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国医节 ----1929 年 3 月 17 日

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 huzhen998@yahoo.com.cn. 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

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国医节 ----1929 年 3 月 17 日

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  1. 国医节----1929年3月17日

  2. 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 huzhen998@yahoo.com.cn

  3. 巴西库利提巴市1993

  4. 纳米比亚1996-1998年

  5. 泰国 2005--2012 东方大学孔子学院 Confucius Institute at Burapha University Thailand

  6. 2014/9/24 13

  7. 美国

  8. 2014/9/24 18

  9. 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.

  10. The Basic Knowledge and Advances in The Research糖尿病的基本知识和研究新进展 EpidemiologyThe 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)

  11. Epidemiology • 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)

  12. The top 10 countries(in the number of people with diabetes) India, China, the United States, Indonesia, Japan, Pakistan, Russia, Brazil, Italy, and Bangladesh.

  13. The Basic Knowledge and Advances in The Research糖尿病的基本知识和研究新进展 • One of the leading causes of morbidity and mortality • The major cause of blindness in adults aged 20-74 years • The leading contributor to end-stage of renal disease (ESRD) • The leading cause of nontraumatic lower limb amputations

  14. 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.

  15. (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

  16. Simplified scheme for the pathophysiology of type 2 diabetes mellitus

  17. (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)

  18. 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。

  19. (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 glucoseIFG: fasting plasma glucose FPG ≥6.1mmol ／L（110mg／dL） ＜7.0mmol／L（126mg／dL） ⑤Impaired glucose toleranceIGT: 2hr postprandial plasma glucose ≥7.8mmol／L（140mg／dL ＜11.1mmol／L（200mg／dL）

  20. Classification • 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.

  21. (3)The treatment for diabetes mellitus糖尿病的治疗 • 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%)

  22. Rational administration of drugs for DM（OAD） • Prof Ralph DeFronzo • advocate • The treatment based on theetiology • Early diagnosis • Combined Therapy ( the β-cell proliferation ) • Approaches: • Life style intervention • Three Drugs Combined Therapy TroglitazoneTZD(噻唑烷二酮)、 Metformin(二甲双胍) Exenatide(依克那肽)

  23. Other treatment approaches • Gastric bypass(GBP) 胃旁路手术 • Stem cells 干细胞技术

  24. The Advantages of Chinese Medicine for the Treatment of DiabetesMellitus中医治疗糖尿病优势 • Treating the human body as a whole • Individualized treatment a treatment for a patient • Prevention and cure of complications

  25. (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 symptom-complex(辩证论治取穴) 肺脾肾 3 Biological holographic theory （生物全息理论取穴） 耳穴 ，

  26. Effects of multi-targets多靶点作用 • Protect β-cells and stimulate insulin secretion • Increase insulin receptors and affinity • Inhibit glucagon secretion • Enhancethe ability of utilization of sugar in target organs and tissue • Correct metabolic disturbance of carbohydrate, fat and protein • Improve microcirculation

  27. 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， • Increasethe excretion of insulin

  28. 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

  29. (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

  30. 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 middlewarmer ----spleen 中消：脾 diabetes involving the lower warmer----kidney 下消：肾

  31. 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） • stagnant blood and blood stasis(血瘀脉络) • dampness and heat in spleen(湿热困脾)

  32. Five stages and five types(五期五型论治)Chinese Diabetes Association diagnosis criteria of diabetes mellitus in 19911991年全国糖尿病学会辩证标准 • 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

  33. 脏腑论治 differentiation of diseases according to pathological changes of the viscera and their interrelations

  34. 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

  35. 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

  36. 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

  37. 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》

  38. 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》

  39. 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

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