| Objective;This trial was carried out to explore and summarize the developing tendency of symptomatic patterns, in terms of TCM, and the changing rules of symptomatic patterns and treating methods during convalescence via a clinical observation on nasopharyngeal carcinoma (NPC) patients following radiotherapy in order to support a much better TCM rehabilitation therapy for such cases during the period of convalescence guided under these rules.Methods:Included in this study were94NPC cases following their primary lesion treated by radiotherapy from Jan,2002to Mar,2015to receive systematic TCM rehabilitation therapy with complete ill history record, collected in the special clinic of head and neck tumor at the Department of Otolaryngology, the First Affiliated Hospital, Chinese Medicine of Hunan. They were kept under clinical observation during the whole period of rehabilitation therapy to systematically record their general condition, quality of life, prognostic status as well as the developing tendency of symptomatic patterns and the correlation of changing rules of symptomatic patterns and treating methods with rehabilitation progress and treating measurements. Then, a preliminary exploration was done to prepare a normative treatment intervention scheme through summing up the developing rules of symptomatic patterns and treating methods for NPC cases during the period of convalescence following radiotherapy so as to guide the TCM rehabilitation therapy for such patients.Results:Ninety-four NPC cases following radiotherapy were included in this work based the inclusion criteria. Their gender distribution were63males and31females, and the age distribution was3cases aged under30years old,25aged between31to40years,42between41to50years old,15between51to60years,7between61to70years and2older than70years. The distribution of rehabilitation courses were25cases located between1to2years,29between2to3years,16between3to4years,14between4to5years, and10lasted more than5years. As seen at the last time of following up point, their prognostic and restored status could be divided into5levels, i.e.10cases at the level of not efficiency, referring in particular to those without improving in their symptoms and signs during convalescence following rehabilitation therapy,10at the one of local relapse,4being distant metastasis,3being local relapse plus distant metastasis, and77being improved. As a result of observation on the systematically carried out rehabilitation therapy, the correlation of pattern differentiation and treatment with symptomatic pattern developing tendency were summed up as followings.The pattern of Qi-Yin dual deficiency was the most frequently seen pattern at the first visit in this group of cases when they went into convalescence following radiotherapy, with this pattern being36.6%, exuberant heat and liquid depletion pattern being26.9%, Yin deficiency and blood stasis pattern being6.0%, Qi-Yang deficiency with evil-toxin retention (phlegm turbidity agglomeration) pattern being6.0%, phlegm-stasis interties pattern (blood stasis-phlegm congeal) being5.5%, kidney Yin deficiency pattern, Qi stagnation and blood stasis pattern being4.1%, Qi deficiency and phlegm congeal pattern being4.1%, Qi deficiency and blood stasis pattern being3.7%, and spleen-stomach weak and Qi-Yang insufficient pattern being3.2%.As extending of rehabilitation course, the change of distribution in symptoms and symptomatic patterns showed some regular developing tendency, with x2=21-324,p=0.000, P<0.05, suggested that there were differences present in the constitution and distribution of symptomatic patterns during different period of convalescence. However, the developing tendency by the pathogenesis of Qi and Yin deficiency, even Qi and Yang deficiency, was relatively stable during the whole period of rehabilitation therapy.It was shown that the levels of therapeutic effect were associated significantly with the distribution of symptomatic patterns and the scores of quality of life, with x2=12.120, P=0.019. It suggested that the improvement in QOL was closely related with the regular developing tendency and treating procedures.As shown from the analysis on the use of herbs in this group of cases receiving rehabilitation therapy, the most frequently used herbs were Shudihuang, Huangqi, maidong, xuanshen, banxia, tianhuafen, taizishen, baihuasheshecao and danshen, being the first10commonly used herbs. It was shown that the therapeutic progress of practically used pattern differentiation and treating method as well as description and herb use were basically remained consistent with the developing tendency of pathogenesis and symptomatic patterns. Conclusions:1. There are a regular developing tendency and some rules for their symptomatic patterns and the use of treating methods during the period of rehabilitation therapy among NPC cases following radiotherapy radiotherapy.2. Qi-boosting toxin-resolving method plus heat clearing is the most commonly used treating principle during the first year of rehabilitation course, Qi-boosting Yin-nourishing and spleen-fortifying are frequently used during the1to3years of.rehabilitation course, while Qi-boosting Yin-nourishing method is the main treating principle in the.rehabilitation course for those of NPC cases following radiotherapy undergoing more than3years of rehabilitation therapy.3. It can be concluded from this study that clinical manifestation of Qi deficiency may present in all symptomatic patterns among NPC cases following radiotherapy getting into the period of rehabilitation, while there are some differences in their levels. Moreover, Qi deficiency can be present in a combined way with other forms of pathogenesis to constitute some mixed patterns to give influence on the development of symptomatic patterns, even on their development of prognosis.4. It has been shown from this study that very important are the setting up of treating methods of Qi boosting, even Yang worming, as well as the use of herbs with the treating action of fortifying the spleen and boosting Qi, even Yang-worming. It should be taken as the basic procedures during the rehabilitation course for NPC cases following radiotherapy to improve their constitution for preventing the lesion from worse developing and making the prognosis better. |
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