clinical randomized control trials on nourishing yin and activating blood therapy with western medicine treating diabetic nephropathy was studied. The effect of treating group and control group in included literature and chemical indicators were compared and analyzed by the software RevMan 5.0.25. The quality of literature was evaluated following the standards of Cochrane collaborative group.ResultPart one:There are relationships in symptom, TCM syndrome and pathogenesis between diabetes and its microangiopathy. Elevated blood pressure and metabolic disorders of blood sugar and lipid closely related to diabetic microangiopathy. In comparison between simple diabetes group and microangiopathy group, symptom score was increasing as the development of the disease, and the syndrome pattern of TCM and pathogenesis also changed that the proportion of patients with yin deficiency and blood stasis syndrome increased. The level of urinary microalbumin of patients with yin deficiency and blood stasis syndrome was higher than that of patients with yin deficiency syndrome. Part two:Compared with patients with yin deficiency syndrome, patients with yin deficiency and blood stasis syndrome were older, their courses were longer, the levels of urinary microalbumin were higer,and the possibility of occurring microangiopathy especially diabetic nephropathy was greater. There is close relation between blood stasis and the occurance of diabetic microangiopathy. It can forecast diabetic nephropathy earlier than urinary microalbumin. Urinary microalbumin can be regarded as one of the indicators of blood stasis. Carboxymethyl lysine can forecast early stage microangiopathy, so it can be regarded as the objective indicator of blood stasis.Part three:1.Liuwei Dihuang pills(decoction)and its modified formula combined with western medicine reduced the level of 24-hour urine protein of patients with early or middle stage diabetic nephropathy to some extent. It also reduced serum creatinine of the patients at IV stage, and improved their kidney function to some extent. It reduced triglyceride and cholesterol, and better controlled fasting blood glucose and HbAlc of patients with diabetic nephropathy; The effect of reducing the level of urinary microalbumin, triglyceride and cholesterol with Liuwei Dihuang pills (decoction) and its modified formula is better than that with ACEI or ARB. The effect of reducing serum creatinine is similar to ACEI or ARB;2.Taohong Siwu decoction and its modified formula combined with western medicine reduced the level of fasting blood glucose, HbAlc, triglyceride and cholesterol of patients; It reduced the level of 24-hour urine protein and urinary microalbumin of patients with middle stage diabetic nephropathy. It reduced serum creatinine of the patients at III or IV stage. It also reduced BVH,BVL, plasma viscosity and VAI;3.The A class or best evidence to support that the effect of treatment group by nourishing yin and activating blood therapy was better than that of control group was not be found because of the low quality of literature. However, the C class (defective clinical trials) evidences were be found. It implies a promising choice to treat diabetic nephropathy by nourishing yin and activating blood therapy with western medicine, and it is worth further exploration.Conclusion1.The level of urinary microalbumin of patients with yin deficiency and blood stasis syndrome was higher than that of patients with yin deficiency syndrome, and the possibility of occurring microangiopathy especially diabetic nephropathy was greater;2.There is close relation between blood stasis and the occurance of diabetic microangiopathy. It can forecast diabetic nephropathy earlier than urinary microalbumin. Urinary microalbumin can be regarded as one of the indicators of blood stasis. Carboxymethyllysine can forecast early stage microangiopathy;3.It implies a promising choice to treat diabetic nephropathy by nourishing yin and activating blood therapy with western medicine,but need to design more rigorous large-scale population clinical randomized controlled trial to verify it.
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