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Article in Chinese | WPRIM | ID: wpr-872780


A good neural microenvironment is an important basis for improving the damaged nerves and promoting axonal repair and regeneration. The destruction of neural microenvironment, closely related to the lack of neurotrophic factors, microcirculation disorders and immune abnormalities, is the key pathogenesis leading to diabetic peripheral neuropathy (DPN). In traditional Chinese medicine, disharmony between Ying and Wei is considered as the key pathology in the development of DPN. It may be manifested as Ying and Wei deficiency, or Ying and Wei impassability, or Ying, Wei, Qi and blood intersection disorders, all of which may cause body fluid condensed into phlegm, blood into blood stasis, further leading to the mutual knot of phlegm and blood stasis, meridian obstruction, numbness and pain of limbs. "Regulating Ying and Wei and tonifying spleen and stomach" is the main therapeutic idea to promote intersection between Ying and Wei and unblock Qi and blood. The method has a significant effect on DPN. However, the current studies on the mechanism of regulating Ying and Wei in the treatment of DPN are still in lack of in-depth discussion, and the studies are mostly limited to the microcirculation disorders. Numerous studies have confirmed that the courses and distribution, physiological characteristics, functions of Ying and Wei are closely related to nerve, immune, metabolic substances and microcirculation. Based on the modern medicine essence of Ying and Wei, the author thinks that the discussion on connotation of the Ying and Wei from the perspective of neural microenvironment has a scientific basis, and regulating Ying and Wei is not only inherited from the traditional Chinese medicine theory, but also conforms to the modern understanding on DPN pathogenesis and treatment. Regulating Ying and Wei and smoothing middle-jiao can improve neural microenvironment and give play to the role of restoring damaged nerve, and its mechanism may be related to regulating neurotrophic factors, immune active substances, metabolites, and microcirculation dysfunction.

Article in Chinese | WPRIM | ID: wpr-801851


The gut microbiota and its metabolites play a critical role on health maintenance, because they are involved in the absorption and metabolism of nutrients in the human bodies. This is also similar to traditional Chinese medicine (TCM) view that the ascending and descending of Qi movement affects Yin-Yang, Qi-blood, pneuma and body fluid, viscera and meridians of our bodies. More and more studies have demonstrated that gut microbiota is closely related to the development and progression of diabetes and its complications. Gut microbiota disorder could affect host metabolic signaling pathways, thereby promoting the formation and development of diabetes. The smooth ascending and descending of Qi movement is the basic form of maintaining host metabolic homeostasis, whose dysfunction however can lead to internal environment disturbance. Based on the theory of ascending and descending of Qi movement, this paper focuses on the pathogenesis of imbalanced intestinal flora in the process of the induction of diabetes mellitus from a dynamic perspective. It is assumed that the imbalance of Qi ascending and descending may act as a trigger for such symptoms as lung Qi impairment, spleen deficiency to dissipating essence, liver Qi stagnation and kidney Yang deficiency. Under this circumstance, gut microbiota will be out of balance, which will further lead to the nutrient substance metabolic disturbance in the body, and thus induce diabetes. Thus, it is significant to explore the regulatory mechanism of gut microbiota and its metabolites on diabetes based on the theory of ascending and descending of Qi movement, so as to reveal the scientific connotation of TCM in regulating substance metabolism homeostasis in the body.

Article in Chinese | WPRIM | ID: wpr-798519


Reducing glycemic excursion is of great importance to the successful practice for diabetes intervention and complication prevention. This is also an advantage of traditional Chinese medicine (TCM) in the treatment of diabetes. More and more studies have shown that the dysfunction of islet microcirculation is the key pathological link for glycemic excursion caused by decrease of islet function. The over-activation of local renin-angiotensin system (RAS) in islet microcirculation is a key ring to the islet decompensation, intimately related to the functionality of islet endocrine cells, and has gradually become the focus in the study of islet functionality. In TCM, it is believed that glycemic excursion in diabetes mellitus is closely related to the incapability of "spleen Qi to dispersing essence". If spleen fails to disperse essence, the essence will be accumulated in the body and become harmful stuffs. The stuffs further break the blood glucose homeostasis, acting as the key pathogenesis of diabetes. By supplementing the "spleen" Qi and promoting the dispersion of nutrient substance (hormone) in "pancreas", the balance between sugar-regulated hormones can be restored and therefore glycemic excursion can be reduced. However, the regulation mechanism of "spleen Qi to dispersing essence" on glycemic excursion remains unclear at present. Based on the previous clinical and scientific work, the following ideas were proposed by the authors:the effects of "spleen Qi to dispersing essence" on the improvement of islet function and the regulation of glycemic excursion may be achieved by promoting islet microcirculation, and its mechanism may be related to inhibiting the activation status of local RAS in islet microcirculation. It is important to note that the mutual antagonistic relationship between the signal pathways of RAS in islet microcirculation is similar to the antagonistic relationship between "spleen Qi to dispersing essence" and spermatozoa in TCM. Thus, the mechanism of "spleen Qi to dispersing essence" on the regulation mechanism of blood glucose fluctuations needs to be further explored from the perspective of the overall regulation of RAS in islet microcirculation, so as to reveal the scientific connotation of TCM on regulating the body's environmental homeostasis and reducing glycemic excursion in diabetic patients.

Journal of Medical Postgraduates ; (12): 1192-1195, 2018.
Article in Chinese | WPRIM | ID: wpr-818009


The metabolic memory formed by early hyperglycemia in diabetes is one of the important factors triggering the development of diabetes and relavant complications. At present, treatment of various adverse factors of metabolic memory shows a limited clinical efficacy. In recent years, exosome emerged as an important mediator of cellular communication and have gradually gained importance attendance in the field of diabetes treatments. This review summarizes the main mechanisms involved in the metabolic memory of exosomes in the pathological state, including inflammation, insulin resistance, oxidative stress and apoptosis. In addition, protection mechanisms of the stress pretreatment and stem cells derived exosomes on metabolic memory are discussed in this review. Finally, the possible ways to obtain therapeutic exosomes are elaborated, which is beneficial to generate new ideas for the clinical drug treatment.