| ObjectivesTo review the understanding of Traditional Chinese Medicine(TCM)on encephalopathy and the pulmonary infection and research progress of TCM diagnosis and treatment on pulmonary infection,to summarize Prof.Huang Liping' s academic thought on diagnosis and treatment of encephalopathy and experience on the treatment of encephalopathy complicated with pulmonary infection systematically.In order to further explore the action mechanism of rectal instillation with formula for clearing heat,eliminating phlegm and relaxing bowel on encephalopathy complicated with pulmonary infection,provide evidence for application and enrich methods of treatment,the efficacy and safety of rectal instillation with the formula on treating encephalopathy complicated with pulmonary infection were evaluated by randomized controlled clinical trials.Methods1.Through literature review,TCM classics study and clinical practice with teachers,to review the TCM understanding on encephalopathy and the pulmonary infection,research progress of TCM diagnosis and treatment on pulmonary infection and to summarize Prof.Huang Liping' s academic thought on diagnosis and treatment of encephalopathy and experience on the treatment of encephalopathy complicated with pulmonary infection systematically.2.Eighty eligible cases with encephalopathy complicated with pulmonary infection were randomly divided into treatment group and control group,40 cases in each group.Control group was given conventional treatment and treatment group was given rectal instillation treatment with formula for clearing heat,elimnating phlegm and relaxing bowel.The treatment was given once a day and one course was 14 days.The changes of index were observed before and after treatment in two groups including temperature(T),antifebrile time,white blood cell count(WBC),neutrophils ratio(N),C-reactive protein(CRP),procalcitonin(PCT),sputum pathogenic bacteria cultivation,chest CT,pneumonia severity index(PSI),the efficacy score of TCM syndrome,deteriorative situation and adverse reactions and were made contrastive analysis by statistics software.Results1.Prof.Huang Liping' s academic thought on treating ecephalophacy included four aspects.First was combination of disease and syndrome differentiation and to highlight the TCM characteristics.It was thought that western medicine focus on differentiation of disease and TCM was differentiation of syndrome.Disease differentiation was premise.Prof.Huang advocated combining disease and syndrome differentiation and highlighting TCM characteristics of treating body as a whole.Second was the relevance between occurrence of encephalopathy and organs.Third was that brain and heart diseases attacking at the same time were treated together by improving blood circulation and removing blood stasis.Four was lung and brain diseases or brain and intestine disease attacking at the same time were treated together by relaxing bowel to treating lung(large intestine)and or relaxing bowel to protect brain.2.Prof.Huang Liping's experiences for the treatment of encephalopathy complicated with pulmonary infection were summed up as following:First was to attach great importance to the relationship between brain and viscera.According to its spirit "onset of brain and heart disease at the same time" and "onset of lung and brain disease at the same time",etiology was that brain injury caused formation of pathological products like phlegm and blood stasis.Pathogenesis was obstruction of cerebral vein or spill of blood veins which damaged brain and the phlegm turbidity and blood stasis blocked qi activity and caused lung and spleen dysfunction.Second was to do syndrome differentiation according to different stages of encephalopathy and the primary symptom.Third was to prescribe medication following the classical formulas and diversify treatment methods which reflected Prof.Huang Liping's treatment characteristics of treating brain and lung disease together and brain and intestine diseases together.Fourth was to advocate early TCM intervention and participation in the whole course and emphasized on the combination of Chinese and western medicine comprehensive treatment.3.Results of a randomized controlled study3.1 The temperature was decreased significantly after treatment in both groups(P<0.01).Hypothermia and antifebrile time in treatment group were better than those of control group(P<0.05).3.2 Using antipyretic or not and times of using antipyretic in treatment group were less than those in control group(P<0.05).That was no need to use cathartic in treatment group and difference was significant compared with control group(P<0.01).3.3 TCM common symptom score and syndrome integral were decreased in two groups after treatment significantly(P<0.01).The TCM syndrome integral and symptom score on yellow phlegm,constipation,yellow urinary etc.were decreased significantly in treatment group than those in control group(P<0.05,P<0.01).About the evaluation of curative effect,total effective rate which was 92.5%in treatment group was significantly higher than that of control group which was 65%(P<0.01).3.4 PSI score after treatment in two groups was decreased significantly(P<0.01).Difference was no statistical significance between groups before and after treatment(P>0.05).3.5 In treatment group,inflammation of lung was absorbed and improved in 27 cases,there was no change in 10 cases and progress was made in 3 cases.There were 24 improved cases,12 cases without change and 4 progressed cases in control group.There were 25 cases with positive sputum culture in treatment group and 24 cases in control group before treatment.After treatment,there were 20 cases in treatment group and 21 cases in control group with positive sputum culture.There was no statistical difference in results of CT and sputum culture between two groups(P>0.05).3.6 WBC,N,CRP and PCT were decreased after treatment in two groups and the difference was significant(P<0.01).WBC,N,CRP and PCT were decreased more after treatment in the treatment group than those of the control group.Difference of PCT was statistically significant between groups before and after treatment.(P<0.01).3.7 During the treatment,there was no patient to transfer to other departments or ICU due to illness deterioration and no adverse reaction in two groups.Indexes of security check were all no abnormal damage and safety evaluation was grade A.ConclusionsRectal instillation with formula for clearing heat and eliminating phlegm to relax bowel can better improved encephalopathy complicated with pulmonary infection with syndrome of phlegm-heat obstructing in which the patients have yellow sputum,constipation,yellow urinary and other symptoms.It can reduce TCM syndrome score and level of serum calcitonin,relieve inflammation,enhanc antibacterial effect,and improve the clinical curative effect,especially in antifebrile,aperient effect.The curative effects of rectal instillation with formula for clearing heat and eliminating phlegm to relax bowel on treating encephalopathy complicated with pulmonary is definite which is no adverse reaction and safety use.It is worthy of further popularizing in clinic. |
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