• Users Online: 68
  • Print this page
  • Email this page

 
Table of Contents
REVIEW ARTICLE
Year : 2019  |  Volume : 5  |  Issue : 4  |  Page : 202-213

Tonifying kidney, lung, and spleen combined with western medicine for stable chronic obstructive pulmonary disease: A systematic review


1 Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, China
2 Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai; National Clinical Research Base of Traditional Chinese Medicine, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi, China

Date of Submission03-Nov-2018
Date of Decision13-Mar-2019
Date of Acceptance24-Apr-2019
Date of Web Publication03-Dec-2019

Correspondence Address:
Prof. Zhen Gao
Huashan Hospital, Fudan University, Shanghai 200433
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/wjtcm.wjtcm_17_19

Rights and Permissions
  Abstract 


Introduction: This study aimed to evaluate the clinical effectiveness and safety of tonifying kidney, lung, and spleen (TKLS) combined with Western medicine for stable chronic obstructive pulmonary disease (COPD). Materials and Methods: Randomized controlled trials (RCTs) of TKLS for stable COPD were searched from four databases including PubMed, the Cochrane Library, China Biology Medicine, and China National Knowledge Infrastructure from inception to December 2017. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. RevMan5.3 software was used for meta-analysis. Results: Fourteen RCTs involving 1339 patients with stable COPD were included. Five of the included articles described the specific method of randomization, 1 of them was double-blind method research, and 1 of them was single-blind method research. Compared with the conventional Western medicine (CWM) group, the use of TKLS, if combined with CWM demonstrated significantly improved effective rate (relative risk = 1.25, 95% confidence interval [CI]: 1.18–1.33, P < 0.00001), decreased traditional Chinese medicine syndrome score (mean difference [MD] −5.72, 95% CI: −8.31 to −3.14, P < 0.0001), Decreased St George's Respiratory Questionnaire total score (MD −7.39, 95% CI: −10.46 to −4.31, P < 0.00001), increased 6-min walk distance in meters (MD 78.46, 95% CI: 60.18–96.73, P < 0.00001), increased forced expiratory volume 1% (MD 6.49, 95% CI: 3.64–9.33, P < 0.00001), increased CD4 (MD 9.84, 95% CI: 6.73–12.94, P < 0.00001), CD8 (MD −1.84, 95% CI: −3.62 to −0.06, P = 0.04) and CD4/CD8 (MD 0.26, 95% CI: 0.20–0.32, P < 0.0001), and increased immunoglobulin M (MD 0.15, 95% CI: 0.10–0.20 P < 0.00001).. Conclusions: For stable COPD, TKLS combined with CWM is superior to CWM alone with regard to clinical effectiveness, symptoms, and quality of life. The above conclusion needs to be validated by further well-designed, multicentric, large-scale, double-blinded RCTs.

Keywords: Chronic obstructive pulmonary disease, traditional Chinese medicine, tonifying kidney, lung, and spleen, systematic review, meta-analysis, randomized controlled trial


How to cite this article:
Liu YY, Gao Z. Tonifying kidney, lung, and spleen combined with western medicine for stable chronic obstructive pulmonary disease: A systematic review. World J Tradit Chin Med 2019;5:202-13

How to cite this URL:
Liu YY, Gao Z. Tonifying kidney, lung, and spleen combined with western medicine for stable chronic obstructive pulmonary disease: A systematic review. World J Tradit Chin Med [serial online] 2019 [cited 2019 Dec 13];5:202-13. Available from: http://www.wjtcm.net/text.asp?2019/5/4/202/271959




  Introduction Top


Chronic obstructive pulmonary disease (COPD) has been a major public health problem in the 21st century,[1] which imposes a substantial economic burden on both patients and government in China.[2] Patients who suffer from COPD may experience cough, dyspnea, chest tightness, and wheezing.[3],[4] Chronic cough, sputum production, and decreased forced expiratory volume 1 (FEV1) have proved to be independently associated with an increased risk of frequent exacerbations and hospitalizations.[5] Pharmacologic and nonpharmacologic therapies are frequently used to manage COPD as recommended by the World Health Organization (WHO) and Global Initiative for Chronic Obstructive Lung Disease.[6] Nevertheless, it is still unclear whether these therapies can suppress the progression of this disease.

Traditional Chinese medicine (TCM) has a long history and is a common aspect of the health-care system in many Asian countries. COPD belongs to the category of lung distention (Feizhang disease) in TCM.[7] Considering that COPD is a chronic disease, researchers should develop medical therapy that can be used continuously for symptom control. Furthermore, treatment of patients in stable phase is very essential for the outcome of COPD. TCM therapies have shown the ability to improve symptoms, to reduce the frequency of acute exacerbation, and to improve the quality of life in stable COPD.[8] According to TCM, being the source of growth and development, the Pi (spleen) provides the material basis for the acquired constitution, whereas the shen (kidney) as the origin of congenital constitution stores vital essence and energy. The mutual generation between the lung and kidney, i.e., Pi (spleen) and Shen (kidney) deficiency, is the basis of the incidence of COPD. Fei (lung) and Shen (kidney) deficiency are the main features of stable COPD, whereas Shen (kidney) deficiency is the root cause. Hence, tonifying kidney, lung, and spleen (TKLS) is one of the most common treatments for stable COPD.

Nevertheless, data supporting the validity of this treatment are insufficient. This systematic review aimed to evaluate the clinical effectiveness and safety of TKLS as a treatment for stable COPD by integrating different outcomes from randomized controlled trials (RCTs).


  Materials And Methods Top


Registration

The study protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO). The study registration number of PROSPERO is CRD 42018090328.

Inclusion and exclusion criteria

All the RCTs reporting the application of TKLS for stable COPD were included in the study. There were no limitations on publication status. The inclusion criteria were the following: (1) articles published in English or Chinese language; (2) randomized or quasi-randomized clinical trials; (3) studies including patients diagnosed with stable COPD; and (4) studies including patients treated according to syndrome differentiation (TCM).

The exclusion criteria were (1) randomized crossover trials, case reports, case series, reviews, qualitative studies, or animal experiments and (2) stable COPD interventions being combined with external therapy of TCM.

Intervention type

RCTs that examined the effects of TKLS combined with the conventional Western medicine (CWM) and CWM were identified. Patients in the treatment group were given TKLS combined with CWM, whereas patients in the control group were treated with CWM. Patients were excluded when the RCTs included external therapy of TCM. We did not set limitations on dosages and course of treatment.

Outcome measures

The primary outcomes analyzed in this meta-analysis were clinical effectiveness, TCM Syndrome Score,[9] exercise capacity (6-min walk distance in meters [6 mWD]),[10] and respiratory-specific quality of life (St George's Respiratory Questionnaire [SGRQ]).[11] The secondary outcomes analyzed for this meta-analysis were lung function (FEV1%), T-lymphocyte subsets (CD4, CD8, and CD4/CD8), and immunoglobulin (IgA, IgG, and IgM). Safety and adverse events were also included.

Literature search strategy

Two Chinese-language databases and two English-language databases were widely searched for all relevant results until December 2017. The Chinese-language databases were China National Knowledge Infrastructure and China Biology Medicine disc. The two English-language databases were PubMed and Cochrane Library.

The search strategy was the following: #1 Bushen; #2 Bu shen; #3 Yishen; #4 nourishing the kidney; #5 tonifying the kidney; #6 Yi shen; #7 tonifying shen; #8 tonifying kidney; #9 nourishing kidney; #10 nourishing shen; #11 reinforcing the kidney; #12 reinforcing kidney; #13 reinforcing shen; #14 Invigorating the kidney; #15 Invigorating kidney; #16 Invigorating shen; #17 kidney-reinforcing; #18 kidney reinforcing; #19 Shen reinforcing; #20 Shen-reinforcing; #21 kidney-Invigorating; #22 kidney Invigorating; #23 Shen-Invigorating; #24 kidney-tonifying; #25 Shen-tonifying; #26 kidney tonifying; #27 Shen tonifying; #28 Shen Invigorating; #29 Invigorating Shen; #30 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 reinforcing kidney or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29; #31 COPD; #32 chronic obstructive pulmonary disease; #33 #31 or #32; #34 #30 and #33.

Data extraction and management

Data were extracted by two reviewers independently. After checking, any disagreements were resolved by consulting a third reviewer. All the data were recorded using a data collection form. The form contents were as follows: (1) title, authors, source, and time of publication; (2) basic characteristics (sample, gender, age, diagnostic criteria, course of disease, intervention, course of treatment, main outcomes, and specific details); and (3) methods (study design, total study duration, sequence generation, allocation sequence concealment, blinding, and other concerns about bias). The collected outcome data were inputted into Review Manager 5.3 software (RevMan5.3, Cochrane Community, London, United Kingdom, 2014).

Assessment of risk of bias

Criteria for judging the risk of bias were taken from the “risk of bias” assessment tool in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0.[12] This judgment was evaluated by two reviewers independently, and the disagreements were resolved by consulting a third reviewer.

Data synthesis

RevMan 5.3 was used for statistical analysis. The extracted data were divided into dichotomous and continuous variables. Data were summarized using odds ratio with 95% confidence intervals (CI) for dichotomous outcomes; mean difference (MD) with 95% CI was presented for continuous outcomes. Cochrane's P values and I2 tests were determined to examine the level of heterogeneity between trials. A random-effects model was used to evaluate the effects of TKLS on stable COPD if I2 > 50% or P < 0.1. Otherwise, a fixed-effects model was utilized. P < 0.01 was considered statistically significant. Data were subjected to meta-analysis by using Review Manager 5.3 software.


  Results Top


Results of the search

A total of 560 potential records (507 records from Chinese databases and 53 records from English databases) were obtained. Among these, 418 records were left for further screening after removing the duplicates. A total of 171 studies were read and analyzed in detail, and 14 studies were finally included for the systematic review. This screening process is summarized in a flow diagram [Figure 1].
Figure 1: Flowchart of the trial selection process

Click here to view


Study characteristics

Among 14 studies, 1339 patients with COPD were included. The control group received CWM, whereas the experimental group received TKLS combined with the CWM. The study characteristics are shown in [Table 1].
Table 1: Basic characteristics of the included studies

Click here to view


Composition of the herbal formulas for chronic obstructive pulmonary disease in this review

Patients in the treatment group were treated with TKLS. The details of herbal medicines in the included studies are presented in [Table 2].
Table 2: Herbal medicines in the included studies

Click here to view


Risk -of -bias assessment

Five of the included articles described the specific method of randomization (four random number table and one randomized block design). None of them described the allocation concealment method. One of them was double-blind method research and one of them was single-blind method research [Figure 2], [Figure 3] and [Table 3].
Figure 2: Risk-of-bias graph of the included trials

Click here to view
Figure 3: Risk-of-bias summary of the included trials

Click here to view
Table 3: Risk of bias of the included studies

Click here to view


Meta-analysis

The meta-analysis was done according to random-effects statistical model. In addition, all the studies included treatment group patients (treated with TKLS combined with CWM) and control patients (treated with CWM).

  1. The clinical effectiveness of TKLS was evaluated in 12 studies which included 587 treatment group patients and 584 controls. Our analysis revealed that TKLS combined with CWM can increase clinical effectiveness (relative risk = 1.25, 95% CI: 1.18–1.33, P < 0.00001). A fixed-effects model was used [Figure 4]
  2. TCM Syndrome Score was evaluated in six studies, including 224 treatment group patients and 222 controls. Our analysis revealed that TKLS combined with CWM can decrease TCM Syndrome Score (MD −5.72, 95% CI: −8.31 to −3.14, P < 0.0001) [Figure 5] Two studies evaluated the cough, sputum, and wheezing scores of TLSK in 69 treatment group patients and 70 controls. Our analysis revealed that TLSK combined with CWM can decrease cough score (MD −1.04, 95% CI: −1.62 to −0.46, P = 0.0004), sputum score (MD −1.09, 95% CI: −1.91 to −0.26, P = 0.010), and wheezing score (MD −0.56, 95% CI: −1.07 to −0.05, P = 0.03). A random-effects model was used [Figure 6]
  3. Respiratory-specific quality of life (SGRQ) was evaluated in four studies, which included 206 treatment group patients and 203 controls. Our analysis revealed that TKLS combined with CWM can decrease SGRQ (MD −7.39, 95% CI: −10.46 to −4.31, P < 0.00001). Three studies evaluated the SGRQ-impacts, SGRQ-symptoms, and SGRQ-activity in 166 treatment group patients and 163 controls. Our analysis revealed that TKLS combined with CWM decreased SGRQ-impacts (MD −7.38, 95% CI: −12.61 to −2.14, P = 0.006), but failed to improve SGRQ-symptoms (MD −7.11, 95% CI: −16.23 −2.01, P = 0.13) and SGRQ-activity (MD −5.27, 95% CI: −12.32 −1.78, P = 0.14). A random-effects model was used [Figure 7]
  4. Exercise capacity (6 mWD) was evaluated in five studies, including 254 treatment group patients and 252 controls. Our analysis revealed that TLSK combined with CWM can increase 6 mWD (MD 78.46, 95% CI: 60.18–96.73, P < 0.00001). A random-effects model was used [Figure 8]
  5. Lung function was assessed in ten studies which included 463 treatment group patients and 460 controls. Our analysis revealed that TLSK combined with CWM can increase FEV1% (MD 6.49, 95% CI: 3.64–9.33 P < 0.00001). A random-effects model was used [Figure 9]
  6. T-lymphocyte subsets (CD4, CD8, and CD4/CD8): CD4 was evaluated in five studies (244 treatment group patients and 240 controls), CD8 in four studies (214 treatment group patients and 210 controls), and CD4/CD8 in four studies (214 treatment group patients and 210 controls). Briefly, our data revealed that TLKS combined with CWM can increase CD4 (MD 9.84, 95% CI: 6.73–12.94, P < 0.00001) [Figure 10], can decrease CD8 (MD −1.84, 95% CI: −3.62 to −0.06, P = 0.04 [Figure 11], and can increase CD4/CD8 (MD 0.26, 95% CI: 0.20–0.32 P < 0.0001) [Figure 12]. A fixed-effects model was used for analyzing CD4/CD8, whereas a random-effects model was used for evaluating CD4 and CD8
  7. Immunoglobulin (IgA, IgG, and IgM) was evaluated in two studies, including 129 treatment group patients and 126 controls. Our analysis revealed that TLSK combined with CWM can increase IgM (MD 0.15, 95% CI: 0.10–0.20 P < 0.00001) [Figure 13], but it has no effect in increasing IgA (MD 0.27, 95% CI: −0.10–0.64 P = 0.15) [Figure 14] and IgG (MD 2.43, 95% CI: −0.70–5.57 P = 0.13) [Figure 15]. A random-effects model was used for analyzing IgA and IgG, whereas a fixed-effects model was applied for IgM
  8. [Table 4] summarizes the frequency of acute exacerbation which was not included in the meta-analysis but reported in RCTs.
Figure 4: Comparison of tonifying kidney, lung, and spleen combined with conventional Western medicine versus conventional Western medicine in patients with stable chronic obstructive pulmonary disease: change in clinical effectiveness

Click here to view
Figure 5: Comparison of tonifying kidney, lung, and spleen combined with conventional Western medicine versus conventional Western medicine in patients with stable chronic obstructive pulmonary disease: change in traditional Chinese medicine syndrome score

Click here to view
Figure 6: Comparison of tonifying kidney, lung, and spleen combined with conventional Western medicine versus conventional Western medicine in patients with stable chronic obstructive pulmonary disease: change in cough, sputum, and wheezing scores

Click here to view
Figure 7: Comparison of tonifying kidney, lung, and spleen combined with conventional Western medicine versus conventional Western medicine in patients with stable chronic obstructive pulmonary disease: change in St George's Respiratory Questionnaire

Click here to view
Figure 8: Comparison of tonifying kidney, lung, and spleen combined with conventional Western medicine versus conventional Western medicine in patients with stable chronic obstructive pulmonary disease: change in 6-min walk distance in meters

Click here to view
Figure 9: Comparison of tonifying kidney, lung, and spleen combined with conventional Western medicine versus conventional Western medicine in patients with stable chronic obstructive pulmonary disease: change in forced expiratory volume 1%

Click here to view
Figure 10: Comparison of tonifying kidney, lung, and spleen combined with conventional Western medicine versus conventional Western medicine in patients with stable chronic obstructive pulmonary disease: change in CD4

Click here to view
Figure 11: Comparison of tonifying kidney, lung, and spleen combined with conventional Western medicine versus conventional Western medicine in patients with stable chronic obstructive pulmonary disease: change in CD8

Click here to view
Figure 12: Comparison of tonifying kidney, lung, and spleen combined with conventional Western medicine versus conventional Western medicine in patients with stable chronic obstructive pulmonary disease: change in CD4/CD8

Click here to view
Figure 13: Comparison of tonifying kidney, lung, and spleen combined with conventional Western medicine versus conventional Western medicine in patients with stable chronic obstructive pulmonary disease: change in immunoglobulin M

Click here to view
Figure 14: Comparison of tonifying kidney, lung, and spleen combined with conventional Western medicine versus conventional Western medicine in patients with stable chronic obstructive pulmonary disease: change in immunoglobulin A

Click here to view
Figure 15: Comparison of tonifying kidney, lung, and spleen combined with conventional Western medicine versus conventional Western medicine in patients with stable chronic obstructive pulmonary disease: change in immunoglobulin G

Click here to view
Table 4: Frequency of acute exacerbation which was not included in the meta-analysis reported in randomized controlled trials

Click here to view


Safety and adverse events

Among 14 included RCTs, five RCTs (including 540 participants) mentioned safety evaluation [Table 5], whereas two RCTs (including 120 participants) reported adverse events associated with TCM [Table 6].
Table 5: Safety evaluation of the included studies

Click here to view
Table 6: Adverse events in the included studies

Click here to view


Discussion Chronic obstructive pulmonary disease in traditional Chinese medicine

Tonifying kidney, lung, and spleen for chronic obstructive pulmonary disease

According to TCM, COPD is mainly caused by the deficiency of lung, spleen, and kidney, which is the internal cause of acute exacerbation of COPD.[27] Being the source of growth and development, the Pi (spleen) provides the material basis for the acquired constitution, whereas the shen (kidney) as the origin of congenital constitution stores vital essence and energy. The mutual generation between the lung and kidney, i.e., Pi (spleen) and Shen (kidney) deficiency, is the basis of the incidence of COPD. Fei (lung) and Shen deficiency are the main features of stable COPD, whereas the Shen deficiency is the root cause. For stable COPD, TKLS is one of the most important treatments aiming at its pathogenesis. TKLS including herbs that can tonifying kidney, lung and spleen, Not the same as chemical drugs, one Chinese herb may have many multiple therapeutic effects, such as Chinese yam (Shan yao) can tonifying kidney, lung and spleen. whether TKLS is beneficial for stable COPD and which aspect, was not clear.

Summary of evidence

In the present systematic review, a total of 1339 patients with stable COPD were selected and analyzed from 14 RCTs. It was found that, compared with CWM, TKLS combined with CWM significantly improved the clinical effectiveness; decreased TCM Syndrome Score and cough, sputum, and wheezing scores; decreased SGRQ; increased 6 mWD and FEV1%; increased CD4, CD8, and CD4/CD8; and increased IgA and IgM.

We did not find strong evidence to prove that TKLS was associated with any serious adverse events. However, five RCTs (including 540 participants) mentioned safety evaluation, whereas two RCTs (including 120 participants) reported adverse events associated with TCM. From this study, it was not possible to draw a firm conclusion about the safety of TKLS for stable COPD, but we found that adverse events such as stomach upset and stool frequency increased, which self-improved after stopping the consumption of herbs. In this review, TKLS combined with CWM improved the clinical effectiveness (MD 6.49%); decreased TCM Syndrome Score and cough, sputum, and wheezing scores; decreased SGRQ; increased 6 mWD (for FEV1%, MD was 6.49%); increased CD4, CD8, and CD4/CD8; and increased IgM; this result might indicate the potential of TKLS in improving the clinical effectiveness, symptoms, respiratory-specific quality of life, exercise capacity, and lung function. TKLS was found beneficial in treating low immune function of stable COPD.

Overall, this analysis revealed the clinical effectiveness and safety of the use of TKLS combined with CWM for stable COPD. According to the above analysis, the clinical effectiveness of TKLS was encouraging. We can give stable COPD TKLS according to TCM syndrome differentiation, and TKLS were beneficial for stable COPD.

Limitations

The methodologic quality of this review was poor. Although all the studies were randomized, no trials involved sequence generation. No trials reported allocation concealment. If patients and implementers were aware of the interventions, this meta-analysis would directly result in performance and detection biases. Five trials reported adverse events, and these adverse events were described briefly. Therefore, a definite conclusion about the safety of TKLS could not be obtained.


  Conclusions Top


For stable COPD, TKLS combined with CWM is superior to CWM alone with regard to clinical effectiveness, symptoms, and quality of life. The above conclusion needs to be validated by further well-designed, multicentric, large-scale, double-blinded RCTs.

Acknowledgments

This work is supported by the National Natural Science Foundation of China (no. 81760901).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
López-Campos JL, Tan W, Soriano JB. Global burden of COPD. Respirology 2016;21:14-23.  Back to cited text no. 1
    
2.
Chan KY, Li X, Chen W, Song P, Wong NWK, Poon AN, et al. Prevalence of chronic obstructive pulmonary disease (COPD) in China in 1990 and 2010. J Glob Health 2017;7:020704.  Back to cited text no. 2
    
3.
Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009;33:1165-85.  Back to cited text no. 3
    
4.
Stockley RA. Progression of chronic obstructive pulmonary disease: Impact of inflammation, comorbidities and therapeutic intervention. Curr Med Res Opin 2009;25:1235-45.  Back to cited text no. 4
    
5.
Burgel PR, Nesme-Meyer P, Chanez P, Caillaud D, Carré P, Perez T, et al. Cough and sputum production are associated with frequent exacerbations and hospitalizations in COPD subjects. Chest 2009;135:975-82.  Back to cited text no. 5
    
6.
Tian Y, Li Y, Li J, Feng S, Li S, Mao J, et al. Bufei yishen granules combined with acupoint sticking therapy suppress inflammation in chronic obstructive pulmonary disease rats: Via JNK/p38 signaling pathway. Evid Based Complement Alternat Med 2017;2017:1768243.  Back to cited text no. 6
    
7.
Tian Y, Li J, Li Y, Dong Y, Yao F, Mao J, et al. Effects of bufei yishen granules combined with acupoint sticking therapy on pulmonary surfactant proteins in chronic obstructive pulmonary disease rats. Biomed Res Int 2016;2016:8786235.  Back to cited text no. 7
    
8.
Haifeng W, Hailong Z, Jiansheng L, Xueqing Y, Suyun L, Bin L, et al. Effectiveness and safety of traditional Chinese medicine on stable chronic obstructive pulmonary disease: A systematic review and meta-analysis. Complement Ther Med 2015;23:603-11.  Back to cited text no. 8
    
9.
Zheng XY. Clinical Guideline of New Drugs for Traditional Chinese Medicine. Beijing: Medicine Science and Technology Press of China; 2002.  Back to cited text no. 9
    
10.
Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, et al. An official European Respiratory Society/American Thoracic Society Technical Standard: Field walking tests in chronic respiratory disease. Eur Respir J 2014;44:1428-46.  Back to cited text no. 10
    
11.
Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St. George's respiratory questionnaire. Am Rev Respir Dis 1992;145:1321-7.  Back to cited text no. 11
    
12.
Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available from: http://www.cochrane-handbook.org. [Last accessed on 2015 Nov 10].  Back to cited text no. 12
    
13.
Wang LY, Liu B, Zu Q, Zhang Y. Effect of Bufei Jianpi Yishen decoction on nutritional status immune function of chronic obstructive pulmonary disease at stable period. Chin J Exp Tradit Med Formulae 2017;23:182-7.  Back to cited text no. 13
    
14.
Song C. Clinical observation on Bufei Jianping Yishen decoction for treatment of COPD and mechanism study on regulating T lymphocyte immunologic function. Chengdu Univ Tradit Chin Med 2009:25-35.  Back to cited text no. 14
    
15.
Fan DB, Qin XP, Xu JZ, Bai HH, KS, Zeng YH, et al. Clinical observation on treating 90 cases of stable chronic obstructive pulmonary disease with Bufei Jianpi Yishen decoction combined with Western medicine. J Sichuan Tradit Chin Med 2012;30:83-5.  Back to cited text no. 15
    
16.
Yang L. Pulmonary disease asthma airway spasm of different diseases with the same method. Beijing Univ Chin Med 2013:108-56.  Back to cited text no. 16
    
17.
Liang AL. Effect of invigorating Pi (Spleen) and Shen (Kidney) and benefiting Fei (Lung) on quality of life in patients with stable chronic obstructive pulmonary disease. Beijing Univ Chin Med 2009:43-59.  Back to cited text no. 17
    
18.
Liang AW, Tan YP, Liang W, Nong TQ, Su QJ, Liu JY, et al. The effect of Runfei Jianpi Bushen decoction on symptoms of TCM and 6MWT of patients with stable chronic obstructive pulmonary disease. J Emerg Tradit Chin Med 2013;22:1125-7.  Back to cited text no. 18
    
19.
Liang AW, Wang YS, Nong TQ, Tan YP, Liu JY, Feng Y, et al. Effects of Runfei Jianpi Bushen recipe combined with inhaled hormone on quality of life in patients with very severe stable chronic obstructive pulmonary disease. J New Chin Med 2011;43:14-6.  Back to cited text no. 19
    
20.
Gong CY. 45 Cases of FeiPi Qi deficiency syndrome in stable COPD period treated by Bufei Jianpi Yishen decoction and Western medicine. Tradit Chin Med Res 2017;30:42-4.  Back to cited text no. 20
    
21.
Mei YW. Bufei Jianpi Yishen decoction combined with Western medicine in treating 64 cases of chronic obstructive pulmonary disease. Tradit Chin Med Res 2016;29:32-4.  Back to cited text no. 21
    
22.
Liu LJ. Clinical observation of Yifei Jianpi Bushen Recipe in treating stable chronic obstructive pulmonary disease. Shaanxi J Tradit Chin Med 2016,36:1458-9.  Back to cited text no. 22
    
23.
Mayinuer S, Wan Z, Alimu K, Hong J. Influence of Bufei Jianpi Yishen decoction on subgroup of T lymphocytes, BODE index and life quality of old COPD patients during stable period. J Hainan Med Univ 2015;21:920-2.  Back to cited text no. 23
    
24.
Ke GS. The effects of 'Yu Fei Ning' prescription on the level of serum IL-8 and TNF-α in patients with chronic obstructive pulmonary disease in stable phase. Fujian Univ Tradit Chin Med 2014:3-8.  Back to cited text no. 24
    
25.
Liang AW, Tan YP, Nong TQ, Yang YB, Feng Y, Su QJ, et al. Effect of Runfei Jianpi Bushen recipe on pulmonary function in patients with stable chronic obstructive pulmonary disease. Lishizhen Med Material Med Res 2014;25:110-2.  Back to cited text no. 25
    
26.
Hao SY, He M, Liang AL, Liu XR, Li Y, Wu ZR, et al. Clinical study of spleen-strengthening kidney-boosting lung-supplementing decoction in treatment of patients with chronic obstructive pulmonary disease (COPD) in relieving course. J Liaoning Univ Tradit Chin Med 2013;15:116-8.  Back to cited text no. 26
    
27.
Huang LM. The important of sputum, blood stasis and deficiency in traditional Chinese medicine disease differentiation of COPD. J Guiyang Coll Tradit Chin Med 2000;22:5-7.  Back to cited text no. 27
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Materials And Me...
Results
Conclusions
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed74    
    Printed4    
    Emailed0    
    PDF Downloaded22    
    Comments [Add]    

Recommend this journal