【作者】 侣丽萍；

【导师】 范冠杰；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2012， 博士

【摘要】 目的：随着生活水平的提高和生活方式的改变,2型糖尿病的发病率日益增加,严重危害着人们的生命,糖尿病已成为各国医学界关注的重要问题。本研究采取随机、对照的形式,以“动-定序贯范氏八法”纯中药复方治疗早期2型糖尿病,观察患者的临床症状、体征及各项理化指标,并与拜糖苹治疗及单纯饮食运动治疗相比较,观察范冠杰教授运用“动-定序贯八法”治疗早期2型糖尿病的主要临床经验、临床疗效,总结证候的动态演变过程和规律,为早期2型糖尿病的中医诊治提供诊疗依据。方法：将我院范冠杰教授内分泌门诊2009年12月-2011年12月诊断为早期2型糖尿病的患者共120人作为研究对象,采用随机对照的研究方法,按病例进入研究的顺序随机分为纯中药治疗组、拜糖苹对照组及单纯饮食运动对照组3组,每组各40例,其中纯中药治疗组应用范冠杰教授创立的“动-定序贯八法”对患者进行辨证施治,各组均治疗(24周)6个月,检测治疗前后的有效率、临床症状、血糖、糖化血红蛋白、血脂、尿酸、体重、体重指数等水平的变化,记录纯中药治疗新诊断2型糖尿病过程中证候的动态演变过程。结果：1.疗效观察：3组治疗后纯中药组、拜糖苹两组在降低血糖、降低糖化血红蛋白水平比较差异无统计学意义(P>0.05),纯中药组分别和拜糖苹组、饮食运动组、在改善血脂、尿酸水平、减轻体重、降低体重指数比较差异有统计学意义(P<0.05)2.3组有效率比较：纯中药组有效率为82.5%,拜糖苹组有效率为77.5%,饮食运动组有效率为45.0%,3组比较差异有统计学意义(P<0.01),进一步比较纯中药组和拜糖平组(P>0.05),两组差异无统计学意义；纯中药组和饮食运动组比较差异有统计学意义(P<0.05)3.3组中医证候疗效比较：A组总有效率为85.0%,B组总有效率为50.0%,C组总有效率为32.5%,3组比较差异有统计学意义(P<0.01)；进一步比较纯中药组和拜糖平组,两组差异有统计学意义(P<0.05)；纯中药组和饮食运动组比较差异有统计学意义(P<0.01)4.治疗前后证候分布及动态变化情况：早期2型糖尿病气阴两虚证最多见,占初诊的62.5-67.5%,其次为肝气郁结、血脉瘀阻、脾虚湿困、肾虚、湿热内阻证,以血分郁热、燥热内盛、热扰心神证最少见,3组中无论是治疗前还是治疗后,其证次均不超过25%。3组证候中未见阳虚证,提示阳虚证可能不是早期2型糖尿病的常见证候。气阴两虚、血脉瘀阻、肾虚证随着拜糖苹、饮食运动治疗4周、12周及到24周病程的延长,其发生率逐渐增加,增长率为10%。经过“动-定序贯八法”纯中药干预治疗24周后,其发生率降低,降幅均超过治疗前的10%。气滞、郁热、湿浊等实证较治疗前有明显改善,说明中医药治疗的有效性。临床辨证以虚实夹杂多见,实则以湿热、血热、血瘀、气滞证为主要证候表现,兼夹燥热、湿浊、痰浊等。虚证以气虚或阴或气阴两虚为主。从证候相兼的情况看,消渴病早期病变复杂,随着疾病的进程,证候组合呈动态变化。可单见1证,也有4、5、6证并见,3种或4种病邪组合为主。随着治疗的进展,4、5种病邪兼夹的出现率有所减少,趋于2种或3种病邪的组合增多。本虚证候减少,部分标实的证候减少或消失,说明随着治疗,患者病情得以缓解,证候组合逐渐简单化,疾病向愈。5.病位变化情况：由病位统计结果可知,脏腑发病第一位为“脾”,其次为“肝”,再次为“肾”、“肺”,“心。”经过拜糖苹治疗及饮食运动治疗后脾病病位的发生率降低,病位在肝、肺、心的发生率无明显变化,肾病病位发生率随着病程的延长呈逐渐上升趋势。经“动-定序贯八法”纯中药干预治疗后,在脾、肝、肾病位的发生率显著下降,降幅超过10%,其中在肾的发生率下降最著,超过20%。6.辨证用药分析：在应用纯中药对早期2型糖尿病患者进行治疗中,共涉及常用药物种类约40种。其中甘草出现的频次最高,为37次,40例患者中几乎每位都有应用。生地位居第二,频次为27次。绵茵陈在药物中排列第三位,频次为25次。其余药物如丹皮、丹参、薏苡仁、连翘等清热利湿、清热凉血或活血的药味的使用频次较高；多使用生地、地骨皮、玄参、竹茹、桑白皮、沙参、桑叶、玉竹、百合、石斛、麦冬、竹叶等药以清热养阴生津。苍术、绵茵陈、车前草、茯苓、法夏、紫草、田基黄等甘淡渗利、清热润燥之品常用于兼见湿热、燥热者；布渣叶、神曲、山楂、麦芽等味则用于兼有食滞苔厚腻者。血瘀症状轻者用丹参、当归、益母草、泽兰；重者用三棱、莪术、酒川牛膝,上述用药体现了应用“动-定序贯八法”纯中药治疗早期糖尿病用药多样性、灵活性的特点。7.安全性观察：“动-定序贯八法”纯中药治疗组及拜糖苹治疗组、饮食运动治疗组均无不良事件发生,安全性较好。结论：在本研究中口服拜糖苹、良好的饮食控制及坚持长期运动对于患者血糖、糖化血红蛋白、体重、体重指数等指标减轻有临床意义,但许多临床观察及在本研究中显示,西医治疗DM虽然能将血糖、血脂等生化指标控制在正常范围,但并没有阻止其并发症的发生,患者的临床症状及生活质量并没有很有效地改善。本研究中运用“动-定序贯八法”纯中药治疗早期2型糖尿病不但有效控制患者的血糖等各项实验室指标,而且对于改善患者的各种症状有西医药不可比拟的确实疗效,可预防并延缓早期糖尿病及其并发症向中后期发展,提示中医药治疗早期T2DM可能是阻断DM发展的一个契机。消渴病病因复杂,病机特点和临床证候多种多样,范冠杰教授运用“动-定序贯八法”辨证治疗早期2型糖尿病疗效显著,提示本病临证防治绝不能局限于一方一药,在辨证论治的前提下,整体动态把握疾病的演变规律,才能获得满意疗效。更多还原

【Abstract】 ObjectiveWith the improvement of living standards and the changing in life style,the prevalence of type2diabetes has increased,it seriously harms people’s lives.Diabetes has becomed the important problem of medical attention all countries,In this research we take randomized, controlled form to observe the clinical symptoms,signs and various physical and chemical indexes using pure Chinese herbal medicine to treat new diagnosed type2diabetes of The Eight methods of Fan Surname movement and immovable sequential,and compared with BaiTangping and simple exercise therapy.To observe the clinical curative effect that professor Fanguanjie using The Eight methods of Fan Surname movement and immovable sequential to treat early type2diabetes,and Summary the evolution process and regularity of syndrome dynamicly develop,we will provide the basis of diagnosis and treatment of traditional Chinese medicine for the new diagnosed type2diabetes.MethodsAs120patients which diagnosed as early type2diabetes in endocrine outpatient service of professor Fanguanjie in December2009to May2011for the research object,randomly divided into pure Chinese herbal medicine treatment group,BaiTangPing treatment group and pure diet and movement contrast group Each40cases,pure Chinese herbal medicine treatment group patients were different and treat use the method of,The Eight methods of Fan Surname movement and immovable sequential,each group is treated for6months,observed the efficient and clinical symptoms,blood glucose,and glycated hemoglobin,blood fat,uric acid,weight,Body mass index level changed before and after treatment,Record the evolution process and regularity of syndrome dynamicly develop that the new diagnosed type2diabetes to treat disease.Rresults1.Observe curative effect:there is no statistic difference in lowing the blood glucose,and glycated hemoglobin,blood fat,uric acid,weight,Body mass index level after treating of the three groups;BaiTangPing group and Eating and movement group compared respectively have significant difference in statistic(P<0.05).2.Efficient compared three groups:the efficient of pure Chinese herbal treatment group reached to82.5%, the efficient of BaiTangPing treatment group reached to77.5%, the efficient of Eating and movement treatment group is45.0%, the statistics of the three groups has difference(P<0.01);Pure Chinese herbal treatment group compared with BaiTangPing treatment group, there is no statistic difference;Pure Chinese herbal group,BaiTangPing group and Eating and movement group compared respectively have significant difference in statistic(P<0.05).3. Traditional Chinese medical syndrome curative effect of Three groups:the efficient of pure Chinese herbal treatment group reached to85%, the efficient of BaiTangPing treatment group reached to80%,the efficient of Eating and movement treatment group is32.5%, the statistics of the three groups has difference(P<0.01);Pure Chinese herbal treatment group compared with BaiTangPing treatment group,there is no statistic difference,Pure Chinese herbal group, BaiTangPing group and Eating and movement group compared respectively have significant difference in statistic(P<0.05).4.Syndrome distribution and the dynamic change:Qiyin deficiency syndrome is the most in XiaoKeBing,accounting62.5%to67.5%for the first visit,followed by stagnation of liver qi,Blood stasis resistance, water retention due to hypofunction of the spleen, Kidney deficiency card, Damp and hot resistance card,the most rare cards are blood points heat,hot and dry contains, hot cross mind.the card times are not more than25%of the3groups whether before or after treatment.Deficiency of yang syndrome has not seen in the Three groups,certificate that deficiency of yang syndrome is not common in early type2diabetes.As the course of disease extend, the incidence Yin deficiency of both qi and blood stasis,Kidney deficiency card are increasing gradually, and the rate both are10%.After24weeks later of pure Chinese herbal medicine intervention,the incidence reduced by more than10%of all before treatment. After treatment,qi stagnation, heat, wet and muddy empirical card were obviously improved than before,account for the effectiveness of traditional Chinese medicine.Mingled with the actual card is often seen in Clinical syndrome differentiation, but damp and hot,blood hot and blood stasis,and qi stagnancy are proved to be the main syndrome performance,and clip hot and wet muddy, sputum turbidity,etc.qi deficiency syndrome or Yin deficiency of both qi Yin are the more often card.From the syndrome of phase to see,XiaoKeBing early lesions complex, along with the progress of the disease and syndrome combination dynamiclly changes.a single card can be seen, also have4,5,and6license be there,three or four kinds of disease combin together mainly.Along with the progress of treatment,4,and5kinds of disease evil decreased, tend to be two or three kinds of disease combination increase。 the virtual syndrome reduced, part of the standard syndrome reduce or disappear,indicate that as the treatment Illness ease,syndrome combination gradually simplistic, and tend to recover.5.Disease location changing:by the statistics results,indicate that the zang-fu organs attack diserse first for "spleen",followed by "liver", again for "kidney","lung","the heart". After western medicine and eating movement therapy after the disease incidence of spleen decreased, the disease incidence in liver,lungs,heart have no change, kidney disease incidence has a rising trend to gradually.After intervention of pure Chinese herbal medicine,disease incidence in the spleen,liver,kidney have a significant decline by more than10%, in the incidence renal down the most,with more than20%.6.Differentiation of herbs using analysis:in the course of treating early type2diabetes by pure Chinese herbal medicine, there are about40types commonly used drugs.Among them the present frequency of licorice is the highest,about37,and40patients have almost ever application.Raw land in second place,and frequency for27times.Cotton gall in drug ordering the third, frequency of25times. The rest drugs like Dan skin,danshen,kindhearted,taste YiRen forsythia bush concretion run smoothly,cool heat blood or Promoting blood circulation. drug the using frequency is higher;Use moreraw land,bone skin, scrophula-riacede,bamboo,white mulberry radha,straight ladybell,mulberry leaf, jade bamboo, lily, stone, such as bamboo leaves, radix ophiopogonis dendrobium medicine to clear away heat oneself nourish"Yin".Cangzhu, continous gall,plantain,tuckahoe,method,borage,summer Tianji yellow wait for Kennedy light,heat the permeability of the dryness is often used in damp and hot,hot and dry syndrome;the Cloth slag leaf, divine comedy,hawthorn, and malts etc taste is used in both food sluggish moss thick the greasy.Person with blood stasis symptoms light use salvia miltiorrhiza,angelica,motherwort,ZeLan;The person that weigh use three edges and shows, wine beef shanks Sichuan,the application of the drug embodies to treat early type2diabetes using pure Chinese medicine is diversity and flexibility.7.Safety observation:Chinese medicine treatment group and BaiTangping treatment group were no adverse events,security is better.ConclusionIn this studym,taking baitangping orally and good diet controlling and long-term movement have clinical significance for patients to reduce blood glucose, and glycated hemoglobin, weight,and body mass index, but many clinical observation and in this study shows,although western medicine therapy DM can ameliorate blood glucose, blood fat,but didn’t stop its complications,the clinical symptoms and quality of life are not effectively improved.Treating early type2diabetes patients in this study using"the eight methods of Fan Surname movement and immovable sequential "pure Chinese herbal medicine not only effectively control of blood sugar and each laboratory parameters,but also have western medicine incomparable really curative effect in improving symptoms of patients,it can prevent and delay early diabetes and its complications develop to mid and later period, indicating that the traditional Chinese medicine for early T2DM may be a turning pointto block DM develop.The causes of XiaoKeBing are complex,pathogenesis characteristics and clinical syndrome are varied,professor Fanguanjie uses"The Eight methods of Fan Surname movement and immovable sequential"to treat early type2diabetes the effect is significant.Tips that to prevention and control the card can not be limited to party of medicine, under the premise of syndrome ifferentiation and treatmentto grasping the evolution laws of disease overalland dynamicly,we can get satisfied results.更多还原