Clincal Study On The Relationship Between The Pulmonary Function And Differentiation With Tradition Chinese Medicine In Stable Chronic Obstructive Pulmonary Disease

Purpose:The study provides some useful reference data on syndrome differentiation with Traditional Chinese Medicine(TCM) to study the relationship between pulmonary function and the syndromes of TCM in stable stage of Chronic Obstructive Pulmonary Disease(COPD) by retrospective investigation and research methods.Objectives and Methods:Collect cases of 200 patients who have been diagnosed as COPD in stable period and are in accordance with the requirements of the study of TCM syndromes.Both outpatients and patients are from the Physical Examination Center whose diseases are in the stable period,no matter if they fall sick for the first time,whose tongue, pulse and body signs will be differentiated by different TCM syndrome.Moreover,the patients are in hospital with symptoms,relief and keeping stable more than one month after treatment,during the return visiting,whose tongue,pulse and body signs will be differentiated.The patients' results can be divided into five groups by differentiation, including the phlegm dampness in lungs(PDL),the phlegm-heat accumulated in the lung (PHAL),the retention of phlegm and blood stasis in the lung(PBSL),the lung-spleen deficiency(LSD) and the lung-kidney deficiency(LKD).Make a careful observation and a detailed record about the patient's sex,age,height,weight,smoking history,level of education,living and working conditions,whether initial diagnosed or not,duration of illness, there exists a history of recurrent respiratory tract infection or not,TCM syndrome and pulmonary function test results.Finally,make a statistical analysis of the above information by using SPSS software.Results: 1.The general situations:The nosogenesis of COPD is related to the factors such as the smoking,socioeconomic status,level of education,and recurrent respiratory tract infection. Indeed,male prevalence rate and the number of male smokers are higher than those of female obviously.These results are in accord with the reported the epidemiology information.2.The age of stable COPD and syndrome type:The LSD group and the LKD group have an obvious difference(P＜0.05),and also have a significant difference compared with the rest of groups(P＜0.01);The age of both groups of the PDL and the PHAL is younger than others and no difference between them(P＞0.05).3.In the Body Mass Index(BMI) comparison,the LSD group and the LKD group have no significant difference(P＞0.05),but both of them are significantly different compared with the remaining groups(P＜0.01);There are no significant difference among the three groups including the PDL group,the PHAL group,the PBSL group(P＞0.05).4.By the duration of illness comparison,the PDL group and the PHAL group mainly distribute in the course of less than 10 years,while most of patients suffering COPD from 10 years to 20 years are in the PBSL group;For the duration of illness more than 20 years,a large amount of patients suffer the deficiency syndrome(the LSD or the LKD).Especially, the performance of the LKD is significantly higher than the performance of the LSD for those patients whose durations of illness are more than 30 years.5.TCM syndromes type and classification of pulmonary function:TCM syndromes and pulmonary function classification have significant correlation(P＜0.05).The Lung function damage of the PDL and the PHAL patients are concentrated in the levelâ… and levelâ…¡;The PBSL patients are mainly concentrated in the levelâ…¡,â…¢;The LSD of lung function patients are distributed in levelâ…¢,and the group of patients with the LKD of lung function are focused in the levelâ…¢,â…£.6.In stable COPDâ… ,50%patients suffer the disease of PDL,37%patients for PHAL. The probability of these two groups is markedly higher than other 3 groups(P＜0.01).7.TCM syndromes and pulmonary function test values:Several ventilation indexes, such as FEV_1.0%,MVV%,FEV_1.0/FVC%:The PDL group and the PHAL group are significantly different(P＜0.01) from the remaining groups but there is no difference between each other(P＞0.05);The LKD group is significantly lower than the others(P＜0.01).Lung volume(RV/TLC%):The lowest increase occurs in both groups of the PDL and the PHAL (P＜0.01),and no obvious difference between them(P＞0.05);The greatest increase is in the group of the LKD(P＜0.01).Diffusion lung capacity(DLCO%):The PDL group and the PHAL group,respectively comparing with the PBSL group,the LSD group and the LKD group are significantly different(P＜0.01);The LSD group and the LKD group have the obvious difference from the PBSL group respectively(P＜0.05);There are no significant difference by comparison between the PBSL group and the PHAL group,and between the LSD group and the LKD group separately(P＞0.05).Determination of airway resistance by impulse oscillometry:Fres:The rank from lowest to highest is in the order from the group of PDL,the PHAL,the PBSL,the LSD,to the LKD,among which there are significant difference(P＜0.01).Rp,R₅,Zrs:For aspects of Rp,R₅,Zrs,the lowest probability of is in the PDL group and the PHAL group,but the highest one is in the LKD group(P＜0.01 or P＜0.05). R₂₀:The tests of the PDL group,the PHAL group and the PBSL group are changed slightly and no obvious difference among them(P＞0.05);The greatest increase is in the group of LKD(P＜0.01),and the mean is near the limit of normal measured value.Conclusions:1.Classification of lung function can be used as the reference of a stable-period of COPD TCM syndromes differentiation.With the pathogenesis of COPD to the phlegm dampness,phlegm heat,the phlegm and blood stasis,the LSD and to the LKD,the location of the lesion were followed by the lung to the spleen,gradually to the renal,the pulmonary function also graded from classâ… ,classâ…¡,classâ…¢to classâ…£.Most of patients with stable COPD on classâ… have the PDL or the PHAL TCM syndromes,while the patients with classâ…¢have the LSD or the LKD.2.Test of pulmonary function can work as an effective method for TCM syndromes differentiation.The lung ventilation capacity(FEV_1.0%,MVV%),the degree of airflow obstruction(FEV_1.0/FVC%),emphysematous extent(RV/TLC%),peripheral airway resistance(Rp),total airway resistance(R₅) and total respiratory resistance(Zrs) of the phlegm-syndrome group(the PDL group and the PHAL group) changed slightly and their sickness conditions are the best to cure;While the LKD group is the most serious sickness. The sharp decreasing of the pulmonary diffusing capacity(DLCO%) is related with the formation of phlegm and blood stasis as well as the lung,spleen,kidney deficiency.During the levelâ… of COPD,the phlegm dampness and the phlegm heat performances in patients. Meanwhile,pulmonary function test values only show difference of the small airway resistance(Fres);The PHAL group increase significantly.The diseased region in some people of the LKD group have involved central air passage(R₂₀).3.BMI,age and duration of illness can also provide the reference for TCM syndromes differentiation of COPD.The patients with less than 10 years sickness course,no obvious decline in BMI,relatively young,are mostly in the group of the PDL or the PHAL;The patients with the course of more than 20 years,sharp decline in BMI,the elderly,are mostly in the LSD-oriented or the LKD-oriented groups,especially when the course is more than 30 years,the patients are mainly in the LKD group.4.In our study,we get the results that it is better to treat the stable COPD patients in levelâ… by chinese herbology intervention treatment and eliminating phlegm from patients.(It is necessary to do mass clinical trials).