Study On The Syndrome Feature Of Children Recurrent Respiratory Tract Infection In Non-acute Infective Stage

ObjectiveDocumentary research:to review systematically the TCM remedial documents of recurrent respiratory tract infection(RRTI);to evaluate the overall quality of relative researches and the efficacy and safety of TCM therapy; and to determine the research methods for this subject.Clinical research:to identify the types and characteristics of RRTI sick children in non-acute inflammation stage in Guangzhou;to illustrate the relations among Traditional Chinese Medicine(TCM) types and symptoms,the four physical examinations in TCM,symptoms in Western Medicine,and immunity index,which may provide some guidelines for the standardization of the differentiation and treatment,and scientific thinking and ways for the research of this disease.MethodsDocumentary research:firstly,to establish the "the Evaluation and Information Collection Form on TCM Therapy of Children RRTI",based on the TCM remedial documents of children RRTI,and following the principles and methods of epidemiology or DME methodology;secondly,to evaluate the quality of clinical researches on RRTI,and then analyze their problems in terms of their research design,implementation and curative effects evaluation with Meta statistic analysis.Clinical research:417 cases of RRTI sick children in non-acute infective stage were selected as research objectives.With the use of epidemiology methods,the following information were collected and recorded into data base by questionnaire:the general and prospective information of sick children, the four physical examinations in TCM,clinical symptom in Western Medicine, and the immunoglobulin,alexin,T cell subset figures of some patients.All indexes were analyzed in terms of frequency,clustering.The distribution of symptom complex in TCM was generalized and the basic syndromes and corresponding diagnosis criteria were determined.As to different types of samples,Kruskal-Wallis Test,Cochran-Mantel-Haenszel Test,Variance Test, chi-square Test were used for analyzing the relations among disease types and grading,the four physical examinations in TCM,clinical symptom in Western Medicine,and the immunity index.ResultsDocumentary research:1.Altogether 141 articles were selected as samples for random contract test(RCT).After being scored by Jadad in terms of quality,1 was marked as 3 points;another 27 were marked as 2 points;and the rest 113 were marked as 1 point.The low quality of articles was reflected in the following aspects:(1) Lack of definite inclusive and exclusive criteria,especially criteria for the diagnosis of TCM Syndrome.(2) Fail to attach importance to standardization,stability and monitoring of adverse drug reaction in TCM therapy.(3) Improvement is needed the level of methodology,such as correct application of randomization principle,blind method and statistical method.2.The Meta results show that the odds ratio(OR) falls within 95% credibility interval,no matter in Chinese Materia Medica group,Chinese Patent Medicine group,or Chinese Materia Medica loaded western medicine group, Chinese Patent Medicine loaded with western medicine or western medicine mentioned above,which shows that there is statistical significance between TCM therapy and its curative effect.Clinical research:The types of syndrome and basic features of children Recurrent Respiratory Tract Infection in non-acute infection period in Guangzhou area:(1) Deficiency of lung,and instability in "wei yang":altogether there are 103 cases,accounting for 24.7%.The main syndromes are low and weak cough, shortness of breath,aversion to wind,aversion to cold,cold in hands and feet,spontaneous perspiration,borborygmus,dry mouth,pale complexion, light white tongue,and weak pulse.(2) Deficiency of both lung and spleen along with stagnation:altogether there are 145 cases,accounting for 34.8%.The main syndromes are repeated cough without heal,aversion to wind,hypodynamia,losing appetite, absent-minded,abdominal distension,abdominal pain,dry and hard stool, difficult evacuation of the bowels,sleepless and fret at night,horizontal "shah gen",dry mouth,white fur,thick fur,slippery pulse,thready pulse.(3) Deficiency of spleen and liver sthenia:altogether there are 87 cases, accounting for 20.9%.The main syndromes are complexion turning yellow, absent-mindedness,repeated cough without heal,green "shan gen", sleeplessness and fret at night,irritability,dry mouth,burning sensation of five centers,light white lip,red tongue,wiry pulse.(4) Deficiency of lung and kidney with phlegm:altogether there are 82 cases,accounting for 19.7%.The main syndromes are repeated cough without heal,low and weak cough,sputum with dull and heavy resonance,shortness of breath,spontaneous perspiration,grey complexion,losing appetite, absent-mindedness,black eye ring,unmated hair,nocturia and enuresis at night,sleeplessness and fret at night,slippery pulse,and weak pulse.2.The comparison among the clinical data of all kinds' syndrome types:(1)In comparing the age stage,overall illness course,disease frequency, disease type,disease course,immunoglobulin,alexin,T cell subsets,repeated cough without heal,expectoration,shortness of breath,hypodynamia and complexion changes of each syndrome,there is no statistical significance in the differences(P＞0.05).(2)There is statistical significance in the difference of the comparison of weak cough of each syndrome(P＜0.05).The statistical significance lies in deficiency of lung,and instability in "wei yang",deficiency of spleen and liver sthenia,and deficiency of lung and kidney with phlegm(P＜0.01). No statistical significance is found in comparison among other groups (P＞0.05).(3) There is statistical significance in the difference of the comparison of aversion to wind and perspiration of each syndrome(P＜0.05) The statistical significance lies in all four types of syndromes(P＜0.05).(4) There is statistical significance in the difference of the comparison of the color and shape of "shah gen"(P＜0.05).The statistical significance lies in all four types of syndromes(P＜0.05).(5) There is statistical significance in the difference of the comparison of black eye ring,nocturia and enuresis,aversion to cold and cold in hands and feet between deficiency of both lung and spleen along with stagnation and the other three types(P＜0.05).There is statistical significance in the difference of the comparison of hair condition between deficiency of both lung and spleen along with stagnation and deficiency of spleen and liver sthenia (P＞0.05).There is statistical significance among other group comparisons (P＜0.05).(6) There is statistical significance in the difference of the comparison of body emaciation,losing appetite,absent-mindedness,abdominal distension, abdominal pain,and borborygmus between deficiency of lung,and instability in "wei yang" and the other three types.(P＜0.05) The statistical significance lies in vomiting for comparison of deficiency of both lung and spleen along with stagnation,deficiency of spleen and liver sthenia,and deficiency of lung and kidney with phlegm(P＜0.05).There is no statistical significance in the difference of the comparison of dry and hard stool(P＞0.05). There is statistical significance among other group comparisons(P＜0.05).(7) There is statistical significance in the difference of the comparison of burning sensation of five centers,dry mouth,sleepless and fret at night between spleen deficiency and liver sthenia and the other three types(P＜0.05). There is no statistical significance among deficiency of lung,and instability in "wei yang",deficiency of both lung and spleen along with stagnation, and deficiency of lung and kidney with phlegm(P＞0.05)(8) There is statistical significance in the difference of the comparison of tongue color between deficiency of lung,and instability in "wei yang" and the other three types and between spleen deficiency and liver sthenia and lung and kidney deficiency along with stagnation(P＜0.05).There is statistical significance in the difference of the comparison of fur among deficiency of lung,and instability in "wei yang",deficiency of spleen and liver sthenia,and deficiency of lung and kidney with phlegm(P＜0.05).There is statistical significance in the difference of the comparison of pulse tracings among deficiency of lung,and instability in "wei yang",deficiency of spleen and liver sthenia,and deficiency of lung and kidney with phlegm, and also among deficiency of both lung and spleen along with stagnation, deficiency of spleen and liver sthenia,and deficiency of lung and kidney with phlegm(P＜0.05).ConclusionsDocumentary research:(1) Meta analysis shows that TCM therapy does have certain degree of effects for children RRTI,but the difference of effect between treatment group and contrast group may due to the low quality of research methods.(2) The analysis of documentary research shows that the research quality of random comparison study of children RRTI by TCM still needs to be improved. The conclusions drawn so far are lack of persuasiveness.Clinical research"(1) There are four types RRTI in non-acute infective stage in Guangzhou" deficiency of lung,and instability in "wei yang";deficiency of both spleen and lung with stagnation;deficiency of spleen and liver sthenia;and deficiency of lung and kidney with phlegm.The main type is the second type.(2) The following criteria is not valuable for syndrome differentiation in TCM:age,overall course of disease,grading of illness,immunity index, repeated coughing without recovery,phlegm,asthma,lack of strength,change of complexion.(3) Cough with low and weak voice,aversion to wind and perspiration are closely related to deficiency of lung,instability in "wei yang" and deficiency of both spleen and lung with stagnation.The followings are important criteria for differentiation of the second and third type" horizontal "shan gen",greenish-yellow complexion,tarnish,physically thin, dull,lacking of appetite,inflated abdominal pain,nausea or vomit,dry and hard stool and borborygmus.The symptoms of dysphoria,dry mouth and pharynx, sleeplessness is for the recognition of the third type.The symptoms of black eye pit,yellow and dry hair,enuresis,and aversion to cold are important for the differentiation the fourth type.The tongue and pulse demonstration can reflect the etiology,nature,location,degree and transformation of diseases.Their function of differentiation is irreplaceable.