Clinical Study Of Treatment Combined With Self-Made Concha Margaritifera Daotan Decoction For Schizophrenia With Phlegm And Qi Stagnation

Objective To explore the application of traditional Chinese medicine prescriptions in psychiatry with self-made concha margaritifera daotan decoction.There is no ideal treatment for schizophrenia at present.To provide a better treatment for schizophrenia patients.(1)To observe the clinical effect of self-made concha margaritifera daotan decoction combined with SGAs in the treatment of schizophrenia with phlegm and Qi stagnation,and to analyze the compatibility of self-made concha margaritifera daotan decoction.(2)Network pharmacology-based research theories and approaches.To explore the material basis and molecular mechanism of self-made concha margaritifera daotan decoction in the treatment of schizophrenia by combing the chemical compositions of various medicines contained in self-made decoction,targets for chemical compositions and the interaction between schizophrenia-related pathogenic genes.Methods(1)In the randomized controlled study,80 patients of schizophrenic with the pattern of phlegm-qi stagnation syndrome hospitalized from August2017 to February 2019 were selected.The latest admission time was September 2018.According to different categories of traditional Chinese medicine(TCM)and Western medicine practice of doctors-in-charge of the patients,patients were divided into observation group with practicing physicians trained in TCM(n = 40)and control group with practicing physicians trained in Western medicine(n = 40).The patients were hospitalized in the same ward for observation.Patients in the observation group were given TCM prescription-self-made concha margaritifera daotan decoction combined with SGAs orally,while patients in the control group were given SGAs orally.The admission time of the patients was different,but all patients were hospitalized for observation and treatment for 20 weeks or above.Criteria for schizophrenia diagnosis and treatment based on the authoritative International Classification of Diseases,10 th Edition(ICD-10),Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in TCM ZY/T001.1-94 and the BPRS,an internationally recognized and commonly used schizophrenia symptom assessment tool,were adopted.Changes in treatment effects on clinical symptoms,BPRS scores and levels of four items of blood fat test before and after treatment were compared.Relevant data were collected,and the statistical analysis was carried out using IBM SPSS Statistics 22 software.Compatibility analysis of self-made concha margaritifera daotan decoction was conducted with TCM theory.(2)The online database systems,including TCMSP,Pub Chem,etc.were searched comprehensively to collect chemical compositions corresponding to 10 herbs of self-made concha margaritifera daotan decoction,the corresponding targets were identified by using the effective chemical compositions,and a multi-composition-multi-target network was constructed to screen out key targets.Schizophrenia was used as a key word for retrieval in OMIM and CTD databases,genetic data with higher scores associated with schizophrenia were collected.Using the Cytoscape3.2.1 software to map the disease genes and target genes of component interaction.The key target of self-made concha margaritifera daotan decoction-schizophrenia was obtained.Results(1)Comparison in effective rates of TCM syndromes: the effective rates of TCM syndromes were compared between the observation group and the control group after 20 weeks of treatment,and the effective rate of TCM syndromes in observation group was significantly higher than that in control group,and the difference was statistically significant(90% vs.72.5%,p <0.05).Comparison in total scores of BPRS: the total scores of BPRS after 20 weeks of treatment in the observation group(28.54±5.758 vs.35.21±5.718,p<0.05)and the control group(30.79±5.639 vs.35.13±5.832,p<0.05)were significantly lower than those before treatment,with statistical significance.However,the total score of BPRS in the observation group was significantly lower than that in the control group,suggesting that the treatment effect in the observation group was superior to that in the control group.Comparison in BPRS scores: after 20 weeks of treatment,the BPRS score of the two groups was compared.Regarding "hostility" index score,the range of changes in the observation group was similar to that in the control group.Regarding four index scores of "anxiety and depression","lack of vitality","thinking disorder" and "activation",the ranges of changes in the observation group were better than those in the control group,and the differences were statistically significant(all p<0.05).Comparisons in the levels of four items in blood fat test: the levels of TC,TG,HDL-C and HDL-C of the two groups were compared before and after treatment.There was no significant difference in the levels of TC,TG,HDL-C and HDL-C between the two groups before treatment(p > 0.05),which was comparable.TG level in the observation group was improved significantly after treatment,with significant difference(p<0.05),indicating that concha margaritifera daotan decoction may have the effect of improving blood lipid function.(2)The concha margaritifera daotan decoction contains 10 Chinese herbal medicines,such as concha margaritifera,radix glycyrrhizae,pericarpium citri reticulatae,poria,rhizoma pinelliae preparatum,etc.520 chemical compositions were collected with capabilities of acting on 8257 targets,including 653 different types of target points: TNF,inflammatory cytokines(IL6,IL13,IL8 and IL2),DA receptor,5-HT 2A receptor,glutamic acid receptor,etc.The composition-target network was analyzed,with the degree value more than 30 as the screening condition.Key targets were obtained.A total of 98 related target genes were obtained by mapping of composition targets and pathogenic genes.Conclusions(1)The self-made concha margaritifera daotan decoction combined with SGAs is effective in the treatment of schizophrenia,with capabilities of increasing the change range of BPRS score,alleviating clinical symptoms,improving clinical symptoms and alleviating abnormal lipid metabolism.(2)The results of network pharmacology research are basically consistent with contents of Literature study.The D2 dopamine receptor antagonist is the most common therapeutic drug target for schizophrenia at present,followed by 5-HT2 receptor antagonist,sodium channel(SLC6A4),adrenergic receptor,GABA receptor,NMDA receptor and other key targets for the treatment of schizophrenia.In the study,the effective chemical compositions of concha margaritifera daotan decoction were selected as the material basis to clarify that the decoction have the effect of treating schizophrenia by acting on the corresponding target pathways,thus providing the basis for further pharmacodynamic experiment study.(3)At present,there are no recognized indicators of organ,cell,molecule and gene levels in the diagnosis and evaluation of schizophrenia.In the study,no specific changes in objective indicators of schizophrenia were found in various test reports except BPRS scale.