| The thesis consists of three parts:literature review on diabetic retinopathy(DR)of TCM and modern medicine,TCM pattern and treatment regulation investigation of 238 non-proliferate diabetic retinopathy(NPDR)patients based on clinical pathway management,clinical observation of NPDR patients treated with herbal decoction that boost qi,nourish yin and invigorate blood.1.Literature review:Objective:To summarize the research progress on DR of TCM and modern medicine,and to provide theoretical basis for treating DR with the method of boosting qi,nourishing yin and invigorating blood.Method:Summarize the etiology and pathogenesis of DR and its clinical treatments.Generally reviewed the research progress on DR by treating with the method of boosting qi,nourishing yin and invigorating blood.Sum up the risk factors,pathogenesis and oral drug treatment of DR.Conclusion:The core pathogenesis of DR is qi-yin depletion and stasis-phlegm obstructing collateral.The method of boosting qi,nourishing yin and invigorating blood for treating DR has had theoretical basis.2.TCM pattern and treatment regulation investigation of 238 NPDR patients based on clinical pathway management:Objective:To investigate TCM pattern and treatment regulations of diabetic retinopathy at non-proliferate stage.Method:238 cases with NPDR who were hospitalized in endocrinology ward of Guang'an men Hospital from Oct.1 st 2018 to Sep.30th 2019 were retrospectively studied.Their basic information,co-morbidity,laboratory examinations,ophthalmic examination and fundus photography,four examinations and pattern differentiation and treatment of TCM were collected to investigate TCM pattern and treatment regulations of NPDR,risk factors,as well as the correlation between DR and DN,etc.Result:?The frequency of pattern of qi-yin depletion and stasis obstructing collateral ranks highest,accounting for 44.96%.?The frequency of decoction Shengmaisan ranks highest,accounting for 12.18%.Conclusion:The predominant pattern of NPDR is pattern of qi-yin depletion and stasis obstructing collateral.The main therapeutic method of TCM treatment is boosting qi,nourishing yin,invigorating blood and dissolving stasis.3.Clinical observation of NPDR patients treated with herbal decoction that boost qi,nourish yin and invigorate blood:The study is based on Research Project of Capital Health Development Foundation,TCM Prevention and Management of Diabetes Based on Precision Medical Mode-Clinical Study on The Effect of Qizhi Jiangtang Capsule in Treating Non-proliferative Diabetic Retinopathy(No.Capital Development 2016-1-4151).Objective:To observe the clinical efficacy and safety of herbal decoction that boost qi,nourish yin and invigorate blood in the treatment of NPDR.Provide new thoughts and methods of treatment of TCM for NPDR.Method:60 cases of NPDR who were diagnosed as qi-yin depletion and blood stasis in Changping,Miyun,Pinggu District TCM Hospitals and Beijing Shijitan Hospital were included in the trial.In accordance with randomized,controlled principle,the cases were divided into treatment group and control group,30 patients respectively.Both groups were given general treatment such as lifestyle guidance,hypoglycemia,antihypertensive and lipid reduction.Patients in treatment group were given Qizhi Jiangtang Capsule and calcium dobesilate orally,while control group treated by Qizhi Jiangtang Capsule placebo and calcium dobesilate orally.Evaluate clinical efficacy and safety by observing the changes of corrected visual acuity,fundus lesion,blood glucose(FBG,2hPBG),HbAlc,blood lipid(TC,TG,LDL-C),TCM pattern integral and safety indexes.Result:?TCM pattern integral:Both groups can relieve TCM patterns(P<0.01).The total effective rate was 86.67%in treatment group and 50.00%in control group.The decreasing trend of TCM pattern integral of treatment group was more obvious than control group(P<0.05).?Fundus lesion and vision:The improvement of fundus lesions in treatment group was better than that in control group(P<0.01).Patients in treatment group had better vision after treatment(P<0.01),while no statistically improvement was showed in control group(P>0.05).?Hypoglycemia effect:The levels of FBG,PBG,HbAlc of both groups decreased significantly(P<0.01).The decrease of blood glucose in treatment group was statistically more obvious than that in control group(P<0.05).?Lipid-lowering effect:Treatment group showed obvious reductions in the level of all three blood lipid indexes including TC,TG and LDL-C(P<0.01),while control group only showed reductions in TC(P<0.01)but not in TG and LDL-C(P>0.05).?Safety evaluation:The safety indexes of both groups were all in the normal range before and after treatment,and no adverse reactions were reported.Conclusion:Qizhi Jiangtang Capsule,a formula that boost qi,nourish yin and invigorate blood,can relieve symptoms,lower blood glucose and lipid,improve microcirculation,enhance retinal blood perfusion,delay the development of DR and it is proved to be safe and effective in clinical application. |
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