| Microcosmic syndrome differentiation is the product of research of traditional Chinese Medicine (TCM) tends to be integrated with Western medicine(WM) and one of specific performance in the modernization of TCM. In the 80s of the 20th century, the academician, Mr.Shen ziyin definitely put forward the new concept "microcosmic syndrome differentiation" in the article "Microcosmic syndrome differentiation and syndrome differentiation micro-adjustment" for the first time. Then professor Guozhenqiu put forward "syndrome differentiation micro-adjustment" and "Microcosmic syndrome differentiation theory(MSD)". Tutor and professor Wu zhengzhi further developed and improved the subject concept of microcosmic syndrome differentiation theory.He put forward definitely that MSD is a modern newly basic subject of TCM and WM combination,which is directed by theory of TCM and applied mordern multi-subjest methods and technology, explore the TCM diagnosis and dialectical theory from microcosmic field and illuminate the modern scientific essence and pathology change rule of "symptoms", for providing TCM clinical diagnosis with objective, microcosmic quantify evidence. He systematically put forward and explored subject attribute, discipline structure, the history and drections of subject and pushed the establishment and development of the subject. The establishment of microcosmic syndrome differentiation theory illuminate pathophysiology basis of syndrome, help the early diagnosis of TCM clinics and promote the standardization of TCM diagnosis. It can be helpful in objective evalution of clinical efficacy and academic innovation of TCM and subject differentiation. The deep and systematic researches of the subject will drive the expanding and developing of the TCM Pathogenesis, the Diagnostic Methods of TCM, TCM syndrome differentiation and TCM therapeutic principle. It is significant in promoting the development of TCM and WM combination basis subjects and TCM modernization.With the deepening of the research of combination of TCM and WM, which takes syndrome differentiation and treatment as the core, microcosmic syndrome differentiation theory develops continuously and becomes mature. This subject has differentiated three related field-----microcosmic diagnostic methods, microcosmic symptoms and signs theory and doctrine of microscopic diagnosis and treatment. Microcosmic diagnostic methods, which are represented by pulse taking and tongue inspection, apply modern scientific methods to illuminate theory of fur and pulse condition to make inspection of tongue and "mai" diagnosis objective, microcosmic and modern. Microcosmic symptoms and signs theory raises traditional differential diagnosis to the level of cell, sub cell, molecule and gene by using advanced technology of modern multi-subject for illuminate the modern scientific TCM symptoms and signs and its microcosmic change rule. Doctrine of microscopic diagnosis and treatment is based on the principle of Chinese medicine diagnosis and treatment. By combining microcosmic syndrome differentiation of disease, TCM intervention efficacy study is done to explore the rules of microcosmic treatment of disease. Microcosmic symptoms and signs theory is the main research field of doctrine of microscopic diagnosis and treatment.Secretory Otitis Media(SOM) is a common otological disease with a high incidence, which can cause a variety of clinical symptoms including ear fullness, tinnitus, ear blocking and hearing impairment. SOM maybe the ear fullness and block in TCM. And it is characterized by intratympanic fluid and easy to repeated attacks, which can result in the adhesive otitis media and long-term hearing loss. Ear fullness is in the initial stag of SOM. Patients always have a feeling of fullness, blockage pressure and pain in their ear, which is caused by cold invasion. Therefore, SOM is known as "anemogenous deafness" by the ancients. Ear block is due to the long delay of SOM. Pathogens block the upper orifices in the pathogenesis of this disease. Patients have the symptoms of aural fullness, hearing impairment, and vertigo, the pathogenesis of which is that ear fullness recur repeatedly and evil pathogens deadblock in the external acoustic meatus to worsening the illness. As a result, SOM is also referred to as "deafness with qi stagnation". The ear fullness and block are divided into 4 types by otorhinolaryngology of TCM. However, combined the characteristics of regional distribution and weather in Lingnan, Wind-heat invading upward and meridian-QI stuffiness(wind-heat type), hepatochlic hygropyrexia invading ears(damp-heat type) and stagnation of evil-poison and phlegm-blood accumulation(Phlegm and Blood Stasis type) are common seen in clinic.In modern medicine, etiology and pathogenesis of SOM is not yet clear, mainly involving the middle ear negative pressure, infections, eustachian tube surfactant, immune theory and the combined effects of multiple factors theory, etc. The middle ear fluid (MEF) of patients with SOM is mainly due to middle ear inflammatory exudate, In recent years, studies have shown that MEF is closely related to the inflammatory mediators, such as:histamine,5-hydroxytryptamine (5-HT), interleukin (IL), Tumor necrosis factor (TNF), platelet-activating factor (PAF), endothelin (ET) and so on, which play an important role in the initiation and progression of inflammation, PAF and TNF play a critical role in the initial stages of SOM. Some scholars have found that the inflammatory mediators have certain rules of distribution in serum and MEF of patients with SOM, which has some clinical significance in guiding the treatment. However, the study of correlation between differentiation of symptoms and signs for classification of syndrome and inflammatory mediators, such as:PAF,IL-2,ET-1 and so on, has not yet been reported. In this study, the levels of serum PAF, IL-1 and ET-1 and effusion PAF of SOM patients with different syndrome differentiation were determined by the method of enzyme-linked immunosorbent assay (ELISA) and compared to normal group to probe the variation of inflammatory mediators of patients with different classification of syndrome, which provide the objective clinical trial basis for microcosmic syndrome differentiation of SOM.Objective:To observe the relationship between SOM TCM syndrome differentiation and the levels of PAF, IL-2 and ET-1 in serum and inflammation mediater PAF content in fluid in patients with SOM. To explore the changing characteristics of SOM syndrome differentiation MEF and inflammation mediater content in serum so as to provide objective clinical experimental basis for microcosmic syndrome differentiation and elucidate the essence of inflammation mediater in the formation and development of SOM, enrich microcosmic syndrome differentiation of TCM diagnosis theory and promote objective differentiation and microcosmic differentiation of differentiation standard of TCM.Method:According to SOM syndrome differentiation written in "Otolaryngology of TCM", the patients with different syndrome differentiation including wind-heat type (36 cases),damp-heat type(38 cases) and phlegm and blood stasis type (20 cases)were collected, and were compared with healthy control group(normal group,40 cases), PAF content in MEF and serum, IL-2 and ET-1 content in serum in SOM of each group were detected by using ELISA and the analysis of the changes of the content of inflammation mediaters compared with those in normal group was done.Result:1. The PAF contents in serum in SOM patients with wind-heat type, damp-heat type and phlegm and blood stasis type were 117.16±19.52,168.31±35.48, 89.73±10.75 ng.ml"1 respectively. PAF content in serum in normal group was 91.06±18.70ng.ml-1. Damp-heat type was the highest in content, phlegm and blood stasis type the lowest, and wind-heat type and normal group took the second and third place. In each SOM type, Serum PAF content in normal group was significantly lower than those in wind-heat type group and damp-heat type group (P=0.000), but there was no significant difference between the normal group and phlegm and blood stasis type group(P=1.000); Serum PAF content in wind-heat type was obviously lower than that in damp-heat type(P=0.000),but obviously higher than those in phlegm and blood stasis type group and normal group(P=0.000). Serum PAF content in damp-heat type group was obviously higher than those in wind-heat type, phlegm and blood stasis type and normal group. Serum PAF content in phlegm and blood stasis type was obviously lower than wind-heat type and damp-heat type but there was no significant difference between phlegm and blood stasis type group and normal group (P=1.000).2. IL-2 contents in serum in patients with wind-heat, damp-heat and phlegm and blood stasis type were 11.65±1.73,14.20±3.66,9.83±1.60pg.ml"1 respectively. IL-2 content in serum in normal group was 9.91±2.94pg.ml-1. IL-2 content in SOM patients with damp-heat type was the highest, phlegm and blood stasis type the lowest, and wind-heat and normal group took the second and the third place. The IL-2 content in normal group was significantly lower than those in wind-heat type group and damp-heat type group(P=0.013, P=0.000).There was no significant difference between normal group and phlegm and blood stasis type group(P=1.000).The IL-2 content in wind-heat was significantly lower than that in damp-heat group (P=0.002),but significantly higher than those in phlegm and blood stasis group and normal group (P=0.002, P=0.013).IL-2 in damp-heat group was obviously higher than those in wind-heat group phlegm and blood stasis and normal group (P=0.002, P=0.000 and P=0.000).IL-2 in phlegm and blood stasis type was obviously lower than those in wind-heat and damp-heat type. There was no significant difference between phlegm and blood stasis type group and normal group.3. ET-1 contents in serum in patients with wind-heat, damp-heat and phlegm and blood stasis type were 1.27±0.83,1.69±1.00,0.49±0.43ug.L-1 respectively. ET-1 content in serum in normal group was 0.64±0.53 ug.L-1. ET-1 content in serum in damp-heat type group was the highest, phlegm and blood stasis type was the lowest, wind-heat and normal group took the second and third place. The ET-1 content in normal group was obviously lower than those in wind-heat and damp-heat type group (P=0.001, P=0.000).There was no significant difference between the normal group and phlegm and blood stasis type type group(P=0.515).The ET-1 content in wind-heat type group was obviously lower than that in damp-heat type group (P=0.022) but obviously higher than those of phlegm and blood stasis type and normal group(P=0.000, P=0.001).The ET-1 content in phlegm and blood stasis type group was obviously higher than those in wind-heat type group, phlegm and blood stasis type group and normal type group (P=0.022, P=0.000, P=0.000).The ET-1 in phlegm and blood stasis was obviously lower than wind-heat type and damp type but there was no significant difference between phlegm and blood stasis type group and normal group (P=0.515).4. The PAF contents in MEF in SOM patients with wind-heat, damp-heat and phlegm and blood stasis type were 144.66±35.19,203.53±45.10 and 92.57±15.51ng.ml"1 respectively. The PAF content in MEF in SOM patients with damp-heat type was the highest, phlegm and blood stasis the lowest, wind-heat type the second. The PAF content in wind-heat group was significantly lower than that in damp-heat (P=0.000), and significantly higher than that in phlegm and blood stasis group(P=0.000). The PAF content in damp heat type group was significantly higher than those in wind-heat and phlegm and blood stasis type group(P=0.000). The PAF content in phlegm and blood stasis type was obviously lower than that in wind-heat and damp-heat type (P=0.000).5. The PAF contents in seraum in SOM patients with wind-heat, damp-heat and phlegm and blood stasis type were 117.16±19.52,168.31±35.48 and 89.73±10.75 ng.ml-1 respectively, while the PAF contents in MEF were 144.66±35.19, 203.53±45.10 and 92.57±15.51ng.ml-1. The PAF contents in fluid in wind-heat and damp-heat type were obviously higher than those in serum(P=0.000), but there was no significant difference between PAF content in fluid and PAF in serum in SOM patients with phlegm and blood stasis type.6.The change characteristics of PAF, IL-2 and ET-1 contents in serum in different type in SOM patient was consistent with the PAF content in fluid, with damp-heat highest, wind-heat second and phlegm and blood stasis lowest. There was statistical significance among three groups (P<0.01). The PAF, IL-2 and ET-1contents in serum and PAF content in fluid in damp-heat and wind-heat type group were obviously higher than those in normal group and phlegm and blood stasis type group. The PAF, IL-2 and ET-1 contents in serum and PAF content in fluid in damp-heat type group were obviously higher than that in wind-heat type group. It was demonstrated that the change rule of three inflammatory mediators PAF, IL-2 and ET-1 contents in serum in SOW patient was consistent with the PAF content in fluid. The high expression of PAF, IL-2 and ET-1 in serum and fluid in SOM patient was the characteristics of damp-heat type, medium expression was the characteristics of wind-heat type, and phlegm and blood stasis was mainly expressed low. The elevated PAF content in MEF in patients with damp heat and wind heat type was more significantly than that of PAF content in serum. The difference between them was significant (P<0.01). There was no statistically significant difference between the PAF content in MEF and PAF content in serum in phlegm and blood stasis type (P>0.05).Conclusion:1. The change characteristics of PAF, IL-2 and ET-1 contents in serum in each type in SOM patient are consistent with that of the PAF content in fluid, with damp-heat highest, wind-heat second and phlegm and blood stasis lowest. There is significant difference among three types. They can be used for microcosmic basis for syndrome differentiation of each type.2. The PAF, IL-2 and ET-1 contents in serum and PAF content in fluid in damp-heat and wind-heat type group are obviously higher than those in normal group and phlegm and blood stasis type group. The PAF, IL-2 and ET-1 contents in serum and PAF content in fluid in damp-heat type group are obviously higher than those in wind-heat type group. The high expression of PAF, IL-2 and ET-1 in serum and fluid in SOM patient is the characteristics of damp-heat type, medium expression is the characteristics of wind-heat type, and phlegm and blood stasis is mainly expressed low.3. The elevated f PAF content in MEF in patients with damp heat and wind heat type is more significantly than that of PAF content in serum. There is no significant difference between PAF content in MEF and PAF content in serum in the phlegm and blood stasis type. It is demonstrated that the PAF content in MEF in SOM patients with damp-heat and wind-heat type has more microcosmic diagnosis value than PAF content change in serum.4. The inflammatory mediators PAF, IL-2 and ET-1 in serum and PAF in MEF in SOM patient have certain reference value in microcosmic syndrome differentiation typing, which provides objective clinical experimental basis for microcosmic syndrome differentiation, enriches the connotation of TCM diagnosis theory and microcosmic symptoms and signs theory. They have an important theoretical and clinical significance to promote the objectification and microcosm of TCM clinical syndrome differentiation. |
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