Literature Research On Wendan Decoction Based On Theoretical Framework Of Traditional Chinese Medicine Prescription And Data Mining

ObjectiveBased on the theoretical framework of TCM prescription,this study aimed to explore the source,rationale,inheritance and evolution of Wendan decoction by comprehensively sorting out and analyzing Wendan Decoction(hereinafter referred to as WD,WD I referred to WD created by Jiyan Fang or A Collection of Empirical Prescriptions and WD II referred to WD created by Sanyin Ji Yi Bingzheng Fang Lun or Treatise on Three Categories of Pathogenic Factors)from six aspects: indication,composition,compatibility,usage,efficacy and classification,based on the timeline of Chinese dynasties.At the same time,this study was also designed to find out the syndrome and treatment laws of modern clinical application of Wendan Decoction by using the Traditional Chinese Medicine Inheritance Computer System(TCMICS)and R language software to conduct data mining of modern medical records of Wendan Decoction.MethodsThe theoretical framework of TCM prescription: Based on documents of Wendan Decoction from the Traditional Chinese Medical Classics,Wendan Decoction was analyzed from six aspects: indication,composition,compatibility,usage,efficacy and classification.Data mining: By applying the Traditional Chinese Medicine Inheritance Computer System(TCMICS),we collected statistics on the diseases,symptoms,tongue or pulse manifestations and drug use from modern medical records of Wendan Decoction.With R language software,Apriori algorithm and hierarchical clustering algorithm were applied to conduct association analysis and cluster analysis on symptoms,tongue or pulse manifestations,and drug.The results were visualized through two packages,pheatmap and arules Viz.ResultsResults based on the theoretical framework of TCM prescription are as follows:1.Dispute has continued until now over the source of Wendan Decoction.WD was first recorded in Jiyan Fang during China’s Southern and Northern Dynasties(420-589).By creating WD II,Chen Wuze adjusted the composition and dosage of WD I.With indications expanded,WD II has become the commonly used WD in later generations.Nevertheless,the compatibility characteristics of WD II are all based on WD I,including the combined use of cold and warm or bitter and pungent drugs,and assisting the ascending of yang with pungent and warm natured drugs.Therefore,it is concluded that Wendan Decoction originated from Jiyan Fang.The creation of WD can be traced back to Banxia Shumi decoction in Huangdi Neijing(Inner Canon of Yellow Emperor),and Xiao Banxia decoction,Jüpi decoction,Shengjiang Banxia decoction and other prescription from Jingui Yaolüe(Synopsis of Golden Chamber).2.The indications of WD has experienced changes from gallbladder cold or deficiency to stagnation of qi and phlegm and phlegm-heat.Despite these changes,the fundamental pathogenesis always lies in the deficiency of gallbladder-qi in Shaoyang meridian and the failure of gallbladder-qi to rise and spring up,leading to qi stagnation and the generation of phlegm.On the basis of the fundamental pathogenesis,several heat syndrome patterns can occur,including heat transformed from phlegm stagnation,and phlegm disturbing the heart or the mind or blocking the spleen and the stomach.3.As for the drug composition of WD,most of the drugs are pungent and warm natured.Shengjiang(fresh ginger)and Banxia(pinellia tuber)are warm to dissipate phlegm.Chenpi(dried tangerine peel)and Zhishi(immature orange fruit)are pungent to regulate qi-flowing for activating stagnancy.Zhuru(bamboo shavings),sweet and slightly cold,is able to clear heat and dissipate phlegm.Gancao(liquorice root)strengthens spleen,supplement qi,and harmonize all drugs.WD II added Fuling(Indian bread)to promote diuresis,diffuse dampness,and tranquillize,and added Dazao(Chinese date)to harmonize spleen and stomach together with fresh ginger.4.Two patterns of compatibility are included in WD,mutually reinforcing between Chinese herbs with similar or same natures or herbs with opposite natures.5.In ancient literatures,the formulations of Wendan Decoction were mostly decoctions,and boiled powder were popular in the Song Dynasty.The removal and dosage of fresh ginger cannot be ignored.High dose of fresh ginger is used in WD I.Although the dose of fresh ginger is reduced in WD II,the formulation of WD II is boiled powder,which means that the dosage of other drugs has also been reduced.Therefore,the proportion of fresh ginger in WD I is not significantly less than that in WD II.6.Controversy over the efficacy of Wendan Decoction has always been whether it can warm gallbladder cold or clear gallbladder heat.It is concluded in the study that the most important efficacy of both WD I and WD II is warming gallbladder cold,which means regulating qi flowing so as to restore the temperateness and the rising nature of gallbladder qi.Some physicians in later generations believed that the efficacy of WD is to clear gallbladder-heat or phlegm-heat.The reason supporting this opinion is that bamboo shavings and immature orange fruit,both clod in nature,are used in WD.Based on this study,WD is able to treat both manifestation by clearing phlegm-heat and root cause of disease by regulating qi-flowing and dissipate phlegm.Based on the addition and removal of drugs in the modified prescriptions of WD,the main effect of WD is activating qi flowing with pungent and warm natured drugs.The purpose of adding or drugs is to enhance the original effect or increase other effects.For example,Suanzao Ren(spine date seed)can be added to strengthen tranquilization.7.Before the Ming and Qing dynasties,Wendan Decoction was mostly by indicated diseases.From the book Yifang Jijie(Collected Exegesis of Prescriptions)in the Qing Dynasty,physicians started to classify WD according to its efficacy.Results from data mining are listed as following:1.The indications of WD cover internal medicine,gynecology,pediatrics,dermatology,ENT,etc.In internal medicine,WD is frequently used to treat diseased related to the heart,brain,spleen,stomach,qi,blood and body fluid.Common diseases include insomnia,dizziness,palpitation,chest pain,stomachache,and depression.2.The most frequently used drugs in Wendan Decoction are pinellia tuber,bamboo shavings,dried tangerine peel,Indian bread,liquorice root,and immature orange fruit,while fresh ginger and Chinese date are less frequently used.Among all medical records of Wendan Decoction,cold natured herbs are most frequently used by a majority of prescriptions,followed by warm herbs.3.In Wendan Decoction,pinellia tuber,dried tangerine peel,immature orange fruit and Indian bread are often replaced by other similar herbs.4.Differences in drug doses of WD were mainly reflected in the highest doses of pinellia tuber,Indian bread,bamboo shavings and immature orange fruit.5.Cluster analysis was performed on 4 highly frequent diseases of insomnia,dizziness,palpitation,and depression.It was found that the most commonly used drugs in WD medical records were pinellia tuber,bamboo shavings,dried tangerine peel,Indian bread,liquorice root,immature orange fruit,and huanglian(Rhizoma Coptidis).Commonly seen symptoms include insomnia,dreaminess,dizziness,palpitation,dizziness,anxiety,sorrow,anorexia,and chest tightness.Common tongue manifestations are red tongue,yellow coating,greasy coating,and common pulse manifestations include slippery,wiry,and rapid pulse.6.The results of the association analysis of high-frequency diseases showed that the added drugs with high support and confidence included baizhu(largehead atractylodes rhizome),danshen(Radix Salviae Miltiorrhizae),yujin(turmeric root tuber),huanglian(Rhizoma Coptidis),huangqin(baical skullcap root),suanzaoren(spine date seed),and yuanzhi(milkwort root).ConclusionThe source of WD is Jiyan Fang and its creation is based on prescriptions from Inner Canon of Yellow Emperor and Synopsis of Golden Chamber.The fundamental pathogenesis of WD is qi and phlegm stagnation and WD is frequently expanded to treat phlegm-heat or dampness-heat syndromes.The compatibility of WD is characterized by the combined use of cold and warm natured drugs.Modification of drug composition and can be made for the treatment of heat syndromes.The efficacy of WD focuses on regulating qi and resolving phlegm,as well as harmonizing gallbladder and stomach.The ultimate goal is to restore the physiological characteristics of gallbladder qi rising and springing up.In modern clinical practice,fresh ginger and Chinese date are mostly removed and other drugs are often added to expand the indications of WD.Most of them are heatclearing drugs and tranquilizers.Therefore,Wendan Decoction is often used to treat phlegm-heat disturbing the mind in heart and brain diseases.With the help of data mining technology,clustering and association analysis of Wendan Decoction symptoms and drugs can be conducted to find the regularity between the symptoms and the addition and removal of drugs.