A Study On The Diagnosis And Treatment Of Common Pulmonary Diseases In Patients With Phlegm And Blood Stasis Syndromes

ObjectivesTo review the success path of Professor Du Huaitang, systematically study the origins of his academic thought, summarize his academic thought and clinical experience, focus primarily on his train of thought on the diagnosis and treatment in pulmonary diseases, particularly on the syndrome differentiation and characteristics of the medicinal prescribed, lest to further contemplate his academic concepts so as to inherit his clinical practice system and expertise.Methods1. By adopting the method of clinical review and follow up, a detailed record of Professor Du Huaitang’s diagnosis and treatment process that are used to treat patients for the past 3 years is kept; by way of clinical attachment with teacher, cultivate learning insights, methodically read up teacher’s work, thesis, related classics works referred by teacher and through interaction, fully comprehend the essence contributed to the road of his success, probe in depth on the academic source and consequently, conclude his academic thought and clinical experience.2. By using the multi-centers clinical case studies collection method, cases which have fulfilled the inclusion criteria are selected from Professor Du Hauitang’s 150 first visit outpatient cases whom are diagnosed with phlegm and blood stasis syndrome of chronic bronchitis in acute exacerbation period, bronchial asthma acute attack stage and chronic duration, cough variant asthma, secondary infection in patients with bronchial dilation at Dongzhimen Hospital affiliated to Beijing University of Chinese Medicinal, Beijing Chaoyang District Hospital of TCM and Beijing Fengtai District Iron Camp Hospital for the period from Jul 2012 till Jul 2015. Of which, there were 53 case studies with phlegm and blood stasis syndrome of chronic bronchitis in acute exacerbation period,53 case studies with bronchial asthma acute attack stage and chronic duration,24 case studies with cough variant asthma and 20 case studies with secondary infection in patients with bronchial dilation. Using Excel and Access software to construct a medical record collection platform for the purpose of data input.Weka 3.7 software is put to use for data mining in quantitative research, making use of the system internal frequency statistical methods, bays algorithm and correlation concepts and Apriori algorithm to obtain data mining so as to perform research on Professor Du Huaitang’s treatment in phlegm and blood stasis syndrome of chronic bronchitis in acute exacerbation period, bronchial asthma acute attack stage and chronic duration, cough variant asthma, secondary infection in patients with bronchial dilation based on the symptoms differentiation, tongue and pulse manifestation and characteristics of the medicinal prescribed as well as the relationship in cases which occurred between the syndromes, symptoms, relation between tongue and pulse manifestation with medicinal prescribed and the rule of compatibility and concept on the traits of the medicinal used. Subsequently, by applying quantitative research as the foundation, conduct in-depth interviews with qualitative research extensively and thus complete Professor Du Huaitang’s experience in diagnosis and treatment in pulmonary diseases and rule on the medicinal used.Results1. Results obtained from data mining based on the quantitative research used on Professor Du Huaitang’s experience in treatment of pulmonary diseases: Chronic bronchitis:cardinal symptoms:cough with yellow phlegm, tongue in light purple color with yellow greasy coating, wiry and slippery pulse or choppy pulse. Commonly used medicinal are Radix Bupleuri, Semen Armeniacae Amarum, Radix Scutellariae, Radix Codonopsis, Bulbus Fritillariae Thunbergii, Radix Platycodonis, Radix Glycyrrhizae, Poria, Radix Angelicae Sinensis, Exocarpium Citri Rubrum. Correspond to bays algorithm, the correlation between the symptoms associated:coughing as the core concern with symptoms of cough with yellow phlegm, tongue in light purple color with yellow greasing coating which constitute the syndrome. Relation of symptoms, tongue and pulse manifestation with medication:coughing, cough with yellow phlegm, tongue in purple color with yellow greasy coating, wiry and slippery pulse with the use of Radix Bupleuri and Semen Armeniacae Amarum, constitute the treatment process. Considering the rules on correlation and compatibility of medication used:Semen Armeniacae Amarum and Radix Bupleuri can be combined and used for treatmentAcute bronchial asthma:cardinal symptoms:panting, labored breathing, chest oppression, coughing, shortness of breath, tongue in light purple color with yellow greasy coating. Commonly used medicinal are Semen Armeniacae Amarum, Radix Scutellariae, Radix Angelicae Sinensis, Radix Codonopsis and Radix Bupleuri. Correspond to bays algorithm, the correlation between the symptoms associated:panting as the core concern with symptoms of coughing, labored breathing, chest oppression, constitute the syndrome. Relation of symptoms, tongue and pulse manifestation with medication:use of Semen ArmeniacaeAmarum, Radix Bupleuri, Radix Scutellariae and Radix Angelicae Sinensis on symptoms of panting, coughing, labored breathing, tongue in purple color with yellow greasy coating, constitute the treatment process. Considering the rules on correlation and compatibility of medication used:Semen Armeniacae Amarum and Radix Scutellariae are the core medicinal used and may include the combination of Radix Bupleuri and Radix Angelicae Sinensis.Chronic bronchial asthma:cardinal symptoms:panting, labored breathing and tongue in light purple color. Commonly used medicinal are Semen Armeniacae Amarum, Radix Scutellariae, Radix Angelicae Sinensis and Poria. Correspond to bays algorithm, the correlation between the symptoms associated:panting as the core concern with symptoms of labored breathing and tongue in light purple color, constitute the syndrome. Relation of symptoms, tongue and pulse manifestation with medication:use of Semen Armeniacae Amarum, Exocarpium Citri Rubrum, Radix Scutellariae and Radix Angelicae Sinensis on symptoms of panting, labored breathing, tongue in light purple color, constitute the treatment process. Considering the rules on correlation and compatibility of medication used:Semen Armeniacae Amarum, Radix Angelicae Sinensis, Radix Scutellariae and Exocarpium Citri Rubrum can be combined and used for treatmentCough variant asthma:cardinal symptoms:coughing, panting, itchy throat, cough with yellow phlegm, shortness of breath, tongue in light purple color with yellow greasy coating, wiry and slippery pulse. Commonly used medicinal are Radix Bupleuri, Semen Armeniacae Amarum, Radix Scutellariae, Rhizoma Pinelliae Concisum, Radix Glycyrrhizae, Radix Codonopsis, Radix Platycodonis and Radix Angelicae Sinensis. Correspond to bays algorithm, the correlation between the symptoms associated:coughing as the core concern with symptoms of panting, itchy throat, cough with yellow phlegm, shortness of breath, constitute the syndrome. Relation of symptoms, tongue and pulse manifestation with medication:use of Radix Bupleuri, Semen Armeniacae Amarum, Radix Scutellariae, Radix Codonopsis, Rhizoma Pinelliae Concisum, Radix Glycyrrhizae on symptoms associated with coughing, panting, tongue in light purple color, constitute the treatment process. Considering the rules on correlation and compatibility of medication used:Radix Bupleuri, Semen Armeniacae Amarum, Radix Scutellariae, Rhizoma Pinelliae Concisum, Radix Codonopsis, Radix Platycodonis, Radix Angelicae Sinensis can be combined and used for treatment.Bronchiectasis:cardinal symptoms:coughing, cough with yellow phlegm, chest oppression, expectoration of blood, shortness of breath, tongue in light purple color with yellow greasy coating, wiry and slippery pulse. Commonly used medicinal are Radix Bupleuri, Semen Armeniacae Amarum, Radix Scutellariae, Rhizoma Phragmitis, Semen Coicis, Semen Persicae, Semen Benincasae, Radix Platycodonis. Correspond to bays algorithm, the correlation between the symptoms associated:coughing as the core concern with symptoms of cough with yellow phlegm, chest oppression, constitute the syndrome. Relation of symptoms, tongue and pulse manifestation with medication:use of Radix Bupleuri, Semen Armeniacae Amarum, Radix Scutellariae, Rhizoma Phragmitis, Semen Coicis on symptoms associated with coughing, cough with yellow phlegm, chest oppression, tongue in light purple color, constitute the treatment process. Considering the rules on correlation and compatibility of medication used:Radix Bupleuri, Semen Armeniacae Amarum, Radix Scutellariae, Rhizoma Phragmitis, Semen Coicis, Semen Persicae, Semen Benincasae, Radix Platycodonis can be combined and used for treatment.2. Results obtained from in-depth interviews based on the qualitative research used on Professor Du Huaitang’s experience in treatment of pulmonary diseases:Chronic bronchitis: ①Rendering additional clinical observation on dusky tongue and choppy pulse will also plays an important role on the diagnosis, which in turn will derive to the conclusion on dull dusky tongue, yellow greasy coating, slippery pulse, or choppy pulse theory. ②Identifying Minor Bupleurum Decoction as the main decoction used reflects on the application of regulating’Qi’mentality. ③Radix Bupleuri and Semen Armeniacae Amarum are the main components used to treat chronic bronchitis which embodies the unique feature of diffusing the lung and directing the ’Qi’ downward, regulating the movement of ’Qi’ Bronchial asthma: ① Semen Armeniacae Amarum, Radix Scutellariae, Radix Angelicae Sinensis, Radix Codonopsis, Radix Bupleuri are the commonly used medicinal for treating acute bronchial asthma. Semen Armeniacae Amarum, Radix Scutellariae, Radix Angelicae Sinensis, Radix Codonopsis, Poria, Exocarpium Citri Rubrum are the commonly used medicinal for chronic bronchial asthma. Harmonizing formulas focus on regulating the movement of ’Qi’ and invigorating the blood circulation and for that aspect, besides using it to treat patients with acute bronchial asthma, it is also used for chronic bronchial asthma to strengthen the spleen and benefit the lung. ②Besides using Minor Bupleurum Decoction, can include Ramulus Cinnamomi with combination of Houbu Xingzi Decoction, Perilla Fruit Qi-Descending Decoction, Houbu Mahuang Decoction.Cough variant asthma: ①Characteristics of the symptom is coughing manifested to chronic cough, obvious during night time, coughing due to itchy throat, intermittent, panting when severe. ㎝ain cause is due to wind invading the lungs thus effecting phlegm stasis obstructing the lung. Minor Bupleurum Decoction is the formula used with Semen Armeniacae Amarum, Radix Platycodonis, Radix Angelicae Sinensis, and is also to enhance ’Qi’in upper jiao, Radix Angelicae Sinensis aids in boosting blood circulation, scatter wind therapy must be used to penetrate the disease throughout the course of treatment.Bronchiectasis: ①recurrent attacks as the main traits, often caused by infection, besides having phlegm and stasis as the pathologic factors, deficiency of the’Qi’in lung is also closely associated to this disease. ②Commonly used formulas are Minor Bupleurum Decoction and Thousand Gold Pieces Phragmites Decoction. ③ Rhizoma Phragmitis medicinal properties is sweet and cold, can clear heat and purge fire; Semen Persicae activates blood circulation and dispel stasis; Semen Coicis relates to the lung meridian.Conclusions1. By way of applying both quantitative research and qualitative research, we can derive from the statistical results that Professor Du Huaitang’s experience in treating pulmonary diseases was based on the tongue and pulse manifestation to which the tongue is dull and dark in color, yellow and greasy coating, wiry and slippery pulse; common medicinal prescribed are Semen Armeniacae Amarum, Radix Scutellariae, Radix Angelicae Sinensis, Radix Codonopsis, Poria, Exocarpium Citri Rubrum. Minor Bupleurum Decoction is the main formula used in which reflects the characteristics of regulating’Qi", improves blood circulation and clearing the phlegm, with regulating’Qi’as the core aspect in treatment. He is adept at using’Qi’to determine and treating the relevant diseases, eventually infer that Professor Du Huaitang’s treatment in pulmonary diseases derived from the theory of"’Qi resulted in hundred kinds of diseases".2. After analyzing the data acquired from the data mining, the syndrome differentiation and prescriptions are mostly in consistent with Professor Du Huaitang’s experience in treatment.3. Combining the data mining collected from quantitative research and in-depth interviews conducted with qualitative research, it is deemed to be relatively accurate in analyzing the famous TCM doctors’clinical experience in treatment, and summarizing the clinical experience and academic thoughts of famous TCM doctors, thus should be encouraged to be used widely.