TCM Syndromes And Clinical Analysis In Type 2 Diabetic Patients With Non-alcoholic Fatty Liver

Objective:According to TCM Syndromes in Type 2 diabetic patients with non-alcoholic fatty liver,we are going to study the distributing regulation of their Syndromes,reveal their pathology,and combined with the modern medical examination results.In order to provide the Chinese medicine clinical classification quantitative indicators,make Chinese type more impressive and provide the basis for prescription under the theory of TCM.Method:We collected 182 cases according to the diagnostic criteria.We made four diagnostics by TCM and relevant modern medical examinations on the selected cases,and established a corresponding syndrome for each case.After dealing and analysing these data in statistical way,we summarized the distribution characteristics of the TCM syndromes of type 2 diabetes mellitus with nonalcoholic fatty liver,and found the relationship between the syndromes and modern medical examinations.Results:182 cases were divided into five syndromes:deficiency of both Qi and Yin with phlegm syndrome(62cases,accounting for 34.06%),deficiency of both Qi and Yin with phlegm and heat syndrome(44cases,accounting for 24.18%),deficiency of both Qi and Yin syndrome(35cases,accounting for 19.23%),Yin deficiency with internal heat syndrome(25 cases,accounting for 13.74%),deficiency of both Qi and Yin with phlegm and blood stagnation syndrome(16cases,accounting for 8.79%).Ten symptoms are most frequently seen in these cases:fatigue,thirst,polyuria,insomnia,lack of appetite,dizziness,chest tightness,spontaneous perspiration/night sweats,discomfort of waist and knees,bitter taste. Whitish tongue,thin white tongue coating,and string and thin pulse is also regarded as the important feature of these syndromes.There were no statistically significant differences among the genders and ages of each syndrome(P＞0.05).Among the indexes,BMI in patients with Yin deficiency with internal heat syndrome was significantly lower than those without phlegm and blood stagnation(P＜0.01),and BMI in patients with deficiency of both Qi and Yin with phlegm syndrome was significantly higher than those with deficiency syndrome or with heat syndrome(P＜0.01).The HbA1c values in patients with heat syndrome were significantly higher than those without heat syndrome(P＜0.05),and the values Were significantly higher in patients with deficiency of both Qi and Yin with phlegm and blood stagnation syndrome(P＜0.05).The ALT values in patients with deficiency of both Qi and Yin syndrome were significantly lower than those with phlegm syndrome(P＜0.05). The TG and CHOL values in patients with deficiency of both Qi and Yin with phlegm and blood stagnation syndrome were significantly higher than the other syndromes(P＜0.05).The Cr values in patients with phlegm syndrome or with phlegm and blood stagnation syndrome were significantly higher than those With Yin deficiency with internal heat syndrome(P＜0.05).There were no statistically significant differences among the remaining indexes(fasting blood glucose,B-Ultrasound,PT,APTT,INR,Fg,TB,IB,DB,AST,GGT,ALP,BUN, UREA,urine glucose,urine ketone,urine protein,urine occult blood,etc) of each TCM syndrome.Through 15 Variables of BMI,CHOL,weakness,more urine,chest tightness, chest pain,constipation,Shehong,dark tongue,Moss thin yellow,moss Boni,Moss yellow greasy and less Moss,Waterloo veins and Rapid pulse,discriminant testing and the cross-validation results show that the discriminant model for the correct rate:85.7%- with heat caused by Yin deficience syndrome,88.6%- the deficiency of Qi and Yin with phlegm and heat Syndrome,77.4%-deficience of Qi and Yin syndrome,81.2%-the deficiency of Qi and Yin with phlegm and blood stagnation syndrome,92%- the deficiency of Qi and Yin syndrome.Conclusion:The basic pathogenesis of type 2 diabetes mellitus with nonalcoholic fatty liver is deficiency in origin and excess in superficiality.The deficiency is focused on deficiency of both Qi and Yin,and the excess is caused by phlegm,heat and blood stagnation.The location of the disease is related to spleen,liver and kidney.Deficiency of both Qi and Yin with phlegm and blood stagnation syndrome is the most common TCM syndrome clinically.The blood glucose and blood lipid of the patients with heat syndrome is usually poorly controlled, so in addition to heat-clearing,the treatment should include the use of medication to control the blood glucose and blood lipid.The blood glucose,blood lipid and BMI of the patients with phlegm syndrome is higher,so in addition to strengthening spleen and eliminating phlegm,the treatment should include weight-losing(diet control,exercise,etc) to control the blood glucose and blood lipid.When treating patients with blood stagnation syndrome,we should nourish kidney-Yin and protect the kidney's function.Various laboratory tests can help to establish the TCM syndromes.With dialectical Chinese tongue and pulse and other symptoms,discriminant,and the correct rate of more than 75%,through the discriminant function can be carried out preliminary clinical classification.