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Based on the understanding of TCM and western medicine on diabetes mellitus (DM) and diabetic peripheral neuropathy (DPN), the relationship between DPN pathogenesis and blood stasis of TCM is discussed from the perspective of modern medicine. It is indicated blood stasis is the key pathogenesis to DPN, and a two-step acupuncture treatment of DPN from the theory of blood stasis is proposed. The first step is to analyze the pathogenesis of blood stasis, which could block the progress of the disease and diminish the symptoms. The second step is to apply acupuncture for pathological result of blood stasis by following the principle of eliminating exogenous pathogen , as a result, the purpose of treating both symptoms and root cause is achieved.

Objective: To compare the clinical efficacy between acupuncture and intravenous administration of lipoic acid and alprostadil for distal symmetric multiple peripheral neuropathy of diabetes mellitus., Methods: Sixty patients were randomly divided into an acupuncture group (31 cases) and a medication group (29 cases). Patients in the two groups received basic treatment to control blood sugar within a safe range. On this basis, patients in the acupuncture group were treated with acupuncture at Geshu (BL 17), Weiwanxiashu (EX-B 3), Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23), Zusanli (ST 36), Taixi (KI 3), ashi points, etc. Patients in the medication group were treated with intravenous administration of lipoic acid (0.6 g) and alprostadil (10 mg). The treatment was given once a day, 10 days for a course of treatment; there was an interval of 2 days between courses, and totally 3 courses were given. The score of peripheral neuropathy of diabetes mellitus, the change of nerve conduction: velocity and clinical efficacy before and after treatment in the two groups were observed., Results: After treatment, the score of peripheral neuropathy was significantly reduced in the two groups (both P < 0.05), which was more significant in the acupuncture group (P < 0.05). After treatment, the sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV) of median nerve and common peroneal nerve were significantly increased in the two groups (all P < 0.05). Compared between two groups, the SNCV and MNCV of common peroneal nerve in the acupuncture group were significantly superior to those in the medication group (both P < 0.05); the MNCV of median nerve in the acupuncture group was significantly superior to that in the medication group (P < 0.05); the SNCV of median nerve in the acupuncture group was not significantly different from that in the medication group (P > 0.05). The total effective rate was 83.9% (26/31) in the acupuncture group, which was significantly superior to 62.1% (18/29) in the medication group (P < 0.05)., Conclusion: Acupuncture and conventional medication both have satisfied effects for distal symmetric multiple peripheral neuropathy of diabetes mellitus, and acupuncture is superior to medication on improving clinical signs of sensory disorder, reflection disturbance and muscle weakness, nerve conduction and clinical curative effect.

Objective: To explore the risk factors of diabetic peripheral neuropathy (DPN) and the relationship between DPN and diabetic retinopathy (DR)., Methods: The data of the in-patients with type 2 diabetes mellitus (T2 DM) were retrospectively studied. A total of 200 T2 DM patients were divided into DPN group (n = 136) and non-DPN group (n = 64) according to peripheral neuropathy. The basic clinical data and the incidence rate of DR were compared between two groups. Logistic regression analysis was used to study the risk factors of DPN., Results: The course of disease, the level of BMI, glycosylated hemoglobin (HbA1c), 2 hour postprandial blood glucose (2 hPG), 2 hour glucose C peptide (2 hC-P) and the incidence rate of the DR were significantly different between two groups (P < 0.01). Logistic regression analysis showed that significant differences were observed in T2 DM complicated by DR (P = 0.023), the course of disease (P = 0.008), the level of HbA1c (P = 0.006), BMI (P = 0.000) and 2 hC-P (P = 0.065)., Conclusion: Diabetic retinopathy, the course of disease, the level of BMI,HbA1c and 2 hC-P are the risk factors for type 2 diabetic peripheral neuropathy. Diabetic peripheral neuropathy is positive correlated with diabetic retinopathy.

Objective: To explore the relationship between plasma homocysteine levels and diabetic peripheral neuropathy (DPNP)., Methods: A crossectional analysis was conducted on 227 patients with type 2 diabetes. Peripheral neuropathy was confirmed using electromyography (EMG). The risk factors possibly associated with diabetic neuropathy or plasma homocysteine levels were analyzed in relation to likelihood of occurrence of DPNP., Results: Eighty patients with neuropathy and 147 patients without neuropathy were included. Plasma homocysteine levels were significantly higher in patients with diabetic neuropathy [(12.6 ± 3.6) µmol/L] than without diabetic neuropathy [(8.2 ± 0.9) µmol/L] (P < 0.001), and the relationship remained significant after adjusting for duration of diabetes, glycosylated hemoglobin A1c (HbA1c), age, renal status, serum folate acid and vitamin B(12), and metformin [OR 1.15 (1.02 - 1.28), P < 0.05]. In addition, per increase of 4.0 µmol/L plasma homocysteine was closely related to the occurrence of neuropathy after controlling for per unit increase of other confounding factors [OR 1.17 (0.94 - 1.33), P < 0.05]., Conclusions: Hyperhomocysteinemia was an independent risk factor for the occurrence of diabetic peripheral neuropathy.

Objective: To observe changes in activity and proliferation of cultured Schwann cells under the high glucose condition and effect of allyl glycoside extracted from Herba Rhodiolae (AG) on these changes for exploring the possible mechanism of diabetic peripheral nerve injury and the pharmacologic action of AG on them., Methods: Adopting refined Brokes method, Schwann cells were isolated from the sciatic nerve tissue of newborn Wistar rats and purified. Their activity and proliferative capability were determined using XTT method and 3H-TdR incorporative method respectively., Results: High glucose showed marked inhibitory effect on both activity and proliferative capability of Schwann cells, and the inhibition could be markedly improved by AG., Conclusion: Diabetic peripheral nerve injury is possibly related to inhibitory effect of high glucose on activity and proliferative capability of Schwann cells. Effect of AG in improving these inhibitory changes provides the experiment basis for clinical use of traditional Chinese medicine, Herba Rhodiolae.

Erectile dysfunction (ED) is a common complication of diabetes mellitus. Diabetes mellitus can cause oxidative stress, which plays a key role in the pathogenesis of diabetes-associated ED by acting on blood vessel endothelia, peripheral nerves and smooth muscles and inducing cell apoptosis. Recent progress in the researches on the correlation of oxidative stress with diabetic ED is briefly reviewed in this article.

Objective: To observe the diabetic optic neuropathy in diabetic rats, and analyze the relation between the diabetic optic neuropathy and change of blood flow and microvascular permeability of the optic nerve., Methods: Twenty male Wistar rats were randomly divided into control and diabetic groups. Diabetic model was induced by the intravenous injection of streptozotocin (50 mg/kg). Three months later blood flow of the optic nerve was measured using laser Doppler perfusion imager. 1.5% Evan's blue was injected into the caudal vein, 1 hour later the rats were killed with their bilateral optic nerves taken out. The permeability of optic nerve was tested by spectrophotometer. The optic nerves are observed with light microscopy and transmission electron microscopy., Results: Atrophy and demyelination of the optic nerve, proliferation of glial cells, neurite swelling, and decrease of organelles in the endothelial cells in optic nerve capillaries were seen. Leukocytes aggregated and adhered to the endothelial cells of pia-mater capillaries. The blood flow of the optic nerve in the diabetic rats was 0.68 v +/- 0.05 v, significantly lower than that of the control rats (1.43 v +/- 0.58 v, P < 0.01). Whereas, the permeability of the optic nerve of the diabetic rats showed a 2.03-fold increase compared with that of the control rats (P < 0.01)., Conclusion: Three-month diabetes induced optic neuropathy may be related to the decrease of blood flow and increase of microvascular permeability.

Objective: To investigate the effects of Tongluo Recipe (TLR), a compound Chinese herbal medicine, on experimental diabetic peripheral neuropathy in rats., Methods: Diabetes was induced by streptozocin in rats. Eight weeks later, the diabetic rats were assigned to 3 groups according to different body weights: untreated group, low-dose TLR-treated group and high-dose TLR-treated group. Eight normal rats were assigned to normal control group. Systemic and sciatic nerve intrinsic antioxidant enzyme activities, lipid peroxide levels, hemorheology and sciatic nerve conduction velocity and ultrastructure changes were evaluated., Results: Glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) activities were lower, and lipid peroxide levels were higher in plasma and sciatic nerve of the untreated group than those in the normal control group (P<0.05). Blood glucose and viscosity in the untreated group were higher than those in the normal control group. Sciatic nerve showed demyelination changes and decrease of conduction velocity. Vasa nervorum expanded and erythrocyte deposited in the capillary in the untreated group. TLR obviously improved sciatic nerve conduction velocity and ameliorated morphology changes, decreased blood viscosity, improved SOD and GSH-Px activities., Conclusion: TLR can obviously improve sciatic nerve function and ameliorate morphology changes in rats with diabetic peripheral neuropathy, probably through depleting free radical production, improving endothelial cell function and ameliorating hemorheology changes.

Objective: To evaluate the efficacy of neuropathy symptom score/neuropathy disability score (NSS/NDS), Michigan Neuropathy Screening Instrument (MNSI), vibration perception threshold (VPT) and 24010 g monofilament examination in the diagnosis of diabetic peripheral neuropathy (DPN)., Methods: 240 patients with type 2 diabetes underwent the 4 simple tests: NSS/NDS, MNSI, VPT, and 10 g monofilament examination and nerve conduction velocity (NCV) examination. Using the results of NCV as golden criteria, the sensitivity, specificity, positive and negative predictive values, accuracy and kappa values of these tests were analyzed., Results: The sensitivity, specificity, accuracy, and kappa value of MNSI score over 2 were 78.15%, 88.43%, 83.33%, and 0.67 respectively. The validity could be ranked in the following order with respect to the diagnosis of DPN: MNSI > VPT > NSS/NDS > 10 g monofilament examination., Conclusion: MNSI is a rapid, simple and reliable test for screening DPN in both diabetes clinics and epidemiological surveys.

Objective: To explore the role of insulin-like growth factor-I (IGF-I) gene expression abnormality in neurotrophic causes of diabetic peripheral neuropathy., Methods: Diabetes was induced in Sprague Dawley rats by alloxan. Various parameters were measured as follows: IGF-I mRNA by reverse-transcriptase polymerase chain reaction (RT-PCR), IGF-I peptide by enzyme-linked immunosorbent assay (ELISA), electrophysiological parameters of nerves by evoked electromyogram, morphometric evaluation of sciatic nerve under light microscope and transmission electron microscope., Results: During the early diabetic stage, IGF-I mRNA (0.430 +/- 0.031 vs 0.370 +/- 0.016 +/- 0.280 +/- 0.010, P < 0.01, < 0.001) and IGF-I peptide contents [(0.430 +/- 0.031) ng/mg vs (30.06 +/- 3.60 +/- 23.71 +/- 2.70) ng/mg, P < 0. 01, < 0.001] in sciatic nerve tissue reduced in diabetic rats with hyperglycemia and varied with severity of diabetes. These parameters were further down regulated in diabetic rats with less duration of diabetes and non-diabetic control rats [IGF-I mRNA 0.320 +/- 0.021 - 0.230 +/- 0.060; IGF-I peptide (28.8 +/- 3.30 - 19.51 +/- 1.80) ng/mg]. They also correlated with nerve functional (sensory nerve conduction velocity: r = 0.714, P < 0.001, amplitude of evoked potentials: r = 0.716, P < 0.001, respectively) and structural abnormality (axonal size r = 0.81, P < 0.001) of the sciatic nerve. No difference was found in the above parameters between diabetic rats with euglycemia and non-diabetic control group., Conclusion: IGF-I gene expression in tissues was down-regulated from the early diabetic stage and the down-regulation varied with the severity and duration of diabetic state. The decrement in IGF-I level might contribute to the initiation and development of diabetic neuropathy via autocrine or paracrine pathway.

42 coronary heart disease (CHD) (21 with NIDDM) were studied with a noninvasive cardiovascular autonomic function tests Namely; 1. Heart rate response to valsalva manoeuvre; 2. Immediate HR response to standing; 3. BP response to standing; 4. BP response to sustained handgrip, on two groups; Group 1: 21 NIDDM with CHD; Group 2: 21 CHD. The results showed that the incidences of abnormal of 4 tests were: 28.6%, 42.9%, 19.0%, and 42.9% in Group 1 respectively, and all were 0% in Group 2. Significant difference (P < 0.05) was found between two groups. It suggested that cardiovascular autonomic function tests is useful in diagnosing autonomic neuropathy in NIDDM with CHD patients.

Experimental diabetes rats was induced in rats by intraperitoneal streptozotocin. The changes of glucose, sorbitol, fructose and free myoinositol in diabetic sciatic nerve and plasma, the changes of enzyme activity of sciatic nerve in relation to glucose, lipid and protein metabolism were studied during 1, 2, 4, 6, 12 weeks after induction of diabetes. The structural changes of 6 and 12 week diabetic sciatic nerve were observed sequentially by light and electron microscopy during the course of 6 and 12 weeks. The results showed that glucose, sorbitol and fructose in blood and sciatic nerve were increased markedly, but free myo-inositol was normal in blood and decreased in sciatic nerve. The enzyme activity such as ICDH, MDH, LDH, alpha-GPDH all reduced, but the activity of sorbitol dehydrogenase increased. Various ultrastructural changes such as swollen unmyelinated fibers, swollen mitochondria in axon, degenerative changes of myelin sheath and atrophic axon were observed, but no changes was found by light microscopy.