【作者】 林玉堂；

【导师】 林培政；

【作者基本信息】 广州中医药大学 ， 中医临床基础学， 2010， 博士

【摘要】 糖尿病属中医消渴病范畴,中医认为其病因与素体阴亏、禀赋不足、喜食肥甘膏腴；情志失调,精神过度紧张；房事不节、精虚肾燥有关。其病理改变涉及气血阴阳及五脏六腑各个系统,并以气阴两虚、肾虚为本,燥热血瘀为标。祝氏认为糖尿病的基本病机是气阴两虚、络脉瘀阻,贯穿于疾病的始终,并发现2型糖尿病患者中以气阴两虚型为最多,约占70%-80%。而祝谌予降糖基本方补益脾肾、气阴,兼予活血,治疗2型糖尿病气阴两虚型很是恰当。在临床上用本方治疗2型糖尿病根据辨证适当加减,疗效显著。目的本研究采用随机对照的方法探索祝谌予降糖基本方加减治疗糖尿病气阴两虚挟瘀证的可行性。方法研究对象为符合中医气阴两虚挟血瘀证辨证标准,同时符合西医糖尿病诊断标准的患者。随机分为两组,一组服用祝谌予降糖基本方加减活血化瘀药,另一组服用六味地黄丸加活血化瘀药,以临床综合疗效、中医症候评分和血糖、糖化血红蛋白为观察指标,评价祝谌予降糖基本方加减的有效性和安全性。统计方法：分类资料用x2检验,等级资料用两样本比较Wilcoxon秩和检验(校正),两样本均数比较用t检验或Wilcoxon秩和检验,自身前后比较用配对t检验或Wilcoxon配对秩和检验。结果本研究最后符合纳入排除标准参与分析的有70例,祝谌予降糖基本方加减治疗组和六味地黄丸配伍活血化瘀药对照组分别35例。患者的平均年龄为42.7±5.9岁；男女比例相当；平均病程为36.8±7.2月。从临床治疗总效果看,祝谌予降糖基本方加减的愈显率为77.14%,而对照组为54.28%,差别有统计学意义,说明祝谌予降糖基本方加减对于治疗糖尿病有显著疗效。从临床症状的改善情况看,口干喜饮、自汗或盗汗、气短懒言、五心烦热、失眠、腰膝酸软和多尿症状两组都有所改善,而治疗组的疲困乏力和心悸症状在治疗后明显地得到了改善,这提示祝谌予降糖基本方加减在改善疲困乏力和心悸两个症状上有优势。从临床症状评分变化情况看,两组均可有效地改善疲困乏力、五心烦热、心悸、腰膝酸软和多尿症状；而降糖方组比对照组药物六味地黄丸能够更好地改善口干喜饮、自汗盗汗、气短懒言症状。降糖方组可有效降低实验室三种指标(P<0.05),而六味地黄丸组仅在降低餐后血糖上有统计学意义(P<0.05)；可认为降糖方组疗效优于对照组药物六味地黄丸。安全性检测表明,治疗前血、尿、大便常规、肝肾功能、心电图正常者,治疗后未见异常改变,表明该药临床应用安全。结论经治疗后发现祝谌予降糖基本方加减对于治疗气阴两虚挟血瘀型糖尿病有其独特的优势与特点,其优势最主要表现在改善临床症状上,并且安全有效,具有专方的潜质。更多还原

【Abstract】 Diabetes was belong to diabetes disease, traditional Chinese medicine thought the origin of disease was concerned with the weakness of body, innate deficiency, liking to eat the food which have much mastic and subcutaneous, sentiment out of tune, psyche overstress, intemperance in sexual life, weakness of semen and dryness of nephros. The change of diabetes was refer to basi-pathogenesi QI-blood diabetes was deficiency of both vital energy and yin, deficiency of both vital energy and yin to stop that ran though the disease. What is more,2-type diabetes yin-yang and five solid organs five viscera and six entrails were discovered, and signed it by deficiency of both vital energy and yin, basing on renal deficiency, blood stasis with dryness-heat. Zhu thought that the most of those who are suffering from the diabetes was type of deficiency of both QI and YIN, about 70 to 80 percent of these with promoting blood flow. Zhu-chenyu basic decoction was very appropriate to treat 2-type diabetes with type of deficiency of both QI and YIN. Used this recipe to treat 2-type diabetes would have a good curative effect in clinical.ObjectiveTo explore the possibility which was used Zhu-chenyu basic decoction for treating the diabetes with type of deficiency of both QI and YIN with syndrome of blood stasis and stagnation of blood by random and control methods.MethodsThe object of the investigation that was consistent with the standard of the traditional Chinese medicine of the diabetes with type of deficiency of both QI and YIN with syndrome of blood stasis and stagnation of blood, meanwhile, also was consistent with the standard of diabetes diagnosed by western doctor. Divided two groups in random, one group was set to take the medicine of Zhu-chenyu basic decoction combined drug for invigorating blood circulation and eliminating stasis, the other group was set to take the medicine of the Liuweidihuangwan decoction combined with the drug for invigorating blood circulation and eliminating stasi. To observe the synthetic curative effect、the score of the traditional Chinese physician symptom、blood sugar and glycosylated hemoglobin, then to evaluate the validity and the safety of the Zhu-chenyu basic decoction. Statistical methods:we usedχ2 test for the classify data, used Wilcoxon rank sum test for the ranked data, used t test or Wilcoxon rank sum test to test two specimen mean and used t test or Wilcoxon rank sum test or test to compare self-comparison.ResultsFinally, there were 70 cases which have been met the exclusion criteria in the analysis, the Zhu-chenyu basic decoction treatment group and the Liuweidihuangwan decoction combined with the drug for invigorating blood circulation and eliminating stasis control group each have 35 cases. The average patient age was 42.7±5.9 years; at the same ratio of men and women; average duration was 36.8±7.2 months. According to the conclusion of the clinical treatment, there was 77.14 percent of patient has the obvious effect which used Zhu-chenyu basic decoction, and 54.2 percent of patient has the obvious effect in the control group, there was statistical difference between two groups, which indicating that it has significant effect for treating diabetes. According to the clinical symptom, dry mouth, spontaneous or night sweats, shortness of breath lazy words, five upset hot, insomnia, weak waist and more urinary symptoms were improved in both groups, while the treatment group sleepy fatigue and heart palpitations symptoms after treatment significantly improved, it was indicated that has significant effect in treatment group. According to the changeable score of the clinical symptom, each group has significant effect in dry mouth, burning sensation of five centres, palpitation, weak waist, weak waist and more urinary symptoms; but the treatment group was better than the control group for improving mouth, spontaneous or night sweats, and shortness of breathe lazy words. The Zhu-chenyu basic decoction group can effectively reduce the laboratory of three indicators (P<0.05), while the control group only can reduce postprandial blood glucose. There was statistically significat (P<0.05); it can be considered hypoglycemic side effects than the control group. Safety testing showed that the blood routine test, urine routine test, stool routine test, liver and kidney functions and normal ECG were normal after treatment. It indicated that the Zhu-chenyu basic decoction was safety in the clinical application.ConclusionAfter treatment, it was found that Zhu Chen basic Decoction had its unique advantages and feature in improving clinical symptoms, so it has significant effect in the diabetes of deficiency of both vital energy and yin with blood stasis type. Further more, it was safe and effective and has the potential of further development.更多还原