Clinical Observation Of Zhixuesanyu Mingmu Tang For The Treatment Of Nonproliferative Diabetic Retinopathy(npdr) (blood Stasis And Deficiency Of Qi And Yin)

Objective: Non-proliferative diabetic retinopathy (NPDR) is a diabetic retinopathy (DR) of the early stages. NPDR fundus manifestations include microvascular tumor, bleeding spots, hard exudation, cotton wool spots and vascular lesions and so on. If no treatment is carred out timely in a more severe NPDR, it will be developed as proliferative diabetic retinopathy (PDR) in one year time or so. In this stage, if patients can get timely and effective treatment, it can help slow the progress of diabetic retinopathy, maintain the visual acuity (visual acuity, VA), reduce the rate of blindness and improve the quality of life. Therefore, early treatment of NPDR is of great practical significance. For the treatment of NPDR addition to controlling blood sugar, blood pressure, blood lipids, we can also use the retinal microcirculation drugs to improve the absorption of tumor capillaries, bleeding points, hard exudation, and cotton wool spots, and even to reduce the macular edema. The main representative of the treatment of early DR drugs are Doxium, Difrarel and Methycobal and so on. Modern Chinese medicine treatment of DR's main mechanism is to improve microcirculation and protect the vessel wall, removing free radicals, nutrition nerves, reducing edema and exudation. Drugs on behalf of San Qi preparations, puerarin injection, Salvia Ligustrazin and so on achieve good effect.This study is mainly focused on the treatment of the DR using traditional Chinese medicine. It is intended to fulfill the advantages of Chinese traditional medicine, using traditional Chinese medicine as a whole concept. We have summarized in interpreting a traditional Chinese medicine on the DR of the dialectical sub-types (2-3), and corresponds the sub-types to the DR periods defined in the Western medicine. According to the correspondence we make modifications on the ancient prescriptions and experience prescriptions. Combined with the current DR research results at home and abroad, we have developed the Chinese medicine for different clinical stages in order to achieve improvement and treatment of systemic symptoms and fundus DR lesions. This study interprets one of the researches on the treatment of moderate NPDR and severe NPDR using Zhixue Sanyu Mingmu Tang, curing the Qi and Yin Deficiency Syndrome Differentiation, context stasis -type patients before and after treatment for clinical indicators for its monitoring and traditional Chinese medicine to improve the efficacy of clinical signs, preliminary evaluation of traditional Chinese medicine prescription bleeding Sanyu eyesight TCM decoction is a Qi and Yin Deficiency, vein stasis model NPDR effectiveness.Methods: The patients were from the Fourth Hospital of Hebei Medical University, ophthalmology clinic. We chose a total of 60 cases of patients with DR dating from June 2009 to October 2009--Male 26, female 34 cases; and the youngest 32 years old, the oldest 70 years old, average age of 54.57±9.65 years; ill-course 1 to 30 years, with an average duration of 9.48±5.42 years. According to proposed inclusion criteria and exclusion criteria included type 2 diabetes, non-proliferative retinopathy TCM is Qi and Yin Deficiency, context stasis cases 60 patients (113 eyes), according to their degree of retinopathy were randomly divided into the treatment group and the control group. The treatment group (TCM group): a total of 30 patients (57 eyes), in which lesions 18 eyes in stageⅠ,Ⅱperiod of disease 26 eyes,Ⅲperiod of eye disease 13. Taking 12 weeks to Zhixue Sanyu Mingmu Tang (a treatment). The control group (blank control): a total of 30 patients (55 eyes), of which 19 eyes in stageⅠdisease,Ⅱperiod of disease 22 eyes,Ⅲperiod of eye disease 14.The treatment group and control group patients were treated with basic therapy, including diabetes education, using low-salt, low fat diabetic diet, adequate exercise, blood sugar, the higher choice of hypoglycemic agents or insulin injections to control blood sugar fasting blood glucose FBG <7.0mmol / L, postprandial blood glucose PBG <11.1mmol / L. All patients before treatment and after 12 weeks of treatment were subjective indicators (eye easily, depending on the material to increase clarity, depending on the fatigue improvement), the objective indicators (visual acuity, retinal microvascular tumor, edema, bleeding spots, hard exudation, cotton wool spots, etc. ) and the efficacy of TCM symptoms and other indicators to detect and determine the standards under the effect of before and after treatment comparison and statistical analysis.Results: In this study, patients were included 60 cases, non-removed cases, fall off in 4 cases, off the reasons: lost to follow.1 After treatment, the treatment group of subjective symptoms improved in 22 cases, the total effective rate was 81.5% in the control group of subjective symptoms improved in 3 cases, the total effective rate 10.3%. The group using Zhixue Sanyu Mingmu Tang are effective in improving the subjective symptoms (X2 = 28.631, P <0.01).2 After treatment, the treatment group (53 eyes) visual acuity improved in 43 eyes (81.1% efficiency), the control group (54 eyes) visual acuity improved in seven eyes (effective rate 12.9%). The group using Zhixue Sanyu Mingmu Tang are effective in improving the visual aspects (t = 2.451, P <0.05).3 After treatment, the treatment group (38 eyes) and 31 reduction in tumor microvessel eyes (the total effective rate 81.6%); the control group (32 eyes) had reduced tumor microvessel 12 eyes (total effective rate 37.5%) . The group using Zhixue Sanyu Mingmu Tang absorption in the promotion of tumor microvessels and effective (X2 = 14.245, P <0.01).4 After treatment, the treatment group (42 eyes) with fundus hemorrhage plaque reduction of 35 eyes (total effective rate was 83.3%); the control group (44 eyes) with fundus hemorrhage plaque reduction of 13 eyes (overall response rate was 29.5%). The group using Zhixue Sanyu Mingmu Tang Fundus hemorrhagic spots in the promotion of the effective absorption (X2 = 25.208, P <0.01). 5 After treatment, the treatment group (29 eyes) should be to reduce leakage of 21 eyes (72.4% total efficiency); the control group (27 eyes) should be to reduce leakage has three eyes (overall response rate was 11.1 %). The group using Zhixue Sanyu Mingmu Tang hard exudate in the promotion of the effective absorption (X2 = 21.073, P <0.01).6 After treatment, the treatment group (13 eyes) with cotton wool plaque reduction in 9 eyes (the total effective rate 69.2%); the control group (14 eyes) with cotton wool plaque reduction with 2 eyes (the total effective rate 14.2%) . The group using Zhixue Sanyu Mingmu Tang absorption in the promotion of cotton patches and effective (X2 = 8.117, P> 0.05).7 After treatment, the treatment group to reduce fluorescein leakage in 8 eyes (the total effective rate 61.5%); control group, fluorescein leakage mitigation have an eye (the total effective rate 6.3%). The group using Zhixue Sanyu Mingmu Tang are effective protection of the vessel wall. (X2 = 9.890, P <0.01).8 After treatment, the treatment group improved markedly TCM syndrome in 11 cases (40.7%), effective in 13 cases (48.1%) and ineffective in 3 cases (11.1%), total effective rate of 88.9%; control group, symptoms improved markedly a traditional Chinese medicine cases (3.4%), 8 cases (27.6%), ineffective in 20 cases (69.0%), the total effective rate of 41.0%; the group using Zhixue Sanyu Mingmu Tang bleeding symptoms in traditional Chinese medicine in improving the results are obvious. (X2 = 19.337, P <0.01).Conclusion: Zhixue Sanyu Mingmu Tang decoction Qi and Yin Deficiency, vein stasis model NPDR, with improvements in patients with ocular lesions and clinical symptoms of systemic effects, can improve vision and reduced retinal microvascular tumor, bleeding and leakage, the promotion of retinal edema the absorption and improve the level of retinal microvascular disease. The recipe to improve moderate to severe NPDR patients with ocular symptoms, systemic symptoms, as well as the effect of retinal microcirculation in no significant difference.