Xinglou Chengqi Decoction In The Treatment Of Acute Cerebral Infarction With Phlegm-heat Fu-organs And Its Effect On RAAS

Background:In recent years,the incidence of stroke in China is on the rise,and the age in onset of stroke is getting younger and younger.Stroke is still the leading cause of death and disability in adults in China,which brings a heavy economic and spiritual burden to the patients and society.Traditional Chinese medicine has its unique advantages in the treatment of stroke.After long-term clinical observation,Professor Wang Yongyan put forward Xinglouchengqi Decoction,a representative decoction of the therapy of resolving phlegm and constipation problems,which has achieved good results.Objective:To evaluate the efficacy of Xinglouchengqi Decoction in acute cerebral infarction patients who have the problem with phlegm and constipation and observe the change characteristics of renin-angiotensin-aldosterone(RAAS)in patients with acute cerebral infarction and phlegm-heat and bowel-qi-obstructed syndrome,and to preliminarily explore the effect of Xinglouchengqi decoction on RAAS from the perspective of neuroendocrine mechanismMethods:Fifty-six patients with acute cerebral infarction and phlegm-heat and bowel-qi-obstructed syndrome within 14 days were included.The subjects were randomly divided into experimental group and control group in a 2:1 ratio.There were 38 cases in the experimental group and 18 cases in the control group.All subjects were given anti-platelet,lipid-lowering stable spots and other Western medicine treatment,at the same time,subjects in the experimental group took Xinglouchengqi decoction,while the control group took Duphalac(dose could be increased or combined with enema with kaiselu or glycerin when the curative effect was not good).The course of treatment is 5±2 days.During the treatment,we visit the patients everyday and record their symptoms until the patient’s bowel-qi was unobstructed.The main active ingredients concluding plasma renin activity(PRA),aldosterone(ALD)and angiotensin Ⅱ(Ang Ⅱ)were tested on the day of enrollment and after the observation.Traditional Chinese Medicine(TCM)stroke scale,scale of stroke syndrome,scale for phlegm-heat and bowel-qi-obstructed syndrome and National Institutes of Health Stroke Scale(NIHSS)were also examined on the day of enrollment and after the observation.Safety indexes such as blood routine were tested before and after treatment.Spss20.0software was used for statistical analysis,and P<0.05 was considered statistically significant.Results:(1)Analysis of stroke related scale before and after treatment:After treatment,scores concluding TCM stroke scale,scale of stroke syndrome(inner wind,inner fire,phlegm-dampness and blood-stasis),scale for phlegm-heat and bowel-qi-obstxucted syndrome and NIHSS were lower than those before treatment in both groups(P<0.05).The difference of score with phlegm-heat and bowel-qi-obstructed syndrome in the experimental group was more obvious than the control group,There was statistically significant differences between the two groups(P<0.05).(2)Effects of two therapy for constipation on RAAS:ALD,PRA and AngⅡ were all lower than before treatment in both group.ALD was statistically significant differences before and after treatment(P<0.05)and no statistically differences was found in PRA and AngⅡ in experimental group(P>0.05).There was no statistically differences on ALD,PRA and AngⅡ before and after treatment in the control group(P>0.05).The reduction of ALD,PRA and AngⅡ in the experimental group was larger than that in the control group.However,there was no statistically differences on RAAS after treatment between the two groups(P>0.05).(3)Analysis of RAAS on patients with hypertension(HTN)history:PRA and AngⅡ of HTN patients before treatment were higher than those without HTN,and there was statistical difference between groups(P<0.05),and no statistical difference with ALD(P>0.05).The level of ALD,PRA and AngⅡ in patients with different types of hypertensive drugs were analyzed,and there was no statistical difference between these groups(P>0.05).ALD,PRA and AngⅡ of HTN patients in the experimental group after treatment were decreased compared with that before treatment(P<0.05).ALD,PRA and AngⅡof HTN patients in the control group after treatment were lower than before treatment and there was no statistical difference(P>0.05).There was no statistical difference between the two groups after treatment(P>0.05).(4)Analysis of RAAS on patients without HTN history:There was no statistical difference in ALD,PRA,AngⅡ before and after treatment between the two groups(P>0.05).(5)Characteristics of acute cerebral infarction in RAAS and correlation analysis between RAAS and acute cerebral infarction:The level of PRA and AngⅡwere higher than upper limit of normal and ALD was within normal range before treatment in acute cerebral infarction patients.There were no linear correlation between ALD,PRA,AngⅡand TCM stroke scale,scale for phlegm-heat and bowel-qi-obstructed syndrome and NIHSS scores(P>0.05).However,with the increase of TCM stroke scale and NIHSS scores,AngⅡshows a rising trend.Conclusion:(1)Compared with Western medicine laxative method,Xinglouchengqi Decoction shows a better trend to improve improve phlegm-heat and bowel-qi-obstructed syndrome,which is charactered by constipation,tongue thick and greasy,thready and slippery pulse.(2)Xinglouchengqi Decoction may have inhibitory effect on RAAS,especially for patients with HTN history.