2010年9月14日 星期二

羅漢果對糖尿病病人是否有好處?

首先談論中醫學對羅漢果和糖尿病的了解。

羅漢果 :Siraitia grosvenori
別名:假苦瓜、拉漢果、金不換或神仙果等。
來源:葫蘆科植物羅漢果的果實,原產中國的廣西、廣東、海南、湖南、江西等省的熱帶、亞熱帶山區。
性味:味甘、酸,性涼。
歸經:肺、脾、肝、腎、大腸經。
功效 : 潤肺、清熱、消暑、生津、止咳、潤腸 。
主治: 肺熱或肺燥咳嗽,百日咳、扁桃體炎、咽喉炎、哮喘、急性胃炎、血燥便秘及暑熱傷津口渴等 。
禁忌:肺寒及外感咳嗽者忌用,脾胃虛弱易腹瀉者不宜。
文獻選錄:《嶺南採藥錄》:“果實味甘,理痰火咳嗽,和精肉湯服之。”

中醫對糖尿病當然絕不陌生,早在《黃帝內經》中已提到「消渴」一病,與糖尿病很接近。中醫認為「消渴」病的成因,包括禀賦不足、五臟虛弱、精神刺激、情志 失調、過食肥甘、形體肥胖等,中醫對糖尿病不同階段亦有深刻的觀察。糖尿病是長期的病患,分早期、中期和後期,因為受損傷的內臟不同,病情也有極大分別。中醫從病況來分析,因早期病狀為口乾口渴,認為主要的病機為陰津虧耗、燥熱偏盛;中期因為病人易倦,唔夠氣力,病機為氣陰兩傷、脈絡瘀阻;而後期腎病及各內臟衰竭,病人虛弱,中醫則認為是陰損及陽,陰陽俱虛等。不知是否因為是南方的物產,傳統的中醫書甚少提及羅漢果,更沒有用羅漢果治糖尿病的處方。(歡迎讀者提出修正)

羅漢果可否治糖尿病呢?我個人意見是糖尿病人食用羅漢果,以其潤肺、清熱、消暑、生津功能,用來調理早期糖尿病時的陰津虧耗、燥熱偏盛較適合,但單靠它可能是不足夠。後期糖尿病的氣陰兩傷、脈絡瘀阻或陰損及陽,陰陽俱虛等則一定要配合其他藥了。中醫講求「辨証論治」,而不是西醫的「診病用藥」,故不會單見是糖尿病(而不分証型)和用一味羅漢果治療的。

很多時食療提到羅漢果治糖尿病,有理據否?有沒有科研來支持這做法呢?有,在老鼠和家兔實驗中,羅漢果的不同成份 (如羅漢果多醣 Siraitia grosvenorii polysaccharide 、 配糖體 Triterpene Glycosides) ,有減低餐後血糖的升副,和改善糖尿,膽固醇,血脂等指標。(本文下部有引用,請參考)。不過我找不到以病人作為研究的記錄,任何藥物作用,一定要以病人療效為唯一標準。讀者若知到有可靠的文獻,請多多提點。

所以若有糖尿病人想用羅漢果治糖尿病,實際的建議是:找醫生確診是糖尿病,驗血 ( 包括空腹血糖、糖化血紅蛋白Hemoglobin A 1 C、高和低密度 膽固醇、三酸甘油酯 Triglyceride、肝、腎 功能),繼續食醫生一向所處方的糖尿藥,可試加上服用羅漢果的湯水,天天飲用。最好是每日自我測驗血糖(即拮手指),大約十週後再在同一化驗所驗血作對比。在這過程中,如有血糖低之象hypoglycaemia(頭暈、易餓、心跳、手震、出冷汗),或有任何不適,立刻找醫生跟進。不過要知到,假如西醫沒有加重了糖尿藥,病人也沒有明顯的多做運動或戒口節食,只是單單加上用羅漢果治糖尿病,若間中出現血糖低之情況,這可能是羅漢果的降血糖功效。抽血確定後,可能有減用糖尿藥的空間。現時未有單單用羅漢果治糖尿病的證據 。


食療治病有很大的研究價值,希望做科研的人多多努力以赴。

1 ) Exp Diabetes Res. 2007;2007:67435.
Effect of Siraitia grosvenorii polysaccharide on glucose and lipid of diabetic rabbits induced by feeding high fat/high sucrose chow.

Lin GP, Jiang T, Hu XB, Qiao XH, Tuo QH.
School of Life Science and Technology, University of South China, Hengyang 421001, Hunan, China. linguo098@yahoo.com

Abstract
The Siraitia grosvenorii polysaccharide (SGP) from the Siraitia grosvenorii (Swingle) was isolated and purified. The therapeutic effects of SGP on diabetic rabbits induced by feeding high fat/high sucrose chow were studied. After administration of SGP for 4 weeks, the fasting blood glucose (FBG), plasma insulin levels (INS), plasma total cholesterol (TC), triglyceride (TG), and HDL-C were assayed. The results showed that administration of SGP can significantly decrease plasma total cholesterol, triglyceride, and glucose levels; and increase HDL-C levels after 4 weeks of treatment. The antihyperglycaemic effect of SGP at dose of 100 mg.kg(-1) bw was the most significant in three dosage groups. Furthermore, SGP could restore the blood lipid levels of diabetic rabbits (P<.05). These data indicate that SGP not only ameliorates the lipid disorder, but also lowers plasma glucose levels. So SGP have obvious glucose-lowering effect on hyperglycaemic rabbits induced by feeding high fat/high sucrose chow, its mechanism may be related to amelioration of lipid metabolism and restoring the blood lipid levels of hyperglycaemic rabbits.


2 ) Triterpene Glycosides of Siraitia grosvenori Inhibit Rat Intestinal Maltase and Suppress the Rise in Blood Glucose Level after a Single Oral Administration of Maltose in Rats

J. Agric. Food Chem., 2005, 53 (8), pp 2941–2946
DOI: 10.1021/jf0478105
Publication Date (Web): March 25, 2005
Copyright © 2005 American Chemical Society

Abstract
The effect of the crude extract from Siraitia grosvenori Swingle (SG-ex) on the postprandial rise in blood glucose level was investigated. The increase in plasma glucose level in response to the oral administration of maltose was significantly suppressed in rats when SG-ex was given orally 3 min before the maltose administration. There was, however, no effect when glucose was administered instead, suggesting that the antihyperglycemic effect of SG-ex is elicited by inhibition of maltase in the small intestinal epithelium. In vitro, SG-ex inhibited rat small intestinal maltase. Similar effects were also observed both in vivo and in vitro when the concentrate of the sweet elements (triterpene glycosides) prepared from SG-ex was used. Furthermore, the main sweet element of SG-ex, mogroside V, and some minor elements such as mogroside IV, siamenoside I, and mogroside III also exhibited maltase inhibitory effect with IC50 values of 14, 12, 10, and 1.6 mM, respectively. These results suggest that SG-ex exerts anti-hyperglycemic effects in rats by inhibiting maltase activity and that these effects are at least partially exerted by its sweet elements, triterpene glycosides.

3 ) Efficacy Study on Siraitia Grosvenori Powder and its Extractson Reducing Blood Glucose in Diabetic Rabbits[J];Food Science;2003-12

Objective: To study the efficacy of Siraitia grosvenori powder and its extracts on blood glucose in normal and diabetic mice. Methods: Normal mice and alloxan-induced diabetic mice were fed Siraitia grosvenori powder and its extracts at dosage of0.5、1.0、3.0g/kg·bw respectively for 30d. The blood glucose levels and oral glucose tolerance test (OGTT) of diabetic mice and normal mice were assayed. Results: Siraitia grosvenori powder and its extracts had no effect on the weight, blood glucoseand oral glucose tolerance of normal mice. Siraitia grosvenori powder at dose of 3.0g/kg·bw and Siraitia grosvenori extracts at dose of 0.5~1.0g/kg·bw could significantly lower the fasting blood glucose and blood glucose of 30min in oral glucose tolerance test (OGTT) in diabetic mice. Further more the hypoglycemic effect decreased with the increase of dose of Siraitia grosvenoriextracts, but the increase of dose of Siraitia grosvenori powder showed better blood glucose-lowering effect increased. Conclusion:Siraitia grosvenori powder and its extracts had anti-diabetic preventive activity.

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