Specification Of Syndrome Differentiation On Diabetic Kidney Disease

Objective:Method of literature review and data mining was performed to analyse of the treatment methods and prescriptions reported in random controlled clinical trials on treating diabetic kidney disease (DKD) with traditional Chinese medicine (TCM) or therapies integrated TCM and western medicine, aimed at exploring laws of syndrome differentiation, ingredients, and compatibility of medicines and providing literature evidence for clinical research of traditional Chinese medicine (TCM) treatments on DKD, and then to sum up and dig out effective experiences of TCM treatments on DKD, which contributed to provide clinical evidence for developing effective herbs on treating DKD.Methods:The literature on treatment of TCM on DKD from seven literature databases such as CNKI, Wanfang data, VIP and CBM, PubMed, Cochrane Library and EMBASE from the day of database built to August 2015 was retrieved, and targeted literature of random controlled clinical trials on treating DKD by TCM prescriptions was screen out.Establish a database and then to pick out research contents that including stage of DKD, types of TCM syndrome, sample capacity, treatment methods and herbs, dosage, meridian tropism and four natures and five flavors and so on. Prescriptions, herbs and types of TCM syndrome were sum up using statistical methods such as frequency statistics, association rules and clustering analysis. Based on statistical results syndrome elements, frequently-used prescriptions and herbs and compatibility law of TCM on treating DKD were explored.At last,the etiology and pathogenesis and medication rules of DKD were summarized and analyzed.Results:1. Summarization of DKD treatments differing from various stages and prescriptions and herbs modification according to different complications.There were 111 articles about phase III DKD,50 articles about phase IV DKD, and 5 articles about phase Ⅴ DKD included into this study. Herbs accounting for higher than 10% were arranged from highest to lowest by presence frequency. The number of literatures about phase Ⅴ DKD was too small to have statistical power. Statistical results showed that there was no significant difference in frequently-used herbs between phase Ⅳ and phase Ⅲ DKD. And herbs were used in both phases and the top 10 were still as followed:astragalus membranaceus, salvia miltiorrhiza and wolfiporia extensa, angelica sinensis, cornus officinalis, atractylodes, yam, rhizoma alismatis, radix rehmanniae and ligusticum wallichii. The difference between the two phases was the addition of nine high frequently-used herbs in phase Ⅳ that not in phase Ⅲ, including rhizoma atractylodis, epimedium, grifola, prepared rhubarb, pericarpium citri reticulatae, fructus schisandrae, rhizoma polygonati, semen plantaginis and herba lycopi and subtraction of three commonly used herbs such as peach seed, semen cuscutae and earthworm. Results partly reflected that patients in phase Ⅳ suffered much more severe symptoms of edema and phlegm stasis than patients in phase Ⅲ. And addition of herbs for yang-warming and promoting dieresis and resolving dampness was contributed to treatment of patients with water-dampness syndrome in mid-term of diabetes.There were 135 articles about DKD accompanied by dyslipidemia,114 articles about DKD accompanied by unstable blood glucose control,14 articles about DKD accompanied by hypertension. Similarly, herbs accounting for higher than 10% were arranged by presence frequency. Statistical results showed that herbs commonly used for treating DKD complications were roughly the same with no signigicant difference. The difference was that in the treatment of DKD accompanied by hypertension, application frequency of herbs for heat-clearing (rhizoma anemarrhenae, cortex phellodendri and pulsatilla chinensis) and herbs for expelling wind and relieving pain (bombyx batryticatus and periostracum cicada) were increased slightly. Statistical results conformed to pathologic characteristics of glucose and lipid metabolism disorder in diabetes and DKD was one of the complications of diabetes. Therefore, there was no significant difference in therapeutic herbs for treating complications of DKD.2. Syndrome differentiation of DKDA total of 107 references were involved in this study. We have summarized 18 kinds of standard type of TCM syndrome, frequency in top 5 was as followed:syndrome of qi and yin deficiency, blood stasis, deficiency of spleen and kidney yang, qi deficiency and blood stasis, accumulation of phlegm and blood stasis. Statistical results of syndrome elements showed that disease location of DKD was mainly the kidney followed by the spleen and liver. The nature of DKD was given priority to deficiency syndrome, which was followed by qi deficiency, yin deficiency and yang deficiency. Sthenia syndrome of DKD included syndrome of blood stasis, phlegm dampness and dryness-heat. DKD have always involved in syndrome of principal deficiency and secondary excess.3. Statistical results of prescriptions and herbs433 references were included in this study and 433 prescriptions and 217 herbs were summed up. The utilization frequency of herbs for restoratives, invigorating the blood and removing blood stasis, and heat clearing, promoting dieresis and resolving dampness and astringent was higher than other herbs. And meridian tropism of herbs was mainly attributive to the liver, kidney and spleen meridian. Flavor of herbs was mainly attributive to sweet, bitter and pungent and nature of herbs was mainly attributive to cold, warm and mild. The four natures and five flavors could be applied cooperatively, such as pungent used in conjunction with sweet, pungent used in conjunction with bitter and pungent used in conjunction with cold. Correlation analysis of two herbs showed that the common Herb Pair of DKD was astragalus membranaceus paired with radix pseudostellariae, astragalus membranaceus paired with ligusticum wallichii and wolfiporia extensa paired with rhizoma alismatis, salvia miltiorrhiza paired with lycium barbarum, salvia miltiorrhiza paired with radix rehmanniae. Clustering analysis showed that basic treatment herbs of DKD were astragalus membranaceus, salvia miltiorrhiza and yam, wolfiporia extensa, cornus officinalis, radix rehmanniae, angelica sinensis, ligusticum wallichii, rhizoma alismatis, prepared radix rehmanniae, atractylodes macrocephala koidz, rheum officinale, radix paeoniae rubra, lycium barbarum, leonurus heterophyllus, radix pseudostellariae and hirudo. Clustering regular volume data indicated that common treatment prescriptions of DKD were Liuwei Dihuang Wan, Sijunzi Tang and Liujunzi Tang, Siwu Tang, Buyang Huanwu Tang, Yuye Tang, Qiwei Baizhu San, Zhibai Dihuang Wan, Jingui Shenqi Wan, Jisheng Shenqi Wan, Zhuling Tang, Wuling San, Erzhi Wan, Erchen Tang and Xiexin Tang and so on.Conclusions:l.The occurrence of diabetes and nephrosis is closely related to the imbalance of yin and yang in kidney, spleen and liver. These diseases are characterized by deficiency in origin and excess in superficiality:deficiency in origin is manifested as deficiency of Qi and Yin and excess in superficiality phlegm-turbidity and blood-stasis. The remedy is Shenqi Dihuang Decoction and Bazhen Decoction. This remedy has no significant differences from common drugs for stage treatment of diabetes and nephrosis, even in the case of concomitant drugs, which indicates the principle of treating diabetes is systematically regulating glucose and lipid metabolism disorder and combining disease-symptom-syndrome2. According to statistics, it is proposed to divide symptoms into three primary symptoms and three secondary symptoms. The primary symptoms include Qi and Yin deficiency, spleen-kidney Yang deficiency, liver-kidney Yin deficiency and the secondary symptoms blood stasis, phlegmatic hygrosis and heat pain.3. The Medication Rule:The commonly used drugs are tonic drug, blood-activating and stasis-resolving drug and heat-clearing drug. These drugs are helpful to kidney, spleen and liver. Mild drug and drug matching is preferred, and specific conditions are considered. Sweet, pungent and bitter drugs are favored:sweet and pungent drugs matching, pungent and bitter drugs matching, sweet, pungent and cold drugs matching are preferred. The commonly used drugs are Huangqi with Radix Pseudostellariae, Astragalus with Chuanxiong and Fuling with Zexie. The combination of three relevant drugs of different taste is manifested as Four Ling Decoction and the combination of four or five Liuwei Dihuang Pill.