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BACKGROUND: Prediabetes mellitus (PreDM) is a high-risk state for developing type 2 diabetes mellitus (T2DM) and often goes undiagnosed, which is closely associated with obesity and characterized by insulin resistance that urgently needs to be treated. PURPOSE: To obtain a better understanding of the biological processes associated with both "spleen-dampness" syndrome individuals and those with dysglycaemic control at its earliest stages, we performed a detailed metabolomic analysis of individuals with various early impairments in glycaemic control, the results can facilitate clinicians' decision making and benefit individuals at risk. METHODS: According to the diagnostic criteria of TCM patterns and PreDM, patients were divided into 4 groups with 20 cases, patients with syndrome of spleen deficiency with dampness encumbrance and PreDM (PDMPXSK group), patients with syndrome of dampness-heat in the spleen and PreDM (PDMSRYP group), patients with syndrome of spleen deficiency with dampness encumbrance and normal blood glucose (NDMPXSK group), and patients with syndrome of dampness-heat in the spleen and normal blood glucose (NDMSRYP group). Plasma samples from patients were collected for clinical index assessment and untargeted metabolomics using liquid chromatography-mass spectrometry. RESULTS: Among patients with the syndrome of spleen deficiency with dampness encumbrance (PXSK), those with PreDM (PDMPXSK group) had elevated levels of 2-hour post-load blood glucose (2-h PG), glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), and systolic blood pressure (SBP) than those in the normal blood glucose group (NDMPXSK group, P < 0.01). Among patients with the syndrome of dampness-heat in the spleen (SRYP), the levels of body mass index (BMI), fasting blood glucose (FBG), 2-h PG, HbA1c, and fasting insulin (FINS) were higher in the PreDM group (PDMSRYP group) than those in the normal blood glucose group (NDMSRYP group, P < 0.05). In both TCM syndromes, the plasma metabolomic profiles of PreDM patients were mainly discriminatory from the normal blood glucose controls of the same syndrome in the levels of lipid species, with the PXSK syndrome showing a more pronounced and broader spectrum of alterations than the SRYP syndrome. Changes associated with PreDM common to both syndromes included elevations in the levels of 27 metabolites which were mainly lipid species encompassing glycerophospholipids (GPs), diglycerides (DGs) and triglycerides (TGs), cholesterol and derivatives, and decreases in 5 metabolites consisting 1 DG, 1 TG, 2 N,N-dimethyl phosphatidylethanolamine (PE-NMe2) and iminoacetic acid. Correlation analysis identified significant positive correlations of 3α,7α,12α,25-Tetrahydroxy-5ß-cholestane-24-one with more than one glycaemia-related indicators, whereas DG (20:4/20:5) and PC (20:3/14:0) were positively and PC (18:1/14:0) was inversely correlated with more than one lipid profile-related indicators. Based on the value of correlation coefficient, the top three correlative pairs were TG with PC (18:1/14:0) (r = - 0.528), TG with TG (14:0/22:4/22:5) (r = 0.521) and FINS with PE-NMe (15:0/22:4) (r = 0.52). CONCLUSION: Our results revealed PreDM patients with different TCM syndromes were characterized by different clinical profiles. Common metabolite markers associated with PreDM shared by the two TCM syndromes were mainly lipid species encompassing GP, GL, cholesterol and derivatives. Our findings were in line with the current view that altered lipid metabolism is a conserved and early event of dysglycaemia. Our study also implied the possible involvement of perturbed bile acid homeostasis and dysregulated PE methylation during development of dysglycaemia.
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Qingfei Paidu decoction has a remarkable clinical effect, which has been recommended by the Diagnosis and Treatment Plan of Novel Coronavirus Pneumonia (Trial Sixth Edition) of the National Health Commission and National Administration of Traditional Chinese Medicine. In this paper, the authors intend to explore the pathogenesis of cold pestilence of coronavirus disease-2019 (COVID-19) and composition mechanism of Qingfei Paidu decoction, and believe that this formula can be used to relieve internal and external pressure and regulate triple energizer with the functions of promoting lung Qi, dispelling evil and detoxification, moistening and dampening, and purging heat by removing water. This formula is suitable for the pathogenesis of COVID-19, including cold, dryness and dampness, and can effectively treat symptoms. Therefore, it should be widely used throughout the country to contain the spread of the epidemic.
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We report one case of bullous pemphigoid that did not respond to the standard western medical treatment with topical and oral steroid therapy. This case achieved complete remission after the application of Yizongjinjion seihijoshitsuinkagen (Yizongjinjion Qing Pi Chu Shi Yin Hua Cai), a spleen-dampness-eliminating beverage. The patient was a 78-year old female who had soy bean or 5 mm to 25 mm sized blisters covering a wide area of her back since two years ago. She had visited a neighborhood physician who diagnosed her with bullous pemphigoid and initiated the standard treatment. Although some improvements were observed after the start of western medical treatment, her symptoms eventually grew worse. Therefore, she visited our clinic and requested the traditional Chinese treatment. We diagnosed her skin blisters as the heart-fire spleen-dampness type of bullous pemphigoid using the four diagnostic examinations, and treated her with the modulated spleen-dampness-eliminating beverage which resulted in a complete remission within 10 months. Taken together, our results suggest that the modulated spleen-dampness-eliminating beverage (Yizongjinjion seihijoshitsuinkagen) is effective for the treatment of the heart-fire spleen-dampness type of bullous pemphigoid.