?? Diabetes

1
?? Diabetes
2
Introduction

• (?) Definition
• ?????????,???????????(Polydipsia)???(Polyuria
  )???(Polyphagia) ?????(Emaciation) ,?????(Sweat
  urine)???????????
• ??????????????

3
Introduction

• (?)Evolution
• 1.????,????????
• ??????,?????
• ??????????,?????
• ??????????????
• 2. Etiology and pathology
• ???????????,??????,??????,?????,?????

4
Evolution

• 3.?????????????????????????
• ????,??????????????
• ????,????,????,????,??????

5
Evolution

• 4.The General Treatise on the Etiology and
  Symptomology (618-907 AD) said that the case of
  diabetes often suffer from the carbuncle and
  deep-root carbuncle.
• 5.?????????????????,??????????????????

6
Evolution

• 6.?????????????????????. ??????????????????
• 7.?????????,?????????????????,?????

7
Evolution

• 8.??????????????????,???????????????????(????
  )???????(????)?????????(????)?

8
(?)??Scope

• ??????(Diabetes)????????
• ????( diabetes insipidus ),?????,???????,?????????
  ??,??????????

9
Etiology and Pathology

• (?)????(Constitution of Deficiency)
• ??????,????,???????,?????,?????????????
• ??.?????????,?????

10
Etiology and Pathology

• ?????????????
• ? HLA-DR3??????IDDM???????
• ????????????,?102?NIDDM??????9?????D9S171?D9S175??
  ?????????
• ???InsR??????????????????
• ?ACE???NIDDM???????????????

11
Etiology and Pathology

• (?)????(Dietary Irregularity)
• ??????,????,????
• ?????
• ???????,????,????,????,?????
• ????,????

12
Etiology and Pathology

• ??????,??????????????
• ????????gt30?NIDDM???????,???????DM???????????8?
• ??????????,??????,???????(??????????????),????????
  ??
• ?????????????????????

13

• ???????????????????????????,???DM????????,????
  ??,?????,???????????(???????????2000.6)

14
Etiology and Pathology

• (?)????(Emotional disorder)
• ????,?????????,????,?????????????
• ?????????????,????,?????.

15
Etiology and Pathology

• ??????????????????????
• ?????????????????????(?????????2000.8.1)
• ????????????????????(????????2000.9.4)
• ? A?????????DM??(????????2002.11.3)
• ???131???????91????18??,??????????DM?,????????????
  ??????(?????????1997.5.3)?

16
Etiology and Pathology

• (?)????(Overstrain Over indulgency)
• ????,????,??????,?????
• ????????????????,?????????????????????????????(???
  ?2001.6)?

17
Etiology and Pathology ??

• ???? ????
• ?? ?
• ???? ???? ??
• ? ??
• ???? ???? ??
• ?? ?
• ???? ????

18
Etiology and Pathology

• ????????????????,??????,???????????????,??????????
  
• ???????????????,???????

19
Pathology for Manifestation

• ???? ?????? ????
• ?
  ?
• ???? ???? ???? ?
• ???? ???? ???? ?
• ?
• ???? ???? ???? ?
• ???? ?????? ??
• ???? ????

20
Pathology for Manifestation

• ???? ???? ????
• ? ???? ???? ?
• ???? ???? ?? ?
• ???? ??
• ??????????????,????

21
????

• ????,????
• ?? ???? ? ????,??,??
• ????,????
• ?? ???? ? ????,????
• ????,????
• ??,??,??,????????????
  ??????????

22
Pathology for Manifestation

• Questions
• 1.???????????
• ????????,???????
• 2. ??????????????????
• ?????,?????,?????????
• ????????,?????????????????????????????(??????19
  95.3?????????1997.6)?
• ??????
• ???????????????????
• ??????

23
Diagnosis

• 1.?????????
• ???????????(20?/d),????(300010000ml/d),?????
• ?????????????
• ????,??????,???????
• ????,?????

24
Diagnosis

• 2.????????
• ?????????????,?????????????????????????????
• ??????????????????,?????????
• ????????????

25
????
26
??(????)
27
??(????)
28
Diagnosis

• 3.?????????
• 1999?WHO?????????????????????
• ??????2?FPG(????)7.0mmol/L(126mg/ml)
• ????????????11.1mmol/L(200mg/ml),?OGTT
  2h(?????????)11.1mmol/L
• ???????,???FPG7.0mmol/LOGTT 2h11.1mmol/L(??????
  ?11.1mmol/L)?,?????FPG7.0mmol/L?OGTT
  2h11.1mmol/L?

29
Differential Diagnosis

• 1.??? ??????????????????????,????????????????
  ?????????????????
• 2.?? ????????,????????????????????????????,??
  ??????.

30

• ???????

31
????Main points for Differentiation of Syndrome

• 1.???(Disease location)
• ????,?????????
• ????,?????????
• ????,??????????
• ??????
• ?????
• ????????
• ?????????

32
Main points for Differentiation of Syndrome

• 2.???(Superficial and Origin)
• ???????,?????
• ??????? ??????? ????????? ?????
• 3.??????? (Primary Manifestation and
  Complication)
• ???????????????,???????????????.

33
Therapeutic principle

• Clearing away heat and moistening for dryness
  Nourishing yin to promote the production of body
  fluid.
• ????,????
• ??????,???????????????????????

34
Basic Treatment

• (1)????
• ????125.5167.4KJ(3040kcal)/d/Kg,????????5?,????,
  ?????
• (2)??
• (3)????????
• (4)???????
• (5)??????????
• (6)??????

35
????

• ??????
• (Consumption of body fluid due to the
  dryness-heat)
• 1.????
• (1)??????,????,????,????,????
• (2)??????,????,????
• (3)???????,??????
• (4)???????????

36
????

• 2. ????
• ????,????????,????,????
• ????,????????
• ????,????,????,????????,??
• ????????
• ?????????????
• ???????????????????

37
????

• 3.?? ????
• 4.?? ??????????
• ????,??????
• ????,?????? ????
• ??????????????
• ?????????
• ???????????? ????
• ???????
• ???????

38
????

• 5.????
• (1)????????(??),???(??)
• ????????? ???????
• ???????????????????
• (2)????,????,????,???????
• (3)????,????,????,????????

39
????

• ????
• ??????,???????????,??lt5?,???lt50?,?????,???
  ????????,???????

40
??????

• (Deficiency of Yin-essence)
• 1.????
• (1)??????,???????,????,????
• (2)??????,????,????,????,??,??????,????,??????
• (3)????,?????,?????
• (4)????????

41
????

• 2. ????
• ????,????,??????????,???????
• ????,????????,??????
• ????????,????,??
• ????,????????,????,??????
• ???????,??????

42
????

• 3. ??????,????
• 4. ???????
• ????,?????,?????,?????????????

43
????

• 5.????
• ????,????,????,???????,??????,??????
• ????,????????????,????

44
????

• ?????????1??2????,????????,????????????????
• ????
• 1?????????,????????,????
• 2??????????,????????,??ß??????
• ??????200622(2)125?
• ???????20053(6)455?

45
??????

• (Deficiency of Both Qi Yin)
• 1.????
• (1)??????,????,????,????
• (2)??????,???????,?????,????,?????,????,?????,???
  ?,?????
• (3)???????,??
• (4)????????

46
????

• 2. ????
• ????,???????????,????
• ???,?????????(?????)
• ????,????????,????,????
• ????,????????

47
????

• 3. ??????
• 4. ???????????
• ???(?????????)??????
• ?????????,????????

48
????

• 5.????
• ?????,?????,??????,???????,????,???????????????
  ?,??????????????????

49
????

• ????
• ?????????,????,????????,????,????????????,
  ???????????????80,??????????????,????????,???????
  ??,??????????????

50
????

• ?????????,????????????????????,??????????,
  ?????????????
• (??????,04.8)

51
??????

• (Deficiency of both yin and yang)
• 1.????
• (1)??????,??????,????????,????,????,????
• (2)??????,?????,?????,????????
• (3)????????(pale tongue with white coating)
• (4)???????(deep and thready pulse without
  strength)

52
????

• 2.????
• ????,??????,????,??????
• ??????,????,????
• ???? ??????
• ????????
• ????????
• ????,?????????

53
????

• 3.??(Therapy) ??????
• 4.??(Prescription) ?????.
• ????? nourishing yin and reinforcing the
  kidney
• ????? warming yang to recover the function
  of controlling

54
????

• 5.????
• (1)??????,????
• (???????????????)
• (2)???,?????????????
• (3)???????,????????

55
????

• ????
• ??????????,????,?????,?????????,???????

56
??????

• (Blood stasis)
• 1.????
• (1)??????,????,????
• (2)?????????,????,?????,????
• (3)????????,?????????,??????
• (4)???????????

57
????

• 2. ????
• ??????,????,??????,????,?????????,????????,?????
  ????

58
????

• 3.?? promoting the circulation of blood to
  remove blood stasis
• 4.?? ?????
• ???????????,?????????,????
• ?????????????????
• ?????,????

59
????

• ????
• ????????????????,??????????????????????,???????
  ,???????????

60
????

• ????
• ????,2???????????????????1.931,?????????90,???
  ????????????????????
• ???,???????????????,?????????????
• ???????????????????

61
????

• ????
• 1.????????????????(?????????),?????2??????????????
  ,????????84.3?
• 2.?????????188?,?????80?
• 3.??????,????,????????

62
??????

• ?????????????
• ?????????????????
• ????????????????????????
• ?????,???????????,??????????????

63
??????

• 1.????????????????????,????????,?????,????,??????
  ?????????
• 2.???????????????,???????
• 3.?????????????????????

64
??????

• 4. ??(????)?????????,???????
• ????????????,??????????????????,??????????????????
  ???
• ??????????,???????,??????
• ???????,????,??????

65
??????

• 4. ????(?????)????,????,??????
• ???????????Na-K-ATP?????,?????????????????
• ???????,???????,????,?????,?????????????????????

66
????????

• ?????????????????,???,???,??,??,??,??,???
• ???????????????????????,????????,????????????????
  ?????
• ?????????????????????????????????????

67
? ?

• 1.???????????,??????
• 2.?????????????,??????????????????????????
• 3. ?????????????????????
• 4.?????????(???),??,???
• 5.???????????,?????????????????????
• 6.???????5?,????,??,???????

68
????

• ????,?,48?,?????2??????2?????????,???????
  ?,??????,???????3Kg???????,????,????,???????,???.?
  ????10.2mmol/L,??()???????????????????