| Background:Diabetic Foot(DF)refers to the destruction of the skin and deep tissue far from the ankle joint in diabetic patients,which is often accompanied by infection and/or arterial occlusion of the lower extremity.In severe cases,muscle and bone tissue are involved.Peripheral neuropathy,peripheral arterial disease and foot deformity are the main reasons for the increased risk of diabetic foot.According to the Wagner scale of diabetic foot,high-risk diabetic foot was the early stage of diabetic foot,namely Wagner grade 0 diabetic foot,with risk factors for foot ulcers but no ulcers.Diabetic foot emphasizes prevention over treatment.Detailed foot examination should be conducted annually for diabetic patients,including medical history,symptoms,laboratory examination,neurovascular function examination,etc.At the same time,by strengthening health education,controlling blood sugar and cardiovascular factors,we can reduce the risk of complications in patients with diabetes,reduce the risk of ulcers and amputations in patients with high-risk diabetic foot,so as to prevent,diagnose and treat high-risk diabetic foot in an early stage.Over the past decades,many doctors have used a variety of traditional Chinese medicine therapy including internal and external treatment to treat diabetic foot,which has achieved certain curative effect and formed certain understanding.However,the current research status and development trend of "TCM treatment of diabetic foot" lack of systematic and integrated analysis and discussion.Citespace software can quickly and intuitively study the relevant literature in the field of "TCM treatment of diabetic foot".Currently,infrared thermography(IRT)technology is highly sensitive and accurate in temperature measurement.It can detect temperature changes caused by abnormal functional metabolism sensitively before abnormal morphology and structure of human body,thus effectively predicting diseases.Previous studies suggest that infrared thermal imaging can be applied to the early screening of all kinds of chronic metabolic diseases,and this technology is consistent with the classical theories of traditional Chinese medicine,such as "treating diseases without disease" and "treating diseases with external care",and can be interpreted from the perspective of traditional Chinese medicine.In this study,cold load excitation test technology was also introduced to apply low temperature stimulation to the skin surface to induce the dynamic changes of blood flow in blood vessels to generate infrared images.Infrared heat maps were continuously and dynamically collected within a specified time to avoid the false positive abnormal temperature area of the skin caused by temperature changes,providing a basis for the application of IRT in the early screening of high-risk diabetic feet.Objective:To use Citespace software to analyze literatures related to the treatment of diabetic foot by traditional Chinese medicine in China Knowledge Resources(CNKI),and to summarize the research understanding,current situation,treatment and other hot topics in this field,so as to provide reference for subsequent research.To explore the temperature distribution characteristics of the head,face,neck,torso,palms,legs and dorsum of feet under static infrared thermograms in patients with Type 2 diabetes mellitus(T2DM)and high-risk diabetic foot(DF).infrared thermography(IRT)provides a basis for the application of infrared thermography(IRT)in the early auxiliary diagnosis and disease assessment of high-risk diabetic feet.Methods:Study 1:citespace software was used to search and analyze 1560 literatures related to the treatment of diabetic foot by traditional Chinese medicine,summarize the authors,research groups,keyword clustering,keyword emergence,etc.,and explore the research process,hot spots and future development trend in this field.Study 2:This study is a prospective study.A total of 88 subjects were collected in this study and divided into normal group,DM group and diabetic high-risk foot group according to the diagnosis criteria of disease and DM and diabetic high-risk foot.The head and face,neck,torso,double palms,lower limbs and dorsum of feet of each group were selected as the region of interest(ROI).Static infrared heat map study was conducted,ROI temperature of subjects in each group was measured,and temperature characteristics of head,front torso,double palms and back of feet in infrared heat map of DM patients and high-risk diabetic foot patients were explored.The cold excitation test is excitation to both hands in cold water at 10℃.The fingertip and plantar ROI of infrared thermal maps in the normal group,DM patients and high risk diabetic foot patients are observed.The average temperature of ROI in each group is measured.To explore the fingertip and plantar temperature variation characteristics of DM and high risk diabetic foot patients with infrared heat map.Results:① Publication time:from 1995 to 2022,the number of published papers showed an increasing trend,reaching a peak of 117 in 2015;Research author and research institution cooperation network analysis:At present,there is no research institution with strong influence on the research in this field;Keywords co-occurrence analysis:related to external therapy:"external washing of traditional Chinese medicine","external treatment of traditional Chinese medicine"."external application of traditional Chinese medicine",etc.;Mainly involved in the name of the disease:"diabetes","ulcer","gangrene","thirst disease",etc.;Mainly involved clinical trials and methods:"review","curative effect","clinical research","clinical effect",etc.Keywords Cluster analysis:diabetic foot,TCM foot bath,ulcer,TCM syndrome type,Qi and Yin deficiency,nursing,TCM therapy,external treatment,clinical efficacy,review.The clustering module value(Q value)was 0.4284>0.3,indicating that the clustering structure was significant.The average contour value was 0.794>0.6,indicating good homogeneity of the clustering.Keyword breakout analysis:"Clinical effect" was the keyword with the highest mutation intensity,appearing from 2017 to 2022,followed by "wound repair" and "Chinese medicine treatment","acupoint massage","insulin" and "curative effect" also had high mutation intensity.Since the keyword "treatment group" appeared in 2003,each team gradually began to evaluate the efficacy of each treatment for diabetic foot,in order to select and match the treatment,in order to obtain better efficacy.The key words "ankle-brachial index" suggest screening for early diabetic foot,and suggest that early screening methods for diabetic foot become a hot research content.②In the static infrared heat map study,subjects of different genders in the normal group had basically the same temperature in the head and face,neck,front torso,back torso,hands,popliteus,legs and back of feet,and the difference was not statistically significant. In Sanjiao,Shanzhong,Zhongwan,Qihai,Shuangneiguan,Shuangwaiguan and Shuangzusanli points,the temperature of subjects of different genders was basically the same,and the difference was not statistically significant.In DM group,the frontal and lower focal temperature of male trunk was significantly lower than that of female body(P<0.05),and the temperature at middle focal point,Shanzhong point and Zhongwan point was significantly lower than that of female body(P<0.01).The temperature of head and face,right popliteal fossa and right calf in the high-risk diabetic foot group was significantly higher than that of female(P<0.05),and the temperature on the back of both calves was significantly higher than that of female(P<0.01).The temperature at right Neiguan point and right Zussanli point of women in high-risk diabetic foot group was significantly higher than that of men(P<0.05),and the temperature at Shanzhong point was significantly higher than that of men(P<0.01).③The comparison of three groups of male subjects showed that the infrared mean temperature of the three groups showed head>torso front>neck>hands heart>hands back>front legs>popliteal fossa>back legs.The temperature of neck and back of both legs in high-risk diabetic foot group was significantly higher than that in normal group(P<0.05).The dorsum of both feet in high-risk diabetic foot group was significantly higher than that in DM group(P<0.05).The comparison of the three groups of female subjects showed that the infrared mean temperature of the three groups showed trunk front>head>neck>hands heart>hands back>front legs>popliteal fossa>back legs.The head and face temperature of diabetic high-risk foot group was significantly higher than that of normal group(P<0.05).④ Three focal points and acupoints:male subjects in three groups were compared,and the three groups showed upper focal>lower focal>middle focal;Shuangzusanli>Shanzhong>Zhongwan.The average temperature of Shangjiao,Shanzhong,Zhongwan and Youneiguan points in high-risk diabetic foot group was significantly higher than that in normal group(P<0.05),and the average temperature of Zhongwan points in DM group was significantly higher than that in normal group(P<0.01).Female subjects in three groups were compared,the three groups showed medium focus>upper focus>lower focus.Tanzhong>Zhongwan.The average temperature at lower Jiao and Zhongwan points in high-risk diabetic foot group was significantly higher than that in DM group(P<0.05),and the average temperature at Qihai points was significantly higher than that in DM group(P<0.01).The average temperature of Qihai point in diabetic high-risk foot group was significantly higher than that in normal group(P<0.05).⑤Baseline period of cooling-load stimulation test:the mean temperature of fingertip and plantar of subjects of different genders in each group was basically the same,with no statistical significance(P>0.05).Comparison of male subjects in the three groups:Average fingertip temperature:the baseline average temperature of the three groups showed the characteristics:normal group>diabetic high-risk foot group>DM group,the average temperature was basically consistent among the three groups,and the difference was not statistically significant(P>0.05).Plantar mean temperature:The baseline mean temperature of the three groups showed characteristic characteristics:diabetic high-risk foot group>normal group>DM group;Compared with the DM group,the mean temperature of both plantar in the high-risk diabetic foot group was higher than that in the DM group,and the temperature increased in the right heel region with statistical significance(P<0.05),while the temperature increased in the left plantar region,right toe region and right arch region with statistical significance(P<0.01).Compared with the normal group,the average temperature of both plantar in the high-risk diabetic foot group was higher than that in the normal foot group,and the temperature in the left arch,left heel,right metatarsal and right heel areas increased with statistical significance(P<0.05).Comparison of female subjects in the three groups:Average fingertip temperature:average fingertip temperature was basically the same among the three groups,with no statistical significance(P>0.05);Average plantar temperature:Compared with the DM group,the average temperature of both plantar in the high-risk diabetic foot group was higher than that in the DM group,and the temperature increases in the right toe area,right metatarsal area,right heel area and left plantar had statistical significance(P<0.05).The average temperature of both plantar in the high-risk diabetic foot group was basically the same as that in the normal group,with no statistical significance(P>0.05).⑥Before and after cold load stimulation test:the average temperature changes of fingertip and sole of subjects of different genders in normal group,DM group and high-risk diabetic foot group were basically the same before and after cold load stimulation test,with no statistical significance(P>0.05).The comparison between the three groups of male subjects and the three groups of female subjects showed that the diabetic high-risk foot group was higher than the normal group and the DM group at all observation points,and the temperature pattern was DM group<normal group<diabetic high-risk foot group,the difference was statistically significant(P<0.05).Conclusions:①In the field of the treatment of diabetic foot by traditional Chinese medicine,the external treatment of traditional Chinese medicine is the main body,and the treatment is gradually optimized due to the refinement of the stages of diabetic foot.Finally,the overall plan of the treatment of diabetic foot by stages and layers is formed.The combination of early screening method and treatment of high-risk diabetic foot reflects the idea of "treating the disease without disease" in traditional Chinese medicine.② The infrared heat map study of the normal group,the DM group and the high-risk diabetic foot group showed that the ROI of the normal group was basically consistent with that of different genders.In DM group,the temperature of the head,neck,front torso,back torso,hands,lower legs and back feet of male were lower than that of female,and the temperature of the front torso was statistically significant.In the diabetic high-risk foot group,subjects of different genders showed head and neck,lower limbs and four ends:male>female;Body:Female>Male.③ The static temperature area of the high-risk diabetic foot group was lower than that of the normal group,and the limbs were higher than that of the normal group.All temperature areas in DM group were lower than those in high-risk diabetic foot group and normal group.④ Before and after the cold load stimulation test,the plantar temperature of the three groups showed an increasing trend,and the change of plantar temperature of the diabetic high-risk foot group was greater than that of the normal group and the DM group,and the ranking of temperature was DM<normal group<diabetic high-risk foot group.⑤Plantar temperature of high-risk diabetic foot patients will change abnormally after cold load stimulation test.Infrared thermal imaging technology combined with cold load stimulation test can detect and monitor the changes in foot temperature of high-risk diabetic foot patients and provide early warning. |
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