Revealing The Law Of Syndromes Of Kidney Deficiency And Phlegm Stasis Of The Senescent Forgetfulness By The Means Of Clinical Epidemiology And Metabonomics

Objectives:Senile cognitive dysfunction is becoming a major issue that needs resolutionunder the condition of the increasing ageing population. It is of great benefitfor this tough issue using methods under traditional Chinese medical theory onprevention for senescent forgetfulness, because of the similarity of mildcognitive impairment (MCI) and dementia to senescent forgetfulness andidiocy, as the famous saying goes,“superior doctors treat disease before itsonset”. Traditional Chinese Medicine (TCM) treats diseases with theframework of Bian Zheng Lun Zhi (diagnosis and treatment according to thesyndrome differentiation), thus the syndromes are the one of the importantbasis for evaluating the treatment scheme or the therapeutic effect of newdrugs. The method of tonifying kidney and removing phlegm to benefitintelligence is considered effective in treating senile cognitive impairment,whcih aims at the syndrome of kidney deficiency and phlegm stasis. Thisstudy was conducted for revealing the law of the syndrome of kidneydeficiency and phlegm stasis, such as the law of clinical manifestation andquantitative assessment, via searching literatures, means of clinicalepidemiology and metabonomics. Methods:1Theoretical exploration.Working out the origin and realistic basis of the method of tonifying kidneyand removing phlegm to benefit intelligence to summarize through literaturereview the etiology and pathology of senescent forgetfulness, its treatmentformulae and syndrome differentiation for the law of senescent forgetfulness.2Epidemiological investigation.315cases matching the syndrome of kidney deficiency and phlegm syndromefrom the epidemiological investigation on senescent forgetfulness patientswith phlegm syndrome were involved for clustering analysis and frequencystatistics, using SPSS16.0software.3Empty-stomach blood sample from32cases of senescent forgetfulnesspatients with the syndrome of kidney deficiency and phlegm stasis and30healthy elderly volunteers selected from Wuhan Chinese and WesternMedicine Hospital and Hubei Hospital of Traditional Chinese Medicine weredetected using Waters SYNAPT G2-S QTOF liquid chromatograph-massspectrometer (US) for metabonomical analysis.Results:1Epidemiology1.1The clustering analysis together with the frequency distribution on the datafrom the315patients indicated the following3types of symptoms. Type onecontains fatigue, lack of energy, teeth-printed tongue, dyspepsia, weak pulse,spontaneous sweating, greasy coating on the tongue, forgetfulness, sore waist,lumbar and knee strengthlessness, heaviness of limbs, alopecia, gomphiasis,sluggish looking, heaviness of head. Major symptoms in type two includes:white and smooth tongue coating, deep and slow pulse, cold sensation oflimbs and chillness, edema in face and feet, loose stool, clear abundant urine,frequent nocturia, taut pulse, drowsiness, enlarged tongue, uroclepsia, fat body, curdy fur, snooze and gurgling with sputum. The third type symptoms aredysphoria in chestpalms-soles, thready and rapid pulse, thirsty and dry throat,red tongue with little coating, scanty dark urine, night sweat, dry stool,insomnia, expectoration and dirty looking face. Type one in TCM refers tokidney qi deficiency and phlegm stasis. Type two refers to kidney yangdeficiency and phlegm stasis. Type three refers to kidney ying deficiency andphlegm stasis.1.2Proportion of syndrome of315patients. Kidney qi deficiency and phlegmstasis syndrome took up38.41%, and the kidney yang deficiency and phlegmstasis syndrome30.03%, the kidney ying deficiency and phlegm stasissyndrome35.56%.1.3The one-way analysis of variance showed that group of kidney qideficiency and phlegm stasis syndrome was significantly different with kidneyyang deficiency and phlegm stasis syndrome group and the kidney yingdeficiency and phlegm stasis syndrome group, P<0.05. The group of kidneyyang deficiency and phlegm stasis syndrome was observed insignificantlydifference with the group of kidney ying deficiency and phlegm stasissyndrome, P>0.05. This outcome indicates that type one may be transformedinto type two or three with the increase of age or the aggravation of disease.The coexistence of the three types is also possible.2Plasma metabonomics outcomes showed obvious elevated (P<0.05, P<0.01)in the following indices, as compared with healthy elderly contrast:lysophosphatide (16:0), pentaglucose,11,18,21β-trihydroxy-4-olefince-3,20-diketone18-Hydroxycorticosterone. And the following were seenobviously declined (P<0.05, P<0.01): phosphatidyl ethanolaminePE(22:2(13Z,16Z)/15:0), cystathionine L-Cystathionine, glyceryl phosphatidePE(O-18:1(1Z)/20:4(5Z,8Z,11Z,14Z),phosphatidylcholinePC(20:1(11Z)/14:1(9Z). The above results indicate that, when compared with healthy elderly contrast,patient groups underwent multiple changes to their metabolic pathways.Disorder occurred in lipid and energy metabolism.Conclusions:1Kidney deficiency and phlegm turbid interact with and closely related toeach other in senescent forgetfulness. Doctors in Ming and Qing dynasties arethe most skilled practitioners on the treatment for this disease. Tonifyingkidney and removing phlegm are their major treatment method.2The kidney deficiency and phlegm stasis syndrome can be further dividedinto three syndromes: kidney qi deficiency and phlegm stasis, kidney yangdeficiency and phlegm stasis, kidney ying deficiency and phlegm stasis.3This study indicates that the kidney qi deficiency and phlegm stasissyndrome takes the major proportion and is relevant to the three subtypes:patients of kidney qi deficiency and phlegm stasis syndrome are relativelyyoung olds. Theory of deficiency of primordial qi is of great theoretical valuein the exploration of senile cognitive impairment.4Kidney qi deficiency and phlegm stasis syndrome senescent forgetfulnesspatients were different from healthy contrast in plasma metabonomics. Kidneyfunction declined in the group of forgetfulness, together with lipid metabolicdisorder. Markers were observed in syndrome groups.5It is closer to the real clinical condition of the compound syndromes ofsenescent forgetfulness. The literature, epidemiological investigation andmetabonomical analysis facilitate revealing the law and essence of thesyndromes.