Review of the effects of the traditional Chinese medicine Rehmannia Six Formula on diabetes mellitus and its complications

Rehmannia Six Formula (RF) is a formula that is commonly used in Traditional Chinese Medicine to treat patients with diabetes. A literature search was performed in PubMed for the years 2000–2009 using the key words RF, Rehmannia glutinosa, Fructus Corni, Dioscorea sp. (D. alata, D. opposita, D. batatas), Poria cocos, Alisma sp. (A. orientalis, A. plantago aquatica), and Paeonia suffruticosa/Cortex Moutan. On the basis of the publications found, RF appears to have beneficial effects on blood glucose, neuropathy, and nephropathy. There is also evidence of anti‐inflammatory and antioxidant effects. Although there are many studies on compounds extracted from individual herbs, there are not many studies on RF as a whole. Because there is preliminary evidence that RF may be a useful supplement for the prevention of diabetic complications, clinical studies are warranted. For future clinical studies, it is recommended that details are provided regarding the preparation of RF and that the ratio of the individual components in RF is standardized so that results across studies can be compared.     

Epidemiology of cardiovascular complications in type 2 diabetes mellitus

Type 2 diabetes is increasing in epidemic proportions worldwide, and is strongly associated with atherosclerotic cardiovascular disease (CVD). Hyperglycaemia increases risk of CVD, but glycaemic control does not substantially reduce CVD risk. There are several potential explanations for this apparent paradox, including the roles of the metabolic syndrome and post-load hyperglycaemia in the association of type 2 diabetes and CVD.     

Quantitative imaging biomarkers for the evaluation of cardiovascular complications in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a prevalent condition in aged populations. Cardiovascular diseases are leading causes of death and disability in patients with T2DM. Traditional strategies for controlling the cardiovascular complications of diabetes primarily target a cluster of well-defined risk factors, such as hyperglycemia, lipid disorders and hypertension. However, there is controversy over some recent clinical trials aimed at evaluating efficacy of intensive treatments for T2DM. As a powerful tool for quantitative cardiovascular risk estimation, multi-disciplinary cardiovascular imaging have been applied to detect and quantify morphological and functional abnormalities in the cardiovascular system. Quantitative imaging biomarkers acquired with advanced imaging procedures are expected to provide new insights to stratify absolute cardiovascular risks and reduce the overall costs of health care for people with T2DM by facilitating the selection of optimal therapies. This review discusses principles of state-of-the-art cardiovascular imaging techniques and compares applications of those techniques in various clinical circumstances. Individuals measurements of cardiovascular disease burdens from multiple aspects, which are closely related to existing biomarkers and clinical outcomes, are recommended as promising candidates for quantitative imaging biomarkers to assess the responses of the cardiovascular system during diabetic regimens.     

Herbal traditional Chinese medicine and its evidence base in gastrointestinal disorders

Herbal traditional Chinese medicine (TCM) is used to treat several ailments, but its efficiency is poorly documented and hence debated, as opposed to modern medicine commonly providing effective therapies. The aim of this review article is to present a practical reference guide on the role of herbal TCM in managing gastrointestinal disorders, supported by systematic reviews and evidence based trials. A literature search using herbal TCM combined with terms for gastrointestinal disorders in PubMed and the Cochrane database identified publications of herbal TCM trials. Results were analyzed for study type, inclusion criteria, and outcome parameters. Quality of placebo controlled, randomized, double-blind clinical trials was poor, mostly neglecting stringent evidence based diagnostic and therapeutic criteria. Accordingly, appropriate Cochrane reviews and meta-analyses were limited and failed to support valid, clinically relevant evidence based efficiency of herbal TCM in gastrointestinal diseases, including gastroesophageal reflux disease, gastric or duodenal ulcer, dyspepsia, irritable bowel syndrome, ulcerative colitis, and Crohn’s disease. In conclusion, the use of herbal TCM to treat various diseases has an interesting philosophical background with a long history, but it received increasing skepticism due to the lack of evidence based efficiency as shown by high quality trials; this has now been summarized for gastrointestinal disorders, with TCM not recommended for most gastrointestinal diseases. Future studies should focus on placebo controlled, randomized, double-blind clinical trials, herbal product quality and standard criteria for diagnosis, treatment, outcome, and assessment of adverse herb reactions. This approach will provide figures of risk/benefit profiles that hopefully are positive for at least some treatment modalities of herbal TCM. Proponents of modern herbal TCM best face these promising challenges of pragmatic modern medicine by bridging the gap between the two medicinal cultures.     

ApoE基因多态性与中国人2型糖尿病及其心血管并发症的关系

目的为研究载脂蛋白Ｅ（ＡｐｏＥ）基因多态性与２型糖尿病及其心血管并发症的关系。方法以载脂蛋白Ｅ（ＡｐｏＥ）基因为候选基因，运用聚合酶链反应限制性片段长度多态性（ＰＣＲＲＦＬＰ）方法检测了１１２例２型糖尿病患者及６０例正常对照者的ＡｐｏＥ基因型。结果两组研究对象其ε３、ε２和ε４等位基因的分布频率分别为０．８４４，０．０９３，０．０６３和０．８６７，０．０８３，０．０５０（Ｐ＞０．０５），说明ＡｐｏＥ基因多态性与中国人２型糖尿病发病无相关性，通过比较２型糖尿病患者不同ＡｐｏＥ基因型与其血脂指标的关系发现：ＡｐｏＥ基因多态性与血总胆固醇水平（Ｐ＝０．００２９）及血低密度脂蛋白（ＬＤＬ）Ｃ水平（Ｐ＝０．００２１）相关，携带ε４等位基因的个体具有较高的ＴＣ及ＬＤＬＣ水平，而携带ε２等位基因的个体具有较低的ＴＣ及ＬＤＬＣ水平。ＡｐｏＥ基因多态性与２型糖尿病伴高血压无相关（Ｐ＝０．１１１）。携带ε４等位基因的患者冠心病发病率明显较携带其他等位基因患者为高（Ｐ＝０．００８）。结论ε４等位基因可能是２型糖尿病合并冠心病的一个危险因子     

饮酒与糖尿病及其心血管并发症

糖尿病是目前严重危害人类健康和生命的慢性疾病。多项临床观察表明,适量、中等度饮酒可降低糖尿病发病风险,改善血糖控制,降低糖尿病心血管并发症发病风险。其可能机制包括适量饮酒升高机体高密度脂蛋白-胆固醇水平,增加胰岛素敏感性,减轻体内慢性炎症状态等。     

P-selectin gene genotypes or haplotypes and cardiovascular complications in type 2 diabetes mellitus

Background and aimIncreased levels of sP-selectin, a member of the selectin family involved in the transient attachment of leukocytes to endothelial cells, are found in a number of conditions including diabetes and ischemic heart disease. A number of polymorphisms in the gene encoding P-selectin have been identified. The purpose of the present study was to explore the role of three non-synonymous P-selectin gene polymorphisms, Tyr715Pro, Asn562Asp and Ser290Asn, in determining the risk of macrovascular complications in type 2 diabetic patients.Methods and resultsFollowing a cross-sectional case-control design from 837 Italian type 2 diabetics, 301 cases with at least one episode of angina pectoris (AP), acute myocardial infarction (AMI), stroke, transient ischemic attacks (TIA) or peripheral arterial disease (PAD) were compared with 536 controls free of ischemic vascular complications in the period preceding the examination. Case subjects had longer duration of diabetes at the time of examination and were older as compared with controls. Hypertension and male sex were over-represented among cases. Allele frequency and genotype distribution of the three polymorphic variants did not show any significant preferential association in groups of cases or controls. Odds ratios also indicated no effect on risk of cardiovascular disease even after adjustment for potentially confounding variables. There was a strong allelic association between Tyr715Pro and Asn562Asp (D′ = −0.99, P < 0.0001). Ser290Asn was in linkage disequilibrium with Tyr715Pro (D′ = 0.43, P = 0.15) and in almost complete equilibrium with Asn562Asp (D′ = 0.05, P = 0.5). Haplotype phase inferred from genotypic data revealed the presence of 6 haplotypes. Global test of significance showed no difference in three marker haplotype distribution between cases and controls (P = 0.88, df = 5).ConclusionsThe present study excludes a major contribution of Tyr715Pro, Asn562Asp and Ser290Asn P-selectin polymorphisms to a susceptibility to ischemic vascular complications in type 2 diabetes.     

Chinese herbal medicine and acupuncture for the treatment of cardiovascular disease

Traditional Chinese medicine (TCM) is one of the world's oldest healing systems. TCM includes herbal medicine, acupuncture, moxibustion, massage, food therapy, and physical exercise, such as shadow boxing. In modern China, TCM is a fully institutionalised part of health care and widely used with Western medicine.……     

循证医学的启示--糖尿病治疗需全面控制心血管危险因子

大系列的荟萃分析已证实 ,约 70 %的 2型糖尿病 (Ｔ2ＤＭ)患者死于心血管并发症。近十年来 ,多项治疗糖尿病的多中心、大样本、长期、随机对照临床试验 (ＲＣＴ)的结果相继发表 ,证实了糖尿病 (主要是Ｔ2ＤＭ)具备了许多动脉粥样硬化的危险因素 ,如血脂异常、高血压、肥胖、高凝状态及血栓倾向。对这些因素的积极干预不仅改善了相应的临床、生化代谢指标 ,更令人信服的是可以减少糖尿病 (ＤＭ)患者心血管疾病的终点事件 ,从而使对糖尿病的治疗超越了以“葡萄糖为中心”(ｇｌｕｃｏｓｅｃｅｎｔｒｉｃｉｔｙ)的传统观念 ,提出了在糖尿病治疗…     

Gastrointestinal complications in diabetes mellitus

Impaired function of the gastrointestinal tract related to diabetes mellitus (DM) results from diabetic autonomous neuropathy, impaired sensory innervation and a direct effect of chronic hyperglycaemia. Another possible connection between DM and the gastrointestinal tract can be infrequent autoimmune diseases associated with type I DM (celiac disease, autoimmune gastropathy, autoimmune chronic pancreatitis). Functional or organic changes resulting from diabetes can be seen in every organ of the gastrointestinal tract. Some of the diabetic gastrointestinal tract difficulties affect almost 60% of patients with long lasting diabetes. On one side, impaired function of individual organs in diabetics can significantly influence level of diabetes compensation and vice versa. On the other side, unsatisfactory diabetes compensation can result in manifestation of digestive problems. The most frequent and the most serious clinical complication is diabetic gastroparesis (DG). The highest incidence of impaired evacuation and motility of the stomach (and the small intestine) is described in diabetics with long lasting unsatisfactory diabetes compensation, microangiopathic complications, and diabetic neuropathy (55-75% in type I diabetes and 15-20% in type II diabetes). Symptoms accompanying impaired motility and emptying of the stomach (feeling of early fullness, eructation, nausea, vomiting and abdominal pains) can be only temporary or can be missing in some patients. Hyperglycaemia accompanied by slowing down evacuation of the stomach is different in patients with an empty stomach--glycaemia over 7.8 mmol/l, and postprandially--antral motility decreases after blood glucose levels get over 9.7 mmol/l. Treatment options for symptomatic diabetic gastroparesis are limited. Achieving normoglycaemia usually improves diabetic gastroparesis but in up to 80% of cases simultaneous administration of prokinetics is necessary.     

Pharmacotherapy of diabetes mellitus: implications for the prevention and treatment of cardiovascular disease

Diabetes mellitus in adults is associated with an increased risk of premature vascular disease and a higher mortality rate. The presence of other risk factors, often seen in diabetic patients, such as systemic hypertension, augments the rate of vascular diseases. Evidence is growing that tight control of hyperglycemia using insulin and/or oral hypoglycemic agents will modify this risk. More aggressive control of concomitant hypertension and/or hyperlipidemia is also required. Diabetic patients who have myocardial infarctions do worse than nondiabetic patients. Various strategies to improve outcomes include the use of tight blood glucose control, and various coronary interventions are currently under clinical study.     

Pulmonary complications in diabetes mellitus

Clear decrements in lung function have been reported in patients with diabetes over the past two decades, and many reports have suggested plausible pathophysiological mechanisms. However, there are no reports of functional limitations of activities of daily living ascribable to pulmonary disease in patients with diabetes. This review attempts to summarize the available information from the present literature, to describe the nature of the lung dysfunction in diabetes and the emerging clinical implications of such dysfunction.     

中西医结合治疗肝癌的思考

中医和西医在肿瘤治疗方面各有优势,西医注重消灭肿瘤,而中医则注重调变肿瘤和机体。肝癌治疗方面,中医适合于不能耐受手术/介入疗法患者,作为姑息性治疗,以改善生活质量,延长带瘤生存;作为其他疗法的辅助治疗,达到促进治疗后的恢复,减少复发转移、延长生存期。实验研究发现,5味中药的“松友饮”可通过抑制血管生成、降低肿瘤侵袭,可减少化疗和姑息性切除后的转移,并延长荷瘤鼠生存期,提示这方面中西医结合的可能性。临床实践中需要重视中医理论,而     

中药抗纤维化刍议

损伤的肝细胞在修复时，常与肝细胞的再生和间质胶原组织的增生同时并进的，若纤维组织增生超过肝细胞的再生，则易导致肝纤维化和肝硬化的结局。因此，抗肝纤维化的治疗也是慢性肝病防治中的重要环节。     

Herbal medicine and treatment of diabetes in Africa: an example from Guinea

AIM: Use of medicinal plants is widespread in Africa, particularly in Guinea where oral transmission of practices is part of the social ritual. The purpose of this study was to determine the proportion of diabetic patients who use herbal medicine and identify the types of plants in use. Reasons for using herbal medicine and the formulations employed were also noted. METHODS: A questionnaire on use of herbal medicine was proposed to all diabetic patients hospitalized or consulting the Endocrinology Unit of the Conakry University Hospital between April 1 and June 30, 2003. RESULTS: A total of 397 patients responded; 33% declared they used herbal medicine. They proposed many motivations, sometimes in association: belief in its efficacy (74%), easy access to medicinal plants (70%), lower cost (48%), and search for complete cure of diabetes (37%). Hearing about a positive experience had convinced 78% of the users to use herbal medicine. The majority of the users were satisfied (85%). One or more clinical manifestations occurring concomitantly with use of herbs was observed in 23 patients (18%), particularly gastrointestinal disorders (n = 10) and skin problems (n = 8). Two cases of hypoglycaemia were noted. CONCLUSION: Herbal medicine plays an important role in anti-diabetes treatment in Guinea. This type of treatment should be based on scientific evidence but very few studies have been conducted. Conditions of use should be better defined and patients should be informed of potential adverse effects.     

中药抗肝纤维化治疗

肝纤维化（ｈｅｐａｔｉｃ ｆｉｂｒｏｓｉｓ）是肝细胞发生坏死或炎症刺激时,肝内纤维结缔组织异常增生的病理过程,是慢性肝病重要的病理特征,也是肝硬化发生的前奏和必经中间环节。阻断肝纤维化的发生和发展,对防治肝硬化具有重要意义[1,2]。 肝纤维化的发展是一动态过程,这一过程一方面取决于各种病因和损伤因素的存在,另一方面,而且是更重要的,取决于肝内炎症活动性及其持续性。肝内病变活动性即肝纤维化活动性。消除了肝损伤的致病因素,肝内组织学病变活动性降低,肝纤维化便减轻或停止发展。在多数情况下,纤维化发展的过程…