Transcript PowerPoint - American TCM Society 美国中医药针灸学会

国医节----1929年3月17日
The Therapeutic Effect and
Advantages of Chinese Medicine for
the Treatment of Diabetes Mellitus
中医治疗糖尿病的优势与进展
Prof.Hu Zhen
Wenzhou Medical College
[email protected]
巴西库利提巴市
1993
纳米比亚
1996-1998年
泰国
2005--2012
东方大学孔子学院
Confucius Institute at Burapha University
Thailand
2015/4/13
13
美国
2015/4/13
18
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In this book, the authors
emphasize certain key
principles commonly applied
in clinical practice.
Numerous case studies and
classical quotes are included
to assist the reader in
understanding the profound
concepts involved in
diagnosis and treatment.
The Basic Knowledge and
Advances in The Research
糖尿病的基本知识和研究新进展
Epidemiology
The diabetes mellitus is
geographically widespread,
occurring throughout the
world.
At least 171 million people
are currently affected with
diabetes
(According to the International Diabetes
Federation)
350
300
250
200
1985
2000
2025
150
100
50
0
the number of DM (million)
Epidemiology
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26 million diabetes cases in the United State.
79 million Americans with prediabetes.
Diabetes affects 8.3% of Americans of all ages
11.3% of adults aged 20 years and older,
About 27% of those with diabetes(7 million )
Americans—do not know the fact that they have
the disease.
Prediabetes affects 35% of adults aged 20 years
and older.
A 2011 Centers for Disease Control and Prevention (CDC) report (USA)
The top 10 countries
(in the number of people with diabetes)
India, China, the United States, Indonesia, Japan,
Pakistan, Russia, Brazil, Italy, and Bangladesh.
The Basic Knowledge and
Advances in The Research
糖尿病的基本知识和研究新进展
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One of the leading causes of morbidity and
mortality
The major cause of blindness in adults aged 2074 years
The leading contributor to end-stage of renal
disease (ESRD)
The leading cause of nontraumatic lower limb
amputations
TheBasic Knowledge and
Advances in The Research
糖尿病的基本知识和研究新进展
 Diabetes mellitus is a group of metabolic
disorders with one common manifestation:
hyperglycemia.
 Chronic hyperglycemia causes damage to the
eyes, kidneys, nerves, heart and blood vessels.
 The etiology and pathophysiology leading to
the hyperglycemia, however, are markedly
different among patients with diabetes mellitus,
dictating different prevention strategies,
diagnostic screening methods and treatments.
(1) The occurrence and development of
diabetes mellitus
糖尿病的发生与发展
Pancreatic β-cells ↓ Insulin Resistance
↓
Insulin
deficiency (defective insulin secretion, insulin action )
↓
Abnormal Metabolism(hyperglycemia )
↓
Oxidative Stress
↓
diabetes mellitus
↓
diabetic complications
(damage, dysfunction and failure )
kidney, eye, nerves, heart and blood vessels
Simplified scheme for the pathophysiology of
type 2 diabetes mellitus
(2)Criteria for the diagnoss of diabeters
mellitus and impaired glucose homeostasis
糖尿病诊断标准（WHO 和IDF 标准）
①Classic symptoms of diabetes mellitus ：
polyuria、polydipsia、polyphagia、weight loss
②Fasting plasma glucose FPG
≥7.0mmol／L（126mg／dL）
③2hr postprandial plasma glucose
≥11.1mmol／L（200mg／dL）
 DM:hemoglobin A1c diagnostic tests （ HbA1c）
≥6·5%(ADA: 2010)
美国糖尿病协会（ADA），
在2003 年11 月，则将IFG 的诊断标准从
6.1mmol／L （110mg／dL） 下调为5.5mmol
／L（100mg／dL）。
 2010年ADA
:hemoglobin A1c diagnostic tests （ HbA1c）
≥6·5%列为糖尿病诊断标准之一,并将
HbA1c≥5·7%作为糖尿病筛查标准之一。
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(2)Criteria for the diagnoss of diabeters
mellitus and impaired glucose homeostasis
糖尿病诊断标准（WHO 和IDF 标准）
④Impaired fasting glucose IFG:
fasting plasma glucose FPG
≥6.1mmol ／L（110mg／dL）
＜7.0mmol／L（126mg／dL）
⑤Impaired glucose tolerance IGT :
2hr postprandial plasma glucose
≥7.8mmol／L（140mg／dL
＜11.1mmol／L（200mg／dL）
Classification
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2.
3.
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1.
2.
Type 1 diabetes
(insulin-dependent diabetes mellitus IDDM)
pancreatic beta-cell destruction
ketoacidosis
autoimmune process
type 2 diabetes
(non-insulin-dependent diabetes mellitus NIDDM)
insulin resistance
inadequate insulin secretion due to pancreatic
beta cells.
(3)The treatment for diabetes mellitus
糖尿病的治疗
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No effective treatments have been identified
Lowering blood sugar (hemoglobin A1c )
Reducing the blood pressure
Lowering blood lipids
Controlling the risk factors
(a program of diet and exercise -- risk reduction about 25%)
Rational administration of drugs for DM
（OAD）
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1.
2.
3.
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1.
2.
Prof Ralph DeFronzo
advocate
The treatment based on the etiology
Early diagnosis
Combined Therapy ( the β-cell proliferation )
Approaches:
Life style intervention
Three Drugs Combined Therapy
Troglitazone TZD(噻唑烷二酮)、
Metformin(二甲双胍)
Exenatide(依克那肽)
Other treatment approaches
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Gastric bypass(GBP)
胃旁路手术
Stem cells
干细胞技术
The Advantages of Chinese Medicine for the
Treatment of Diabetes Mellitus
中医治疗糖尿病优势
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Treating the human body as a whole
Individualized treatment
a treatment for a patient
Prevention and cure of complications
(1) Treating the human body as a whole
整体调节
Treatment based on differentiation of symptom-complex
1 Selecting acupoint along channel (循经取穴)
三焦经穴外关为主穴
，
2 Selecting acupoint
based on differentiation of symptomcomplex(辩证论治取穴)
肺脾肾
3 Biological holographic theory （生物全息理论取穴）
耳穴
Effects of multi-targets
多靶点作用
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Protect β-cells and stimulate insulin secretion
Increase insulin receptors and affinity
Inhibit glucagon secretion
Enhance the ability of utilization of sugar in
target organs and tissue
Correct metabolic disturbance of carbohydrate,
fat and protein
Improve microcirculation
Dazhui(大椎) moxibustion
Shenque(神阙) moxibustion
 Reduce the level of fasting blood glucose ，
 Increase the capacity response of glucose load
of Pancreatic lslet Beta Cells，
 Increase the excretion of insulin
The comprehensive therapy
综合性治疗
Alimentary therapeutics饮食、
Cinesiatrics 运动、
Message 推拿、
Acupuncture and moxibustion 针灸、
Pharmacotherapy药物
(2) Individualized Treatment
个体化治疗
To identify the nature and location of a disease
辨性定位
 To infer the cause and judge the pathogenesis of a
disease
求因审机
 To differing conditions in terms of locality, time, and
persons involved
因人、因地、因时制宜
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辨证分型
Clinical Stage and Type
三消论治Triple diabetes
diabetes involving the upper warmer----lungs
上消：肺
diabetes involving middle warmer ----spleen
中消：脾
diabetes involving the lower warmer----kidney
下消：肾
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Three types
《the Chinese herbal medicine new medicine
clinic research guideline 》
三型《中药新药消渴病（糖尿病）临床研究指导原则》
extreme heat due to deficiency of yin
in an early stage(阴虚热盛--早期）

deficiency of both qi and yin
in a middle stage（气阴两虚--中期）
 yin-yang deficiency
in a Late stage（阴阳两虚--晚期）
 accompanying symptoms（兼证）
1.
stagnant blood and blood stasis(血瘀脉络)
2.
dampness and heat in spleen(湿热困脾)
Five stages and five types(五期五型论治)
Chinese Diabetes Association diagnosis criteria of
diabetes mellitus in 1991
1991年全国糖尿病学会辩证标准
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Preclinical(糖尿病前期)
Prodrome period(糖尿病症状期)
Early complications糖尿病合并症早期
Middle complications糖尿病合并症中期
Late complications糖尿病合并症重危期
脏腑论治
differentiation of diseases according to
pathological changes of the viscera and their
interrelations
The Prescriptions of TCM
White Tiger Decoction(白虎汤）
Shanghan Lun (treatise on Exogenous伤寒论）
Shigao(石膏）（Gypsum Fibrosum) 50g
Zhimu (知母）（ Rhizoma Anemarrhenae）18g
Gancao(甘草）（Radix Glycyrrhizae)6g
Jingmi(粳米） （Semen Oryzae Sativae)9g
Actions: Clearing away heat
Promoting the production of body fluid
Clinical Application: High fever,polydipsia, profuse
perspiration ,large pulse
The Prescriptions of TCM
Yunu Jian (玉女煎）
Jingyue Quanshu (jingyue’s Complete Works)
景岳全书
Shigao (石膏Gypsum Fibrosum) 50g
Dihuang (地黄Radix Rehmanniae )6g
Maimendong (麦门冬Radix Ophiopogonis)6g
Zhimu(知母 Rhizoma Anemarrhenae)5g
Niuxi(牛膝Radix Achyranthis Bidentatae)5g
Actions: Clearing away stomach-heat
nourishing yin of stomach
Clinical Application: syndrome of stomach-heat and yin deficiency
The Prescriptions of TCM
Shenqi Wan(肾气丸)
Jingui Yaolue (synopsis of prescriptions of the Golden Cabinet)
Shengdihuang(Radix Rehmanniae)240g
Shanyao (Rhizoma Dioscoreae)120g
Shanzhuyu(Fructus Corni)120g
Zexie(Rhizoma Alismatis)90g
Fuling(poria)90g
Mudanpi(Cortex Moutan Radicis)90g
Guizhi ( Ramulus Cinnamomi) 30g
Fuzi(Radix Aconiti)30g
Actions: Warming and invigorating kidney- yang
polyuria、polydipsia
The disease patteren defined in the Internal
Canon of Medicine
《内经》消渴发病模式
 Xiaoke was first mentioned in the Internal
Canon of Medicine
消渴之名首见于《内经》
The disease patteren defined in the Internal
Canon of Medicine
《内经》消渴发病模式
Etiologic factors

deficiency of the spleen and stomach(脾胃虚弱)
“脾脉微小为消阐” 《灵枢・邪气脏腑病形篇》

heat formation due to food stagnation (食滞化热)
“脾阐，此肥美之所发也，此人必数食甘美而多肥也，肥者令人内热，
甘者令人中满， 故其气上溢，转为消渴” 《灵 枢・奇病论》

functional injury of the spleen by medicine
(药物伤脾)
“夫石药之气悍，适足滋热，与热气相合，必内伤脾，此药石之渴
也”。张子和在《儒门事亲》
The disease patteren defined in the Internal
Canon of Medicine
《内经》消渴发病模式
甘美
中满
脾虚 + 数食 —— 令人 —— 消渴
多肥
内热
deficiency of the spleen
a large number of food --------internal heat------- Xiaoke
(sweet + fat )
food stagnation
A formula for Xiaoke recorded in the Internal
Canon of Medicine
《内经》消渴的治方
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“治之以兰（佩兰eupatorium） ，除陈气也”
The treatment based on Spleen
消渴从脾论治
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Nourishing Spleen Yin：
玉竹yuzhu(radix polygonati officinalis )、石斛
shihu(dendrobe)
Reinforcing Spleen Qi：
黄芪huangqi(Astragalus mongholicus )、山药
shanyao(Chinese yam)
Eliminating Spleen Dampness：
白术baizhu(bighead atractylodes rhizome )、茯
苓fuling(Poria cocos )
The treatment based on Spleen
消渴从脾论治
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Clearing Spleen Heat：
黄连huanglian(the rhizome of Chinese
goldthread); 知母zhimu(rhizoma anemarrhenae )
Promoting Spleen Yang：
葛根gegen（the root of kudzu vine） 、升麻
shengma(rattletop )
Warming Spleen Yang：
桂枝guizhi(cassia twig )、 附子fuzi
（monkshood ）
Experimental Research on SQ-Complex
Prescription
升清降糖合剂实验研究
1.材 料 与 方 法
Materials and methods
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1.1 laboratory Animal实验动物：
Male clean degree SD rats 45，with a body
mass from 200g to 240g
1.2 Test Drug ：
SQ-Complex Prescription(升清降糖汤)
葛根the root of kudzu vine ，黄芪Astragalus mongholicus
2.实验方法
Experimental Method
2.1 Establishment of rat model
and
group division
 2.2 Dose and Administration
 2.3 Sample Collection
2.5 Data Analysis (by statistical package )
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3.实 验 结 果
Experimental results
3.1升清降糖合剂对糖尿病大鼠一般状况的影响
effect of SQ-Complex Prescription on the general
status of diabetic rats
 Normal group(正常组) :
normal drinking and food intake ，a silky coat ,
flexible mobility ，bowel acting properly 。
 Model group(糖尿病模型组):
polydipsia, polyphagia, polyuria ，lost weight ，fur
lackluster ，decrease in activity ，
 Treatment group:
Better in the general status ，
3.2升清降糖合剂对糖尿病大鼠血糖值的影响
Effects of SQ-Complex Prescription on the levels of blood
glucose of diabetic rats
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The results fasting serum glucose (Treatment lasting 60 days ):
Model group: before and after the treatment no
obvious difference (P>0.05) in blood glucose ，
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Treatment group and model group:
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significant difference after treatment (P<0.05) in
both groups and the treatment group was
effective 。
3.3 升清降糖合剂对糖尿病大鼠胰腺病理的影响(见附
图)Effect of SQ-Complex Prescription on Pathology of
Pancreas of DiabeticRats
图1 糖尿病模型组
Model group(模型对照组)：
loose in the pancreatic
islets structure ，islet cell
atrophy fibrosis were
formed in islets，
图2 升清降糖合剂中剂量组
Treatment group(升清降
糖合剂组):normal
pancreatic islets,A tiny
amount of islet cell
atrophy
图3 正常对照组
Normal group
(正常对照组)：
结论
Conclusion
1）The results show that SQ-Complex
Prescription improves the status of diabetic rats,
reducing the level of blood glucose
2）The results show that SQ-Complex
Prescription improves the number of Pancreatic
Islet β Cells in rat and protects diabetic rats’
pancreas
(3)Prevention and Cure of Complications
防治并发症
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The disorders are characterized by
hyperglycemia
associated with
2.
microvascular (ie, retinal, renal, possibly neuropathic),
macrovascular (ie, coronary, peripheral vascular),
3.
neuropathic (ie, autonomic, peripheral) complications.
1.
Diabetic Enteropathy
Diabetic enteropathy ' is a condition in which patients
suffer episodes of diarrhea and watery stool , or
constipation and diarrhoea appear alternately . The
effects on diabetic control, physical health and
emotional quality of life are severe. Patients do not
respond reliably to general supportive management or
conventional medications. Surgical options have
disappointing results. The need for more effective
treatment is acknowledged universally
 Treatment by Chinese herbs
 Acupuncture and moxibustion
 Herbal coloclysis
Buzhong Yiqi Tang(补中益气汤）
黄芪Huangqi (radix astragali seu hedysari)18g
甘草Gancao （radix glycyrrhizae)9g
Renshen(radix ginseng)6g
Danggui(radix angelicae sinensis)3g
Jupi(pericarpium citri reticulatae)6g
Shengma(rhizoma cimicifugae)6g
Chaihu(radix bupleuri)6g
Baizhu(rhizoma atractylodis macrocephalae)9g
Zengye Chengqi Tang(增液承气汤）
purgative decoction for increasing fluid
玄参Xuanshen(radix scrophulariae)30g
麦门冬Maimendong(radix ophiopogonis)25g
生地黄Shengdihuang(radix rehmanniae)25g
大黄Dahuang(radix et rhizoma rhei)9g
芒硝Mangxiao(natrii sulfas)5g
Neutrogenic bladder
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The normal function of the urinary bladder is to store
and expel urine in a coordinated, controlled fashion.
This coordinated activity is regulated by the central and
peripheral nervous systems. Neurogenic bladder is a
term applied to a malfunctioning urinary bladder due to
neurologic dysfunction or insult emanating from
internal or external trauma, disease, or injury.
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Treatment by Chinese herbs
Acupuncture and moxibustion
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Shenqi Wan(肾气丸)
Jingui Yaolue (synopsis of prescriptions of the Golden Cabinet)
Shengdihuang(Radix Rehmanniae)240g
Shanyao (Rhizoma Dioscoreae)120g
Shanzhuyu(Fructus Corni)120g
Zexie(Rhizoma Alismatis)90g
Fuling(poria)90g
Mudanpi(Cortex Moutan Radicis)90g
Guizhi ( Ramulus Cinnamomi) 30g
Fuzi(Radix Aconiti)30g
Actions: Warming and invigorating kidney- yang
polyuria、polydipsia
Diabetic Nephropathy
3.
Diabetic nephropathy is the leading cause of chronic kidney
disease. It is also one of the most significant long-term
complications in terms of morbidity and mortality for individual
patients with diabetes. Diabetes is responsible for 30-40% of all
end-stage renal disease (ESRD) cases in the United States.
Diabetic nephropathy is a clinical syndrome characterized by
the following:
Persistent albuminuria (>300 mg/d or >200 μg/min) that is
confirmed on at least 2 occasions 3-6 months apart
Progressive decline in the glomerular filtration rate (GFR)
Elevated arterial blood pressure
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Treatment by Chinese herbs
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