The Clinical Research Of Umbilical Sticking With "Xiaozhang Cataplasm" In Treating Liver Cirrhosis Caused Ascites

Objective:Cirrhosis as a serious systemic chronic disease with its incidence rate showed a rising trend, is easy to cause many serious complications or even death in clinical, and the treatment is extremely difficult. The external treatment derived from traditional Chinese medicine for thousands of years of clinical accumulation, who has simple, convenient, cheap and effective characteristics and certain advantages on the treatment of cirrhosis and related diseases. In order to understand the function mechanism and the curative effect of this treatment more clearly and get better use of it to solve the clinical problems, we use "xiaozhang cataplasm" to stick to the umbilicus of some cirrhotic patients with ascites,then observe the result and preliminary analysis the principle,also find some deficiencies of it.Methods:By making standards of inclusion, exclusion, excluding and falling based on the diagnostic standard of Cirrhosis by Chinese medicine and modern Medicine,we select from October 2008 to September 2009 in the Hepatopathy department of ZhongShan Hospital in HuBei Province,67 cases of diagnosed patients to randomly divided into treated group 34 cases and the control group of 33 cases according to the order of hospitalization,at the same time we divided these cases into Xu type and Shi type by the theory of TCM. All the 67 patients enrolled were treated by conventional treatment but with restrictive use of diuretics. The treated group were given additionally by umbilical sticking, and the control group were not received the cataplasm treatment. The changes of symptoms, body weight, abdominal perimeter and amount of urine before and after treatment were observed, and amount of ascites was examined with B-ultrasound to evaluate the efficacy according to comprehensive grading criteria. Also, the toxicity was observed. Then we grade the curative effect and record the data, analyze it by SPSS14.0.Results:(1) As compared with the corresponding control group, the amount of flatus increased remarkably, abdominal distension reduced, appetite and stool improved in the treated group, with the effective of rate gradel comes up to 52.9%which is higher in Xu type group.(2)As compared with the corresponding control group, body weight, abdominal perimeter andamount of ascites decreased, while amount of urine discharging increased remarkably in the treated group (P<0.05)(3)The comprehensive efficacy in patients of treated group was much better than that in control group (P<0.05). The effective rate of gradeⅠ/Ⅱwas17.6%and 15.4%for patients in the control group of Xu type and Shi type respectively, while it was 75.0% and 84.6%in the treated group of Xu and Shi type respectively. Better therapeutic effect was shown in patients of Shi type.(4)As compared with the corresponding control group, the serum total bilirubin, ALT levels, albumin level, electrolytes and endotoxin levels had no significant improvement in the treated group. The white blood cell mean number of the patients in the treated group were 4.07±1.92×109/L,while the number after treatment were 4.15±1.80×109/L; The albumin levels before and after were 29.4±2.86g/L and 29.74±2.69g/L; The platelet count before and after were 89.3±34.1×109/L and 92.3±29.7×109/L.All the difference was not statistically significant (P=0.081>0.05)。 Conclusion:The treatment with umbilical compressing with chinese herbal medicine effects through the meridian conduction, qi-blood running and neural regulation to play an integral role in therapy, And through the percutaneous absorption of drugs to achieve local therapeutic effect. The transdermal absorption of drugs into the blood circulation can avoid the gastrointestinal stimulate, the liver's "first-pass effect" as well as the short half-life of drug, Shortcoming of numerous administration and so on, while it has a convenient administration and can reduce the phenomenon of drug concentration peak and valley. According to the pathogenesis of liver cirrhosis ascites, we use astragalus, aconite, cinnamon and other "yiqiwenyang" kind for tonic, while rhubarb, radish seed, glauber's salt and other "xingqilishui" kind for diuresis, and add with the "xinxiangtongluo" kind such as borneol, musk, Angelica and so on for "yinjinghuoxue". The results showed that this method based on the principle of transdermal absorption has good assistant effects in treating patients with liver cirrhosis, it can significantly improve the treatment and shorten the hospital stays, improve life quality, which has the advantage that traditional Chinese and Western medicine therapy by oral administration do not have. This treatment which proved to be convenient and cheap, efficacy sure, safe and non-toxic side effects is worthy of clinical application. However, due to the limited case into group, the different conditions of the patients, the non-balanced use of antibiotics, albumin and other drugs, combined with the fallen cases, the question of patients'compliance, the accuracy of the related data may be affected.