| BackgroundThe incidence of diabetes (DM) is growing rapidly around the world. Type2diabetes (T2DM), which is the most common type of DM, is seriously threating human health. Traditional Chinese Medicine (TCM) has a great wealth of experience in treat with T2DM. As the dramatically change of modern lifestyle, the disease changes as well. The therapy of replenishing qi and nourishing yin, which guided by the traditional thinking often cannot achieve a satisfactory effect. Therefore, the TCM syndromes distribution, etiology and pathogenesis of T2DM need to be refreshed.ObjectiveIn order to be acquainted with the distribution of syndrome manifestations features of T2DM. and the correlation between the change of syndrome manifestations and objective indicators, especially the heat syndrome. So as to discover the mechanisms of heat-clearing and qi-replenishing drug. Coptis and ginseng in treating with T2DM and its action on beta-cell protection. Thus, verify the T2DM pathogenesis hypothesis "superheat consuming qi" to enrich T2DM pathogenesis theory, and provide new ideas for Chinese medicine treatment of type2diabetes.Method1Clinical researchThrough the cross-sectional survey, we observed T2DM patients with general situation. symptoms, and objective indicators such as metabolic indicators, islet function. Analysis the symptoms and syndrome elements through frequeney cluster and factor analysis. Compare the differences of objective indicators among patients of different syndromes elements and do canonical correlation analysis as well. Through seven days longitudinal observation, compare the results of twice syndromes and blood glucose fluctuations, analysis the correlation between syndrome factors diversification and blood glucose fluctuations by multiple linear regression analysis. 2Experimental studySet up the spontaneous T2DM rat model by GK rats induced by High-calorie high fat diet. using heat-clearing and qi-replenishing Chinese medicine Coptis and ginseng for intervention. and set Wistar rats as the control group, detecting the metabolic markers, inflammatory factors and adiponectin levels, as well as pancreatic pathology. So as to observe the islet structure damage repair effect of Coptis and ginseng, and TNF-alpha. adiponectin receptors apoptosis factor expression in islets.Results1Clinical researchThe peak incidence of T2DM, men are about10years earlier than women.incidence of younger age in men are more serious than that in women. Over half of the T2DM patients are obese or overweight, regardless of gender. DR, DPN, DN are of the highest incidence of early T2DM complications. Hyperlipidemia, hypertension, fatty liver, and coronary heart disease are of the highest incidence of T2DM comorbidities.The basic characteristics of T2DM syndromes are as follows:Syndromes mainly are deficiency-excess complications. Simple excess or simply deficiency syndromes are relatively rare; The main types of deficiency syndromes are qi and yin deficiency syndrome, and yang deficiency is relatively rare, while, blood deficiency syndrome does not appear in the survey. Meanwhile, for the excess syndromes, the internal heat syndromes are widespread, and the phlegm and blood stasis syndromes are also prominent, qi depression syndromes are exist as well. There are a variety of forms of the performance of the internal heat syndromes, which can appear with phlegm, qi depression or blood stasis simultaneously, and manifested as humid-heat, heat retention, stagnated heat, etc.,or appear alone as well. Its main loci are the liver and gallbladder, spleen and stomach, gastrointestinal, or involved with the heart, lung and kidney.HbAlc, LDL-C levels are associated with the internal heat syndrome. UAE levels are associated with qi deficiency and phlegm syndrome. TG levels are associated with the degree of the internal heat syndrome as well as phlegm syndrome. UA.TC and HDI.-C levels are associated with phlegm. BUN levels are associated with yin and yang deficiency. There is close correlation among the internal heat, phlegm and blood stasis syndrome with islet function. Blood glucose levels and the extent of islet beta cells demand are related to the internal heat syndrome. The beta cell function, the deposition ability are both related to the blood stasis and the internal heat syndromes. BMI, insulin resistance level and insulin sensitivity are related to the phlegm syndrome.The blood glucose fluctuations are also related with the change of syndromes. Yin deficiency syndrome change with the blood glucose levels of before dinner. Yang deficiency syndrome change with the blood glucose levels of2hours after dinner. Qi depression syndromes change with the blood glucose levels of before lunch. The internal heat syndrome change with the blood glucose levels of before and after every meal.2Experimental studyTreat the spontaneous type2diabetic rats model with Coptis and ginseng treatment for4weeks, body weight, fasting insulin, adiponectin levels, insulin resistance and insulin sensitivity of the three groups had not significant difference.The postprandial blood glucose, blood lipids, uric acid, and serum high sensitivity C reactive protein levels of the model group and the Coptis and ginseng group were significantly higher than for normal group, for islet beta cell function was significantly lower than normal group, but there is no significant difference between the two groups.The serum TNF-alpha levels, islets TNF-alpha and Bax expression of Coptis and ginseng group were significantly lower than the model group, and had no difference with the normal group, and the expression of adiponectin receptor1in islet was significantly higher than that in the model group, and had no difference with the normal group.the degree of structural disorder of Islet is not that serious as the model group.Conclusion1Clinical researchIt is the root of the reason that the heat pathogenesis goes throughout the whole course of T2DM. leading that the internal heat syndrome ubiquitous. The essence of T2DM heat pathogenesis is glucose metabolic disorder and which result in β-cell disfunction and apoptosis. The internal heat syndrome can conbine with either phlegm or blood stasis, which are both the important factors of T2DM progressing.2Experimental studyThe mechanism of Heat-clearing and qi-replenishing Chinese medicine Coptis and ginseng is that, down regulate the expression of proinflammatory cytokines and pro-apoptotic factors in islets, meanwhile increase the expression of adiponectin receptor in islets, thereby contributing to the islet beta-cell damage repair. |
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