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Liu Li, Ding Yi, Wang Jian, et al. “Five Sounds and God” treats the clinical efficacy of mild moderate liver stagnation and spleen deficiency type stroke and its impact on the level of intestinal flora and serum 5-hydroxylidine. [J] . China General Medicine, 2021, 24 (30): 3882-3887. Doi: 10.12114/J.ISSN.1007-9572.2021.02.025.
Stroke is one of the common cardiovascular and cerebrovascular diseases in my country. According to statistics, the number of patients with strokes in my country has reached 13 million, accounting for about 25%of all patients with cerebrovascular disease. In recent years High trend has become a major disease that seriously endangers the health and public health and safety of Chinese residents . After-stroke depression (PSD) is the most common emotional disorders for stroke patients, mainly manifested as emotional indifference, interested, irritable, slow thinking, etc. It was diagnosed as PSD in the next 3 months. About 75%of PSD patients had one or more physical symptoms and caused missed diagnosis, misdiagnosis, rehabilitation delay, increased risk of stroke recurrence, and patient self -efficacy caused by physical symptoms. And the motivation to participate in rehabilitation exercise is reduced .
PSD accompanied by gastric and intestinal symptoms is a special PSD subtype. At present, the clinical symptoms of PSD and its accompanying gastrointestinal tract are mostly treated, but the long -term effects of drug treatment and patient treatment compliance are poor. The author’s research team is committed to the inheritance and development of the rehabilitation technology of traditional Chinese medicine. In long -term clinical practice, the five -element music therapy combined with acupuncture treatment PSD diagnosis and treatment schemes, and named it “five tone tuning method”. This study is a random control test. It aims to explore the clinical efficacy of the “five-tone regulatory method” to treat the clinical efficacy of mild moderate liver stagnation and spleen deficiency PSD patients and their levels of intestinal flora and serum 5-hydroxyline (5-HT) level (5-HT) level The influence in order to provide reference for individualized therapy for such patients to be more secure and effective in clinical and effectively.
1 data and method
1.1 General information
Selected 72 patients with mild moderate liver stagnation and spleen deficiency type PSD patients from the second affiliated hospital of Shandong University of Traditional Chinese Medicine from December 2019 to December 2020. There are 36 cases in each group; the diagnosis of stroke refers to the “Guidelines for the diagnosis and treatment of acute ischemia in China 2018”  and “Chinese Cerebral hemorrhage diagnosis and treatment guide (2019)” . With diagnostic criteria (third edition) (CCMD-3) “, syndrome differential types of liver stagnation and spleen deficiency type refer to the” stagnation “in the 7th edition of” Chinese Medicine Internal Science “. Both groups of patients with gender, age, course, stroke type, and severity of PSD comparison, and the differences are not statistically significant (
> 0.05), see Table 1. This study was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine (approval number: 2019sdzydey-001), and the clinical trial registration number ChicTR-1900023741; all patients agreed with the consent of this study and signed an informed consent.
General information comparison of two groups of patients
Comparison of general information?
Innovativeness of this research:
This study is based on “the governor pulse as the outline and the relevant viscera function” theory. Patients with depression have discussed their mechanisms through changes in the horizontal changes of intestinal flora and serum-5 hydroxylidine, and have a good clinical practice foundation and theoretical innovation.
1.2 Increase and exclusion criteria
Incident: (1) 35 ~ 75 years old; (2) PSD occurs 2 to 36 weeks after stroke; -17, HAMD-17) score is 8 ~ 23 points; (4) clear consciousness, can complete the corresponding scale assessment, dementia, dismissal, and misha. Elimination criteria: (1) HAMD-17 suicidal tendency single term> 3 points; (2) unstable vital signs or severe heart, liver, and kidney disease; (4) There are major history of psychological trauma, alcohol and drug dependence in the past one year; (5) Taking antidepressant drugs in the past 2 weeks; (6) accompanied by dementia, Parkinson disease, depression, etc. Diseases; (7) dislike or unacceptable music; (8) There are taboos of acupuncture treatment.
1.3 treatment method
1.3.1 Conventional internal medicine treatment
Both groups of patients received conventional internal medicine treatment, including regulating blood pressure, controlling blood sugar, and neurotic nutritional therapy. At the same time, referring to the “Chinese Cerebral Vascular Disease Prevention Guide”  for the recovery of hemiplegia limbs.
1.3.2 control group
Patients in the control group are treated on the basis of conventional internal medicine treatment (produced by Xi’an Yangsen Pharmaceutical Co., Ltd., State Pharmaceuticals J20150119). D. Continuous treatment for 4 weeks.
1.3.3 test group
Patients in the test group adopt “Five Tone Minding Methods” on the basis of conventional internal medicine treatment: (1) Acupuncture treatment: patients take supine positions, and local skin routine disinfection uses 0.30 mm × 40.00 mm of a disposable sterile acupuncture needle acupuncture needle Acupuncture, selection points include Yintang, Shenting points, Baihui acupoints, Zhongye points, and Zusanli points. Each acupoint is uniformly twisted and flat -facing the diarrhea. Qi is stopped); 30 min is left; after the needle is out of the needle, a sterile cotton ball or cotton swab is pressed 1 ~ 2 min to prevent bleeding and infection; acupuncture and acupuncture are used for acupuncture and acupuncture. (2) Five Elements Music therapy: Instructed patients to treat the bladder in front of the bladder, play angle tone music once, about 30 min each time, the volume is suitable for the patient feels comfortable, generally 40 ~ 60 dB; the patient lying on the music during the treatment of the music on the music at the music In the treatment room, keep the light in the house soft and the surrounding environment is quiet. Select the palace -style music in the “Chinese traditional Five Elements Music (Tone)” recommended by the Chinese Medical Association as the basic music. After the patient’s audition, the patient selects your favorite track and uses Philips EP200DVD player , Sony WH-CH510 Bluetooth wireless three-dimensional sound headphones are played. In addition, the five elements of music should be played at the same time in acupuncture, 30 min/time, 1 time/d, 5 times/week, 5 times for 1 course of treatment, and continuous treatment of 4 courses.
1.4 Observation indicators
1.4.1 HAMD-17 score
HAMD-17 was compiled by Hamilton  in 1960. It is the most commonly used depression state evaluation table in clinical practice; HAMD-17 contains 17 items, each divided into no, mild, moderate, severe, extremely severe weight , Respectively, 1, 2, 3, 4, 5, and a total of 85 points. Studies have shown that HAMD-17 overall parallel parallel validity and structural validity are ideal .
1.4.2 Gastrointestinal Symptom Rating Scale (GSRS) score
GSRS consists of 15 self -evaluation entries, involving gastrointestinal symptoms, frequency of seizure, seizure duration, and impact on daily life. Each entry is 1 ~ 7 points. serious. Studies have shown that GSRS’s internal consistency is 0.58 ~ 0.88 .
1.4.3 Clinical efficacy
Determine clinical efficacy based on the HAMD-17 scoring reduction rate: HAMD-17 score reduction rate> 75%is clinical control, 50%~ 75%is effective, 25%~ 49%is valid, <25%is invalid; HAMD- 17 Rating scores = (total score before treatment-total score after treatment)/total score before treatment × 100%. The HAMD-17 score and clinical efficacy determination was independently completed by members of the research group that did not participate in research groups and patients.
1.4.4 Number of intestinal flora
Collect 5 ~ 7 g of fresh feces in two groups before and after treatment, add 10 ml of phosphate buffer 10 ml, and mix it at a rate of 140 000 R/min. The upper liquid is 10 min (10 cm of centrifugal radius) at a rate of 140 000 R/min (centrifugal radius 10 cm), and finally extracts DNA through DNA extraction kit and performs 4 intestinal flora (bisidobacterium, E. colorectal, lactobacillus, lactobacillus , Enterococcus) polymerase chain reactions (PCR), primer amplification and production standard curves, calculating the number of intestinal flora, the unit is expressed in LG Copies/G.
1.4.5 serum 5-HT level
Collect two groups of patients with empty vein blood 4 ml before and after treatment, and centrifuge at a rate of 3,000/min 10 min (centrifugal diameter 10 cm) and remove them in -80 ° C in a refrigerator; (ELISA) and 5-HT kits (produced by Wuhan Gene Mei Biotechnology Co., Ltd.) to detect serum 5-HT levels and operate in strict accordance with the kit instructions.
1.5 Statistical method
Data analysis was performed using SPSS 22.0 statistical software. The measurement data of this study conforms to the normal distribution, with (x ±
) It means that the two groups are compared with independent samples
Inspection, compared with pairing before and after the group treatment
Inspection; counting data is represented by relative numbers, and the two groups are compared with χ2 testing; the level data is compared with rank and test. Double -sided inspection level
2.1 HAMD-17 score, GSRS score
The two groups of patients had a HAMD-17 score and a GSRS score before treatment. The difference was not statistically significant (
> 0.05); After treatment in the test group, the HAMD-17 score and the GSRS score were lower than the control group. The difference was statistically significant (
<0.01). After the treatment of the two groups of patients, the HAMD-17 score and the GSRS score were reduced compared to before treatment. The difference was statistically significant (
<0.01), see Table 2.
The HAMD-17 score, GSRS score comparison (x ±
Comparison of Mean Hamd-17 Score and GSRS SCORE BETWEEN Control and Experimental Groups Before and after Treatment
2.2 Clinical efficacy
The clinical efficacy of patients in the test group is better than the control group, and the difference is statistically significant (
= 0.008), see Table 3.
Both groups of patients with clinical efficacy comparison [
Comparison of Clinical Response Between Control and Experiment Groups
2.3 Number of intestinal flora
The number of two groups of patients in the treatment of bisidobacterium, E. colorectal, lactobacillus, and enterococcal in the two groups comparison.
> 0.05); After the treatment of patients in the test group, the number of bisidobacterium and lactobacillus was more than the control group.
<0.01). After the treatment of the two groups of patients, the number of bisidobacterium and lactobacillus increased compared to before treatment.
<0.01), see Table 4.
Comparison of the number of intestinal flora in the two groups of patients (x ±
Comparison of the Mean Number of Species of Gut Flola Between Control and Experimental Groups Before and after Treatment
2.4 Serum 5-HT level
Both groups of patients are compared before serum 5-HT levels, and the differences are not statistically significant (
> 0.05); After the treatment of patients in the test group, the serum 5-HT level was higher than the control group, and the difference was statistically significant (
<0.01). After the treatment of the two groups of patients, the serum 5-HT level has increased compared to before treatment, and the differences are statistically significant (
<0.01), see Table 5.
The serum 5-HT level comparison (x ±
Comparison of the Mean Serum Serotonin Level Between Control and Experimental Groups Before and after Treatment
PSD’s pathophysiological mechanism is more complicated, and although it has been a large number of clinical research, its exact pathogenesis is not yet conclusive. PSD model research shows that Hypothalamus-Pituitary-Adrenal (HPA) axis excitability is enhanced, stress-regulatory dysfunction, and monomatamine neurotransmitters (such as norepinephinxin, 5-HT, dopamine ) Equality may be a key factor that leads to the occurrence and development of PSD . The theory of Chinese medicine believes that “the shape of the shape is the gods, but the gratitude is the destruction of the gods” . God’s “relationship looks at PSD; the main disease of PSD is in the brain, involving the liver, spleen, lungs, and kidneys, and liver qi stagnation is its basic pathogenesis . Li Dezhi  summarizes 6 common depression syndrome through summary of a large number of literatures, of which the liver stagnation and spleen deficiency syndrome is the most common. Patients with liver stagnation and spleen deficiency type PSD are mainly manifested in depression, full chest, too good at ease, poor natal, loose stool, yellowing, pale tongue, thin white moss, and gastrointestinal symptoms. Traditional Chinese Medicine Health Studies pay attention to calm and calmness, and have a good reference value for conditioning depression. Acupuncture and five elements of music therapy are traditional Chinese medicine rehabilitation technology, which plays an important role in the treatment of physical and mental illness .
Du Mai is in the spine, with the Communications Communications, the marrow to the brain, and the top of the liver meridian. Therefore, the relationship between the gu pulse is closely related to the brain and the liver; Qi can regulate the yang and the whole body qi and blood, alleviate the symptoms of yang depression and the symptoms of gods, and promote brain function recovery. Based on the theory of “Du Mai as the outline and the relevant viscera function”, this study selected two related viscera points of Yintang, Shenting acupoints, Baihui acupoints, and Zhonglu acupoints, and Zusanli acupoints. Among them, the three governor veins of the acupuncture point, Shenting acupoint, and Baihui acupoint can be filled with brain marrow and regulate the liver. The two related viscera acupuncture points, acupuncture, acupuncture, and Zusanli acupoints can adjust the spleen and stomach, Yizhong Qi, and the three supervisors of Yintang, Shenting acupoint, and Baihui acupoint. The function of spleen the liver and spleen, and adjust the air. In addition, there is a cloud in “Famous Medicine Recipes”: “The liver is wooden, and it depends on the soil with Zipei … If the qi is deficient, the nine land will not be born, and the woody is depressed.” “The importance of the treatment of the spleen theory.
The Five Classic “Book of Rites · Rites” records “Gong’s spleen” and “is not full of viscera, the internal organs should be, the five elements belong to the soil, and the five internal organs pass through the spleen”. 17]. The five elements of music therapy combine the five elements with the five internal organs and the five minds based on the theory of “physical and mental and mental”, which is often used to treat emotional diseases. Among them, the palace -style music can regulate the middle palace, smooth aircraft, Bloodline blood, and relieve worry. This study selected the positive palace as the basic music to treat the mild moderate liver stagnation and spleen deficiency PSD, and cooperate with acupuncture to prinites, Shenting points, Baihui acupoints The five elements of the five elements of the Zhongli acupoint, the foot of the Zusanli acupoint and the listening palace are based on the spleen and qi, and the spirit of regulating the spirit, and finally the formation of the “five -tone regulatory method” to promote the dirty function of the patient’s viscera. Improve the mental state and gastrointestinal function of patients. Wang Xiaohong et al.  research confirmed that the clinical efficacy of acupuncture and five elements to treat liver qi depression is accurate; Huang Lijun et al.  research showed that music rehabilitation training can enhance the effect of acupuncture treatment, but still lacks discussion on the mechanism of action mechanism Essence The results of this study show that the clinical efficacy of patients in the test group is better than the control group. After the treatment, the HAMD-17 score and the GSRS score are lower than the control group, indicating that the “five-tone regulatory method” treats the clinical efficacy of mild moderate liver stagnation and spleen deficiency PSD patients than better than patients with PSDs. Aisi Pulan can effectively reduce the degree of depression in patients and gastrointestinal symptoms, which is consistent with the results of the above research.
Individuals based on depression and body symptoms may have the same pathogenic factors. RIEF et al.  The correlation between 5-HT pathways through establishing symptoms development models may be the biological mechanism of depression and physical symptoms. Studies have shown that 5-HT is closely related to the development of nerves and plasticity , PSD patients with a decrease in the use of pinerine in the brain, and the availability of the dusterine is related to nerve conduction through 5-HT pathways; at the same time, color ammonia Acid is a forefront of 5-HT. It will enter the central nervous system through the blood-cerebrospinal fluid barrier and eventually sewn a nucleus to synthesize 5-HT . Therefore, the serum 5-HT level can be used as an indirect indicator that reflects the content of the central nervous system 5-HT. Wang Fenghua et al.  found that the content of mouse tissue 5-HT and 5-hydroxylidal acetic acid with depression was significantly reduced through the establishment of a desperate mouse model. closely related. The results of this study show that after the treatment of patients in the test group, the serum 5-HT level is higher than the control group. The mechanism of its role may be: acupuncture therapy and five-element music therapy can improve the 5-HT content in patients with mild moderate liver stagnation and spleen deficiency PSD, thereby regulating neurotransmitting levels and improving nerve function.
The intestinal flora plays an important role in congenital and adaptive immunity. It can media the formation, maturity and its functions of immune cells, reducing the occurrence of intestinal inflammation, and also plays an important role in repairing intestinal barriers. Studies have shown that PSD will cause intestinal flora disorders and intestinal inflammation through the neuromance system, and then affect the synthesis, metastasis and destroying the 5-HT signal transmission of color metabolic products, further aggravating PSD, and this kind of intestinal bacteria The two-way brain-intestinal communication pathway of the group connection is called “brain-intestinal axis” . In addition, about 95%of the 5-HT in the human body synthesize, store and release it in the intestine. 5-HT through the NA+/CL-dependent 5-hydroxylidin transport protein (Sert) with several receptor subtypes (Sert) Combining and played an important role in promoting intestinal peristalsis and secretion reflex: 5-HT can activate the inherent intestinal reflection, media the “communication” and “brain-intestinal axis” pathway of the intestinal-central nervous system, regulate the brain and intestine Peptide (gastric and intestinal peptide, 5-HT) balance, thereby alleviating gastric gastrointestinal symptoms such as abdominal pain, diarrhea, loss of appetite, qi (liver stagnation and spleen deficiency syndrome). Clinical studies have shown that there are obvious intestinal flora dysfunction in patients with elderly depression , while supplementary probiotics and lactobacillus can be used as alternative to improving anxiety and depression, which is conducive to reducing stress reactions, reducing reducing stress reactions, reducing reduction Cortisol level . The results of this study show that after the treatment of patients in the test group, the number of bisidobacterium and lactobacillus is more than the control group. The intestinal flora in patients with PSD is conducive to alleviating gastrointestinal symptoms of PSD patients. In addition, because the intestinal flora will use the “brain-intestinal shaft” to reaction to neurotransmitters, it can improve post-improvement and improve the nerve function of PSD patients and reduce depression.
In summary, the “Five Sounds and Turning Gods” can achieve the purpose of physical and mental governance, and can effectively reduce the depression and gastrointestinal symptoms of mild moderate liver stagnation and spleen deficiency PSD patients. , By improves the patient’s neurological function, neurotransmitter disorders, etc., it is worthy of clinical promotion and application. However, this study is a single center research and a small sample volume. The results and conclusions of the income need to be further confirmed by large samples and multi -center research.
There is no conflict in this article.