| Research background and ObjectivesChronic sinusitis and nasal polyps is very easy to deferral and relapse, The disease rate is very high, it is the most common disease of upper respiratory. Both the traditional Chinese medicine and western medicine may obtion some curative effects, but often difficult to thorough cured. Functional Endoscopic Sinus Surgery is a milestone for curing CRS and NP. It is in line with the thought and requirement of slight trauma, It create favourable condition for the optimum turnover of accessory nasal sinuses mucous membrane, But its curative effects and prognosis are related with multiple factors. The cure of surgey and aftertreatment of surgey are two very important and undetachable steps. With the gradual mature of surgical technic for FESS. the clinical attention is biginning turn to the care of raw surface and comprehensive treatment. In the post-op combined therapy, Seeking more effective and more ideal therapeutic measure to promote mucomembranous renovation and raw surface epithelization is important research .which to be faced with for rhinologist of contemporary. Among these the measure of rinse after operation is more and more to be thought highly of. Chinese drugs pharmaceutics which to be as rinse solution have both outstanding medication effect and without provocation also without asepsis and side effect. It is in the process of being developed and utilized. Wang Dejian is the famous veteran teran doctor of TCM. He has been engaged in the research of naso sinusitis and nasal polyp for long-term;According to the theory of TCM, Hehad summarized the theory , The disequilibrium for YIN and YANG, QI and blood of rhinopathia, and created therapeutic principle, "Warming yang Benefiting vital energy >. Promoting blood flow Detumescence " . According to this therapeutic principle , He advanced development Nasal Sinuses Perfusate, which has been devoted considerable groundwork in clinic and experiment . It has been used in clinic about 30 years to puncture antral rinse and atomizate inhalation . and received fine clinical therapeutic effect. For the purpose of inheriting precious experience of the famous veteran teran doctor of TCM. We develop and utilize it to rinse raw surface after operation for the ORS . It is*good for promoting decrustation and eliminating Mucosal edema;also ]preventing Ves form and promoting raw surface epithelization. so it had elevated healing rate of ORS. With the purpose of investigating the internal relationship between "the disharmony of YIN and YANG, QI and blood" and "immunological regulation of organism about the balance of Thl / Th2" , and investigating exact mechanism of action about Nasal Sinuses Perfusate, try to explain the mechanism of ORS after endoscopic sinus surgery from point of view for histology and molecular level, To open up a new curative pathway of ORS after endoscopic sinus surgery. Thus can better inherit and make the most of the experience of the famous veteran teran doctor of TCM. to bring into full play the predominance of traditional Chinese medicine, to bring into full play larger effect of Chinese drugs pharmaceutics for ORS after endoscopic sinus surgery.Research content, means and results The first part: Documentary StudyTo test the TCM understanding of the name, the pathogenesis, the treatment and the study progress about chronic sinusitis and nasal polyp, the application of Chinese herb preparation to chronic sinusitis and nasal polyp before or after operation as well. To test the pathogeny, pathogenesis and the progress of treatment of chronic sinusitis and nasal polyp.Conclusion:1. Chronic sinusitis and nasal polyp are equivalent to "biyuan" , "naolou" ,"naoshen" , "kongnaosha" , " bizhi" , " birong" and "birouzhi" in TCM.The pahtogeny is related to a lot of factors, which can be devided into interiorand exterior factors, appearance and substance. The imbalance of zangfu organis the substance, namely the interior factor, while phlem, dampness, heat and stagnation are the key factors which are the appearance, namely the exterior factor. Qi deficiency of lung and spleen is the main reason for the deficiency of substance, while phelm, dampness, heat and stagnation are for the excess of appearance. Sometims, deficiency first, then followed by exterior evil qi, namely coldness due to qi deficiency of lung , then wei qi fail to defend the skin which leads to the failure of defending exterior evil qi, or the deficiency of spleen Qi which leads to the malnutrition of nasal orifices. And some toxin get together in nasal orifices and block the nasal orifices. All these mentioned above lead to the onset of the two dieases. In sum, coldness due to deficiency is the most common pathogeny for the disease, followed by phlem, dampness, heat and stagnation.2. The TCM treatment of chronic sinusitis and nasal polyp embody the thinking of different treatment for different symptom fully, namely the diversity and pleiotropia of the function of medicine, the same function for several medicines and various function for single medicine, which can prevent the disease from being worsen from different links. Furthermore, the external use of Chinese herb is the effective treatment which embodys the unique advantage of Chinese herb.3. Chinese herbal preparation can be fully used in treating the chronic sinusitis and nasal polyp before or after operation, which will enlarge the use of TCM in treating chronic sinusitis and nasal polyp. The TCM rinse solution which has a good applicant perspective still need further study.4. That infection, the blockage of OMC, the dysfunction of ultramicrostru-cture of mucous membranes cilia, the disturbance of immunity, the imbalance of cytokine networkThl/Th2 and allergy should be blamed for the bad circulation and protraction of chronic sinusitis and nasal polyp. Most doctors think that the interaction of derm infection and the blockage of OMC are the main reason, while the toxin of derm, the metabolic wastes, the structure and function dysfunction of mucous membranes cilia results from the deposition of immune complex and environment matters are the nessary condition for the onset of chronic sinusitis and nasal polyp.The second part: Clinical Curative Effect Observation of CRS afterEndoscopic Sinus Surgery Treated by Douching with the Nasal Sinuses PerfusateWith a randomized trial, all 43 patients were divided into two groups, namely treating group with 22 patients and control group with 21 patients. In according with Chinese Medical Association naso sinusitis endoscopic sinus surgery clinical classification and curative effect assessment(Haikou standard, 1997) , then making a comparision between the patients of two groups about the symptoms of self-sensation, the physical sign of nasal cavity, the cleaning time of nasal cavity , the time for epithelization of nasal cavity and the total clinic effectiveness before treatment, three months after operation respectively. The result show that the total effectiveness of treating group is 90.91%, while that of control group is 76.19%. There is no difference for the clinic effectiveness between two groups through Nonparametric Test(P<0. 05). The same to epithelization of nasal cavity(P <0.01). But there is no defference for the cleaning time of nasal cavity between two groups (P>0. 05), which means that the physical scouring function of rinse solution played a leading role at the early stage of chronic sinusitis, getting rid of blood scabs, superficial scabs and secretion in cavity. Nasal Sinuses Perfusate is more effective than NS in quickening the epithelization of nasal cavity, getting rid of edema of mucous membrane , quickening blood circulation and the absorpation of secretion, quickening the regeneration and reparation, bettering the function of cilia , renewing the function of self-protect as well. Nasal Sinuses Perfusate is more effective in bettering patient' s symptom and physical sign at middle and late stage . In sum, There is obvious difference between two groups in all aspects.The third part: the Mechanism Study of CRS after Endoscopic Sinus Surgery Treated by Douching with the Nasal Sinuses PerfusateThe First Study: the Observation of the Function of Cilia and the Ultramicro-structure of Mucous membrane of OMC for CRS after ESS Treated by Douching with the Nasal Sinuses PerfusateWith benzosulfimide test, the same person test the transmitting speed of nasal mucous membrane cilia between two groups before operation , four weeks, three months after operation. Then making a comparision between two groups in the change of the transmitting speed of nasal mucous membrane cilia. Observing the change of the ultramicro-structure of OMC mucous membrane with electron microscope. The result proved that Nasal Sinuses Perfusate is better than NSin quickening the transmitting speed of nasal mucous membrane cilia which will promote the recovery of the function of nasal mucous membrane and the ultra-microstructure of mucous membrane cilia in cavity.The Second Study: the Influence to Thl/Th2 of Cytokine for CRS after ESS Treated by Douching with the Nasal Sinuses PerfusateBecause cytokine usually has the same character as network, we detect the content of four related cytokine in the mucous membrane of accessory nasal cavity and nasal polyp between two groups before operation and three months after operation respectively with ELISA test. The purpose is to test the influence to Thl/Th2 of cytokine for CRS after ESS Treated by Douching with the Nasal Sinuses Perfusate, so that we can test further about the potential relation between the TCM theory of imbalance of yin-yang, qi and blood and the modern medicine theory of the balanced adjusting method of Thl/Th2. The results showed that the expression of cytokine in the tissue of chronic sinusitis and nasal polyp has the tendency to be the main stream. The content of IL~4 and IL-5 increased significantly. The results also showed that the content of IFN- y increased too. The mechanism inside still need further study. We found that the adjustment that Nasal Sinuses Perfusate to cytokine presented as network which take effect by adjusting the patient' s whole post-operation body state which makes the Thl/Th2 network system go back to the correspondent health balanced state. There is a possible relation between the theory that what mentioned above and the TCM theory of warming yang and tonify qi, promoting blood flow and detumescence, harmonizing qi and blood and balancing YIN-YANG.The Third Study: the Influence to the number and the configuration change of Eosinophile granulocyte for CRS after ESS Treated by Douching with the Nasal Sinuses PerfusateWith pathology of tissue method, patients from two groups were observed about the influence of the number and the configuration change of eosinophile granulocyte with two kind of drugs. Testing the function of eosinophile granulocyte in the onset of sinusitis and nasal polyp and the effectiveness of Nasal Sinuses Perfusate to post-operation CRS. The results showed that both Nasal Sinuses Perfusate and NS are all effective in restraining the exudation caused by inflammation and decreasing the infiltration number of eosinophile granulocyte. There is no difference between two groups, which showed thatChinese herb is effective to the activation and aggregation of EOS of chronic sinusitis and nasal polyp to same extent. And the corresponding mechanism still need further study.Conculsion:Clinic study showed that Nasal Sinuses Perfusate as rinse solution is quite effective to post-ESS for CRS though getting rid of edema of mucous membrane, quickening the epithelization of mucous membrane of nasal cavity. So, Nasal Sinuses Perfusate is an ideal preparation which deserve being generalized. The experimental study showed that Nasal Sinuses Perfusate can speed the recovery of ultramicro-structure and function of OMC mucous membrane cilia, quickening the transmitting speed of cilia of nasal mucous membrane, promoting the functional recovery of cilia of nasal mucous membrane as well. The study also showed that the preparation can regulate the balancing function of Thl/Th2 network system, restraining local imflammation exudation, decreasing the number of eosinophile granulocyte infiltration as well, which has possible correlation with the function of Nasal Sinuses Perfusate which is warming yang and tonify qi, promoting blood flow and detumescence, harmonizing qi and blood, balancing yin-yang.
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