Study Of Evolution Of TCM Syndromes Of COPD And Observation Of TMC Normative Regulations During The Stable Phase Of COPD

The clinical study of this paper is divided into two parts: one is Chronic Obstructive Pulmonary Disease(COPD);(hereinafter referred to as COPD)syndrome changes from acute stage to stable stage(main symptoms,disease locations,syndrome types);The second is the effect of standardized management of traditional Chinese medicine on patients with COPD at stable stage.Objectives :(1)To observe the evolution of TCM syndromes(main symptoms,disease sites and syndromes)in chronic obstructive pulmonary disease(COPD)from acute stage to stable stage,and to analyze its clinical characteristics,so as to provide some ideas for clinical intervention of COPD.(2)Observe the effect of standardized management of traditional Chinese medicine on COPD stable period,conduct scientific evaluation on it,promote the management methods with traditional Chinese medicine characteristics to participate in the management of COPD stable period,and prevent and cure COPD scientifically.Methods: Baseline data of 100 patients with COPD in acute stage were collected and randomly divided into TCM management group(TCM group)and control group.Observation of COPD stable stage patients from acute stage to stable stage syndrome evolution(main symptoms,main disease site,syndrome type);A follow-up visit was conducted at multiple time nodes and in multiple ways after discharge to observe the effect of standardized management of traditional Chinese medicine on COPD stable period management.Results:1)Evolution of TCM syndromes from the acute phase of COPD to the stable phase:(1)Main symptoms:(1)Cough: the degree of cough was significantly reduced from the acute stage to the stable stage,and there was a significant statistical difference between the two stages(P=0 < 0.01).(2)Phlegm coughing: from COPD acute stage to stable stage,the situation of sputum coughing was significantly improved,and there was a significant statistical difference between the two stages(P=0 < 0.01).(3)Sphlegm color: The color of sputum changed from yellow to white from the acute stage of COPD to the stable stage,with significant statistical difference between the two stages(P=0 <0.01).(4)wheezing: the severity of wheezing was significantly reduced from the acute COPD stage to the stable COPD stage,and there was significant statistical difference between the two stages(P=0 < 0.01).(5)Shortness of breath: the severity of shortness of breath was significantly improved from COPD acute stage to COPD stable stage,and there was a statistically significant difference between the two stages(P=0 < 0.01).(2)Main disease sites: COPD from acute stage to stable stage changed from single to complex with the increase of disease course.The distribution of disease sites in acute stage:lung(73%)> lung + kidney > lung + spleen > lung + spleen + kidney;The distribution of disease sites in stable stage: lung + kidney > lung > lung + spleen = lung + spleen + kidney,with significant statistical difference between the two stages(P=0 < 0.01).(3)Syndrome types: Syndrome types in the acute stage of COPD: phlegm-heat obstructing the lung syndrome > external cold and internal drinking syndrome > wind-cold attack on the lung syndrome >> phlegm hinder mind syndrome;Stable period: lung and kidney qi deficiency syndrome >lung and spleen qi deficiency syndrome >lung qi deficiency syndrome >lung and kidney qi Yin deficiency syndrome.The specific syndromes change from acute stage to stable stage:lung and kidney qi deficiency syndrome >lung and spleen qi deficiency syndrome >lung qi deficiency syndrome >lung and kidney qi and Yin deficiency syndrome.There was no statistical difference in the evolution and distribution of the syndromes(P= 0.17> 0.05).(4)Changes of main disease sites and syndromes in different lung function grades:(1)Changes of main disease sites: the distribution of main disease sites in the acute stage of all lung function grades was mainly in the lung,and there was no statistical difference(P=0.16> 0.05).In stable stage,the main disease sites of mild,moderate,severe and extremely severe lung function grades were lung(68.20%)and lung + kidney(60.8%),with significantstatistical difference(P=0 < 0.01).(2)There was no statistical difference in the distribution of syndromes in acute stage among different lung function grades(P= 0.49> 0.05).The grades of mild,moderate,severe and very severe lung function were as follows: lung qi deficiency syndrome(68.20%)and lung and kidney qi deficiency syndrome(71.60%),with significant statistical difference(P=0 < 0.01).2)Standardized management effect of TCM in stable period:(1)CAT score: the CAT score in the TCM group was better than that in the control group;There was statistical significance between the two groups(P=0.02 < 0.05).(2)MMRC grading: the MMRC grading in the TCM group was better than that in the control group;There was statistical significance between the two groups(P=0.01 < 0.05).(3)Comparison of other indicators: in the past 1 year,acute plus frequency of TCM group was better than the control group,with statistical significance between the two groups(P=0.03 < 0.05);St.George’s score and lung function(FEV1,FEV1/FVC)were not statistically significant between the two groups(P > 0.05).(4)The differences of each index between the two groups(M12-stable period);CAT score,MMRC grade and the frequency of acute exacerbation in the past year were all better in the TCM group than the control group,with statistical difference(P < 0.05).St.George’s score and lung function(FEV1,FEV1/FVC)were not statistically significant between the two groups(P > 0.05).Conclusion:(1)Symptoms evolution from the acute phase to the stable phase of COPD: major symptoms were significantly reduced;The main disease sites tended to compound from single to complex.In the acute stage of syndrome type,phlegm and heat obstructed the lung,and in the stable stage,lung and kidney qi deficiency were the main symptoms.There were no significant differences in the main disease sites and syndromes of different pulmonary function grades in the acute stage,but there were significant differences in the main disease sites and syndromes of different pulmonary function grades in the stable stage.(2)Effect of standardized management of traditional Chinese medicine in COPD stable period:standardized management of traditional Chinese medicine has a positive regulating effect in improving clinical symptoms,improving quality of life,reducing the number of acute exacerbations and many other aspects.