王琦教授主病主方学术思想和临床经验总结及治疗变异性鼻炎的临床研究
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摘要
背景
较长时期以来,辨证论治被提到至高无上的地位,成为中医诊疗特色的代名词,甚至演化为评析中医诊疗的价值标准,逐渐趋向“轻辨病重辨证”的态势。中医疾病史研究表明,识病辨病、以病统证、据病施方,为中医诊疗之原始。徐大椿在《兰台轨范·序》明确指出“一病必有主方,一方必有主药”。然而,这种观点并未引起后世足够重视,取而代之的却是“专病专方专药”论,由此进入“重辨病轻辨证”的另一走向。如何科学地评价和应用中医多元化的诊疗模式是当今转化医学面临的一个重要问题。
变应性鼻炎(Allergic rhinitis, AR)是IgE介导的鼻黏膜慢性炎症反应性疾病,该病对病人的睡眠、记忆、情绪、生活质量造成了严重的影响。王琦教授从伏热上干异气外侵调体论治变应性鼻炎能够明显改善病人的症状、并且部分患者能够治愈,显示出中药治疗AR的优势。
目的
本研究基于王琦教授倡导的已病状态下辨病为纲结合辨证、辨体的“三维诊疗”思想,以人的“病”为切入点,凝练导师主病主方的学术思想,领悟导师的制方思路和方法,总结导师主病主方的临床经验,进而系统观察评价王琦教授治疗AR经验用方的临床疗效和安全性。本课题将为名老中医学术思想和学术经验的传承提供研究模式,对于丰富和发展中医多元化的诊疗思想、促进和推广“三维诊疗”模式在已病状态下的转化应用,具有重要的理论和实践意义。
内容与方法
1.王琦老中医药专家主病主方学术思想与临床经验总结
通过相关文献调研、定期跟师门诊、医案整理、听师讲座、临床观察等多种途径,在导师指导下,凝练其主病主方的学术思想,进而选择10个代表性病种,从辨病审机、立法制方探究主病主方的适应范围、制方原理、加减运用(结合辨证、兼顾辨体),并附案例赏析、推新师意等方面,全面反映导师的主病主方创制方法、临床经验,以及跟师心得、实践体会、个人观点及创新思路等。
2.王琦教授从伏热上干异气外侵调体论治成年人变应性鼻炎的临床研究
采用病历对照研究的方法,观察组为导师采用伏热上干异气外侵调体论治变应性鼻炎的病例,对照组为学术继承人从传统的寒饮伏肺外邪诱发辨证论治变应性鼻炎的病例,观察导师经验用方的疗效和不良反应。变应性鼻炎的诊断标准和疗效评价标准采用中华医学会耳鼻咽喉科分会2009年版《变应性鼻炎诊断和治疗指南》。
结论
1.主病主方的内涵
王琦教授根据清·徐灵胎《兰台轨范》中提出的“主病主方主药”构想,将主病主方的内涵界定为,“一病多方”中高度针对贯穿整个疾病始终的主导病机的方剂。如东汉时期张仲景论治百合病有百合地黄汤、百合知母汤、滑石代赭汤、栝蒌牡蛎散多方,其中高度针对百合病心肺阴虚内热这一主导病机的主方便是百合地黄汤。主病主方有别于“一病一方”的专病专方,也异于“多病一方”的通治方。
2.主病主方“四级”制方思路
首先,主病主方的精髓是审机制方。其实施思路有三：一是分清病机层次,有序遣药组方；二是揆度病机态势,把握制方法度；三是辨识复杂病机,注重“无者求之”。其二主病主方的特长是专病专药。如竹茹止血,稽豆衣止汗,延胡索止痛,苦参治心悸等。专药直指病症；专药不宜单用,通常在主病主方中多用作君药,或在主方中针对主症配伍用药；专药用量宜大,实际上“量足”,以“药-病(症)对应”、“安全有效”为原则。其三,主病主方的根本是辨体制方。这里所谈“辨体制方”并非针对体质本身的调治,而是基于“体病相关”、“治病求本”和“异病同治”的辨体制方。其四,主病主方的方法是移植成方挪作新用、组合小方分层合击、新拟验方另辟蹊径。其中,新拟验方的思路是注重方剂理论、针对专病制方、擅用药对组方、参合药理组方。
3.主病主方“四维”运用模式
中医辨病用方与辨证、辨体用方存在“离合关系”,决定这一“离合关系”的一是已病状态下病情的轻重缓急和证候的有无,二是体-病相关的关联度大小,三是疾病防治的目标与策略,四是治疗前后疗效的观察。即疾病急骤或突显,病势进展比较迅速,此时疾病的主要矛盾远重于证候表现或体质状态时,应当纲举目张,即以主病主方为纲,也可结合辨证和(或)辨体加减；当疾病的病情较为轻缓,证候表现较为明显,一般“合方分击”,即主方主方与辨证用方同时兼顾；如并存的多种病症与体质密切相关,则可“多元归一”,即通过辨体用方调治多种病症；若主病主方或结合辨证用方已获显效时,则可“序贯用方”,即以辨体用方为主可巩固疗效。
4.主病主方临床经验总结
王琦教授从事中医临床工作40余年,对已病状态下倡导辨病为纲结合辨证辨体的“三维诊疗观”,贯穿主病主方专药的学术思想。文中从辨病审机、立法制方探究主病主方的适应范围、制方原理、加减运用(结合辨证、兼顾辨体),并附案例赏析,系统总结王琦教授善治10个病种的临床经验,概要如下：①阳痿的主要病机是肝筋不利,主方是具有疏肝通络、调达宗筋功效的“疏肝振痿汤”；②慢性前列腺炎盆腔综合征的主要病机是肝络瘀阻,主方是具有清热凉血、活血止痛功效的“前列止痛汤”；③少弱精子症的主要病机是肾虚夹湿热瘀毒,主方是具有补肾填精兼清湿热、活血化瘀之功的“升精赞育汤”；④肥胖与代谢综合征的主要病机是痰湿体质为本、气血食郁为标,主方为具有益气温阳、化痰祛湿、消食祛瘀之功的“益气轻健汤”；⑤原发性高血压病的主要病机是气血逆乱热扰水停,主方是功善清肝镇逆、活血利水的“镇逆降压汤”；⑥冠心病的主要病机是痰瘀互结、气微邪痹,主方是功具化痰祛瘀、益气通痹的“宽胸通痹汤”；⑦失眠的主要病机是阴阳失交,肝魂不藏,主方是功效为燮理阴阳、调肝安魂的“高枕无忧汤”；⑧过敏性荨麻疹的主要病机是禀赋不耐,血热风动,主方是具有清热凉血、脱敏消风之功的“脱敏消风汤”；⑨痤疮的主要病机是湿热体质为本,毒瘀痰结为标,主方是具有清热利湿、解毒祛瘀、化痰散结之功的“消痤汤”；⑩慢性疲劳综合征的基本病机是肝郁血虚,筋不耐劳,主方是调肝柔筋的“调肝除疲汤”。
5.61例变应性鼻炎临床观察
共纳入61例成年人变应性鼻炎的病例,导师治疗组纳入30例中,显效11例,有效13例,无效6例,总有效率为80%,2例患者服药后出现胃痛。学术继承人治疗组纳入31例中,显效1例,有效16例,无效14例,总有效率为54.8%,未发现明显的不良反应。采用两组等级资料的非参数检验法进行两组疗效的统计学差异分析。Z=-6.426,双侧P=0.000(<0.05),说明两组疗效有统计学差异。结论：导师治疗变应性鼻炎的辨体用方经验优于学术继承人的辨证用方传统经验。
讨论
1.10个病种诊治新论
在传承导师临床经验的基础上,结合本人的实践体会,对以下10个病种的诊治提出以下观点：①阳痿：提出从“奇经八脉”论治的观点,临证需结合调体及心理疏导；②慢性前列腺炎：重视“瘀浊”病机,诊治慢性前列腺炎不能仅着眼于“炎症”,用药忌一味苦寒清热解毒；③少弱精子症：提出从“脾”资化精血论治的观点,选配温阳药的原则是宜温润而不宜温燥；④肥胖与代谢综合征：探讨肥人气虚、阳虚、血瘀体质与痰湿质的“离合关系”,强调应加强复合体质的研究；⑤原发性高血压病：重视气虚血瘀水停理论在舒张压偏高的高血压病病机学和治疗学中的意义,发挥抗劳、安神及调体在高血压病防治中的积极作用；⑥冠心病：指出胸痹“阳微阴弦”的病机是宗气“不荣”与“不通”的新观点,提出补通宗气为冠心病的基本治法；⑦失眠：提出从“五神脏”论治的整体观；⑧过敏性荨麻疹：倡导从风邪稽伏“卫血同病”论治的新认识；⑨痤疮：指出“体病相关”的辨体制方意义；⑩慢性疲劳综合征：提出从“心身双向调治”的主张。
2.变应性鼻炎的临床研究
①对比分析导师“脱敏止嚏汤”与经方小青龙汤的制方方法,本人提出“脱敏止嚏汤”适用于变应性鼻炎的特禀体质、小青龙加石膏汤适用于阳虚兼特禀复合体质的新论点；②提出规范体质与证候的临床界定、确定“病-体-方相关”、“病-证-方相关”的临床范围等新主张；③呼吁加强对中药不良反应的观察和预防；④本研究提示导师从伏热上干异气外侵调体论治较之传统的辨证论治变应性鼻炎具有较高的优势,但是病例对照研究的局限性提示其疗效需要更高等级的临床研究进一步证实；⑤本研究为中药治疗AR的临床研究提供方法学的启示,需进一步优化治疗方案、完善AR结局评价体系、优化临床研究方法。
中文摘要:背景:变应性鼻炎(Allergic rhinitis,AR)是IgE介导的鼻钻膜慢性炎症反应性疾病,该病对病人的睡眠、记忆、情绪、生活质量造成了严重的影响。王琦教授从伏热上干异气外侵调体论治变应性鼻炎能够明显改善病人的症状、并且部分患者能够治愈,显示出中药治疗AR的优势。目的:观察评价王琦教授治疗AR经验用方的临床疗效和安全性。方法:本研究采用病历对照研究的方法,观察组为导师采用伏热上干异气外侵调体论治变应性鼻炎的病例,对照组为学术继承人从传统的寒饮伏肺外邪诱发辨证论治变应性鼻炎的病例,观察导师经验用方的疗效和不良反应。变应性鼻炎的诊断标准和疗效评价标准采用中华医学会耳鼻咽喉科分会2009年版《变应性鼻炎诊断和治疗指南》。结果:共纳入61例成年人变应性鼻炎的病例,导师治疗组纳入03例中,显效11例,有效13例,无效6例,总有效率为80%,2例患者服药后出现胃痛。学术继承人治疗组纳入31例中,显效1例,有效16例,无效14例,总有效率为54.8%,未发现明显的不良反应。采用两组等级资料的非参数检验法进行两组疗效的统计学差异分析。Z=-6.426,双侧=P.0000(<0.05),说明两组疗效有统计学差异。结论:导师治疗变应性鼻炎的辨体用方经验优于学术继承人的辨证用方传统经验。讨论:①对比分析导师“脱敏止嚏汤”与经方小青龙汤的制方方法,本人提出“脱敏止嚏汤”适用于变应性鼻炎的特票体质、小青龙加石膏汤适用于阳虚兼特察复合体质的新论点;②提出规范体质与证候的临床界定、确定“病-体-方相关”、“病-证-方相关”的临床范围等新主张;③呼吁加强对中药不良反应的观察和预防;④本研究提示导师从伏热上干异气外侵调体论治较之传统的辨证论治变应性鼻炎具有较高的优势,但是病例对照研究的局限性提示其疗效需要更高等级的临床研究进一步证实;⑤本研究为中药治疗AR的临床研究提供方法学的启示,需进一步优化治疗方案、完善AR结局评价体系、优化临床研究方法。
Background:Syndrome differentiation and treatment has been considered the authority and golden criteria, and becoming the characteristic brand of traditional Chinese medicine (TCM) therapy, even has been established the valuable criteria when evaluating TCM treatment for a long time. It is believed that there is a trend of focus on syndrome differentiation instead of disease differentiation. Researches on TCM history of disease diagnostic and treatment indicate that disease diagnosis and differentiation, syndrome identification from disease, prescription based on disease have become the origin of TCM treatment. In the Preface to Lan Tai Gui Fan by Xu Dachun, the author pointed that a kind of disease must refer to a specified main prescription (zhu-fang), meanwhile, a special prescription must respond to a monarch medicinal (zhu-yao). However, this point of view was not given enough concentration since then, instead, the theory of special prescription with medicine for specified disease leads to the focus on disease differentiation over syndrome differentiation. How to scientifically evaluate and practice multiple diagnostic models of TCM is acknowledged as one of the most issue in translational medicine nowadays.
Allergic rhinitis (AR) is a chronic inflammatory reactive disease on schneiderian membrane mediated by IgE, and can seriously impact on patients'sleeping, memory, emotion and quality of life. Professor Wang Qi applies the treatment idea of regulating physic against latent heat adverse rising and unhealthy qi external invade for treatment of adult with allergic rhinitis, which could obviously relieve patients'symptoms, and even cure some patients. This indicates that Chinese herbal medicine has advantages in treating AR.
Objective:This study is based on the idea promoted by Professor Wang Qi that disease differentiation, as the key link, should be combined with syndrome differentiation and body differentiation, namely, the three-dimensional diagnosis-treatment ideology, with the disease as the cut-point when the patient is ill. This study is expected to concentrate on the ideology of monarch disease and main prescription by the supervisor, digest the prescription establishing process, and summarize the academic experience of monarch disease and main prescription by the supervisor, in order to systematically review and evaluate the clinical effectiveness and safety of Professor Wang Qi's experienced prescription for treatment of AR. The purpose of this study is to provide with a research model for succeeding elderly famous TCM practitioners'ideology and academic experience, which is believed to be significance, both in theory and in practice, for translational application of the three-dimensional diagnosis-treatment, and for the enrichment and development of multiple TCM diagnosis-treatment ideas.
Methods:1) Academic study and extraction of Professor Wang Qi's monarch disease and main prescription ideology:by relevant literature research, clinical practice following the supervisor, cases study, learning from presentations, clinical observations and various ways, under the guidance of supervisor, to concentrate the academic ideology of monarch disease and main prescription. Therefore, a total of ten representative diseases were selected, from the disease differentiation and mechanism examination, application field of the monarch disease and main prescription, the establishment theory of prescription, modification (combined with syndrome differentiation and body differentiation), review on case reports and new construction based on experience would be followed, in order to systematically and thoroughly reflect the establishment of monarch disease and main prescription, clinical experience,.gain from practice following the supervisor and its experience, personal ideas and innovations, et al.2) Clinical research of Professor Wang Qi's "Body Recuperation Theory on Summer Heat Upsetting and External Invasion by Pathogenic Factor" for treatment of adult patients with AR:in this case control study, participants were divided into Group Treated by Advisors (Group A), and Group Treated by Academic Successors (Group B). Participants in Group A received treatment from advisor's applying the treatment idea of "Body Recuperation Theory on Summer Heat Upsetting and External Invasion by Pathogenic Factor", and participants in Group B received treatment from the academic successors applying the traditional method of treatment against cold-water retention storing in the lungs and stimulated by external evil. We observed the effectiveness and safety of the prescription from the advisors. The Guideline on the Diagnosis and Treatment of Allergic Rhinitis, which is issued in 2009 by the China Medical Association Otolaryngology Seminal, was employed for diagnosis and effectiveness evaluation criteria of AR in this study.
Conclusions:
1. The concept of main prescription for its disease
Professor Wang Qi pointed out the construction of "monarch disease, main prescription and key medicine (zhu ming zhu fang zhu yao)" from Lan Tai Gui Fan by Xu Lingtai (Qing dynasty), and defined the concept of "monarch disease and main prescription" as the prescription targeting at the leading mechanism that impenetrate the disease from the beginning to the end in the "many prescriptions for one disease". For example, Zhang Zhongjing used Baihe Dihuang decoction, Baihe Zhimu decoction, Huashi Daizhe decoction, Gualou Muli powder, and so on, in treating lily disease, neurosis characterized by mental strain, listlessness, sleeplessness, anorexia, yellow urine, et al., in which, Baihe Dihuang decoction is highly concentrated for heart-lung yin-deficiency with internal heat mechanism. The main prescription for its disease is different from one prescription for one disease, specified formula for specified disease, and one prescription for multiple diseases.
2. Four-step establishment idea of monarch disease and main prescription
First, the kernel of monarch disease and main prescription is that the combination of medicine in the prescription should be logically examined and considered. There are three ways leading to its practice.1) distinguish different levels of disease mechanism and prescribe orderly; 2) hold the trend of disease mechanism, and grasp the rule of prescription establishment; 3) differentiate the complicated disease mechanism, focusing on explore the hidden mechanism (wu zhe qiu zhi). Second, the specialization of monarch disease and main prescription is specified medicinal for its disease. If a kind of medicine is effective for a kind of disease, it's called the specified medicinal of this disease. For example, Bambusa breviflora Munro is for hemostasis, Glycine max (L.) Merr. is used to check sweating, Corydalis turtschaninovii Bess. is for relieving pain, and Sophora flavescens Ait. is for treatment of palpitation, et al. specialized medicine should not be used singly. Commonly, the specialized medicine in monarch disease and main prescription is the monarch medicine (jun yao), or targeting at the main symptom in medicine matching-up; furthermore, the amount of specialized medicine should be large, actually, should be enough, as the "medicine relates to disease or symptom", safe and effective, as the principle. Third, the nature of monarch disease and main prescription is body differentiation and prescription, which is not targeting at coordinating the body, but disease-related body, treatment by the root cause, same treatment for different symptom related disease. Forth, the method of monarch disease and main prescription is to transform the original formula for new application, combine small formula from different levels, establish experienced formula to find different treatment efficacy. In which, the establishment of new prescription idea is focusing on formula theory, specialized prescription for special disease, medicine matching-up and combination of formula, as well as considering the TCM Pharmacology.
3. "Four-dimension" application mode of monarch disease and main prescription
There is an eccentrically-syncretic relationship between TCM body differentiation and syndrome-disease differentiation and treatment. This kind of relationship is determined byfollowing:1) the degree of ill condition and the existence of syndrome,2) the association between human body and disease,3) the purpose and strategy of prevention and treatment, and 4) the observation of effectiveness before and after the treatment. When the disease is getting worse or presents suddenly, the disease trend develops quickly, the main issue should be over the syndrome presentation or signs, and the compendium of main prescription for its disease should be emphasized, also modification should be considered by syndrome differentiation and/or body differentiation. On the other hand, when the disease trend is less distinct than the syndrome presentation, it is expected to use the formula for divided targets, namely, to combine the main prescription for its disease and syndrome differentiation-treatment. If the disease is complicated with body conditions, the idea that multiple sides lead to one (duo yuan gui yi) is employed, therefore, the complicated diseases should be treated with body differentiation. If the effectiveness is achieved by the above treatment, the order of prescription (xu guan yong fang) could be used, therefore, body differentiation and treatment is for further effectiveness.
4. Summary on clinical experience on monarch disease and main prescription
Prof Wang Qi has been practiced TCM in clinic for more than forty years, and promoted the "Three-dimensional diagnostic perspective" of the combination of syndrome differentiation and body differentiation with the key kernel of disease differentiation when the patient is ill, and this perspective should be considered through the academic ideology of monarch disease and main prescription with specialized medicine. This study would systematically review the clinical experience of ten diseases'treatment by Prof Wang Qi.1) the main mechanism of impotence is liver-meridian failing to function normally, therefore, the main prescription is Shugan Zhenwei Decoction, targeting at soothing liver and strengthening liver, and unblocking meridian; 2) the main mechanism of Chronic prostatitis pelvic syndrome is stasis blocking liver-meridian, therefore, the main prescription is Qianlie Zhitong Decoction, targeting at clearing hear and cooling blood, activating blood and relieving pain; 3) the main mechanism of asthenospermia is the kidney-deficiency complicated with dampness-heat and stasis toxicity, therefore, the main prescription is Shengjing Zanyu Decoction, targeting at notifying kidney by adding essence and clear dampness-heat, activating blood and removing stasis; 4) the main mechanism of obesity and metabolism syndrome is phlegm-dampness as body characteristic as the root cause, and qi-blood and impound food as symptoms, therefore, the main prescription is Yiqi Qingjian Decoction, targeting at strengthening qi and warming yang, removing phlegm and dampness, promoting digesting to remove the stasis; 5) the main mechanism of primary hypertension is qi-blood upsetting and heat leading to fluid stagnation, therefore, the main prescription is Zhenni Jiangya Decoction, targeting at clearing liver to keep down the reversing by qi and heat, activating blood to promote the fluid; 6) the main mechanism of coronary heart disease is phlegm-stasis combined, pathogen obstruction the qi movement, therefore, the main prescription is Kuanxiong Tongbi Decoction, targeting at removing phlegm and stasis, strengthening qi and unblocking the obstruction; 7) the mechanism of insomnia is the yin and yang failing to interact, leading to the collection of liver-vigor, therefore, the main prescription is Gaozhen Wuyou Decoction, targeting at coordinating yin and yang, adjusting the liver-vigor; 8) the main mechanism of allergic urticaria is upsetting characteristic of natural endowment, blood-heat and wind, therefore the main prescription is Desensitized Removing-wind Decoction, targeting at clearing heat and cooling blood, desensitizing and removing wind; 9) the main mechanism of acne is dampness-heat as body characteristics as the root cause, and toxicity of phlegm-stasis as symptoms, therefore, the main prescription is Xiao Cuo Decoction, targeting at clearing heat to remove dampness, detoxicity and removing stasis; 10) the main mechanism of chronic fatigue is liver-depression and blood-deficiency, therefore, the main prescription is Tiaogan Chupi Decoction, literally, to relieve the fatigue by coordinating the liver and its meridian.
5. Clinical observation on 61 patients with AR
A total of 61 adult patients with AR were included in this case series. Group A totally included 30 patients with AR, involving 11 cases of obvious effective,13 cases effective,6 failed, with the total effective rate 80%. Two patients got stomachache after taking the medication. Group B included 31 patients, involving 1 case of obvious effective,16 cases effective,14 failed, with the total effective rate 54.8%, and no adverse reaction was found. We applied non-para metric rank quantizer to test the statistical difference between two groups. There is statistical significance between two groups (Z=-6.426, two-tailed P=0.000<0.05). It could be concluded that the experience from supervisor's body differentiation and prescription for treatment of AR is superior to that from academic successors'syndrome differentiation and prescription.
Discussions:
1. New idea on the diagnosis and treatment for ten diseases
Based on the clinical experience of succeeding Prof Wang Qi, and combined personal experience from practice, the author promoted the following perspectives:1) treatment for impotentia should be focused on body condition coordination and psychological education, the treatment perspective is from "eight extra channels"; 2) treatment for chronic prostatitis could be concentrated on stasis-pathogen leading to disease, and the diagnosis and treatment should not only focus on inflammation, but also avoiding the medications of bitter-cold and clearing heat and detoxicity; 3) asthenospermia should be treated according to the perspective that spleen essence transforms to blood, and medication rules should be warm-embellishing instead of warm-dryness; 4) obesity and metabolism syndrome have great relation with fatty body of qi-deficiency, yang-deficiency and blood stasis as body characteristics, and the away-join relation with phlegm-dampness; 5) during the treatment for primary hypertension, the qi-deficiency and blood-stasis and fluid stagnation theory has great significance in the mechanism of hypertension when the diastolic pressure is high, and the treatment should focus on the positive function of anti-fatigue and adjusting body condition for treatment and prevention of hypertension; 6) in treating coronary heart disease, the new perspective that chest arthromyodynia is related to the prosperity loss or blocking of Zong-qi, therefore, the main therapy is to strengthening Zong-qi; 7) in treating insomnia, the Concept of holism of Five-Sprit Zang treatment theory has been promoted; 8) in treating allergic urticaria, the perspective that Wei-blood being both invaded should be promoted; 9) in treating acne, the combination of body-differentiation for prescription should be concentrated; 10) in treating chronic fatigue, it is expected to coordinate both body condition and psychological condition.
2. Clinical research on AR
1) By comparing and analyzing the supervisor's prescription of Tuomin Zhiti Tang (Decoction for desensitization and relieving sternutation) with Xiao Qionglong Decoction, the author pointed out that the former is for patients of special body characteristic with AR, while the latter should be employed for treatment of patients with yang-deficiency combined with special body characteristics; 2) the promotion of clinical definition of regulating body and syndrome, and define the relation between disease-body-prescription, the relation between disease-syndrome-and prescription, such clinically novel innovations; 3) observation and prevention on adverse reaction of Chinese herbal medicine; 4) the study suggested that the experience from supervisor's body differentiation and prescription for treatment of AR is superior to that from academic successors'syndrome differentiation and prescription, but the case-control design's limitations should be also considered, and further researches are expected; 5) this study is expected to provide with clinical research in mythology when using Chinese herbal medicine in treating AR, therefore, further effective treatment plan, perfect AR outcome measurement system, and superior clinical research mythology should be given great concentration in the future.
Background: Allergic rhinitis (AR) is a chronic inflammatory reactive disease on schneiderian membrane mediated by IgE, and can seriously impact on patients' sleeping, memory, emotion and quality of life. Professor Wang Qi applies the treatment idea of regulating physic against latent heat adverse rising and unhealthy qi external invade for treatment of adult with allergic rhinitis, which could obviously relieve patients' symptoms, and even cure some patients. This indicates that Chinese herbal medicine has advantages in treating AR.
Objectives: To observe the clinical effectiveness and safety of Prof. Wang Qi's experiences in treating AR.
Methods: This study was a case control study, participants were divided into Group Treated by Advisors (Group A), and Group Treated by Academic Successors (Group B), and participants in Group A received treatment from advisors applying the treatment idea of regulating physic against latent heat adverse rising and unhealthy qi external invade, and participants in Group B received treatment from the academic successors applying the traditional method of treatment against cold-water retention storing in the lungs and stimulated by external evil. We observed the effectiveness and safety of the prescription from the advisors. The Guideline on the Diagnosis and Treatment of Allergic Rhinitis, which is issued in 2009 by the China Medical Association Otolaryngology Seminal, was employed for diagnosis and effectiveness evaluation criteria of AR in this study.
Results: A total of 61 adult patients with AR were included in this case series. Group A totally included 30 patients with AR, involving 11 cases of obvious effective, 13 cases effective, 6 failed, with the total effective rate 80 %. Two patients got stomachache after taking the medication. Group B included 31 patients, involving 1 case of obvious effective, 16 cases effective, 14 failed, with the total effective rate 54.8%, and no adverse reaction was found. We applied non-para metric rank quantizer to test the statistical difference between two groups. There is statistical significance between two groups (Z—6.426, two-tailed P=0.000 <0.05). Conclusion: Treatment in Group A is more effective than the traditional treatment method applied in Group B in treating AR.
Discussion: (D By comparing and analyzing the supervisor's prescription of Tuomin Zhiti Tang (Decoction for desensitization and relieving sternutation) with Xiao Qionglong Decoction, the author pointed out that the former is for patients of special body characteristic with AR, while the latter should be employed for treatment of patients with yang-deficiency combined with special body characteristics; ? the promotion of clinical definition of regulating body and syndrome, and define the relation between disease-body-prescription, the relation between disease-syndrome-and prescription, such clinically novel innovations; ? observation and prevention on adverse reaction of Chinese herbal medicine; ? the study suggested that the experience from supervisor's body differentiation and prescription for treatment of AR is superior to that from academic successors' syndrome differentiation and prescription, but the case-control design's limitations should be also considered, and further researches are expected; (§)his study is expected to provide with clinical research in mythology when using Chinese herbal medicine in treating AR, therefore, further effective treatment plan, perfect outcome measurement system, and superior clinical research mythology should be given great concentration in the future.
较长时期以来,辨证论治被提到至高无上的地位,成为中医诊疗特色的代名词,甚至演化为评析中医诊疗的价值标准,逐渐趋向“轻辨病重辨证”的态势。中医疾病史研究表明,识病辨病、以病统证、据病施方,为中医诊疗之原始。徐大椿在《兰台轨范·序》明确指出“一病必有主方,一方必有主药”。然而,这种观点并未引起后世足够重视,取而代之的却是“专病专方专药”论,由此进入“重辨病轻辨证”的另一走向。如何科学地评价和应用中医多元化的诊疗模式是当今转化医学面临的一个重要问题。
变应性鼻炎(Allergic rhinitis, AR)是IgE介导的鼻黏膜慢性炎症反应性疾病,该病对病人的睡眠、记忆、情绪、生活质量造成了严重的影响。王琦教授从伏热上干异气外侵调体论治变应性鼻炎能够明显改善病人的症状、并且部分患者能够治愈,显示出中药治疗AR的优势。
目的
本研究基于王琦教授倡导的已病状态下辨病为纲结合辨证、辨体的“三维诊疗”思想,以人的“病”为切入点,凝练导师主病主方的学术思想,领悟导师的制方思路和方法,总结导师主病主方的临床经验,进而系统观察评价王琦教授治疗AR经验用方的临床疗效和安全性。本课题将为名老中医学术思想和学术经验的传承提供研究模式,对于丰富和发展中医多元化的诊疗思想、促进和推广“三维诊疗”模式在已病状态下的转化应用,具有重要的理论和实践意义。
内容与方法
1.王琦老中医药专家主病主方学术思想与临床经验总结
通过相关文献调研、定期跟师门诊、医案整理、听师讲座、临床观察等多种途径,在导师指导下,凝练其主病主方的学术思想,进而选择10个代表性病种,从辨病审机、立法制方探究主病主方的适应范围、制方原理、加减运用(结合辨证、兼顾辨体),并附案例赏析、推新师意等方面,全面反映导师的主病主方创制方法、临床经验,以及跟师心得、实践体会、个人观点及创新思路等。
2.王琦教授从伏热上干异气外侵调体论治成年人变应性鼻炎的临床研究
采用病历对照研究的方法,观察组为导师采用伏热上干异气外侵调体论治变应性鼻炎的病例,对照组为学术继承人从传统的寒饮伏肺外邪诱发辨证论治变应性鼻炎的病例,观察导师经验用方的疗效和不良反应。变应性鼻炎的诊断标准和疗效评价标准采用中华医学会耳鼻咽喉科分会2009年版《变应性鼻炎诊断和治疗指南》。
结论
1.主病主方的内涵
王琦教授根据清·徐灵胎《兰台轨范》中提出的“主病主方主药”构想,将主病主方的内涵界定为,“一病多方”中高度针对贯穿整个疾病始终的主导病机的方剂。如东汉时期张仲景论治百合病有百合地黄汤、百合知母汤、滑石代赭汤、栝蒌牡蛎散多方,其中高度针对百合病心肺阴虚内热这一主导病机的主方便是百合地黄汤。主病主方有别于“一病一方”的专病专方,也异于“多病一方”的通治方。
2.主病主方“四级”制方思路
首先,主病主方的精髓是审机制方。其实施思路有三：一是分清病机层次,有序遣药组方；二是揆度病机态势,把握制方法度；三是辨识复杂病机,注重“无者求之”。其二主病主方的特长是专病专药。如竹茹止血,稽豆衣止汗,延胡索止痛,苦参治心悸等。专药直指病症；专药不宜单用,通常在主病主方中多用作君药,或在主方中针对主症配伍用药；专药用量宜大,实际上“量足”,以“药-病(症)对应”、“安全有效”为原则。其三,主病主方的根本是辨体制方。这里所谈“辨体制方”并非针对体质本身的调治,而是基于“体病相关”、“治病求本”和“异病同治”的辨体制方。其四,主病主方的方法是移植成方挪作新用、组合小方分层合击、新拟验方另辟蹊径。其中,新拟验方的思路是注重方剂理论、针对专病制方、擅用药对组方、参合药理组方。
3.主病主方“四维”运用模式
中医辨病用方与辨证、辨体用方存在“离合关系”,决定这一“离合关系”的一是已病状态下病情的轻重缓急和证候的有无,二是体-病相关的关联度大小,三是疾病防治的目标与策略,四是治疗前后疗效的观察。即疾病急骤或突显,病势进展比较迅速,此时疾病的主要矛盾远重于证候表现或体质状态时,应当纲举目张,即以主病主方为纲,也可结合辨证和(或)辨体加减；当疾病的病情较为轻缓,证候表现较为明显,一般“合方分击”,即主方主方与辨证用方同时兼顾；如并存的多种病症与体质密切相关,则可“多元归一”,即通过辨体用方调治多种病症；若主病主方或结合辨证用方已获显效时,则可“序贯用方”,即以辨体用方为主可巩固疗效。
4.主病主方临床经验总结
王琦教授从事中医临床工作40余年,对已病状态下倡导辨病为纲结合辨证辨体的“三维诊疗观”,贯穿主病主方专药的学术思想。文中从辨病审机、立法制方探究主病主方的适应范围、制方原理、加减运用(结合辨证、兼顾辨体),并附案例赏析,系统总结王琦教授善治10个病种的临床经验,概要如下：①阳痿的主要病机是肝筋不利,主方是具有疏肝通络、调达宗筋功效的“疏肝振痿汤”；②慢性前列腺炎盆腔综合征的主要病机是肝络瘀阻,主方是具有清热凉血、活血止痛功效的“前列止痛汤”；③少弱精子症的主要病机是肾虚夹湿热瘀毒,主方是具有补肾填精兼清湿热、活血化瘀之功的“升精赞育汤”；④肥胖与代谢综合征的主要病机是痰湿体质为本、气血食郁为标,主方为具有益气温阳、化痰祛湿、消食祛瘀之功的“益气轻健汤”；⑤原发性高血压病的主要病机是气血逆乱热扰水停,主方是功善清肝镇逆、活血利水的“镇逆降压汤”；⑥冠心病的主要病机是痰瘀互结、气微邪痹,主方是功具化痰祛瘀、益气通痹的“宽胸通痹汤”；⑦失眠的主要病机是阴阳失交,肝魂不藏,主方是功效为燮理阴阳、调肝安魂的“高枕无忧汤”；⑧过敏性荨麻疹的主要病机是禀赋不耐,血热风动,主方是具有清热凉血、脱敏消风之功的“脱敏消风汤”；⑨痤疮的主要病机是湿热体质为本,毒瘀痰结为标,主方是具有清热利湿、解毒祛瘀、化痰散结之功的“消痤汤”；⑩慢性疲劳综合征的基本病机是肝郁血虚,筋不耐劳,主方是调肝柔筋的“调肝除疲汤”。
5.61例变应性鼻炎临床观察
共纳入61例成年人变应性鼻炎的病例,导师治疗组纳入30例中,显效11例,有效13例,无效6例,总有效率为80%,2例患者服药后出现胃痛。学术继承人治疗组纳入31例中,显效1例,有效16例,无效14例,总有效率为54.8%,未发现明显的不良反应。采用两组等级资料的非参数检验法进行两组疗效的统计学差异分析。Z=-6.426,双侧P=0.000(<0.05),说明两组疗效有统计学差异。结论：导师治疗变应性鼻炎的辨体用方经验优于学术继承人的辨证用方传统经验。
讨论
1.10个病种诊治新论
在传承导师临床经验的基础上,结合本人的实践体会,对以下10个病种的诊治提出以下观点：①阳痿：提出从“奇经八脉”论治的观点,临证需结合调体及心理疏导；②慢性前列腺炎：重视“瘀浊”病机,诊治慢性前列腺炎不能仅着眼于“炎症”,用药忌一味苦寒清热解毒；③少弱精子症：提出从“脾”资化精血论治的观点,选配温阳药的原则是宜温润而不宜温燥；④肥胖与代谢综合征：探讨肥人气虚、阳虚、血瘀体质与痰湿质的“离合关系”,强调应加强复合体质的研究；⑤原发性高血压病：重视气虚血瘀水停理论在舒张压偏高的高血压病病机学和治疗学中的意义,发挥抗劳、安神及调体在高血压病防治中的积极作用；⑥冠心病：指出胸痹“阳微阴弦”的病机是宗气“不荣”与“不通”的新观点,提出补通宗气为冠心病的基本治法；⑦失眠：提出从“五神脏”论治的整体观；⑧过敏性荨麻疹：倡导从风邪稽伏“卫血同病”论治的新认识；⑨痤疮：指出“体病相关”的辨体制方意义；⑩慢性疲劳综合征：提出从“心身双向调治”的主张。
2.变应性鼻炎的临床研究
①对比分析导师“脱敏止嚏汤”与经方小青龙汤的制方方法,本人提出“脱敏止嚏汤”适用于变应性鼻炎的特禀体质、小青龙加石膏汤适用于阳虚兼特禀复合体质的新论点；②提出规范体质与证候的临床界定、确定“病-体-方相关”、“病-证-方相关”的临床范围等新主张；③呼吁加强对中药不良反应的观察和预防；④本研究提示导师从伏热上干异气外侵调体论治较之传统的辨证论治变应性鼻炎具有较高的优势,但是病例对照研究的局限性提示其疗效需要更高等级的临床研究进一步证实；⑤本研究为中药治疗AR的临床研究提供方法学的启示,需进一步优化治疗方案、完善AR结局评价体系、优化临床研究方法。
中文摘要:背景:变应性鼻炎(Allergic rhinitis,AR)是IgE介导的鼻钻膜慢性炎症反应性疾病,该病对病人的睡眠、记忆、情绪、生活质量造成了严重的影响。王琦教授从伏热上干异气外侵调体论治变应性鼻炎能够明显改善病人的症状、并且部分患者能够治愈,显示出中药治疗AR的优势。目的:观察评价王琦教授治疗AR经验用方的临床疗效和安全性。方法:本研究采用病历对照研究的方法,观察组为导师采用伏热上干异气外侵调体论治变应性鼻炎的病例,对照组为学术继承人从传统的寒饮伏肺外邪诱发辨证论治变应性鼻炎的病例,观察导师经验用方的疗效和不良反应。变应性鼻炎的诊断标准和疗效评价标准采用中华医学会耳鼻咽喉科分会2009年版《变应性鼻炎诊断和治疗指南》。结果:共纳入61例成年人变应性鼻炎的病例,导师治疗组纳入03例中,显效11例,有效13例,无效6例,总有效率为80%,2例患者服药后出现胃痛。学术继承人治疗组纳入31例中,显效1例,有效16例,无效14例,总有效率为54.8%,未发现明显的不良反应。采用两组等级资料的非参数检验法进行两组疗效的统计学差异分析。Z=-6.426,双侧=P.0000(<0.05),说明两组疗效有统计学差异。结论:导师治疗变应性鼻炎的辨体用方经验优于学术继承人的辨证用方传统经验。讨论:①对比分析导师“脱敏止嚏汤”与经方小青龙汤的制方方法,本人提出“脱敏止嚏汤”适用于变应性鼻炎的特票体质、小青龙加石膏汤适用于阳虚兼特察复合体质的新论点;②提出规范体质与证候的临床界定、确定“病-体-方相关”、“病-证-方相关”的临床范围等新主张;③呼吁加强对中药不良反应的观察和预防;④本研究提示导师从伏热上干异气外侵调体论治较之传统的辨证论治变应性鼻炎具有较高的优势,但是病例对照研究的局限性提示其疗效需要更高等级的临床研究进一步证实;⑤本研究为中药治疗AR的临床研究提供方法学的启示,需进一步优化治疗方案、完善AR结局评价体系、优化临床研究方法。
Background:Syndrome differentiation and treatment has been considered the authority and golden criteria, and becoming the characteristic brand of traditional Chinese medicine (TCM) therapy, even has been established the valuable criteria when evaluating TCM treatment for a long time. It is believed that there is a trend of focus on syndrome differentiation instead of disease differentiation. Researches on TCM history of disease diagnostic and treatment indicate that disease diagnosis and differentiation, syndrome identification from disease, prescription based on disease have become the origin of TCM treatment. In the Preface to Lan Tai Gui Fan by Xu Dachun, the author pointed that a kind of disease must refer to a specified main prescription (zhu-fang), meanwhile, a special prescription must respond to a monarch medicinal (zhu-yao). However, this point of view was not given enough concentration since then, instead, the theory of special prescription with medicine for specified disease leads to the focus on disease differentiation over syndrome differentiation. How to scientifically evaluate and practice multiple diagnostic models of TCM is acknowledged as one of the most issue in translational medicine nowadays.
Allergic rhinitis (AR) is a chronic inflammatory reactive disease on schneiderian membrane mediated by IgE, and can seriously impact on patients'sleeping, memory, emotion and quality of life. Professor Wang Qi applies the treatment idea of regulating physic against latent heat adverse rising and unhealthy qi external invade for treatment of adult with allergic rhinitis, which could obviously relieve patients'symptoms, and even cure some patients. This indicates that Chinese herbal medicine has advantages in treating AR.
Objective:This study is based on the idea promoted by Professor Wang Qi that disease differentiation, as the key link, should be combined with syndrome differentiation and body differentiation, namely, the three-dimensional diagnosis-treatment ideology, with the disease as the cut-point when the patient is ill. This study is expected to concentrate on the ideology of monarch disease and main prescription by the supervisor, digest the prescription establishing process, and summarize the academic experience of monarch disease and main prescription by the supervisor, in order to systematically review and evaluate the clinical effectiveness and safety of Professor Wang Qi's experienced prescription for treatment of AR. The purpose of this study is to provide with a research model for succeeding elderly famous TCM practitioners'ideology and academic experience, which is believed to be significance, both in theory and in practice, for translational application of the three-dimensional diagnosis-treatment, and for the enrichment and development of multiple TCM diagnosis-treatment ideas.
Methods:1) Academic study and extraction of Professor Wang Qi's monarch disease and main prescription ideology:by relevant literature research, clinical practice following the supervisor, cases study, learning from presentations, clinical observations and various ways, under the guidance of supervisor, to concentrate the academic ideology of monarch disease and main prescription. Therefore, a total of ten representative diseases were selected, from the disease differentiation and mechanism examination, application field of the monarch disease and main prescription, the establishment theory of prescription, modification (combined with syndrome differentiation and body differentiation), review on case reports and new construction based on experience would be followed, in order to systematically and thoroughly reflect the establishment of monarch disease and main prescription, clinical experience,.gain from practice following the supervisor and its experience, personal ideas and innovations, et al.2) Clinical research of Professor Wang Qi's "Body Recuperation Theory on Summer Heat Upsetting and External Invasion by Pathogenic Factor" for treatment of adult patients with AR:in this case control study, participants were divided into Group Treated by Advisors (Group A), and Group Treated by Academic Successors (Group B). Participants in Group A received treatment from advisor's applying the treatment idea of "Body Recuperation Theory on Summer Heat Upsetting and External Invasion by Pathogenic Factor", and participants in Group B received treatment from the academic successors applying the traditional method of treatment against cold-water retention storing in the lungs and stimulated by external evil. We observed the effectiveness and safety of the prescription from the advisors. The Guideline on the Diagnosis and Treatment of Allergic Rhinitis, which is issued in 2009 by the China Medical Association Otolaryngology Seminal, was employed for diagnosis and effectiveness evaluation criteria of AR in this study.
Conclusions:
1. The concept of main prescription for its disease
Professor Wang Qi pointed out the construction of "monarch disease, main prescription and key medicine (zhu ming zhu fang zhu yao)" from Lan Tai Gui Fan by Xu Lingtai (Qing dynasty), and defined the concept of "monarch disease and main prescription" as the prescription targeting at the leading mechanism that impenetrate the disease from the beginning to the end in the "many prescriptions for one disease". For example, Zhang Zhongjing used Baihe Dihuang decoction, Baihe Zhimu decoction, Huashi Daizhe decoction, Gualou Muli powder, and so on, in treating lily disease, neurosis characterized by mental strain, listlessness, sleeplessness, anorexia, yellow urine, et al., in which, Baihe Dihuang decoction is highly concentrated for heart-lung yin-deficiency with internal heat mechanism. The main prescription for its disease is different from one prescription for one disease, specified formula for specified disease, and one prescription for multiple diseases.
2. Four-step establishment idea of monarch disease and main prescription
First, the kernel of monarch disease and main prescription is that the combination of medicine in the prescription should be logically examined and considered. There are three ways leading to its practice.1) distinguish different levels of disease mechanism and prescribe orderly; 2) hold the trend of disease mechanism, and grasp the rule of prescription establishment; 3) differentiate the complicated disease mechanism, focusing on explore the hidden mechanism (wu zhe qiu zhi). Second, the specialization of monarch disease and main prescription is specified medicinal for its disease. If a kind of medicine is effective for a kind of disease, it's called the specified medicinal of this disease. For example, Bambusa breviflora Munro is for hemostasis, Glycine max (L.) Merr. is used to check sweating, Corydalis turtschaninovii Bess. is for relieving pain, and Sophora flavescens Ait. is for treatment of palpitation, et al. specialized medicine should not be used singly. Commonly, the specialized medicine in monarch disease and main prescription is the monarch medicine (jun yao), or targeting at the main symptom in medicine matching-up; furthermore, the amount of specialized medicine should be large, actually, should be enough, as the "medicine relates to disease or symptom", safe and effective, as the principle. Third, the nature of monarch disease and main prescription is body differentiation and prescription, which is not targeting at coordinating the body, but disease-related body, treatment by the root cause, same treatment for different symptom related disease. Forth, the method of monarch disease and main prescription is to transform the original formula for new application, combine small formula from different levels, establish experienced formula to find different treatment efficacy. In which, the establishment of new prescription idea is focusing on formula theory, specialized prescription for special disease, medicine matching-up and combination of formula, as well as considering the TCM Pharmacology.
3. "Four-dimension" application mode of monarch disease and main prescription
There is an eccentrically-syncretic relationship between TCM body differentiation and syndrome-disease differentiation and treatment. This kind of relationship is determined byfollowing:1) the degree of ill condition and the existence of syndrome,2) the association between human body and disease,3) the purpose and strategy of prevention and treatment, and 4) the observation of effectiveness before and after the treatment. When the disease is getting worse or presents suddenly, the disease trend develops quickly, the main issue should be over the syndrome presentation or signs, and the compendium of main prescription for its disease should be emphasized, also modification should be considered by syndrome differentiation and/or body differentiation. On the other hand, when the disease trend is less distinct than the syndrome presentation, it is expected to use the formula for divided targets, namely, to combine the main prescription for its disease and syndrome differentiation-treatment. If the disease is complicated with body conditions, the idea that multiple sides lead to one (duo yuan gui yi) is employed, therefore, the complicated diseases should be treated with body differentiation. If the effectiveness is achieved by the above treatment, the order of prescription (xu guan yong fang) could be used, therefore, body differentiation and treatment is for further effectiveness.
4. Summary on clinical experience on monarch disease and main prescription
Prof Wang Qi has been practiced TCM in clinic for more than forty years, and promoted the "Three-dimensional diagnostic perspective" of the combination of syndrome differentiation and body differentiation with the key kernel of disease differentiation when the patient is ill, and this perspective should be considered through the academic ideology of monarch disease and main prescription with specialized medicine. This study would systematically review the clinical experience of ten diseases'treatment by Prof Wang Qi.1) the main mechanism of impotence is liver-meridian failing to function normally, therefore, the main prescription is Shugan Zhenwei Decoction, targeting at soothing liver and strengthening liver, and unblocking meridian; 2) the main mechanism of Chronic prostatitis pelvic syndrome is stasis blocking liver-meridian, therefore, the main prescription is Qianlie Zhitong Decoction, targeting at clearing hear and cooling blood, activating blood and relieving pain; 3) the main mechanism of asthenospermia is the kidney-deficiency complicated with dampness-heat and stasis toxicity, therefore, the main prescription is Shengjing Zanyu Decoction, targeting at notifying kidney by adding essence and clear dampness-heat, activating blood and removing stasis; 4) the main mechanism of obesity and metabolism syndrome is phlegm-dampness as body characteristic as the root cause, and qi-blood and impound food as symptoms, therefore, the main prescription is Yiqi Qingjian Decoction, targeting at strengthening qi and warming yang, removing phlegm and dampness, promoting digesting to remove the stasis; 5) the main mechanism of primary hypertension is qi-blood upsetting and heat leading to fluid stagnation, therefore, the main prescription is Zhenni Jiangya Decoction, targeting at clearing liver to keep down the reversing by qi and heat, activating blood to promote the fluid; 6) the main mechanism of coronary heart disease is phlegm-stasis combined, pathogen obstruction the qi movement, therefore, the main prescription is Kuanxiong Tongbi Decoction, targeting at removing phlegm and stasis, strengthening qi and unblocking the obstruction; 7) the mechanism of insomnia is the yin and yang failing to interact, leading to the collection of liver-vigor, therefore, the main prescription is Gaozhen Wuyou Decoction, targeting at coordinating yin and yang, adjusting the liver-vigor; 8) the main mechanism of allergic urticaria is upsetting characteristic of natural endowment, blood-heat and wind, therefore the main prescription is Desensitized Removing-wind Decoction, targeting at clearing heat and cooling blood, desensitizing and removing wind; 9) the main mechanism of acne is dampness-heat as body characteristics as the root cause, and toxicity of phlegm-stasis as symptoms, therefore, the main prescription is Xiao Cuo Decoction, targeting at clearing heat to remove dampness, detoxicity and removing stasis; 10) the main mechanism of chronic fatigue is liver-depression and blood-deficiency, therefore, the main prescription is Tiaogan Chupi Decoction, literally, to relieve the fatigue by coordinating the liver and its meridian.
5. Clinical observation on 61 patients with AR
A total of 61 adult patients with AR were included in this case series. Group A totally included 30 patients with AR, involving 11 cases of obvious effective,13 cases effective,6 failed, with the total effective rate 80%. Two patients got stomachache after taking the medication. Group B included 31 patients, involving 1 case of obvious effective,16 cases effective,14 failed, with the total effective rate 54.8%, and no adverse reaction was found. We applied non-para metric rank quantizer to test the statistical difference between two groups. There is statistical significance between two groups (Z=-6.426, two-tailed P=0.000<0.05). It could be concluded that the experience from supervisor's body differentiation and prescription for treatment of AR is superior to that from academic successors'syndrome differentiation and prescription.
Discussions:
1. New idea on the diagnosis and treatment for ten diseases
Based on the clinical experience of succeeding Prof Wang Qi, and combined personal experience from practice, the author promoted the following perspectives:1) treatment for impotentia should be focused on body condition coordination and psychological education, the treatment perspective is from "eight extra channels"; 2) treatment for chronic prostatitis could be concentrated on stasis-pathogen leading to disease, and the diagnosis and treatment should not only focus on inflammation, but also avoiding the medications of bitter-cold and clearing heat and detoxicity; 3) asthenospermia should be treated according to the perspective that spleen essence transforms to blood, and medication rules should be warm-embellishing instead of warm-dryness; 4) obesity and metabolism syndrome have great relation with fatty body of qi-deficiency, yang-deficiency and blood stasis as body characteristics, and the away-join relation with phlegm-dampness; 5) during the treatment for primary hypertension, the qi-deficiency and blood-stasis and fluid stagnation theory has great significance in the mechanism of hypertension when the diastolic pressure is high, and the treatment should focus on the positive function of anti-fatigue and adjusting body condition for treatment and prevention of hypertension; 6) in treating coronary heart disease, the new perspective that chest arthromyodynia is related to the prosperity loss or blocking of Zong-qi, therefore, the main therapy is to strengthening Zong-qi; 7) in treating insomnia, the Concept of holism of Five-Sprit Zang treatment theory has been promoted; 8) in treating allergic urticaria, the perspective that Wei-blood being both invaded should be promoted; 9) in treating acne, the combination of body-differentiation for prescription should be concentrated; 10) in treating chronic fatigue, it is expected to coordinate both body condition and psychological condition.
2. Clinical research on AR
1) By comparing and analyzing the supervisor's prescription of Tuomin Zhiti Tang (Decoction for desensitization and relieving sternutation) with Xiao Qionglong Decoction, the author pointed out that the former is for patients of special body characteristic with AR, while the latter should be employed for treatment of patients with yang-deficiency combined with special body characteristics; 2) the promotion of clinical definition of regulating body and syndrome, and define the relation between disease-body-prescription, the relation between disease-syndrome-and prescription, such clinically novel innovations; 3) observation and prevention on adverse reaction of Chinese herbal medicine; 4) the study suggested that the experience from supervisor's body differentiation and prescription for treatment of AR is superior to that from academic successors'syndrome differentiation and prescription, but the case-control design's limitations should be also considered, and further researches are expected; 5) this study is expected to provide with clinical research in mythology when using Chinese herbal medicine in treating AR, therefore, further effective treatment plan, perfect AR outcome measurement system, and superior clinical research mythology should be given great concentration in the future.
Background: Allergic rhinitis (AR) is a chronic inflammatory reactive disease on schneiderian membrane mediated by IgE, and can seriously impact on patients' sleeping, memory, emotion and quality of life. Professor Wang Qi applies the treatment idea of regulating physic against latent heat adverse rising and unhealthy qi external invade for treatment of adult with allergic rhinitis, which could obviously relieve patients' symptoms, and even cure some patients. This indicates that Chinese herbal medicine has advantages in treating AR.
Objectives: To observe the clinical effectiveness and safety of Prof. Wang Qi's experiences in treating AR.
Methods: This study was a case control study, participants were divided into Group Treated by Advisors (Group A), and Group Treated by Academic Successors (Group B), and participants in Group A received treatment from advisors applying the treatment idea of regulating physic against latent heat adverse rising and unhealthy qi external invade, and participants in Group B received treatment from the academic successors applying the traditional method of treatment against cold-water retention storing in the lungs and stimulated by external evil. We observed the effectiveness and safety of the prescription from the advisors. The Guideline on the Diagnosis and Treatment of Allergic Rhinitis, which is issued in 2009 by the China Medical Association Otolaryngology Seminal, was employed for diagnosis and effectiveness evaluation criteria of AR in this study.
Results: A total of 61 adult patients with AR were included in this case series. Group A totally included 30 patients with AR, involving 11 cases of obvious effective, 13 cases effective, 6 failed, with the total effective rate 80 %. Two patients got stomachache after taking the medication. Group B included 31 patients, involving 1 case of obvious effective, 16 cases effective, 14 failed, with the total effective rate 54.8%, and no adverse reaction was found. We applied non-para metric rank quantizer to test the statistical difference between two groups. There is statistical significance between two groups (Z—6.426, two-tailed P=0.000 <0.05). Conclusion: Treatment in Group A is more effective than the traditional treatment method applied in Group B in treating AR.
Discussion: (D By comparing and analyzing the supervisor's prescription of Tuomin Zhiti Tang (Decoction for desensitization and relieving sternutation) with Xiao Qionglong Decoction, the author pointed out that the former is for patients of special body characteristic with AR, while the latter should be employed for treatment of patients with yang-deficiency combined with special body characteristics; ? the promotion of clinical definition of regulating body and syndrome, and define the relation between disease-body-prescription, the relation between disease-syndrome-and prescription, such clinically novel innovations; ? observation and prevention on adverse reaction of Chinese herbal medicine; ? the study suggested that the experience from supervisor's body differentiation and prescription for treatment of AR is superior to that from academic successors' syndrome differentiation and prescription, but the case-control design's limitations should be also considered, and further researches are expected; (§)his study is expected to provide with clinical research in mythology when using Chinese herbal medicine in treating AR, therefore, further effective treatment plan, perfect outcome measurement system, and superior clinical research mythology should be given great concentration in the future.
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