The Study Of Traditional Chinese Medicine Treatment For Patients With Extra Hepatic Bile Duct Stones Before And After Operation

ObjectiveUsing retrospective study of clinical cases,to analyze the Chinese medicine dialectical situation before and after operation and treatment of traditional Chinese medicine by syndrome differentiation after operation for patients with extra hepatic bile duct stones,and explore the ideas and characteristics of clinical treatment of extra hepatic bile duct stones using traditional Chinese medicine,provide some reference for clinicians.MethodsThis subject retrospectively collected 146 patients diagnosed as extra hepatic bile duct stones from September 1,2015 to January 31,2018 in the Third Surgery Department of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine.A total of 126 cases eventually met the inclusion criteria.Patients were treated with sub-time diagnosis and treatment,the observation period is stipulated: The first day of admission is the first visit,postoperative 1-3 days is the second visit,postoperative5-7 days is the last visit.All cases were included routine Western medicine treatment.The clinical research questionnaire was used to collect and record data.Excel software and SPSS22.0 software were used to make statistical analysis and data mining of TCM syndrome differentiation and medication for patients with extra hepatic bile duct stones before and after operation.Observations include:(1)General conditions: age,gender,place of birth,occupation,course of disease,past history,allergy history,personal history,family history and so on.(2)safety indicators: vital signs,drug allergies or adverse reactions.(3)clinical indicators:(1)Clinical manifestation:abdominal pain,back radiating pain,yellow dye,yellow urine,fever chills,poor appetite,dry mouth,bitter taste,nausea and vomiting,abdominaldistension,constipation and so on;(2)tongue,pulse;(3)Syndrome;(4)laboratory test indicators: WBC、AST、ALT、GGT、TB、DB、IB.(4)indicators of use of traditional Chinese medicine: all traditional Chinese medicine used during observation.Results1.Changes of clinical manifestation of patients with extra hepatic bile duct stones before and after operationThe results showed that the main clinical manifestations of the final 126 patients at first visit were abdominal pain,back radiating pain,poor appetite,yellow urine and yellow dye,followed by dry mouth,poor sleep,constipation,bitter taste,nausea and vomiting,fever chills and sticky mouth.After the operation,the clinical manifestations were mostly abdominal pain,poor appetite,poor sleep,dry mouth and abdominal distension.Compared with the first diagnosis(preoperative),abdominal pain,abdominal distension,poor appetite,poor sleep,dry mouth,cough,slump,fatigue were significantly increased,while yellow dye,yellow urine,fever chills nausea and vomiting decreased significantly.After the treatment of Chinese medicine,the cases of abdominal pain,abdominal distention,poor appetite,poor sleep,dry mouth,bitter taste cough were significantly reduced in the final diagnosis,and the fatigue,slump,unregulated stool were increased accordingly.2.Changes of tongue and pulse of patients with extra hepatic bile duct stones before and after operationThe common tongue in the first visit were red tongue with yellow sticky coating,red tongue with thin and yellowish coating,pale tongue with white greasy coating,pink tongue with toothed mark and thin white coating,bleak tongue with Greasy coating,while the common pulse were string sliding pulse,taut pulse,small and wiry pulse,wiry and rolling pulse,immerse fine pulse.After surgery,the mostly tongue of the patients were still pink tongue with toothed mark and thin white coating,pale tongue with white greasy coating,dark red tongue with yellow sticky coating red tongue with yellow sticky coating,while the mostly pulse were small and wiry pulse,string sliding pulse,immerse fine pulse and wiry and rolling pulse.Compared with the first visit,purple tongue with petechia,small and wiry pulse,deep and thread pulse were significantly increased,while taut pulse obvious reduced.Compared with the secondary visit,purple tongue with petechia,pink tongue with toothed markand thin white coating were further increase and became the most common tongue image at the last visit.The largest increase in the tongue and pulse is the purple tongue with petechia,small and wiry pulse,while the small and wiry pulse was the most common pulse,and red tongue or dark red tongue with yellow sticky coating,string sliding pulse,wiry and rolling pulse significantly reduced at the same time.3.Changes of syndromes of patients with extra hepatic bile duct stones before and after operationIn the final 126 patients,the main syndrome types included hepatochlic hygropyrexia,liver depression qi stagnation,spleen deficiency and dampness stagnation,liver depression and spleen deficiency,cold dampness repression.The main syndrome types were similar to the first diagnosis at the time of the second visit.The top 5 were hepatochlic hygropyrexia,spleen deficiency and dampness stagnation,liver depression and spleen deficiency,liver depression qi stagnation,stagnation of blood stasis.The main syndrome types at the last visit were liver depression and spleen deficiency,stagnation of blood stasis,spleen deficiency and dampness stagnation,liver yin deficiency,cold dampness repression.Compared before and after the operation,hepatochlic hygropyrexia,liver depression qi stagnation were significantly reduced while stagnation of blood stasis,liver depression and spleen deficiency and liver yin deficiency obviously increased.The biggest decrease was the hepatochlic hygropyrexia,while the biggest increase was the stagnation of blood stasis.4.Chinese medicine application of patients with extra hepatic bile duct stones after operationThe final 126 patients were treated with oral or external use of traditional Chinese medicine after the operation.The total use of traditional Chinese medicine collected from the first and last prescription after the operation was 104.The total use frequency of traditional Chinese medicine was 2867 times,with an average of 11.4 flavors.The first 30 rows of Chinese traditional Chinese medicine are Bupleurum,licorice,Atractylodes,tuckahoe,Codonopsis,Pinellia ternata,cortex magnolia,orange peel,Fructus aurantii,white peony,rhubarb,Fructus aurantii,Yin Chen,tulips,yerjua,chicken inner gold,Wu Zhuyu,five fingers peaches,angelica,Scutellaria,Amomum,ginger,wheat,malt,jujube,and barley.Coix seed,Herba lysimae,Gardenia jasminoides.If divided according to efficacy,the frequency of use from high to low are supplement of deficiency drugs,drugs for regulating Qi flow,drugs for clearing damp and promoting diuresis,relieving drugs,drugs for invigorating blood circulation and eliminating stasis,drugs for removing dampness,Phlegm and cough medicine,Heat-clearing drugs,digestant drugs,purging medicine,drugs for dispelling internal cold,astringent medicine,drugs for improving sleep,and hemostatics.As far as drug property is concerned,the use of more is cold,warm and peaceful drugs;for the taste of medicine,the use of more is sweet,bitter and pungent drugs;to the meridian tropism,more use is the medicine to the lung meridian,the liver meridian,the spleen meridian and the stomach meridian.By using the systematic cluster analysis Ward method,when the distance between classes is 5,the Chinese medicine can be divided into 3 categories.The first category includes Radix Bupleuri,licorice,Atractylodes,Poria,Radix Codonopsis,Pinellia ternata,cortex magnolia,orange peel,Fructus aurantii trifoliate,Radix Paeoniae Alba and Rhubarb;the second category includes 30 kinds of traditional Chinese medicine,such as Fructus aurantii,Yin Chen,tulip,yerhu,Wu Zhuyu,five fingers peaches,angelica,Scutellaria,kernels,ginger and malt,and the third category including the radix and peach kernel.Rhizoma Alisma,Plantago asiatica,dried ginger,Schisandra chinensis,lotus seed,Herba Hedyotis diffusa,almond,Rhizoma rehmanniae,and sour jujube seed and so on are 63 kinds of Chinese herbs.Conclusion1.Patients with extra hepatic bile duct stones had significant changes in clinical manifestations,tongue images,and pulse patterns before and after surgery,leading to significant differences in preoperative and postoperative major syndrome types.The syndrome differentiation of extra hepatic bile duct stones can be divided into deficient syndrome and sthenia syndrome.Preoperatively,sthenia syndrome was in the majority,damp heat,Qi stagnation,blood stasis and cold resistance are the common case,accompanied with weakness of the spleen and stomach.The main contradictions of deficiency and solid after operation were gradually transformed,the deficiency syndrome gradually increased,spleen Qi deficiency and liver Yin deficiency are the common case,accompanied with damp heat retention,blood stasis and Qi stagnation,colddampness repression.In general,the deficiency of middle-jiao as the core persists,while the wetness,heat,stasis and stagnation as the sign go through the whole course,and wet can be condensed into phlegm,Qi stagnation can produce heat,heat can Heat can be transformed into cold.2.The use of drugs and prescriptions for extra hepatic bile duct stones is often carried out according to the changes of pathogenesis and syndrome type,often supplementing the middle-jiao with the supplement of deficiency drugs,eliminating dampness,heat,blood stasis and Qi stagnation with drugs for removing dampness,drugs for clearing damp and promoting diuresis,Heat-clearing drugs,drugs for invigorating blood circulation and eliminating stasis and drugs for regulating Qi flow,while combined with relieving drugs,Phlegm and cough medicine,digestant drugs,purging medicine,drugs for dispelling internal cold,astringent medicine,drugs for improving sleep,hemostatics for symptomatic treatment;supplementing positive Qi in the middle-jiao with tonifying recipes represented by the decoction of Four Mild Drugs,exorcising the pathogenic factor of semi-exterior-interior with formulas for relieving both superficial and internal disorders represented by Da Chai Hu Tang and conciliatory medicinal preparations represented by Si-Ni-San,regulating Qi activity with prescriptions for regulating Qi flow represented by Chaihu Shugan powder,dispelling dampness and yellowing with desiccating formulas represented by Yinchenhao Decoction,promoting blood circulation for removing blood stasis with blood-regulating recipes represented by Xuefu Zhuyu Decoction,clearing heat-fire with heat-clearing prescriptions represented by Longdan Xiegan Tang,Purging the foul in the viscera with purgative drugs prescriptions represented by Xiao Chengqi Tang,resolving phlegm and relieving cough with expectorants represented by Erchen Decoction.3.The use of traditional Chinese medicine for adjuvant therapy may reduce the levels of transaminases,bilirubin,leukocytes,etc.,and may have a positive effect on improving liver function and reducing inflammatory response,but it still needs to be verified by prospective studies.