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Professor Wang Qi identified the body - of Diseases - dialectical combination of academic thought and clinical experience and treatment of chronic insomnia clinical studies

Author: JiangMin
Tutor: WangZuo
School: Beijing University of Traditional Chinese Medicine
Course: Chinese medical science
Keywords: Academic thoughts Clinical experience Disease differentiation Insomnia Physique differentiation Syndrome differentiation Chronic insomnia Gaozhenwuyou decoction Pittsburgh sleep quality index(PSQI) Syndrome integral scale
CLC: R249.2
Type: Master's thesis
Year: 2011
Downloads: 66
Quote: 0
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Abstract


Being the professor of Beijing University of Chinese Medicine and doctoral supervisor in Basic Theory of Traditional Chinese Medicine, Wang Qi is one of the 500 famous veteran doctors in TCM selected by Ministry of Personnel, Ministry of Health and State Administration of Traditional Chinese Medicine. He founded TCM constitutional doctrine, TCM andrology, saved the examination method of palpation of abdomen and constructed TCM visceral manifestation theory.OBJECTIVE:1 This research carries on complete summarizing to Wang Qi academic thoughts of combination of physique-disease-syndrome differentiation, which make us have an overall, clear and deep understanding to the thoughts, so that they can be passed on generation by generation and provide scientific guidance for clinical practice.2 This research tries to carry forward and develop the treatment thought and characteristic of drugs of professor Wang Qi by summarizing the clinical experiences in treatment.3 This research carries on investigation in the experiences of Wang Qi in treatment of chronic insomnia by Gaozhenwuyou decoction. we can provide scientific statistic evidence for Wang Qi experience, make it more convincing. This also will play an active role in the extensive use of experience of Wang Qi in TCM clinical and provide effective thought and method for the practice of succession of teachers of Chinese medicine.METHOD:1 Summarizing Wang Qi academic thoughts of combination of physique-disease-syndrome differentiationThis research makes an analysis of the succession and theoretical sources and clinical background of the thought of Wang Qi, organize and summarize the connotation in the thought of physique-disease-syndrome and clinical experience2 Summarizing the clinical experiences of Wang Qi in treatment of seven diseases with good effect according to the feeling of learning.3 Study on the clinical effect in treatment of chronic insomnia by Gaozhenwuyou decoction prescribed by professor Wang QI.In the prospective group controlled study,120 cases with chronic insomnia were divided into 2groups. All the patients came from TCM Department in Beijing Shijitan Hospital.60 cases in treating group were given Gaozhenwuyou decoction which was prescribed by professor Wang QI, modified according to physique and syndrome,200ml each time, two times daily. 60 cases in control group were given Cizhu pills,3g each time,two times daily.21days is for a course. All the patients of chronic insomnia were evaluated with syndrome integral scale, Pittsburgh sleep quality index(PSQI) and security scale before and after the treatment. All the data were analyzed with SPSS 16.0 statistical software package.RESULTS:1 Wang Qi academic thoughts of physique-disease-syndrome differentiationThe theory of Wang Qi is premised on the relationship of physique, disease and syndrome. It is also based on the thesis of adjustable physique and the relationship of physique and disease. The core of the theory is treatment based on differentiation of physique. Wang Qi emphasis that physique differentiation, disease differentiation and syndrome differentiation should be combined together to fully recognize the essence of disease, which will be helpful to the diagnosis and treatment.The objective of physique differentiation is human being. The objective of disease differentiation is the general understanding of the pathological characteristics and the law of occurrence and development in the whole process. The objective of syndrome differentiation is to uncover the pathological characteristics and rules, the situation of viscera, yin and yang,qi and blood in a certain stage. Physique, disease and syndrome reflect the essence and characteristic from different angles and levels. They are mutually connected, inseparable, unified and indispensable, while the key point is physique differentiation. Physique not only plays an important role in the occurrence, development and prognosis of the disease but also has great influence and restriction to the formation and evaluation of syndrome. The physical factors should be fully considered when we try to establish the therapeutic principles and prescriptions.2 clinical experiences of combination physique-disease-syndrome differentiation of Wang QiIt is necessary to identify physique before syndrome differentiation, physique differentiation should never be forgot when we diagnose disease. When physique is connected with diseases and the syndrome closely, treatment should begin with adjusting physique. For the disease without syndrome, the treatment should be given according to physique differentiation and physique adjusting.3 understanding and development This study reported that Combination is the main clinical manifestation of physical type in disease. Thus we should pay more attention to the adjustment of physique. At the same time, when we chose drugs to adjust physique in clinical treatment, the character of syndrome should be the guidance.4 Clinical experience of professor Wang QiThe mechanism of chronic prostatitis is toxin, stagnant blood, and turbid pathogen. It can be treated by classic prescriptions stage by stage. Impotence should be treated from liver, using Shuganzhenwei decoction. Psychological counseling before drugs can be helpful. The mechanism of azoospermia is toxin, stagnant blood, heat, parasitic, dampness and kidney insufficiency. It can be treated by Shengjingzanyu decoction and Huangjingzanyu capsule. The mechanism of chronic urinary infection is toxin being fastened with stagnant blood and damp-heat inside. It can be treated from toxin and stagnant blood while clearing heat and draining damp, using Wucao decoction prescribed by professor Wang Qi.Allergic rhinitis should be treated from adjusting physique. The treatment in acute period and remission period are different. Acne is treated by qianjinweijing decoction add purslane hurb and oldenlandia. The mechanism of hypertension is phlegm-damp, stagnant blood, reversed flow of Qi. It can be treated by Zhenganjiangya decoction. Control the dosage of prepared Common Monkshood Daughter Root. It is combined with Dried Ginger and Liquorice Root to reduce the toxicity.5 Clinic study of Gaozhenwuyou decoction prescribed by Professor Wang Qi in treatment of chronic insomnia.5.1 It was comparable between the two groups in gender, age, course of disease, the classification of TCM constitution, score of syndrome integral scale and Pittsburgh sleep quality index(PSQI).5.2 Among 120 subjects, deficient of Qi constitution 1.67%, deficient of Yang constitution 1.67%, deficient of Yin constitution 12.50%, phlegm-dampness constitution 0%, dampness-heat constitution 12.50%, stagnant blood constitution 33.33%, blahs<depressed> constitution 38.33%. The data shows that patients with stagnant blood constitution and blahs <depressed> constitution are more susceptible to chronic insomnia than patients with other constitution.5.3 All of the two treatments can improve the clinical symptoms of the patients(p< 0.05), but therapeutic group was superior to that of control group especially in difficulty falling asleep, sleeping time, dreaminess, frequent arousals (p< 0.05).There was no significant difference in fatigue between the two groups. (p>0.05). TCM syndrome efficiency rate in therapeutic group:cure rate36.67%, apparent rate 48.33%,response rate 10%,overall response rate 95%.Rank sum test show that the treatment effect in therapeutic group was significantly superior to that in the control groups, (p< 0.05).5.4 analyze of Pittsburgh sleep quality index(PSQI):Both of the two treatment can improve the patients’ sleep quality, sleep time, sleep efficiency, daytime function and reduce hypnotic(p< 0.05), but the therapeutic group was superior to that of control group. Pittsburgh sleep quality index(PSQI) efficiency rate:cure rate 28.33%, apparent rate 51.66%, response rate13.34%, overall response rate 93.33%. Rank sum test show that the treatment effect in therapeutic group was significantly superior to that in the control group. (p<0.05). This indicate the Jiaoheanmian Decoction of professor Wang Qi is more effective than CIZHU pills in improve the symptoms related to PSQI.5.5 There is no side effect and adverse event was found in both groups.CONCLUSION:1 Combination of physique-disease-syndrome differentiation is an important academic thoughts of professor Wang Qi. It exits all the processes of clinic treatment. The core of the theory is physique differentiation, which is the fundamental of disease and main target of treatment. The experience of clinic treatment is include:physique differentiation is necessary to syndrome differentiation, adjust the physique before medical treatment, treat disease while modulate individuals’body constitution, modulate individuals’body constitution when syndrome can not be identified.2 Professor Wang Qi has rich experience and his understanding to disease is comprehensive and profound. He can use classic prescriptions flexibly and make his own prescriptions.3 Using TCM symptom integral scale and Pittsburgh sleep quality index to statistic, analyze and summarize the experience of professor Wang Qi in the treatment of chronic insomnia. Objective data shows that the effect is definite and convincing. It also enriched the connotation of the effect in the treatment of insomnia and became an innovation of this study. It also provide an effective method to practice inheritance of Traditional Chinese Medicine. OBJECTIVE:In order to summarize and inherit the clinical experience of professor Wang Qi in treating chronic insomnia, we analyzes the clinical effect of Gaozhenwuyou decoction which is prescribed by professor Wang Qi in prospective group controlled study.This study aim to support the clinical effect with evidence, improve the reliability, and enrich the connotation of the experience of professor Wang Qi.METHOD:1 In order to grasp the related studies of chronic insomnia, we reviewed the treatment of insomnia in West medicine and Traditional Chinese Medicine and learn the experience of more than ten famous TCM doctors in treating the disease.2 In the prospective group controlled study,120 cases with chronic insomnia were divided into 2groups.60 cases were given Gaozhenwuyou decoction which was prescribed by professor Wang QI,200ml each time, two times daily.60 cases in control group were given Cizhu pills,3g each time,two times daily.21 days is for a course. All the patients of obstinate insomnia were evaluated with Syndrome integral scale, Pittsburgh sleep quality index(PSQI) and security scale before and after the treatment. All the data were analyzed with SPSS 16.0 statistical software package.RESULT:1 It was comparable between the two groups in gender, age, course of disease, the classification of TCM constitution, score of syndrome integral scale and Pittsburgh sleep quality index(PSQI).2 Among 120 subjects, deficient of Qi constitution 1.67%, deficient of Yang constitution 1.67%, deficient of Yin constitution 12.50%, phlegm-dampness constitution 0%, dampness-heat constitution 12.50%, stagnant blood constitution 33.33%, blahs<depressed> constitution 38.33%. The data shows that patients with stagnant blood constitution and blahs <depressed> constitution are more susceptible to chronic insomnia than patients with other constitution.3 All of the two treatments can improve the clinical symptoms of the patients(p< 0.05), but therapeutic group was superior to that of control group especially in difficulty falling asleep, sleeping time,dreaminess, frequent arousals (p< 0.05).There was no significant difference in fatigue between the two groups. (p>0.05). TCM syndrome efficiency rate in therapeutic group:cure rate 36.37%, apparent rate 48.33%,response rate10%,overall response rate 95%. Rank sum test show that the treatment effect in therapeutic group was significantly superior to that in the control groupe. (p< 0.05)4 Analyze of Pittsburgh sleep quality index(PSQI):Both of the two treatment can improve the patient,s sleep quality, sleep time sleep efficiency, daytime function and reduce hypnotic(p<0.05), but the therapeutic group was superior to that of control group. Pittsburgh sleep quality index(PSQI) efficiency rate: cure rate 28.33%, apparent rate 51.66%,response rate13.34%, overall response rate 93.33%. Rank sum test show that the treatment effect in therapeutic group was significantly superior to that in the control group. (p< 0.05).5 There is no side effect and adverse event wes found in both groups.CONCLUSION:Gaozhenwuyou decoction of professor WangQi is composed of Common Selfheal Fruit-spike, Pinellia Tuber, Perilla Leaf, Lilly Bulb, Silktree Albizia Bark. These two herbs are combined together to regulate liver and stomach, balance Yin and Yang. Thus nutrient and defense can move regularly, Yin and Yang can join each other. Perilla Leaf is pungent-warm. It can regulate Qi and harmonize nutrient blood. Lilly Bulb is sweet and cold and is good at tranquilizing. Silktree Albizia Bark is sweet and even. it is also good at at tranquilizing and anti-depression. The growth characteristic of these three drugs is bloom in day and close at night, which have the same sleep pattern with human. That is why the decoction can lead to a good clinical effect.The experience of professor Wang Qi in treating chronic insomnia is include:identify the main cause of disease, main syndrome and the mechanism of disease first; search for fundamental of disease in treatment; make Yin and Yang join each other; treat insomnia from regulating liver and tranquilizing; pay great importance to physique adjustment and tranquilize through stasis-resolving.INNOVATION:1 It is the first time to quantitative analyzes the clinical effect of Gaozhenwuyou decoction in a prospective group controlled study. In this study, the coherence of the baseline of two groups was strictly controlled, scales and scientific statistic method were used.These methods can support the clinical effect with evidence, improve the reliability, and enrich the connotation of the experience of professor Wang Qi. 2 I submit that doctors should pay more attention to regulate Qi and Blood when treating female patients with insomnia according to the theory of professor Wang Qi. This has leaded to a great effect in clinical treatment.3 Take foot bathing, one of the external treatments, as a adjuvant therapy of internal therapy to patients with insomnia. This treatment conforms the theory of joining Yin and Yang. Thus the patients with insomnia can be fully treated.

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