Cough From The State Of Governance Theory And Clinical Research

Traditional Chinese medical science is an important part of excellent traditional Chineseculture, it is a system of science that has the original thinking, the original predominance, theself-own intellectual property rights. So it is important and urgent to explore the regularity ofthe diagnosis and treatment of traditional Chinese medicine and to bring new theories oftraditional Chinese medicine from our own practice, so as to improve the theory ofdetermination of treatment based on differentiation of syndromes. The advisor proposed thenew clinical theory of determination of treatment based on the state of human body, and it isfrom years of clinical practice, and it is combined with the latest achievements of modernsystems science and informatics and other subjects. The study choose cough, the most frequentdisease in clinic, as the incisivus point to approach the theory and clinical application ofdetermination of treatment based on the state of human body.This thesis includes three parts: theoretic research , clinical research and conclusions.1 The theoretic researchBased on the analysis of the research status of determination of treatment based ondifferentiation of syndromes at present, we considered the key issues are as follows. First, it isdifficult to express the theory of traditional Chinese medicine with modern language exactly;second, the current theory didn't grasp the marrow of traditional Chinese medicine, didn'tabsorb the achievement of modern science, and it can't guide the clinical practice well. So weconsider that there are three basic requirement to bring new ideas of traditional Chinesemedicine theory. First, to seize the marrow of traditional Chinese medicine theory, and toreflect the academic nature of traditional Chinese medicine. Second, a new theory must guidethe practice effectively, so it should improve the curative effect in medical practicesignificantly. Third, absorb the latest outcome of science, reflect the characteristics of the time,and it can express the truth that posed by traditional Chinese medicine with language that couldbe understood by modern people.The advisor proposed the new theory that identifying the state of human body frominformation, finding the basic pathogenesis that formed the state, and treating synthesized. Itwas summarized from advisor's experience of nearly 30 years of clinical practice, andabsorbed the latest achievements of the study of body constitution, environment medicine,psychology, systems science, and other subjects. State is a conception that introduced from modern systems science, and state of human body is the state that human body has at certainphase, and it can be described with proper state index. The state of human body is complex,and it is influenced by body constitution, age, gender environment, seasonal variation, psycho,society, etc. It is difficult to describe the state of human body with any single informationexactly,"syndrome"is a description of comprehensive state of human body in the state ofdisease. Any state is comprised of three basic elements, i.e. space-time, etiological factor, basisstatus. And it is important to identify the state from these three elements. The following are thediscuss of specific methods to identify the state of human body in clinic, the comprehensivetreatment and basic requirements that aim directly at the state of human body, stateaccommodation and angle-herb compatibility, and we consider that comprehensive treatment isthe best way to accommodate the state of human body eventually.The initial summary of the advisor's clinical experience of determination of treatmentfor cough based on the state of human body is as follows. To recognize the pathogenesis withChinese integrative method, and consider that the functional activity of QI being not smooth isthe basic pathogenesis of cough. To think highly of differentiation of syndromes of meridian,we locate the disease by examining the ear-point and meridian, and improve the objectivity ofidentifying state of human body. We consider that detail is important for the identifying of state,and details conclude the success or failure. Smoothing the functional activity of QI is the basicmethod of curing cough. We usually use angle-herb to accommodate state, for angle-herbcompatibility aims directly at complex state more strongly. We pay more attention to the use ofcomprehensive treating method, and it can improve the curative effect.2 The clinical researchPart I :Retrospective analysis of 1354 cases of cough1 resource of documentRetrieving the medical records database of Liang-duo JIANG from August 1999 to April 2004,with"cough"in chief complaint, there are 1354 cases in all. Mainly from Beijing, male: 499cases, female: 855 cases, the ratio of male compare with female is 1:1.7, the oldest is 86 yearsold, and the youngest is 11, mean age is 49.53±17 years.2 seasonal distribution of cough patientSpiring:299, 17.7%; summer:176, 13.0%; autumn:411, 32.6%; winter:498, 36.7%. It shows that patients that suffer from cough in winter is the most and summer is the least, and winter is2.8 times of that in summer. It reflects that pathogenic cold is the main reason of cough. Andcough that caused by pathogenic dryness is more than pathogenic wind.3 The age distribution of cough patients shows that middle and old people is at dominance.4 The distribution of tongue proper color with season variation shows that dark red is themost usual, flowed by carmoisine, red, and light is the least. The season distribution showsthat carmoisine is usual in spring, dark red is usual in winter, and there is no significancebetween summer and autumn.5 The tongue coating distribution in different season of 1335 cough cases shows that thinand whitish fur is the most usual, followed by yellowish greasy fur, thin and yellowish fur,others, white and greasy fur, and exfoliative fur is the least. The season distribution shows thatthin and whitish fur is usual in spring, thick and yellowish fur is usual in summer, thin andyellowish fur is usual in autumn, and yellowish greasy fur is usual in winter.6 The pulse tracing distribution of 1327 cough cases shows that thready pulse, wiry pulse,and slippery pulse are at dominance.PartⅡ: To analyze the regularity of differentiation of symptoms and medication of 250cough cases from professor Liang-duo JIANG.250 cough cases from Liang-duo JIANG medical record management system between2002 and 2005, most of them are exogenous cough with bases of internal damage. Afterstandardization of subject, enter and analyze with the medical record-prescription analysissystem which was developed by institute of traditional Chinese medicine information ofBeijing university of traditional Chinese medicine. Results: the fore 25 syndromes appear 245times in all, it occupy 57.4% of the all 132 species/427 items of syndromes. In which, there are47 times of wind-cold, 7 times of wind-dryness, 5 times of wind-heat, 5 times of pathogenicdryness, 7 times of pathogenic wind, 32 times of humid heat, so there are 103 times ofsyndromes that caused by exogenous pathogenic factor in all. And on the whole cough withinternal damage basis is at dominance in this 250 cases, but wind-cold syndrome andhumid-heat syndrome are the two most frequently appear in all syndromes. We can concludethat the exogenous cough has significant bases of internal damage. Deficiency of vital energyand yin is the most usual syndrome, and it is followed by hyperactivity of liver-yang, blood stasis and sputum coagulation, incoordination between the liver and stomach. The most usualcause of exogenous cough is wind-cold, then is the humid heat.The regularity of medication, there are 220 herbs in the 250 prescriptions in all, 121 herbsthat appear more than 5 times, 78 herbs that appear more than 10 times, 42 herbs that appearmore than 25 times,. The first 9 herbs are as follows: Radix Scutellariae, armeniacae semen,Fructrs Trichosanthis, Rhizoma Anemarrhenae, Radix Asteris, Fructus Arctii, BulbusFritillariae Cirrhosae, Bupleurum chinense, all of which appear more than 100 times.PartⅢ:Clinical research of the theory that determination of treatment based on the state ofhuman body.According to the diagnostic criteria of cough, most of the cases are from the clinic, andconsider the diagnose and treat method of Liang-duo JIANG as determination of treatmentbased on the state of human body, and the diagnose and treat method of other doctor's as theusual determination of treatment based on differentiation of syndromes. To study whether it issuperiority to use the theory of determination of treatment based on the state of human body bycomparing the curative effect of two groups.1 Resource and grouping of medical records232 cases of cough patients that were collected in the specialist and special requirementclinic in Dongzhimen Hospital, the respiratory department and special requirement clinic inDongfang Hospital from January 2006 to December 2006. consider the 97 patients ofLiang-duo JIANG as the observation group and 135 patients of other doctor's(associatedirector or director of respiratory department) as control group. In the course of observation,there are 5 cases withdraw in observation group and 12 in control group, and 215 casescompleted the observation. 65 males and 150 females, the oldest is 75 and the youngest is 14,mean age is 43±11. it is comparable between two groups in the distribution of course, age,season.2 Treatment methodsObservation group: The main method was the prescription that was determined according todifferent kinds of human body state. Chinese patent medicine, cupping cup, and stickingsemen ion ear acupoints were giving when necessary.Control group: prescriptions and Chinese patent medicine were given based on the results of differentiation of syndromes, and symptomatic treatment with western medicine were givenwhen necessary.3 Results: In the observation group: 92 cases in all, fully recover 39 cases, excellence 41cases, improve 9 cases, ineffective 3 cases, the rate of fully recover and excellence is 87.0%,total efficient 96.7%, the symptom integral calculus improvement rate 81.32%; In the controlgroup, fully recover 20 cases, excellence 35 cases, improve 48 cases, ineffective 20 cases, therate of fully recover and excellence 44.7% more, total efficient 83.7%, the integral calculusimprovement rate is 55.38%.Through statistics an examination, There is significance in therate of fully recover and excellence between two groups, improvement rate has already shownthe difference, P<0.05PartⅣ: Initial approach of the relationship between the reactive site on ear acupoints andthe differentiation of syndromes.Observe the positive reaction points on the ear acupoints in 45 cough cases, there are 311positive reaction points in all. Result: The positive rate of lung is the highest, occupy 18.4%,and it is followed by sanjiao which occupy 17.4%, then it is spleen 10.3%, kidney 10.1%.3 Conclusions1 It is manifestated that wind-cold is the main cause of cough. Humid-heat is common incough patients, and it is worth of thinking highly. Disorder of Qi is essential in thepathogenesis of cough, and dredging and modulating the activities of Qi is the most importantmethod of treating cough.2 It is superiority to determine the treatment of cough based on the state of human body. Wepay more attention to the information from time, past history, the constitution, accompanimentsymptoms and causative factors, improve all the information to the height of pathogenesis, andthink entirely with main symptoms and objective signs, so as to analyze the pathogenesisintimately. Then we treat with combination method and it come to better effect.3 Treating based on the state of human body, which is the inheritation and development oftreating based on the differentiation of syndromes. The conception of state is clear and distinct,and it is easy to be widely accepted by academic circles. It is more exactly to describe humanbody with state than with syndromes. Syndrome is a part of state. Determine the treatmentbased on the state of human body, it can improve the curative effect significantly with combined therapy.4 It is from the clinical practice that the theory of determination of treatment based on thestate of human body, it inherits the essence of determination of treatment based onsyndromes, and it absorbs the achievement of modern science. It is certified that it canguide the clinical practice effectively. So it is worth of generalization and application.