| Zheng,"syndrome" or "pattern" is a highlight summarization of disease acknowledgement and diagnosis by traditional Chinese medicine(TCM),and is a unique concept in TCM.The study of medicinal dose-effect relationship in a formula cannot avoid talking about syndrome.Research on syndrome-dose-effect relation is the key on studying medicinal dose-effect relationship.Syndrome directly influences on and is crucial to effect.The paper tries to clarify the characteristics and principle of syndrome-dose-effect relationship by researching on classic formula Má X́ng Shí G?n T?ng(Ephedra,Apricot Kernel,Gypsum and Licorice Decoction,abbreviation as MXSGT)syndrome in order to guide the clinical practice better.Frist of all,the paper tidied the medical cases of MXSGT practiced by ancient TCM doctors over the ages,and there were 135 medical cases met the inclusion criteria.After that,symptoms from each case were analyzed in emphasis.The correlation among main symptoms was studied and the principle of original formula of MXSGT used by doctors was summarized.Besides,by mathematical statistics(analytic hierarchy process)and expert inquiry,the four main syndromes appropriate for MXSGT included external cold and internal heat syndrome,wind heat invading the lung syndrome,exuberance of lung heat syndrome,and phlegm heat obstructing the lung syndrome,and the subordination of main syndromes was assessed.After that,the quantitative results before and after treatments were obtained in each medical case aiming at analyzing the syndrome-dose-effect relationship for each pattern.It was showed that MXSGT was often used to treat diseases like fever and asthma by external contraction,mainly by new contraction.With regards to external pathogens,cold pathogen was predominant,and wind heat pathogen and seasonal pathogen were secondary.After invasion of the body by wind-cold pathogen,the main developmental tendency was that external pathogen entered the internal and transformed into heat.Time for cold pathogen residing in body surface was usually within one week.Fever(86%)and panting(76%)were the two main symptoms in MXSGT syndrome.When talking about the degrees of fever,from lower fever,moderate,to high fever,all of which was occurred in MXSGT syndrome without focusing on absence of high fever in the original clause recorded in Treatise on Cold Damage.Except that,there was no marked relationship between degree of fever and absence/presence of sweating and degree of sweating in MXSGT syndrome.The possibility of cough and panting together with phlegm was 50%.With regards to treatment principle,clearing method was predominant,and usually combination of clearing and diffusing,which could be summarized as clearing,diffusing,and opening.The characteristics of herbs in the original formula of MXSGT were the maximal doses of na huang(Herba Ephedrae),sheng shi gao(Gypsum Fibrosum),gan cao(Radix et Rhizoma Glycyrrhizae),and xing ren(Semen Armeniacae Amarum)were 10,5,4,and 1.7 times than those in the minimal values.The dose of sheng shi gao was usually 4 times than that by ma huang.The dose of ma huang was slightly higher than that of gan cao.In the modifications of MXSGT with herbs no more than 4,herbs in frequency from high to low were huang qin(Radix Scutellariae),sang bai pi(Cortex Mori),bei mu(Bulbus Fritillaria),ting li zi(Semen Lepidii),jie geng(Radix Platycodonis),su zi(Fructus Perillae),lu gen(Rhizoma Phragmitis),and yin hua(Flos Lonicerae Japonicae).In aspects of medication,3 gram,5 to 6 gram,and 9 to 10 grams were mainly used in ma huang.For xing ren,dose of 6 gram,9 gram,and 10 gram were frequently prescribed.The dose of sheng shi gao was mostly in 30 gram.The most frequently dose of gan cao was 3 gram,and then 6 gram and 10 gram.With regards to dose prescription based on geography,dose of ma huang used by doctors in the south was lower than that by the northern doctors.For the southern doctors,three dose intervals were 9 to 10 gram,5 to 6 gram,and 3 gram,which were used in moderate.However,in the north,usage of ma huang was drastic manifested by 9 to 10 gram and 6 gram.The doses of sheng shi gao and xing ren were not displayed great differences between the south and the north.The dose of gan cao in the south was lower than that in the north,which was in accordance with the characteristics of ma huang's dose.When talking about dose based on each individual,there was a marked difference in the dosages of original MXSGT in adults and infants.The dose of na huang prescribed in adults was two times of that in infants.The dose of sheng shi gao used in adults was also more than that in infants.Gan cao prescribed in adults was almost two times of that in infants.According to dose varied from symptoms,fever as a principal symptom in MXSGT,the characteristics of sheng shi gao was that its dose was greatly increased with rise of fever if the body temperature was over 39 ?.It was displayed a statistical difference compared with that in non-high fever conditions.The relationship between herbal doses and panting was complicated.As for infants,with the severity of panting,the dose of na huang was slight increased,while dose in xing ren was reduced,which were both not displayed statistical differences.Dose prescription based on varied syndrome for the original formula of MXSGT,the ration of sheng shi gao and ma huang was minimal in external cold and internal heat syndrome as 2.88:1,and maximal in wind-heat invading the lung syndrome as 5.7:1.The ratios in other syndromes were slightly lower than that in wind-heat invading the lung type.In the aspect of syndrome-dose-effect,the more severe the disease conditions was(the higher the score of medical case),the better the effect was in only one pack.Usually after administration of one pack,the disease condition was alleviated by 1/3.If disease condition belonging to MXSGT syndrome was aggravated,no matter the doses in original formula or in modified formula,it was greatly increased.Among four ingredients in MXSGT,the doses of ma huang and xing ren were not directly related with the severity of syndrome,but a remarkable association was displayed in sheng shi gao.With the severity of disease conditions,the dose of sheng shi gao was increased,which was displayed a statistical difference.In addition,the dose of gan cao was slightly increased based on the syndrome severity,which was displayed a statistical difference in gan cao's doses between mild condition and severe condition.It was deduced that sheng shi gao played a vital role in the treatment of MXSGT syndrome.Finally,the paper made some supplement of the original clause of MXSGT in Treatise on Cold Damage as follows:Shanghan for two to three or four to five days,(there were)fever,panting,gasping,or sputum expectoration(53%),or thirst(38.5%),or sweating(28.9%),or cough(21%),rapid pulse,and tongue coating,Má X́ng Shí G?n T?ng governs.The originality in the study is the systematic research on the relationship of syndrome-dose-effect from the point of medical cases.To be specific,set the syndrome as the core,and deeply analyze the aspects of etiology,evolution,symptoms,syndromes,and herbal doses in order to give expression to the characteristics and principles of TCM research and to obtain some conclusions on instruction value in clinic. |
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