从二阳结论治2型糖尿病Meta分析

A Meta-analysis of treating T2D from the Eryang therapy

目的:中医治疗疾病方法灵活,虽然辨证论治是中医治疗疾病的特点,但是临床辨证和辨病往往相互结合使用,甚至有时候以辨病论治为主。而辨病论治往往针对的是影响疾病发生、发展的关键病因病机。本研究对中医治疗2型糖尿病的常用经典方葛根芩连汤、白虎汤的临床观察进行Meta分析,并根据古代中医论著对二方清热养阴,并入于阳明经之腑胃肠的论述,反证2型糖尿病的关键病因病机是《黄帝内经》所论述的"二阳结",即归属于阳明经的胃肠道聚湿生热耗伤阴津。方法:计算机检索CNKI,Wan Fang,Pub Med,Cochrane Library数据库,收集有关葛根芩连汤和白虎汤对T2D降糖作用的临床疗效随机对照临床试验文章,采用Meta分析的方法对检索到的符合纳入标准的文献进行系统评价,初步论证葛根芩连汤、白虎汤治疗T2D的临床疗效。结果:纳入系统评价文章24篇,总样本量2232例。Meta分析显示,入阳明经清热常用方(葛根芩连汤、白虎汤)与西药治疗T2D有效率相比,中医清阳明经热治疗优于西药治疗[OR=3.17,95%CI(2.48,4.05),Z=9.29,P<0.01]。结论:中医清阳明经胃肠之热药物治疗T2D疗效显著优于西药治疗,胃肠聚湿生热是导致T2D发展、变化的关键病因病机。同时患者往往胃肠湿热与痰瘀交结,虽然清热本身可以促进湿、痰、瘀的消散,但是同时使用祛痰、健脾、燥湿、活血化瘀药物可以使治疗更有针对性,从而提高疗效。

Objective:TCM is flexible in the treatment of diseases.Although syndrome differentiation and treatment are the characteristics in TCM,clinical syndrome differentiation and disease differentiation are often applied in conjunction with each other,and sometimes treatment based on disease differentiation is dominant.Disease differentiation is often focused on the key etiologies and pathogenesis that affect the occurrence and development of diseases.This study conducted a meta-analysis of treating type 2 diabetes with the Gegen Qinlian decoction(葛根芩连汤)and the Baihu decoction(白虎汤).According to ancient TCM treatises,the above two decoctions were explored,and that Eryangjie(二阳结)was the key cause of type 2 diabetes was proved.Methods:CNKI,WanFang,PubMed,Cochrane Library database were searched,clinical trial articles on clinical efficacy of the Gegen Qilian decoction and the Baihu decoction on T2D were collected.Clinical efficacy of the Gegen Qinlian decoction and the Baihu decoction on type 2 diabetes were preliminary testified according to Meta-analysis.Results:24 systematic review articles were included and the total sample size was 2232 cases.The Meta-analysis showed that the Gegen Qinlian decoction and the Baihu decoction were more effective than western medicine on T2D[OR=3.17,95%CI(2.48,4.05),Z=9.29,P<0.01].Conclusion:The Re decoctions(热药)were more effective on T2D than Western medicine.Gastric heat and gastrointestinal accumulation are the key cause and pathogenesis of T2D.At the same time,patients often showed Changwei Shire(胃肠湿热)and Tanyu Jiaojie(痰瘀交结).Although Qingre(清热)can promote the dissipation of wet,sputum,sputum,TCM medicine of Qutan(祛痰),Jianpi(健脾),Zaoshi(燥湿),Huoxue Huayu(活血化瘀)can make the treatment more targeted and thus improve efficacy.