The Related Research Of Collateral Stagnation And The Early Stage Of Diabetic Nephropathy

With the entry point of early stage diabetic nephropathy and theory of Chinese medicine collateral disease.as guiding principle,the paper is about the associated relationship between collateral stagnation and the early stage diabetic nephropathy(DN) pathology.It initially attempt to do Meta analysis on the basis of clinical research literature which comply with the randomized controlled trial(RCT) standard and explore the pros and cons of Chinese treatment of DN as well as Chinese medicine clinical decision-making.Diabetic nephropathy is one of the common serious diabetic capillary complications.Along with the gradual increase of incidence,recently diabetic patients become more and more.Early stage diabetic nephropathy occurs hidden.Once it begins,the kidney damage grows rapidly.Persistent albuminuria,hypertension,edema and renal failure will rapidly appear and the kidney disease will be irreversible.As the pathogenesis of the disease has not been completely clear and there are no effective treatment measures,most patients enter end-stage renal disease (ESRD) in short period of time.Therefore,revealing the pathology of the disease and giving specific prevention at early stage make positive significance to control and delay the further development of renal disease.Collateral theory is an important component of Traditional Chinese Medicine basic theory.With the development of modern science, multidisciplinary integration and infiltration apply collateral theory with new content.As a functional network system of communication both inside and outside the body,collateral vessel is not only the running channel of both qi and blood,but also the pathway of pathogen.While kidney is rich of capillaries and renal collateral is thin and tortuous as well as slow blood flow determines the pathological changes of evil injury and collateral stagnation.From the perspective of Chinese medicine,DN is due to the deficiency of qi and yin in a long time.Deficiency of qi makes the blood flow unsmooth and deficiency of yin make high blood viscosity and leading to blood stagnation. Blood stasis,as the pathological products of body fluid imbalance,is due to deficiency of spleen and kidney.Vital qi deficiency causes the generation of pathological products,whereas the products inhibit the production of qi and blood and the splenorenal function leading to a vicious cycle.It can be said thatblood stasis is the main pathology of DN,which is in line with Chinese medicine in "invalidism must accompany with blood stagnation" "invalidism develop into collaterals" The view of blood stasis also match the modern medical point of hemodynamics changes and capillaries disease in patients with DN,such as increased hemorheology general index,blood viscosity and lipids, reduced kidney blood flow,platelet aggregation,sclerosis of blood vessels, renal microcirculation disturbance,even hypercoagulability.Furthermore, herbs which could promote blood circulation to remove meridian obstruction, improve glomerular hemodynamics,reduce albuminuria and hematuria and protect renal function.These researches also prove the theory of collateral stasis pathology.In order to explore the further relationship between collateral stagnation and early stage diabetic nephropathy and pros and cons of Chinese medical treatment,the research comprehensively assess clinical early stage diabetic nephropathy literatures from 1998.1 to 2007.12,with the principle and methods of evidence-based medicine(EBM).There are 6711 papers about DN research,according electronic and manual search.27 randomized controlled trials(RCT) are adapted for Meta analysis according to the standard.The trial periods are from 1 to 6 months,and studies all proceed in Chinese Medical University Affiliated Hospitals or the three-level hospitals.The number of patients in all studies varies from 28 to 80,a total of 1341.Age of patient changes from 28 to 76,and the average age 55.2,average course 8.9 years.All the 27 studies are on the basis of controlling diet,proper sports, and stable blood glucose with western medicine.Compare the treatment of combination of Chinese medicine to single intervention with western medicine.The main index of this assessment include:blood glucose(FBG, HbAlc),lipids(TC,TG,HDL-C),renal function(Scr,Bun),urine protein excretion rate(UAER) and hemorheology indices as well as the Early stage diabetic nephropathy syndrome distribution,Chinese medical recipes and herbs application,symptom score and life quality standard evaluation.The findings indicate:1) Chinese medical differentiation syndromes are combined with western medical basic treatment to cure early stage diabetic nephropathy in the 27 randomized controlled literatures.It could effectively reduce albuminuria, edema,and blood glucose,regulate lipid metabolism,improve microcirculation and rectify renal function.The effect is much better than western medicine alone.The good result and low side effect make it an important means of intervention.2) It is the unique advantage of Chinese medicine that improving patients' clinical symptoms and quality of life through regulating viscera function.3) Deficiency of qi and yin is the highest syndrome in early stage diabetic nephropathy(68.6%),followed by deficiency of yin and excessive of heat syndrome(19.2%),and the latter is deficiency of yin and yang(12.2%).The distribution differentiates obviously.While the distribution characteristics of the accompanied symptoms show that blood stasis is number 1,with a incidence rate of 70.54%,followed by damp heat and muddy syndrome (28.49%),and exogenous syndrome only account for 0.97%.Moreover blood stasis syndrome also accompany with damp heat and muddy syndrome.So,blood stasis syndrome has the highest rate of emergence in early stage diabetic nephropathy. This also confirms the relevant relationship between early stage diabetic nephropathy and collateral blood stasis.4) Studies show spleen and kidney are the basement of early stage diabetic nephropathy.Although the five viscera are involved in DN,spleen and kidney are the key organs according analysis of the herbs.More than 30%prescriptions make by Liuwei Dihuang pills and Zuogui pills.The commonly used herbs are reinforcing spleen medicine,such as:shen,qi,zhu,ling.In the 27 prescriptions,invigorating spleen and kidney penetrate all along.Therefore, deficiency of spleen and kidney is the characteristics of the disease.5) Studies show reinforcing qi and yin,activating blood and removing stasis are the treatment characteristics of early stage diabetic nephropathy. The main pathology of diabetes is yin deficiency and dryness-heat.Yin deficiency is the basement and dryness-heat is the surface.After long period, it develops into DN.As excessive heat consume qi and yin,leading to deficiency of qi and blood.Therefore,reinforcing qi and yin is the main measure in early stage,and this can be speculated from the most common herbs,such as huangqi, shen,dihuang.The sthenia syndrome means blood stasis,dampness,muddy and poison.Deficiency could lead to sthenia syndrome,whereas sthenia syndrome also causes deficiency,generating a vicious circulation.Muddy stasis as the pathologic products,obstruct in renal collateral throughout the whole disease course.In the study,Danshen' s using rate is 51.8%.Moreover,during the former 22 kinds of herbs,activating blood herbs occupy 11 kinds.Therefore, reinforcing qi and yin,activating blood and removing stasis are the main therapeutic principle in early stage diabetic nephropathy.From respective of evidence-based medicine(EBM),this study attempt to explore Chinese medical treatment decision in early stage diabetic nephropathy, with the above Meta analysis.Decide the basic DN syndrome,grasp the general pathology and changes of different of periods,and crate targeted formula and herbs.Make optimal diagnostic and therapeutic scheme,reach satisfactory effect and make a best prognosis for patients.These are the basic demands of EBM.Therefore,the study propose suggestions,such as:make best use of individual advantage of Chinese and Western medicine,and improve clinical effect;establish diagnosis assisted by modern medical testing technology; reinforce qi and yin,invigorate spleen and tonify kidney;activate blood and remove the stasis,combining with eliminating muddy dampness and astringing; syndrome differs on albuminuria to manifest individual characteristics of TCM; according to modern pharmacology,add proper hypoglycemic effect herbs and soon.According to theory of Chinese medical collateral disease,pathology of early stage diabetic nephropathy in modern medicine and the Meta analysis of 27 RCT in this study,three conclusions are made.1 There is obvious correlation between renal collateral blood stasis and incidence and development of DN.It runs through the whole process of early stage diabetic nephropathy.2 The main Chinese medical syndrome is deficiency of qi and yin in early stage diabetic nephropathy,and the therapeutic principle is reinforcing qi and yin,activating blood and removing stasis.3 The advantage of TCM in treating early stage diabetic nephropathy base on stable blood glucose.It is a promising method for delaying early stage diabetic nephropathy development.While quality of TCM clinical trial still need to improve and develop.Evidence-based medicine(EBM) marks the transformation from traditional empirical medicine to the new form of modern clinical medical practice and clinical basic research,EBM,with the basis of large-scale clinical trial proof.With the basis of Clinical researching literature proof of early stage diabetic nephropathy,the study initially attempt to do Meta analysis.While, many problems of TCM clinical literature are discovered in this research, such as lacking rigorous reasonable design and operational specification;Few RCT materials and unsatisfactory quality of randomizing;Rarely application of blind;lacking unified standard of TCM clinical stage,syndrome and efficiency;small sample size of clinical data,lacking of large prospective studies;insufficiency of observation of recurrence and side effect in TCM treatment;deficiency of long-term effect and little follow-up;inadequacy of quality of life evaluation and so on.How to establish standardized modern TCM characteristic diagnostic evidence,syndrome and effect standards? With the principle of multi-centre, randomized,controlled,blind,how to improve the basic and clinical research of TCM in treating DN? How does Chinese medicine application not only show the quantitative criteria,but also play multi-centre,multi-target flexible advantage? This is an issue scientific development evidence TCM must be faced.