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Theoretical and Clinical Study on the Law of Syndrome Differentiation of Diabetic Damp Heat Syndrome and Diabetic Cardiopathy

Author: LiSaiMei
Tutor: LinPeiZheng
School: Guangzhou University of Traditional Chinese Medicine
Course: Clinical basis for TCM
Keywords: Diabetes mellitus Heart disease The damp heat syndrome Epidemic febrile disease of Lingnan Summary of literature Analyze of cases Rule of diagnosis and treatment Inflammatory factor Glucose tolerance Insulin release
CLC: R259.8
Type: PhD thesis
Year: 2005
Downloads: 351
Quote: 4
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Section 1 Theoretical studyObjective and methodsThe author reviewed and refined the related literature from three points of view, which were damp-heat syndrome, damp-heat syndrome and diabetes mellitus and diabetes mellitus and cardiopathy. This dissertation made a study of future research clew and provided theoretic reference for treating diabetes and diabetic cardiopathy under damp heat theory.Conclusion and reveal1. Recently, researches on damp heat syndrome were one of the active fields in TCM. Its hot points included clinical application, animal model and objective indicator, etc. Further investigation clew included that to strengthen integration of outcome in order to do spatial and global dynamic investigation, to enhance survey of susceptible population of damp heat syndrome on habitus, environment and correlation factors, to compare the syndrome or symptom complex feature and evolution regulation of external affection with internal injury and combined pathogens, to discuss pathogen and pathogenesis tache of difficult diseases, which related to damp heat syndrome, by cutting in today’s hot point and difficulty in medical field, to enhance the production transform and investigation of TCM classic-famous prescription.2. Hot points of investigation on diabetic damp heat syndrome includedepidemiological investigation, pathogeny and pathogenesis, treatment principle, prescription and complication. Future clew of investigation were as follows. The introduce of modern new theory of environment factor, inflammatory factor and cholecystokinin could bring new chance and cut-in point for diabetic damp heat syndrome and its related researches of treatment principle and prescription. We should pay attention to the series investigation of compound recipe formation regulation, dose-effect relationship, phase of exerting effect and target point of action. We should not be limited to the tache of lower glucose. We should do systemic, holistic and all-around investigations from the improvement of insulin resistance and metabolism syndrome to prevention and cure of complications, especially cardiovascular ones.3. This dissertation summed up the TCM researches on diabetic cardiopathy and brought up the clew of future as follows. We should put stress on standardization and quantization of clinical analyses and differentiate diseases. The treatment should be various and serial. We should use research method of evidence-based medicine and tackle key problems by multiple units. In experiments, we should introduce research findings of modern science so as to discuss the essential of TCM syndrome of diabetic cardiopathy and the possible active mechanism of herbs. We could do further optimize and extraction on prescriptions so as to establish basis for development of new drugs. At the same time, new self-contained model of diabetic cardiopathy should be developed.Section 2 Clinical studyObjective and methodsForm near to distant, we analysis the recent data of 1,000 diabetic patients in ward in order to find out the relativity of diabetes mellitus and damp heat syndrome and the relativity of diabetic cardiopathy and damp heat syndrome. We expected to find out the clinical characteristics, feature of syndrome, location of the disease and pathogenesis and the regulation of development of damp heat syndrome and diabetic cardiopathy. We also wanted to get the relativity of inflammatory factor and damp heat syndrome and diabetic cardiopathy. We hoped the results could offer reference for clinical treatment of diabetes mellitus.Results1. Analyzes on the clinical data of 1,000 hospitalized diabetic patients.All cases came from wards of medicines, surgery, orthopaedics, specialty of ophthalmology and department of tumor, etc, Cases form ward of medicine took 90.6% and male ones were equivalent to female ones. The age ranged form 7 to 88 years old and the average age was 60.5 years old. The course of diseases was 1 to 28 years and the average course of disease was 7.1 years. Every case was in hospital for 3.2 times averagely and the ratio of time after time be in hospital was 70.8%. Theratio of type 2 diabetes mellitus was 95.8% and the mortality rate was 1.3%.The highest incidence rate of complication was heart disease, and the next in turn was high blood pressure, nephropathy, hyperlipemia, peripheral nervous lesion, pulmonary infection, arteriosclerosis, fatty liver, cholecystitis and cholelithiasis, retrograde disease of joint, ophthalmopathy, ketosis, cerebral infarction and urinary tract infection.The ratio of red tongue and pale tongue was 52.7:47.3. The percentage of dismal body of the tongue was 33%, and 52.2%, 24.5% in greasy and yellow fur on the tongue and in greasy and yellow fur on the tongue plus greasy and white fur on the tongue. The deficient pulse cases were equivalent to replete pulse ones. The percentage of deficiency of both the vital energy and yin was 79.9%, and the percentage of deficiency both the yin and yang was fewer and deficiency of yin and dryness heat was the fewest. As to the location of the disease, the liver got the highest, and the next in turn was kidney, spleen, stomach, heart, lung, bladder, gall bladder and large intestine. Each case deals with 3 to 4 locations of the disease. As to deficiency syndrome, deficiency of yin got the highest, and the next in turn was deficiency of qi, deficiency of yang and deficiency of blood. As to evil factors, this turns was blood stasis, depressed vital energy, wind and yang, damp heat, damp turbidity, accumulation of dryness, water, phlegm heat, fire, phlegm damp, poison, evil wind, cold and cold turbidity. The percentages of hot natured pathogen and damp natured pathogen were 53.3% and 32.9%.2. Analyzes on the clinical data of 307 moist-heat syndrome diabetic patients.Compared with the non-damp heat group, the damp heat group had characteristics as follows. The incidence of disease was higher in female patients. The age was older. Significantly higher complications of heart disease, nephropathy, peripheral nervous lesion, diabetic foot and cerebral infraction were seen in this group. The incidence of urinary tract infection, alimentary infection, gangrene, cholelithiasisand hyperuricemia was significantly increased. The deficiency of both the vital energy and yin got the highest incidence and the gall bladder, large intestine and bladder got the most in the location of the disease. The damp heat factor and toxic factor was significant in this group. The levels of erythrocyte sedimentation rate and c-creative protein were higher than that in non-damp heat group. But the wind yang, water and fire factors in non-damp heat group were higher.3. Analyzes on the clinical data of 528 patients of diabetic cardiopathy.Compared with non-cardiopathy group, the diabetic cardiopathy group had significant difference as follows. More female patients, older in age, longer in course of disease and more times for hospitalization could be seen in this group. The youngest age for the coming on age was 22. More complications of nephropathy, nervous lesion, cerebral fraction, hypertension and arteriosclerosis could be seen in this group. The incidence of pulmonary infection, urinary tract infection and cholelithiasis was increased also. The deficiency of both yin and yang syndrome got the most in this group. As to the location of disease, diabetic cardiopathy group deal with kidney, heart and lung and non-diabetic cardiopathy group deal with stomach. As to the disease due to asthenia of viscera, diabetic cardiopathy group mainly deal with deficiency of yang and non-diabetic cardiopathy group with deficiency of qi. As to the evil factors, the wind yang, phlegm heat, damp turbidity, blood stasis, dry stagnation and water got the most in diabetic cardiopathy group.Conclusion1. Patients of diabetes mellitus mainly accepted treatment in the ward of medicine. They could be in hospital of the wards, according to its complications, of surgery, orthopaedics, specialty of ophthalmology and department of cancer, etc. There was no gender difference in the incidence of diabetes. Most of the complications were gray-headed diseases but youngster and young adults also could get it. Type 2 diabetes mellitus was the main type and the death rate was relatively low because of the combined treatment of Chinese medicine and Western medicine. Heart disease was the all-important complication of diabetes mellitus. The main tache of pathological changes was related to cardiovascular disease, nervous lesion, infectious diseases, metabolic diseases, endocrine diseases, immunological disease and degenerative diseases. Analyze of TCM tongue and pulse showed that it was mix of cold and heat and mix of deficiency and excess. We also found out that blood stasiswas the main pathogenic factor and result. The main syndrome type was deficiency of both qi and yin. Deficiency of both qi and yin and deficiency of both yin and yang were the most important leading pathogenic changes in the medium and late term of diabetes. Blood stasis, depression, wind yang, damp heat and damp turbidity were the most prominent evil factors during the course of diabetes mellitus. And stagnancy of qi and blood stasis, accumulated damp-heat and going up of wind and yang were the main pathogeneses of complications, especially for cardiovascular diseases and nervous diseases, of diabetes. Thus regulating qi and blood, eliminating damp and heat and calming the wind of liver were the important keys in the prevention and cure of complications of diabetes. The dryness, fire, phlegm, water and toxin, which sharpened the impaired qi and yin so as to form the vicious circle, were the pathogenic factors that could not be ignored during the course of complications of diabetes.2. The syndrome of damp-heat took 30.7% in the medium and late stage of diabetes and mellitus. As to the analysis of evil factors, damp-heat just behind the blood stasis, stagnation of qi and wind yang. All this proved that damp-heat was penetrated through the whole course of diabetes and was a important pathogenic factor and tache. There was close relationship between damp heat syndrome and diabetic complications of heart, brain, kidney, vascular and nerve. There was correlation between the formation of damp heat syndrome, which position of disease was in middle warmer and lower warmer, and infection. The deficiency of qi and yin type was relatively high in damp heat group. Thus we should pay more attention to deal with the relationship between resolving heat and eliminating damp and supplementing qi and nourishing yin during the medium and late course of diabetes. There was correlation between damp heat and hollow-organ disease, especially with diseases of gall bladder, large intestine and bladder. As to the evil factors, exogenous pathogenic factors were the main factor in damp heat group and inner factors were the main ones in non-damp heat group. The incidence and its degrees of complications in the medium and late course of diabetes has no direct correlation with glucose and insulin level of blood. As to the pathogenic changes, the damp heat group took on inflammation changes and the non-damp heat group took on disorder of immunity.3. Patients in diabetic cardiopathy group had features such as more female patients, older in age, longer in course of disease and more times of being in hospital.

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