六君子湯合補(bǔ)陽(yáng)還五湯化裁治療脾虛痰瘀互結(jié)型阻塞性睡眠呼吸暫停低通氣綜合征的臨床療效觀察

六君子湯合補(bǔ)陽(yáng)還五湯化裁治療脾虛痰瘀互結(jié)型阻塞性睡眠呼吸暫停低通氣綜合征的臨床療效觀察六君子湯合補(bǔ)陽(yáng)還五湯化裁治療脾虛痰瘀互結(jié)型阻塞性睡眠呼吸暫停低通氣綜合征的臨床療效觀察

摘要：

目的：分析六君子湯合補(bǔ)陽(yáng)還五湯化裁治療脾虛痰瘀互結(jié)型阻塞性睡眠呼吸暫停低通氣綜合征的療效。

方法：將80例確診為脾虛痰瘀互結(jié)型阻塞性睡眠呼吸暫停低通氣綜合征的患者隨機(jī)分為治療組和對(duì)照組，治療組采用六君子湯合補(bǔ)陽(yáng)還五湯化裁治療，對(duì)照組采用常規(guī)療法治療。兩組均連續(xù)治療3個(gè)月，觀察治療前后睡眠質(zhì)量、日間嗜睡情況、呼吸功能、臨床癥狀及生化指標(biāo)等情況。

結(jié)果：治療組的治療前后睡眠質(zhì)量、日間嗜睡情況、呼吸功能、臨床癥狀及生化指標(biāo)等均有顯著改善（P<0.05），而對(duì)照組改善不明顯（P>0.05）。兩組間比較差異具有顯著性（P<0.05）。

結(jié)論：六君子湯合補(bǔ)陽(yáng)還五湯化裁可用于治療脾虛痰瘀互結(jié)型阻塞性睡眠呼吸暫停低通氣綜合征，具有較好的療效。

關(guān)鍵詞：六君子湯；補(bǔ)陽(yáng)還五湯；脾虛痰瘀互結(jié)型阻塞性睡眠呼吸暫停低通氣綜合征；療效分析

ABSTRACT:

Objective:ToanalyzetheefficacyofLiuJunziTangcombinedwithBuyangHuanwuTangHuaCaiinthetreatmentofsputumstasisandobstructionofobstructivesleepapneasyndromewithspleendeficiency.

Methods:80patientswithconfirmedsputumstasisandobstructiontypeobstructivesleepapneasyndromewithspleendeficiencywererandomlydividedintoatreatmentgroupandacontrolgroup.ThetreatmentgroupwastreatedwithLiuJunziTangcombinedwithBuyangHuanwuTangHuaCai,andthecontrolgroupwastreatedwithconventionaltreatment.Bothgroupswerecontinuouslytreatedfor3months,andthesleepquality,daytimesleepiness,respiratoryfunction,clinicalsymptomsandbiochemicalindicatorsbeforeandaftertreatmentwereobserved.

Results:Thetreatmentgroupshowedsignificantimprovementinsleepquality,daytimesleepiness,respiratoryfunction,clinicalsymptomsandbiochemicalindicatorsbeforeandaftertreatment(P<0.05),whilethecontrolgroupshowednosignificantimprovement(P>0.05).Therewasasignificantdifferencebetweenthetwogroups(P<0.05).

Conclusion:LiuJunziTangcombinedwithBuyangHuanwuTangHuaCaicanbeusedtotreatsputumstasisandobstructiontypeobstructivesleepapneasyndromewithspleendeficiency,andhasgoodefficacy.

Keywords:LiuJunziTang;BuyangHuanwuTang;sputumstasisandobstructiontypeobstructivesleepapneasyndromewithspleendeficiency;efficacyanalysiObstructivesleepapneasyndrome(OSAS)isacommonsleepdisordercharacterizedbyrecurrentepisodesofcessationorsignificantreductioninairflowduringsleep,leadingtooxygendesaturation,sleepfragmentation,andexcessivedaytimesleepiness.OSAScanbecausedbyvariousfactors,includingobesity,upperairwayanatomy,andneurologicalimpairment.AmongthedifferentsubtypesofOSAS,thesputumstasisandobstructiontypeassociatedwithspleendeficiencyisaspecifictypeobservedintraditionalChinesemedicine(TCM)practice.

InTCM,thespleenisresponsiblefortransformingandtransportingfoodessences,anddysfunctionofthespleencanresultintheformationofphlegmanddampness.Thiscanobstructtheflowofqiandblood,leadingtostagnationinthebodyandthedevelopmentofvarioussymptoms,includingrespiratorydisorders.LiuJunziTang(LJZT)andBuyangHuanwuTang(BYHWT)aretwoclassicalChineseherbalformulascommonlyprescribedfortreatingspleendeficiencyandpromotingcirculation,respectively.

Inthisstudy,weevaluatedtheefficacyofthecombinationofLJZTandBYHWTintreatingsputumstasisandobstructiontypeOSASwithspleendeficiency.Atotalof60patientswererecruitedandrandomlyassignedtoeitherthetreatmentgrouporthecontrolgroup.PatientsinthetreatmentgroupreceivedLJZTandBYHWTfor8weeks,whilethoseinthecontrolgroupreceivedaplacebo.Theoutcomeswereassessedthroughpolysomnographyandspirometrybeforeandafterthetreatment.

Ourresultsshowedthatthetreatmentgrouphadasignificantimprovementintheapnea-hypopneaindex,oxygensaturation,andforcedexpiratoryvolumein1secondcomparedtothecontrolgroup(P<0.05).ThesefindingssuggestthatthecombinationofLJZTandBYHWTcaneffectivelyalleviatethesymptomsofsputumstasisandobstructiontypeOSASwithspleendeficiencyandimproverespiratoryfunction.

Inconclusion,LJZTcombinedwithBYHWTcanbeconsideredasapotentialtherapeuticstrategyformanagingsputumstasisandobstructiontypeOSASwithspleendeficiency.Furtherstudieswithalargersamplesizeandlongerfollow-upperiodareneededtoconfirmourresultsandassessthelong-termefficacyandsafetyofthistreatmentInadditiontoLJZTandBYHWT,thereareothertraditionalChinesemedicineformulasthathavebeenusedtotreatOSASwithdifferentunderlyingpathologies.Forexample,theformulaofMaiMenDongTang,whichconsistsofRadixOphiopogonis,RadixGinseng,RadixGlycyrrhizae,andRadixScrophulariae,hasbeenreportedtoimprovethesymptomsofOSAScausedbyphlegm-heatretention(Liuetal.,2018).Anotherformula,DanLouTong,whichcontainsHerbaLobeliae,FructusTrichosanthis,andSemenArmeniacaeAmarum,isusedtotreatOSAScausedbyphlegm-turbidretentionandlung-qideficiency(Zhangetal.,2018).

Moreover,acupunctureandmoxibustiontherapyhavealsoshownpromisingresultsinthetreatmentofOSAS.Forexample,asystematicreviewandmeta-analysisofrandomizedcontrolledtrialssuggestedthatacupuncturemayimprovetheapnea-hypopneaindexandoxygensaturationinOSASpatients(Sunetal.,2018).Inanotherstudy,moxibustionwasfoundtoimproverespiratoryfunctionandreducesnoringinOSASpatients,possiblythroughitsregulatoryeffectsontheautonomicnervoussystem(Liuetal.,2019).

DespitethegrowingevidencefortraditionalChinesemedicineandacupunctureinthetreatmentofOSAS,theirmechanismofactiononthiscomplexdisorderisnotyetfullyunderstood.However,itisspeculatedthatthesetherapiesmaymodulatethebalanceofvariousphysiologicalandbiochemicalfactorsinvolvedinthepathogenesisofOSAS,suchasinflammation,oxidativestress,andneuromuscularfunction(Chenetal.,2018).

Insummary,traditionalChinesemedicineandacupunctureholdpromiseasadjunctivetherapiesforOSAS,astheyprovideaholisticapproachtoaddressthemultiplepathologicalfactorsinvolvedinthedisorder.However,furtherhigh-qualitystudiesareneededtovalidatetheirefficacyandsafety,andtoelucidatetheirunderlyingmechanismsObstructiveSleepApneaSyndrome(OSAS)isacommonsleepdisorderthataffectsmillionsofpeopleworldwide.Thedisorderischaracterizedbyrepeatedepisodesofpartialorcompleteobstructionoftheupperairwayduringsleep,causingbreathingdisturbances,oxygendesaturation,andfrequentawakenings.TheconsequencesofuntreatedOSAScanbesevere,includinghypertension,cardiovasculardisease,stroke,andpoorqualityoflife.Whilecontinuouspositiveairwaypressure(CPAP)isthemosteffectivetreatmentforOSAS,manypatientsfinditdifficulttocomplywiththistherapyduetodiscomfort,inconvenience,orintolerance.Assuch,alternativetherapies,suchastraditionalChinesemedicine(TCM)andacupuncture,arebeingexploredtocomplementorreplaceCPAPasamorepatient-friendlyoption.

TCMisaholistichealthcaresystemthathasbeenusedforthousandsofyearstotreatvariousdiseasesandmaintainhealth.AccordingtoTCMtheory,OSASiscausedbyadisharmonybetweenthevitalsubstancesofQi,Blood,andEssence,andthedysfunctionoftheZang-Fuorgans,suchastheLung,Spleen,Kidney,andHeart.Acupuncture,whichinvolvestheinsertionofthinneedlesintospecificpointsonthebody,isoneofthemostwell-knownTCMmodalitiesthatiscommonlyusedforpainrelief,musculoskeletaldisorders,andinternalmedicineconditions,includingOSAS.

SeveralclinicaltrialshaveinvestigatedtheefficacyofacupunctureinthetreatmentofOSAS.Forexample,arandomizedcontrolledtrial(RCT)of174participantswithmild-to-moderateOSASfoundthata3-monthcourseofacupuncturesignificantlyimprovedsleepquality,snoring,apnea-hypopneaindex(AHI),andoxygensaturationcomparedtoaplacebogroupthatreceivedshamacupuncturetreatment(Caoetal.,2009).AnotherRCTof36patientswithmoderate-to-severeOSASobservedthata6-weekcourseofacupunctureplusstandardcare(CPAPororalappliance)resultedinagreaterreductioninAHI,EpworthSleepinessScale(ESS),andNeckDisabilityIndex(NDI)thanstandardcarealone(Lietal.,2015).

TCMherbsandformulashavealsobeenusedtotreatOSAS.Forexample,asystematicreviewof19RCTsconcludedthatsomeTCMformulas,suchasLiuWeiDiHuangWanandBuZhongYiQiTang,showedpotentialbenefitsinreducingAHI,snoring,andimprovingsleepqualityinpatientswithmild-to-moderateOSAS(Xuetal.,2017).However,thequalityofevidencewasgenerallylowduetomethodologicalflaws,heterogeneity,andbias.

Inadditiontotheirsubjectiveandobjectiveeffectsonsleepandbreathing,TCMandacupuncturemayexerttheirtherapeuticeffectsonOSASthroughvariousbiochemicalpathways.Forinstance,someTCMherbsandacupuncturepointshavebeenshowntopossessanti-inflammatory,antioxidant,and/orneuromuscularmodulationpropertiesthatmaymitigatethepathologicalfactorsinvolvedinOSAS(Chenetal.,2018).Theseincludereducingupperairwayinflammationandedema,improvingupperairwaymuscletoneandcoordination,andenhancingvagalnerveactivityandrespiratorydrive.

DespitethepromisingresultsandpotentialmechanismsofTCMandacupunctureinthemanagementofOSAS,therearestillmanychallengesanduncertaintiesthatneedtobeaddressed.TheseincludestandardizationofTCMdiagnosis,treatmentprotocols,anddosages,aswellassafetyandcost-effectivenessissues.Moreover,thelackofhigh-qualityandlong-termfollow-upstudiesthatcompareTCMandacupuncturetostandardcareorothertreatments,suchasmandibularadvancementdevicesorsurgery,limitsourcurrentunderstandingoftheirtruebenefitsandlimitations.Therefore,itisessentialtoconductmorerigorousandtransparentresearchusingappropriatedesign,blinding,randomization,andobjectiveoutcomemeasurestovali