The Pathological Distribution Of Small Pulmonary Nodules And A Preliminary Study Of Professor Zhang Shunan's Traditional Chinese Medicine Treatment Rules

Objective:with the development of imaging technology,the detection rate of Pulmonary micronodules is increasing.Pathology is the gold standard for the diagnosis of the nature of pulmonary nodules.However,at present,most of the clinical Pulmonary micronodules lack clear pathological basis.On the one hand,there are some damage and complications to the normal lung tissue of the patients with small pulmonary nodules biopsy,especially the multiple small pulmonary nodules all biopsies will damage the lung function too much,it is difficult for the patients to accept;On the other hand,because thoracoscopic biopsy is performed on most small nodules less than 8mm in diameter or farther from the visceral pleura(larger than 1cm),especially in pure ground-glass nodules that do not contain solid components and are difficult to reach with the fingers,Processing capacity remains limited.As a result of this medical status,there is no recognized effective clinical treatment for the time being,and regular low-dose CT follow-up is generally recommended.Patients with subcentimeter pulmonary nodules bear great cost and psychological burden in the course of follow-up.How to intervene the focus in time and grasp the best possible intervention window period is a hot issue in the research of traditional Chinese medicine and western medicine.Professor Zhang Shu-nan relieves difficulties,in clinic,patients with sub-centimeter grade pulmonary nodules are often seen to see a doctor,under the pressure of patients and the responsibility of doctors,they pay attention to participating in the west in the clinic and dare to find a new way,starting from the pathological basis of pulmonary nodules.Using Xuanfei Huatan,Yiqi Sanyu,Wenyang Sanjie and other traditional Chinese medicine treatment,achieved good results.In this study,the auxiliary platform of traditional Chinese medicine inheritance was used to summarize the drug use characteristics and prescription rules of Professor Zhang Shu-nan in the treatment of Pulmonary micronodules,and to explore the etiology and pathogenesis of the disease,so as to provide an objective reference for the clinical treatment of traditional Chinese medicine.Methods:This paper is mainly divided into three parts:the first part is a summary,through the method of literature collection,the understanding and research of Chinese and western medicine scholars at all times and in all over the world about Pulmonary micronodules are analyzed and summarized;the second part is literature research,First of all,using "pulmonary nodule,pathology" as the retrieval term,the Chinese literature published during the period from November 30,1998 to November 30,2018 in the knowledge network database was searched.a total of 918 articles were retrieved,and 606 articles were excluded from the clinical imaging data.There were 8630 cases of puncture pathology of pulmonary nodules(including the pathological results of 253cases of Pulmonary micronodules)as the source of case data,and the literature overlapped with 6 articles,and 59 articles were finally included in the statistical analysis,and 8630 cases of puncture pathology of pulmonary nodules(including the pathological results of 253 cases of Pulmonary micronodules)were used as the source of case data.Then a meta-analysis was carried out to explore the pathological types and benign and malignant pathological distribution of pulmonary nodules,and to provide effective evidence for the early prevention and treatment of Pulmonary micronodules with traditional Chinese medicine to improve the prognosis of the diseases,the third part is a clinical study.Through the collection of the effective prescriptions for the treatment of Pulmonary micronodules in the clinical practice of Professor Zhang Shu-nan,a total of 68 prescriptions were collected and recorded into and with the help of the auxiliary platform of traditional Chinese medicine inheritance.,on the one hand,the law of drug use was found according to the prescription data set.One is to use data mining algorithm to obtain a new prescription according to the prescription data set,that is,to generate a new prescription for the treatment of pulmonary nodules.And from the tutor outpatient records,select typical cases,so as to summarize the mentor Professor Zhang Shu-nan for the treatment of sub-centimeter grade pulmonary nodules drug use law.Results:8630 pulmonary nodules(diameter ?3.0 cm)with complete CT imaging and pathological data were collected in the literature,of which 253 were pulmonary nodules(diameter ? 10mm).Pathological distribution of Pulmonary micronodules:135 cases(45.45%)of benign pulmonary nodules,including 26 cases of inflammatory pseudotumor,18 cases of tuberculoma,14 cases of hamartoma,14 cases of intrapulmonary lymph node enlargement,9 cases of sclerosing hemangioma,10 cases of atypical pneumonia and atypical pneumonia.There were 17 cases of type A hyperplasia,5 cases of mycosis,6 cases of chronic granuloma,3 cases of sarcoidosis,3 cases of bronchiectasis,2 cases of organic pneumonia and 8 cases of precancerous lesions.There were 138 cases(54.55%)of malignant pulmonary nodules,including 78 cases of lung adenocarcinoma,10 cases of lung squamous cell carcinoma,9 cases of alveolar carcinoma,8 case of atypical carcinoid,1 case of unclassified lung cancer,12 cases of unclassified lung cancer and 20 cases of metastatic carcinoma.In the clinical study,a total of 68 effective prescriptions for the treatment of Pulmonary micronodules were collected,a total of 140 kinds of traditional Chinese medicine were used,and the frequency of use was 977 times.The first ten flavors of traditional Chinese medicine were as follows:Pleurotus ostreatus,Prunella vulgaris,Herba Euphorbiae,Astragalus membranaceus,Dioscorea opposita,Huangjing,peach kernel,grilled licorice,cinnamon branch and Fructus Aurantii.With the help of "prescription analysis-prescription law" in the"data analysis system" module of the auxiliary system of traditional Chinese medicine inheritance,the top ten combinations of drug compatibility in the inputted prescription were obtained as follows:(1)Prunella vulgaris and Pleurotus ostreatus(34);(2)Pleurotus ostreatus and Immortals.Euphorbia pulcherrima(27);(3)Prunella vulgaris and Herba Agrimoniae(26);(4)Prunella vulgaris and Astragalus membranaceus(24);(5)Astragalus membranaceus and Huangjing(23);(6)Prunella vulgaris,Pleurotus ostreatus and Herba Euphorbiae(22);(7)Tulip and Herba Euphorbiae(22);(8)Prunella vulgaris and Polygonatum odoratum(22);(9)mountain mushroom and tulip(21);(10)mountain mushroom and astragalus membranaceus(21).And obtain the network diagram of drug relevance(see the main body for details).The core drugs are:peach kernel,Pleurotus ostreatus,Dendrobium,Astragalus membranaceus,Huangjing,Achyranthes bidentata,tulip,Herba Euphorbiae,Dioscorea opposite,Cinnamomum cassia,Prunella vulgaris,Coix seed,Panax quinquefolium.The core combinations were as follows:(1)Achyranthes bidentata->Prunella vulgaris(1);(2)Pleurotus ostreatus,Huangjing->Prunella vulgaris(1);(3)Pleurotus ostreatus,Astragalus membranaceus->Prunella vulgaris(1);(4)Achyranthes bidentata,Huangjing->Prunella vulgaris(1);(5)Tulip->Herba Euphorbiae(0.9565);(6)Pleurotus ostreatus,Tulip->Herba Euphorbiae(0.9524);(7)Achyranthes bidentata->Polygonatum odoratum(0.9444);(8)Summer.Withered grass,tulip->Herba Euphorbiae(0.9444);(9)Prunella vulgaris,Achyranthes bidentata->Polygonatum odoratum(0.9444);(10)Achyranthes bidentata->Prunella vulgaris,Polygonatum odoratum(0.9444).The new prescription analysis showed that:(1)dried ginger,compound flower,loofah,Coix seed,Panax quinquefolium;(2)Notopterygium,aloes,roses,Scutellaria baicalensis Georgi and Pleurotus ostreatus;(3)Scutellaria baicalensis Georgi,tulip,Pleurotus ostreatus,Magnolia officinalis;(4)peach kernel,Amomum villosum,safflower,grilled Astragalus membranaceus.(5)Chebula,wood butterfly,Fritillaria thunbergii,Gardenia jasminoides Ellis,gum;(6)Peran,Atractylodes macrocephala,patchouli,Pinellia ternata,Aster;(7)Cinnamomum cassia,yam,tangerine peel,Pueraria lobata.The treatment principles of Pulmonary micronodules were summarized as follows:tonifying the lung;warming turbid phlegm;promoting blood circulation and removing blood stasis;clearing heat and disinfection;soothing the liver and regulating qi.Conclusions:The pathological biopsy of Pulmonary micronodules is difficult and its popularization rate needs to be improved,and the malignant pathological rate of Pulmonary micronodules may be seriously underestimated,and advocates abandoning the traditional follow-up strategy of regular reexamination.Early intervention should be carried out for small pulmonary nodules.Professor Zhang Shu-nan used traditional Chinese medicine to treat sub-centimeter grade pulmonary nodules:Pleurotus ostreatus,Prunella vulgaris,Herba Euphorbiae,Astragalus membranaceus,Dioscorea opposita,Huangjing,peach kernel,grilled licorice,Cinnamomum cassia twig and Fructus Aurantii.The core drugs are:peach kernel,Pleurotus ostreatus,Dendrobium,Astragalus membranaceus,Huangjing,Achyranthes biden tata,tulip,Herba Euphorbiae,Dioscorea opposita,Cinnamomum cassia,Prunella vulgaris,Coix seed,Panax quinquefolium.