Clinical Study On Effect Of Chinese Herbal Medicine Therapy To Chronic Nasal Sinusitis After Endoscopic Surgery For Chronic Nasal Sinusitis

[Objective]To study the effect of Chinese herbal medicine(CHM) therapy to chronic nasal sinusitis patients after endoscopic sinus surgery (ESS), discuss the preliminary effectiveness of CHM in the overall treatment after ESS, and look for the regularity of the syndromes differentiastion. [Methods] 103 in-patients from the first affiliated hospital of Guangzhou University of TCM were randomly allocated to treatment group(n=51,95 nasal and sinus cavities)and control group(n=52, 95 nasal and sinus cavities). All the cases were administrated with the treatment plan refer to xu-geng' s , herbal drug was add to treatment group postoperation for at least 12 weeks. We summarized to 4 syndromes in these patients as followed :syndrome of wind-heat on lung meridian, syndrome of damp and heat on the gallbladder and spleen-stomach, syndrome of qi deficiency on the lung and Spleen, syndrome of yang deficiency on Spleen and kidney. After operation, endoscope examine was done each week during the first 8 weeks and each two weeks during the next 4 weeks, and the TCM syndrome type, the clean of nasal and sinus cavity, mucosa edema, vesicles, granulation tissue, mini-polyps, fibrous hyperplasia, and complete epithelization etc were recorded. At the 12th week, the therapy effect was evaluated separately according to the Haikou' s standard in 1997. [Results]1. There were significant differences between the two groups(P<0.05)on the time of the clean of nasal and sinus cavity,the lasting time of vesicles and mucosa edema, the time of complete epithelization. The stage II and III showed significancial difference in curative effct( P<0.05), the treatment group was better than the control group.2. The Curative effect between the 4 syndromes showed that:the syndrome of damp and heat on the gallbladder and spleen-stomach was the highest of the 4, was 48. 42%, then was the syndrome of wind-heat on lung meridian, the syndrome of qi deficiency on the lung and pleen, the syndrome of yang deficiency on the pleen and kidney, were 33. 68%> 17. 37% and 0. 53%. The syndrome of yang deficiency on the pleen and kidney because of amount of sample was small, merger into the syndrome of qi deficiency of the lung and pleen carried on the covariance. By x2 test, the 4 syndromes showed different curative effect, among them, a cure rate and efficient rate of all was highest, was the syndrome of damp and heat on the gallbladder and spleen-stomach, the next was the syndrome of wind-heat on lung meridian, the syndrome of qi deficiency on the lung and pleen in order. The syndrome of damp and heat on the gallbladder and spleen-stomach and the syndrome of wind-heat on lung meridian showed the significancial difference of curative effect between treatment group and control group( P<0.05), the treatment group was better than the control group.3. Between the 2 groups, the time of the subordinate syndrome of blood stasis and the subordinate syndrome of excessive dampness due to asthenia of the spleen showed insignificance( P>0. 05). To treatment group, the subordinate syndrome of excessive dampness due to asthenia of the spleen show that the lasting time was shorter than the control group( P<0. 05).4. As for the leaving symptoms after operation between the 2 groups: the total scores of symptoms of treatment group were lower than the control group( P<0.05). Nasal discharge is the highest leaving symptom in the control group, which is 69.23%.[Conclusions]1. CHM therapy may improve the effect of sinus surgery, release the discomfort syndrome in region and the whole body, and promote the cleaning of nasal and sinus cavity, and complete epithelization, particularly in stage II. CHM showed the advantage on its allround treatment.2. According to the distribution of the syndromes, the syndrome of damp and heat on the gallbladder and spleen-stomach was the most, then was the syndrome of wind-heat on lung meridian,the syndrome of qi deficiency on the lung and pleen, and the syndrome of yang deficiency on the pleen and kidney. And the efficient rate of the syndrome of damp and heat on the gallbladder andspleen-stomach is the highest, then to the syndrome of wind-heat on lung meridian, and the syndrome of qi deficiency on the lung and pleen. As the treatment group, the syndrome of damp and heat on the gallbladder and spleen-stomach and the syndrome of wind-heat on lung meridian were better than the control group in curative effect.3. We found some interesting regularity of the syndrome changes in recovery phase of ESS , the first 2 weeks after operation most patients showed the subordinate syndromes of blood stasis;After cleaned nasal and sinus cavity , the stage of active mucous membrane regenerating, most of cases showed 'the subordinate syndromes of excessive dampness due to deficiency of the spleen. Compared to preoperative stage ,all cases did not change the main syndromes after the therapy. There were statistic difference between the 2 groups on the days of the subordinate syndrome of blood stasis stage and the subordinate syndrome of excessive dampness stage due to weekness of the spleen , treatment group showed the less time than the control group.