Study On Chinese Medical Literature Of Diabetic Cardiopathy And The Law Of Prescriptions, Syndrome Differentiation And Treatment

Diabetic Cardiopathy (DC) is one of the most important complications of diabetes, including diabetic cardiac microvascular disease, macrovascular disease, cardiomyopathy and cardiac autonomic dysfunction. Cardiovascular complications of diabetes have become the main threat to long-term survival and the first reason of mortality in patients with diabetes. At present, under the guidance of traditional Chinese medicine theory, some achievements have been made in the experimental research and clinical research and causes and pathogenesis of the disease and differentiation therapy have been made clear initially. Effective prescriptions for treatment have been developed. Although the western medicine in treating DC has much significant effects, the medicine has increased side effects and the illness always relapses. Through syndrome differentiation treatment, Chinese medicine can improve patients through the body's resistance to diseases and it has played a certain role in the control and improvement of the DC disease. What's more, it has improved the quality of life of patients, which is incomparable by western medicine. At present, the types of Chinese prepared medicine for treating DC are rare. Many prescriptions in treating DC have been recorded in the Chinese classical literature and pharmacological studies show that some of the Chinese medicine can not only lower blood sugar but also play a role on prevention and treatment of cardiovascular disease. The main contents and results of this study are as follows:1 Study on Chinese medical literature of DCⅠStudy on Chinese classical literatureThrough sorting out the classical literature in all ages, classifying the discussions of ancient physicians about DC, and making the conclusion that the causes of DC are weak endowment, improper diet, over-serving elixir, emotional disorders, over working and sexual life and the pathogenesis are deficiency of kidney yin, exuberance of heart fire, blood stasis obstrucing the collaterals, phlegm due to spleen deficiency and phlegm obstrucing. According to the application of the related prescriptions, the therapies of DC are summed up by nourishing qi and yin, clearing the heart fire, relieving convulsion, tranquilizing by nourishing the heart, both treating the heart and the kidney, eliminating dampness by invigorating the spleen and activating qi to excrete water. Besides, some related terminologies like "ge-xiao","fei-xiao","shang-xiao" have been discriminated.ⅡStudy on modern Chinese medical literature of DC(Ⅰ)Approch to the Chinese medical name of DC:the naming of DC can be divided into Diabetes·heart disease, Diabetes·chest pain, Diabetes·palpitations, Diabetes·diaphragm retention of fluid and edema.(Ⅱ)Approch to the etiology and pathogenesis:in the early stage:deficiency of heart yin,lack of heart yang; in the middle stage:heart blood stasis, phlegm obstrucing and accumulation of blood stasis and heat; in the later stage: yang deficiency of heart and kidney, water and fluid invading the heart.(Ⅲ)Therapeutical development of Chinese medicine for DC:differentiation therapies for different syndromes; differentiation syndromes for different stages; Chinese prepared medicine treatment; experimental study; study on the single herb.(Ⅳ) Development of research on DC by western medicine.2 Study on the law of differentiation therapies and prescriptionsTo explore the application of Chinese medicine and prescriptions of DC treatment in the ancinent and modern literature, the statistical analysis is used to study the law of compatibility of prescriptions and differentiation therapies in the treatment of DC by Chinese medicine.ⅠStudy on the law of classical differentiation therapies and prescriptions (Ⅰ) MethodsThe choice of the ancinent prescriptions depends on the Dictionary of Chinese Medical Prescriptions as the main retrieval. The classsical literature is chosen from Shanghan Lun written by Zhang Zhongjing in the Donghan dynasty to the late Qing period. The literature of prescriptions about heart syndromes like palpitation, irritancy and chest pain is chosen to the research. Then make the data standard, establish the database and use the statistical methods like frequency analysis and cluster analysis to explore the law of differentiation therapies and prescriptions.(Ⅱ) ResultsThe ancient precriotions in this study include 217 kinds of Chinese medicine involving 152 prescriptions before the Ming and Qing dynasties, 88 prescriptions in the Ming and Qing dynasties, for a total of 240 prescriptions. The medicine of high frequency appearing in the ancient prescriptions is:Radix ophiopogon, Baked Licorice, Ginseng, Coptis, Anemarrhenae, kirilowii root, raw land, skullcap, Tuckahoe, licorice, gypsum, bamboo root, radices puerarire, astragalus, red Poria, Schisandra, Rehmannia, Cinnamon, Fu Shen, white peony root, Morus alba, Cimicifuga, oysters.The frequency of previous five of medicine categories in the ancient prescriptions is tonic herbs, herbs for clearing away heat, herbs for eliminating phlegm and stopping cough, herbs for relieving exterior syndrome, herbs for excreting water and dampness; the high frequency of medical potency is cold, warm and ping; the high frequency of medical taste is sweet, bitter and pungent; the high frequency of meridian tropism is liver, lung, stomach, heart, spleen and kidney.The results of cluster analysis show that the DC therapies of the ancient prescriptions are clearing away heat, nourishing yin, strengthening the spleen to eliminate dampness and strengthening the spleen and kidney. The medicine is some kinds of sweet and warm for nourishing and strengthening the spleen to eliminate dampness.ⅡStudy on the law of modern differentiation therapies and prescriptions(Ⅰ)MethodsThe choice of the modern prescriptions depends on the VIP database as the main retrieval, combining with manual retrieval methods. The literature is screened from the academic journals and specialist books for the past 20 years reported about the medical treatment of DC. The related diseases and syndromes like chest pain, palpitations, or coronary heart disease, cardiomyopathy, arrhythmia, cardiac autonomic neuropathy are chosen for research. Then make the data standard, establish the database and use the statistical methods like frequency analysis and cluster analysis to explore the law of differentiation therapies and prescriptions. (Ⅱ) ResultsThis research includes two categories:the prescriptions of diabetic coronary heart disease and the prescriptions of DC, involving a total of 223 herbs. The prescriptions of DC are 275, involving prescriptions of diabetic coronary heart disease 120. The medicine of high frequency appearing in the modern prescriptions is Radix salvia miltiorrhiza, astragalus, Radix ophiopogon, Radix rehmannia, schisandra chinensis, rhizoma chuanxiong, Poria, Radix pseudostellaria, radices puerarire, angelica, ginseng, radices trichosanthis, red peony root, Scrophulariaceae, yam, berberine, safflower, Breit, Trichosanthes and cinnamomum ramulus. The medicine of high frequency appearing in the prescriptions of diabetic coronary heart disease is Radix salvia miltiorrhiza, astragalus, Radix ophiopogon, Radix rehmannia, schisandra chinensis, rhizoma chuanxiong, Poria and angelica.The frequency of previous five of medical categories in the modern prescriptions is tonic herbs, herbs for clearing away heat, herbs for removing blood stasis, herbs for regulating qi flow and herbs for excreting water and dampness. The high frequency of medical potency is cold, warm and ping. The high frequency of medical taste is sweet, bitter and pungent. The high frequency of meridian tropism is liver, stomach, spleen, lung, heart and kidney.The results of cluster analysis show that the DC therapies of the modern prescriptions are removing blood stasis, activating qi to relieve pain, tranquilizing by nourishing the heart, warming the yang qi, nourishing qi, eliminating dampness and resolving phlegm. The syndromes are deficiency of qi and yin, yin deficiency of liver and kidney, both deficiency of heart and spleen, yang deficiency of heart and kidney, blood stasis in the heart meridian, phlegm and qi obstructing the meridian, stagnation of yin-cold, accumulation of blood stasis and heat and water and fluid invading the heart.3 ConclusionⅠAccording to the frequency analysis of medical categories, the medicine of DC treatment is mostly tonic herbs, combining with herbs for clearing heat and removing dampness, promoting blood circulation, strengthening the spleen to eliminate dampness and activating qi to excrete water. This is decided by the pathogenesis of DC, the principal deficiency and sthenia of pathogenic factors like phlegm and blood stasis. ⅡAccording to the frequency analysis of medical potency and taste, the herbs for treating DC are sweet and warm, compatibility with the bitter and cold, sweet and warm for nourishing, bitter and cold for eliminating heat. This is the same with the pathogenesis of DC, the principal deficiency and sthenia of pathogenic factors like phlegm and blood stasis.ⅢAccording to the frequency analysis of meridian tropism, the meridian tropism of herbs for treating DC is mainly liver meridian and stomach meridian and the secondary is spleen meridian, lung meridian, heart meridian and kidney meridian. It can be seen that the treatments of DC by Chinese medicine are dispersing the depressed liver-energy, clearing away stomach heat, strengthening the spleen and nourishing the heart and the kidney.ⅣThe treatment of DC needs differentiation therapies according to different patients, and it should not be limited to a particular application or certain kinds of prescriptions for treatment. The clinical efficacy of DC can improve effectively only by adhering to the overall concepts and principles of differentiation therapies. This research aims to lay the foundation of Chinese medical literature, explore the etiology and pathogenesis of DC and the law of differentiation therapies and prescriptions and provide the basis for clinical medicine in the prevention and treatment of DC.