| Background:Traditional Chinese Medicine (TCM) has gained rich experience in the treatment of stroke attributed to the long-term practice. Etiology analysis and syndrome differentiation are two distinguishing insights in stroke-treating. After long-term clinical observation, Wang Yongyan found that phlegm-heat and bowel-qi-obstructed syndrome is very common among acute stroke patients and put forward Xinglouchengqi Decoction, as the representative decoction of therapy of resolving phlegm and relaxing bowels, to treat the syndrome. The therapy has been widely used among patients and it has witnessed obvious clinical efficacy.Objective:In order to explore the characteristics and mechanism of the therapy of resolving phlegm and relaxing bowels, we selected acute ischemic stroke patients with phlegm-heat and bowel-qi-obstructed syndrome as research objects. The treatment group and control group was administered with Xinglouchengqi Decoction and routine laxative treatment respectively. By comparing relative scale scores before and after the treatment, we tried to interpreter syndrome evolution and analyze effect features of the therapy. Serum cortisol concentration was recorded to discuss mechanism of the therapy in the aspect of neuroendocrine regulation.Methods:48 patients with acute ischemic stroke and syndrome of phlegm-heat and bowel-qi-obstructed who met the inclusion criteria were enrolled and randomly divided into treatment and control group with the ratio of 2:1,33 cases in the treatment group and 15 cases in the control group. The treatment group was prescribed with Xinglouchengqi Decoction while the other with routine laxative medication (Duphlac or Glycerine Enema).The course of treatment was limited between 3 to 7 days and it can be adjusted flexibly according to specific bowel movement of each patient. In the duration of the treatment, patients were given conventional therapy such as anti-platelet, blood lipid stabilization, nerve-protection, improvement of blood circulation and standard therapy of underlying diseases in accordance with clinical condition. Daily observation and record of symptoms and physical signs were guaranteed. National Institute of Health Stroke Scale (NIHSS), TCM Stroke Scale, scale of stroke syndrome factors, scale for phlegm-heat and bowel-qi-obstructed syndrome were examined on the 1st day of enrollment and after bowel-qi-obstructed syndrome was relieved. In the meanwhile, safety indexes were detected. Data calculation and analysis were performed using SPSS version 22.0.Results:(1) 3 to 7 days after treatment, the improvement of NIHSS score and score of scale for phlegm-heat and bowel-qi-obstructed syndrome was statistically significant in both groups (P<0.05). Additionally, the improvement of TCM Stroke Scale score was statistically significant in treatment group (P<0.05). However, no statistical difference can be seen between two groups regarding the scores of scales mentioned above (P>0.05). (2) The scores of inner fire, and blood-stasis were proven to be statistically lower after treatment in control group (P< 0.05)and scores of all six syndrome factors (inner wind, inner fire, phlegm-dampness, blood-stasis, qi-deficiency, yin-deficiency) were proven to be statistically lower after treatment in treatment group (P<0.05), the decrease of phlegm-dampness score was more obvious in treatment group compared with the control group (P<0.05) and changes of the rest five syndrome factors were not proven to be statistically different between two groups (P>0.05). (3) The overall efficiency was 75.8% in treatment group and 73.3% in control group, with no statistical difference between groups (P>0.05). (4)The cortisol concentration before and after therapy indicated no statistical difference within or between two groups (P>0.05). There were 3 cases with excessive cortisol level before treatment and cortisol level fell back to normal after medication with an improvement of NIHSS score at the same time. One case with normal cortisol level before treatment experienced excessively high cortisol concentration after medication with an aggravation of TCM Stroke Scale score at the same time. After medication,14 cases in treatment group and 7 cases in control group with decreased cortisol level before treatment experienced increasing level of cortisol, which indicated a gradual tendency to get close to or return to the normal value, and they also experienced an improvement of NIHSS score or TCM Stroke Scale score at the same time. No statistically significant correlation was found between cortisol concentration and stroke syndrome factors or NIHSS score or score of scale for phlegm-heat and bowel-qi-obstructed syndrome.Conclusion:(1) Therapy of resolving phlegm and relaxing bowels can effectively relieve phlegm-heat and bowel-qi-obstructed syndrome in patients with acute ischemic stroke and it can effectively improve stroke condition, and additionally, it can effectively reduce the degree of nerve function defect. (2) Therapy of resolving phlegm and relaxing bowels can effectively relieve excess syndrome factors (inner wind, inner fire, phlegm-dampness, blood stasis) and deficiency syndrome factors (qi-deficiency, yin-deficiency) in patients with acute ischemic stroke, which reflects its dual effects of purgation and tonifying. Therapy of resolving phlegm and relaxing bowels has an obviously superior effect in relieving phlegm-dampness syndrome compared with routine laxative medication. (3) After medication, cortical level of 14 cases in treatment group indicated a gradual tendency to get close to or return to the normal range and we may infer that therapy of resolving phlegm and relaxing bowels may play a role in regulating cortisol disorders so as to keep it within normal range. Further researches are needed to validate this hypothesis. |
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