Systematic Review And Case Investigation Of Clinical Randomized Controlled Trials Of Chinese Medicine For Postinfectious Cough In Adults

Objective:1.To systematically evaluate the efficacy and safety of traditional Chinese medicine in treating postinfectious cough in adults through evidence-based medicine,and provide evidence-based evidence for clinical research;2.To carry out clinical case investigation and research,summarize and analyze the distribution of cough syndromes and drug characteristics in postinfectious cough in adults,summarize the pathogenesis characteristics,and provide a basis for further research on clinical treatment and efficacy evaluation of postinfectious cough in adultsMethods:1.Systematic Review of Clinical Randomized Controlled Trials of Chinese Medicine for Postinfectious Cough in AdultsChina Knowledge Network(CNKI),Wan Fang Data Knowledge Service Platform(Wan Fang Data),VIP Network(VIP),Chinese Clinical Trial Registry website(Chinese Clinical Trial Registry),Dutch Medical Abstract Database(Embase),evidence-based medical books The library(The Cochrane library),the American Biomedical Journal Literature Database(Pub Med),etc.are the main search sources,and the search time is limited to the beginning of the library until September 2019.Search by combining the subject word search and the free word search.The search terms are"Chinese medicine","Chinese herbal medicine","cough after infection","cough after cold","subacute cough","long cough","Intractable cough","Traditional Chinese Medicine","Chinese Herbal Medicine","Post-infection Cough","Persistent Cough",etc.,the research type is limited to clinical research.Meta analysis was performed using Cochrane Rev Man5.3 software.2.Investigation on The Characteristics of TCM Syndromes of Postinfectious Cough in AdultsThe patients with post-infection cough in the outpatient and inpatient wards of the respiratory department of the second affiliated hospital of tianjin university of traditional Chinese medicine from January 2019 to January 2020 were investigated.A database was established by using Excel 2010,and frequency analysis,decision tree analysis and factor analysis were performed by SPSS Statistics 23.0.3.Data Mining Study of Medications for Postinfectious Cough in AdultsThe TCM prescriptions with prescription information in the second part of the cases were collected,and the standardized prescriptions were recorded into the TCM inheritance assistance platform(referred to as the inheritance platform).The statistical report module in the inheritance platform was used to analyze the frequency of included prescriptions,and the association rule algorithm in the data analysis module,the improved mutual information method,and the entropy clustering algorithm in the complex system were used to analyze the included prescriptions.Results:1.Systematic Review of Clinical Randomized Controlled Trials of Chinese Medicine for Postinfectious Cough in AdultsA total of 22 RCTS were eventually enrolled,and a total of 2207 patients with post-infection cough were enrolled,including 1118 in the observation group and 1089 in the control group.Meta analysis results show that the observation group than the control group can significantly improve the clinical curative effect,shortening the time of cough,reduce the total integral,cough cough symptoms and TCM syndrome integral visual simulation,improve patient quality of life,and significantly lower airway neurogenic inflammation medium index and factor level,regulate immune response,in terms of safety,no serious adverse reaction report.2.Investigation on The Characteristics of TCM Syndromes of Postinfectious Cough in AdultsA total of 233 cases were included in the investigation of post-infection cough syndrome,including 110 males(47.21%)and 123 females(52.79%).The oldest patient was 83 years old and the youngest was 17 years old.2.1 Descriptive Analysis of Syndrome InformationThe main symptoms of postinfectious cough in adults appeared at a higher frequency(from high to low):cough,less phlegm sticky,cough sound turbid,dry cough without phlegm,phlegm white in color,phlegm yellow in color,wheezing,phlegm more prone to cough,phlegm in throat,phlegm bubbling,phlegm yellow and white in phase,phlegm smelly,cough sound low,phlegm with bloodiness,the frequency of occurrence was more than 10%;Accompanying symptoms of postinfectious cough in adults at a higher frequency(from high to low)in turn is:dry mouth thirsting,urinate short color yellow,heart heat,cold,hands and feet upset,nasal congestion,oral scarlet,red red,day heavy night light,sore throat,dry throat,lip lubricious weak,voice hoarse,insomnia,body weight,bad cold,white surface flatness,constipation,fever,weight,night and day,light sense of pharyngeal obstruction,bosom frowsty,appear in more than 40%;On the tongue vein,the tongue quality of the cough patients after infection was mostly thin tongue,tongue dry less fluid,red tongue,light red tongue(frequency of more than 40%),tongue coating was mostly thin tongue,yellow tongue coating,white tongue coating(frequency of more than 40%),pulse shape was mostly a number of veins,floating veins,string veins(frequency of more than 35%).2.2 TCM Syndrome DistributionIn this investigation,a total of 9 TCM syndromes were obtained,among which,the frequency of wind-induced heat in lung syndrome was the highest,with 53 cases,accounting for 22.75%of the total population,followed by 41 cases(17.60%)of wind-induced lung syndrome and 34 cases(14.59%)of phlegm-induced heat-induced lung syndrome.In this survey,a total of 20 TCM syndromes were obtained,with a total frequency of 1232 times,including 7 disease location factors,a total frequency of 593 times,and 13 disease factors,a total frequency of 639 times.The highest frequency of disease location elements was lung,with a total of 376 times(63.41%),followed by spleen and liver(65 times(10.96%)and 39times(6.58%),respectively.Among the pathogenic factors,wind was the most frequent,with a total frequency of 130 times(20.34%),followed by heat and phlegm(123 times(19.25%)and 66 times(10.33%),respectively.2.3 Correlation Analysis2.3.1 TCM Syndrome and Age CorrelationThere was no obvious trend of change.Pearson chi-square test and spearman correlation analysis showed that x~2=10.757,the correlation coefficient was 0.197,P=0.657,and the difference was not statistically significant(P>0.05).There is no correlation between age and TCM syndrome.2.3.2 Seasonal Correlation between TCM SyndromesThe number of spring and winter festival patients was more,accounting for 87.55%of the annual incidence.Among them,the spring of the disease patients,to hot wind make lung syndrome as the main syndromes,the second is the wind evil fu lung card,the rest of the syndrome were all low level,after the summer,hot wind make lung syndrome,wind evil fu lung gradually reduce average,qi and Yin deficiency syndrome,phlegm wet aggregates lung began to rise,after the autumn reached the highest level,then began to fall,the wind dry lung injury syndrome,cold phlegm fu lung autumn began to slowly rise,continued through the winter,the winter is in yu lung phlegm heat syndrome as the main syndromes,followed by cold phlegm fu lung syndrome,cold love lung;But the air fire makes the lung syndrome a year four seasons is flat,does not have the obvious change trend.Pearson chi-square test and spearman correlation analysis showed that x~2=271.264,correlation coefficient 3.726,P=0.000,the difference was statistically significant(P<0.05),indicating that there was a certain correlation between the onset season and syndrome.2.3.3 Correlation between TCM Syndrome and Course of CoughThe number of patients with wind fever in the course of disease was large,accounting for 53.97%of the total number of patients,followed by wind evil fu lung syndrome,wind dryness lung syndrome,and wind cold lung syndrome.With the increase of the duration of the disease,phlegm-heat stagnation lung syndrome and cold-phlegm-lung syndrome began to increase and reached the highest level at 5/6 weeks,and then began to decline.Phlegm-dampness pulmonary syndrome continued to rise,and qi and Yin deficiency syndrome did not appear in 3/6 weeks.In the course of disease 7/8 weeks,the number of qi and Yin deficiency syndrome was relatively large,accounting for 61.11%of the total population.The change of qi and Yin deficiency syndrome was not obvious.Pearson chi-square test and spearman correlation analysis showed that x~2=348.993,correlation coefficient 6.447,P=0.011,the difference was statistically significant(P<0.05),indicating that the course of disease was correlated with TCM syndrome.2.4 Decision Tree AnalysisThe decision tree analysis screened a total of 8 dialectical key indicators of cold wind,cold,constipation,string veins,yellow and cloudy snot,sore throat,unwanted diet,hoarseness,and foamy sputum,and 12 judgment rules:(1)if"Evil Wind Cold=Yes",it is biased in the diagnosis of"Wind-Fever Cold Lung Syndrome";(2)If"Evil Wind Cold=Yes"+"Xinmai=Yes",it is biased in the diagnosis of"Feng Xie Fu Lung Syndrome";(3)If"Xin Feng Han=Yes"+"Xuan Mai=Yes"+"Do not want to eat=Yes",it is biased to diagnose"Wind Cold Attack Lung Syndrome";(4)If"Xiao Feng Han=Yes"+"Xin Mai=Yes"+"Do not want to eat=No",it is biased in the diagnosis of"Feng Xie Fu Lung Syndrome";(5)If"Evil Wind Cold=No",it is biased in the diagnosis of"Sputum Heat Stagnation Lung Syndrome";(6)If"evil cold=no"+"constipation knot=yes",the diagnosis of"phlegm-heat stagnation and lung syndrome"is preferred;(7)if"evil cold=no"+"fecal constipation=yes"+"sore throat"=Yes",it is preferred to diagnose"Qihuo Lung Syndrome";(8)If"Evil Wind Cold=No"+"Constipation=No",it is biased to diagnose"Qiyin Deficiency Syndrome";(9)If"evil wind cold=no"+"constipation=No"+"Yellow and cloudy tears=Yes",it is biased to diagnose"wind and dry lung syndrome";(10)If"Evil wind cold=No"+"Constipation=No"+"Yellow and cloudy tears=No"+"Hoarseness=Yes",it is biased to diagnose"Qiyin Deficiency Syndrome";(11)If"Evil Wind Cold=No"+"Constipation=No"+"Yellow Cloudy Snot=No"+"Hoarseness=No",it is biased to diagnose"phlegm dampness lung syndrome";(12)If"evil wind cold=No"+"constipation constipation=No"+"flowing yellow turbid tear=No"+"Hoarseness=No"+"More foamy sputum=Yes",the diagnosis of"cold phlegm and lung deficiency"is biased.2.5 Factor AnalysisFactor analysis revealed a total of 8 common factors,including F1:less sputum,sticky sputum,yellow sputum,dry mouth,thirst for cold drinking,deep red lips,constipation,upset,yellow short urine,fever,hot hands and feet,Red face,red tongue,yellow fur,yellow veins,pulses;F2:dry cough without phlegm,sore throat,dry throat,yellow and cloudy snot,hoarseness,dry mouth,thirst to drink cold,short yellow urine,fever,hands,feet,heart Heat,thin tongue,dry tongue,thin moss,floating veins,counting pulses;F3:nasal congestion,cold,cold,uncomfortable neck,thin moss,floating veins;F4:sputum with less stickiness,thin body,red tongue,Thin tongue;F5:sputum with less stickiness,thin moss,string veins,tight pulse;F6:day and night light;F7:sneezing;F8:cough and coughing;use the obtained 8 factor scores as the new Variables were subjected to factor clustering to obtain 3 syndromes,which were analyzed in combination with professional knowledge.The three syndromes were successively named as:wind-cold lung syndrome,wind-heat lung syndrome,lungheat Yin deficiency syndrome.3.Data Mining Study of Medications for Postinfectious Cough in AdultsFor 233 cases,131 prescription drug analysis,the results showed that 183 of TCM,mixed distribution to use frequency is highest,the bitter drugs(35.96%),followed by herbs,31.02%,26.84%,adjuvant sour medicine accounted for 3.40%,astringency and less salty medicine,1.49%,1.29%respectively,medicinal distribution is given priority to with cold,warm,flat,including cold drugs accounted for 44.36%,warm drugs(37.71%),drug for the mainly in lung,spleen,stomach,liver meridian is given priority to,the second is the heart,colon,kidney,gallbladder and so on;High-frequency medicines are qian hu,zi wan,sang baipi,bai qian,kuan donghua,di gupi,chuan beimu,hou po,ban xia,etc.,through association rule mining zi wan,qian hu,sang baipi,bai qian,kuan donghua are six core drugs,as well as the"bai qian-qian hu","qian hu-sang baipi","zi wan-kuan donghua","bai qian-sang baipi"152 core drug pairs,and 22 set of association rules.Through the analysis of the improved mutual information method,33 core combinations with high correlation degree were obtained.On this basis,10 new solutions were obtained through entropy hierarchical clustering analysis of complex systems.Conclusions:From the perspective of evidence-based medicine,this study systematically evaluated the efficacy and safety of traditional Chinese medicine in the treatment of adult cough after infection.The results show that traditional Chinese medicine syndrome differentiation treatment of cough after infection is accurate,can significantly shorten the cough time and reduce airway neurogenicity Media index and inflammatory factor level,regulate immune response,improve patient's quality of life,good safety,no obvious adverse reactions.At the same time,clinical symptom investigation and research were carried out,using multi-dimensional statistical analysis methods to explore the characteristics of traditional Chinese medicine syndrome of cough after infection in Tianjin area,and summarized the pathogenesis characteristics.The results showed that cough after infection is actually not migrating from exogenous cough Most of them are due to mistreatment,mistreatment,or righteousness and evil love.Among them,wind-heat offending lung syndrome is the main symptom of cough after infection,and it has a certain trend with the progress of the disease.The disease is located in the lung,and is related to the liver and spleen.The chronic disease and the kidney are mostly empirical and mixed syndromes.Finally,through the analysis of prescriptions for clinical treatment of cough after infection through the aid of traditional Chinese medicine inheritance assistance platform,a total of cicada slough,silkworm,earthworm,perilla seed,raw gypsum,honeysuckle,forsythia,scutellaria baicalensis,fritillary 25 core medicines including winter melon seeds,mulberry skin,houttuynia cordata,Hundred,Qianhu,melon,aster,radix seed,etc.,and 10 new prescriptions have been created.These medicines and new prescriptions are closely linked The core pathogenesis of"Feng Xie Fu Lung",while at the same time grasping the evidence of combination,can be compatible with each other in the treatment of cough after infection,plus or minus use,which provides a reference for the treatment of adult cough after infection by traditional Chinese medicine.