A Retrospective Study On The Modern Clinical Application Of Ephedra Based On The Literature

Objective:This article focuses on the herb,Herba Ephedrae(??)as the main subject of research.The research is based on the systematic collection of medical records from modern clinical applications of Herba Ephedrae for the treatment of diseases.By means of retrospective research from clinical application and through statistical analysis of diseases and syndromes,along with its compatibilities,nature of processing,dosages and methods of decoction,we are able to provide reliable data and theoretical support,thereby developing a more regulated usage as well as to expand its scope in clinical application in order to achieve definitive results and mostly to ensure safer,flexible and more effective clinical practices for Herba Ephedrae.Methods:Our main sources of research is based on the database of the China Knowledge Resources Database(CNKI),Wanfang Database and the Chinese Science and Technology Journal Database(Weipu.com).Using "??","ma huang" and "Herba Ephedrae" as the main search terms,we retrieve all the publicly published periodicals or articles in journals containing "Herba Ephedrae" in prescriptions since the establish of the database till to January 2020.All these prescriptions containing "Herba Ephedrae" are included in the scope of the preliminary statistics and organized into different categories.The categories of,patient's name,gender,age,name of disease or symptome,type of differentiation pattern,composition of the prescription,dosage,types of Herba Ephedrae processed products used and any other special decoction methods,are entered into an Excel 2010 document.After which this Excel document is uploaded into the established "Traditional Chinese Medicine Inheritance Assistance Platform(V 2.5)" database and utilizing the platform's "Statistical Report System" and "Data Analysis System" we are able to retrieve statistical analysis based accordingly to its formulating rules on the rate of recurrence in the different categories of diseases,symptomes,syndromes,compatibility,processing,dosages and decoction methods.The derived calculation method for rate of recurrence is;(frequency/medical records)x 100%.Results:A total of 2819 medical records containing Herba Ephedrae used in treatment of disease were collected and with a total of 103 types of diseases.Among them,there are 37 kinds of disease occurring more than 5 times out of the 2489 medical records.Diseases with occurrences above 100 totalled up to 8 different types.They are,in descending order,cough,asthma,arthralgia,edema,urticaria,allergic rhinitis,paediatric enuresis and cold.Diseases with occurrences between 50 to 100 amount up to 10 different types of diseases.In descending order,they are,chest numbness,fever,headache,asthma,heart palpitations,dumbness,cough,lower back pain,itching and fever.Diseases with occurrences less than 50 includes 19 types of disease,separated into dizziness,sore throat,eczema,lethargy,accumulation of symptoms,jaundice,deafness,pulmonary distension,facial paralysis,acne,psoriasis,edema,retention of urine,blood disorders,no sweating,anejaculation,sexual exhaustion,pleural rheum,diarrhea and constipation.According to Zang-Fu Pattern Differentiation,a total of 1678 medical cases were recorded,of which accounts for 21 kinds of diseases/symptomes and 26 types of patterns.Listed in the following order,are,wind-cold attack/pulmonary binding(orifice),cold phlegm obstruction/stasis in the lung,heart and kidney yang deficiency,wind-cold dampness blockage/impediment,lung heat stagnation,wind and water contention edema,phlegm heat depression or accumulation in the lung,insufficient kidney yang,heart vessel obstruction,yang deficiency with exuberant cold,lung qi depression,rheumatic fever impediment,exterior cold with lung heat,spleen and kidney deficiency,lung and spleen qi deficiency,blood stasis obstructing vessels,blood deficiency with wind-dryness,lung qi deficiency with cold,soaking of rheumatic fever,impediment of phlegm stasis,wind heat attacking exterior,damp heat depressing exterior,wind-heat in lung meridian,insufficiency of lung qi,non-interaction/disharmony of the heart and kidney and internal exuberance of cold-damp.According to the Eight-Principle Pattern Differentiation,the number of cases related to the syndromes are as follows;556 exterior patterns,733 interior patterns,446 for both interior and exterior patterns,949 cold patterns,765 heat patterns,265 for cold and heat complex,789 excess patterns,579 deficiency patterns,318 for both excess and deficiency patterns.Herba Ephedrae is most compatible with warm natured herbs,followed by cold and balanced natured herbs.It is more commonly used with sweet natured herbs,followed by acrid and bitter herbs and less common used with sour,salty and astringent herbs.Compatible herbs typically used together with Herba Ephedrae in the 5 types of disease of the Lung system are;Semen Armeniacae Amarum(??),raw Radix Et Rhizoma Glycyrrhizae(???),Radix Et Rhizome Asari(??)and Ramulus Cinnamomi(??).For the 4 types of diseases in the system of the Heart,commonly used herbs are;Radix Et Rhizoma Asari(??)processed Radix Aconiti Lateralis Praeparata(???),Ramulus Cinnamomi(??),roasted Radix et Rhizoma Glycyrrhizae(???)and raw Astragali(???).Regularly used herbs for meridians and collaterals diseases are;Radix Et Rhizoma Asari(??),processed Radix Aconiti Lateralis Praeparata(???)and Ramulus Cinnamomi(??).For the 5 types of dermatologic diseases,it is most frequently used with raw Radix Et Rhizoma Glycyrrhizae(???).In prepared Chinese herbal medicinal products,2 main types Herba Ephedrae are used,raw or roasted.Referring to the 2489 medical cases,raw Herba Ephedrae is used most frequently at 79.07%.Amongst the different medical fields,raw Herba Ephedrae is most frequently used in the field of dermatology(90.88%)whereas in the field of paediatrics,the least(66.02%).In the field of internal medicine,raw Herba Ephedrae is most commonly use to treat diseases or disorders of the spleen,stomach,kidney and meridians whereas in disease of the lung system,raw Herba Ephedrae is used the least(66.04%).For the specific diseases of diarrhea,retention of urine and facial paralysis,raw Herba Ephedrae is applied most frequently,while in contrast,in the field of internal medicine for asthma and pulmonary distention and in paediatrics for asthma and cough,it is applied the least.The total average dose of Herba Ephedrae is 8.56g.Among the various diseases,the average dose of Herba Ephedrae used in paediatrics is at 6.15g and the average dose used in internal medicine is the highest,at 9.25g.The average dose of cold syndrome is higher than that of heat syndrome and for excess syndromes it is higher than deficiency syndromes.Hence the use of raw Herba Ephedrae stands between 6-10g,followed by 3-5 g and lastly 11-15g,giving the range of dosage at 0.5-50g.For roasted Herba Ephedrae(???)the initial dosage stands at 6-10g,followed by 3-5g and the range stands between 1.4-40g.Conclusion:As the saying goes,"light medicinals to eliminate exces's"("????"),Herba Ephedrae can effectively treat pulmonary diseases while the other saying,"activating yang to disperse depression"("????"),It is also effective for chest impediment,neart palpitations and skin diseases.As to,"revive yang to uphold yang"("????"),it is able to treat children's enuresis,dizziness,lethargy and relieve diarrhea and in "lifting the pot and remove the lid"("????"),it can treat edema,retention or incontinence of urine,suspended rheum,constipation and jaundice.In "unblocking the orifice"("???")it is used for rhinitis,dumbness and deafness.For "dispersing cold to unblock meridians"("????")it is able to treat meridians diseases and in "dispersing exterior pathogens and expel interior pathogens"("???,???")it can disperse the pathogenic factors both on the superficial and in the internal levels.Similarly,it also treats both cold and heat syndromes,in "outthrust evils and dissipate pathogens"("????")and for "reviving yang to reinforce yang"("????")it can be used for deficiency syndromes.The use of Herba Ephedrae for qi dynamic can be understood as "resolving the obstruction of circulation of qi to revive yang"("???,???"),and it's main influence on the water metabolism of water and liquid is to induce sweating and diuresis and transformation of qi("????????").The main combination of Herba Ephedrae are as follows;1)with Poria(??)to treat various types of edema.Their pairing enables accumulated water to escape through sweating and urination.2)with Rhizoma Acori Tatarinowii(???)to treat all types of enuresis problems in children.On one hand it focuses on reviving the yang and on the other hand,it arouses and awaken the spirit,playing the role of reviving yang and awakening qi.The roots of Rhizoma Acori Tatarinowii(???)is able to enter into the interior and the stem of Herba Ephedrae works mainly on the surface,thus these two compliment each other in reaching areas where the other cannot reached.3)for cold syndromes it is often combined with Ramulus Cinnamomi(??).Paired together with Ramulus Cinnamomi(??),it not only induces perspiration but is also able to relieve sweating.Ramulus Cinnamomi(??),alone enters the heart meridians,humbly easing the limbs and allowing Herba Ephedrae to reach these areas too.4)with Rhizoma Glycyrrhizae(??),as it not only harmonizes the strong and drastic nature of Herba Ephedrae but it can also assist in improving yang with both acridity and sweetness.5)with Semen Armeniacae Amarum(??)for both cold and heat syndromes,for together,it can balance the effects of Herba Ephedrae and regulate the diffusion of lung qi in descending.It also assists Herba Ephedrae to relieve constipation by loosening the bowels,allowing an exit for the evil qi,particularly dehumidifying the heat evil from the body.6)for both internal and external treatment,it is compatible with Radix Aconiti Lateralis Praeparata(??)and Radix Et Rhizoma Asari(??)which acts on both the lungs and the yang,penetrating both the interior and exterior and acts on the meridians.The preparation,dosages and decoction methods of Herba Ephedrae depends on the purpose of it's clinical usage.Under similar doses,raw Herba Ephedrae has a strong effect in lifting and freeing the yang hence inducing perspiration and releasing the exterior,whereas processed is stronger in calming wheezing.To determine the dosage and the type of processing of Herba Ephedrae,it is necessary to make a comprehensive judgement based on the patient's weight,age,physical strength and severity of the illness.In general,the dosage of cold syndrome is greater than that of heat syndrome and the dosage of excess syndrome is greater than that of deficiency syndrome.Reduction of adverse effects:1)Herba Ephedrae is compatible with sour and sweet herbs such as Fructus Schisandrae Chinensis(???),Radix Paeoniae Alba(??)and Radix et Rhizoma Glycyrrhizae(??);with cold herbs such as raw Gypsum Fibrosum(???);with tonifying qi herbs such as Radix et Rhizoma Ginseng(??),Radix Rehmanniae Praeparata(???)and other herbs that are able to alleviate the harshness of Herba Ephedrae thereby reducing it's toxicity and side effects.2)In the processing of Herba Ephedrae,the sweating effects of processed Herba Ephedrae and the fine fibres on Herba Ephedrae(???)is less than that of raw Herba Ephedrae thus it should be used appropriately.3)In respect to dosage,it should be determined clinically according to the patient's condition and physique.It is better not use large doses if one is unsure.4)In the decocting methods,it is important to decoct it first till the nodes on the Herba Ephedrae have dissipated and to remove any excess foam as these factors will induce excessive sweating.5)In the methods of medicating,it is advised to take smaller amounts of the decoction more frequently and stop medicating once sweating is induced,otherwise continue till perspiration begins.This is to prevent excessive sweating which could lead to a collapse of yang.