Clinical Study Of Guyuan Yizhi Decoction(Deficiency Of Yuanjing And Stasis Of Phlegm)in The Treatment Of Vascular Cognitive Impairment No Dementia

Objective:To evaluate the clinical efficacy of Guyuan Yizhi Decoction in the treatment of non-dementia-type vascular cognitive impairment of Yuanjing D eficiency and its possible mechanismMethods:Using a random number table method,70 patients who met the i nclusion criteria of this trial were completely randomized into a control group and an observation group,with 35 patients in each group.The control group re ceived oral donepezil hydrochloride tablets and the basic treatment of cerebrova scular disease.The observation group was given the traditional Chinese medicin e decoction solid Guyuan Yizhi Decoction on the basis of the control group.T he course of treatment was 8 weeks.Observed Scale for differentiation of synd rome in vascular dementia（SDSVD）,Mini-Mental State Examination（MMSE）s core,The Montreal Cognitive Assessment（Mo CA）score,Activity of Daily Livi ng（ADL）score,and Serum homocysteine（Hcy）content before and after treat ment.Clinical evaluation of SDSVD and Mo CA scales.Results:（1）During the clinical observation period,there were 3 cases in the control group and the observation group,and 64 cases were finally completed,32cases in the control group and 32 cases in the observation group.Baseline data before treatment,age,gender,education,past history score,hypertension,hyperlipidemia,myocardial infarction,atrial fibrillation,diabetes,cerebral infarction（key site,multiple）,cerebral small vessel disease,The cerebral hemorrhage,smoking,drinking,TCM syndrome score,MMSE score,Mo CA score,ADL score,Hcy content were statistically analyzed.The results showed no significant difference（P>0.05）,which was comparable.（2）Comparison of SDSVD scores between the two groups:Compared with before treatment,the scores of TCM syndromes in the two groups decreased,but the difference between the two groups was significantly higher than that in the control group,the difference was significant（P<0.001）,indicating that Guyuan Yi Zhi Decoction is better than the control group in improving the clinical symptoms of TCM.（3）Comparison of MMSE scores between the two groups:Compared with before treatment,the MMSE scores of the two groups were improved compared with those before treatment,but the increase of MMSE scores in the observation group was significantly higher than that of the control group（P<0.001）.Guyuan Yizhi Decoction is superior to the control group in improving cognitive function.（4）Comparison of Mo CA scores between the two groups:Compared with before treatment,the Mo CA scores of the two groups were improved compared with those before treatment,but the increase of Mo CA scores in the observation group compared with the control group was significantly higher than that of the control group（P=0.025<0.05）,It shows that Guyuan Yizhi Decoction is better than the control group in improving cognitive function.Furthermore,the scores of Mo CA sub-items after treatment were compared.The results showed that the observation group improved significantly in terms of visual space and execution ability,attention and delayed recall.The difference was significant(P_{Visual space and execution ability}=0.024<0.05,P _Attention=0.037<0.05,P _{Delayed recall}=0.010<0.05),and there was no significant difference in naming,abstraction,language,and orientation improvement(P_Name=0.089>0.05,P_Abstract=1.000>0.05,P_Language=1.000>0.05,P_{Orientation force}=0.732>0.05),indicating that the observation group improved better than the control group in the three areas of visual space and execution ability,attention,and delayed recall,suggesting that Guyuan Yizhi Decoction has heterogeneity in improving cognitive function,or may be the treatment is short.（5）Comparison of ADL scores between the two groups:After treatment,compared with before treatment,the ADL scores of the two groups decreased,but the observation group was superior to the control group,the difference was significant（P=0.011<0.05）,suggesting that the solid element puzzle The soup is better than the control group in improving the ability of daily living.（6）The serum Hcy content of the two groups was compared:the serum Hcy content of the two groups was lower after treatment and the two groups were better than the control group,the difference was significant（P=0.039<0.05）,suggesting the solid element.Guyuan Yizhi Decoction has an effect on the improvement of serum Hcy index.（7）Efficacy evaluation of TCM syndrome scores in the two groups:the clinical efficacy of TCM syndrome scores in the two groups.The total effective rate of the two groups was compared by x²test,P<0.05（x²=5.741,P=0.017）.The efficacy grades of clinical TCM syndromes in the two groups were compared by Mann-Whitney U rank sum test,P<0.05（Z=-2.538,P=0.011）,suggesting that the observation group was superior to the control group,the difference was significant,indicating that Guyuan Yizhi Decoction improved Chinese medicine.The clinical symptoms were better than the control group.（8）The efficacy scores of the two groups were evaluated by the Mo CA scores.The total effective rate of the two groups was compared by x²test,P<0.05（x²=5.333,P=0.021）.The clinical Mo CA scores of the two groups were compared by Mann-Whitney U rank sum test,P<0.05（Z=-2.373,P=0.018）,suggesting that the observation group was superior to the control group,the difference was significant,indicating that Guyuan Yizhi Decoction improved cognitive function.The effect is better than the control group.Conclusion:（1）Guyuan Yizhi Decoction is used to treat patients with VCIND who are deficient in phlegm and blood stasis,which can significantly improve the cognitive function of VCIND patients,the clinical symptoms of Chinese medicine and the ability to improve independent daily life.（2）The modern mechanism of Guyuan Yizhi Decoction for the treatment of VCIND may be partially related to anti-Hcy.（3）The clinical application of Guyuan Yizhi Decoction was safe and no obvious adverse reactions were observed.