Initial Study Of Five Zang-organ-related Theory Of Tranquilization Period Of Chronic Obstruct Pulmonary Disease

Speciality: Internal Medicine of integrated TCM-WMAuthor: Tan Xin-yuanTutor: Professor Lin LinBackgroundchronic obstructive pulmonary disease (COPD) is the common disease of old people. With the extended life expectancy and the population trends are significant, COPD has gradually become the more and more important public health issue which afflicts many doctors and patients because of its characteristics of high morbidity, relapse rate, mortality rate, and its treatment difficulty, heavy socio-economic burden, e.t.c. So far, there have been no explicit pathogenesis and effective and specifically treatment of Western medicine for the disease. Particularly, in the tranquilization period of COPD, there is little effective issue of Western medicine. Perhaps more resistance, side reaction and toxic reaction if you use. So that is not a type of long-term treatment. The treatment of traditional Chinese medicine(TCM) is more and more important significance and clinical value as it can make a good recovery, improve the quality of life, strengthen body constitution, forbide the progression of disease lessen the times of acute exacerbation. The five zang-organ-related theory introduced by cerebrated traditional Chinese medical scientist Deng Tie-Tao can explain the philosophical phenomenon of the relationship of Zang and Fu. And be confirmed sure curative effect in clinic. So far, nobody has used this theory to analyze the theoretical system of traditional Chinese medicine the tranquilization period of COPD, and even to make a clinical examination. Therefore investigating the etiopathogenesis,pathogenesis,tendency of disease,the rule of relationship of Zang and Fu,therapeutical principle and method,precaution and health protection in traditional Chinese medicine by the five zang-organ-related theory to set up unified standard and objective theory of TCM below the system of this new theory. It is important to have a study of the relationships between Five Zang in the special disease, as COPD is an enter-point. And it should be proved the evidence of the theory guiding the treatment of COPD.ObjectiveUsing clinical epidemiological methods to have a clinical examination of patients of tranquilization period of COPD and aggregately analyze the crowd's character, the composition of four diagnostic information from the TCM methods, the relationships and transferable rule between the five Zang of pathological condition of COPD, for initial study of relationships between the five Zang of tranquilization period of TCM, and providing clinical evidence of applicating the five-organ-related theory to sub-type quantification diagnosis of tranquilization period of COPD.Method1. Clinical observations collected according to primary collated and summary ancient and present literature and rudiment questionnaire from clinic, we carried out the clinical observations. Then set up the information data of the clinical syndrome. We could analyze the relationships and transferable rule between the five Zang by multiple methods of statistics.2. Statistics methods Data analysis performed in the statistical analysis software package for SPSS13.0. The samples and valuable cluster analysis method was adopted to analyze TCM syndromes sub-type of this disease and the relationship between the Zang-Fu. The descriptive and fluctuated statistical method was adopted to analyze the crow's character,the composition of four diagnostic information from the TCM methods, the relationships and transferable rule between the five Zang of pathological condition of COPD.Results1. Crowd's character COPD is likely to take place in midlife and agedness men(mean 71.70±9.188 years male: female 3.35:1)with middle or low educational background(middle or primary), manual workers(workers)or office workers. Smoking, occupational exposure to dust/contacting chemical material are the common risk factors. Most of the examinates were insufficient to receive medical treatment in the initial stage and to have the consciousness of rehabilitation exercise of lung2. Course of disease and symptoms distribution of TCM Main of the patients of COPD which receive medical treatment have long term course(mean 14.79±10.949 years), most of the examinate was in 3 levels of the degree of severity(42.2%). And they were in balance of YIN and Yang who were health in the past history. The symptoms overall distribution shows that the numbers of cough, expectoration, asthma, cyanosis are the most of all, and all the compositions above 75%. So the four symptoms constitute the main symptoms of the disease. The spleen symptoms which contained sallow complexion, weakness, lassitude, reduced appetite was also have a high percentage of the simultaneous phenomenon. The distribution characteristics of the main symptoms show that in this disease cough appeared as mild to moderate extent. The cough character was spit cough. And spit appeared white and stiff, or liquid sometimes. Asthma appeared as mild to moderate extent, low voice, induced by movement and happened in daytime mostly.3. The distribution of TCM syndromes sub-types According to the cluster analysis and the discrimination from experts, the 135 cases was divided into 4 types in TOM categorical identification. They are deficiency of the lung and spleen qi retention of phlegmopyrexia and blood stasis in the lung, deficiency of the lung spleen and kidney qi retention of phlegm and blood stasis in the lung, deficiency of the lung and spleen qi liverYin retention of phlegmopyrexia and blood stasis in the lung, deficiency of the lung and spleen qi lung Yin retention of phlegmopyrexia and blood stasis in the lung.4. The disposition of the relationship between FiveZang Most of the patients were deficiency of origin and stheniamixed. The patients who were in leverⅡ,Ⅲ,Ⅳof the degree of severity appeared that Zang-Fu allocation was along with the aggravation of the disease when the compositions fluctuate of "lung and spleen comorbidity" was more and more higher, besides the number of the patients inⅠlever was few(only 2). The names of the distribution of TCM syndromes sub-types of the tranquilization period of COPD and the symptoms which were allocated by TOM sub-type quantification diagnosis both had compact relationships between the lung, the spleen and the kidney, especially between the spleen and the kidney which not only emerged in the every name of the distribution of TCM syndromes sub types, but also had high compositions percentage of allocation of the symptoms. The lung and the spleen were in relationship all along when in the 2 to 3 categories we used the symptom variable cluster analysis.Conclusion1. The clinical research shows that the characteristics and the epidemiology of patient with COPD who were investigated in our research are on the whole consistent with the current epidemiological research results both here and abroad which shows that the samples of this study have a certain representation based on finding this research presentation strictly according to the study purpose.2. The main display of symptoms distribution of TCM is the sthenia symptoms of the lung "cough spit asthma", asthenia symptoms "low voice, white and liquid spit, chilly, symptoms of the spleen "sallow complexion, weakness, lassitude", and symptoms of the kidney "frequent nocturia, bombus and deafness, sore waist and lumbago". So the conclusion shows that the symptom character oftranquilizationperiod of COPD is "asthenia main, asthenia and sthenia mixed"3. The TCM syndromes sub-types is combination. The deficiency of the lung, the spleen, and the kidney qi is the main appear by the clinical sub-types. The main pathological material is tanyu. That reflects the basic pathogenesis of "qixutanyu"4. The conclusion of disposition of the relationship between Five Zang is that the lung has the most closest correlation with the spleen, and then the kidney, which appears that the lung and the spleen are comorbidity, a relationship between them. All of clinical examination shows the correctness of the five zang-organ-related theory.