Case Analysis And Research Of TCM Syndromes Of 100 Cases Of Chronic Refractory Urticaria

ObjectiveThrough the investigation of epidemiological background and case annlysis for 100 patients who were diagnosed with refractory chronic urticaria in our hospital from August 2015 to August 2016,we understand the demographic characteristics,clinical manifestation,relevant laboratory examination,treatment,prognosis and so on,find the related factors of prognosis,comparison and judgement of curative effect of existing therapies,summarize the characteristics of clinical epidemiology,on this basis,discuss the types and characteristics of TCM Syndrome,to improve and clarify the pathogenesis of chinese medicine theory and the clinical regularity of TCM syndrome differentiation about refractory chronic urticaria.That would provide some reference and help for the dermatology doctor in future on diagnosis,clinical practice evaluation and treatment of such patients in disease.MethodsThrough the development of “refractory chronic urticaria epidemiological questionnaire”,we choose 100 patients who meet the criteria of refractory chronic urticaria in the department of dermatology of Wuhan integrated TCM and western medicine hospitalfrom August 2015 to August 2016,among them,there are 24 people from the inpatient department,76 people from the outpatient department,according to the unified clinical questionnaire,make a investigation and regular telephone follow-up by the specialists who experienced professional training.The contents include:general information,gender,age,course of disease,the characteristic of onset,possible causes,evolution of the disease process,the accompanying symptoms,the history of disease,the phenomenon of tongue and pulse,TCM syndrome type,aboratory examination,treatment,effect and so on.Then we collect the clinical data,check it carefully and input it into the EXCEL table,perform statistical analysis by SPSS.19 software,in order to ensure the authenticity of the data in the database.We need four kinds of traditional diagnostic methods :looking,smelling,asking,touching,make the clinical manifestations and the phenomenon of tongue and pulse of patients as a basis,in order to ensure the reliable and accurate diagnosis,diagnostic data must be collected by two doctors of traditional Chinese medicine more than deputy chief physician,who analyze the patients with syndrome differentiation respectively,finally take consistent resolution type as the patient's TCM type,and summarize the dialectical analysis of intractable chronic urticaria type characteristics.In the end,we summarize the TCM dialectical thinking of chronic refractory urticaria,related factors of syndrome type.ResultsIn the 100 cases of patients with refractory chronic urticaria,Gender: male 47 cases,female 53 cases,the sex ratio was 1:1.1;The age of onset was 7-62 years,The average age was(37.79±12.86)years old.The course ranged from 1.5-240 months,among them 90%patients within 1 year.62% patients in Wuhan and its jurisdiction,36% patients in Hubei province and other cities,only 2% patients are not in Hubei Province.Disease characteristics: 66% of the patients had never had this disease before,74% of the patients have red rash almost every day,have circadian rhythm,which is mainly aggravated at night,53% of the patients' rash can be dissipated in 2-24 hours,the wheal number of most patients is more than 15 every day,the diameter is more than 1.5cm,the light red plaque like lesions is more common,and accompanied by consciously itching.13% patients have pigmentation spots after the skin rash subsided.14% patients suffer from palpitation,dyspnea,abdominal pain,joint pain and other symptoms at the same time.Only 2% patients have a fever,20% patients felt warm but temperature is not clear.Pathogeny and inducement: 40% patients always combined with other diseases,such as gastritis and duodenal ulcer,hepatitis,fatty liver.14% patients are caused by food,such as fish,seafood,red meat,egg,milk,alcohol and so on.Laboratory examination: In Allergen detection,51% patients are detected allergen,such as house dust mites/dust mite,shrimp,seafood,egg,nuts and so on.39 patients were tested for autoantibodies,antinuclear antibody of 7 people is positive.10 patients were examined by ASST test,The results of of 8 patients is positive.41 patients were examined by C-14 breath test,The results of 16 patients is positive.41% patients have abnormal blood routine,19% patients have abnormal thyroid function and antibody,16% patients have abnormal myocardial enzymes,16% patients havehumoral immune abnormalities.The treatment and curative effect: Relationship between medication and curative effect-in addition to the number of antihistamines and antibiotics was less but effective in the first treatment,the number of patients treated with antihistamines alone was the largest,and the efficiency was highest,it was 89.1%.H1RAS+H2RAS + Membrane stabilizer + Immunomodulator was the most widely used in current treatment options,but in comparison,the efficiency was not high(74.2%).But the effective rate was above90% by increasing dose of H1 RAS or combined use of H1 RAS and H2 RAS.ASST positive patients had the lowest effective rate(50%).The response of C-14 positive patients to histamine treatment was obvious,after triple therapy and quadruple therapy,the effective rate was 100%.However,the effective rate of patients who had not been treated with HP or only used antacids was low.TCM syndrome:the phenomenon oftongue and pulse:red tongue,yellow moss,fast pulse is most common,always with wet,blood stasis,blood weak and so on.The most commom syndrome is the invasion by the wind,cold,wet,then the wind,heat,blood stasis.In male patients,the distribution of heat syndrome was significantly higher than that of female,mainly manifested as wind heat and gastrointestinal damp heat;The distribution of cold syndrome in female patients was significantly higher than that in male,mainly manifested as the invasion on surface by the wind cold.ConclusionThrough the above research,we find that chronic refractory urticaria in the pathogenesis of young women with the highest rate,diet,heat and other factors can induce or aggravate thedisease,more than half of patients have circadian rhythm,which is mainly aggravated at night,and always combined with other diseases,such as gastritis and duodenal ulcer.A minority of patients suffer from fever,palpitation,dyspnea,abdominal pain,joint pain and other symptoms.And the clinical symptoms of this type of CU were more serious:the large number and diameter of skin rash,long duration,severe itching,even with burning and tingling,seriously affect the life quality of patients.The diagnostic efficiency of a large number of laboratory test results is not too high.Comprehensive examination has certain guiding significance to the treatment only when it is necessary.If combined corticosteroids or antibiotics with once used drugs,the efficacy of conventional antihistamines is poor in general,the dosage of antihistamine has a certain effect on improving the efficiency.Immune antibody,HP infection has a different degree of influence on the curative effect.Summarize the disease external causes are cold,wind heat invasion,The internal cause are gastrointestinal damp heat,blood deficiency and wind dryness combined with dampness,blood stasis,deficiency,etc,which lead skin rash,with severe itching.Among male patients,the syndrome of wind heat invading the blood stasis syndrome was the largest,easy to feel Yang evil;among female patients,the syndrome of wind cold syndrome is the largest,susceptible to Yin evil.