Study On The Syndrome Differentiation And Drug Usage Of Diabetic Foot In Traditional Chinese Medicine

Diabetic foot(DF) is one of the serious chronic complications, which is gradually appeared in the natural course in diabetic patients. The survey found that patients with diabetic foot are mostly aged people,who have the characteristic of low education degree, low income, higher incidence、morbidity and medical costs.In the United States,15%～25% of patients have a risk of foot ulcer among 22.3 million diabetes patients.The report said that the recurrence rate of ulcer is 30%～40% in patients with Diabetic foot ulcers after one year healing. DF’s high medical costs has a positive correlation with patients whom have diabetic nephropathy, the degree of ulcer, infection, etc.So far the treatment of DF is mainly about the combination of Chinese and western medicine. A large number of clinical studies show that traditional Chinese medicine combined with western medicine treatment on DF is much more effective than that of western medicine treatment only.Objective:Treatment based on syndrome differentiation is one of the basic principles of traditional Chinese medicine in treating disease and embodies the therapeutic view which varies from person to person.The studies of syndrome differentiation type on DF is active, and modern physicians have different understanding about it. The literature based on the study of drug laws. So it is necessary to research common syndrome differentiation type of DF and to further study drug laws and characteristics of DF. On the one hand it can provide data support for standardization of DF syndrome differentiation, at the same time to discuss the pathogenesis of DF,on the other hand it can improve the clinical efficacy and better prevention by studying the drug laws and characteristics and summarizing the doctor medicine experience for the treatment of DF.Methods:To collect literature published in China hownet (CNKI), wanfang data knowledge service platform, weipu database related to Chinese medicine treatment for diabetic foot from January 1,2000 to January 1,2016. By adopting keywords like "diabetic foot" "syndrome differentiation" "syndrome classification" etl, we include the standard literature, then figer out statistics analysis on syndrome differentiation type and frequency, prescription, the type/frequency/four properties/five flovor/meridian of TCM. Using factor analysis method to probe into the rule of drug use and syndrome types of diabetic foot.Results:1.It is concluded that there are seven kinds of common syndrome differentiation by analyzing 117 standard literature. They are,in turn, blood stasis winding resistance syndrome, toxic heat flaming syndrome, qi and Yin deficiency-blood stasis syndrome, damp and hot flaming syndrome, qi and Yin deficiency syndrome, qi and blood deficiency syndrome, qi deficiency and blood stasis syndrome.2.By decomposing all syndrome type into a single element, obtained before 7 syndrome factor, respectively is blood stasis, Yin deficiency, qi deficiency, toxic heat, damp and hot, Yang deficiency, blood deficiency.3. According to the frequency, the first 12 taste of traditional Chinese medicine of seven common syndrome classification respectively are listed below:①Blood stasis winding resistance syndrome:angelica, safflower, rhizoma ligustici wallichii, semen persicae and radix paeoniae rubra, twotooth achyranthes root, radix rehmanniae, radix astragali, bitter orange, liquorice, frankincense and myrrh.②toxic heat flaming syndrome:honeysuckle, angelica, dandelion, radix scrophulariae, herba violae, radix paeoniae rubra, forsythia, twotooth achyranthes root, salvia miltiorrhiza and radix glycyrrhizae, cortex moutan, earthworm.③qi and Yin deficiency-blood stasis syndrome:astragalus, angelica sinensis, rhizoma ligustici wallichii, radix rehmanniae, peach kernel, safflower, twotooth achyranthes root, radix paeoniae rubra, radix paeoniae alba, radix scrophulariae, salvia miltiorrhiza, licorice.④damp and hot flaming syndrome:honeysuckle, angelica, radix scrophulariae, cortex phellodendri, radix glycyrrhizae, radix paeoniae rubra, forsythia, Chinese violet, dandelion, glabrous greenbrier rhizome, rhizoma coptidis, rhizoma atractylodis.⑤qi and Yin deficiency syndrome:astragalus, codonopsis, salvia miltiorrhiza, angelica, radix rehmanniae and rhizomo chuanxiong, twotooth achyranthes root, dwarf lilyturf, poria cocos, radix scrophulariae, atractylodes, radix paeoniae alba.⑥qi and blood deficiency syndrome:angelica, atractylodes, prepared rhizome of rehmannia, radix paeoniae alba, radix astragali, radix glycyrrhizae, poria cocos, rhizoma ligustici wallichii, dangshen, ginseng, Chinese honeylocust spine, cinnamon.⑦qi deficiency and blood stasis syndrome:astragalus root,angelica,safflower, radix paeoniae rubra, rhizoma ligustici wallichii, peach kernel, earthworm,atractylodes,caulis spatholobi, achyranthes, dangshen, poriacocos.Conclusion:1.The common syndrome differentiation of DF are blood stasis winding resistance syndrome, toxic heat flaming syndrome, qi and Yin deficiency-blood stasis syndrome, damp and hot flaming syndrome, qi and Yin deficiency syndrome, qi and blood deficiency syndrome, qi deficiency and blood stasis syndrome.2. The nature of DF is intermingled deficiency and excess, deficiency include Yin deficiency,qi deficiency,yang deficiency,blood deficiency, excess is mainly blood stasis, toxic heat, damp and hot.3. Diabetic foot have internal mechanism that is Yin deficiency with internal heat of Diabetes Mellitus,but obviously exist the pathological factors of blood stasis and damp and hot, for a long time can cause toxic heat.4. The syndrome differentiation of DF should be given priority to viscera syndrome differentiation, combining of differentiation of qi-blood-body fluid5. The therapy of activating blood to resolve stasis runs through the treatment of each syndrome differentiation of DF. For the problem of blood stasis, can use the traditional classical prescription of Buyanghuanwu decoction add-subtract, drugs for promoting blood circulation should be given priority to angelica sinensis.6. Treatment for diabetic foot should attach importance to invigorating spleen and supplementing qi, with small dose of astragalus membranaceus is first selection.7. Toxic heat flaming syndrome and damp and hot flaming syndrome can use simiaoyong’an decoction with wuwei xiaodu drink add-subtract.8. In the treatment of DF,the pharmaceutical taste should be given priority to bitterness, sweetness, pungency, drug properties should be given priority to cold and warm, cold property is particularly suitable for toxic heat flaming syndrome and damp and hot flaming syndrome, cold medicine do not overuse in treatment of DF, meridian tropism is given priority to liver heart spleen stomach lungs kidney meridian.