糖尿病性心脏病越南东医和中医文献研究及348例临床病案回顾分析
|
摘要
糖尿病性心脏病(Diabetic Cardiopathy, DC)死亡的人数约占糖尿病患者死亡率的80%,其中70%是死于糖尿病冠心病。目前,DC的发病机制仍未能阐明,其与非糖尿病病人所发生的心脏病关于病因、病机、病理生理、临床表现、治疗方法上有着不同的特点。DC的研究尚处于初级阶段,西医治疗本病的效果虽然较显著,却不能根治本病,且西药的副作用较大,病情较反复。通过中医辨证论治能有效提高患者的抗病能力,对糖尿病并发心血管疾病起到了一定的控制和改善作用,提高患者的生存质量,这是治病求本的方法。这也正是中医药治疗DC的优势所在。
目的
越南传统医学(东医)被中医深深地影响,因此在越南东医研究文献中治疗DC与中医密切相关。因越南东医学和中医学都有其自身的特色及历史、地域性质,所以越南东医学和中医学都要找到一个有效的措施、方药和药物。防治DC就是人们共同关注的话题。
方法
1通过越中两地文献研究收集整理文献,从历史发展的角度,及历代医家关于DC的病名沿革、病因、病机、辨证、治则、方药等诸多方面来探索和总结。
2系统观察分析中越两地数家医院较大样本DC病例对各种证型的症状、检查指标,运用科学的统计学方法进行对比分析,设计回顾性调查研究方法。
2.1分组方法：抽取广州中医药大学第一附属医院内分泌科及内分泌门诊部(中国组)与越南传统医药大学慧静附属医院、越南传统中央医院(越南组)最近五年来的DC病案。
2.2将中国组及越南组比较特异性指标及中医证型表现列表。
2.3观察项目：性别、年龄、BMI、血压、心率、空腹血糖(FBG)、随机血糖(PBG)、糖化血红蛋白、血清总胆固醇、甘油三脂、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、心电图、中医症状前后治疗比较及两组对比。
结果
1文献研究
1.1越南东医和中医对于DC的病名、病因及病机
中医学中虽无DC这一病名,但相当于中医学“消渴”并发“心痛”、“胸痹”、“水肿”等范畴。本病在越南东医既属消渴病,又兼属心脏病。
传统东医认为先天不足,后天失养是引起消渴病重要的内在因素。情志失调、长期过度的精神刺激、老年劳倦亦可发为消渴。
DC发病病机：①早期主要以阴虚为本,燥热为标；②中期病机主要以本虚标实为主；③后期气血阴阳俱虚,主要是心肾阳虚,水气凌心犯肺,多见于心力衰竭的阶段。
1.2传统医学验方治疗DC极为有效
本研究提出一些植物和动物,其中包括单味药及其提取物、越南东医的草药、验方和民间食疗对DC的效果。
2临床研究
2.1一般情况的分析
2.1.1性别：中国组女性比例高于男性,而越南组男性比例的DC高于女性,两组组性别比较中差异有统计学意义。
2.1.2年龄：中国组年龄最小为31岁,最大为85岁,年龄平均61.8±11.2岁。越南组年龄最小为41岁,最大为84岁,年龄平均63.2±9.9岁,但两组年龄比较中差异无统计学意义。
2.1.3BMI：在中国组BMI平均与男性为23.9±1.5；女性BMI为23.4±1.4在越南组男性BMI平均为23.0±3.3；女性BMI平均为24.9±3.4。两组组BMI平均比较中差异有统计学意义。
2.1.4血压：在中国组血压高比例为51.8%；在越南组为41.7%,但两组血压比较中差异无统计学意义。
2.1.5血脂：中国组血脂高患者占87.5%；在越南组为94.4%,两组血脂水平比较中差异有统计学意义。
2.1.6按临床的“三实三虚”证型的DC：中国组“三虚”占53.6%,“三实”占46.4%；越南组“三虚”占53.9%；“三实”占46.1%,但两组按“三实三虚”征型的DC比较中差异无统计学意义。
按中医各证型的DC：中国组气阴两虚型占41.1%,心肾阳虚型1.8%,阴阳两虚型10.7%,痰浊湿阻型30.3%,水气淩心型1.2%,心脉瘀阻型14.9%；越南组气阴两虚型占41.7%,心肾阳虚型1.1%,阴阳两虚型11.1%,痰浊湿阻型28.9%,水气淩心型1.1%,心脉瘀阻型16.1%。
2.1.7血糖：越南组空腹血糖(FBG)及随机血糖(PBG)平均皆比中国组高,其中在中国组FBG平均为9.12±2.48mmol/l与越南组为11.34±3.51mmol/l;PBG在中国组为14.44±3.85与越南组为15.86±4.86mmol/l,两组血糖比较中差异有统计学意义。
2.2临床症状及实验检查治疗前后比较
2.2.1临床症状积分均及临床症状疗效比较
治疗后,中国组症状积分均下降为16.1±5.8分与越南组为14.2±7.1分,表明在两组临床症状都好转,更明显在中国组,差异有统计学意义(P<0.01)。
中医症状疗效：在中国组痊愈占3.6%,显效占72.6%,有效占23.8%,无效占0%,总有效100%与在越南组痊愈占6.7%,显效占48.9%,有效占33.3%,无效占11.1%,总有效88.9%。中国组与越南组中医症状疗效比较中差异有统计学意义(P<0.05)。
2.2.2实验检查值前后治疗对比
2.2.2.1控制血糖：同组治疗前后比较中FBG及PBG水平定量在中国组和越南组均有明显下降。两组对比及同组治疗前后比较差异都有统计学意义(P<0.01)。
2.2.2.2总胆固醇、甘油三酯、低密度脂蛋白、糖化血红蛋白：同组前后治疗比较都下降而高密度脂蛋白增高趋势,差异有显著统计学意义(P<0.01)。但在越南组低密度脂蛋白值前后治疗对比差异无统计学意义(P>0.05)。
2.2.2.3心电图疗效：综合性评价来看,在中国组显效占16.1%；有效占69.6%；无效占14.3%；总有效85.7%。在越南组显效占16.7%；有效占56.7%；无效占26.6%；总有效占73.3%。两组心电图疗效比较差异有统计学意义(P<0.05)。
2.2.2.4心率、收缩压及舒张压：治疗后同组心率、收缩压及舒张压都下降,差异有显示性统计学意义(P<0.01)。
2.2.2.5治疗糖尿病效果比较
综合性评价：中国组显效占38.1%,有效占61.9%,无效占0%,总有效为100%与越南组显效占8.9%,有效占86.7%,无效占4.4%,总有效为95.6%。两组糖尿病疗效对比差异有统计学意义(P<0.05)。
中医辨证分型判定：中国组在各证型观察总有效都达到100%,但无统计学意义(P>0.05)；在越南组除了心肾阳虚型及水气凌心型治疗都无效果外,痰浊湿阻型、阴阳两虚、心脉瘀阻总有效也达到(100%)稍高于气阴两虚型为(94.7%),在越南组中医辨证分型判定差异有统计学意义(P<0.05)。
结论
本文据文献研究及临床对比分析的结果可说明：
1因越南东医与中医有着深刻的关系和历史根源,两地相互交流从古至今,其理论体系一脉相承。通过研究已发现传统东医和中医学在DC的临床和研究方面有很多共同特征,但二者各有特色具有不可替代性。特别是越南传统东医学具有明显的地域特色,与中医药学有很强的优势互补性；双方治疗DC在经验和研究成果中能进行迅速而有效的交流。两地所产的大量地道药材亦可通过边贸采用。研究表明,东医治疗DC所用的不少药物来自中国就证明了这一点。
2临床回顾性研究中已收集共348例DC的病例,其中中国组168例及越南组180例。通过研究发现相同之处：DC患者中中越两地均以气阴两虚证为多见,次为痰浊阻滞证、心脉瘀阻、阴阳两虚、心肾阳虚证、水饮淩心证。按临床上分为“三实三虚”征型的DC,两国“三虚”比例均高于“三实”。在两组同组治疗前后来比较临床症状都明显改善,控制血糖效果较好；胆固醇、甘油三酯及糖化血红蛋白均有下降。但研究也提示两地DC者的不同：如在越南组DC患者的病例男性比例高于女性,而在中国组女性比例高于男性；越南组DC患者血脂高于中国组；FBG及PBG定量越南组皆比中国组高。治疗后,控制血糖、改善临床症状及心电图等方面的疗效比较中,中国组的治疗效果都比越南组要高一些。这可能与中医药理论体系较为完善有关。
3本研究对越南东医和中医治DC的方药证治规律有了一定的了解。同时也发现了不少传统东医治疗DC较为有效的方法和方药。其中一些具有明显的越南地域特色。如“南药”及越南古代名医的验方等,这在DC的临床研究及应用方面,皆有较大的价值和发展潜力。并且这对双边共同探讨DC辨治,有良好的优势互补及相互借鉴的重要意义。
Diabetic Cardiopathy (DC) is the major cause of80%of the death of diabetes, of which70%die from the coronary complications. So far, the mechanism of diabetic cardiopathy development is not yet clear while the causes, disease mechanism, disease biophysiology, clinical signs and symptoms, and therapies vary from those of non-diabetic cardiopathy. Studies on diabetic cardiopathy are still at the initial stage. Although the Western medicines have obviously effective treatments for this disease, the side effects of the medicines remain considerable and the disease usually recurs. The Traditional Chinese medicines (TCM), via a logical dialectics in treatment, prove effective enhancement of resistance capacities of the body that brings about certain effects in diabeti cardiopathy control and improvement of life quality for the patients. This is a causal treatment therapy, which is the advantage of the TCM in treatment of diabetic cardiopathy.
Objectives
The Traditional Vietnamese medicines (TVM) are remarkably influenced by the TCM. Therefore, studies on TVM in diabetic cardiopathy diagnosis and treatment are certainly related to the TCM. Nevertheless, the TCM and TVM have their own historical and geographical features. Hence, it is essential that both the TVM and TCM find a therapy and medicines for better effective prevention and treatment of the diabetic cardiopathy.
Methodology
1. Desk review of documents coupled with observation of a considerable amount of DC including signs and symptoms of each type of disease in accordance with the TCM, laboratory testing indicators, and utilization of statistics to analyze and compare, and application of the retrospective research techniques.
2. Research principals:The DC clinical files admitted to the study must strictly pass the screening criteria. Based on the collected data on the patients'general information, disease history, signs and symptoms, laboratory tests, and treatment therapy, the statistical analysis was conducted.
2.1Group sampling method:Collecting data of patients who came for the first hospitalization from the hospital number1of the Guangzhou University of Chinese Medicines (the Chinese group) and that of patients from the Viet Nam Hospital of Traditional Medicines and the Tue Tinh Hospital of the Viet Nam Traditional Medicines Academy (the Vietnamese group) for the last5years.
2.2Listing disease types in accordance with the Chinese medicines, comparing between the two groups Chinese and Vietnamese.
2.3Observations:sex, age, Body Mass Index (BMI), Blood pressure (BP), heartbeat, fasting blood glucose (FBG), post-meal blood glucose (PBG), Glycohemoglobin (HbAIC), total cholesterol (TC), triglycerides (TG), High-density lipoprotein (HDL-C), Low-density lipoprotein (LDL-C), electrocardiogram (ECG), Chinese medical symptoms and signs. The research utilize before and after treatment comparison of patients among the same group and between the two groups.
Results
1Study on TCM literature of DC
1.1Name,causes and pathogenesis of DC by TCM
Name of DC:The DC is called according to TCM category of "Xiao-ke" or "wasting and thirsting" disease complicating with "Diabetes· Chest pain","Diabetes· palpitation","Diabetes· diaphragm retention of fluid and adema" And according to TVM, DC belongs to category of "Xiao-ke ","Diabetes· heart disease"
Causes of DC:The theory of TCM showed that the important internal factors of the "Xiao-ke" syndrome are deficiency of before heaven and acquired loss of support after heaven. Furthermore, emotional disorders, long-term excessive mental stimulation and the elderly to have work hard for a very long time can also lead to the "Xiao-ke"
Onset and pathogenesis of DC:①The early stage, yin deficiency is the root, dry heat is the manifestation.②The middle stage is root deficiency menifestation excess.③The later stage is deficient Qi-blood and yin-yang which are mainly "yang deficiency of heart and kidney" and "retention of fluid infringe heart" and most common in the stage of heart failure.
1.2TCM prescription treatment is extremely effective in DC.
The research showed that there are some documents, herbs and animals including single herbs and their extract of which TVM edicine prescription and folk therapeutic foods have effective for treatment of DC.
2Results of clinical studies
2.1General findings:
2.1.1Sex re I ated:The Chinese group has higher rate of male patients while it is lower among the Vietnamese group.
2.1.2Age:Among the Chinese group, the youngest age is31years old and the eldest is85, the average age of morbidity is61.8±11.2years old. Among the Vietnamese group the youngest age of having disease is41, the eldest is84, the average age of morbidity is63.2±9.9years old.
2.1.3BMI:The Chinese group has an average BMI for males at23.9±1.5and23.4±1.4for females. The average BMI for the Vietnamese group is23.0±3.3for males and24.9±3.4for females. The BMI difference between the Chinese and Vietnamese groups is significant.
2.1.4Blood Pressure:Among the Chinese group, proportion of hypertension is51.8%, that of the Vietnamese group is41.7%, Nevertheless, the difference between the two groups is insignificant.
2.1.5Lipid:The Chinese group has a proportion of87.5%hyperlipidaemia. This is94.4%for the Vietnamese. Nevertheless, the difference between the two groups is insignificant.
2.1.6Analysis of DC patient rate of the two groups in accordance with two categories of "three excess" and "three deficiency"
On the basis of DC dialectically standard classification of the TCM in accordance with "three excess" and "three deficiency", the "three deficiency" and "three excess" account for53.6%and46.4%relatively among the Chinese group. These are53.9%and46.1%relatively for the Vietnamese group. Nevertheless, these differences between the two groups are insignificant.
Particular proportion of each disease type among the Chinese group in accordance with the "three deficiency" include:deficiency of both qi and yin41.1%; deficiency of both yin and yang10.7%; yang deficiency of heart and kidney1.8%and with "three excess" include:Phlegm dampness obstacle30.3%, heart pulse obstacle14.9%, retention of fluid infringe heart1.2%. These among the Vietnamese group with "three deficiency " include:deficiency of both qi and yin41.7%; deficiency of both yin and yang11.1%; yang deficiency of heart and kidney1.1%, and with "three excess" include phlegm dampness obstacle28.9%; heart pulse obstacle16.1%; retention of fluid infringe heart1.1%. Nevertheless, the difference between the two groups is insignificant.
2.1.7Fasting Blood Glucose (FBG) and Post-meal Blood Glucose (PBG)
The Chinese group has an average of FBG at9.12±2.48mmol/1, and this is11.34±3.51mmol/1for the Vietnamese group. The average PBG among the Chinese group is14.44±3.85and that of the Vietnamese group is15.86±4.86mmol/1. Obviously FBG and PBG among the Vietnamese group are both higher than that of the Chinese. The difference is significant.
2.2Comparison of before and after treatment clinical signs and laboratory tests
2.2.1Comparison of the general treatment effects on cl inical signs and symptoms of the Chinese medicines
After treatment, both the groups has significant reduction in the scores of clinical signs and symptoms in comparison with before treatment (P<0.01). The Chinese group reduced16.1±5.8points and the Vietnamese reduced14.2±7.1points. This shows that both the groups received effective treatment of the clinical signs and symptoms yet the Chinese has clearer improvement.
The Chinese group has3.6%excellent effect;72.6%good,23.8%medium; and0%no effects, the total effective treatment is100%. The Vietnamese group has6.7%excellent;48.9%good;33.3%medium; and11.1%no effects; the total effective treatment is88.9%. The difference between the two groups is significant (P<0.05).
2.2.2Comparison of treatment effects based on the before and after treatment laboratory tests
2.2.2.1Effects in Blood Glucose control:After treatment, the laboratory tests of the Chinese and Vietnamese groups both show declining FBG and PBG. The differences among the same group and between the two groups are significant (P<0.01).
2.2.2.2After treatment, the two groups Chinese and Vietnamese both have declining average HbAIC, TC, TG, and LDL-C, the HDL-C indicator tends to increase. The differences are significant (P<0.01) except the difference of LDL-C among the Vietnamese group before and after treatment.
2.2.2.3Comparison of the ECG:In general, the Chinese group has16.1%clearly effective,69.6%effective, and14.3%ineffective; total effective treatment is85.7%. The Vietnamese group has16.7%clearly effective,56.7%effective, and26.6%ineffective; total effective treatment is85.7%. The difference between the two goups is significant (P<0.05).
2.2.2.4Observations show slight decline in heartbeat, systolic blood pressure, and diastolic blood pressure. The difference among the same group before and after treatment is significant (P<0.01).
2.2.2.5General assessment of the DC treatment effects
Based on the assessment criteria, in general the Chinese group has38.1%obviously effective treatment and69.1%effective treatment, total effective treatment is100%; The Vietnamese group has8.9%obvious effective treatment,86.7%effective, and4.4%ineffective, total effective treatment is95.5%. The differences between the two groups are significant (P<0.05).
Treatment effects for each particular type of disease as following:the Chinese group has100%effective treatment for all6types of disease yet the difference is insignificant. The Vietnamese group, except two types yang deficiency of heart-kidney and retention of fluid infringe heart having ineffective treatment, the rest types including deficiency of both yin and yang, phlegm dampness obstacle, heart pulse obstacle, all have100%effective treatment, which is higher than that of the type deficiency of both qi and yin (94.7%). The difference is significant (P<0.05).
Conelusions
By literature review and clinical retrospective analysis, the results as follow;
1. Because of the close historical relationship between the TVM and the TCM, there has been mutual communication between the two countries and the theory system has hesitated from generation to generation. Through studies, we have found common points between the TVM and TCM in terms of scientific studies and clinical treatment of diabetic cardiopathy yet each country has its own features that are not replaceable. Especially, the TVM have its geographic features that the TCM could have additional advantages. There could be an effective exchange between the two countries on their experience and achievements in DC studies. The two countries both have crucial herbal materials that could be selected for use via goods exchange. The research has pointed out that the TVM, in DC treatment, uses a considerable amount of herbal materials that are imported from China. This supports the above-mentioned points.
2. The clinically retrospective research has collected a total of348DC files, of which the Chinese group has168and the Vietnamese has180files.
The research shows that there are common points in terms of clinical aspects between the two group including:Classifications of disease types in accordance of the TCM of the two groups both have highest proportion of deficiency of both qi and yin, followed by phlegm dampness obstacle, heart pulse obstacle, yang deficiency of heart and kidney, deficiency of both yin and yang and retention of fluid infringe heart respectively. According to the classification of "three excess" and "three deficiency", the two groups clinically both have higher rate of "three deficiency" than the "three excess". After treatment, the two groups both have improvement of clinical signs and symptoms, blood glucose is controlled, and TC, TG and HbAIC are all declined
The research also found some different points between the two groups as following:there is a higher proportion of female patients than males among the Chinese group while the Vietnamese is in a reverse angle. There are more patients who have hyperlipidaemia in the Vietnamese group than that of the Chinese. The PBG rate among the Vietnamese group is higher than the Chinese. After treatment, the Chinese group has better results in terms of BG control, improvement of clinical signs and symptoms, and ECG in comparison with the Vietnamese.
3. The study also found a considerable amount of treatment therapies and herbal combinations for DC treatment, especially some geographically Vietnamese herbs that are highly potential for research and clinical application. This is valuable for DC treatment.
目的
越南传统医学(东医)被中医深深地影响,因此在越南东医研究文献中治疗DC与中医密切相关。因越南东医学和中医学都有其自身的特色及历史、地域性质,所以越南东医学和中医学都要找到一个有效的措施、方药和药物。防治DC就是人们共同关注的话题。
方法
1通过越中两地文献研究收集整理文献,从历史发展的角度,及历代医家关于DC的病名沿革、病因、病机、辨证、治则、方药等诸多方面来探索和总结。
2系统观察分析中越两地数家医院较大样本DC病例对各种证型的症状、检查指标,运用科学的统计学方法进行对比分析,设计回顾性调查研究方法。
2.1分组方法：抽取广州中医药大学第一附属医院内分泌科及内分泌门诊部(中国组)与越南传统医药大学慧静附属医院、越南传统中央医院(越南组)最近五年来的DC病案。
2.2将中国组及越南组比较特异性指标及中医证型表现列表。
2.3观察项目：性别、年龄、BMI、血压、心率、空腹血糖(FBG)、随机血糖(PBG)、糖化血红蛋白、血清总胆固醇、甘油三脂、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、心电图、中医症状前后治疗比较及两组对比。
结果
1文献研究
1.1越南东医和中医对于DC的病名、病因及病机
中医学中虽无DC这一病名,但相当于中医学“消渴”并发“心痛”、“胸痹”、“水肿”等范畴。本病在越南东医既属消渴病,又兼属心脏病。
传统东医认为先天不足,后天失养是引起消渴病重要的内在因素。情志失调、长期过度的精神刺激、老年劳倦亦可发为消渴。
DC发病病机：①早期主要以阴虚为本,燥热为标；②中期病机主要以本虚标实为主；③后期气血阴阳俱虚,主要是心肾阳虚,水气凌心犯肺,多见于心力衰竭的阶段。
1.2传统医学验方治疗DC极为有效
本研究提出一些植物和动物,其中包括单味药及其提取物、越南东医的草药、验方和民间食疗对DC的效果。
2临床研究
2.1一般情况的分析
2.1.1性别：中国组女性比例高于男性,而越南组男性比例的DC高于女性,两组组性别比较中差异有统计学意义。
2.1.2年龄：中国组年龄最小为31岁,最大为85岁,年龄平均61.8±11.2岁。越南组年龄最小为41岁,最大为84岁,年龄平均63.2±9.9岁,但两组年龄比较中差异无统计学意义。
2.1.3BMI：在中国组BMI平均与男性为23.9±1.5；女性BMI为23.4±1.4在越南组男性BMI平均为23.0±3.3；女性BMI平均为24.9±3.4。两组组BMI平均比较中差异有统计学意义。
2.1.4血压：在中国组血压高比例为51.8%；在越南组为41.7%,但两组血压比较中差异无统计学意义。
2.1.5血脂：中国组血脂高患者占87.5%；在越南组为94.4%,两组血脂水平比较中差异有统计学意义。
2.1.6按临床的“三实三虚”证型的DC：中国组“三虚”占53.6%,“三实”占46.4%；越南组“三虚”占53.9%；“三实”占46.1%,但两组按“三实三虚”征型的DC比较中差异无统计学意义。
按中医各证型的DC：中国组气阴两虚型占41.1%,心肾阳虚型1.8%,阴阳两虚型10.7%,痰浊湿阻型30.3%,水气淩心型1.2%,心脉瘀阻型14.9%；越南组气阴两虚型占41.7%,心肾阳虚型1.1%,阴阳两虚型11.1%,痰浊湿阻型28.9%,水气淩心型1.1%,心脉瘀阻型16.1%。
2.1.7血糖：越南组空腹血糖(FBG)及随机血糖(PBG)平均皆比中国组高,其中在中国组FBG平均为9.12±2.48mmol/l与越南组为11.34±3.51mmol/l;PBG在中国组为14.44±3.85与越南组为15.86±4.86mmol/l,两组血糖比较中差异有统计学意义。
2.2临床症状及实验检查治疗前后比较
2.2.1临床症状积分均及临床症状疗效比较
治疗后,中国组症状积分均下降为16.1±5.8分与越南组为14.2±7.1分,表明在两组临床症状都好转,更明显在中国组,差异有统计学意义(P<0.01)。
中医症状疗效：在中国组痊愈占3.6%,显效占72.6%,有效占23.8%,无效占0%,总有效100%与在越南组痊愈占6.7%,显效占48.9%,有效占33.3%,无效占11.1%,总有效88.9%。中国组与越南组中医症状疗效比较中差异有统计学意义(P<0.05)。
2.2.2实验检查值前后治疗对比
2.2.2.1控制血糖：同组治疗前后比较中FBG及PBG水平定量在中国组和越南组均有明显下降。两组对比及同组治疗前后比较差异都有统计学意义(P<0.01)。
2.2.2.2总胆固醇、甘油三酯、低密度脂蛋白、糖化血红蛋白：同组前后治疗比较都下降而高密度脂蛋白增高趋势,差异有显著统计学意义(P<0.01)。但在越南组低密度脂蛋白值前后治疗对比差异无统计学意义(P>0.05)。
2.2.2.3心电图疗效：综合性评价来看,在中国组显效占16.1%；有效占69.6%；无效占14.3%；总有效85.7%。在越南组显效占16.7%；有效占56.7%；无效占26.6%；总有效占73.3%。两组心电图疗效比较差异有统计学意义(P<0.05)。
2.2.2.4心率、收缩压及舒张压：治疗后同组心率、收缩压及舒张压都下降,差异有显示性统计学意义(P<0.01)。
2.2.2.5治疗糖尿病效果比较
综合性评价：中国组显效占38.1%,有效占61.9%,无效占0%,总有效为100%与越南组显效占8.9%,有效占86.7%,无效占4.4%,总有效为95.6%。两组糖尿病疗效对比差异有统计学意义(P<0.05)。
中医辨证分型判定：中国组在各证型观察总有效都达到100%,但无统计学意义(P>0.05)；在越南组除了心肾阳虚型及水气凌心型治疗都无效果外,痰浊湿阻型、阴阳两虚、心脉瘀阻总有效也达到(100%)稍高于气阴两虚型为(94.7%),在越南组中医辨证分型判定差异有统计学意义(P<0.05)。
结论
本文据文献研究及临床对比分析的结果可说明：
1因越南东医与中医有着深刻的关系和历史根源,两地相互交流从古至今,其理论体系一脉相承。通过研究已发现传统东医和中医学在DC的临床和研究方面有很多共同特征,但二者各有特色具有不可替代性。特别是越南传统东医学具有明显的地域特色,与中医药学有很强的优势互补性；双方治疗DC在经验和研究成果中能进行迅速而有效的交流。两地所产的大量地道药材亦可通过边贸采用。研究表明,东医治疗DC所用的不少药物来自中国就证明了这一点。
2临床回顾性研究中已收集共348例DC的病例,其中中国组168例及越南组180例。通过研究发现相同之处：DC患者中中越两地均以气阴两虚证为多见,次为痰浊阻滞证、心脉瘀阻、阴阳两虚、心肾阳虚证、水饮淩心证。按临床上分为“三实三虚”征型的DC,两国“三虚”比例均高于“三实”。在两组同组治疗前后来比较临床症状都明显改善,控制血糖效果较好；胆固醇、甘油三酯及糖化血红蛋白均有下降。但研究也提示两地DC者的不同：如在越南组DC患者的病例男性比例高于女性,而在中国组女性比例高于男性；越南组DC患者血脂高于中国组；FBG及PBG定量越南组皆比中国组高。治疗后,控制血糖、改善临床症状及心电图等方面的疗效比较中,中国组的治疗效果都比越南组要高一些。这可能与中医药理论体系较为完善有关。
3本研究对越南东医和中医治DC的方药证治规律有了一定的了解。同时也发现了不少传统东医治疗DC较为有效的方法和方药。其中一些具有明显的越南地域特色。如“南药”及越南古代名医的验方等,这在DC的临床研究及应用方面,皆有较大的价值和发展潜力。并且这对双边共同探讨DC辨治,有良好的优势互补及相互借鉴的重要意义。
Diabetic Cardiopathy (DC) is the major cause of80%of the death of diabetes, of which70%die from the coronary complications. So far, the mechanism of diabetic cardiopathy development is not yet clear while the causes, disease mechanism, disease biophysiology, clinical signs and symptoms, and therapies vary from those of non-diabetic cardiopathy. Studies on diabetic cardiopathy are still at the initial stage. Although the Western medicines have obviously effective treatments for this disease, the side effects of the medicines remain considerable and the disease usually recurs. The Traditional Chinese medicines (TCM), via a logical dialectics in treatment, prove effective enhancement of resistance capacities of the body that brings about certain effects in diabeti cardiopathy control and improvement of life quality for the patients. This is a causal treatment therapy, which is the advantage of the TCM in treatment of diabetic cardiopathy.
Objectives
The Traditional Vietnamese medicines (TVM) are remarkably influenced by the TCM. Therefore, studies on TVM in diabetic cardiopathy diagnosis and treatment are certainly related to the TCM. Nevertheless, the TCM and TVM have their own historical and geographical features. Hence, it is essential that both the TVM and TCM find a therapy and medicines for better effective prevention and treatment of the diabetic cardiopathy.
Methodology
1. Desk review of documents coupled with observation of a considerable amount of DC including signs and symptoms of each type of disease in accordance with the TCM, laboratory testing indicators, and utilization of statistics to analyze and compare, and application of the retrospective research techniques.
2. Research principals:The DC clinical files admitted to the study must strictly pass the screening criteria. Based on the collected data on the patients'general information, disease history, signs and symptoms, laboratory tests, and treatment therapy, the statistical analysis was conducted.
2.1Group sampling method:Collecting data of patients who came for the first hospitalization from the hospital number1of the Guangzhou University of Chinese Medicines (the Chinese group) and that of patients from the Viet Nam Hospital of Traditional Medicines and the Tue Tinh Hospital of the Viet Nam Traditional Medicines Academy (the Vietnamese group) for the last5years.
2.2Listing disease types in accordance with the Chinese medicines, comparing between the two groups Chinese and Vietnamese.
2.3Observations:sex, age, Body Mass Index (BMI), Blood pressure (BP), heartbeat, fasting blood glucose (FBG), post-meal blood glucose (PBG), Glycohemoglobin (HbAIC), total cholesterol (TC), triglycerides (TG), High-density lipoprotein (HDL-C), Low-density lipoprotein (LDL-C), electrocardiogram (ECG), Chinese medical symptoms and signs. The research utilize before and after treatment comparison of patients among the same group and between the two groups.
Results
1Study on TCM literature of DC
1.1Name,causes and pathogenesis of DC by TCM
Name of DC:The DC is called according to TCM category of "Xiao-ke" or "wasting and thirsting" disease complicating with "Diabetes· Chest pain","Diabetes· palpitation","Diabetes· diaphragm retention of fluid and adema" And according to TVM, DC belongs to category of "Xiao-ke ","Diabetes· heart disease"
Causes of DC:The theory of TCM showed that the important internal factors of the "Xiao-ke" syndrome are deficiency of before heaven and acquired loss of support after heaven. Furthermore, emotional disorders, long-term excessive mental stimulation and the elderly to have work hard for a very long time can also lead to the "Xiao-ke"
Onset and pathogenesis of DC:①The early stage, yin deficiency is the root, dry heat is the manifestation.②The middle stage is root deficiency menifestation excess.③The later stage is deficient Qi-blood and yin-yang which are mainly "yang deficiency of heart and kidney" and "retention of fluid infringe heart" and most common in the stage of heart failure.
1.2TCM prescription treatment is extremely effective in DC.
The research showed that there are some documents, herbs and animals including single herbs and their extract of which TVM edicine prescription and folk therapeutic foods have effective for treatment of DC.
2Results of clinical studies
2.1General findings:
2.1.1Sex re I ated:The Chinese group has higher rate of male patients while it is lower among the Vietnamese group.
2.1.2Age:Among the Chinese group, the youngest age is31years old and the eldest is85, the average age of morbidity is61.8±11.2years old. Among the Vietnamese group the youngest age of having disease is41, the eldest is84, the average age of morbidity is63.2±9.9years old.
2.1.3BMI:The Chinese group has an average BMI for males at23.9±1.5and23.4±1.4for females. The average BMI for the Vietnamese group is23.0±3.3for males and24.9±3.4for females. The BMI difference between the Chinese and Vietnamese groups is significant.
2.1.4Blood Pressure:Among the Chinese group, proportion of hypertension is51.8%, that of the Vietnamese group is41.7%, Nevertheless, the difference between the two groups is insignificant.
2.1.5Lipid:The Chinese group has a proportion of87.5%hyperlipidaemia. This is94.4%for the Vietnamese. Nevertheless, the difference between the two groups is insignificant.
2.1.6Analysis of DC patient rate of the two groups in accordance with two categories of "three excess" and "three deficiency"
On the basis of DC dialectically standard classification of the TCM in accordance with "three excess" and "three deficiency", the "three deficiency" and "three excess" account for53.6%and46.4%relatively among the Chinese group. These are53.9%and46.1%relatively for the Vietnamese group. Nevertheless, these differences between the two groups are insignificant.
Particular proportion of each disease type among the Chinese group in accordance with the "three deficiency" include:deficiency of both qi and yin41.1%; deficiency of both yin and yang10.7%; yang deficiency of heart and kidney1.8%and with "three excess" include:Phlegm dampness obstacle30.3%, heart pulse obstacle14.9%, retention of fluid infringe heart1.2%. These among the Vietnamese group with "three deficiency " include:deficiency of both qi and yin41.7%; deficiency of both yin and yang11.1%; yang deficiency of heart and kidney1.1%, and with "three excess" include phlegm dampness obstacle28.9%; heart pulse obstacle16.1%; retention of fluid infringe heart1.1%. Nevertheless, the difference between the two groups is insignificant.
2.1.7Fasting Blood Glucose (FBG) and Post-meal Blood Glucose (PBG)
The Chinese group has an average of FBG at9.12±2.48mmol/1, and this is11.34±3.51mmol/1for the Vietnamese group. The average PBG among the Chinese group is14.44±3.85and that of the Vietnamese group is15.86±4.86mmol/1. Obviously FBG and PBG among the Vietnamese group are both higher than that of the Chinese. The difference is significant.
2.2Comparison of before and after treatment clinical signs and laboratory tests
2.2.1Comparison of the general treatment effects on cl inical signs and symptoms of the Chinese medicines
After treatment, both the groups has significant reduction in the scores of clinical signs and symptoms in comparison with before treatment (P<0.01). The Chinese group reduced16.1±5.8points and the Vietnamese reduced14.2±7.1points. This shows that both the groups received effective treatment of the clinical signs and symptoms yet the Chinese has clearer improvement.
The Chinese group has3.6%excellent effect;72.6%good,23.8%medium; and0%no effects, the total effective treatment is100%. The Vietnamese group has6.7%excellent;48.9%good;33.3%medium; and11.1%no effects; the total effective treatment is88.9%. The difference between the two groups is significant (P<0.05).
2.2.2Comparison of treatment effects based on the before and after treatment laboratory tests
2.2.2.1Effects in Blood Glucose control:After treatment, the laboratory tests of the Chinese and Vietnamese groups both show declining FBG and PBG. The differences among the same group and between the two groups are significant (P<0.01).
2.2.2.2After treatment, the two groups Chinese and Vietnamese both have declining average HbAIC, TC, TG, and LDL-C, the HDL-C indicator tends to increase. The differences are significant (P<0.01) except the difference of LDL-C among the Vietnamese group before and after treatment.
2.2.2.3Comparison of the ECG:In general, the Chinese group has16.1%clearly effective,69.6%effective, and14.3%ineffective; total effective treatment is85.7%. The Vietnamese group has16.7%clearly effective,56.7%effective, and26.6%ineffective; total effective treatment is85.7%. The difference between the two goups is significant (P<0.05).
2.2.2.4Observations show slight decline in heartbeat, systolic blood pressure, and diastolic blood pressure. The difference among the same group before and after treatment is significant (P<0.01).
2.2.2.5General assessment of the DC treatment effects
Based on the assessment criteria, in general the Chinese group has38.1%obviously effective treatment and69.1%effective treatment, total effective treatment is100%; The Vietnamese group has8.9%obvious effective treatment,86.7%effective, and4.4%ineffective, total effective treatment is95.5%. The differences between the two groups are significant (P<0.05).
Treatment effects for each particular type of disease as following:the Chinese group has100%effective treatment for all6types of disease yet the difference is insignificant. The Vietnamese group, except two types yang deficiency of heart-kidney and retention of fluid infringe heart having ineffective treatment, the rest types including deficiency of both yin and yang, phlegm dampness obstacle, heart pulse obstacle, all have100%effective treatment, which is higher than that of the type deficiency of both qi and yin (94.7%). The difference is significant (P<0.05).
Conelusions
By literature review and clinical retrospective analysis, the results as follow;
1. Because of the close historical relationship between the TVM and the TCM, there has been mutual communication between the two countries and the theory system has hesitated from generation to generation. Through studies, we have found common points between the TVM and TCM in terms of scientific studies and clinical treatment of diabetic cardiopathy yet each country has its own features that are not replaceable. Especially, the TVM have its geographic features that the TCM could have additional advantages. There could be an effective exchange between the two countries on their experience and achievements in DC studies. The two countries both have crucial herbal materials that could be selected for use via goods exchange. The research has pointed out that the TVM, in DC treatment, uses a considerable amount of herbal materials that are imported from China. This supports the above-mentioned points.
2. The clinically retrospective research has collected a total of348DC files, of which the Chinese group has168and the Vietnamese has180files.
The research shows that there are common points in terms of clinical aspects between the two group including:Classifications of disease types in accordance of the TCM of the two groups both have highest proportion of deficiency of both qi and yin, followed by phlegm dampness obstacle, heart pulse obstacle, yang deficiency of heart and kidney, deficiency of both yin and yang and retention of fluid infringe heart respectively. According to the classification of "three excess" and "three deficiency", the two groups clinically both have higher rate of "three deficiency" than the "three excess". After treatment, the two groups both have improvement of clinical signs and symptoms, blood glucose is controlled, and TC, TG and HbAIC are all declined
The research also found some different points between the two groups as following:there is a higher proportion of female patients than males among the Chinese group while the Vietnamese is in a reverse angle. There are more patients who have hyperlipidaemia in the Vietnamese group than that of the Chinese. The PBG rate among the Vietnamese group is higher than the Chinese. After treatment, the Chinese group has better results in terms of BG control, improvement of clinical signs and symptoms, and ECG in comparison with the Vietnamese.
3. The study also found a considerable amount of treatment therapies and herbal combinations for DC treatment, especially some geographically Vietnamese herbs that are highly potential for research and clinical application. This is valuable for DC treatment.
引文
[1]吕仁和,赵进喜.糖尿病及其并发症中西医诊治学[M].北京：人民卫生出版社,2011：554-72.
[2]李兰.现代中医糖尿病学[M].北京：人民卫生出版社,2008：460-499.
[3]陈方敏.糖尿病心脏病中医药文献研究与方药证治规律探微.博士论文.广州中医大学,2010.
[4]广州中医药大学第一属附医院.消渴心痹[M].内分泌科医院管理年材料汇编,2011：37-39.
[5]段光辉,郭志军,高秀梅等.越中传统医药历史和现状比较研究[J].天津中医药,2005,22(1)：74.
[6]孙捷,王西迅,崔永峰.越南的传统医学《国外医学(中医中药分册》2004(4)http://mall.cnki.net/magazine/Article/GWZY200404008.htm
[12]邹节明.广西特色中草药资源选编[M].北京科学出版社,2011：239；638.
[14]葛敏,刘彤,关宿东等.绞股蓝总普对糖尿病心肌病大鼠心脏功能的影响[J].沈阳药科大学学报,2007；24(6)：355-358.
[17]李维林,郑江臣.治疗糖尿病的中草药[M].东南大学出版社,2006.
[18]唐德才.中药现代研究与临床应用[M].上海科学技术出版社,2010：76；147.
[19]陈蔚,叶红英.黄芪多糖对糖尿病心肌胶原代谢的影响[J].上海交通大学学报,2007,27(10)：1206-1209.
[22]李时珍著御史编译.《本草纲目》白话精译[M].北京科学技术出版社,2006.1：69；82.
[23]赵中振,肖培根.当代药用植物典[M].上海世界图书出版公司,第一册,2009.10：69.
[24]陈春元.糖尿病肾病越南东医文献研究及261例临床病案回顾分析.博士论文.广州中医药大学,2009.
[25]邢小燕,马永刚,孙玉琦.循证药学在中药安全性和有效性评价中的应用[J].中草药Chinese Traditional and Herbal Drugs,2006,37(8):1269.
[26]陈治淦,陈小燕.通心络胶囊为主治疗糖尿病合并冠心病42例[J].安徽中医学院学报,2004,23(5)：16-17.
[27]Duang Bo Banh. Histoire de la medicine du Vietnam [M],1952.
[33]朱明丹,杜武勋,柴山周乃等.糖尿病性冠心病中医研究进展[J].天津中医药大学学报,2009,28(2)：110-112.
[34]张文康.《Integrated traditional Chinese and western medicine》[M].北京：中国中医药出版社,2006：17.
[35]王金梅,薛丽辉,吕博燕等.益气养阴化癖汤治疗60例糖尿病心肌病的临床观察[J].中国老年保健医学,2008,6(1)：60-61.
[36]钱超尘,温长路.孙思邈研究集成[M].中医古籍出版社,2005：856-857.
[37]赵进喜.《黄帝内经》与中医现在临床[M].人民军医出版社,2006：246-250.
[38]马明姬,吕岩妍,张杰.糖尿病并发症的中医治疗分析[J].中国现代药物应用,2010,17.
[39]李兰.糖尿病中西医结合诊疗规范2010[M].军事医学出版社,2010：47.
[40]郑筱英.中药新药临床研究指导原则(试行).北京：中国医药科技出版社,2002：233-236.
[41]张润云,倪青,孟凤仙等.糖尿病性心脏病中医诊疗思路与方法[J].中国中医药信息杂志,2006,13(1)：90.
[43]赵亚莉,胡惠英.祛痰活血汤对45例痰浊内阻型冠心病心电图的影响[J].陕西中医,2002,23(2)：139.
[44]周学平,吴勉华.从疲热论治风湿免疫性疾病一周仲瑛学术思想举要[J].中华中医药杂志,2007,22(1)：44-46.
[45]晃梁,周仲瑛.周仲瑛辨证论治糖尿病的经验特色[J].辽宁中医杂志2006,33(12)：1536-1537.
[46]吕仁和,张法荣,高彦彬.消渴病(糖尿病)中医分期辨证疗效评定标准[C].中医诊断荟萃——全国第五次中医糖尿病学术大会论文集1999.
[47]宋爱军,陈丽兰,彭万年.彭万年教授治疗糖尿病经验[J].中医药学刊,2006,24(5)：793-794.
[48]陈氏秋云,彭万年.彭万年教授运用经方治验糖尿病性心脏病验案三则[J].亚太传统医药刊,2012,11(8)：164.
[49]李赛美,林培政.糖尿病性心脏病中医研究近况[J].中医药学刊,2006,24(6)：989-991.
[50]李赛美,李易崇,李伟华等.糖尿病心脏病证候特征及演变规律探讨[J].中华中医药杂志,2007,8.
[51]薛军,刘梅,陈镜合.中西医结合治疗糖尿病性心脏病40例[J].中国中医急症,2006,15(10)：1067-1068.
[52]尧应才.养阴化瘀法在治疗糖尿病冠心病中的运用[J].江西中医药,2005,36(11)：18.
[53]高怀林.从络论治糖尿病心脏病[J].中国中医基础医学杂志,2012,12.
[54]章小平.益气养阴活血法治疗糖尿病合并冠心病研究进展[J].安徽中医学院学报,2001,20(1)：60.
[55]栗明,栗德林,于阳等。栗德林教授关于糖尿病并发冠心病中医病机新理论简介[J].天津中医药大学学报,2008,27(4)：250-251.
[56]胡东鹏,倪青.巧定病性明标本中西合参论治疗一辨治糖尿病心脏病的经验[J].辽宁中医杂志,2000,27(27)：289-290.
[57]广州中医药大学第一属附医院.消渴心痹[M].内分泌科医院管理年材料汇编,2011：37-39.
[58]黄建辉,张伟杰,邵华.糖尿病慢性并发症的中医治疗与展望[J].福建中医药,1991,22(6)：58
[59]闫振文,陈谦,曹继萍.通心脉汤治疗糖尿病冠心病42例[J].中国民间疗法,2005,13(9)：27.
[60]张明.活血化瘀法治疗糖尿病冠心病42例[J].湖南中医杂志,2009,25(1)：42-43.
[61]魏玲玲.益心舒胶囊治疗糖尿病性冠心病的临床观察[J].中国中西医结合杂志,2008,28(4)：374-375.
[62]谢中全.糖尿病性心脏病及其防治进展[J].中国医药指南,2009,7(2)：15-16.
[63]范世平,饶振芳,马晓霖等.糖心宁胶囊治疗糖尿病性冠心病的临床研究[J].新中医,2001,33(1)：34.
[64]杨晓辉,吕仁和.糖尿病性心脏病的中医分期辨证探讨[J].北京中医,2006,25(7)：403-405.
[65]杨晓晖,吕仁和.试论络脉病变是早期糖尿病性心脏病的病理基础[J].北京中医药大学学报,2005,28(3)：85-87.
[66]王建华.糖尿病性心脏病的防治[J].糖尿病新世界,2005,(3)：19.
[67]张磊,周鹏.冠心病调养与防治必读[J].中国妇女出版社,2009：107.
[68]杜廷海,吕小红,吕靖中.消渴安胶囊治疗糖尿病性冠心病150例临床观察[J].中国中医药科技,2001：8(2)：117-118.
[69]Anna R. Schmidt BA, Matthias G. Friedrich, MD FESC FACC. Imaging Targets in Diabetic Cardiomyopathy:Current Status and Perspective [J]. Canadian journal of diabetes, 2011;35(4):353-362.
[70]中国中医科学院编写.中医循证临床实践指南[M].中国中医药出版社,2011：100-101.
[71]中华医学会糖尿病学分会.中国2型糖尿病防治指南2010年版[M].北京大学医学出版社,2011：5.
[72]丁学屏.中西医结合糖尿病学[M].北京：人民卫生出版社,2004：42-49.
[73]南征,高彦彬,钱秋海.糖尿病中西医结合治疗[M].北京人民卫生主板社,2002：170-183.
[74]王素美.糖尿病慢性并发症的中西医结合治疗[M].中医古籍出版社,2006：123-139.
[75]赖淑华.2型糖尿病合并心脏病中医证型与相关性因素的研究.博士论文.广州中医大学,2009.
[76]黄峥.糖尿病合并冠心病的中医药研究概况[J].中国健康月刊(学术版),2011,10.
[78]宋亚俊,谢连和.胸痹丹对糖尿病性心脏病患者血脂及血液流变性的影响[J].中国民族民间医药,2008,17(6)：31-32.
[79]清·唐宗海原著,欧阳兵等点校.《血证论》[M].天津科学技术出版社,2012.
[80]王有奎.治痰——解决疑难病症的关键[J].中国中医药,2006,2239.
[81]王学良,朱章志,熊曼琪等.从心胃相关论治糖尿病性心脏病[J].新中医,2009,(2)：5-8.
[82]郑亚军,陈良秋,龙翊岚.鹅掌柴提取物的抗氧化活性[J].热带作物学报,2009,30(4)：500.
[83]杨国庆,陆菊明,郑华等.胰岛素治疗后血糖控制与2型糖尿病患者血浆同型半胱氨酸的关系[J].中华内科杂志,2006；45(1)：34.
[84]Xinli Chang, Chen Chen. A new insight of mechanisms, diagnosis and treatment of diabetic cardiomyopathy[J]. Endocrine,2012:41(3):398-409.
[85]Voulgari C, Papadogiannis D, Tentolouris N. Diabetic cardiomyopathy:from the pathophysiology of the cardiac myocytes to current diagnosis and management strategies [J].Vasc Health Risk Manag,2010; 21 (6):883-903.
[86]Miki T, Yuda S, Kouzu H, Miura T. Diabetic cardiomyopathy:pathophysiology and clinical features [J]. Heart Fail Rev,2013 Mar;18(2):149-66.
[87]Betsy B. Dokken, PhD, NP, CDE. The Pathophysiology of Cardiovascular Disease and Diabetes:Beyond Blood Pressure and Lipids [J]. Diabetes Spectrum July 2008;21(3): 160-165.
[88]杨晓辉,阮氏心顺,王保华等.三黄降糖片治疗糖尿病冠心病的临床观察[A].第十次全国中医糖尿病大会论文集[C],2007,6：497-502.
[89]江成林.中医治疗预防糖尿病并发症的思路分析[J].中医临床研究,2012,4.
[90]Fabien Forcheron, Alexandra Basset, Pauline Abdallah. Diabetic cardiomyopathy: effects of fenofibrate and metformin in an experimental model-the Zucker diabetic rat[J]. Cardiovascular Diabetology 2009,8:16
[91]Ly Ba Tuoc, Nguyen Thi Bay, et al. Hypoglycemic effect of "LUC VI GIA GIAM" formula in type 2 Diabetic patients[J]. Y hoc thanh ph6 Ho Chi Minh,2007,11 (2):91-98.
[92]Pham Viet Sang. Dieu tri tieu duong bang thuoc nam[J]. Tap chi Y hoc co truyen Viet Nam,2000,331:8-9.
[2]李兰.现代中医糖尿病学[M].北京：人民卫生出版社,2008：460-499.
[3]陈方敏.糖尿病心脏病中医药文献研究与方药证治规律探微.博士论文.广州中医大学,2010.
[4]广州中医药大学第一属附医院.消渴心痹[M].内分泌科医院管理年材料汇编,2011：37-39.
[5]段光辉,郭志军,高秀梅等.越中传统医药历史和现状比较研究[J].天津中医药,2005,22(1)：74.
[6]孙捷,王西迅,崔永峰.越南的传统医学《国外医学(中医中药分册》2004(4)http://mall.cnki.net/magazine/Article/GWZY200404008.htm
[12]邹节明.广西特色中草药资源选编[M].北京科学出版社,2011：239；638.
[14]葛敏,刘彤,关宿东等.绞股蓝总普对糖尿病心肌病大鼠心脏功能的影响[J].沈阳药科大学学报,2007；24(6)：355-358.
[17]李维林,郑江臣.治疗糖尿病的中草药[M].东南大学出版社,2006.
[18]唐德才.中药现代研究与临床应用[M].上海科学技术出版社,2010：76；147.
[19]陈蔚,叶红英.黄芪多糖对糖尿病心肌胶原代谢的影响[J].上海交通大学学报,2007,27(10)：1206-1209.
[22]李时珍著御史编译.《本草纲目》白话精译[M].北京科学技术出版社,2006.1：69；82.
[23]赵中振,肖培根.当代药用植物典[M].上海世界图书出版公司,第一册,2009.10：69.
[24]陈春元.糖尿病肾病越南东医文献研究及261例临床病案回顾分析.博士论文.广州中医药大学,2009.
[25]邢小燕,马永刚,孙玉琦.循证药学在中药安全性和有效性评价中的应用[J].中草药Chinese Traditional and Herbal Drugs,2006,37(8):1269.
[26]陈治淦,陈小燕.通心络胶囊为主治疗糖尿病合并冠心病42例[J].安徽中医学院学报,2004,23(5)：16-17.
[27]Duang Bo Banh. Histoire de la medicine du Vietnam [M],1952.
[33]朱明丹,杜武勋,柴山周乃等.糖尿病性冠心病中医研究进展[J].天津中医药大学学报,2009,28(2)：110-112.
[34]张文康.《Integrated traditional Chinese and western medicine》[M].北京：中国中医药出版社,2006：17.
[35]王金梅,薛丽辉,吕博燕等.益气养阴化癖汤治疗60例糖尿病心肌病的临床观察[J].中国老年保健医学,2008,6(1)：60-61.
[36]钱超尘,温长路.孙思邈研究集成[M].中医古籍出版社,2005：856-857.
[37]赵进喜.《黄帝内经》与中医现在临床[M].人民军医出版社,2006：246-250.
[38]马明姬,吕岩妍,张杰.糖尿病并发症的中医治疗分析[J].中国现代药物应用,2010,17.
[39]李兰.糖尿病中西医结合诊疗规范2010[M].军事医学出版社,2010：47.
[40]郑筱英.中药新药临床研究指导原则(试行).北京：中国医药科技出版社,2002：233-236.
[41]张润云,倪青,孟凤仙等.糖尿病性心脏病中医诊疗思路与方法[J].中国中医药信息杂志,2006,13(1)：90.
[43]赵亚莉,胡惠英.祛痰活血汤对45例痰浊内阻型冠心病心电图的影响[J].陕西中医,2002,23(2)：139.
[44]周学平,吴勉华.从疲热论治风湿免疫性疾病一周仲瑛学术思想举要[J].中华中医药杂志,2007,22(1)：44-46.
[45]晃梁,周仲瑛.周仲瑛辨证论治糖尿病的经验特色[J].辽宁中医杂志2006,33(12)：1536-1537.
[46]吕仁和,张法荣,高彦彬.消渴病(糖尿病)中医分期辨证疗效评定标准[C].中医诊断荟萃——全国第五次中医糖尿病学术大会论文集1999.
[47]宋爱军,陈丽兰,彭万年.彭万年教授治疗糖尿病经验[J].中医药学刊,2006,24(5)：793-794.
[48]陈氏秋云,彭万年.彭万年教授运用经方治验糖尿病性心脏病验案三则[J].亚太传统医药刊,2012,11(8)：164.
[49]李赛美,林培政.糖尿病性心脏病中医研究近况[J].中医药学刊,2006,24(6)：989-991.
[50]李赛美,李易崇,李伟华等.糖尿病心脏病证候特征及演变规律探讨[J].中华中医药杂志,2007,8.
[51]薛军,刘梅,陈镜合.中西医结合治疗糖尿病性心脏病40例[J].中国中医急症,2006,15(10)：1067-1068.
[52]尧应才.养阴化瘀法在治疗糖尿病冠心病中的运用[J].江西中医药,2005,36(11)：18.
[53]高怀林.从络论治糖尿病心脏病[J].中国中医基础医学杂志,2012,12.
[54]章小平.益气养阴活血法治疗糖尿病合并冠心病研究进展[J].安徽中医学院学报,2001,20(1)：60.
[55]栗明,栗德林,于阳等。栗德林教授关于糖尿病并发冠心病中医病机新理论简介[J].天津中医药大学学报,2008,27(4)：250-251.
[56]胡东鹏,倪青.巧定病性明标本中西合参论治疗一辨治糖尿病心脏病的经验[J].辽宁中医杂志,2000,27(27)：289-290.
[57]广州中医药大学第一属附医院.消渴心痹[M].内分泌科医院管理年材料汇编,2011：37-39.
[58]黄建辉,张伟杰,邵华.糖尿病慢性并发症的中医治疗与展望[J].福建中医药,1991,22(6)：58
[59]闫振文,陈谦,曹继萍.通心脉汤治疗糖尿病冠心病42例[J].中国民间疗法,2005,13(9)：27.
[60]张明.活血化瘀法治疗糖尿病冠心病42例[J].湖南中医杂志,2009,25(1)：42-43.
[61]魏玲玲.益心舒胶囊治疗糖尿病性冠心病的临床观察[J].中国中西医结合杂志,2008,28(4)：374-375.
[62]谢中全.糖尿病性心脏病及其防治进展[J].中国医药指南,2009,7(2)：15-16.
[63]范世平,饶振芳,马晓霖等.糖心宁胶囊治疗糖尿病性冠心病的临床研究[J].新中医,2001,33(1)：34.
[64]杨晓辉,吕仁和.糖尿病性心脏病的中医分期辨证探讨[J].北京中医,2006,25(7)：403-405.
[65]杨晓晖,吕仁和.试论络脉病变是早期糖尿病性心脏病的病理基础[J].北京中医药大学学报,2005,28(3)：85-87.
[66]王建华.糖尿病性心脏病的防治[J].糖尿病新世界,2005,(3)：19.
[67]张磊,周鹏.冠心病调养与防治必读[J].中国妇女出版社,2009：107.
[68]杜廷海,吕小红,吕靖中.消渴安胶囊治疗糖尿病性冠心病150例临床观察[J].中国中医药科技,2001：8(2)：117-118.
[69]Anna R. Schmidt BA, Matthias G. Friedrich, MD FESC FACC. Imaging Targets in Diabetic Cardiomyopathy:Current Status and Perspective [J]. Canadian journal of diabetes, 2011;35(4):353-362.
[70]中国中医科学院编写.中医循证临床实践指南[M].中国中医药出版社,2011：100-101.
[71]中华医学会糖尿病学分会.中国2型糖尿病防治指南2010年版[M].北京大学医学出版社,2011：5.
[72]丁学屏.中西医结合糖尿病学[M].北京：人民卫生出版社,2004：42-49.
[73]南征,高彦彬,钱秋海.糖尿病中西医结合治疗[M].北京人民卫生主板社,2002：170-183.
[74]王素美.糖尿病慢性并发症的中西医结合治疗[M].中医古籍出版社,2006：123-139.
[75]赖淑华.2型糖尿病合并心脏病中医证型与相关性因素的研究.博士论文.广州中医大学,2009.
[76]黄峥.糖尿病合并冠心病的中医药研究概况[J].中国健康月刊(学术版),2011,10.
[78]宋亚俊,谢连和.胸痹丹对糖尿病性心脏病患者血脂及血液流变性的影响[J].中国民族民间医药,2008,17(6)：31-32.
[79]清·唐宗海原著,欧阳兵等点校.《血证论》[M].天津科学技术出版社,2012.
[80]王有奎.治痰——解决疑难病症的关键[J].中国中医药,2006,2239.
[81]王学良,朱章志,熊曼琪等.从心胃相关论治糖尿病性心脏病[J].新中医,2009,(2)：5-8.
[82]郑亚军,陈良秋,龙翊岚.鹅掌柴提取物的抗氧化活性[J].热带作物学报,2009,30(4)：500.
[83]杨国庆,陆菊明,郑华等.胰岛素治疗后血糖控制与2型糖尿病患者血浆同型半胱氨酸的关系[J].中华内科杂志,2006；45(1)：34.
[84]Xinli Chang, Chen Chen. A new insight of mechanisms, diagnosis and treatment of diabetic cardiomyopathy[J]. Endocrine,2012:41(3):398-409.
[85]Voulgari C, Papadogiannis D, Tentolouris N. Diabetic cardiomyopathy:from the pathophysiology of the cardiac myocytes to current diagnosis and management strategies [J].Vasc Health Risk Manag,2010; 21 (6):883-903.
[86]Miki T, Yuda S, Kouzu H, Miura T. Diabetic cardiomyopathy:pathophysiology and clinical features [J]. Heart Fail Rev,2013 Mar;18(2):149-66.
[87]Betsy B. Dokken, PhD, NP, CDE. The Pathophysiology of Cardiovascular Disease and Diabetes:Beyond Blood Pressure and Lipids [J]. Diabetes Spectrum July 2008;21(3): 160-165.
[88]杨晓辉,阮氏心顺,王保华等.三黄降糖片治疗糖尿病冠心病的临床观察[A].第十次全国中医糖尿病大会论文集[C],2007,6：497-502.
[89]江成林.中医治疗预防糖尿病并发症的思路分析[J].中医临床研究,2012,4.
[90]Fabien Forcheron, Alexandra Basset, Pauline Abdallah. Diabetic cardiomyopathy: effects of fenofibrate and metformin in an experimental model-the Zucker diabetic rat[J]. Cardiovascular Diabetology 2009,8:16
[91]Ly Ba Tuoc, Nguyen Thi Bay, et al. Hypoglycemic effect of "LUC VI GIA GIAM" formula in type 2 Diabetic patients[J]. Y hoc thanh ph6 Ho Chi Minh,2007,11 (2):91-98.
[92]Pham Viet Sang. Dieu tri tieu duong bang thuoc nam[J]. Tap chi Y hoc co truyen Viet Nam,2000,331:8-9.