Research On The Strategy Of "SuiZhengShiLiang" Demonstrated By The Treatment Of Infantile Pneumonia With Maxing Shigan Decoction

Objective: By conducting a demonstrative study on the key elements of "SuiZhengShiLiang(SZSL)" in clinical prescriptions,this study investigates the dynamic adjustment process of traditional Chinese medicine(TCM)in clinical diagnosis and treatment.Utilizing the quantitative expression of the key elements of "SZSL" in the treatment of pediatric pneumonia with Maxing Shigan Decoction(MXSG)as a model,the study aims to guide the improvement of clinical efficacy and establish a research model for the strategic application of "SZSL" in clinical practice..This study contributes to the enhancement of the "medicine based" and "SZSL" strategy within the framework of TCM prescriptions,offering scientific validation and theoretical underpinning for the judicious and effective modification of dosages in clinical settings.Furthermore,it aims to establish a novel paradigm for investigating clinical dosage strategies in TCM formulations.The research employs a mixedmethod approach encompassing literature review,questionnaire survey,clinical quantification,and qualitative interviews,with a focus on the treatment of pneumonia using the MXSG formula as a case study.Methods: This study integrated a mixed-method approach encompassing "literature reviewquestionnaire survey-clinical quantification-qualitative interviews",with a focus on the treatment of pneumonia using the MXSG formula as a demonstration.Those key elements of "SZSL" for treating pneumonia with MXSG were summarized based on clinical medical cases.Pediatric pneumonia was then chosen as the primary focus,and a questionnaire survey method was utilized to investigate the implementation of dosage strategies by clinical physicians.An empirical analysis framework was established and developed.An individual case meta-analysis(IPDMA)was conducted to express the key elements of "evidence-based administration" accurately and quantitatively in clinical diagnosis.The study examined the efficacy and treatment outcomes of pediatric pneumonia treated with MXSG by analyzing the clinical data from three previously conducted RCTs.Additionally,qualitative research methods were employed,including interviews with frontline clinical physicians nationwide,to validate the clinical relevance of the research findings and offer a comprehensive and objective evaluation of the key components of MXSG in treating pediatric pneumonia with "SZSL."Results: Study 1: This study suggested that the "SZSL" strategy is integrated into the diagnostic and treatment practices of TCM,influencing clinical decision and therapeutic outcomes.Coughing and fever were identified as primary indicators for attention in pneumonia treatment with MXSG.The third,sixth,and tenth days were the "turning points/timing" for physicians to adjust the prescription after observing medication reactions.The modifications in dosage encompassed various factors such as ineffective formula,maintenance of original dosage,reduction or alteration of the entire prescription,adjustment of dosage or taste,discontinuation or modification of the prescription based on observed effects,and augmentation of dosage or taste.The components of "indication," "timing," and "quantity adjustment" were interconnected and causally related,illustrating the evolving nature of clinical decision by TCM practitioners as they assess and anticipate disease progression,thereby contributing to the development of clinical dosage strategies.Study 2: Cough,shortness of breath,body temperature,and lung signs were indicators related to disease efficacy.Pediatricians demonstrated a higher likelihood of identifying the association between body temperature,shortness of breath,and clinical efficacy,with statistically significance(P<0.05).Similarly,physicians holding senior and intermediate professional titles exhibited a greater propensity to recognize the correlation between body temperature and clinical efficacy,with statistically significance(P<0.05).These findings from medical cases and survey questionnaires provided additional validation of the significance of cough and fever in diagnosing diseases.Thus,a research framework was established utilizing fever and cough as indicators,and non-empirical empirical research was conducted to further quantify the essential components of "SZSL" of MXSG in the management of pediatric pneumonia.Study 3: In the management of pediatric pneumonia,body temperature at Day 3 served as a crucial indicator for clinical decision-making in patients presenting with fever as the primary symptom.Specifically,a reduction of 0.7 ℃ from baseline in the body temperature at Day 3was considered a pivotal point for adjusting clinical interventions in the high-dose gypsum group,while a decrease of 0.5 ℃ from baseline in the third-day body temperature was significant for the medium dose gypsum group.The precise protocol for implementing changes in dosage is outlined as follows:(1)if the high-dose group of gypsum is initiated as the initial dosage,and the decrease in body temperature at Day 3 is equal to or less than 0.7 ℃,the original dosage will be sustained;conversely,if the temperature reduction exceeds 0.7 ℃at Day 3,the dosage should be decreased.In the case where the medium dose group of gypsum is utilized as the starting dosage,and if the decrease in body temperature on the third day is equal to or less than 0.5 ℃,the original dosage should be maintained.Conversely,if the body temperature decrease surpasses 0.5 ℃ at Day 3,the dosage should be reduced.In patients presenting with fever as the primary symptom,it is not advisable to initiate treatment with a low dose of gypsum.Conversely,for patients with cough as the predominant symptom,the cough scores at Day 5/6 serve as crucial indicators.Specifically,a reduction of 2 points in the cough score at Day 6 compared to baseline in the medium dose group of almonds,and a reduction of 4 points in the cough score at Day 5 compared to baseline in the low dose group of almonds,represent pivotal moments for clinical intervention.The specific strategy for adjusting quantity in the context of almond dosing involves monitoring cough scores over a specified period of time.If the high-dose group exhibits a 2-point increase in cough score on the second day compared to baseline,this suggests inadequate therapeutic response and necessitates a corrective action.Conversely,if the medium-dose group shows a 2-point decrease in cough score on the sixth day,the original dosage should be maintained.Any deviation from this 2-point decrease warrants a reassessment of the prescription.At Day 5,a4-point decrease compared to the baseline in cough score was observed in the low-dose almond group.The initial prescription was maintained,with adjustments made if the cough score decreased by less than 4 points.Study 4: This part verified the findings,affirming that cough and fever serve as crucial indicators,with their fluctuations correlating with the efficacy of pediatric pneumonia treatment.The timing of therapeutic monitoring revealed that cough(5-6 days)laged behind fever,aligning with the nature of pediatric pneumonia and treatment goals.This finding provided additional support for the alignment of the key elements identified in this study with clinical practice,enhancing their potential to inform and improve clinical practice.Mixedmethods research could offer a more comprehensive and objective understanding of the clinical dynamics of diagnosis and treatment by considering multiple perspectives,thereby contributing to the achievement of the research objectives outlined in the study.Conclusion: The key elements of "SZSL" holds significant practical implications for guiding the clinical drug dosing regimen of MXSG for pediatric pneumonia.Cough and fever(body temperature),considered as the fundamental indicators,interact with the concepts of "inflection point/timing" and "change in quantity" in a causal relationship.The integration of qualitative interviews within a mixed-method research design has been found to enhance the accuracy of research conclusions and the scientific rigor of the study.This integration facilitates a closed loop of internal and external linkage,combining qualitative and quantitative data to validate scientific objectivity through peer expert review.Hence,this study has the potential to offer valuable qualitative and quantitative scientific evidence for the dynamic prescription dosage in clinical settings,as well as contribute to a more diverse and scientifically rigorous research paradigm for the development and execution of "evidencebased dosing" studies within the realm of prescription dosage and efficacy.