The Huangdi Neijing proposes the " using bitter herbs to nourish or purge" theory to guide clinical prescription and formulation of herbal remedies based on the physiological characteristics and functions of the five zang viscera, along with the properties and flavors of medicinal herbs. This study explored diabetic kidney disease pathogenesis and treatment based on the " using bitter herbs to nourish or purge" theory. Kidney dryness is a key pathological factor in diabetic kidney disease, and the disharmony of kidney dryness is an essential aspect of its pathogenesis. Strengthening is the primary therapeutic principle, and kidney dryness is a persistent factor throughout the occurrence and progression of diabetic kidney disease. In the early stage, the pathogenesis involves heat-consuming qi and injuring yin, leading to kidney dryness. In the middle stage, the pathogenesis manifests as qi deficiency and blood stasis in the collaterals, resulting in turbidity owing to kidney dryness. In the late stage, the pathogenesis involves yin and yang deficiency, with kidney dryness and disharmony. This study proposes the staging-based treatment based on the " need for firmness" characteristic of the kidney. The aim is to provide new insights for clinical diagnosis and treatment in traditional Chinese medicine by rationally using pungent, bitter, and salty medicinal herbs to nourish and moisturize the kidney. This approach seeks to promote precise syndrome differentiation and personalized treatment for different stages of diabetic kidney disease, thereby enhancing clinical efficacy.

Objective To explore the correlation between estimated pulse wave velocity(ePWV)and diabetic retinopathy(DR).Methods Totals of 7468 patients with type 2 diabetes mellitus(T2DM)who were hospitalized from January 2018 to December 2022 were retrospectively selected and classified into the DR group and the no DR group based on fundus examination.Logistic regression was used to analyze the relationship between ePWV,its quartile and cutoff value strata,and the prevalence of DR.Results The ePWV level in the DR group was significantly higher than that in no DR group(P＜0.001);the prevalence of DR was significantly higher in the remaining three groups compared to the lowest quartile of ePWV(Q1 23.2％,Q2 30.4％,Q3 31.9％,Q4 30.1％,P＜0.001);the ePWV cutoff value was 9.27m/s,and the high ePWV group DR prevalence was significantly higher than in the low ePWV group(30.9％vs 22.4％,P＜0.001).ePWV was a risk factor for DR prevalence(OR=1.070,P＜0.001)but was affected by age,sex,diastolic blood pres-sure,lipids,and renal function;whereas,ePWV＞9.27m/s was a risk factor for the prevalence of DR independently of diabetes-related factors(OR=1.421,P＜0.001)and general condition and other confounding factors(OR=1.494,P＜0.001)in addition to risk fac-tors for DR prevalence.Conclusion ePWV was associated with DR prevalence,and T2DM patients with high ePWV levels were at high-er risk of having DR.

Objective To explore the correlation between estimated pulse wave velocity(ePWV)and diabetic retinopathy(DR).Methods Totals of 7468 patients with type 2 diabetes mellitus(T2DM)who were hospitalized from January 2018 to December 2022 were retrospectively selected and classified into the DR group and the no DR group based on fundus examination.Logistic regression was used to analyze the relationship between ePWV,its quartile and cutoff value strata,and the prevalence of DR.Results The ePWV level in the DR group was significantly higher than that in no DR group(P＜0.001);the prevalence of DR was significantly higher in the remaining three groups compared to the lowest quartile of ePWV(Q1 23.2％,Q2 30.4％,Q3 31.9％,Q4 30.1％,P＜0.001);the ePWV cutoff value was 9.27m/s,and the high ePWV group DR prevalence was significantly higher than in the low ePWV group(30.9％vs 22.4％,P＜0.001).ePWV was a risk factor for DR prevalence(OR=1.070,P＜0.001)but was affected by age,sex,diastolic blood pres-sure,lipids,and renal function;whereas,ePWV＞9.27m/s was a risk factor for the prevalence of DR independently of diabetes-related factors(OR=1.421,P＜0.001)and general condition and other confounding factors(OR=1.494,P＜0.001)in addition to risk fac-tors for DR prevalence.Conclusion ePWV was associated with DR prevalence,and T2DM patients with high ePWV levels were at high-er risk of having DR.

ObjectiveTo investigate the impact of yang deficiency syndrome on the progression to end-point events of diabetic kidney disease （DKD）. MethodsA retrospective study among patients with stage Ⅳ DKD admitted to Dongzhimen Hospital of Beijing University of Chinese Medicine from September 1st， 2016 to September 30th， 2021 was conducted. Data on the patients' general information， clinical indicators including duration of diabetes， duration of proteinuria， history of smoking and drinking， hemoglobin （HGB）， fasting blood glucose （FBG）， albumin （ALB）， serum creatinine （Scr）， urea nitrogen （BUN）， uric acid （UA）， cholesterol （TC） ， triglycerides （TG）， low-density lipoprotein （LDL）， 24-hour urine protein quantification （24h-UTP） and estimated glomerular filtration rate （eGFR）， and TCM syndromes including symptoms， tongue and pulse， and syndrome scores were collected. The patients were divided into exposure group （yang-deficiency group） and non-exposure group （non-yang-deficiency group）. The general information， clinical indicators and incidence rates of end-point events were compared， and the impact of yang deficiency syndrome on the end-point events of stage Ⅳ DKD was analyzed. Survival analysis was performed using Kaplan-Meier method， and multivariate Cox proportional risk models were used to identify independent predictors of end-point events. ResultsA total of 160 patients with stage Ⅳ DKD were included in the study， including 43 cases of yang deficiency syndrome and 117 cases of non-yang deficiency syndrome. Compared to those in the non-yang deficiency group， the waist circumference， BUN and the incidence of end-point events in the yang deficiency group were significantly higher （P＜0.05 or P＜0.01）. Spearman correlation analysis showed that yang deficiency syndrome was positively correlated with incidence of end-point events of stage Ⅳ DKD （r = 0.167， P = 0.035）. Furthermore， 24h-UTP and BUN levels were also positively correlated with end-point events in stage Ⅳ DKD patients （P＜0.01）， while ALB and HGB levels were negatively correlated （P＜0.01）. Kaplan-Meier survival curves showed that yang deficiency syndrome was associated with an increased risk of end-point events （Log Rank P = 0.011）. Moreover， 24h-UTP levels ≥3500 mg， BUN level ≥8 mmol/L， ALB level ＜30 g and HGB level ＜11 g were all associated with the increase of the risk of end-point events （P＜0.05 or P＜0.01）. Multivariate Cox regression analysis showed that yang deficiency syndrome was an independent risk factor for patients with stage Ⅳ DKD to progress into end-point events （HR = 2.36， 1.32 to 4.21； P = 0.004）， as well as 24h-UTP ≥ 3500 mg， BUN ≥ 8 mmol/L， HGB＜11 g and ALB＜30 g （P＜0.05 or P＜0.01）. ConclusionsFor stage Ⅳ DKD， patients with yang deficiency syndrome are more likely to have end-point events， which is an independent risk factor for the progression into end-point events.