Clinical And Experimental Research On The Prevention And Treatment Of Stable COPD With Yiqi Xiaozheng Recipe Based On Jusan Theory

This study includes theoretical discussion,clinical research and experiment research.Theoretical discussionComprehensive collateral disease,mass and assembling and dispersing theory,combining with modern pathology of chronic obstructive pulmonary disease,we think that COPD pathology of the airway and pulmonary vascular remodeling is related with the theory of "assembling",and damage of lung parenchyma is related with "dispersing".We put forward the imbalance of "assembling and parting of pulmonary collateral mass" is pathogenesis essence of COPD,the key link of prophylaxis and treatment of COPD is adjusting the assembling and dispersing of pulmonary collateral mass,so as to achieve the dynamic balance.According to the theory of "dispersing accumulation and assembling dispersion",we propose the use of Tonifying qi and eliminating masses method in the treatment of COPD,at the same time basing on this rule we propose the Yiqi Xiaozheng formula.The clinical studyObjective:To evaluate the therapeutic effect of Yiqi xiaozheng formula on patients with stable COPD,from the main symptoms,TCM syndrome,pulmonary function,blood viscosity,chronic obstructive pulmonary disease assessment test,and to explore its mechanism of action.Methods:46 cases of patients with stable COPD,randomized into Chinese medicine group of 23 cases,and control group of 23 cases.The control group was given routine treatment of Western medicine.The Chinese medicine group was given Yiqi xiaozheng formula on the basis of routine treatment of Western medicine.After 8 weeks of treatment,we compare the change of above indexes.Results:The Chinese medicine group and control group,3 cases were excluded respectively.Two groups with comparable baseline data before treatment.In 40 patients,males accounted for 62.5%;the age distribution of the 48-86 years,over 70 years patients are most,accounting for 55%;occupation distribution with non high risk occupation person be in the majority,accounting for 67.5%;smokers accounted for 80%.After 8 weeks of treatment,the total effective rate of stable COPD is 35%in the Chinese medicine group,25%in the control group,no significantly difference between the two groups.The total effective rate of main symptoms(wheezing,coughing,expectoration)is 80%in the Chinese medicine group,55%in the control group,no significantly difference between the two groups.The main symptoms of single score,wheezing score:after 4 weeks of treatment,there is no difference between two groups;after 8 weeks of treatment,the Chinese medicine group and the control group have significantly difference(P<0.05),and there is significantly different before and after treatment in the Chinese medicine group(P<0.05).Cough score:after 4 weeks of treatment,there is significantly difference between two groups(P<0.05),and there is significantly difference before and after treatment in the Chinese medicine group(P<0.05);after 8 weeks of treatment,there is no difference between two groups,and there is significantly difference before and after treatment in the Chinese medicine group(P<0.05).Sputum score:after 4 weeks of treatment,there is significantly difference between two groups(P<0.05),and there is significantly difference before and after treatment in the Chinese medicine group(P<0.05);after 8 weeks of treatment,there is significantly difference between two groups,and there is significantly difference before and after treatment in the Chinese medicine group(P<0.05).About syndrome of traditional Chinese medicine,efficiency of syndrome of lung qi deficiency,spleen Qi deficiency,blood stasis and phlegm obstructing,there is significantly difference between two groups P<0.05).In pulmonary function,the Chinese medicine group and control group are both increased in FEV1(L)?FEV1(%)?FEV1/FVC,but no significantly difference;In Chinese medicine group,FEF75,FEF50 and MMEF75/25 increased significantly than that in the control group(P<0.05),and the Chinese medicine group MMEF75/25 is significantly increased as compared with before treatment(P<0.05).All blood viscosity index of Chinese medicine group decreased significantly compared with the control group(P<0.05).4 weeks after the treatment,there is no significantly difference in CAT scores between two groups,but there is significantly difference in scores of CAT scores variables between two groups(P<0.05);after 8 weeks of treatment,there is no significantly difference in CAT scores between two groups,but there is significantly difference in scores of CAT scores variables between two groups(P<0.05),and there is significantly difference in CAT scores before and after treatment in Chinese medicine group(P<0.05).Conclusion:In patients with COPD,male,70 years old,smokers are most.Using Yiqi Xiaozheng formula on the basis of routine western medicine,can further improve the symptoms of patients with stable COPD,improve the lung qi deficiency,spleen qi deficiency,blood stasis,phlegm syndrome,and also can improve pulmonary function,blood viscosity and other physiological and biological index,improves the quality of life of patients.The experimental studyObjective:To evaluate the preventive and therapeutic effect of Yiqi xiaozheng formula on COPD model rats,from the general condition,lung tissue morphology,matrix metalloproteinase-9(MMP-9)and matrix metalloproteinase inhibitor-1(TIMP-1)expression,and to explore its mechanism of action.Methods:30 Wistar rats were randomly divided into control group,model group and Yiqi Xiaozheng group,with 10 rats in each group.Except the control group,the rats were exposed to cigarette smoke and airway instillation of lipopolysaccharide(LPS)to established COPD model.From the second day,the model group and Yiqi Xiaozheng group were intragastrically given saline and decoction,respectively.To observe the general condition of rats during the experiment(feeding and drinking condition,hair gloss,activity,weight,oronasal secretions and so on).In 113rd day,all rats were killed,to observe the morphology of lung tissue,analysis the small airway wall thickness by image analysis software,and detecte the expression of MMP-9 and TIMP-1 in airway epithelium by immunohistochemistry.Results:The general condition of Yiqi Xiaozheng rats such as feeding and drinking condition,hair gloss,activity,weight,oronasal secretions,cough,sneeze,shortness of breath,have improved compared with the model group.From the fourth week,rat weight of Yiqi Xiaozheng group were higher than those in the model group,and from eighth weeks weight showed statistically significant difference between the two groups(P<0.05).The lung tissue morphology of Yiqi Xiaozheng group rats such as airway and pulmonary vascular remodeling,have improved compared with model group;quantitative analysis showed that Yiqi Xiaozheng group rats' bronchial wall thickness lower than those in the model group,the difference was statistically significant(P<0.05).The results of immunohistochemistry showed that the protein expression of MMP-9 and TIMP-1 of Yiqi Xiaozheng group decreased compared with the model group,the MMP-9/TIMP-1 ratio increased compared with the model group,and the difference has statistical significance of TIMP-1 protein expression(P<0.05).Conclusion:The Yiqi Xiaozheng formula can improving the general condition,raising the body weight increase,improving the emphysema and airway,pulmonary vascular remodeling,reducing hyperplasia and hypertrophy of small airway of COPD model rats.At the same time it can preventing and treating COPD by reducing protein expression of MMP-9 andTIMP-1 in COPD rat airway epithelial,regulating MMP-9/TIMP-1 balance,of which the effect of decreasing the expression of TIMP-1 and improving airway remodeling is more obvious.