| Systems science is one of the most influential integrated basic subjects in the world, and it has been penetrated in various sectors, for example, industry, agriculture, defense, medical and health, science and technology. In China, the application of methods and technology of system science in population, financial policy and wage distribution researches, all achieved good results. Especially, its application is very successful in the field of aerospace.The research object of system science is the system, which is composed of interrelated and mutual restraint, with a certain function of the overall. The main features of the system contain the integrity, relevance, dynamic, orderly and pre-decision. The purpose of studying system is to clarify the relationship among internal elements of the system, and build a new system with objective function based on needs. The overall concept, yin and yang theory, organs and meridians coincide in Traditional Chinese Medicine are fully embodied in the concept of the system. TCM understand the nature of health and disease with the dynamic, comprehensive and contact views, which summed up the experience of clinical practice and theory, and it is fully equipped with characteristics of the system. Therefore, TCM can be used as the research object of system science. It will help us to grasp the overall trend of Chinese medicine syndrome and clarify the internal rules and mutual relations among various elements better, through the guidance of system scientific thoughts.The medical case is the true record of the clinical facts, which is to summarize the successful experience of clinical practice or failures of misdiagnosis and mistreatment, and could help to refine the text of the classification proposed combination of the academic characteristics of physicians.Mr Zhang said:"Medical Records are suitable to reflect the role of Chinese medicine. If you want to get the successful experience of other people’s, researching his medical cases is a good way." The medical case is true record of clinical practice, which can objectively reflect the physician’s clinical experience and academic thinking, so this is an important carrier of the research on medical theory. We can found rich theoretical essence in medical cases and the academic thinking of physicians through medical case studies. More importantly, it can help to explore the tacit knowledge of physicians, and inspire clinical thinking to guide clinical practices and improve clinical outcomes. It is worth noting that, the medical case studies were exposed some problems although it was in full swing to carry out. For example, the theoretical concepts and techniques in a variety of disciplines are difficult to fusion with TCM, and maybe the advanced theoretical methods do not match with the study of medical case, sometimes. Alternatively, the objective of medical case studies is inconsistent with research methods.Based on above introduction, we believe that the study of medical case with application of system science is feasible and innovative. Therefore, we studied the medical cases on the treatment of acute phase of stroke patients with phlegm-heat and bowel-repletion syndrome of Wang Yong-yan professor, who is the well-known traditional Chinese medicine expert, and summarized the law of clinical diagnosis and treatment to inherit and carry forward his academic thoughts.This study is divided into the literature review, the systematic research of medical case, the systematic building of phenomenon thinking and the academic thoughts on treating stroke of Wang Yong-yan professor.The literature review:we elaborated the overview on modern research methods of medical cases and system science research in detail.The medical case research:including the single medical case research, the overall design of medical cases system, the construction of the subsystems and the analysis on academic characteristics of the medical cases.Section1:The single medical case research. The aim is to understand his basic ideas on the treatment of acute phase of cerebral hemorrhage patients with the phlegm-heat and bowel-repletion syndrome, which can provide the basis for the overall design of medical cases and construction of subsystems. The object of study is the82cases. Apply the comprehension analysis method to analyze every medical record of this research, and make the medical case as a system. Tease out the context and structure of each record, from the four aspects of diagnosis, syndrome, therapy and prescription, to verify the interrelationship among the elements in records, based on the relevant literature of professor Wang. Through the above analysis, we have preliminary understood that Wang’s basic idea on the treatment of stroke patients with the phlegm-heat and bowel-repletion syndrome is the main decoction and drug addition or subtraction.Section2:The overall design of medical cases system and construction of the subsystems. We applyed the theory and methods of system engineering to overall design the medical cases system, which was divided into the main decoction subsystem and drug addition or subtraction subsystem, and established the system information database of medical cases. Among them, the main decoction subsystem consists of six parameters, namely the combination of main symptoms and main decoction; while the drug addition or subtraction subsystem also includes six parameters, namely the combination of secondary symptoms and complementary drugs. Through the statistic analysis of these parameters, the results showed that the vast majority of medical cases were constituted by the two subsystems, and the matching relationship of symptoms and drugs in every parameter was well specific. Meanwhile, the study also verified a higher incidence of the "primary-side subsystem in symptoms-the main square" relationship according to the principle of association rules, which suggest that the association is very clear. This indicated that our systematic design of medical records was in line with the diagnosis and treatment ideas of Wang Yong-yan professor.Section3:The analysis on academic characteristics of the medical cases. We preliminarily understood the overall framework and level of medical cases, as well as the close links among these information, through the systematic study. On this basis, we analyzed the academic ideas contained in the medical cases in-depth. On the diagnosis of syndrome, professor Wang Yong-yan attaches great importance to the TCM diagnostic methods, and also uses the multi-pulse and humane care to receive the comprehensive and detailed collection of information. At the same time, these information is screened, categorized and summarized according to his clinical experience, in order to draw accurate syndrome diagnosis. Through the analysis, we believe that his main features of diagnosis and prescription should have3aspects. First, few drugs and powerful effect. He specifically use less drugs to force the compatibility, and target the clinical syndrome accurately, to play the effect of each drugs. Second, stock of the situation and ingenious use of rhubarb. He usually investigates the patient’s physical and severity of disease and was flexible to give full consideration in the diagnosis and treatment; moreover, he pays attention to weigh the role of rhubarb in specific situations. Again, focus on dynamic and taking precautions. Moreover, he also gives full consideration to the rapid changes and complex syndromes in acute phase of stroke disease, and emphases on early intervention, early blocking a poor prognosis.The systematic building of phenomenon thinking, namely section4in this paper, aims to build the systematic model of phenomenon thinking. The phenomenon thinking is the most important guide for the research and clinical practice of TCM, which is the scientific way of thinking. And it is throughout the whole process of diagnosis and treatment in TCM, which is characterized by great importance to the main focus on the relationship and the importance of changes. To this end, we built the symptoms matrix, the tongue phenomenon matrix, the pulse phenomenon matrix, the other clinical features matrix, the syndrome factor matrix, the rule matrix, the governance matrix and the prescriptions matrix, and established the structure model of the overall matrix of phenomenon thinking, based on the medical case researches. The work aims to analyze the combination of matrixes in different phases and different levels of phenomenon thinking, for example phenomenon, hormone and hou et al, as well as the academic details of implementation. At the same time, we also used the technology of TRIZ to construct the process model of phenomenon thinking about the treatment of heat phlegm syndrome in acute stage of stroke, so as to deepen our understanding for its application rules. Through this research, we had the recognition and understanding on the core essence and law of phenomenon thinking. This would help to prevent or reduce the decision-making error in TCM scientific research and clinical practice, and have an important and far-reaching significance to ensure the scientific development of TCM.The academic thoughts on treating stroke of Wang Yong-yan professor, namely the5section in this paper. We mainly carried on the analysis from two aspects, which were the innovative academic theory and the clinical characteristics, respectively. The theory of poisonous injure of brain networks is the core of stroke pathogenesis, and the theory sublimation and innovation of TCM. It is highly summarized the occurrence, development and prognosis of stroke patients at various stages and trends. Under the guidance of the theory, we can understand the law on occurrence and development of phlegm-heat and bowel-repletion syndrome in acute phase of stroke, as well as the key factors which affect the outcomes and prognosis of stroke patients, more clearly. Professor Wang Yong-yan emphasizes the guidance of overall constant dynamic concept on syndrome differentiation treatment, and pays attention to the dynamic trends, and advocates early intervention, early blocking the adverse prognosis. In the syndrome differentiation and treatment, the comprehensive information, accurate diagnosis, specific herbal prescription and respected classical prescriptions are all his remarkable characteristic. At the same time, he also actively promotes the academic innovation and interdisciplinary integration of TCM, which formed his unique academic thought.The use of tongfu therapy on phlegm-heat and bowel-repletion syndrome in the acute stage of stroke advocated by professor Wang Yong-yan, is one of the important annulus in system structure of TCM syndrome differentiation on stroke. Based on the pathogenesis theory of poisonous injure of brain networks and the guidance of phenomenon thoughts in syndrome differentiation and treatment, the final clinical efficacy is achieved by tongfu therapy. In recent years, the scientific clinical path on the prevention and treatment of stroke is gradually formed with tongfu therapy as the foundation. To this end, we designed the meta analysis to introduce the current clinical application of this approach. Objective:To evaluate the efficacy of the tongfu therapy on acute period of cerebral hemorrhage. Method: systematically search PubMed, EM base, CNKI, VIP and WanFang database, collect randomized controlled trial (RCT) of treatment cases of tongfu therapy on acute period of cerebral hemorrhage. Randomized controlled clinical trials were screened and reviewed by meta-analysis in RevMan version5.0software. Result:Nine controlled clinical trials were reviewed by meta-analysis. The result demonstrates that the effectiveness rate of treatment based on tongfu therapy show significant difference compared with the control group (OR:2.54,95%C1:1.81—3.56), also improve neurological function rating score significantly(OR:2.54,95%CI:1.62—3.99). Conclusion:The treatment based on tongfu therapy show advantage on efficacy and neurological function rating score compared to the control group. But due to quality of original literature, more studies of high quality and good design are expected to confirm the effectiveness and safety of tongfu therapy. It is fully proved that the tongfu therapy is the core method on the treatment of phlegm-heat and bowel-repletion syndrome in acute phase of stroke. Of course, it needs to be pointed out that, although the clinical observations incorporated by us are the researches about the efficacy of tongfu therapy, those specific herbal prescription could be quite different, which would be impact on clinical effect. Therefore, it is very important to develop the case study about professor Wang Yong-yan for providing the specific treatment guidelines.In this study, we conducted in-depth analysis and discussion on medical cases of the famous TCM expert Wang Yong-yan in treatment of the acute phase of stroke, through the theories and methods of the system science. Based on careful single-case analysis, we understood the structure and the information level of the medical case through a systematic scientific approach. We conducted the overall design and build the main decoction subsystem and the drug addition or subtraction subsystem. We also carried on the detailed explanation about the diagnosis and treatment process and the characteristics of traditional Chinese medicine theory. Not only that, used the phenomenon thinking as the main line, we constructed a conceptual system of phenomenon thinking with semi-quantitative relationship matrix. And we understood its specific implementation details and academic characteristics. Moreover, we also profoundly comprehend the treatment principle of "detoxification and protection of brain networks". Meanwhile, we in-depth understand the "imagery of thinking" mode created by professor Wang. In conclusion, the study on academic thoughts of Wang Yong-yan professor is a gradual deepening process, and we need to continue moving forward in exploring. Because of the limitation of research methods, in the traditional medical case researches, we can only understand the appearance of the connotation in medical cases. Like, although we live in the edge of woodlands, but only see a "lush", namely the forest but not the tree. With the broadening and development of methods on medical case studies, we can dredge the road of excavating the essence of medical cases, and have the tools. Therefore, we can drill woodlands, and see more than a "lush", but forest and trees, namely entirety and each contingent. |
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