| China is one of the three countries prevailing diabetes in the world. In2010, The New England Journal of Medicine issued the survey result of diabetes prevalence rate in our country made by China Diabetes and metabolic syndrome Research Group of Chinese Diabetes Society. Survey showed that the prevalence rate of diabetes of men and women over20years old was respectively10.6%and8.8%, with9.7%of total prevalence rate. The prevalence rate of pre-diabetes in the same period had reached15.5%. According to the reckoning of survey result, the total number of diabetic patients in our country has been more than92million, and the number of pre-diabetic patients has reached1.48billion. Our country is facing a severe challenge in preventing and curing diabetes.Since70s in the previous century, Professor Lin Lan did research in diabetes. Based on years of clinical practice, she has established three-typed differentiation treatment system of diabetes. The principles of three types include Yin-deficiency and excessive heat, deficiency of both qi and yin, deficiency of both yin and yang. There are "items","dampness (moist heat and cold-dampness)", blood stasis combined syndrome. It was included into Guidance principle of clinical study on new drug (Chinese traditional drug) of diabetes by the Pharmacy Department of Health Ministry and is used until now, widely recognized and quoted by experts in the field.This dissertation is divided into four parts, including review on academic achievement, study on the three-typed differentiation theory of diabetes, clinical treatment experience and case collation aiming at researching the academic thought of Professor Lin Lan, inheriting clinical experience and deeply exploring academic achievement.The first part is to collate the academic achievement of Professor Lin Lan. The seminar mainly with tutors will undertake26projects, successively assuming5projects of national natural science funds,3projects of National Administration of Traditional Chinese Medicine and3brainstorm projects of national technology. The study on clinical application and mechanism of three-typed differentiation of diabetes has been rewarded the first prize of2008Science and Technology Awards of China Society of Integrated Traditional Chinese and Western Medicine. It allocates the clinical experience and study methods of Professor Lin Lan on diabetes through the previous reviewing study on scientific research achievements.The tutor never stops establishing and gradually completing the theory of diabetes three-typed differentiation to use them in the practice treating diabetes and complications. She is the first one to put forward theory on the complication of blood stasis and diabetes and angiopathy, which is widely recognized and quoted by professions throughout the country and providing evaluation standard for further developing the new Chinese traditional medicine of diabetes and its complications. Besides, she succeeded in building animal models of heart, brain and kidney of diabetes, as well as the study methods of cell culture and gene expression related to diabetes. He was also leading in the "Tangweikang Capsule on Diabetic Nephropathy study", which is the brainstorm project in the ninth five-year plan in China, which has got a good effect in treating the diabetic nephropathy during the early period in clinical application. She is the first one to discuss the etiology and pathogenesis of diabetic nephropathy and molecular target of Chinese traditional medicine by applying technologies as DNA Methylase, RNA Polymerase and Rnase as well as representing etiology and pathogenesis of diabetic nephropathy and functions of Chinese traditional medicine, Tangweikang from the perspectives of cytology and serum pharmacology."’Chinese traditional medicine’s impact on the progression of microangiopathy in the earlier period of diabetes", the nation’s tenth five-year plan was led by the professor, aiming to discuss whether the Chinese traditional medicine could lower the incidence rate, improvement rate and remission rate of microangiopathy complications in the earlier period of diabetes under the principles of multi-centers, large samples and random contrary. Last but not least, she was the first one to bring in UKPDS and DCCT method to apply in the clinical study field of Chinese traditional medicine, the first one to study on the standardized treatment scheme of microangiopathy complications in the earlier period of diabetes in China, which was a precedent in the study field of Chinese traditional medicine of diabetes throughout the country.The second part is theory study, clearing the historical origins of three-typed differentiation academic thought of diabetes. From literature research, it will standardize the name, etiology and pathogenesis, syndrome diagnosis of diabetes, summarize the basic syndrome and clinical manifestations of diabetes such as Yin deficiency, excessive heat, Qi deficiency, Yang deficiency, dampness, stasis, specify the clinical manifestations of syndrome of Yin-deficiency and excessive heat, deficiency of both qi and yin, deficiency of both yin and yang, dampness and blood stasis. Study shows that diabetes has six basic syndromes, including Yin-deficiency, excessive heat, Qi-deficiency, Yang-deficiency, dampness and blood stasis. Diabetes is caused by poor physical condition, five weak internal organs; stagnation of liver qi, yin injured by stagnated heat; improper diet, fluid injured by intrinsic heat; external causes, yin injured by heat transmission; excessive work and leisure, deficiency of kidney essence; consumptive weakness comes to stasis, and after stasis it becomes more consumptive;dampness gathering and coagulated phlegm, combination of dampness and heat. Materials of modern epidemiology indicates that95%of diabetes is2-type. Due to the changes of life style and improvement of modern treating techniques, the disease symptom has been changed greatly, and "three more and one less" symptom of diabetes patient is no longer apparent. With disease progressing, the pathological change induced by the root of yin deficiency has shown phrasal characteristics. The clinical manifestation of Yin-deficiency and excessive heat syndrome are thirsty, bitter taste, dysphoria with feverish sensation in chest, palms and soles, tension and anxiety, constipation, yellow coat and rapid pulse. The clinical manifestation of deficiency of both qi and yin syndrome include spontaneous sweating, fatigue, Qi shortness and talking laziness, lumbar debility, anorexia, cardiopalmus and thready pulse. The clinical manifestation of deficiency of both yin and yang syndrome refers to oedema, chills and cold extremities, aversion to wind and cold, impotence, sloppy diarrhea, nycturia, swollen tongue and slow and sunken pulse.Dampness and blood stasis are the pathological production of diabetes and pathogen of combined syndrome, which mainly appear in various diabetes complications and in the early, medium and late period of diabetes. The clinical manifestations of combined syndrome of diabetes:numbness and tingle over limbs, activity limitation, dark-purse lips, pain in heart and chest, dark tongue proper, purplish spot on tongue, dark-purse and varicose on sublingual vein and sluggish pulse. The clinical manifestation of diabetes dampness:thirsty but without much drinking, heavy head, bloating and focal distension of abdomen, heavy cumbersome limbs, swollen tongue with indentation, greasy or slippery coat, slow, wiry or slippery pulse.Part three is to summarize and make conclusion on tutor’s clinical experience on the three-typed differentiation of diabetes and her treatment knowledge in individual clinical practice. For example, the treatment of diabetic nephropathy emphasizes the early intervention by combining Chinese and western medicine, attaching importance to the cohesion of micro and macro differentiation, syndromes, suiting measures to different periods, protruding discussing treatment from stasis. The diabetes and coronary heart disease have syndromes of root deficiency and branch excess, with deficiency in qi and yin as root, turbid-phlegm, heart vessel blocked by stasis blood as branch. Its syndromes are deficiency in both qi and yin, turbid-phlegm, heart vessel blocked by stasis blood. Its treatment shall mainly be increasing heart qi and yin, invigorating blood circulation, dissolving blood stasis, relieving chest oppression and dredging channel blockage. The root of deficiency is cardionephric insufficiency, deficiency in qi and yin, stasis blood blockage. Yin and qi deficiency is the major pathological basis of stasis blood and phlegm-dampness. Therefore, replenishing the yin and benefiting the qi is good for invigorating blood circulation and eliminating the phlegm. The differentiation combination is Tangxinping composed by raw Astragalusmembra, shizandra and hirudo, which will be increased or reduced with the syndromes.The differentiation of diabetes and hypertension shall focus on distinguishing the physical conditions of patients. The patients suffering from diabetes and hypertension are mainly those with melanuria jueyin but liver-yang hyperactivity, yin deficiency but liver-yang hyperactivity and yin deficiency but yang hyperactivity. Secondly, attach importance to the positioning of viscera of definitely pathological changes. The access of patients with diabetes and hypertension has relation with the disorders of liver, kidney, spleen, stomach and heart, especially liver and kidney. Thirdly, pay attention to distinguish the root and branch of syndrome is deficient or excessive. Among the patients with diabetes and hypertension, for branch excess, the most frequent examples are hyperactivity of liver yang, flaming up of liver fire and phlegm-fire attacking upwards; for root deficiency, the most common instances shall be yin deficiency and deficiency in yin and qi.For the differentiation treatment of surrounding nerves of diabetes, we shall diagnose flexibly, caring about the external treatment and cure the disease. For complications such as heart vegetative nervous pathological change of diabetes, retinopathy, abnormal sweating, cutaneous pruritus, impotence, hyperlipidemia and metabolic syndrome, child and sensile diabetes, the tutor attaches importance to the psychological issue of the diabetes patients in clinically with her special treating experience.Part four is following the teachers and collating the cases. This part will analyze the entire clinical case on treating diabetes by Professor Lin Lan to reveal the symptoms, physical signs, distribution of syndrome type, treatment principle and methods, diagnosis, medicine discipline of three-type differentiation basis, usages of core medicine, features of normal dosage, compatibility and modification of herbs. |
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