RESUMO
To develop a traditional Chinese medicine （TCM） diagnostic scale for type 2 diabetes mellitus with turbid-toxin accumulation syndrome and to validate the performance of the scale. A candidate pool was established through literature review and expert consultation， and a clinical case information collection form was developed accordingly. Patients with type 2 diabetes mellitus admitted to the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from July 2021 to January 2022 were investigated， and 312 valid clinical case information collection forms were obtained， which were randomly divided into 235 cases in the study group and 77 cases in the validation group. Four statistical methods， namely， differentiation analysis， Cronbach's coefficient， correlation coefficient， and stepwise regression， were used to screen out the candidate items， and Logistic regression analysis and factor analysis were used to assign weights to the items， and the final diagnostic model was determined by the receiver operating characteristic （ROC） curve， and the diagnostic thresholds were calculated for the Yoden index. The final TCM diagnostic scale for type 2 diabetes mellitus was composed of 8 items： turbid dirt coating （with a weight value of 23， the same below）， sticky stools （16）， fullness in the epigastrium and abdomen （12）， dark complexion （12）， irritability （11）， brown spots on the skin （11）， heaviness of head （10）， and chest stuffiness （5）， and the degree score was 0， 0.5， 1.0， and 1.5 points corresponding to no， mild， moderate and severe symptoms， respectively. The total score was the sum of the degree score multiplied by the weighted value of each item， and when the total score reached 33 points， it is diagnosed as the turbid-toxin accumulation syndrome. The established scale was tested and evaluated in the study group and the validation group， and the results showed that the sensitivity of the study group and the validation group was 89.38% and 89.47%， with the specificity of 95.90% and 89.74%， the Yoden index of 0.85 and 0.79， the positive predictive value of 95.28% and 89.47%， the negative predictive value of 90.70% and 89.74%， the diagnostic advantage ratios of 198.18 and 72.67， and the Kappa values of 0.86 and 0.79， which indicated that the TCM diagnostic scale for turbid-toxin accumulation syndrome of type 2 diabetes mellitus showed good diagnostic ability.
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This paper summarized clinical experience of treating recurrent subacute thyroiditis based on the theory of internal toxin. It is believed that the core pathogenesis of recurrent subacute thyroiditis is the accumulation of internal toxin. The dysfunction of the spleen in transportation leads to the internal retention of turbidity， which serves as the basis for the formation of toxins. The combination of fire， dampness， and toxins is the key to the disease mechanism. Prolonged accumulation of dampness and turbidity leads to the formation of phlegm， fire， and stasis， and prolonged accumulation of pathogenic factors transforms into secondary toxins. For patients with severe fire， dampness， and toxins， the treatment focuses on dispersing stagnated liver qi， invigorating spleen， and differentiation treatment of fire and water， using a self-designed Chaihu Jiedu Decoction （柴胡解毒饮）. For patients with spleen deficiency and toxin accumulation， the treatment focuses on invigorating the spleen， eliminating turbidity， and cutting off the source of toxins， using a self-designed Shiwei Baizhu Powder （十味白术散）. For patients with yang deficiency and toxin stagnation， detoxification is combined with warming yang， nourishing blood， and supporting toxin expulsion， using a self-designed Heyang Baidu powder （和阳败毒散）.
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Space-time is extremely attached importance to in the thinking of recognizing diseases and syndrome differentiations in TCM. For instance, internal/external and upper/lower in Neijing, are the concept of compartmentalization of the tissue and structure in the body, also are the mechanism of recognizing generations and changes of diseases by combining both space and time organically. Moreover, the thinking of upper/lower and internal/external syndrome differentiations and treatments in TCM constitute a relatively completely space-time system, which are in favor of systematicness and integrality of syndrome differentiation and analysis, and then are usually used clinically. Therefore, upper/lower syndrome differentiation is the medical concept deriving from yin/yang. However, it exceeds mechanical space-time concept, also has the meaning of‘principle’ to guide syndrome differentiation and treatment. Thus, raising an issue that blending the thinking of upper/lower syndrome differentiation into eight principles and other methods of syndrome differentiation, in order to make methods of syndrome differentiation more practical.
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In this paper,we study on turbidity-toxin from the connotation,the pathological characteristics and process of diabetes,and explored the relationship of type 2diabetes with abnormal lipid metabolism and lipid toxicity.We found that insulin resistance,apoptosis of Islet,cell and various complications caused by abnormal lipid metabolism and lipid toxicity had signifi cant correlation with the process of the generation and variation of turbidity-toxin:it was argued that blood turbidity and its subsequent toxin accumulation were the pathogenic basis of the formation,combing with the turbidity-toxin,phlegm and blood stasis,then various complications occurred.So it provided a good theoretical and practical foundation for further treatment of type 2 diabetes associated with abnormal lipid metabolism by removing turbidity and detoxication.
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<p><b>OBJECTIVE</b>To investigate the clinical efficacy of modified huanglian wendan decoction (MHWD) on diabetic asymptomatic myocardial ischemia.</p><p><b>METHODS</b>Ninety patients were randomly divided into two groups. The control group (n=30) was given Xinkang tablet (XKT) at a dose of 20 mg, twice a day. The treated group (n=35) was given MHWD besides XKT as that given to the control group. The treatment course for both groups was 1 month. Indexes, including blood glucose, glycosylated hemoglobin, blood lipids, myocardial zymogram, hemorheologic parameters, urinary albumin, routine examination of blood and urine, function of liver and kidney, as well as 24h dynamic electrocardiogram and electrocardiogram exercise test were measured in the two groups before and after treatment.</p><p><b>RESULTS</b>The total clinical effective rate in the treated group and the control group was 88.33% and 56.67% respectively (P < 0.05), showing significant difference between them. The frequency of ischemia attacking, paroxysmal cumulative time, motion related incidence were lower in the treated group after treatment than those in the control group. Besides, in the treated group after treatment, the level of blood lipids and hemorheologic parameters were significantly improved (P < 0.05 or P < 0.01), hematocrit was unchanged and triglyceride, red blood cell agglutination index and erythrocyte deformability index were obviously different to those in the control group (P < 0.05). While in the control group after treatment, except the improving of whole blood viscosity (P < 0.05), no significant change was found in the other indices.</p><p><b>CONCLUSION</b>MHWD has effects in improving myocardial ischemia, bettering hemorheologic condition and reducing blood lipids.</p>
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 2 , Sangue , Tratamento Farmacológico , Esquema de Medicação , Medicamentos de Ervas Chinesas , Usos Terapêuticos , Agregação Eritrocítica , Deformação Eritrocítica , Hemorreologia , Isquemia Miocárdica , Sangue , Tratamento Farmacológico , FitoterapiaRESUMO
The clinical effect on treatment of diabetic retinopathy with acupuncture plus herbal decoction has been observed. Eighty cases were randomly divided into treatment group and control group by the odd and even serial numbers. Forty cases in the treatment group were treated with needling Taiyang (Ex-HN 5), Yangbai (GB 14) toward Yuyao (Ex-HN 4) and Cuanzhu (BL 2) plus the herbal decoction called Mingmu Wuzi Decoction. Forty cases in the control group were treated with intravenous drip of Venorutin and oral administration of dipyridamole and vitamin E. And the result showed the total effective rate of 92.5% in the treatment group and that of 55.0% in the control group with significant difference (P＜0.01), which suggested that acupuncture plus herbal decoction had better therapeutic effect than western medications alone.