The Vietnamese And Chinese Traditional Medicines Literature Review And Retrospective Analysis Of348Clinical Files Of The Diabetic Cardiopathy

Diabetic Cardiopathy (DC) is the major cause of80%of the death of diabetes, of which70%die from the coronary complications. So far, the mechanism of diabetic cardiopathy development is not yet clear while the causes, disease mechanism, disease biophysiology, clinical signs and symptoms, and therapies vary from those of non-diabetic cardiopathy. Studies on diabetic cardiopathy are still at the initial stage. Although the Western medicines have obviously effective treatments for this disease, the side effects of the medicines remain considerable and the disease usually recurs. The Traditional Chinese medicines (TCM), via a logical dialectics in treatment, prove effective enhancement of resistance capacities of the body that brings about certain effects in diabeti cardiopathy control and improvement of life quality for the patients. This is a causal treatment therapy, which is the advantage of the TCM in treatment of diabetic cardiopathy.ObjectivesThe Traditional Vietnamese medicines (TVM) are remarkably influenced by the TCM. Therefore, studies on TVM in diabetic cardiopathy diagnosis and treatment are certainly related to the TCM. Nevertheless, the TCM and TVM have their own historical and geographical features. Hence, it is essential that both the TVM and TCM find a therapy and medicines for better effective prevention and treatment of the diabetic cardiopathy.Methodology1. Desk review of documents coupled with observation of a considerable amount of DC including signs and symptoms of each type of disease in accordance with the TCM, laboratory testing indicators, and utilization of statistics to analyze and compare, and application of the retrospective research techniques.2. Research principals:The DC clinical files admitted to the study must strictly pass the screening criteria. Based on the collected data on the patients’general information, disease history, signs and symptoms, laboratory tests, and treatment therapy, the statistical analysis was conducted.2.1Group sampling method:Collecting data of patients who came for the first hospitalization from the hospital number1of the Guangzhou University of Chinese Medicines (the Chinese group) and that of patients from the Viet Nam Hospital of Traditional Medicines and the Tue Tinh Hospital of the Viet Nam Traditional Medicines Academy (the Vietnamese group) for the last5years.2.2Listing disease types in accordance with the Chinese medicines, comparing between the two groups Chinese and Vietnamese.2.3Observations:sex, age, Body Mass Index (BMI), Blood pressure (BP), heartbeat, fasting blood glucose (FBG), post-meal blood glucose (PBG), Glycohemoglobin (HbAIC), total cholesterol (TC), triglycerides (TG), High-density lipoprotein (HDL-C), Low-density lipoprotein (LDL-C), electrocardiogram (ECG), Chinese medical symptoms and signs. The research utilize before and after treatment comparison of patients among the same group and between the two groups.Results1Study on TCM literature of DC1.1Name,causes and pathogenesis of DC by TCMName of DC:The DC is called according to TCM category of "Xiao-ke" or "wasting and thirsting" disease complicating with "Diabetes· Chest pain","Diabetes· palpitation","Diabetes· diaphragm retention of fluid and adema" And according to TVM, DC belongs to category of "Xiao-ke ","Diabetes· heart disease"Causes of DC:The theory of TCM showed that the important internal factors of the "Xiao-ke" syndrome are deficiency of before heaven and acquired loss of support after heaven. Furthermore, emotional disorders, long-term excessive mental stimulation and the elderly to have work hard for a very long time can also lead to the "Xiao-ke"Onset and pathogenesis of DC:①The early stage, yin deficiency is the root, dry heat is the manifestation.②The middle stage is root deficiency menifestation excess.③The later stage is deficient Qi-blood and yin-yang which are mainly "yang deficiency of heart and kidney" and "retention of fluid infringe heart" and most common in the stage of heart failure.1.2TCM prescription treatment is extremely effective in DC.The research showed that there are some documents, herbs and animals including single herbs and their extract of which TVM edicine prescription and folk therapeutic foods have effective for treatment of DC.2Results of clinical studies2.1General findings:2.1.1Sex re I ated:The Chinese group has higher rate of male patients while it is lower among the Vietnamese group.2.1.2Age:Among the Chinese group, the youngest age is31years old and the eldest is85, the average age of morbidity is61.8±11.2years old. Among the Vietnamese group the youngest age of having disease is41, the eldest is84, the average age of morbidity is63.2±9.9years old.2.1.3BMI:The Chinese group has an average BMI for males at23.9±1.5and23.4±1.4for females. The average BMI for the Vietnamese group is23.0±3.3for males and24.9±3.4for females. The BMI difference between the Chinese and Vietnamese groups is significant.2.1.4Blood Pressure:Among the Chinese group, proportion of hypertension is51.8%, that of the Vietnamese group is41.7%, Nevertheless, the difference between the two groups is insignificant.2.1.5Lipid:The Chinese group has a proportion of87.5%hyperlipidaemia. This is94.4%for the Vietnamese. Nevertheless, the difference between the two groups is insignificant.2.1.6Analysis of DC patient rate of the two groups in accordance with two categories of "three excess" and "three deficiency"On the basis of DC dialectically standard classification of the TCM in accordance with "three excess" and "three deficiency", the "three deficiency" and "three excess" account for53.6%and46.4%relatively among the Chinese group. These are53.9%and46.1%relatively for the Vietnamese group. Nevertheless, these differences between the two groups are insignificant.Particular proportion of each disease type among the Chinese group in accordance with the "three deficiency" include:deficiency of both qi and yin41.1%; deficiency of both yin and yang10.7%; yang deficiency of heart and kidney1.8%and with "three excess" include:Phlegm dampness obstacle30.3%, heart pulse obstacle14.9%, retention of fluid infringe heart1.2%. These among the Vietnamese group with "three deficiency " include:deficiency of both qi and yin41.7%; deficiency of both yin and yang11.1%; yang deficiency of heart and kidney1.1%, and with "three excess" include phlegm dampness obstacle28.9%; heart pulse obstacle16.1%; retention of fluid infringe heart1.1%. Nevertheless, the difference between the two groups is insignificant.2.1.7Fasting Blood Glucose (FBG) and Post-meal Blood Glucose (PBG)The Chinese group has an average of FBG at9.12±2.48mmol/1, and this is11.34±3.51mmol/1for the Vietnamese group. The average PBG among the Chinese group is14.44±3.85and that of the Vietnamese group is15.86±4.86mmol/1. Obviously FBG and PBG among the Vietnamese group are both higher than that of the Chinese. The difference is significant.2.2Comparison of before and after treatment clinical signs and laboratory tests2.2.1Comparison of the general treatment effects on cl inical signs and symptoms of the Chinese medicinesAfter treatment, both the groups has significant reduction in the scores of clinical signs and symptoms in comparison with before treatment (P<0.01). The Chinese group reduced16.1±5.8points and the Vietnamese reduced14.2±7.1points. This shows that both the groups received effective treatment of the clinical signs and symptoms yet the Chinese has clearer improvement.The Chinese group has3.6%excellent effect;72.6%good,23.8%medium; and0%no effects, the total effective treatment is100%. The Vietnamese group has6.7%excellent;48.9%good;33.3%medium; and11.1%no effects; the total effective treatment is88.9%. The difference between the two groups is significant (P<0.05).2.2.2Comparison of treatment effects based on the before and after treatment laboratory tests2.2.2.1Effects in Blood Glucose control:After treatment, the laboratory tests of the Chinese and Vietnamese groups both show declining FBG and PBG. The differences among the same group and between the two groups are significant (P<0.01).2.2.2.2After treatment, the two groups Chinese and Vietnamese both have declining average HbAIC, TC, TG, and LDL-C, the HDL-C indicator tends to increase. The differences are significant (P<0.01) except the difference of LDL-C among the Vietnamese group before and after treatment.2.2.2.3Comparison of the ECG:In general, the Chinese group has16.1%clearly effective,69.6%effective, and14.3%ineffective; total effective treatment is85.7%. The Vietnamese group has16.7%clearly effective,56.7%effective, and26.6%ineffective; total effective treatment is85.7%. The difference between the two goups is significant (P<0.05).2.2.2.4Observations show slight decline in heartbeat, systolic blood pressure, and diastolic blood pressure. The difference among the same group before and after treatment is significant (P<0.01).2.2.2.5General assessment of the DC treatment effectsBased on the assessment criteria, in general the Chinese group has38.1%obviously effective treatment and69.1%effective treatment, total effective treatment is100%; The Vietnamese group has8.9%obvious effective treatment,86.7%effective, and4.4%ineffective, total effective treatment is95.5%. The differences between the two groups are significant (P<0.05).Treatment effects for each particular type of disease as following:the Chinese group has100%effective treatment for all6types of disease yet the difference is insignificant. The Vietnamese group, except two types yang deficiency of heart-kidney and retention of fluid infringe heart having ineffective treatment, the rest types including deficiency of both yin and yang, phlegm dampness obstacle, heart pulse obstacle, all have100%effective treatment, which is higher than that of the type deficiency of both qi and yin (94.7%). The difference is significant (P<0.05).ConelusionsBy literature review and clinical retrospective analysis, the results as follow;1. Because of the close historical relationship between the TVM and the TCM, there has been mutual communication between the two countries and the theory system has hesitated from generation to generation. Through studies, we have found common points between the TVM and TCM in terms of scientific studies and clinical treatment of diabetic cardiopathy yet each country has its own features that are not replaceable. Especially, the TVM have its geographic features that the TCM could have additional advantages. There could be an effective exchange between the two countries on their experience and achievements in DC studies. The two countries both have crucial herbal materials that could be selected for use via goods exchange. The research has pointed out that the TVM, in DC treatment, uses a considerable amount of herbal materials that are imported from China. This supports the above-mentioned points.2. The clinically retrospective research has collected a total of348DC files, of which the Chinese group has168and the Vietnamese has180files.The research shows that there are common points in terms of clinical aspects between the two group including:Classifications of disease types in accordance of the TCM of the two groups both have highest proportion of deficiency of both qi and yin, followed by phlegm dampness obstacle, heart pulse obstacle, yang deficiency of heart and kidney, deficiency of both yin and yang and retention of fluid infringe heart respectively. According to the classification of "three excess" and "three deficiency", the two groups clinically both have higher rate of "three deficiency" than the "three excess". After treatment, the two groups both have improvement of clinical signs and symptoms, blood glucose is controlled, and TC, TG and HbAIC are all declinedThe research also found some different points between the two groups as following:there is a higher proportion of female patients than males among the Chinese group while the Vietnamese is in a reverse angle. There are more patients who have hyperlipidaemia in the Vietnamese group than that of the Chinese. The PBG rate among the Vietnamese group is higher than the Chinese. After treatment, the Chinese group has better results in terms of BG control, improvement of clinical signs and symptoms, and ECG in comparison with the Vietnamese.3. The study also found a considerable amount of treatment therapies and herbal combinations for DC treatment, especially some geographically Vietnamese herbs that are highly potential for research and clinical application. This is valuable for DC treatment.