Medical Case Study On The Adverse Reactions And Prevention Of Edema Caused By Licorice

Gancao is one of the most pervasively used traditional Chinese herbs in clinic,which is said that"Not to be fired with honey,it can moderately tonify insufficiency of spleen and stomach,as well as purge heart fire;To be fired with honey,it can warmly replenish original qi of sanjiao and disperse exterior cold."Zhigancao focuse on tonifying and shenggancao on clearing heat and removing toxins,which can be more remarkable by the compatibility with other herbs.It may cause edema and other adverse reactions in clinical use because of its glycyrrhizic acid component,and it may lead to abdominal distention and fullness by ancients.At present,the pharmacological studies of gancao have suggested that the edema caused by gancao is related to its metabolite glycyrrhetinic acid,which can lead to pseudoaldosteronism and water and sodium retention.However,few studies have analyzed the reasons of the edema caused by gancao from medical records,and lacking of researching on preventing edema as well.This study aims at providing consultation for clinical application of gancao and enabling gancao to play its due role rather than harmonization based on the relationship between the edema caused by gancao and diseases,symptoms,herbs usage and duration of administration,and the way to avoid edema when gancao is used,via collecting,collating and analysing modern medical records.Objective:(1)Through the analysis of the medical cases of edema caused by gancao,this study preliminarily explored the related factors of gancao-induced edema to provide a basis for the following study on the prevention of gancao-induced edema.(2)To provide a reference basis for avoiding the occurrence of edema for the clinical application of glycyrrhizic acid preparations by the case study of edema caused by them.(3)Providing consultation for clinical application of gancao to obtain the greatest therapeutic effect and the lowest probability of edema,and compareing the difference between shenggancao and zhigancao in avoiding edema,via the analysis of medical records.These records is free from side effect edema and based on the results of the first part of case research.Methods:The first part of medical case study was to search and collect medical cases of edema caused by gancao or glycyrrhizic acid preparations through online databases such as CNKI.Then screening medical records according to inclusion and exclusion criteria,the records that meet the requirements were standardized according to the input criteria and were input into Excel 2010.Data analysis is carried out with SPSS20.0.In the second part of the medical record study,the "gancao and record"was searched on the internet databases such as CNKI to collect the medical records which is free from side effect edema and based on the results of the first part of case research.The data were screened,standardized and input according to the criteria,and divided into shenggancao group and zhigancao group.The data was input into the analysis pool of ancient and modern medical records cloud platform to analyze the basic information,prescriptions,diseases and syndromes,etc.in each module.Finally,derive the analysis results of each module.Results:Based on the results of the first part of case research,the minimum daily dose of glycyrrhizic acid preparations was 73.50mg and the maximum daily dose was 300mg.The dose mainly varied from 77.50 mg to 200mg.There was no significant gender difference in these cases,and the age was concentrated between 46 and 63 years old.Most of the patients with edema have a history of chronic diseases.The edema mainly starts from the lower limbs and face,mostly accompanied by abdominal distention and fullness.The duration of edema varies from 2to 10 days.The degree of edema is mostly mild edema,and no severe edema occurs.It can disappear about 7 days after drug withdrawal.The lowest dose was 20 g/d and the maximum dose was 50g/d in the cases of gancao-induced edema.According to the minimum dosage of 20g,medical reports,in which the dosage of gancao which is greater than or equal to 20g/d,were screened according to the standard,and were divided into 110 records in shenggancao group and 176 records in zhigancao group.Through the analysis of cloud platform,it can be concluded that the most common clinical symptoms of shenggancao group are dyschesia,insomnia,poor appetite,thin and white tongue coating,wiry pulse,and mostly used for thin people,no significant difference in age and gender.It is often used in combination with baishao and the ratio of shenggancao to baishao was mainly between 1:2and 1:1.It is mostly used in Shaoyaogancao Tang for convulsions and arthralgia,Gancaoxiexin Tang for throat-anus-genital syndrome,and Gancaoganjiang Tang for stomachache.The average dose of shenggancao is 32 g and the maximum dose is 250 g.Shenggancao is mainly used for clearing heat and detoxification and relieve spasm.The duration of treatment was concentrated in 1 to 10 days;the most common clinical symptoms of zhigancao are palpitation,aversion to cold,insomnia,pale tongue coating and fine pulse,which were mostly used in female patients.There is no significant difference in age.It is often used in combination with guizhi and the ratio of zhigancao to guizhi was 39%between 1:2 and 1:1,and 40%between 1:1 and 2:1.It is mostly used in Zhigancao Tang for the treatment of palpitation,Sini Tang for the treatment of sleepiness and yang collapse,and Shaoyaogancao Tang for the treatment of headache.The average dose of zhigancao is 28g,and the maximum dose is 120g.Zhigancao is mainly used for tonifying qi,nourishing blood and warming yang.The duration of administration was concentrated in 1 to 5 days.The prescriptions containing gancao used in medical records are classical prescriptions with frequencies greater than or equal to 5.Conclusion:According to the results of the first part of case research,the edema caused by gancao is related to dosage,age and strength of human body's healthy qi.A higher dosage,an older age or deficiency of healthy Qi are more likely to suffer from edema.The adverse reactions of edema caused by gancao will occur in the former days.Once edema appeared,medication should be stopped.The edema will disappear one week later.It can be found that when the dose of licorice is more than or equal to 20 g,the correct application will not lead to edema through the results of the second part of records research.The following usage can avoid edema:shenggancao and zhigancao can be compatible with baishao and guizhi respectively.In prescriptions,the dose of gancao in prescriptions is generally no more than that of baishao and the dose of zhigancao is no less than half of guizhi.Regardless of deficiency heat or excess heat syndrome,shenggancao is suitable for both.Zhigancao is selected for deficiency syndrome.Generally,the dosage of zhigancao is less than that of shenggancao.The application of gancao in accordance with the compatibility of classical prescriptions,of which the compatibility is rigorous,and differentiation of symptoms can effectively avoid edema.In addition,the length of medication should be controlled,shenggancao group is no more than 10 days and zhigancao is no more than 5 days.