Efficacy Of Xinglou Chengqi Decoction In Treating Acute Ischemic Stroke And Its Effect On NSE

Background:Stroke is a common disease in the elderly. Due to its high rates of morbidity, lethality and disability, stroke brings the society and families with heavy burdens. Traditional Chinese Medicine(TCM) has a good understanding of the pathogenic factors of stroke and TCM therapies always help to recover. Therapy of resolving phlegm and relaxing bowels put forward by WangYongyan is one of the distinctive TCM therapies for stroke. Xinglouchengqi decoction is the representative prescription of this therapy and it has already been widely used in clinical practice and achieved favorable effect.Objective:In order to evaluate the efficacy of Xinglouchengqi decoction and investigate its therapeutic mechanism in the view of nerve injury, we investigated 35 patients with acute cerebral infarction and phlegm-heat and bowel-qi-obstructed syndrome. We prescribed the study group with Xinglouchengqi decoction while routine western laxative treatment with the controls. Detailed symptoms were collected and neurological examination was carried out using related scales pre and post treatment. The venous blood samples for analyzing neuron specific enolase (NSE) were collected at the same time. We also observed and recorded the symptom changes during treatment course. By contrasting the scale scores and the serum NSE levels of the two observation points, we tried to evaluate the efficacy of Xinglouchengqi decoction and explain its therapeutic mechanism.Methods:We investigated 35 subjects with acute cerebral infarction and phlegm-heat and bowel-qi-obstructed syndrome meeting the inclusion criteria. All subjects were divided randomly into two groups in a ratio of 2:1, of which 24 subjects made up the study group and the other 11 in the control group. We assessed the subject the day he or she received our treatment by collecting symptoms and carrying out neurological examinations using National Institute of Health Stroke Scale (NIHSS) and TCM scales with regard to severity of stroke and phlegm-heat and bowel-qi-obstructed syndrome. The venous blood sample for analyzing NSE was drawn at the same time. Apart from the conventional western medicine treatment, subjects in the study group took Xinglouchengqi decoction, while the control group took Duphalac or lubricate the intestines with Glycerine Enema. The treatment course was usually 5±2 days. We visited the patient and observed the symptom changes every day during the study course until the patient’s bowl qi was unobstructed. Moreover, we assessed the subject after the treatment the same way as before. The efficacy of Xinglouchengqi decoction was evaluated by contrasting the scale scores and the serum NSE levels of the two observation points between the two groups and we made an attempt to explain its therapeutic mechanism.Results:Using the TCM stroke scale, scale for the phlegm-heat and bowel-qi-obstructed syndrome and NIHSS to estimate the patients’condition, the scores of post-treatment decreased obviously in comparison with those of pre-treatment in both groups (P<0.05). The study group showed no significant difference with the control group in improvement in terms of TCM stroke scale and NIHSS(P>0.05). However, the changes of scores of scale for the phlegm-heat and bowel-qi-obstructed syndrome were greater in the study group than those of the control group, and the difference was significant (P<0.05). The scores of inner wind, inner fire, phlegm-dampness and blood stasis lowered after treatment in the study group(P<0.05). The scores of inner wind, inner fire and phlegm-dampness lowered after treatment in the control group(P<0.05). The relieve of inner wind, inner fire and phlegm-dampness showed no significant difference between the two groups (P>0.05). The effective rates of the study group and the control group were 86.96% and 62.50% respectively. But there was no statistical significance of the difference(P>0.05).28 out of 31 subjects’ NSE levels were within normal reference range. The average level of NSE went upward in the study group while it’s opposite in the control group. The levels of NSE showed no changes pre and post treatment in both groups (P>0.05). In the study group,16 patients’NSE increased with 7 decreased. In the control group, the numbers were 4 to 4. There was no statistical significance of the difference (P >0.05). Serum NSE levels were not found correlated with the scores of NIHSS, not with the scores of syndrome factors, either.Conclusion:Xinglouchengqi decoction helps to relieve the phlegm-heat and bowel-qi-obstructed syndrome in patients with acute cerebral infarction. As to its impact on serum NSE level, we noticed that 28 out of 31 subjects’NSE levels were within normal reference range. The average level of NSE went upward in the study group while it’s opposite in the control group.