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What are the TCM rehabilitation treatment methods for diabetic complications?
Diabetic complications include acute complications, such as diabetic ketoacidosis, diabetic nonketotic hyperosmolar syndrome, diabetic lactic acidosis, and chronic vascular and neurological complications, such as diabetic heart disease, diabetic cerebrovascular disease, diabetic nephropathy, diabetic retinopathy, diabetic peripheral neuropathy and autonomic neuropathy, and diabetic gangrene. We focus on TCM rehabilitation treatment of chronic vascular and neurological complications of diabetes.

(1) Diabetic heart disease

Diabetic heart disease includes cardiac microangiopathy, macroangiopathy, cardiomyopathy, arrhythmia and cardiac insufficiency caused by autonomic nervous dysfunction, often accompanied by coronary atherosclerotic heart disease and hypertensive heart disease. The clinical manifestations are as follows: ① Tachycardia at rest: the heart rate is more than 90 beats/min, even reaching 130 beats/min, and the heart rate increases, which is not affected by deep breathing and sudden standing. ② Angina pectoris: Patients with coronary heart disease often show typical symptoms of unstable exertional angina pectoris and variant angina pectoris, while patients with diabetes complicated with coronary heart disease often show atypical symptoms, especially those over 40 years old with a course of more than 20 years. ③ Painless myocardial infarction: The symptoms of myocardial infarction in diabetic patients are atypical, about 42% of them can be painless, with only nausea, vomiting, congestive heart failure, arrhythmia, cardiogenic shock and even fatigue. The prognosis is poor and it is easy to be missed and misdiagnosed. ④ Postural hypotension: When the patient stands up from the lying position, such as systolic blood pressure drop > > 20mmHg, diastolic blood pressure drop > 10 mmHg, it is postural hypotension, which is the late manifestation of diabetic neuropathy. ⑤ Sudden death: Patients with diabetic heart disease often suffer from severe arrhythmia, cardiogenic shock and sudden death unconsciously due to various reasons, such as stress, infection and surgical anesthesia. And the mortality rate accounts for 80% of the mortality rate of diabetic patients, of which 53% died of coronary heart disease. Myocardial infarction may be the cause of death in 20% ~ 50% of diabetic patients. Therefore, diabetic patients should pay attention to the prevention and treatment of cardiovascular complications.

Diabetic heart disease is equivalent to chest pain, true heartache, syncope heartache, palpitation, edema, fullness, drinking and other symptoms secondary to diabetes in traditional Chinese medicine. It is mostly caused by prolonged thirst, yin injury and gas consumption, deficiency of both qi and yin leading to deficiency of both yin and yang, qi stagnation and phlegm-dampness blocking the heart pulse, collateral blood stasis, or yang deficiency and water stagnation.

1. TCM rehabilitation therapy

(1) Traditional Chinese Medicine for Treating Diabetic Chest Obstruction and Heartache

① Phlegm dampness blocking chest yang

【 Key points of syndrome differentiation 】 Chest tightness, backache, obesity, mental fatigue, poor sleep, dry mouth and aversion to drinking, pale tongue with white and greasy coating, and slippery or thin pulse.

[Treatment] Eliminating phlegm and dampness, widening chest and removing arthralgia.

[Prescription] Gualou Scallion Pinellia Decoction.

② Phlegm-heat closing chest yang

【 Key points of syndrome differentiation 】 Chest tightness, chest pain, heavy waist and back, upset and insomnia, or retching, dry mouth, listlessness and dreaminess, dry stool, pain according to the heart, dark red tongue, yellow and greasy fur, and slippery pulse.

[Treatment] Resolving phlegm and clearing heat, widening chest and removing arthralgia.

[Prescription] Modified Xiaoxinxiong Decoction.

③ Qi stagnation and blood stasis

【 Key points of syndrome differentiation 】 Chest tightness, chest pain, swelling pain and tingling in chest and hypochondrium are related to emotions, such as heavy breathing, bitter mouth, emotional failure, irregular menstruation, blood clots in menstrual blood, dark purple tongue, white and blistering fur and heavy pulse.

[therapy] regulating qi and promoting blood circulation.

[Prescription] Xuefu Zhuyu Decoction is modified.

④ Qi deficiency and phlegm obstruction, qi stagnation and blood stasis [key points of syndrome differentiation] Heartache occurs from time to time, shortness of breath and fatigue, abdominal distension, irregular stool, loss of appetite, fat and dark tongue, white and greasy fur, thin and smooth pulse, or slippery string.

[Treatment] Yiqi Huatan, Shunqi Huoxue.

[Prescription] Liujunzi Decoction, Wumo Yinzi and Su Xiang Powder.

⑤ Deficiency of both qi and yin, qi stagnation and blood stasis [key points of syndrome differentiation], heartburn, chest tightness and shortness of breath, dry mouth and throat, listlessness, dry stool, dark red or reddish tongue with cracks, little or thin white fur and rapid pulse.

[Treatment] Supplementing qi and nourishing yin, regulating qi and promoting blood circulation.

[Prescription] Shengmai Powder, Su Xiang Powder and Danshen Decoction are modified.

(2) Syndrome Differentiation and Treatment of Diabetic Palpitation ① Yin deficiency and excessive fire.

【 Key points of syndrome differentiation 】 palpitation and restlessness, insomnia and dreaminess, dysphoria in the heart, fever in the five senses, dry throat and mouth, soreness and weakness in the waist and knees, red tongue with yellow fur and heavy pulse.

[Treatment] Nourish yin to reduce fire, clear heart and soothe the nerves.

[Prescription] Tianwang Buxin Dan, Huanglian Ejiao Decoction and Wushen Pill are modified.

② Deficiency of both Qi and Yin

【 Key points of syndrome differentiation 】 Shortness of breath and fatigue, palpitation and asthma, dry mouth and throat, physical weakness and excessive sweating, dark or reddish tongue, thin coating, thready and rapid pulse, or short and irregular pulse.

[Treatment] Supplementing qi and nourishing yin, nourishing the heart and calming the nerves.

[Prescription] Shengmai Powder, Shengxian Decoction and Yilao Maidong Decoction are modified.

③ Deficiency of Yin and Yang

【 Key points of syndrome differentiation 】 Palpitation, shortness of breath, fatigue, dry throat and mouth, chills and cold limbs, soreness of waist and knees, pale tongue, thin white fur and rapid pulse.

[Treatment] Nourishing yin and nourishing blood, activating yang and restoring pulse.

[Prescription] Radix Glycyrrhizae Preparata Decoction and Sanjia Fumai Decoction are modified.

(3) Syndrome Differentiation and Treatment of Diabetic Drinking Edema ① Deficiency of heart qi and blood stasis blocking water.

【 Key points of syndrome differentiation 】 Palpitation, shortness of breath, chest tightness, shortness of breath, inability to lie flat, abdominal distension, hypochondriac fullness, edema of limbs, loose stool or loose stool, pale tongue and thready pulse.

[Treatment] Yiqi Ningxin, Huoxue Huoshui.

[Prescription] Jiawei Shengxian Decoction, Mufangji Decoction, Granule Jujube Xie Fei Decoction and Sijunzi Decoction.

② Deficiency of both qi and yin, blood stasis and water stagnation.

【 Key points of syndrome differentiation 】 Palpitation, shortness of breath, cough and asthma, inability to lie down, strenuous exercise, dry mouth and throat, short and red urine and edema, dark red tongue, thin and white tongue coating, and deep and thin pulse.

[Treatment] Supplementing qi and nourishing yin, promoting blood circulation and flowing water.

[Prescription] Shengmai Powder, Shengxian Decoction, Yilao Maidong Yinzi and Jujube Xie Fei Decoction are modified.

③ Deficiency of yin and yang, blood stasis and water stagnation.

【 Key points of syndrome differentiation 】 Palpitation, shortness of breath, difficulty in breathing, inability to lie flat, dull complexion, cyanosis of labial nails, short and red urine, edema of limbs, chills of limbs, dark tongue with ecchymosis and deep and thin pulse.

[Treatment] Yiqi Yangyin, Wenyang Huoxue, Toarey Yang diuretic.

[Prescription] Shengmai Powder, Shengxian Decoction, Zhenwu Decoction, Granule Jujube Xie Fei Decoction and Ji Fang Fuling Decoction are modified.

2. Other rehabilitation therapies While strictly controlling blood sugar, diabetic heart disease should control blood pressure, quit smoking and drinking, control weight and control fat diet to avoid factors that may induce myocardial infarction, such as emotional excitement, overwork, drinking, satiety and catching cold. Specific dietary principles, first of all, should control total calories, limit fat intake, and limit cholesterol intake; Carbohydrate is suitable for high cellulose food; When you feel hungry, you can always supplement it with green vegetables rich in vitamin C, vitamin E and magnesium.

Dietary remedies such as ginseng asparagus rice porridge, peach kernel stem rice porridge, zedoary pig heart soup, salvia miltiorrhiza hawthorn drink, ginseng leaf tea, seaweed soup and so on. You can choose.

(2) Diabetic cerebrovascular disease The probability of diabetes complicated with cerebrovascular disease is significantly higher than that of non-diabetic patients. According to statistics, its incidence rate is 16.4% ~ 18.6%. Among them, the number of diabetic patients who died of cerebrovascular diseases in China is much higher than that in Europe and America. Diabetic cerebrovascular disease has the following clinical characteristics: ① It mostly occurs in the elderly over 50 years old, with more males than females. ② Ischemic lesions are common in diabetic cerebrovascular diseases, especially multiple lacunar cerebral infarction. ③ There are many infarcts in the blood supply area of vertebrobasilar artery system, mostly thalamus, cerebral infarction and cerebellar infarction. Patients may show dizziness, vomiting, ataxia, stupidity, etc. The symptoms of hemiplegia may be atypical. ④ Diabetic cerebrovascular disease is easy to recur. ⑤ The occurrence and prognosis of diabetic cerebrovascular disease are closely related to hypertension. ⑥ Diabetic cerebrovascular disease is serious, difficult to recover and has a poor prognosis. The mortality rate is about 19%. The most common cause of death is pulmonary infection, followed by heart failure and hyperosmotic diabetic coma.

Diabetic cerebrovascular disease is equivalent to stroke, dizziness, stroke, dryness and other diseases secondary to diabetes in traditional Chinese medicine. Su Wentong's Comment on Deficiency Theory points out that diseases such as prickly heat and stroke are caused by the rich eating too much; Li Dongyuan, a famous doctor in the Jin and Yuan Dynasties, recorded in the Secret Collection of the Blue Room that diabetic patients saw "numbness of upper and lower teeth, stiff tongue base, swelling and pain, and weakness of limbs"; In the Ming Dynasty, Dai Yuanli's "Essentials of Syndrome Treatment" also pointed out: "The essence and blood are deficient for a long time, or the eyes are blind, or the hands and feet are negligent, like a wind disease." Ancient and modern physicians have accumulated rich experience in treating diabetic cerebrovascular disease. Traditional Chinese medicine believes that diabetes is caused by yin deficiency and excessive heat, and it cannot be cured by long-term treatment. At the same time of yin injury, qi is also secretly consumed. Deficiency of both qi and yin can cause blood stasis to block pulse, and accumulated heat can also burn body fluid into phlegm, so phlegm stasis can block brain collateral. If yin deficiency and hyperactivity of yang are added, once liver wind is provoked, wind, phlegm, blood stasis and heat can be combined into one, so that the brain is blocked, the mental machine is useless, and hemiplegia, aphasia, coma, mouth and tongue askew, headache, dizziness and hemianopia appear. It can be called diabetes and stroke.

Please refer to the first section of Chapter 10 for specific treatment.

(3) Diabetic Nephropathy Diabetic Nephropathy is diabetic glomerulosclerosis, and its incidence generally increases with the extension of the course of diabetes.

According to statistics, 50% of patients with type 1 diabetes died of renal failure, while 5% ~ 10% of patients with type 2 diabetes died of renal failure. Diabetic nephropathy can be divided into early, middle and late stages in clinic. Early patients lack specific symptoms that can be distinguished from diabetes. Urine routine can be negative, and the 24-hour urine protein quantification can be below 500, but the urinary albumin excretion rate is abnormal, generally greater than 20μg/min. At this stage, the symptoms of polyuria or low back pain appear, and the serum creatinine is less than132.6 г mol/L (1.5 mg). In the middle stage, the patient is in decompensated renal function, with obvious edema and proteinuria and frothy urine. The serum creatinine is greater than or equal to132.6 mol/L (1.5 mg/DL), but not greater than 442 mol/( 15mg/DL), and the clearance rate of endogenous anhydride is less than 80ml/min. The advanced patient is uremia with symptoms such as edema, fullness, nausea, anorexia, oliguria, irregular stool, palpitation, asthma and convulsion. Anemia, water-electrolyte disorder and acid-base imbalance are common. Serum creatinine ≥442 mol (/L 5.0 mg/dl), endogenous creatinine clearance rate less than 20ml/min. At this time, it is difficult for internal medicine to treat conservatively.

Diabetic nephropathy is equivalent to urine turbidity, edema, fullness, kidney fatigue and blood stasis secondary to diabetes in traditional Chinese medicine, and is also closely related to the so-called "kidney elimination" in ancient times. Traditional Chinese medicine believes that diabetic nephropathy is the result of long-term development of diabetes. In addition to paying attention to the physical factors of renin deficiency, it also emphasizes emotional stagnation, improper diet and misdiagnosis. Neijing pointed out: brittle kidney is good for all diseases, and the kidney is easy to be injured, which means that diabetic patients are prone to congenital deficiency and complications, emphasizing the internal causes of the disease. Clinical observation shows that diabetic nephropathy does have the pathogenesis of kidney deficiency. If the disease of diabetes persists for a long time and the yin deficiency and heat stagnation further develop, it will become a syndrome of deficiency of both qi and yin, heat stagnation and blood stasis. In the early stage, the kidney qi is insufficient and the kidney essence is not solid, then the essence is downward; Insufficient kidney qi and poor gasification will stop water dampness, so urine protein and edema may occur, which is urine turbidity and diabetic edema. The disease develops further, and the deficiency of both qi and yin progresses to deficiency of both qi and blood, stagnation of water and dampness, renin deficiency, turbid toxin retention, triple energizer block, involvement of five internal organs, and qi disorder, which may lead to fullness, oliguria, vomiting, inability to eat and constipation. Belonging to the category of kidney deficiency and thirst quenching in traditional Chinese medicine.

1. The study of TCM rehabilitation therapy on the syndromes of diabetic nephropathy found that deficiency of kidney-qi is more common in the early and middle stages of diabetic nephropathy, and at the same time, deficiency can be combined with yin deficiency and yang hyperactivity, or both yin and yang deficiency, among which deficiency of both qi and yin is the most common. There are blood stasis, qi stagnation, phlegm dampness, accumulated heat, damp heat and water dampness, among which blood stasis, accumulated heat and phlegm dampness are the most common. In the middle and late stage of diabetic nephropathy, the deficiency of renal elements is endogenous, and there is widespread deficiency of qi and blood. Deficiency syndrome can be both yin deficiency and yang deficiency, or even both qi and blood yin and yang deficiency, all of which have both qi and blood deficiency. There are blood stasis, qi stagnation, phlegm-dampness, accumulated heat, damp-heat, water-dampness, turbid toxin, phlegm obstruction, abstinence, wind-moving, blood-moving and strangulation. Patients generally have the syndrome of turbid toxin remaining inside. Therefore, different stages of diabetic nephropathy, treatment based on syndrome differentiation should be different. According to the spirit of syndrome differentiation based on qi deficiency and syndrome differentiation based on empirical evidence, we divide diabetic nephropathy into early and middle stages, three types and six stages, and late stages, three types and eleven stages.

(1) Early and middle stage (diabetic urine turbidity, diabetic edema)

1) three types of essence deficiency.

① Yin deficiency type (both qi deficiency and yin deficiency) [key points of syndrome differentiation]: mental fatigue, soreness of waist and knees, drowsiness of limbs, shortness of breath and spontaneous sweating, susceptibility, dry mouth and throat, soreness of waist and knees, five senses of vexation, vexation and insomnia, fever in the afternoon, night sweats, frequent urination, thirst, red tongue, pale tongue and thin yellow or little fur.

[Treatment] Nourishing kidney and consolidating kidney.

[Prescription] Sijunzi Decoction, Shenqi Dihuang Decoction, Erzhi Pill, Jinsuo Gu Jing Pill, Qingxin Lianzi Decoction, etc.

② Yang deficiency syndrome (both qi deficiency and yang deficiency) 【 Key points of syndrome differentiation 】 Mental fatigue, palpitation, shortness of breath, frequent micturition at night, or short, red and swollen urine, cold pain in waist and knees, cold limbs, impotence and premature ejaculation, cold hands and feet, thin stool, fat tongue with teeth marks, white or greasy tongue coating, and weak pulse.

[Treatment] Warming yang and benefiting qi, consolidating kidney and nourishing yuan.

[Prescriptions] Sijunzi Decoction, Jisheng Shenqi Pill, ginseng soup, Shuilu Erxiandan, Wuling Powder, etc.

③ Deficiency of both yin and yang (both qi deficiency, yin deficiency and yang deficiency) 【 Key points of syndrome differentiation 】 Mental fatigue, shortness of breath, laziness in speaking, dry mouth and throat, cold pain in waist and knees, fear of cold and heat, impotence and premature ejaculation, irregular menstruation in women, fever in hands and feet with cold hands and feet, dry stool, thick tongue, toothmarks, white or greasy tongue coating and weak pulse.

[Treatment] Nourishing yin and strengthening yang, consolidating kidney and nourishing yuan.

[Prescription] Huangqi Decoction, Jinkui Shenqi Pill, Gui You Pill, Erxian Decoction, Xuantu Pill, Wuzi Yanzong Pill, etc.

2) Six stages of standard evidence

① Blood stasis syndrome

【 Key points of syndrome differentiation 】 The lips and tongue are purple and dark, the abdomen, waist and back are tingling, the limbs are numb, hemiplegia occurs, and the pulse is heavy or astringent.

[Treatment] Promoting blood circulation and removing blood stasis.

[Prescriptions] Taohong Siwu Decoction, Xiayu Snow Decoction, Danshen Decoction, etc.

② Qi stagnation syndrome

【 Key points of syndrome differentiation 】 Chest tightness, anorexia, depression, abdominal pain, breath holding, frothy tongue and thready pulse.

[Treatment] Regulating qi and relieving depression.

[Prescription] Sini Powder, Daqiqi Decoction, Wumo Yinzi, Chaihu Shugan Powder, etc.

③ Phlegm dampness syndrome

【 Key points of syndrome differentiation 】 Obesity, listlessness, chest tightness, heavy limb drowsiness, pale and greasy mouth, white and greasy tongue coating and slippery pulse.

[Treatment] Resolving phlegm and eliminating dampness.

[Prescription] Erchen Decoction, Zhimi Fuling Pill, Baijin Pill, etc.

④ Heat accumulation syndrome

【 Key points of syndrome differentiation 】 Thirst, polydipsia, dry stool, frequent micturition, aversion to cold, red tongue with Huang Gan coating and smooth and firm pulse.

[Treatment] Clearing heat.

[Prescription] Sanhuang Pill, Huanglian Jiedu Decoction, Zengye Chengqi Decoction, Geliang Powder, etc.

⑤ damp-heat syndrome

【 Key points of syndrome differentiation 】 Severe dizziness, abdominal distension and tightness, heavy limbs, sticky mouth, unpleasant stool, Huang Chi urine, red tongue, yellow greasy tongue coating, slippery pulse or slippery string.

[Treatment] Clearing heat and eliminating dampness.

[Prescriptions] Sanren Decoction, Simiao Powder, Yinchenhao Decoction, etc.

⑥ Water-dampness syndrome

【 Key points of syndrome differentiation 】 The face and limbs are swollen, or the urine output is low, the limbs are heavy, the tongue is fat with teeth marks, the fur is slippery, and the pulse is slippery or heavy.

[treatment] diuresis and dehumidification.

[Prescription] Wuling Powder, Wuling Drink, Daoshui Fuling Decoction, etc.

(2) Late stage (renal fatigue caused by diabetes, the key point of diabetes) 1) Three types of deficiency syndrome.

① Yin deficiency type (qi deficiency, blood deficiency, yin deficiency and turbid toxin accumulation) [key points of syndrome differentiation] Mental fatigue, dry mouth and throat, mental fatigue, dizziness, palpitation, soreness of waist and knees, upset and fever, upset and insomnia, frequent urination, itchy skin, burning and dry, or leg cramps, anorexia, heartburn, nausea and acid vomiting, pale red tongue and thin yellow fur.

[Treatment] Yiqi Yangxue, Ziyin Bushen.

[Prescriptions] Danggui Buxue Decoction, Bazhen Decoction, Liuwei Dihuang Decoction, Maiwei Dihuang Decoction, Guishao Dihuang Decoction, Qiju Dihuang Decoction, Jiang Sheng Powder, Sanhuang Pill, etc.

② Yang deficiency type (qi deficiency, blood deficiency, stagnation of turbid toxin due to yang deficiency) [key points of syndrome differentiation] Mental fatigue, mental fatigue, lazy speech, cold limbs, dizziness, palpitation, cold pain in the waist and knees, abdominal distension and warmth, anorexia, nausea, watery stool, prone to lying down, frequent urination at night, long and clear urine, wet and itchy skin, and fat tongue.

[Treatment] Supplementing qi and nourishing blood, warming yang and tonifying kidney.

[Prescriptions] Danggui Buxue Decoction, Shiquan Dabu Decoction, Jisheng Shenqi Pill, ginseng soup, Wenpi Decoction, Dahuang Fuzi Decoction, etc.

③ Deficiency of both yin and yang (deficiency of both qi and blood, deficiency of both yin and yang) [key points of syndrome differentiation]: fatigue, dizziness and tinnitus, palpitation and shortness of breath, dry throat and mouth, urine smell in mouth, upset and insomnia, soreness of waist and knees, cold hands and feet, spontaneous sweating and night sweats, frequent micturition or scanty urine, nausea and vomiting, dry stool, fat tongue and dim teeth marks.

[Treatment] Nourishing yin and strengthening yang, benefiting qi and nourishing blood, tonifying kidney and nourishing yuan.

[Prescriptions] Prescriptions such as Danggui Buxue Decoction, Ginseng Yang Rong Decoction, Jinkui Shenqi Pill, Gui You Pill, Dabuyuan Decoction, Radix et Rhizoma Rhei and Radix Glycyrrhizae Yinzi are modified.

2) Eleven stages of standard experience

① Heat accumulation syndrome

【 Key points of syndrome differentiation 】 Excessive thirst, excessive appetite, aversion to heat and cold, dry stool, Huang Chi urine, red tongue with Huang Gan coating, strong and slippery pulse, or slippery number.

[Treatment] Clearing heat.

[Prescription] Sanhuang Pill, Huanglian Jiedu Decoction, Zengye Chengqi Decoction, Geliang Powder, etc.

② damp-heat syndrome

【 Key points of syndrome differentiation 】 Severe dizziness, abdominal distension, aching waist and legs, heavy limbs, sticky mouth, uncomfortable stool, Huang Chi in urine, pruritus of skin or vulva, yellow leucorrhea in women, red tongue, yellow and greasy tongue coating and slippery pulse.

[Treatment] Clearing heat and eliminating dampness.

[Prescriptions] Sanren Decoction, Simiao Powder, Yinchenhao Decoction, etc.

③ Depression-heat syndrome

【 Key points of syndrome differentiation 】 Bitter mouth, dry throat, dizziness, tinnitus and deafness, dysphoria, poor sleep, nausea and vomiting, loss of appetite, fullness in chest and hypochondrium, belching, reddish tongue, yellowish tongue coating, and thready or rapid pulse.

[Treatment] Clearing heat and relieving depression.

[Prescription] Danzhi Xiaoyao Pill, Xiaochaihu Decoction, Dachaihu Decoction, etc.

④ Phlegm heat syndrome

【 Key points of syndrome differentiation 】 Dizziness, heavy head, chest tightness, coughing up yellow phlegm, insomnia and dreaminess, red tongue, yellow and greasy tongue coating, and slippery or slippery pulse.

[Treatment] Eliminating phlegm and clearing heat.

[Prescription] Xiaoxinxiong Decoction, Huanglian Wendan Decoction, etc.

⑤ Qi stagnation syndrome

【 Key points of syndrome differentiation 】 Emotional depression, fullness in chest and hypochondrium, belching, breathlessness, abdominal pain, puffiness, frothy tongue and thready pulse.

[Treatment] Regulating qi and relieving depression.

[Prescription] Sini Powder, Daqiqi Decoction, Wumo Yinzi, Chaihu Shugan Powder, etc.

⑥ Blood stasis syndrome

【 Key points of syndrome differentiation 】 tingling in the part, aggravation at night, numbness of limbs, or hemiplegia, wrong nails, purple mouth, lips and tongue, or dark purple, ecchymosis, purple gas in sublingual collaterals, string or astringent pulse.

[Treatment] Promoting blood circulation, removing blood stasis and dredging collaterals.

[Prescription] Xuefu Zhuyu Decoction, Gexia Zhuyu Decoction, etc.

All landowners phlegm-dampness syndrome

【 Key points of syndrome differentiation 】 Chest tightness and fullness, coughing and spitting, anorexia and nausea, obesity and dizziness, heavy limbs, white and greasy tongue coating and slippery pulse.

[Treatment] Resolving phlegm and eliminating dampness.

[Prescription] Erchen Decoction, Zhimi Fuling Pill, Baijin Pill, etc.

Wind yang syndrome

【 Key points of syndrome differentiation 】 Headache and dizziness, red face and red eyes, irritability and irritability, bitter mouth and dry throat, tinnitus and deafness, strong neck pain, even limb twitching, tremor, red tongue and thready pulse.

[Treatment] To subdue yang and extinguish wind.

[Prescription] Zhengan Xifeng Decoction, Tianma Gouteng Drink, etc.

Pet-name ruby phlegm syndrome

【 Key points of syndrome differentiation 】 The back is aversion to cold, and it is forbidden to lie flat when coughing, or the chest is full, the cough is painful, or the heart is swollen, and the abdominal distension is caused by underwater sound, bowel sounds, pale tongue coating, heavy pulse, and slippery string.

[Treatment] Toarey Yang Huayu Decoction.

[Prescription] Gui Ling Pork Liver Decoction, Poria Licorice Decoction, Mufangji Decoction, Lepidium Jujube Xie Fei Decoction, etc.

Indications for water-dampness syndrome

【 Key points of syndrome differentiation 】 Edema of the face and limbs, or scanty urine, heavy limbs, fat tongue with teeth marks, pale tongue coating and slippery pulse.

[treatment] diuresis and dehumidification.

[Prescription] Wuling Powder, Wuling Drink, Daoshui Fuling Decoction, etc.

■ Dampness and turbidity syndrome [key points of syndrome differentiation]: eating less, eating more, nausea and vomiting, sticky mouth, urine smell, mental retardation, or irritability, itchy skin, white and greasy tongue coating and slippery pulse.

[Treatment] Eliminating dampness and discharging turbidity.

[Prescription] Dahuang Glycyrrhiza Decoction, Jiang Sheng Powder, Rhizoma Dioscoreae Septemlobae, Fenfen Decoction, etc.

It should be pointed out that the syndrome differentiation of diabetes is mostly based on deficiency and excess, and it is common that the deficiency of the source leads to one syndrome, and at the same time, one or more syndromes are seen in the empirical study. Attention should be paid to the relationship between deficiency syndrome and excess syndrome in clinic.

2. Dietotherapy Rehabilitation Therapy The principles of dietotherapy for diabetic nephropathy include the following aspects: ① A high-quality low-protein diet. The total intake of protein should be limited, and high-quality protein should be supplemented appropriately. Fasting bean products, appropriately restricting staple food, and appropriately supplementing high-quality protein such as milk and egg white. ② Appropriate calorie supplement and low-fat diet. Low-fat diet, light taste, eat more starch-rich foods, such as vermicelli, vermicelli, potatoes, yam and so on. ③ Low phosphorus and high calcium diet. Fasting foods with high phosphorus content such as animal viscera and dried fruits. ④ High fiber diet. Eat more coarse grains, corn flour, konjac and so on. In short, the total daily protein should be less than 20% of the basic heat. In the mid-term, beans should be completely fasted, so that the intake of high-quality protein is greater than 1/2 of the total intake of protein. Daily total calories are calculated according to physical activity intensity and standard weight, and determined with reference to body shape, in which protein is 30-45g, fat is 35-40g, and more carbohydrates can be given. When blood sugar rises, the dose of insulin (a hypoglycemic drug) will increase. In the later diet, the distribution in protein should be controlled at 20 ~ 30g, and in protein, milk and egg white are the main foods, and plant protein should be minimized.

3. Other rehabilitation treatment (1) Psychological adjustment: Early patients should know the severity of the disease to attract enough attention, and at the same time firmly believe that the progress of the disease may be contained as long as it is treated reasonably. Mid-term patients should understand the fact that renal function has lost compensation. Hunger, satiety, overwork, excessive consumption of bean products, use of nephrotoxic drugs, complicated infection, etc. Can increase the burden on the kidneys, and the awareness of reasonable treatment should be improved. Patients with advanced stage should reduce their psychological burden and enhance their self-confidence. Don't be superstitious about "magic prescription", "magic technique", "secret recipe" and "proven prescription", and take the initiative to receive formal treatment.

(2) Exercise: light physical activity can be carried out in the early stage, but overwork should be avoided. Some activities, such as jogging, Tai Ji Chuan and disco for the elderly, are all good. Patients in the middle and late stage should increase their bed rest time. Lying on your back is the best way to stay in bed. Lying on your back can relax the whole body, improve the blood circulation of the kidneys, and is conducive to rehabilitation.

(3) Massage: It can relieve patients' symptoms. For constipation patients, you can point Tianshu points on both sides of navel, or let patients massage their abdomen. The method is to massage clockwise around the navel for 36 weeks, then counterclockwise for 36 weeks, once every morning and evening to strengthen gastrointestinal peristalsis. Female patients with depression, abdominal distension, cold pain in the lower abdomen, or fever in the upper body and chills in the lower body, can point at Zhongwan point to make the qi flow smooth and the road of yin and yang help accessible.

(4) Diabetic retinopathy The most common clinical manifestations of diabetic ophthalmopathy are diabetic retinopathy and diabetic cataract. Among them, the incidence of the former accounts for 35.6% ~ 63.5% of the total number of diabetic patients, which is the main cause of blindness caused by diabetes and is extremely harmful to human beings. The disease may only be blurred vision in the early stage, but over time, it will lead to continuous progress until blindness. According to the changes of fundus retina and its blood vessels, fundus diseases in China can be divided into simple type and proliferative type: ① simple type. Stage I: microaneurysms or small bleeding spots. (+) Less, easy to count; (++) is too many to count. Stage Ⅱ: yellow-white hard exudation, or hemorrhage. (+) Less, easy to count; (++) is too many to count. Stage ⅲ: white soft exudation or bleeding point.

(+) Less, easy to count; (++) is too many to count. ② Hyperplastic type. Stage Ⅳ: There are new blood vessels in the fundus or vitreous hemorrhage. Stage ⅴ: There are new blood vessels and fibrous hyperplasia in the fundus. Stage ⅵ: There were neovascularization and fibrous hyperplasia in the fundus, and retinal detachment was found. Therefore, diabetic patients should receive fundus examination and treatment as soon as possible once their vision declines.

Diabetic retinopathy is a cataract eye disease in traditional Chinese medicine, and it is the secondary vision of diabetes. As early as the book Xuan Ming Fang Lun, Liu Hejian of Jin Dynasty clearly pointed out that diabetes can produce "passerine cataract", which belongs to cataract eye disease and blurred vision secondary to diabetes. Its pathogenesis is related to diabetes with yin deficiency and dryness-heat, blood essence injury and blood stasis. Clinical observation: diabetic retinopathy is more common in patients with shaoyin constitution, jueyin constitution and shaoyang constitution, which may be related to deficiency of kidney yin, dystrophy of liver and wood, and blindness due to dampness; Those with Jueyin constitution have yin deficiency and hyperactivity of yang, and liver-fire is disturbed; People with shaoyang constitution are related to stagnation of liver qi, and it is easy to turn fire into smoke. As for the pathogenesis of blood collateral stasis, it is more complicated: ① blood stasis due to yin deficiency and body fluid deficiency; ② Liver depression and qi stagnation, qi stagnation and blood stasis; (3) Deficiency of both qi and yin, qi deficiency and blood stasis; (4) Yin impairs Yang and blood stasis due to cold; ⑤ Stasis caused by prolonged illness entering collaterals. In fact, the formation of blood stasis in diabetic fundus lesions is the result of the comprehensive effects of the above aspects.

1. TCM rehabilitation therapy

(1) Simple type I patients with yin deficiency, blood heat and collateral blood stasis [Key points of syndrome differentiation] Hemangiomas, bleeding spots or bleeding spots can be seen in the fundus. Accompanied by dry mouth, polydipsia, polydipsia, dry stool, dark red tongue, yellow fur and rapid pulse.

[Treatment] Nourishing yin and clearing heat, cooling blood and promoting blood circulation.

[Prescriptions] Zengye Decoction, Huaban Decoction, Xijiao Dihuang Decoction, etc.

(2) Deficiency of both qi and yin, blood stasis blocking collaterals.

【 Key points of syndrome differentiation 】 Most patients are simple type ⅱ, type ⅲ and patients with early hyperplasia. In addition to hemangioma and hemorrhage, hard exudation or flocculent exudation or neovascularization can also be seen in the fundus. It may be accompanied by dry mouth and throat, dizziness, weakness of waist and knees, fatigue, dark red tongue, or dim, less moss, and deep and thin pulse.

[Treatment] Supplementing qi and nourishing yin, promoting blood circulation and softening hardness.

[Prescription] Shengmai Powder, Qijudihuang Decoction, Dendrobium Night Pill, Xiaoyu Pill, Baizhu Alisma Decoction, etc.

(3) Deficiency of both yin and yang, blood stasis blocking collaterals.

【 Key points of syndrome differentiation 】 It is more common in patients with hyperplasia. In addition to simple lesions, neovascularization, retinal edema, fibrous tissue hyperplasia and even retinal detachment can also be seen. May be accompanied by chills, cold limbs, shortness of breath, fatigue, pale face, edema of limbs, thick tongue coating, pale and dark quality, and weak pulse.

[Treatment] Nourishing and strengthening yang, promoting blood circulation and softening hardness.

[Prescription] Jinkui Shenqi Pill, Wuzi Bushen Pill, Luo Xiao Pill, etc.

It should be pointed out that clinical specific medication must also refer to the results of fundus examination for microscopic syndrome differentiation. Notoginseng Radix and Salviae Miltiorrhizae Radix are used for long-term non-absorption of fundus hemorrhage; If you see fresh bleeding in the fundus, use Cortex Moutan, Flos Sophorae Immaturus, Pollen Typhae, Scutellariae Radix, Notoginseng Radix, Radix et Rhizoma Rhei, etc. Flocculent exudation, using Semen Plantaginis, Herba Leonuri and Alismatis Rhizoma; Hard exudation, then use seaweed, kelp, Zhejiang shellfish, oysters, hawthorn; For the organic substance after fundus hemorrhage or old vitreous hemorrhage, seaweed, Fritillaria thunbergii, hawthorn, and even Sparganum burmannii and Rhizoma Curcumae are used. In addition, the treatment of diabetic eye disease should pay attention to soothing the liver and relieving depression. Cihang Tangning Mingmu recipe (Bupleurum, Radix Paeoniae Alba, Fructus Leonuri, Fritillaria thunbergii, etc.). ) has a good therapeutic effect, which can really improve vision and improve the fundus lesions of patients.

2. Other rehabilitation therapies for the rehabilitation of diabetic retinopathy can take mulberry leaf black sesame porridge or drink lotus leaf tea, medlar tea and chrysanthemum tea; Patients with hypertension can also drink kudingcha regularly, or drink cassia seed Polygonum multiflorum tea and Sophora japonica tea. At the same time, patients should be kept in good mood. Avoid anger and depression. Patients should be instructed to return to nature, make friends, relax, face up to reality and adjust their mentality.

In addition, patients with diabetic eye diseases should be instructed to keep doing eye exercises for a long time, massage the temples, the main points, the Jingming and the Sibai points, and massage the Fengchi points and the Waiguan points, which have certain effects on protecting their eyesight.