Professor Qian Ying's Summary Of Academic Thoughts And Clinical Study Of Treating Hepatic Myelopahty

IntroductionHepatic myelopathy?HM?is characterized by progressive weakness and spasticity of the lower extremities,which is a severe spinal cord involvement rarely occurring in patients with cirrhosis or other chronic liver diseases.HM has a huge negative effect on the daily life quality of the patients and their families,although it does not directly lead to death.HM has progressive and irreversible nature and no therapy for this disease has been established even if there are some reports showed the effective results with early liver transplantation.Limited by the short of donated organ,and the huge cost of the transplantation,liver transplatation is not the available therapy for most the patients.Tranditional Chinese Medicine?TCM?has been reported as a promising therapy in recent years especially with the experiences from Professor Qian Ying,who is a very famous and a leading scholar with TCM treating chronic liver diseases for many years.He has established a specific theory system for treating HM.In this study,we will summarize Prof.Qian's theory and experices in HM therapy by performing theoretical and clinic research.Part I.Theoretical Research of Prof.Qian Ying disgnosing and treating HM cases with TCMObjective To summarize the TCM theory of Professor Qian Ying for diagnosing and treating HM based on his understanding of classic literature of TCM and his rich experience in treating liver diseases in clinical practices.Methods Review all the classic TCM literatures describing the similar symptoms as HM,such as meteorism,paralysis,spasm syndrome,arthromyodynia and stoke to track the sources of Qian's understanding of HM.Then make clear Professor Qian's whole TCM theory about the diagnosis,the pathophysiology and the treatment.Take examples to illustrate the theory.Results Inspired by the classic literatures and another TCM expert who is Mr.Qin Bo Wei,specializing in tabes dorsalis,he characterized HM as the category of disease "Fengfei,that is,hemiplegia" and took the core pathogenesis of HM as deficiency of both liver-kidney and yin-yang,which leads to nutritional deficiency of governor vessel.Based on this thinking,Professor Qian Ying treats the HM patients with the TCM decoction of "Dihuang Yinzi" to strengthen the governor vessel.Conclusion The TCM theory from Qian Ying for diagnosing and treating HM originated from the classic TCM theory and other experts' experiences.Together with his own clinical practice for treating HM,he has presented his own theory on the HM,which shows Dihuang Yinzi played a positive role in treating HM.Part II.Retrospective Research about Prof.Qian Ying treating HM with TCMObjective To summarize the efficacy of therapy on HM according to the theory of Professor Qian Ying for diagnosing and treatiing HM by retrospective research.Methods Retrospectively analyzing the HM patients hospitalized in You'an Hospital,Capital Medical University from Jan.1^st,2001 to Dec.31^st,2011.Data were collected such as the demographic data,causes of diseases,history of illness,clinical findings,laboratory findings,imaging data,complication,treatments and prognosis.For those patients who received TCM treatment,the differentiation syndrome and the therapy were recorded.Results Forty-four patients were recruited,including 29 cases with TCM records with syndrome differentiation results and 27 cases with TCM treatment.Among these patients,42 were male and 2 were female.The average age was 49 years old.The most common cause of the disease was chronic HBV infection.There were 39 patients with cirrhosis,5 patients with liver cancer,About the liver function evaluation based on the Child-Pugh classification,Child-Pugh class A 3 cases?6.82%?,class B 14 cases?31.82%?,class C 27 cases?61.36%?,which shows 41 patients with liver function decompensation.All the patients suffered from the spasticity and weakness in the lower extremities in different extent at the begining,but later generally progressed.The median progression time from HM class 1 to class 4 was 6 months.The.muscle strength among the 44 patients distributed from class 0 to class 5,class 0,5 cases?11.36%?,class 1,6 cases?13.63%?,class 3,2 cases?4.55%?,class 3,9 cases?20.45%?,class 4,17 cases?38.65%?,class 5,5 cases?11.36%?.As for HM classificateion,HM class 1,6 cases?13.64%?,HM class 2,18 cases?40.91%?,HM class 3,9 cases?20.45%?,HM class 4,11 cases?24,99%?.About the physical signs,8 cases?18.18%?were with asterixis,24 cases?54.54%?with ankle-clonus,32 cases?72,72%?with muscular tension hyperfunction,9 cases?20.45%?with positive Babinski's sign.Both the upper extremities were normal and no muscular atrophy was present.Among them,6?20.69%?patients were diagnosed as excess syndrome,19?65.52%?were deficiency syndrome,4?13.79%?were syndrome of intermingled deficiency and excess.Ten patients died during the research period.Three patients underwent liver transplantation?2 of them got improved?.Ten patients received TCM treatment for more than 1 year and 7 of them got improved.Conclusion The clinical manefistations of HM include generally progessed bilateral lower extremities.spasticity and weakness,which are often accompnied by asterixis,ankle-clonus,muscular tension hyperfunction.The deficiency syndrome is common in HM patients and the disease usually locates on liver,kidney and spleen.The long-term treatment with Di huang yinzi is a promising therapy.Part III.Prospective Research about Prof.Qian Ying treating HM with TCM "Dihuang Yinzi"Objective To analyze the effectiveness of TCM Dihuang Yinzi for HM by prospective research.Methods Prospectively and openly recruited the HM patients who met the criteria of inclusion and exclusion and treated in You'an hospital,Capital Medical University from Jun.2012 to Dec.2015.According to if the patients received the TCM therapy,the patients were divided into combined TCM and western medicine group?TCM group?and western medicine group.The patients in TCM group were characterized as syndrome of yin deficiency of liver and kidney and were given Dihuang Yinzi each day.All the patients were followed up every month.The activites of daily living?ADL?were scored and the HM classification and the self-report of the motor ability of lower extremes were recorded.Results There were 97 patients were recruited in this study,39 patients in TCM group and 58 patients in western medicine group.There were no differences between the two groups in the baseline parameters.Among the 97 cases,47 cases were with spastic paraparesis?48.45%?,79 cases with weakness and scissors gait?81.44%?,50 cases with impaired muscular strenghth?51.55%?,52 cases with muscular hypertonia?53.6%?,50 cases with hyperreflexia?51.54%?,57 cases with Pathological reflex?58.76%?.Comparing the systemic score before and after the treatment,results showed that TCM goup had the total efficacy of 69.23%and 58.79%in 12w and 24w,respectively,at the same time,the control group had the total efficacy of 36.20%and 36.11%in 12w and 24w,respectively?p<0.05?.One year later,12 patients died and the one-year mortality rate was 12.37%.Four patients underwent the surgery of liver transplantation.The total ADL score and the muscle strength of other 81 patients were decreased among all the patients.However,there was difference between the two groups in the extent of decrease.For patients with HM 1,the decrease of ADL was 5.27 vs 12.83 in TCM group and western medicine group,respectively.As for HM 2,HM3,HM4,the decreases in the different groups were 2.22 vs 13.7,13.34 vs 8,3.64 vs 0,respectively.For the patients in HM 1 and 2,which was early stage of the disease,the score of ADL decreased slower in TCM group than in western medicine group.The self-reported evaluation from the patients also showed that the TCM group patients had more frequency to report improved or stable.We analyzed the TCM used during the treatment and found that the core recipe was coordinated to the Dihuang Yinzi and the common combination is Baishao-Danggui and Chishao-Niuxi.Conclusion The Dihuang Yinzi on the basis of western medicine therapy can help slower the progression of HM and relieve the symptoms of the patients in HM early stage.