| The obstacle of gastrointestinal driving force of diabetes mellitus is a common complication of diabetes mellitus,which can involve the entire gastrointestinal tract.The manifestation of the gastrointestinal driving force obstacle of diabetes mellitus are:gastric emptying delay,abnormalities of the movement of the stomach and duodenum wall and abnormal gastric electricity,etc.It has seriously affected the patients with diabetes glucose control and quality of life.For the reason,how to early diagnose and early intervene in the obstruction of gastrointestinal movements which has not yet appeared gastrointestinal symptoms is an important issue that determine the long-term survival of patients with diabetes.This paper discuss the obstruction syndrome systematically in the field of acupuncture and moxibustion of traditional Chinese medicine.1.Experimental researchPurpose:To probe the effect mechanism on the obstruction of gastrointestinal movements with diabetes mellitus treated with catgut embedding in acupoints from the angle of animal experiment.Methods:The male SD rats fed with special food rich in lipid for two months and then injected with small dose of streptozotocin(STZ)into intraperitoneal were adopted as the animal model of diabetes mellitus.Thirty-nine DM model rats were divided into three groups:the 4 weeks DM model group,the 12 weeks DM model group and the acupoint embedded treatment group.There were 13 rats in each group.And 20 normal male rats were divided as control group.The acupoints of the acupoint embedded treatment group are:Pishu,Zhongwan,Zusanli,Guanyuan,Qihai and Tianshu.Two acupoints of them are selected to catch embedding every time,and the treatment is once every seven days.It is treated 12 times in all.The model control group and the normal control group feed freely, without any disposal.All of the experimental animals were put to death after 4 or 12 weeks, and collected serums and samples,measured and observed the following indexes:(1)Dynamic observation on the change of symptom and physical sign of every group during experiment;(2)Dynamic observation on the change of blood sugar levels of every group during experiment;(3)Dynamic changes of body weight of the rats in each group;(4)Dynamic changes of feeding of the rats in each group;(5)Dynamic changes of loose stools rate and diarrhea index of the rats in each group;(6)Dynamic changes of gastric emptying and small intestine pushing rate of the rats in each group; (7)Dynamic changes of blood plasma gastrin and somatostatin of the rats in each group;(8)Dynamic changes of the content of the vasoactive intestinal peptide in the sinuses ventriculi and the proximal colon tissue of the rats in each group;(9)The changes of the plasma endothelin and nitric oxide of sinuses ventriculi of the rats in each group;(10)The changes of vagus nerve histopathology of the inferior segment of esophagus.Results:(1)During the experiment,the feed and urine of the rats in the normal control group are not abnormal,whose body weight continues to increase.Their mental status is not abnormal. Their autonomic activities are not abnormal,without abnormal secretions,without cataract. The color of their hair is smooth and bright,without death.The spirit of the rats in the acupoint embedded treatment group and the control model group is tired with autonomic activities decreasing.They display the symptoms of polydipsia and polyufia after 1 day. They increase significantly feeding after 1 week.With the extension of the models,the polydipsia,polyphagia,and polyuria symptoms of the model control group is more obvious than the normal group.The extent of increasing body weight is not significant more than that of the normal group.They are worn out,or show fidgets,with powerful aggression. Their decreasing autonomic activities and slow react become more and more obvious with time extends.Their hair withers and loosens,losing gloss.Most obvious is the abdomen. Some rat begins to show cataract after 6weeks.They decrease feed after 8 weeks.Above symptoms become more obvious with the time extends.The symptoms of the rats in the acupoint embedded treatment group lighten obviously,whose mental status is better.Their hair is brighter than the model control group.(2)Compared with the normal control group,the blood sugar in the acupoint embedded treatment group and the model control group increases obviously(P＜0.05);the blood sugar of the acupoint embedded treatment group declines slightly,but compared with the model control group,there is no significant difference(P＞0.05).(3)With the extension of the course,body weight of the acupoint embedded treatment group and the model control group increases,but the extent of increase is not more obvious than the control group(P＜0.05).Body weight of some rat in the model control group decreases instead.(4)Compared with the normal control group,the feed of the rats in the acupoint embedded treatment group and the model control group increases obviously(P＜0.05);the feed of the rats in the model control group decreases,but there is no significant difference(P＞0.05);the feed of 12 weeks decreases obviously than the normal control group(P＜0.05);there is no significant change between 8 weeks and 12weeks in the acupoint embedded treatment group(P＞0.05).(5)Compared with the normal control group,loose stools rate and diarrhea index of the rats' in the model control group and the acupoint embedded treatment group increase gradually with the extension of the course,but the extent of increase of the acupoint embedded treatment group is not more obvious than that of the model control group(P＜0.05).(6)Compared with the normal control group,stomach residues rate increases significantly(P＜0.05).Stomach residues rate of the acupoint embedded treatment group increases slightly,there is no significant difference compared with the normal control group(P＞0.05).(7)Compared with the normal control group,small intestine pushing rate of the model control group decreases significantly(P＜0.05).Small intestine pushing rate of the acupoint embedded treatment group decreases,there is no significant difference compared with the normal control group(P＞0.05).(8)The plasma gastrin of diabetes 4 weeks increases obviously,there is significant difference compared with the normal control group(P＜0.05).The plasma gastrin of diabetes 12 weeks decreases slightly,there is no significant difference compared with the normal control group(P＞0.05).There is no significant difference between the acupoint embedded treatment group and the normal control group(P＞0.05).(9)Blood somatostatin of the model control group decreases obviously,there is significant difference compared with the normal control group(P＜0.05).Blood somatostatin of the acupoint embedded treatment group decreases slightly,there is no significant difference compared with the normal control group(P＞0.05).(10)The vasoactive intestinal peptide in the sinuses ventriculi of diabetes 4 weeks decreases obviously,there is significant difference compared with the normal control group(P＜0.05),The vasoactive intestinal peptide in the sinuses ventriculi of diabetes 12 weeks decreases slightly,there is no significant difference compared with the normal control group(P＞0.05).The vasoactive intestinal peptide in the sinuses ventriculi of the acupoint embedded treatment group decreases slightly,there is no significant difference compared with the normal control group(P＞0.05).(11)The vasoactive intestinal peptide in the proximal colon tissue of both diabetes 4 weeks and diabetes 12 weeks decrease obviously,there is significant difference compared with the normal control group(P＜0.05).There is no significant difference between the acupoint embedded treatment group and the normal control group(P＞0.05).Compared with the model control group,endothelin of the acupoint embedded treatment group decreases obviously(P＜0.05).(12)Compared with the normal control group,nitric oxide of sinuses ventriculi in the model control group decreases significantly(P＜0.05),decreases slightly,there is no significant difference compared with the normal control group(P＞0.05).Compared with the model control group,nitric oxide of sinuses ventriculi in the acupoint embedded treatment group increases obviously(P＜0.05).(13)The morphologic quantitative analysis of vagus nerve under light microscope show that there is no significant difference in nerve tract area among the model control group,the acupoint embedded treatment group and the normal control group(P＞0.05).Nerve fiber crevice of the rats' in the model control group and the acupoint embedded treatment group expands,myelin sheath swelling or deletion.The quantity and density of the myelinated nerve fiber reduces significantly than that of the normal control group(P＜0.05).But the quantity and density of the myelinated nerve fiber is significantly higher than that of the model control group(P＜0.05).Conclusion:(1)The symptoms and physical signs aggravate gradually with the extension of the course, body weight and feed decreases gradually,diarrhea rises.The way early intervention of the acupoint embedded treatment can improve obviously the symptoms and physical signs of DM rats.It can raise body weight and feed of DM rats and reduce loose stools rate and diarrhea index of DM rats.(2)The effective peristalsis of gastric and intestine of DM rats reduces gradually with the extension of the course.The acupoint embedded treatment can effectively enhance the effective peristalsis of gastric and intestine of DM rats,accelerating gastric emptying and small intestine pushing rate of DM rats.(3)The way early intervention of the acupoint embedded treatment can decrease plasma endothelin content of DM rats and enhance nitric oxide content of sinuses ventriculi of DM rats.(4)Early acupoint embedding can protect the vagus nerve damage caused by diabetes.(5)Significant changes happen to the structure and function of neuroendoctrine system in the gastric and intestine of DM rats.It embodies that the secretion and distribution of cerebral intestine peptide appears to be abnormal.The acupoint embedded treatment can regulate the secretion and distribution of cerebral intestine peptide of DM rats,which may provide a valuable research clue for preventing and curing the gastrointestinal motion dysfunction of DM.2.Clinical researchPurpose:Take healthy volunteers as the control to observe the gastrointestinal electricity change of the DM patients without digestive system symptom.The influence on the DM patients without digestive system symptom by the acupoint embedded treatment and electroacupuncture are also observed.Methods:This experiment study is divided into two partsPart one:30 DM patients that accord with the diagnostic criteria,inclusion criteria and exclusion criteria and 8 healthy volunteers are chosen to be observed the following gastrointestinal electricity indicators by WCDF-4B gastrointestinal analyzer.(1)Before and after meal frequency(Fp);(2)Before and after meal average peak rate(Ap);(3)Before and after meal normal gastric frequency(2.4～3.7 cpm)Percentage(PGF);(4)Before and after meal frequency instability coefficient(FpIC);(5)After meal/before meal Ap ratio(ApR).Results:Compared with healthy volunteers,the following gastrointestinal electricity of DM patients:(1)There is no significant difference between before meal frequency(Fp)and after meal frequency(P＞0.05);(2)There is no significant difference between before 1 average peak rate(Ap)and after meal average peak rate(P＞0.05);(3)Both before meal normal gastric frequency(2.4～3.7 cpm)Percentage(PGF)and after meal normal gastric frequency Percentage decrease significantly,there is significant difference between them(P＜0.05);(4)Both before and after meal frequency instability coefficient(FpIC)increase significantly,there is significant difference between them(P＜0.05);(5)Both after meal/before meal Ap ratio(ApR)decrease significantly,there is significant difference between them(P＜0.05).Part two:30 DM patients that accord with the diagnostic criteria,inclusion criteria and exclusion criteria are chosen to be divided randomly into the acupoint embedded treatment group and the EA treatment control group,each of which group is 15 patients.The acuacupoints are chosen Pishu,Zhongwan,Zusanli,Guanyuan,Qihai,Tianshu and the other acuacupoints are also used according to the symptom.The acupoint embedded treatment group is treated once a week,and it is treated continuously 3 weeks in all.The EA treatment control group is treated once a day,and it is treated continuously 3 weeks in all. Besides,the EA treatment control group has two days to rest every 5 treatments.All cases in two groups are observed 3 weeks as a period of treatment.They are observed gastrointestinal electricity indicators of the following by WCDF-4B gastrointestinal analyzer on the first day of treatment and treatment of the end of the day:(1)Before and after meal frequency(Fp);(2)Before and after meal average peak rate(Ap);(3)Before and after meal normal gastric frequency(2.4～3.7cpm)Percentage(PGF);(4)Before and after meal frequency instability coefficient(FpIC);(5)After meal/before meal Ap ratio(ApR).Results:(1)The general situation about the patients of two groups are similar,there is no significant difference between them on gender,age,,BMI and the state of illness(P＞0.05);(2)There is no significant difference before and after treatment about before and after meal frequency(Fp)between the acupoint embedded treatment group and the EA treatment control group(P＞0.05);(3)There is no significant difference before and after treatment about before and after meal average peak rate(Ap)between the acupoint embedded treatment group and the EA treatment control group(P＞0.05);(4)There is no significant difference before treatment about before and after meal normal gastric frequency(2.4～3.7cpm)Percentage(PGF)between the acupoint embedded treatment group and the EA treatment control group(P＞0.05).PGF of the acupoint embedded treatment group is higher obviously than that of the EA treatment control group after the treatment(P＜0.05);(5)There is no significant difference before treatment about before and after meal frequency instability coefficient(FpIC)between the acupoint embedded treatment group and the EA treatment control group(P＞0.05).FpIC of the acupoint embedded treatment group is lower obviously than that of the EA treatment control group after the treatment(P＜0.05);(6)There is no significant difference before treatment about after meal/before meal Ap ratio(ApR)between the acupoint embedded treatment group and the EA treatment control group(P＞0.05).ApR of the acupoint embedded treatment group is higher obviously than that of the EA treatment control group after the treatment(P＜0.05).Conclusion:(1)The rhythm of gastrointestinal electricity of the DM patients without digestive system symptom happens to disorder,while the acupoint embedded treatment can decrease obviously the rhythm disorder of gastrointestinal electricity of the DM patients without digestive system symptom;(2)The before and after meal frequency instability coefficient of the DM patients without digestive system symptom happens to increase,while the acupoint embedded treatment can decrease obviously the before and after meal frequency instability coefficient of the DM patients without digestive system symptom;(3)The after meal/before meal Ap ratio of the DM patients without digestive system symptom happens to decrease,while the acupoint embedded treatment can enhance effectively the after meal/before meal Ap ratio of the DM patients without digestive system symptom;(4)The merits of the acupoint embedded treatment are simple convenient,efficient,cost saving,safety and low incidence of adverse reactions,et al.
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