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Professor Wang Qi academic thought and clinical experience in the main square of the primary disease and treatment variability rhinitis clinical research

Author: NiCheng
Tutor: WangZuo
School: Beijing University of Traditional Chinese Medicine
Course: Chinese medical science
Keywords: Wang Qi main prescription for its disease academic succeeding Allergic rhinitis Tuomin Zhiti Tang (Decoction for desensitization and relieving sternutation) Xiao Qionglong Tang
CLC: R276.1
Type: PhD thesis
Year: 2011
Downloads: 133
Quote: 2
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Abstract


Background:Syndrome differentiation and treatment has been considered the authority and golden criteria, and becoming the characteristic brand of traditional Chinese medicine (TCM) therapy, even has been established the valuable criteria when evaluating TCM treatment for a long time. It is believed that there is a trend of focus on syndrome differentiation instead of disease differentiation. Researches on TCM history of disease diagnostic and treatment indicate that disease diagnosis and differentiation, syndrome identification from disease, prescription based on disease have become the origin of TCM treatment. In the Preface to Lan Tai Gui Fan by Xu Dachun, the author pointed that a kind of disease must refer to a specified main prescription (zhu-fang), meanwhile, a special prescription must respond to a monarch medicinal (zhu-yao). However, this point of view was not given enough concentration since then, instead, the theory of special prescription with medicine for specified disease leads to the focus on disease differentiation over syndrome differentiation. How to scientifically evaluate and practice multiple diagnostic models of TCM is acknowledged as one of the most issue in translational medicine nowadays.Allergic rhinitis (AR) is a chronic inflammatory reactive disease on schneiderian membrane mediated by IgE, and can seriously impact on patients’sleeping, memory, emotion and quality of life. Professor Wang Qi applies the treatment idea of regulating physic against latent heat adverse rising and unhealthy qi external invade for treatment of adult with allergic rhinitis, which could obviously relieve patients’symptoms, and even cure some patients. This indicates that Chinese herbal medicine has advantages in treating AR.Objective:This study is based on the idea promoted by Professor Wang Qi that disease differentiation, as the key link, should be combined with syndrome differentiation and body differentiation, namely, the three-dimensional diagnosis-treatment ideology, with the disease as the cut-point when the patient is ill. This study is expected to concentrate on the ideology of monarch disease and main prescription by the supervisor, digest the prescription establishing process, and summarize the academic experience of monarch disease and main prescription by the supervisor, in order to systematically review and evaluate the clinical effectiveness and safety of Professor Wang Qi’s experienced prescription for treatment of AR. The purpose of this study is to provide with a research model for succeeding elderly famous TCM practitioners’ideology and academic experience, which is believed to be significance, both in theory and in practice, for translational application of the three-dimensional diagnosis-treatment, and for the enrichment and development of multiple TCM diagnosis-treatment ideas.Methods:1) Academic study and extraction of Professor Wang Qi’s monarch disease and main prescription ideology:by relevant literature research, clinical practice following the supervisor, cases study, learning from presentations, clinical observations and various ways, under the guidance of supervisor, to concentrate the academic ideology of monarch disease and main prescription. Therefore, a total of ten representative diseases were selected, from the disease differentiation and mechanism examination, application field of the monarch disease and main prescription, the establishment theory of prescription, modification (combined with syndrome differentiation and body differentiation), review on case reports and new construction based on experience would be followed, in order to systematically and thoroughly reflect the establishment of monarch disease and main prescription, clinical experience,.gain from practice following the supervisor and its experience, personal ideas and innovations, et al.2) Clinical research of Professor Wang Qi’s "Body Recuperation Theory on Summer Heat Upsetting and External Invasion by Pathogenic Factor" for treatment of adult patients with AR:in this case control study, participants were divided into Group Treated by Advisors (Group A), and Group Treated by Academic Successors (Group B). Participants in Group A received treatment from advisor’s applying the treatment idea of "Body Recuperation Theory on Summer Heat Upsetting and External Invasion by Pathogenic Factor", and participants in Group B received treatment from the academic successors applying the traditional method of treatment against cold-water retention storing in the lungs and stimulated by external evil. We observed the effectiveness and safety of the prescription from the advisors. The Guideline on the Diagnosis and Treatment of Allergic Rhinitis, which is issued in 2009 by the China Medical Association Otolaryngology Seminal, was employed for diagnosis and effectiveness evaluation criteria of AR in this study.Conclusions:1. The concept of main prescription for its diseaseProfessor Wang Qi pointed out the construction of "monarch disease, main prescription and key medicine (zhu ming zhu fang zhu yao)" from Lan Tai Gui Fan by Xu Lingtai (Qing dynasty), and defined the concept of "monarch disease and main prescription" as the prescription targeting at the leading mechanism that impenetrate the disease from the beginning to the end in the "many prescriptions for one disease". For example, Zhang Zhongjing used Baihe Dihuang decoction, Baihe Zhimu decoction, Huashi Daizhe decoction, Gualou Muli powder, and so on, in treating lily disease, neurosis characterized by mental strain, listlessness, sleeplessness, anorexia, yellow urine, et al., in which, Baihe Dihuang decoction is highly concentrated for heart-lung yin-deficiency with internal heat mechanism. The main prescription for its disease is different from one prescription for one disease, specified formula for specified disease, and one prescription for multiple diseases.2. Four-step establishment idea of monarch disease and main prescription First, the kernel of monarch disease and main prescription is that the combination of medicine in the prescription should be logically examined and considered. There are three ways leading to its practice.1) distinguish different levels of disease mechanism and prescribe orderly; 2) hold the trend of disease mechanism, and grasp the rule of prescription establishment; 3) differentiate the complicated disease mechanism, focusing on explore the hidden mechanism (wu zhe qiu zhi). Second, the specialization of monarch disease and main prescription is specified medicinal for its disease. If a kind of medicine is effective for a kind of disease, it’s called the specified medicinal of this disease. For example, Bambusa breviflora Munro is for hemostasis, Glycine max (L.) Merr. is used to check sweating, Corydalis turtschaninovii Bess. is for relieving pain, and Sophora flavescens Ait. is for treatment of palpitation, et al. specialized medicine should not be used singly. Commonly, the specialized medicine in monarch disease and main prescription is the monarch medicine (jun yao), or targeting at the main symptom in medicine matching-up; furthermore, the amount of specialized medicine should be large, actually, should be enough, as the "medicine relates to disease or symptom", safe and effective, as the principle. Third, the nature of monarch disease and main prescription is body differentiation and prescription, which is not targeting at coordinating the body, but disease-related body, treatment by the root cause, same treatment for different symptom related disease. Forth, the method of monarch disease and main prescription is to transform the original formula for new application, combine small formula from different levels, establish experienced formula to find different treatment efficacy. In which, the establishment of new prescription idea is focusing on formula theory, specialized prescription for special disease, medicine matching-up and combination of formula, as well as considering the TCM Pharmacology.3. "Four-dimension" application mode of monarch disease and main prescriptionThere is an eccentrically-syncretic relationship between TCM body differentiation and syndrome-disease differentiation and treatment. This kind of relationship is determined byfollowing:1) the degree of ill condition and the existence of syndrome,2) the association between human body and disease,3) the purpose and strategy of prevention and treatment, and 4) the observation of effectiveness before and after the treatment. When the disease is getting worse or presents suddenly, the disease trend develops quickly, the main issue should be over the syndrome presentation or signs, and the compendium of main prescription for its disease should be emphasized, also modification should be considered by syndrome differentiation and/or body differentiation. On the other hand, when the disease trend is less distinct than the syndrome presentation, it is expected to use the formula for divided targets, namely, to combine the main prescription for its disease and syndrome differentiation-treatment. If the disease is complicated with body conditions, the idea that multiple sides lead to one (duo yuan gui yi) is employed, therefore, the complicated diseases should be treated with body differentiation. If the effectiveness is achieved by the above treatment, the order of prescription (xu guan yong fang) could be used, therefore, body differentiation and treatment is for further effectiveness.4. Summary on clinical experience on monarch disease and main prescriptionProf Wang Qi has been practiced TCM in clinic for more than forty years, and promoted the "Three-dimensional diagnostic perspective" of the combination of syndrome differentiation and body differentiation with the key kernel of disease differentiation when the patient is ill, and this perspective should be considered through the academic ideology of monarch disease and main prescription with specialized medicine. This study would systematically review the clinical experience of ten diseases’treatment by Prof Wang Qi.1) the main mechanism of impotence is liver-meridian failing to function normally, therefore, the main prescription is Shugan Zhenwei Decoction, targeting at soothing liver and strengthening liver, and unblocking meridian; 2) the main mechanism of Chronic prostatitis pelvic syndrome is stasis blocking liver-meridian, therefore, the main prescription is Qianlie Zhitong Decoction, targeting at clearing hear and cooling blood, activating blood and relieving pain; 3) the main mechanism of asthenospermia is the kidney-deficiency complicated with dampness-heat and stasis toxicity, therefore, the main prescription is Shengjing Zanyu Decoction, targeting at notifying kidney by adding essence and clear dampness-heat, activating blood and removing stasis; 4) the main mechanism of obesity and metabolism syndrome is phlegm-dampness as body characteristic as the root cause, and qi-blood and impound food as symptoms, therefore, the main prescription is Yiqi Qingjian Decoction, targeting at strengthening qi and warming yang, removing phlegm and dampness, promoting digesting to remove the stasis; 5) the main mechanism of primary hypertension is qi-blood upsetting and heat leading to fluid stagnation, therefore, the main prescription is Zhenni Jiangya Decoction, targeting at clearing liver to keep down the reversing by qi and heat, activating blood to promote the fluid; 6) the main mechanism of coronary heart disease is phlegm-stasis combined, pathogen obstruction the qi movement, therefore, the main prescription is Kuanxiong Tongbi Decoction, targeting at removing phlegm and stasis, strengthening qi and unblocking the obstruction; 7) the mechanism of insomnia is the yin and yang failing to interact, leading to the collection of liver-vigor, therefore, the main prescription is Gaozhen Wuyou Decoction, targeting at coordinating yin and yang, adjusting the liver-vigor; 8) the main mechanism of allergic urticaria is upsetting characteristic of natural endowment, blood-heat and wind, therefore the main prescription is Desensitized Removing-wind Decoction, targeting at clearing heat and cooling blood, desensitizing and removing wind; 9) the main mechanism of acne is dampness-heat as body characteristics as the root cause, and toxicity of phlegm-stasis as symptoms, therefore, the main prescription is Xiao Cuo Decoction, targeting at clearing heat to remove dampness, detoxicity and removing stasis; 10) the main mechanism of chronic fatigue is liver-depression and blood-deficiency, therefore, the main prescription is Tiaogan Chupi Decoction, literally, to relieve the fatigue by coordinating the liver and its meridian.5. Clinical observation on 61 patients with ARA total of 61 adult patients with AR were included in this case series. Group A totally included 30 patients with AR, involving 11 cases of obvious effective,13 cases effective,6 failed, with the total effective rate 80%. Two patients got stomachache after taking the medication. Group B included 31 patients, involving 1 case of obvious effective,16 cases effective,14 failed, with the total effective rate 54.8%, and no adverse reaction was found. We applied non-para metric rank quantizer to test the statistical difference between two groups. There is statistical significance between two groups (Z=-6.426, two-tailed P=0.000<0.05). It could be concluded that the experience from supervisor’s body differentiation and prescription for treatment of AR is superior to that from academic successors’syndrome differentiation and prescription.Discussions:1. New idea on the diagnosis and treatment for ten diseasesBased on the clinical experience of succeeding Prof Wang Qi, and combined personal experience from practice, the author promoted the following perspectives:1) treatment for impotentia should be focused on body condition coordination and psychological education, the treatment perspective is from "eight extra channels"; 2) treatment for chronic prostatitis could be concentrated on stasis-pathogen leading to disease, and the diagnosis and treatment should not only focus on inflammation, but also avoiding the medications of bitter-cold and clearing heat and detoxicity; 3) asthenospermia should be treated according to the perspective that spleen essence transforms to blood, and medication rules should be warm-embellishing instead of warm-dryness; 4) obesity and metabolism syndrome have great relation with fatty body of qi-deficiency, yang-deficiency and blood stasis as body characteristics, and the away-join relation with phlegm-dampness; 5) during the treatment for primary hypertension, the qi-deficiency and blood-stasis and fluid stagnation theory has great significance in the mechanism of hypertension when the diastolic pressure is high, and the treatment should focus on the positive function of anti-fatigue and adjusting body condition for treatment and prevention of hypertension; 6) in treating coronary heart disease, the new perspective that chest arthromyodynia is related to the prosperity loss or blocking of Zong-qi, therefore, the main therapy is to strengthening Zong-qi; 7) in treating insomnia, the Concept of holism of Five-Sprit Zang treatment theory has been promoted; 8) in treating allergic urticaria, the perspective that Wei-blood being both invaded should be promoted; 9) in treating acne, the combination of body-differentiation for prescription should be concentrated; 10) in treating chronic fatigue, it is expected to coordinate both body condition and psychological condition.2. Clinical research on AR 1) By comparing and analyzing the supervisor’s prescription of Tuomin Zhiti Tang (Decoction for desensitization and relieving sternutation) with Xiao Qionglong Decoction, the author pointed out that the former is for patients of special body characteristic with AR, while the latter should be employed for treatment of patients with yang-deficiency combined with special body characteristics; 2) the promotion of clinical definition of regulating body and syndrome, and define the relation between disease-body-prescription, the relation between disease-syndrome-and prescription, such clinically novel innovations; 3) observation and prevention on adverse reaction of Chinese herbal medicine; 4) the study suggested that the experience from supervisor’s body differentiation and prescription for treatment of AR is superior to that from academic successors’syndrome differentiation and prescription, but the case-control design’s limitations should be also considered, and further researches are expected; 5) this study is expected to provide with clinical research in mythology when using Chinese herbal medicine in treating AR, therefore, further effective treatment plan, perfect AR outcome measurement system, and superior clinical research mythology should be given great concentration in the future. Background: Allergic rhinitis (AR) is a chronic inflammatory reactive disease on schneiderian membrane mediated by IgE, and can seriously impact on patients’ sleeping, memory, emotion and quality of life. Professor Wang Qi applies the treatment idea of regulating physic against latent heat adverse rising and unhealthy qi external invade for treatment of adult with allergic rhinitis, which could obviously relieve patients’ symptoms, and even cure some patients. This indicates that Chinese herbal medicine has advantages in treating AR.Objectives: To observe the clinical effectiveness and safety of Prof. Wang Qi’s experiences in treating AR.Methods: This study was a case control study, participants were divided into Group Treated by Advisors (Group A), and Group Treated by Academic Successors (Group B), and participants in Group A received treatment from advisors applying the treatment idea of regulating physic against latent heat adverse rising and unhealthy qi external invade, and participants in Group B received treatment from the academic successors applying the traditional method of treatment against cold-water retention storing in the lungs and stimulated by external evil. We observed the effectiveness and safety of the prescription from the advisors. The Guideline on the Diagnosis and Treatment of Allergic Rhinitis, which is issued in 2009 by the China Medical Association Otolaryngology Seminal, was employed for diagnosis and effectiveness evaluation criteria of AR in this study.Results: A total of 61 adult patients with AR were included in this case series. Group A totally included 30 patients with AR, involving 11 cases of obvious effective, 13 cases effective, 6 failed, with the total effective rate 80 %. Two patients got stomachache after taking the medication. Group B included 31 patients, involving 1 case of obvious effective, 16 cases effective, 14 failed, with the total effective rate 54.8%, and no adverse reaction was found. We applied non-para metric rank quantizer to test the statistical difference between two groups. There is statistical significance between two groups (Z—6.426, two-tailed P=0.000 <0.05). Conclusion: Treatment in Group A is more effective than the traditional treatment method applied in Group B in treating AR.Discussion: (D By comparing and analyzing the supervisor’s prescription of Tuomin Zhiti Tang (Decoction for desensitization and relieving sternutation) with Xiao Qionglong Decoction, the author pointed out that the former is for patients of special body characteristic with AR, while the latter should be employed for treatment of patients with yang-deficiency combined with special body characteristics; ? the promotion of clinical definition of regulating body and syndrome, and define the relation between disease-body-prescription, the relation between disease-syndrome-and prescription, such clinically novel innovations; ? observation and prevention on adverse reaction of Chinese herbal medicine; ? the study suggested that the experience from supervisor’s body differentiation and prescription for treatment of AR is superior to that from academic successors’ syndrome differentiation and prescription, but the case-control design’s limitations should be also considered, and further researches are expected; (§)his study is expected to provide with clinical research in mythology when using Chinese herbal medicine in treating AR, therefore, further effective treatment plan, perfect outcome measurement system, and superior clinical research mythology should be given great concentration in the future.

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