| ObjectivesTo observe the clinical effect of medicinal vesiculation therapy and its regularity. The concentration of IL-4, the IFN-gamma in peripheral blood were tested before and after treatment,to explore the immunological mechanism of medicinal vesiculation act on allergic rhinitis.Methods120patients with allergic rhinitis were adopted in the otorhinolaryngology department,then according to their will divided into three groups. Each group have40patients. The first group named the group of sanfujiu and sanjiujiu, patients in this group were treated during sanfudays (from July and August)and sanjiudays(from December and January in the following year), five times in each period, a total of ten times. The second group named the group of ordinary medicinal vesiculation, patients in this group were treated during nonsanfudays (from April to May), and nonsanjiudays (from September to October), five times in each period, a total of ten times. The third group named the group of medicinal vesiculation in four seasons, patients in this group receive medicinal vesiculation therapy as much as the total of the frist group and the second group, twenty times in total. Because the case fall off become more in the late period,25patients were added (16cases in the first group,9cases in the second group),144patients were included in total,123cases were observed in this study. Another39healthy controls were recruited to test serum cytokine.Three groups choose the same herbal paste and acupoints. The herbal paste was composed of Bai Jie Zi (Semen Sinapis Albae),Xi Xin (Herba Asari), Gan Sui (Radix Kansui), Yan Hu Suo (Rhizoma Cordalis), the proportion according to recipe of Tianjiu Powder of Guangdong Hospital of Chinese Medicine; the four kinds of herbs were ground into powder, and fresh ginger(Zingiber officinale) was blended into juice, then the powder and juice were mixed and made into paste. There are there groups Acupoints:①Feishu, Weishu, Zhishi, three acupoints are on back;②Pishu(on back), Fengmen(on back), Qihai, Guanyuan;③Shenshu(on back), Dingchuan, Zhongwan, Xiawan, points on back are choosed both sides, there are six acupoints in each group. The treatment at first time choose the acupoints of first group, the second time choose the acupoints of the second group, three groups acupoints used interchangeably in each treatment period. Each time the herbal paste will be sticked on the special aucpoints by the therapist, and it will be took off when patients feel unbearable. There is one treatment in every nine days during the sanjiudays, and every ten days during other treatment period. The evaluation of clinic effect and test of concentration of IL-4and IFN-gamma for the group of sanfujiu and sanjiujiu and the group of ordinary medicinal vesiculation before treatment and one week after finish every5times treatment. The clinic effect of the group of medicinal vesiculation in four seasons was evaluated before and after every10times treatment, and the concentration of IL-4and IFN-gamma were tested before and after finish all treatment. There were follow-up for three groups after all treatment, clinic effect will be evaluated at6months and1year after all treatment. Healthy controls were taken blood test one time and the results as a standard baseline. Clinic effect evaluation choose the symptom assessment scale, physical sign, visual analogue scale (VAS) and the rhinoconjunctivitis quality of life questionnaire (RQLQ)as indicators.Adopting the method of ELISA test the concentration of cytokines IL-4and IFN-gamma.Data is collected by Epidata3.1software, and the database established by double person entry data each. Compared before and after treatment in the group with Nonparametric paired signed rank test. The comparison of different time between groups using repeated measurement and univariate statistical analysis in general linear model in the PASW statistics18.0package. The analysis of covariance was used if the baseline is unequal. The correlation analysis of Clinical effect evaluation indicators (symptoms, physical signs, VAS and RQLQ) and the experimental index (IL-4, IFN-gamma) use multivariate correlation analysis. Result1. the effect of medicinal vesiculation therapy(1) The comparison of total score of symptoms and VAS of the group of sanfujiu and sanjiujiu before and after treatment in the first period, before and after total treatment are statistically significantly (P<0.01), and the comparison of VAS before and after treatment in the second period is statistically significant (P<0.05). The comparison of the score of physical signs of the group of sanfujiu and sanjiujiu before and after treatment in the first and second period, before and after total treatment are statistically significantly (P<0.01). The comparison of total score of RQLQ of the group of sanfujiu and sanjiujiu before and after treatment in the first and second period, before and after total treatment are statistically significant (P<0.05).(2) The comparison of total score of symptoms of the group of ordinary medicinal vesiculation before and after treatment in the second period is statistically significant(P<0.05). The comparison of the score of physical signs of the group of ordinary medicinal vesiculation before and after treatment in the first period, before and after total treatment, there are significant statistical significance (P<0.01). There are no statistical significance for comparison of VAS and total score of RQLQ before and after treatment in the first and second period, before and after total treatment (P>0.05).(3) The comparison of total score of symptoms of the group of medicinal vesiculation in four seasons before and after treatment in the second period is statistical significant (P<0.05). The comparison of the score of physical signs and VAS of the group of medicinal vesiculation in four seasons before and after treatment in the first period is statistical significant (P<0.05), and there are significant statistical significance in the second period (P<0.01). The comparison of total score of RQLQ of the group of medicinal vesiculation in four seasons before and after treatment in the first and second period are statistically significantly (P<0.01).2. Analysis of the persistent effect of medicinal vesiculation(1) In the group of sanfujiu and sanjiujiu, compared before treatment in the second period (stop treatment for four months) with before total treatment, there are statistical significance on total score of symptoms and physical signs (P<0.05), and there are no statistical significance on VAS and total score of RQLQ (P>0.05). Compared six months and one year after total treatment with before total treatment, there are significant statistical significance on total score of symptoms and VAS(P<0.01); there are statistical significance on physical score and total score of RQLQ at six months after treatment (P<0.05), and significant statistical significance at1year after treatment (P<0.01).(2) In the group of ordinary medicinal vesiculation, compared before treatment in the second period (stop treatment for four months) with before total treatment, there is statistical significance on physical signs (P<0.05), and there are no statistical significance on VAS and total score of RQLQ (P<0.05). Compared treatment before the second period (stop treatment for four months) with after treatment in the first period, there is significant statistical significance on symptom scores (P<0.01). Compared six months and one year after total treatment with before total treatment, there is statistical significance on total score of symptoms (P<0.05), significant statistical significance on physical sign (P<0.01), and there is on statistical significance on RQLQ total score(P<0.05). Compared six months after total treatment with before total treatment, there is statistical significance on VAS(P<0.05)(3) In the group of medicinal vesiculation in four seasons, compared before treatment in the second period (stop treatment for four months) with before total treatment, there are statistical significance on total score of symptoms, physical signs and VAS (P<0.05) and there is no statistical significance on RQLQ total score (P>0.05). Compared before treatment in the second period (stop treatment for four months) with after the first period treatment, there is significant statistical significance on total score of symptoms (P<0.01), and there are statistical significance on physical signs and total score of RQLQ (P<0.05). Compared one year after total treatment with before total treatment, there is statistical significance on total score of symptoms (P<0.05), Compared six months and one year after total treatment with before total treatment, there is significant statistical significance on physical sign (P<0.01). Compared six months after total treatment with before total treatment, there are statistical significance on VAS and total score of RQLQ (P<0.05), and there are significant statistical significance compared one year after total treatment with before total treatment (P<0.01).3. the time-effect analysis of medicinal vesiculation therapyBetween the group of sanfujiu and sanjiujiu and the group of ordinary medicinal vesiculation, except the comparison of total score of symptoms after treatment in the second period and physical sign at one year after total treamtment are statistical significance(P<0.05), the comparison of the total score of symptoms, physical sign, VAS and RQLQ total score of each time is not significant(P<0.05).4. the quantity-effect analysis of medicinal vesiculation therapy(1) Between the group of sanfujiu and sanjiujiu and the group of medicinal vesiculation in four seasons, there are statistical significance on the comparison of total score of symptoms before and after treatment in the second period(P<0.05),there are statistical significance on the comparison of physical sign after treatment in the first period, before and after treatment in the second period and one year after total treatment(P<0.05), and there are significant statistical significance on the comparison of physical sign at six month after total treatment (P<0.01). the comparison of VAS before the second period treatment is statistically significant(P<0.05).(2) Between the group of ordinary medicinal vesiculation and the group of medicinal vesiculation in four seasons, there are statistical significance on the comparison of total score of symptoms, VAS and RQLQ total score before treatment in the second period(P<0.05), there are statistical significance on the comparison of physical sign after treatment in the first period, before treatment in the second period a (P<0.05), and there are significant statistical significance on the comparison of physical sign at six month after total treatment (P<0.01).5. the cytokines of AR(1) interlukin-4There are statistical significance on the comparison of IL-4between three groups of allergic rhinitis patients before treatment and healthy control group (P<0.05).There are significant statistical significance on the comparison of IL-4of the group of sanfujiu and sanjiujiu before and after total treatment, and IL-4of the group of ordinary medicinal vesiculation before and after treatment in the first period and total treatment (P<0.01).Between the group of sanfujiu and sanjiujiu and the group of ordinary medicinal vesiculation, there is significant statistical significance on the comparison of IL-4before and after treatment in the first period, and there is statistical significance before and after treatment in the second period(P <0.05). Between the group of sanfujiu and sanjiujiu and the group of medicinal vesiculation in four seasons, and between the group of ordinary medicinal vesiculation and the group of medicinal vesiculation in four seasons, there are significant statistical significance on the comparison of IL-4after treatment in the second period (P<0.01).(2) INF-γThere are significant statistical significance on the comparison of INF-gamma between patients in the group of sanfujiu and sanjiujiu and the group of ordinary medicinal vesiculation before treatment and healthy control group (P<0.01), but there isn’t statistical significance on the comparison of INF-gamma between patients in the group of medicinal vesiculation in four seasons before treatment and healthy control group(P>0.05).There are significant statistical significance on the comparison of INF-gamma of the group of sanfujiu and sanjiujiu before and after total treatment, but there isn’t statistical significance on the other comparison of INF-gamma between different group and different time.Between the group of sanfujiu and sanjiujiu and the group of ordinary medicinal vesiculation, and between the group of ordinary medicinal vesiculation and the group of medicinal vesiculation in four seasons, there is statistical significance on the comparison of INF-gamma before and after treatment in the second period.6. The correlation analysisBefore and after treatment in the first and second period total score of symptoms is negatively related with VAS score (P<0.001), and positively related with the total score of RQLQ (P<0.001). Before treatment in the first period IL-4was positively related with INF-gamma (P<0.001)After treatment in the first period total score of symptoms is negatively related with INF-gamma (P<0.01).physical sign and the total score of RQLQ are negatively related with INF-gamma (P<0.05).Before treatment in the second period total score of symptoms is negatively related with INF-gamma (P<0.05).After treatment in the second period physical sign positively related with IL-4(P<0.05).Conclusion1. The medicinal vesiculation therapy is effective for AR. It mainly reflected in two aspects:①The medicinal vesiculation therapy can control the nasal symptoms of AR and improve physical signs.②The medicinal vesiculation therapy can improve the quality of life of AR patients.2. The effect of medicinal vesiculation therapy for AR is sustainable, the more times treated, the longer duration it sustain.3. There isn’t time-effect relationship for the short-term effect of medicinal vesiculation therapy, medicinal vesiculation therapy can be treated-throughout the year;but there maybe time-effect relationship for the long-term effect of medicinal vesiculation therapy.4. The quality-effect relationship for medicinal vesiculation therapy needs further research.5. The immunological mechanism of medicinal vesiculation therapy maybe improve INF-gamma in the human body, and there may be other complicated immunological mechanisms.6. The severity of symptoms of AR is negatively related to the quality of life in patients; symptoms, physical signs and the total score of RQLQ are negatively related with INF-gamma; physical signs is positively related with IL-4. |
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