Search

Objective We employed a multidisciplinary approach incorporating theoretical ideas, clinical experience, psychology, physiology, traditional Chinese medicine (CM), modern practice of CM, and oncology to explore the effect of patients’ repression of negative emotions and traumatic events on breast cancer (BC) pathogenesis. Methods BC female patients, older than 18 years of age, with available pathology reports who were treated at Rabin Medical Center were recruited. All participants completed questionnaires regarding medical history, behavioral tendencies, negative emotions, trauma, symptoms, and pathology (from a CM perspective). Data on tumor characteristics were collected from the pathology reports. The associations were examined using hierarchical binary logistic regressions. Results A total of 155 BC patients were enrolled. The median age was 52 years, with a range of 26–79; 95% were mothers; 28% had estrogen receptor (ER)-negative BC, 52% had progesterone receptor (PR)-negative BC, 48% had human epidermal growth factor receptor 2-negative BC, and antigen Ki-67 ≥ 20% was reported for 52% of tumors. Statistically significant associations were found between the emotional markers (sense of motherhood failure, and lack of self-fulfillment), avoidance behavior, and physical symptoms that are related to emotional repression based on CM. Significant associations were also found between variables associated with physical symptoms of emotional repression, which involves the production and accumulation of non-substantial phlegm (i.e., “high-lipid Qi-like microscopic phlegm”), avoidance behavior which unconsciously uses “high-lipid Qi-like microscopic phlegm” in order to achieve emotional repression, and tumor parameters including tumor grade, PR status, and Ki-67. Patients with higher levels of “high-lipid Qi-like microscopic phlegm” were more likely to have tumors with worse prognosis (PR-negative, higher grade, and higher Ki-67). Conclusion We demonstrated a relationship between emotional parameters, behavioral tendencies, CM parameters, and oncologic parameters in BC. Additional research is warranted to explore these associations and their relevance to clinical practice.

Objective Coronavirus Disease 2019 (COVID-19) has been diagnosed as an epidemic disease characterized by cold and dampness pathogens in TCM clinic. Due to many Chinese medicines with different functions were used in the treatment of COVID-19, it is very important to find the law of application of damp-removing traditional Chinese medicine with high frequency application, with view to providing a reference for the use and research of Chinese medicine to further control the pandemic. Methods The publicly released diagnosis and treatment programs issued by the National Health Commission and Health Commission of provinces, autonomous regions and municipalities, and Chinese herbs prescription information in these were collected, a database was established, and Excel and Graphpad 8.0 software were used to analyze the frequency of use of various Chinese medicines, the frequency and property characters including five flavors (bitter, pungent, sweet, sour, and salty) and four natures (warm, hot, cool, and cold) and channel tropisms of Chinese medicine for removing dampness. Results A total of 137 prescriptions of Chinese medicine for treating COVID-19 were collected, including 178 TCMs showing functions of resolving phlegm, relieving cough and asthma, resolving dampness, clearing damp and inducing dieresis, clearing heat, tonifying deficiency, and relieving exterior syndrome, in which the TCMs with the first four functions that we called the dampness-removing TCMs, accounted for 35.78%. Also a number of TCMs in the rest functions showed removing-dampness. The first four functions were divided into subfunctions including aromatic resolving dampness, clearing heat and drying dampness, drying dampness and tonifying spleen qi, drying dampness and removing phlegm, inducing diuresis and relieving swelling, inducing diuresis and relieving exterior syndrome. Among them, the most frequently used TCMs was Ephedrae Herba, followed by Citri Reticulatae Pericarpium, Pogostemonis Herba, Pinelliae Rhizoma, Poria, Scutellariae Radix, and Atractylodis Rhizoma. The property character analysis in the dampness-removing TCMs showed that bitter and pungent were largely present and sour and astringent were absent, warm and hot were dominant; And the lung, spleen, stomach, large intestine, bladder were main channel tropisms. Conclusion Dampness-removing TCMs is the first important type of traditional Chinese medicine to be considered in the treatment of COVID-19 in Chinese medicine. The application of dampness-removing TCMs in the treatment of COVID-19 needs to be combined with its application law. This study may provide meaningful and useful information on further research to investigate the effective compounds from the dampness-removing Chinese medicine with high frequency application, and also provide a reference for the clinical treatment of COVID-19 accurately against dampness evil with dampness-removing traditional Chinese medicine.

A 45-year-old male patient diagnosed as stage IVa pancreatic cancer received anti-cancer treatment with chemotherapy and radiotherapy. During the treatment, he complained of nausea, appetite loss, and fatigue. He received a Kampo diagnosis of qi deficiency, blood stasis, and heat with phlegm; consequently, qi supplementation, smoothing blood, and relieving fever were initiated using Juzentaihoto and Keppuchikuoto. After this treatment, the symptoms showed remarkable improvement. However, computed tomography revealed multiple lung nodules. We prescribed crude drugs with anti-cancer effects, including Scutellaria barbata and Oldenlandia diffusa. These drugs led to slowed development of lung metastases that could be surgically resected. He survived for 7 years after the advanced diagnosis without loss of quality of life. Kampo medicine may be useful for disease control and supportive care in advanced pancreatic cancer patients.

Background: Metabolic diseases pose considerable burden on the healthcare system worldwide, indicating the significance of prevention and treatment. In constitution theory of traditional Chinese medicine, phlegm-dampness constitution (PDC) is the common basis of metabolic diseases. In clinical practice, Huatan Qushi (HTQS) decoction targeting on PDC can effectively improve metabolic indicators. However, its underlying biochemical mechanism still remains unclear. Methods: Eight PDC participants received HTQS decoction for three months. Their blood was collected at baseline and 1 and 3 months after intervention started. Related biomedical indicators were detected. High-throughput sequencing and RT-qPCR were used for validation. Due to the missing data, repeated measures with missing values in mixed models were used. Results: After 3-month treatment, HDL-C level increased (P

Case Presentation A 69-year-old man consulted for a 3-day history of fever, wet cough, and yellow-green phlegm. He denied having any dyspnea, chest pain, hemoptysis, swallowing disorders, choke, chills, asthenia, anorexia, or weight loss. He reported a continuous dry cough and three episodes of pneumonia in the past 4 years. He was a nonsmoker, without any other personal or familial medical history. He had no known professional exposure. He was born and lived in Vietnam but had no known contact with TB in his family or workplace. He was never imprisoned or homeless and did never travel abroad.

Objective: Syndrome differentiation is a unique part of traditional Chinese medicine (TCM). Syndrome factors play an important role in the diagnosis and treatment of TCM syndromes. Thromboelastography (TEG) intuitively reflects the blood status of patients with acute ischemic stroke (AIS) and is important in the treatment and prognosis of AIS. To identify the relationship between TCM syndrome factors and TEG in AIS patients and standardize TCM syndrome differentiation and treatment objectives, we designed a prospective cohort study of 103 AIS patients. Methods: We used the diagnostic criteria for AIS in the Chinese Guideline for Diagnosis and Management of Acute Ischemic Stroke 2010. Diagnosis of phlegm-heat and fu-organ excess syndrome was based on the TCM Scale for the Syndrome of Phlegm-heat and fu-organ Excess. The ischemic Stroke TCM Syndrome Factor Diagnostic Scale was used to identify and diagnose syndrome factors. General information, scores of syndrome factors and values of TEG parameters of all enrolled patients were recorded. Results: There were significant differences in internal fire and phlegm-dampness scores between patients with and without phlegm-heat and fu-organ excess syndrome (P .05) or between both syndrome factors and TEG parameters in patients without phlegm-heat and fu-organ excess syndrome. Conclusion: The syndrome factor internal fire is a potential predictor of increased platelet function and fibrinogen activity in AIS patients with phlegm-heat and fu-organ excess, and a potentially important predictor of blood hypercoagulability in TCM. Keywords: Clinical relevance, Phlegm-heat and fu-organ excess syndrome, Syndrome factors, Thromboelastography

Objective: To observe the characteristics of gene methylation in obese rats with phlegm-dampness syndrome induced by the high-fat diet, and to study the effect of Wen Dan Decoction on gene methylation after the intervention. Methods: Methylation sites of genes were detected by the MeDIP-seq method. Bioinformatics method was used to analyze the gene methylation characteristics of obesity with phlegm- dampness syndrome and the effect of Wen Dan Decoction. Results: (1) There were 3 242 methylation differential loci in diet- induced obesity with phlegm-dampness syndrome, of which 1 243 were down-regulated and 1 999 were up-regulated, involving 1 579 differential genes. GO analysis showed that “offactory receptor activity” and others were enriched. The possible signal pathways involved were “Olfactory transduction” “Tuberculosis” “Systemic lupus erythematosus” and “Ribosome”. (2) After the intervention of Wen Dan Decoction in obesity with phlegm- dampnesssyndrome,4046differentmethylationlociwereobtained, including 1 067 down-regulated loci and 2 979 up-regulated loci, involving 2 068 genes. GO analysis showed that ''offactory receptor activity'' and others were enriched. These genes involved seven signaling pathways, such as “Metabolic pathways”. (3) Between diet-induced obesity with phlegm-dampness syndrome and Wen Dan Decoction intervening obesity with the phlegm-dampness syndrome, 582 common genes of methylation differential genes were obtained. After the intervention of Wen Dan Decoction, the number of GO enrichment items was more than that of obesity with phlegm-dampness syndrome, and even the same GO enrichment items involved more genes. Conclusions: The phlegm-dampness syndrome of obesity- induced by diet had the characteristics of gene methylation changes, and the intervention of Wen Dan Decoction could also affect the status of gene methylation. The genes affected by Wen Dan Decoction were closely related to the methylation gene of phlegm-dampness syndrome of obesity-induced by diet but covered a wider range. Keywords: Obesity, Phlegm-dampness syndrome, Gene methylation, Wen Dan Decoction, Bioinformatics

Interleukin-13(IL-13) might play an important role in driving aggregate bronchitic symptoms pathogenesis. However, none of the studies assessed the interaction between air pollutants exposure and IL-13 gene on the risk of aggregate bronchitic symptoms in non-asthma children. To assess the independent and joint effects of the exposure to air pollution and IL-13 haplotypes on the risk of aggregate bronchitic symptoms, we conducted a cross-sectional study and focused on non-asthma children. The study population consisted of 2944 children. The effect of each air pollutant on the risk of aggregate bronchitic symptoms was estimated as odds ratios per interquartile range (IQR) change. In the multiple logistic regressions, adjusted for confounding factors, the risk of chronic phlegm was associated with PM2.5 exposure (aOR, 1.59; 95% CI, 1.07–2.37 per 12.51 μg/m3 change), O3 exposure (aOR, 1.54 95% CI, 1.05–2.27 per 8.28 ppb change) and SO2 exposure (aOR, 1.19; 95% CI, 1.02–1.39 per 0.98 ppb change). Our study further provides the evidence that gene-environment interactions between IL-13 haplotype and O3 exposure on chronic phlegm (95% CI for interaction, 1.01–1.38). Identifying children who are more sensitive to air pollution helps us to provide them an efficient prevention to avoid aggregate bronchitic symptoms., Highlights • Limited studies explored the interactions between IL-13 gene and air pollutants exposure on the risk of bronchitic symptoms. • Genetic susceptibility of IL-13 may interact with O3 exposure causing the pathogenesis of bronchitic symptoms. • Identifying children susceptible to air pollutants helps us to provide them an efficient prevention of bronchitic symptoms. Genetic susceptibility may interact with specific environmental factors causing the pathogenesis of aggregate bronchitic symptoms. Limited studies have explored the interactions between Interleukin-13 (IL-13) gene and air pollutants exposure on the risk of aggregate bronchitic symptoms. Our study further provides the evidence that gene-environment interactions between IL-13 gene and O3 exposure may play an important role in aggregate bronchitic symptoms. Identifying children who are more sensitive to air pollutants helps us to provide them an efficient prevention to avoid aggregate bronchitic symptoms.

Background: Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumor, and MECs of the lung are rare, accounting for 0.1–0.2% of malignant lung tumors. Pulmonary MECs are commonly found in the segmental or lobar bronchi, rarely presenting as endobronchial lesions. Case presentation: Here we describe the case of a 21-year-old female with no comorbid conditions who presented at the emergency room with a cough, yellow phlegm, pleuritic chest pain, and a subjective fever. These symptoms had been present for approximately one week prior to the patient's arrival at the hospital. A chest X-ray revealed right lower lobe alveolar infiltrate and computed tomography of the chest showed dense consolidation of the right lower lobe with ovoid intraluminal density in the right main stem bronchus. Upon fiber optic bronchoscopy, an endobronchial lesion was found in the right main stem sparing the right upper lobe uptake. Endobronchial biopsy results was consistent with MEC of the lung. The patient underwent a bilobectomy with complete resection of the tumor. Conclusion: Endobronchial MEC is a rare type of salivary gland tumor. Patients with low-grade MECs have a good prognosis, whereas those with high-grade MECs, which are aggressive and associated with metastatic disease, have a poor prognosis. However, early identification and surgical resection can result in a good prognosis. Keywords: Mucoepidermoid carcinoma, Endobronchial lesion

Introduction : Pattern identification (PI) is a concept compatible with the diagnosis of dementia in East Asian traditional medicine (EATM) theory, that may facilitate individualized management of dementia patients with behavioral and psychological symptoms of dementia (BPSD). The research question in this scoping review was as follows: “What indicative symptoms and patterns have been used when using the PI system in patients with BPSD in existing clinical studies?” Methods : This scoping review followed the framework of Arksey and O'Malley. Relevant literature published up to September 17, 2021, was retrieved from nine electronic medical databases. Information on the patterns based on the PI system, indicative symptoms and/or signs, as well as treatments for the patterns were analyzed. Results : Ten studies with 13 kinds of patterns were included. In general, hyperactivity symptoms were frequently found to be indicative symptoms in patterns related to fire and/or yin deficiency; psychotic symptoms were frequently found in patterns related to blood stasis; affective symptoms were frequently observed in patterns related to heart, spleen, and phlegm; symptoms including lethargic expression and changes in diet were frequently seen in patterns related to blood stasis and phlegm; and sleep disturbance related symptoms were frequently seen in patterns related to the liver. Conclusions : The patterns related to heart, spleen, liver, blood stasis, and phlegm were associated with symptoms related to some categories of BPSD. However, this review only presents a theoretical framework because of the lack of studies, indicating a need for further high-quality research in this field in the future.

Ethnopharmacological relevance Cardiovascular and cerebrovascular diseases have become a severe threat for human health worldwide, however, optimal therapeutic options are still developed. Zhilong Huoxue Tongyu capsule (ZL capsule) is mainly composed of Astragalus membranaceus, Leech, Earthworm, Cinnamomum cassia and Sargentodoxa cuneata, having functions of replenishing qi and activating blood, dispelling wind and reducing phlegm. It is an expanded application on the basis of traditional uses of above TCMs, acquiring a satisfactory curative effect on cardiovascular and cerebrovascular diseases over twenty years. Aim of the study To comprehensively summarize the main components of ZL capsule, understand the mechanisms of ZL capsule, and conclude clinical regimens of ZL capsule for cardiovascular and cerebrovascular diseases. Materials and methods We selected network pharmacology technology to analyze main active compounds and predict underlying mechanism of ZL capsule against atherosclerosis. Molecular docking was performed to simulate the interaction pattern between the active components of ZL capsule and putative targets. Further, PubMed, Web of Science, China National Knowledge Infrastructure and Google Scholar were used to search literatures, with the key words of “Zhilong Huoxue Tongyu capsule”, “cardiovascular and cerebrovascular diseases”, “atherosclerosis”, “clinical study” and their combinations, mainly from 2000 to 2020. Results Both network pharmacology analysis, molecular docking and animal experiments studies confirmed that mechanisms of ZL capsule plays the role of anti-inflammatory, anti-apoptosis and promoting angiogenesis in treating cardiovascular and cerebrovascular diseases by multi-components acting on multi-targets via multi-pathways. Over 1000 clinical cases were benefited from the treatment of ZL capsule, suggesting a holistic concept of “the same therapy for different myocardial and cerebral diseases”. Conclusions For the first time, this systematic review may supply meaningful information for further studies to explore material basis and pharmacodynamics of ZL capsule and also provide a basis for sharing the “Chinese patent medicine” for cardiovascular and cerebrovascular diseases.

Objective To culturally translate the cardiff acne disability index (CADI) into Korean, and to examine its relationship with clinical acne severity, pathological patterns, and general quality of life (QoL). Methods The CADI was culturally and linguistically translated into Korean via translation, back-translation, and face validity test process. Two hundred and fifty-four Korean adolescents were asked to complete the Korean version of the CADI (K-CADI), the Phlegm Pattern, the Cold-Heat Pattern, and the Korean version of the General Health Questionnaires. A clinician estimated acne severity for the adolescents, using the Korean Acne Grading System. Finally, reliability and validity of the K-CADI was examined, and the relationships between acne severity, Phlegm, Cold, and Heat patterns, and QoL level were examined via pathway analysis. Results The K-CADI had satisfactory internal consistency (α = 0.827). The examination of construct validity indicated that the K-CADI had one factor (explaining 59.6% of the total variance). Pathway analysis showed satisfactory model fit (NFI = 0.960 and CFI = 0.983), and acne-related QoL was determinant to Phlegm, Heat, and Cold patterns (0.13-0.27 of β), and Phlegm and Heat patterns lowered one's QoL level (0.17–0.34 of β). Conclusion The K-CADI is a valid and reliable instrument. Phlegm and Heat patterns should be managed when treating acne since they have a moderating effect on general QoL aggravation.

Acne is a kind of common skin disease in modern young people. Damp-heat constitution is the pathological basis of acne. Influenced by external factors, damp-heat constitution can lead to acne in the three pattern types, including lung meridian wind-heat, spleen and stomach damp-heat and phlegm stasis congestion and stagnation. Therefore, according to the thought of traditional Chinese medicine, the only way to completely solve the problem of recurrent acne is to correct the damp-heat constitution. TCM external therapy has always been the common therapy for acne, but the specific application scheme of the therapy has not been systematically summarized. In this paper, the relationship between damp-heat constitution and acne, and the design of TCM external therapy for acne on the face oriented by damp-heat constitution will be systematically discussed on the basis of long-term clinical practice and theory summary.

Objective To explore the recent 20 years' herbal administration rules in TCM treatments of ovarian cysts (OCs) based on data mining. Methods A prescription database for ovarian cysts was established by ACCESS 2007. Importing the database into SPSS17.0 and SPSS Modeler14.1. SPSS17.0 was used for descriptive and cluster analyses, while SPSS Modeler14.1 was used for association rules analysis. Results After screening, 363 prescriptions were obtained. The 10 most frequently-used Chinese herbal medicines are Zedoaria (Rhizoma Curcumae), Poria cocos (Poria), Common buried rubber (Rhizoma Sparganii), Red peony root (Radix Paeoniae Rubra), Peach seed (Semen Persicae), Danggui (Radix Angelicae Sinensis), Chinese angelica (Ramulus Cinnamomi), Liquorice root (Radix Glycyrrhizae), Pangolin scales (Squama Manis) and Moutan cortex (Cortex Moutan Radicis); the 5 most common syndromes of OCs are qi stagnation and blood stasis, phlegm and blood stasis, uterine blood stasis, stagnation of liver qi and retention of phlegm and dampness, nearly to 54.26%; In association rules analysis, 5 sets of two-herbs association rules were obtained, 17 sets of three-herbs association rules were obtained, 22 sets of four-herbs association rules were obtained and 4 sets of five-herbs association rules were obtained; By clustering, 13 sets of core couplet medicinals were obtained. Conclusion Medicinal herbs for promoting blood circulation to remove blood stasis, resolve hard lumps, for strengthening the spleen, eliminating phlegm, and relieving liver qi stagnation were highly used in the treatment of OCs; Herbs attributed to the Liver Meridian, the Spleen Meridian and the Heart Meridian were highly used in OCs; The compatibility of herbs for promoting blood circulation to remove blood stasis and resolve hard lumps were highly used; Guizhi Fuling Wan (GFW) was often used and combined with other herbs in the treatment of OCs.

Background Workers in slaughterhouses are exposed to a wide range of biological contaminants, such as bacteria and fungi, due to their working environment. This study aimed to assess the prevalence of respiratory disorders among workers in slaughterhouses. Methods This study was conducted on 81 workers in slaughterhouses and 81 healthy office workers as a reference group. The American Thoracic Society standard respiratory symptoms questionnaire was used to determine the prevalence of respiratory disorders. Besides, lung function tests were conducted using a calibrated spirometer at the beginning (preshift) and at the end (postshift) of the 1st working day. Single-stage Anderson sampler was used to measure the concentration of bioaerosols in different parts of slaughterhouses. Results The prevalence of respiratory disorders, such as cough, productive cough, breathlessness, phlegm, and wheezing, was 3.17, 4.02, 3.07, 4.66, and 3.94 times, respectively, higher among workers in slaughterhouses compared with the reference group. Conclusion The prevalence of respiratory disorders was significantly higher among workers in slaughterhouses. Thus, the significant reduction in the percentage predicted lung function among workers in slaughterhouses might be associated with exposure to bioaerosols in their work environment.

Objective To develop and validate a Seven Emotions Impairment questionnaire (SEIQ), to define an optimum cut-off point for the SEIQ, and to examine whether SEI was predictive of Phlegm and Blood Stasis (BS). Methods Two hundred outpatients and 75 college students were asked to complete the SEIQ, the Profile of Mood States (POMS), Phlegm Pattern Questionnaire (PPQ), and BS Questionnaire (BSQ). Twelve clinicians determined whether the outpatients exhibited SEI. SEIQ data were used to examine the internal consistency and determine validity for the outpatients. SEIQ, POMS, PPQ, and BSQ data were used to examine concurrent validity and predictability of SEI for Phlegm and BS in the college students. Total SEIQ scores and the clinicians’ diagnoses of the outpatients were considered to define an optimum cut-off score for the SEIQ. Results The 18-item SEIQ had satisfactory internal consistency (α = 0.905) and concurrent validity. In the construct validity test, four factors (chest-anxiety, fatigue-depression, working-family-troubles, and sleep-memory) were identified. In the receiver operator characteristic curve curve analysis, the sensitivity, specificity, and area under the curve of the SEIQ were 67.2%, 72.1%, and 73%, respectively. The optimum cut-off score was defined as nine points. SEIQ scores were strongly predictive of Phlegm and BS (β = 0.862 and 0.673, respectively). Conclusion Based on our results, we concluded that the SEIQ is a reliable and valid instrument for evaluating SEI, and is strongly predictive of Phlegm and BS.

Exposure to ambient air pollutants may significantly affect the incidence of respiratory symptoms and lung function in children. The present study examined the associations between exposure to ambient air pollutants and respiratory symptoms in children. In this cross-sectional study, 1070 children under the age of seven years were recruited from 61 day-care centers of Tehran in 2015. Initially, day-care centers were selected at a radius of 2 km from the air pollution monitoring stations, and subsequently all the children attending these day-care centers were interviewed. The data on the respiratory complaints of children were obtained by using the ATS questionnaire (ATS-DLD-78-C). Moreover, the annual average concentration of pollutants was calculated based on the time children spent at home and at the day-care center using the air pollution monitoring stations. Crude and adjusted logistic regression analysis was conducted. The findings indicated that ambient air SO2 and NO2 concentrations near home were associated with current asthma for 1 part per billion (ppb) increase with an OR of 1.20 (1.00–1.45) and 1.08 (1.01–1.15), respectively. The odds of developing persistent phlegm for each unit (ppm) of raise in the average annual concentration of CO in ambient air near home (OR 1.40; 1.09 to 1.81) increased as well. The daily mean concentration of PM2.5, PM10, and SO2 was higher than the limits provided in the World Health Organization (WHO) air quality guidelines (AQGS). Moreover, the prevalence of severe wheezing, asthma history, and bronchitis was higher in boys. Therefore, long-term exposure to ambient air pollutants such as SO2, NO2, and CO may be associated with an increase in current asthma and persistent phlegm in children.

Introduction The classification of TCM syndromes is central to understanding the nature of diseases and improving treatment. This study focuses on selecting critical features of demographic information, personal medical history and symptoms and improving the accuracy of syndrome classification. Methods A total of 1713 records were collected from the First Affiliated Hospital of Anhui Chinese Medicine University. Five rules for feature selection and six models were applied to classify TCM syndromes. Results Patients with rheumatoid arthritis were diagnosed with one of four TCM syndromes: damp-heat obstruction syndrome (DHO, 60.5 %), phlegm and blood stagnation syndrome (PBS, 19.8 %), liver and kidney deficiency syndrome (LKD, 15.8 %), or wind-cold obstruction syndrome (WCO, 4 %). In total, 200 features were extracted from electronic medical records. From these, 42 were selected as critical features. The classification accuracy of using feature selection was higher than when using all features, with a maximum value of 0.88 for the Artificial neural network (ANN). Conclusions Feature selection methods and classification techniques were applied to mine data on TCM syndromes. Feature selection improved the performance of the classification models. Of six algorithms, ANN had the highest accuracy for syndrome classification.

Introduction Pattern identification (PI) is the core concept of diagnosis in traditional East-Asian medicine. PI plays a role in the selection of treatment methods such as herbal prescriptions, acupuncture, or others. However, despite its importance, the standardization of PI has not been well studied. Here, we developed a decision-making system for PI using symptoms described by patients. Methods To construct a list of symptoms for each pattern, we reviewed the literature and conducted a series of surveys with a committee of experts. Eleven experts, who were practitioners with more than 5 years of clinical experience, participated in this study. Focusing on diagnosis indices for PI, we used a pairwise comparison model to obtain weight of each symptom in relation to each pattern. To assess the consistency of pairwise comparisons, we calculated the consistency ratio of each pattern. Results Eleven patterns were selected by the committee of experts; these patterns included “cold” (13 symptoms), “heat” (12 symptoms), “deficiency” (eight symptoms), “excess” (six symptoms), “qi deficiency” (six symptoms), “qi stagnation” (10 symptoms), “blood deficiency” (nine symptoms), “blood stasis” (15 symptoms), “phlegm” (14 symptoms), “kidney yang deficiency” (10 symptoms), and “kidney yin deficiency” (six symptoms). Pairwise comparison consistency was maintained (consistency ratios Conclusions We developed PI decision-making rules from the weight of PI indices. This study could contribute to simplify the PI process. In addition, it could help estimate the probability of diagnosing proper PI.

SummaryBackgroundChronic bronchitis is related to worse general health status, exacerbations and mortality among subjects with COPD. Also less longstanding cough and phlegm may be related to worse prognosis in COPD but this has rarely been evaluated in population-based studies.AimTo evaluate the relationship between productive cough, exacerbations and mortality among subjects with and without COPD.MethodAll subjects with COPD (n = 993) were identified together with sex- and age matched reference subjects without obstructive lung function impairment from four population-based cohorts in 2002–04. Baseline spirometry and structured interview including data on exacerbations last 12 months were used in this study (n = 1986) together with mortality data collected until February 2012.ResultsProductive cough was more common in COPD than non-COPD (42.8 vs. 23.5%, p

Licorice (the roots of Glycyrrhiza uralensis ) is widely-used in Chinese herbal compound prescriptions for its functions of nourishing qi , alleviating pain, tonifying spleen and stomach, eliminating phlegm, relieving coughing, and harmonizing prescriptions. It contains more than 20 triterpenoids and approximately 300 flavonoids. In recent years, many studies have reported that it possesses various pharmacological activities, such as antitumor, antimicrobial, and antivirus effects. In this paper, the antitumor activity of licorice is deeply summarized. The antitumor active components and the possible antitumor mechanism are analyzed.

Summary Background A series of case–control studies have been conducted to investigate the association between blood lipid and phlegm turbidity syndrome of angina pectoris, but produced inconsistent results. Objective We performed a meta-analysis to determine the association between blood lipid and phlegm turbidity syndrome of angina pectoris more precisely. Methods Manual screening as well as screening of the China National Knowledge Infrastructure (CNKI), Chinese Journal full-text database (VIP), Wanfang database (WF), ScienceDirect, Pubmed, the Cochrane Library, and Embase were carried out for relevant literature. The formula was translated to calculate the pooled mean value and standard deviation value. The “Newcastle–Ottawa Quality Assessment Scale: Case–Control Studies” (NOS) was taken to assess the quality of the included studies. The Revman 5.2.6 software provided by “The Cochrane Collaboration” was used to analyze the collected data. The subgroup analysis was established according to the sample size proportion between the test group and the control group. Sensitivity analysis was constructed by using two different effect models. Besides, a funnel plot was created to analyze potential publication bias. Results No statistically meaningful difference existed between the test group and control group of total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C) in non-Qi and yin deficiency syndrome (QYDS) and non-Yang deficiency syndrome (YDS) subgroup, whereas the two biotic indicators in the test group were higher than the non-phlegm syndrome group in other subgroups. Triglyceride (TG) in phlegm syndrome group showed superior to non-phlegm syndrome group in the rest subgroups except for the non-CCS (Cold coagulating syndrome)-non-YDS subgroup. High-density lipoprotein-cholesterol (HDL-C) levels of the phlegm group were lower than that of the non-phlegm group in all subgroups. Conclusion When comparing with Traditional Chinese Medicine (TCM) syndromes of asthenia nature, such as YDS, QYDS, and heart qi deficiency syndrome), the levels of TG, TC, and LDL-C were higher in phlegm turbidity syndrome. However, for sthenia syndromes such as Qi stagnation syndrome (QSS), heart blood stasis syndrome (HBSS), and CCS, there was no obvious difference. Furthermore, HDL-C levels in the phlegm turbidity group were lower than those of the non-phlegm group. Nevertheless, these results should be confirmed with further studies.

Objectives To examine the short-term effects of ambient temperature on respiratory symptoms for school children with asthma across Australia. Methods A panel of 270 children (7–12 years) with asthma was recruited from six Australian cities. They were asked to record their respiratory symptoms every day in the morning (for night-time symptoms) and evening (for daytime symptoms) for four weeks. Daily ambient temperature, relative humidity and air pollution data were obtained from fixed monitors nearby. A mixed logistic regression model was used to examine the effects of ambient temperature on respiratory symptoms adjusted for children׳s sex, age, standing height, weight and air pollution. Subjects were specified as random effects. Results The relationships between ambient temperature and respiratory symptoms were linear. Increasing temperatures induced the risks of children׳s asthmatic symptoms, especially for “wheeze/chest tightness” and to a lesser extent for “cough/phlegm”. The effects were acute and lasted for four days (lag 0–3) in general. With increasing ambient temperature, boys were more at risk than girls. Conclusions High ambient temperature is a risk factor for respiratory symptoms in children with asthma. As ambient temperature increases, policies and strategies for rising temperatures will be necessary to protect asthmatic children.

Objective To explore the relationships between different lifestyle-behavioral factors and phlegm-wetness type of Traditional Chinese Medicine constitution, so as to provide health management strategies for phlegm-wetness constitution. Methods A case-control study was conducted with the cases selected from the database of Chinese constitution survey in 9 provinces or municipalities of China. 1380 cases met the diagnostic criteria of phlegm-wetness type were taken as the case group, and 1380 cases were randomly selected from gentleness type as the control group. Using Chi-square test to compare the differences of lifestyle-behavior composition in each group; single factor and multiple logistic regression analysis were used to compare the relationships of lifestyle-behavioral factors and phlegm-wetness type. Results There were statistically significant differences between phlegm-wetness type group and gentleness type group in lifestyle behaviors (dietary habits, tobacco and liquor consumptions, exercise habits, sleeping habits). The results of single factor logistic regression analysis demonstrated that the risk of phlegm-wetness constitution decreased significantly in light diet (odds ratio, OR = 0.68); The risk factors of phlegm-wetness type were fatty food intake ( OR =2.36), sleeping early and getting up late ( OR =1.87), tobacco smoking ( OR =1.83), barbecued food intake ( OR =1.68), alcohol drinking ( OR =1.63), salty food intake ( OR =1.44), sleeping erratically ( OR =1.43), less physical activities ( OR = 1.42), sweet food intake ( OR =1.29), sleeping and getting up late ( OR =1.26), and pungent food intake ( OR =1.21), respectively. Regardless of the interaction among lifestyle-behavioral factors, the results of the multiple logistic regression analysis revealed that the risk factors of phlegm-wetness type were sleeping early and getting up late ( OR =1.94), fatty food intake ( OR =1.80), tobacco smoking ( OR =1.50), sleeping erratically ( OR =1.50), barbecued food intake ( OR =1.40), sleeping and getting up late ( OR = 1.40), less physical activities ( OR =1.31), sleeping late and getting up early ( OR =1.27), and sweet food intake ( OR =1.27), respectively, and the risk of phlegm-wetness type still decreased significantly in light food intake ( OR =0.79). Conclusion Light diet can decrease the risk of being phlegm-wetness constitution, and bad lifestyle behaviors such as sleeping early and getting up late, sleeping erratically, fatty food, barbecued food or sweet food intake, tobacco and liquor consumptions, and less physical activities can increase the risks of becoming phlegm-wetness constitution.

Eosinophilic chronic obstructive pulmonary disease (COPD) is a COPD phenotype with several clinical characteristics such as eosinophilic airway inflammation, more common in men and less severe COPD. Eosinophilic COPD has more exacerbations but responds well to corticosteroids and bronchodilators. We hereby report the case of a patient who came to us with shortness of breath, fever, wheezing and a cough with yellow phlegm. He had a history of smoking 4.5 pack-year and two episodes of pulmonary tuberculosis (the second was pulmonary multidrug-resistant tuberculosis). He was diagnosed with eosinophilic COPD exacerbation and pneumonia. Intravenous corticosteroids, bronchodilators and antibiotics were given and his condition improved after a week of hospitalisation.Smoking and pulmonary tuberculosis are risk factors for COPD. In this case, irreversible airflow obstruction is related to COPD and also pulmonary TB. There are several mechanisms that cause airway obstruction in pulmonary tuberculosis, one of which is persistent mycobacterium acting as a co-factor along with smoking and several environmental factors that cause chronic airway inflammation and result in bronchial narrowing with or without parenchymal destruction. Keywords: Eosinophilic COPD, Exacerbation, Multi-drug resistant tuberculosis

Background Autonomic nervous system (ANS) theory has similarities to holism in Oriental medicine (OM). The purpose of this study was to examine the relationships between OM pattern diagnosis and autonomic nervous function estimated by heart rate variability (HRV) parameters. Methods Two hundred and eighty-seven female patients ranging in age from 15 to 74 years (mean = 36.1 ± 10.1 years) were classified into five gynecological problem groups according to their: menstrual dysfunction, infertility, climacteric syndrome, post-operative, and post-labor management groups. They were asked to complete Yin Deficiency (YD), Phlegm pattern, and Cold–Heat questionnaires. Together with the pattern questionnaires, time domain (SDNN, and RMSSD), frequency domain (VLF, LF, HF, TP, and LF/HF), and nonlinear (ApEn) parameters of HRV were calculated using 5 min-ECG recordings. Results The Phlegm and Cold pattern scores had weak negative correlations with TP, LF, and HF in the menstrual dysfunction group. The Cold and Heat pattern scores had medium negative correlations with RMSSD, LF, and HF in the climacteric syndrome group. YD, Cold, and Heat pattern scores had medium negative correlations with ApEn in the post-operative management group. No relationships were seen between pathological patterns and HRV parameters in the infertility and post-labor management groups. Conclusions Phlegm, Cold, Heat and YD patterns should be more carefully considered in the treatment of gynecological problems in order to avoid increasing the risk of cardiovascular disease and depressive disorder in patients with menstrual dysfunction, climacteric syndrome, and post-operative management groups.

Objective To explore the laws governing the distribution of TCM syndrome elements (SEs) of senile diabetes (SD) and their relationship to relevant factors. Method An investigation of patients who met the inclusion criteria was conducted by trained doctors, using case report forms. All related data were collected, including body mass index (BMI =body weight [kg]/height 2 [m]), glycated hemoglobin, illness course, complications, symptoms, and tongue and pulse manifestation. The SEs of each patient were judged by three qualified associate chief physicians independently. Result The main SEs of SD are Yin deficiency, Qi deficiency, blood stasis, and phlegm turbidity. Yin deficiency, Qi deficiency, blood stasis, and phlegm turbidity are most commonly seen among 4-SE combinations. Yang deficiency is typically related to illness course and BMI, phlegm turbidity to hypertension and hyperlipidemia, excessive heat to diabetic microangiopathy, and blood stasis to illness course and diabetic macroangiopathy. Conclusion SD pathogenesis has a deficiency in origin and excess in superficiality. Deficiency syndrome mainly manifests as deficiency of both Qi and Yin, and concurrently in Yang deficiency. Excess syndrome is characterized by blood stasis and phlegm turbidity. SE analysis provides a basis for the prevention and treatment of SD with Traditional Chinese Medicine (TCM) and lays the foundation for objectively evaluating multicentric clinical research for SD in TCM.

We investigated the relationship between Chinese medicine pattern (CMP) types, their severity, and prognosis in patients (n = 187) with acute cerebral infarct (ACI). Six CMPs (wind, phlegm, fire-heat, blood stasis, qi deficiency, and yin deficiency and yang hyperactivity) were evaluated according to inspection, listening and smelling, inquiry, and palpitation. The severity and prognosis of each pattern type was determined according to the Glasgow Coma Scale (GCS), Modified Rankin Scale (MRS), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), and Functional Independence Measure (FIM), recorded at stroke onset and 12 weeks after stroke onset. The phlegm pattern (PP) patients displayed lower GCS, BI, and FIM scales scores, and higher MRS and NIHSS scales scores, than the nonphlegm pattern (N-PP) patients at, and 12 weeks after stroke onset, suggesting the clinical severity is greater and the prognosis is worse in PP patients with ACI than in non-PP patients with ACI.

"Qin-Jiao" is a well-known traditional Chinese medicinal (TCM) herb having been used generally for fighting rheumatoid arthritis (RA) since ancient times. The root of Gentiana dahurica Fisch (Gentianaceae) is one of the four officially validated "Qin-Jiao" as listed in the Chinese Pharmacopoeia. In addition, it is a common Tibetan medicinal herb used for the treatment of tonsillitis, urticaria, and RA, while the flowers have been used as a Mongolian herb for curing cough sore throat and eliminating the phlegm due to its anti-inflammatory effect.The aim of the study was to characterize the anti-inflammatory compounds in "Qin-Jiao", on the basis of detailed investigation on not only the phytochemical study of Gentiana dahurica, but also the bioactive evaluation on compounds obtained presently and previously from different "Qin-Jiao" origins and Gentiana species.The ethanol extract of air-dried roots of Gentiana dahurica was suspended into H2O and extracted with EtOAc and n-BuOH, successively. Repeated column chromatography (CC) and semi-preparative HPLC were carried out on each of the fractions. The isolated compounds were determined by detailed spectroscopic analysis and acidic hydrolysis. Anti-inflammatory activities of 18 isolates, together with 12 typical compounds obtained previously by our group from the other "Qin-Jiao" origins (Gentiana crassicaulis, Gentiana straminea) and Gentiana rigescens, were tested by inhibitory effects on LPS-induced NO production in macrophage RAW264.7 cells and TPA-induced cyclooxygenases-2 and -1 (COXs-2/1) production on zebrafish model.A new lignan glycoside (1) was identified, together with 20 known compounds, including 10 iridoid glycosides (2-11), three steroids (12-14), four lignans (15-18), one phenylpropanoid (19) and two triterpenes (20-21). Anti-inflammatory bioassay showed that only compound 21 displayed potential inhibitory effect on NO production (IC50=16.85 μM), while 20 tested compounds had inhibitory activities on COXs-2/1. Among them, the triterpenoid 21 was the most active compound with an inhibitory value of 78% at a concentration of 30 μM. All the tested compounds showed no cytotoxicity on five human cancer cell lines (40μM) and zebrafish (30 μM), except for 21 displaying weak cytotoxicity on human myeloid leukemia HL-60 (IC50=16.43 μM).Most of compounds particularly iridoid glycosides from "Qin-Jiao" display potential inhibitory effect on COXs-2/1. The results support the historical importance of the well-known TCM herb, "Qin-Jiao", having been commonly used for fighting RA. As major components, the bioactive iridoid glycosides should play important role in the anti-inflammatory effect of "Qin-Jiao". Although further research will be required to evaluate the selective activities of the COXs-2/1 inhibitors, this work validates the medicinal use of "Qin-Jiao" and provides information for different "Qin-Jiao" origins having different treating effects on RA.

Objective To master the syndrome patterns characteristics and explore the effective therapy methods of Traditional Chinese Medicine (TCM) for cardiac syndrome X (CSX). Methods The TCM syndrome characteristics were mastered and the TCM intervention programs were determined by clinical investigations for TCM syndrome patterns characteristics of CSX patients. Then, the clinical efficacy studies on TCM intervention for CSX were carried out through randomized controlled trials. Results CSX is a clinical syndrome with the main manifestations of chest pain and chest stuffiness, and Qi stagnation, phlegm retention and blood stasis are the basic symptoms of CSX. As a result, the Qi-regulating, chest-relaxing and blood-activating therapy integrated with some Western Medicines was adopted for treatment. The effect of Qi-regulating, chest-relaxing and blood-activating therapy can reduce the frequency and degree of angina, improve the symptoms and exercise the tolerance of patients, inhibit the inflammatory response of vascular walls and protect the function of vascular endothelial cells, which is better than that of the simple and conventional Western Medicine alone. Conclusion A good effect was achieved in the integration of Chinese and Western Medicines for CSX. The therapy is worthy to be applied further in clinical practice. On the other hand, more long-term and randomised controlled studies with large samples are still required to further determine the clinical efficacy and safety of the therapy.

Combined treatment of ischemic stroke with Chinese medicine and exogenous bone marrow mesenchymal stem cell (BMSC) transplantation may improve the removal of blood stasis and stimulation of neogenesis. Chinese medicines that remove blood stasis not only promote blood circulation but also calm the endopathic wind, remove heat, resolve phlegm, remove toxic substances and strengthen body resistance. The medicinal targeting effect of Chinese medicine can promote the homing of BMSCs, and the synergistic therapeutic effects of drugs can contribute to BMSC differentiation. As such, exogenous BMSC transplantation has potential advantages for neogenesis. Chinese medicines and exogenous BMSCs provide complementary functions for the removal of blood stasis and stimulation of neogenesis. Therefore, a combination of Chinese medicine and transplantation of exogenous BMSCs may be particularly suited to ischemic stroke treatment.

In the theory of traditional Chinese medicine (TCM), the key pathogenesis of Alzheimer's disease (AD) was kidney-essence deficiency, and this resulted in phlegm stasis. So, in clinical practice, concise prescriptions that consist of herbs, which reinforce kidney qi, activate blood circulation, and detoxicate, exert a good effect on the AD treatment. Based on various kinds of animal models, this article discussed the pharmacological effects of concise prescriptions of Chinese medicine on AD prevention and treatment. The preparation technology and composition of concise prescriptions of Chinese medicine were determined based on the combination of Chinese medicine preparation technology and the efficacy evaluation of the drugs. According to the complex pathogenesis of AD, we developed a basic research method using concise prescriptions prepared by different technologies and various animal models of AD. Changes in some advanced indicators were observed as reflecting the pathological and physiological characteristics of AD and the pharmacodynamic effects of prescriptions. The formation of a safe and effective concise prescription is able to comprehensively reflect the pathogenesis and characteristics of AD based on various kinds of animal models.

Objective To investigate clinical effects of acupuncture method for dredging collaterals and resolving phlegm on stroke in Congo. Methods The patients in Congo China-Congo Friendship Hospital were randomly divided into an acupuncture group and a medicine group, 30 cases in each group. For the acupuncture group, Mailuoning injection was administrated by intravenous drip and acupuncture was given at Sishencōng ( EX-HN 1), Zhōngw n ( CV 12), Fēnglong ( ST 40) and Neiguān ( PC 6), etc., once daily for 10 consecutive days as a course of treatment. For the medicine group, 20 mL Mailuoning or 500 mL low molecular Dextran injection was administrated by intravenous drip, once each day for 10 consecutive days as a course of treatment. After 3 therapeutic courses, clinical therapeutic effects were assessed. Results After treatment, the scores for nervous function were significantly decreased in the two groups (both P Conclusion Acupuncture with the method for dredging collaterals and resolving phlegm has a significant clinical effect on stroke.

Introduction Many reports regarding the effects of air pollution on children’s respiratory health have appeared in the scientific literature. Some investigators found increases in persistent cough and phlegm, bronchitis, and early respiratory infections in communities with poor air quality. The purpose of this survey was to compare the pulmonary function of children living in urban area of Tirana city with children living in suburban area of the city. Material and methods This survey is carried out during 2004–2005 period on 238 children living in urban area and in 72 children living in suburban area, measuring dynamic pulmonary function. A questionnaire was used to collect data on sex, current respiratory symptoms, allergy diagnosed by the physician, parent education and smoking habit of parents, presence of animals, synthetic carpets and moulds in their houses. The selection of schools, and children included in this survey was done by randomized method. Also, we have measured and classic air pollutants. Results Comparing the results of values of pulmonary function of two groups of children, we have shown that differences were significant ( p 0.001), whereas comparing symptoms were for cough ( p 0.011) and for phlegm ( p 0.032). The level of particulate matter (PM10) and total suspended matter (TSP) were over the recommended limit values, whereas the levels of other pollutants have resulted within recommended levels of World Health Organization (WHO) Conclusions The results of this survey suggest that air pollution is associated with respiratory health of children causing a slight decrease in values of pulmonary function in children of urban area compared with those of suburban area.

Background Although China is the most coveted cigarette market worldwide, few studies have examined the longitudinal effects of environmental tobacco smoke (ETS) on health. Purpose To examine the relationship between exposure to ETS and respiratory health in Chinese schoolchildren. Methods The study subjects included 1718 children, who were never-smokers, aged 10.05±0.86 years and asthma-free at baseline. The children performed spirometric tests in 2006 and 18 months later. Parents reported the children's respiratory symptoms and illnesses, ETS exposure, and other related information by self-administered survey at both assessment points. The data were analyzed in 2010. Results Significant exposure–response relationships were found between ETS exposure and coughing at night ( p for trend p for trend=0.031); and sneezing with itchy, watery eyes ( p for trend=0.006) in the first survey, and coughing at night ( p for trend=0.019); phlegm without a cold ( p for trend p for trend=0.036) in the second survey. Compared with those who reported no ETS exposure in either survey, children who had a high ETS exposure level (>5 cigarettes/day) in either survey had lower growth rates in forced expiratory flow between 25% and 75% of forced vital capacity (FEF 25–75 ; β= −0.104, p =0.020) and forced expiratory flow at 25% of forced vital capacity (FEF 25 ; β= −0.077, p =0.027). A monotonic exposure–response effect was observed between ETS exposure and the deficits in the growth rate of FEF 25 and FEF 25–75. Conclusions Exposure to ETS increased the risks of respiratory symptoms in Chinese school-aged children and was associated with impaired lung function growth. A dose–response relationship was observed for the latter effect.

The first surviving Polish publications on epilepsy were written in the 16th and 17th centuries. Many causes of epileptic seizures are quoted and they are divided into two categories: internal and external. Internal causes (causa interna) include imbalance in the basic bodily humors, that is, yellow bile, black bile, phlegm, and blood. According to medieval writers, the principal cause of epilepsy was vapor, a damp, cold volatile substance originating in the excessive production of one of the basic organismic liquids. Vapor allegedly stuck to the openings leading to the cerebral ventricles or blocked them entirely, resulting in convulsions. External causes (causa externa) include overeating and excessive drinking, teething, spoiled milk, poisons, badly treated spots and fever, cold air, moonlight, and wearing donkey hide. Medical treatments for epilepsy included surgical interventions (bloodletting) and pharmacological interventions. The latter included laxatives, sea onion (scilla maritima, urginea maritima), and ground human skull, all of which were supposed to protect the body from vapors. Medical practitioners of that time also advised that the factors and circumstances conducive to epileptic seizures be observed and identified so that patients could be isolated from these alleged causal factors and their seizures reduced or ended.

The Heart-Small Intestine system affects the correct functioning of Shen, which is nourished by Blood and Yin. Correct functioning of the system keeps Shen stable. All chronic diseases causing Humidity, Phlegm, Heat and Fire often lead to overexertion of the heart-small intestine system. Mental disorders, dietary defects and a disordered life mainly cause disturbances in these organs. Basic dietary measures, both restrictive and coadjuvant, work together to re-establish optimal functioning of the Heart-Small Intestine system.

Summary Background Immigration usually implies a complete change of the environment where one lives. Hence, studies on immigrants may help to disentangle genetic and environmental determinants of disease. We investigated whether the incidence of allergic and respiratory symptoms differed for Italian and immigrant children living in one area of Northern Italy. Methods In December 2006, all the children (3–14 years) living in the Viadana district were surveyed through a parental questionnaire (response rate = 99%, n = 3854). Retrospective incidences of several symptoms were compared across different ethnic groups. Results Parental asthma, allergic rhinitis and eczema were less frequent in immigrant children than in Italian children. Wheezing and eczema incidences were lower in children born to foreign parents (especially if born abroad, incidence rate ratio (IRR) = 0.47, 95% CI: 0.26–0.82 and IRR = 0.43, 95% CI: 0.23–0.83, respectively), with respect to Italian children, while the occurrence of nasal allergies was similar among the ethnic groups. The greatest incidence of persistent cough/phlegm was observed in children born in Italy to foreign parents (IRR = 1.98, 95% CI: 1.06–3.71) and in children whose parents had chronic bronchitis (IRR = 2.57, 95% CI: 1.52–4.33). Conclusions Considering the distribution of parental atopic diseases and the low disease prevalence in the immigrants' countries of origin, we suggest that nasal allergies may be more sensitive than wheezing or eczema to the change in the environment related to migration. Genetic or environmental factors clustered into families seem to have a role on chronic bronchitis.

This study aimed at analyzing the clinical distribution of traditional Chinese medicine (TCM) syndrome on cardiovascular diseases and at providing the basis for clinical diagnosis and treatment. Cases of cardiovascular disorder were collected on the basis of unified scales. Syndrome differentiation criteria were used in the identification of the scales. Then the distribution of TCM syndromes on cardiovascular diseases was analyzed. There were 3021 cases, including 1677 cases (55.51%) of heart-qi deficiency, 603 cases (19.96%) of heart- yang deficiency, 699 cases (23.14%) of heart-yin deficiency, 1121 cases (37.11%) of phlegm accumulation, 1624 cases (53.76%) of blood stagnation, and 2057 cases (68.10%) of the syndrome of mixed deficiency and excess. There were 517 cases (17.11%) with only deficiency syndromes and 447 cases (14.80 %) with only excess syndromes. The syndrome of the zang-fu organ is mostly related to the kidney and the spleen. It is concluded that the common clinical distribution of TCM syndromes on cardiovascular diseases is the syndrome of mixed deficiency and excess, which includes heart-qi deficiency, heart-yang deficiency, and heart-yin deficiency and excess syndromes of phlegm accumulation, blood stagnation, and qi stagnation.

ObjectiveTo observe the curative effect of dissolving phlegm-stasis on knee osteoarthritis.MethodsThe 100 patients with knee osteoarthritis were randomly divided into two groups. The 50 patients in the treatment group orally took Chinese medicine while the other 50 patients in the control groups orally took Votalin and Vitamin C for one week as a course of treatment. At the end of 2-week treatment, analytic comparison was carried in evaluate the curative effect and the changes in total score of symptoms before and after treatment between the two groups.ResultsThe total score of symptoms after treatment was significantly lower than that before treatment in both groups (P

When the airways are overwhelmed by noxious particles, gases, or microorganisms, inflammatory and immune responses occur that may cause permanent structural changes. One consequence may be an overproduction of mucus and this may overwhelm mucociliary clearance mechanisms and cause a chronic cough phlegm syndrome. The expectorated mucus is usually clear or white (mucoid) but when it becomes infected, the mucus may become purulent and have a yellow or green color. Diseases associated with chronic productive cough discussed in this article include chronic bronchitis, bronchiectasis, and infectious and noninfectious bronchiolitis and their diagnosis and treatment.

Summary Objective To investigate the role of nutrition in children's respiratory health in subjects participating in a study on air pollution and respiratory health. Study design Cross-sectional survey. Methods The relationships between consumption of fresh fruit, vegetables and milk and pulmonary function (forced expiratory volume in 1 s, FEV 1 ) and respiratory symptoms (phlegm with cold, phlegm without cold, cough with cold, and cough without cold) were examined in 2228 children (age 10.07 ± 0.86 years) in Guangzhou, China. Results A positive association was found between consumption of leafy vegetables and lung function in children. Subjects with the highest consumption of leafy vegetables had significant higher FEV 1 values than subjects who ate leafy vegetables less than once per week (1.68 l vs 1.56 l; P = 0.047). Children with high consumption of fresh fruit and milk had higher lung function values than children with low consumption, although the differences were not statistically significant. Milk consumption was a protective factor for phlegm with cold, cough with cold, and cough without cold [odds ratio (OR) 0.62, 95% confidence interval (CI) 0.39–0.97; OR 0.53, 95% CI 0.36–0.79; OR 0.43, 95% CI 0.21–0.92, respectively, in the highest intake group]. Consumption of vegetables was a protective factor for cough with cold ( P for trend = 0.003) and cough without cold ( P for trend = 0.028). Consumption of fresh fruit was marginally associated with reduced prevalence of respiratory symptoms. Conclusions This study suggests that dietary nutrients are important protective factors for children's respiratory health. Following-up these children may provide more evidence to confirm these associations.

he term bronchiectasis is derived from the Greek bronkia meaning “bronhial tubes” (from bronkhos meaning ‘windpipe’), ek meaning “out,” and asis meaning “stretching.” It literally means the outstretching of the ronchi. Yet it is not this simple as its sequelae can have severe and ebilitating consequences. In this article we will give a general overview of ronchiectasis, describe the etiologies and predisposing factors that lead to its evelopment, and describe its clinical presentation. The management of ronchiectasis, which is multi-faceted, will be described elsewhere. Bronchiectasis is the abnormal and irreversible dilatation of the bronchi. It s accompanied by a chronic productive cough, airway obstruction, and ecurrent infections. Although it does have representative radiographic, athologic, and clinical presentations, it should be viewed as a process more o than a disease entity as it is the end result of a multitude of possible tiologies (Table 1) and predisposing factors. Bronchiectasis was decribed clinically in 1819 when Laennec wrote about patients with “suppuative phlegm” and “dilatation of the bronchi,” but the defining studies were one by Reid in the 1950s linking bronchography with pathological speciens in bronchiectatic lungs. Since that time, with the advance of adiographic imaging, the diagnosis has become much more descriptive. Bronchiectasis can be classified by pathogenetic mechanisms, by redisposing factors, by gross and microscopic pathology, and radioraphically. The most commonly used classification used by pathologist, adiologist, and pulmonologist is based on morphology and was devised y Reid. It is as follows

Background Very few studies have assessed the relative impact of housing characteristics and home environmental factors on asthma and asthma-related symptoms in Chinese children who have lower rates of asthma. To our knowledge few studies have assessed respiratory symptoms and allergies in this context. Methods To assess the effects of housing characteristics, pet keeping, home decorations and other indoor environmental factors on respiratory health of Chinese children. We studied a population of 14,729 children (1–13 years old) from 12 districts in Liaoning province, Northeast China. Information on respiratory health, housing characteristics, and environmental pollutions were obtained by a standard questionnaire from the American Thoracic Society. Results Housing conditions, house adjacent to traffic or not, house with or without pollution source nearby, pet keeping, presence of pests and mold/water damage in the home, home decorations and exposure to environmental tobacco smoke (ETS) were associated with doctor-diagnosed asthma and asthma-related symptoms both in boys and girls. The vulnerability towards exposure to housing conditions and environmental factors differed between males and females. Among boys, the risk of respiratory morbidity appeared to be reduced in households with larger surface areas and more rooms; use of a ventilation device was strongly protective against persistent phlegm (OR = 0.68; 95%CI: 0.48, 0.96). Asthma-related symptoms were more associated with different pets among girls than among boys. The presence of a cat in the household was associated with doctor-diagnosed asthma (OR = 1.89; 95% CI, 1.11–3.20), current wheeze (OR = 2.64; 95% CI, 1.52–4.59), persistent cough (OR = 1.84; 95% CI, 1.18–2.87) and persistent phlegm (OR = 2.17; 95% CI, 1.21–3.87) only among girls. Conclusion Living within the vicinity of a source of pollution, traffic, pet keeping, home decorations, pests, mold and ETS are important determinants of children's respiratory health in China.

Background It has been demonstrated that the attack of persistent vegetative state is associated with the damaged neuron, which produces dopamine, and nervous pathway, the reduce of dopamine or malfunction of dopamine. Objective To observe the effect of self-made traditional Chinese medicine (TCM) Yishen Qiqiao Fang , which has the functions of supplementing qi and nourishing blood, resolving phlegm by promoting blood circulation, restoring consciousness and inducing resuscitation, on the contents of dopamine in serum and cerebrospinal fluid of patients in persistent vegetative state. Design An open randomized controlled clinical trial. Settings Nanjing University of Traditional Chinese Medicine, Nanjing Zijin Hospital. Participants Thirty-eight inpatients of persistent vegetative state were selected from the Department of Neurology, Nanjing Zijin Hospital from August 2005 to November 2006. The patients were diagnosed according to the diagnostic standards set by the summary of a meeting for specialists in Nanjing. Informed contents were obtained from their relatives. According to the order of admission, the enrolled patients were divided into control group ( n =20) and TCM treated group ( n =20). Methods In the control group, the patients were treated with routine treatments for the symptoms. In the TCM treated group, the patients were treated with Yishen Qiqiao Fang besides the same treatments in the control group. TCM dispensing granules: each bag of mongolian milkvetch root, Chinese angelica and peach seed equaled to 10 g crude drug respectively; each bag of grassleaf sweetflag rhizome and dahurian angelica root equaled to 6 g crude drug respectively; Musk 0.05 g. The daily dosage for adults: 4 bags of mongolian milkvetch root, 2 bags of Chinese angelica, 0.05 g musk, 1 bag of peach seed, 2 bags of grassleaf sweetflag rhizome and 2 bags of dahurian angelica root, which should be given though nasal feeding or gastrostogavage before breakfast and supper every day, the course lasted for 2 months. The contents of dopamine in serum and cerebrospinal fluid were determined with enzyme immunoassay analyzer before and after treatment in both groups. Main outcome measures Contents of dopamine in serum and cerebrospinal fluid before and after treatment in both groups. Results Totally 38 patients of persistent vegetative state were enrolled, 33 of them were involved in the final analysis of results, and the other 5 missed. The contents of dopamine in serum and cerebrospinal fluid had no obvious differences between the two groups both before and after treatment ( P > 0.05). In the control group, the contents of dopamine in serum and cerebrospinal fluid had no obvious differences before and after treatment ( P > 0.05). In the TCM treated group, the contents of dopamine in serum and cerebrospinal fluid after treatment were obviously higher than those before treatment ( t =2.174, 2.485, P Conclusion Yishen Qiqiao Fang can significantly increase the contents of dopamine in serum and cerebrospinal fluid of patients in persistent vegetative state, which may be one of the mechanisms for ameliorating persistent vegetative state.

Purpose The purpose of the study is to investigate the cross-sectional and prospective relation between workplace secondhand smoke (SHS) exposure and respiratory symptoms. Methods Cross-sectional data for workplace SHS exposure and respiratory symptoms were collected by using random digit dialing from 7336 never-smoking Hong Kong workers 15 years or older in 1997 to 1998. In the 2000 to 2001 follow-up, 2213 workers who remained never smoking, had the same SHS exposure status, worked at the same job for at least 2 years, and were not exposed to SHS at home at follow-up were included for prospective analysis. Results Cross-sectionally, SHS was associated significantly with frequent colds, cough and phlegm, throat problems, and the presence of any respiratory symptoms with adjusted odds ratios of 1.89 (95% confidence interval [CI], 1.66–2.15), 1.65 (95% CI, 1.35–2.02), 1.88 (95% CI, 1.63–2.15), and 1.96 (95% CI, 1.75–2.20) at baseline, each having significant linear associations with duration of exposure. SHS was not associated with rhinitis. Prospectively, consistent SHS exposure increased the risk for cough and phlegm and any respiratory symptoms by 48% (12% to 97%) and 54% (13% to 109%), respectively. Conclusions This first non-Western population-based prospective study shows that workplace SHS exposure is associated significantly with frequent respiratory symptoms, both cross-sectionally and prospectively, thus providing strong evidence that the association is causal.

HISTORY OF PRESENT ILLNESS The patient is a 59-year-old woman with a history of asthma diagnosed 10 years ago and chronic sinusitis who presented for evaluation of a 1-month history of intermittent fevers with temperatures to 101.5°F, cough productive of white phlegm, and diffuse myalgias. One day before admission, the patient developed dyspnea at rest that did not respond to inhaled albuterol at home. The fevers and cough persisted despite a 2-week course of levofloxacin. Six years before the current hospital admission, the patient was admitted to an outside hospital with similar complaints and erythematous, scaly lesions on the extensor surfaces of her metacarpophalangeal and elbow joints bilaterally. Her inpatient workup included blood tests, chest computed tomography (CT), fiberoptic bronchoscopy, and transesophageal echocardiography. The patient had never been hospitalized for an asthma exacerbation, but she had required 2 emergency department visits for increased asthma symptoms. She had also been treated with oral corticosteroids more than 20 times for asthma exacerbations while concurrently being prescribed inhaled corticosteroids. However, the patient admitted to being noncompliant with both inhaled corticosteroid therapy and physician appointments for management of her asthma. During the previous asthma exacerbations that required treatment with oral corticosteroids, the patient denied having fevers, myalgias, or anorexia. On review of systems, the patient complained of fatigue, anorexia, and a 15-lb weight loss during the past 2 months. There was no history of hemoptysis. She had noted intermittent watery diarrhea and reflux symptoms for 1 year.