Exploration Of TCM Theory On Insulin Resistance And Action Of Zi Sheng Qing Yang Pian For Reversing Left Ventricle Hypertrophy Of Essential Hypertension

Objective:To explore Traditional Chinese Medicine (TCM) theory on insulin resistance(IR) and to study the experimental and clinical effect of Zi Sheng Qing Yang Pian for reversing Left Ventricle Hypertrophy(LVH).Methods:1. By referring to Holism and archaic literature, the position,formation and function of Yi, and the etiology and pathogenesis of insulin resistance of TCM are argued for, which provided thoughts to treat Insulin Resistance Syndrome(IRS), for example hypertension.2. Experimental Study:24 spontaneously hypertensive rats (SHR) are randomly divided into four groups:the ZSQYP group(ZSQYPG),the Captopril group(CapG), the blank group(BG), the model group(MG)(n=6).6 Wistar rats consists of normal group(NG). MG and NG are killed after dividing, other groups are observed for 4 months. Pre-and post-experiments, blood is drawn out and systolic blood pressure(SBP) is measured. After killed, rats'body weight(BW), left ventricle weight(LVM), LVM/BW, the marker of IR:fasting blood sugar(FBS),fasting insulin(FINS),C-peptide(C-P),index's antilogarithm of insulin-sensitivity(IAI) are measured, gene expression of cardiac muscle type-â… and type-â…¢collagen mRNA are quantified by reverse transcription polymerase chain reaction(RT-PCR).In the experiment, ZSQYP's lowering blood pressure(BP) and reversing LVH are observed. 3. Clinical Study:There are 60 patients, whose Syndrome Differentiation typing(SDT) was the Yin-Deficiency and Yang-Hyperactivity, the Deficiency of heart-Qi with dizziness caused by wind accompanied cardiac hypertrophy (essential hypertension left ventricle hypertrophy).The 60 patients are randomly divided into ZSQYPG and CapQ each group with 30 ones patients.4 months is one course of treatment. Pre-and post-therapy, different syndromes of TCM and effects, the levels of BP, left ventricle structure assessed by echocardiography, and FBS, FINS, C-P, IAI in the blood are studied. In the process, ZSQYP's improving TCM syndromes, lowering BP and reversing LVH are observed.Result:1. The animal experiment study shows that:There are significant differences in the SBP, LVM, LVM/BW, FBS,FINS, C-P, IAI between the MG and NG (P< 0.05). The levels of SBP, LVM, LVM/BW in ZSQYPG and CapG are much lower than that in BG (P< 0.05,P< 0.01). FINS, C-P in ZYPGG and CapG are all significant lower than that of BG (P< 0.05), but the IAI is higher than that of BG (P< 0.05), The difference is significant in FINS, C-P, IAI when compared with ZYPGG and CapG, ZYPGG is better than CapG (P< 0.05). The gene expression of cardiac muscle type-â… and type-â…¢collagen mRNA in SHR is significantly much increased than that in NG, the expression level in ZSQYPG and CapG are much decreased than that in BG (P< 0.05),but ZYPGG is better than CapG (P< 0.05).2. The Clinical Study shows that:Compared the treatment group with the control group, the TCM syndromes of two groups are relieved. The total scores and improvements of TCM syndromes are markedly higher than that of the control group, and the significance especially displays on relieving main symptoms, such as dizziness, headache, chest distention and palpitation. After treating, the levels of blood pressure, left ventricle structure in treatment group and control group are marked descent(P< 0.05), the levels of FINS, C-P in treatment group are lower than that of control group (P< 0.05),but the IAI in treatment group is higher than that of control group (P< 0.05). 3. "Sangao" is named Yi, "juice of sweet meat" is material similar to insulin. Inferred from TCM theory, the action of Yi belongs to that of Pi, hence the two are given the Yi-Pi. Insulin resistance(IR) results from inherent defect and acquired factor.Conclusion:1. Experimental and clinical study illustrates that ZSQYP can obviously improve TCM syndromes, and effectively lower BP and FINS,C-P of SHR and patients with essential hypertension and higher IAI of them. The study also illustrates that ZSQYP can decrease the gene expression of cardiac muscle type-â… and type-â…¢collagen mRNA to reverse LVH. The results also shows ZSQYP had the obvious effects in improving TCM syndromes of the Yin-Deficiency and Yang-Hyperactivity, the Deficiency of heart-qi with dizziness caused by wind accompanied cardiac hypertrophy(essential hypertension left ventricle hypertrophy).The effects especially exist in relieving the main symptoms as follows:dizziness, headache, chest distention, palpitation, and regulating gene expression of cardiac muscle type-â… and type-â…¢collagen mRNA down and ameliorating IR. One of the main mechanisms of reversing LVH may be that it decreases FINS, raises IAI and ameliorates IR.2. In TCM theory, IR exists in the Yi-Pi and vessel,and the key to the pathogenesis of TCM is that Yin-Deficiency is the foundation,while dryness-heat(fire) and Yang-Hyperactivity are the appearances.The foundation and appearance are contacted by phlegm, blood distention, fat, turbid.Dizziness caused by wind has similar pathogenesis of TCM.