| Purpose:The treatment of liver cirrhosis ascites mainly consists of two kinds of treatment methods:etiological treatment and symptomatic treatment.However,neither of them can live up to anticipation.Both of them can not make satisfying therapeutic effects.With the development of medical science,some new technologies,some new therapeutic drugs and therapeutic measures have emerged,which can improve the treatment effects of ascites.However,they're hard to be accepted widely by most patients due to their high price and certain complications that they may cause.However,Traditional Chinese medicine can make up for these side effects and difficulties brought by western medical treatment.In a large number of practices,traditional Chinese medicine has accumulated a lot of clinical experience in treating cirrhotic ascites.Besides,traditional Chinese medicine can help patients achieve maximum benefits out of curative effects and cost performance ratio.As a result,the status of Chinese medicine in treating ascites is stick out a mile.Combining the tutor's study on liver and spleen related theories,this study is to observe the clinical efficacy of Shen Ling Baizhu San combined with Lan Dou Feng Zhu decoction in treating ascites that is due to liver cirrhosis in Taiwan.Methods:60 cases of ascites with cirrhosis were selected in this study,which was a randomized,double-blinded clinic trial.The treatment method adopted by the control group is the comprehensive treatment of conventional Integrated western medicine.1.regulate diet and arrange reasonable work schedule.The patients with more anterior ascites should receive albumin input during or after discharge.If the amount of ascites discharged within 1 to 3 hours after puncture is 4,000-6000mL,the patients should be injected albumin timely(6-8 g albumin per liter of ascites.?Routine basic treatment:limit the intake of sodium and water:the maximum sodium intake is 88mmol/d,which is suitable for patients with blood sodium content below 120-125 mmol/L.It doesn' t stress the intake of sodium for other patients.Glycyrrhizin,five ester soft capsules(the dominant sector is Schisandra Chinensis)and other drugs are the most basic drugs to liver protection,excluding patients with cirrhosis.?Diuretics:patients who do not get the best effect from the above treatment and who use diuretic to treat ascites more frequently can combined spironolactone with furosemide at the dosage of about 100mg:40mg.The ideal effect will result in weight loss of 0.3?0.5kg.?increased colloid osmotic pressure of plasma:if the plasma albumin content is lower than 25 g/L,patients should be injected daily with albumin or plasma.? The patients with more anterior ascites should receive albumin input during discharge or after discharge.If the amount of ascites discharged within 1 to 3 hours after puncture is 4,000-6000 mL,the patients should be injected albumin timely 6-8 g albumin per liter of ascites.?For patients with refractory ascites,they can be repeatedly punctured to release ascites,and they can also be reinjected the released ascites after being condensed.2.Causal treatment:to treat protopathy,reduce portal pressure,prevent fibrosis,etc.3.Medical treatment:symptomatic treatment such as ebbing bile pigment from skin,reducing transaminase,diuresis,blood transfusion,etc.In the treated group,the traditional Chinese medicine Shen Ling Baizhu San combined with Lan Dou Feng Zhu decoction was added.(? basic square:15 grams of dangshen,15 grams of tuckahoe,10 grams of large-headed atractylodes,15 grams of Fried semen coicis,15 grams of root of red rooted salvia,10 grams of Chinese herbaceous peony,10 grams of amomum villosum,15 grams of dioscorea japonica thunb,15 grams of ballooflower root,10 grams of hyacinth dolichos seed,10 grams of dried old orange peel,10 grams of oriental water plantain,15 grams of umbellate pore fungus,15 grams of shell of areca nut,12 grams of hirsute shiny bugleweed herb,15 grams of black wild granudnut seed,12 grams of beautiful sweetgum fruit,15 grams of common papermulberry fruit.?Methods of exercise addition and subtraction:add membranous milkvetch root to invigorate spleen to patients with fatigue,lazy speech,intake less and watery stool;For patients with pale complexion,cold limbs and pain,the addition of common cruculigo rhizome and bark of eucommia can warming the kidney to invigorate yang.Syndrome differentiation plus and minus square:patients with jaundic need to add 50 grams of capillary wormwood herbvirgate wormwood herb(fry first 15 minutes);patients who are yang deficiency of spleen and kidney need to add 10 grams of cassiabarktree branchlet and 10 grams of cormmon monkshood root;patients whose increasing secretion of urine is not obvious need to add 5 grams of black lobedleaf pharbitis seedroundleaf pharbitis seed and white lobedleaf pharbitis seedroundleaf pharbitis seed;patients with non-traumatic hemorrhage need to add 30 grams of lalang grass rhizome.).The duration of the study was 16 weeks.Examine patients in temperature,heart rate,respiration and blood pressure.The main therapeutic indexes were:to know the amount of ascites by doing the color ultrasound,in order to know TCM syndromes.Secondary outcome measures:abdominal circumference,weight,and liver function.Methods of measuring abdominal circumference:do not eat in the morning and empty the urine and feces,in the supine position,exposing the abdomen,using a soft ruler to measure the abdominal circumference.?Methods of measuring weight:after emptying and defecating in the morning,you should keep wearing the same clothes every day and weigh yourself on a weighing machine in the lab department.?Detecting the indexes of liver function and conducting the score as the standard of "child".Doing all above in order to determine the degree of liver injury in three different degrees of patients.The measurement methods can be obtained from the following tests;every patient should test a total of 5 indicators,each of which had three levels,and the points were expressed as 1.2.3 to score it.The results of 5 indicators were added to obtain the disease degree of the patients,with the lowest score of 5 and the highest score of 15.Liver function was determined according to the sum.And detection of liver fibrosis indexes of serum HA,PC-III,LN values,coagulation index PT,PTA,urine output,peritoneal recurrence rate,and the inspection record once before and after the treatment.All observed data were obtained after being deal with by SPSS 25.0 statistics.The quantitative data were obtained according to the formula of the mean plus or minus standard deviation.The two groups in the experiment were paired and tested for the probability distribution and data distribution between the two groups.The part with irregular distribution needs to carry out independent test,the part with irregular probability distribution needs to use the rank sum test method,the data with ordered classification will also adopt the rank sum test method,and the one with disordered classification shall adopt the chi-square test method.The test criterion is that a=0.05,P<0.05 is statistically significant.The observation of patients' clinical symptoms,such as conducting inductive analysis,recording patient safety indicators and so on,can effectively evaluate the safety of drugs.Results:(1)Efficacy comparison:after 16weeks of medication.In the treated group,there were 12 patient had apparent results,16 had effective results.The total effective rate in treated group was up to 90%.However,there were 9 patients had apparent results,14 had effective results in control group,and its total effective rate is up to 70%,which is lower than that in treated group.P<0.05,showing significant difference;(2)Comparison of curative effect and TCM symptoms:in terms of total effective rate,the treatment group reached 90%;in terms of apparent efficiency,the treatment group reached 43.3%;in the control group,the total effective rate and apparent efficiency were 80%and 33.3%respectively.Differences between the two groups was statistically significant(P<0.05).(3)Comparison of total integral:?According to within-group comparisons in the study:results showed that there was a lower total score after treatment.?According to between-group comparison:results showed that the total score of the treatment group is relatively lower,P<0.05,showing significant difference,and the treated group performs better.(4)Comparison of symptom integral:?according to within-group comparisons in the study:The results showed that there were lower scores for symptoms such as anorexia after treatment,P<0.05,showing a significant difference and better performance after treatment.?According to between-group comparisons:in term of rigorous statistical analysis,the treated group shows relatively lower symptoms integral in abdominal distension,fatigue,edemajaundice,loss of appetite,and the total sum,P<0.05,showed significant difference,the treated group is better.(5)Comparison of liver function indicators:?According to within-group comparisons in the study:The results showed that ALT was lower after treatment,P<0.05,showing significant difference and better performance after treatment.?According to between-group comparisons:ALT level in the treatment group was good,P<0.05,showing significant difference,but there was little difference in ALB improvement level,P>0.05.(6)Liver fibrosis indexes:after treatment,serum HA,PC-?,LN values were obviously improved in both two groups,with statistical significance(P<0.01,P<0.05).According to the comparison between groups,after treatment,the serum HA,PC-?,LN in treated group were obviously improved compared with control group,with statistical significance(P<0.01).(7)Comparison of blood coagulation function in the study group:?According to within-group comparisons in the study:results showed that after treatment,the coagulation function PT significantly decreased and PTA significantly increased(P<0.01,P<0.05),showing a significant difference.?According to between-group comparisons:the results showed that the coagulation function of the treated group was better improved after treatment,and the changes of PT and PTA were statistically significant(P<0.05),showing significant differences compared with the control group.(8)The comparison between abdominal girth and the urine volume at 24h was conducted in the study group.?According to within-group comparisons in the study:it shows a better effect.P<0.05 showing a significant difference.?According to between-group comparisons:P<0.05 showed significant difference,which means that the treated group has a better effect in peritoneal circumference and urine volume for 24 hours.(9)Comparison of recurrence rate of ascites:within 2 months after the end of treatment,there were 3 cases in the treated group and 8 cases in the control group.Although both groups the treated group had a lower recurrence rate,P<0.05,showing a significant difference.According to the above statistical analysis results and according to the analysis of clinical results,the treatment mechanism of compound Lan Dou Feng Zhu decoction soup were as follows:?Improve the inflammation,and lower the Enzyme index in the liver.According to clinical studies which showed that by adding compound Lan Dou Feng decoction soup,the serum ALT was decreased and the propagated and the ratio of A/G were improved.It can be speculated that the prescription can inhibit the liver inflammatory cells infiltration and inhibit the damage to the liver cells,leading to reduce inflammatory mediator release which is conducive to good circulation.It has reached the anticipated function of protecting liver.?The drug prevents the liver virus from replicating.Modern medical research shows that the immune system dysfunction of patients with chronic hepatitis can not stop the replication of liver viruses,resulting in persistent infection of liver.Once the damage of liver cells can not be repaired,the disease will continue to deteriorate,and eventually form cirrhosis of liver.So for the treatment of liver cirrhosis,it not only need to attach importance to the treatment of primary diseases,but also need to pay attention to prevent the production of liver fibrosis.This prescription can effectively suppress part of hepatitis b virus infection and enhance immune function which can release the symptom.?Resistant to fibrosis.According to the experimental results which show that:compound Lan Dou Feng decoction soup has a significant effect in reducing serum HA,PC-?,LN content.Therefore,this prescription can inhibit and improve the formation of liver fibrosis from the following aspects:? improve the erosion of liver inflammatory cells,protect the liver,and inhibit the development of false hepatic lobules of liver.? It inhibits the secretion of hepatic stellate cells(HSC)and prevents further progression of liver fibrosis.?inhibit the formation of fibrous tissue and degrades the fibrous tissue which had been formed.Although a large number of clinical practice analyses have been conducted in the treatment of ascites with cirrhosis by compound Lan Dou Feng Zhu decoction soup with Ginseng and Poriae Bolus and largehead atractylodes rhizome,there are still a lot of shortcomings in this study.? The size of sample is too small,which leads to lacking a large number of clinical case studies.The problem of clinical promotion needs to be further solved.?The research on the treatment of hepatic ascites by hcompound Lan Dou Feng Zhu decoction soup with Ginseng and Poriae Bolus and largehead atractylodes rhizome is only a clinical observation,but not a deeper exploration of it,especially on the gene level of the treatment mechanism,without a deeper understanding.The design of the experiment itself needs to be improved in the future.For example,conduct the randomized double-blind control study.Besides,the follow-up time is too short,it need to be further strengthened,etc.What's more,it can also be observed from the portal vein inner diameter,dbv-dna,liver fibrosis and other indicators,making the experiment more convincing.In the future research,we should improve the experimental design and summarize more experimental indicators to improve the treatment plan and make our own contribution to clinical practice research.Conclusion:The results showed that the the therapy of western medicine combined with compound Lan Dou Feng Zhu decoction soup with Ginseng and Poriae Bolus and largehead atractylodes rhizome had better effect than adopting western medicine alone in treating cirrhotic ascites.The advantages of the combination are higher safety and fewer side effects.It has a good effect on improving the symptoms of cirrhosis ascites,which can effectively improve the overall health level of patients and improve their quality of life.Ginseng and Poriae Bolus and largehead atractylodes rhizome can invigorate spleen and increase secretion of urine,Lan Dou Feng Zhu decoction soup can increase secretion of urine and nourishing Yin.The combination of these two drugs can effectively improve the symptoms of ascites due to cirrhosis,and there is no toxic side effect in the experiment,the effect is remarkable in Improving the health of patients with cirrhosis,and improve their quality of life.According to the above advantages,it is worth to be popularized in clinical practice.On the basis of summarizing the academic thoughts of the supervisor in the treatment of liver cirrhosis,this study further proposed that solid spleen is the most important pathogenesis to liver cirrhosis ascites.Strengthening spleen,replenishing qi,nourishing Yin and increasing secretion of urine are the basic treatment methods for the treatment of liver cirrhosis ascites.This conclusion is the development and innovation of academic thoughts and experience in treating cirrhosis.In this study,the clinical efficacy and adverse reactions of compound Lan Dou Feng Zhu decoction soup with Ginseng and Poriae Bolus and largehead atractylodes rhizome in the treatment of ascites and side effects in order to verify the safety of the academic thoughts,and the thoughts of the tutor.On the basis of routine ascites due to cirrhosis of liver,the clinical symptoms and symptoms of this patient can be improved by increasing the prescription of Shen Ling Baizhu San combined with Lan Dou Feng Zhu decoction. |
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