Case Analysis Of Nervous System-related Rheumatic Diseases And Literature Mining Of The Diagnosis And Treatment Rules Of "wind-toxin Beriberi"

Background:In the theory of traditional Chinese medicine(TCM),"wind diseases" have a broad connotation,involving diseases of limbs,orifices,zang-fu viscera,or consciousness."Wind diseases" include series of diseases such as hemiplegia,Fengfei,Fengyi,Feng-Du jiaoqi,wind diseases of the head and face,spasms,psychosis,arthralgia and etc."Wind diseases" usually involve nervous system diseases.However,due to the lack of clear definition,syndrome elements and diagnostic criteria of "wind diseases",it’s hard for the theory of wind diseases to guide clinical practice.Feng-Du jiaoqi which is one of the main branches of "wind diseases",refers to a category of diseases with sudden paralysis as its main feature.It is an important theory for the treatment of flaccidity syndrome in Jin and Tang Dynasties,advocating that flaccidity syndrome should be treated by "wind prescription" such as XuMing decoction.Although some doctors have proved the effectiveness of this method clinically from the point of view of Fengfei,it is still the mainstream understanding that flaccidity syndrome cannot use wind medicine due to the influence of doctors in the Jin and Yuan dynasties.There are still many gaps in the differentiation and treatment system of Feng-Du jiaoqi to be explored and clarified.Objective:To explore the clinical features,clinical syndromes and possible diagnosis points of nervous-system-related "wind diseases",and to summarize the rules of "wind medicines" in the treatment of nervous system diseases.On the basis of the above research,to summarize the symptom complex and diagnostic criteria of Feng-Du jiaoqi,as well as the medication rules for the treatment of this disease in Jin and Tang Dynasties,providing a new idea for the treatment of flaccidity syndrome by TCM.Methods:The research is divided into two parts.1.Case Series of Nervous-System-Related Wind Diseases:Patients who were empirically diagnosed as "wind diseases" by clinicians and used the corresponding "wind prescription" were included.In this study,patients were all diagnosed with neurological disease.Patient general condition,diagnosis,auxiliary examination,medical records,tongue and pulse information before and after treatment were prospectively recorded,by which clinical features,clinical syndrome,characteristics of tongue and pulse,possible diagnosis points of "wind diseases",the medication rules for the treatment were concluded.2.Study on the Diagnosis and Treatment of Feng-Du Jiaoqi Based on Data Mining of TCM Classic:Unified the names of symptoms or medicine of Feng-Du jiaoqi recorded in Essential Recipes for Emergent Use Worth a Thousand Gold and Medical Secrets from the Royal Library,and then inputed the symptoms and medicine one by one into Excel.If a certain symptom or medicine exists,it was marked as "TRUE",otherwise,it was marked as"FALSE".The obtained data were inputed into Clementine 12.0.The minimum conditional support was>10.0%,the minimum rule confidence was≥60.0%,and the maximum preceding items were 1-3.The Apriori correlation analysis was conducted on the data,and the network diagram was constructed at the same time,by which core symptoms,common accompanying symptoms,diagnosis points,medication rules for the treatment were concluded.Results:1."Wind diseases" may involve a variety of neurological diseases,including at least neurovascular disease,infectious or inflammatory neuropathy,neurodemyelinating disease,neurodegenerative disease,neuromuscular junction disease,spinal cord trauma,spinal cord occupying,etc.2.The nervous-system-related symptoms of the "wind diseases" include hemiplegia,weakness of limbs,walking instability,lower extremity weakness,alalia,choke,facial paralysis,tongue paralysis,vertigo,ataxia,hypoesthesia,cognitive decline,motor aphasia,sensory aphasia,drowsiness,trance,limb pain,numbness,depression,etc.The symptoms above can be improved after the use of correct "wind medicine" and "wind prescription".In this study,the ratio of accompanying symptom of Yang to those of Yin is about 1.44:1.Some patients are accompanied by exogenous symptoms,while some are not.3.The tongue patterns and pulse conditions of "wind diseases" are diverse and lack obvious characteristic.The frequencise of different tongue body are as follows:pale tongue(1),light red tongue(12),red tongue(2),dark red tongue(3);The frequency of different tongue coating is as follows:white(16),yellow(3),thin(11),thick(8),greasy(3),slippery(1),dry(3)." Wind diseases" refers to two types of pulse,namely,Yin and Yang.The pulse of Yang includes floating pulse(9),rapid pulse(7),slippery pulse(9),large pulse(2)and excess pulse(1),accounting for about 47%.The pulse of Yin includes deep pulse(2),slow pulse(11),hesitant pulse(3),thready pulse(2),weak pulse(2),faint pulse(1),wiry pulse(9),tight pulse(1),hard pulse(1),accounting for about 53%,which means that pulse of "wind diseases" is not only floating pulse.4.Among the symptoms of Feng-Du jiaoqi,paralysis and body pain have highest frequency of 78%and 70%.The symptoms with relatively high frequency are:spasm(22%),hypaesthesia(22%),polypnea(20%),edema(19%),nausea(17%),zonesthesia(13%),fever(13%),etc.Symptoms including paralysis,body pain,spasm,hypaesthesia,edema,polypnea often appear in combination.5.The medicines with relatively high frequency used in Feng-Du jiaoqi include ramulus cinnamomi(59),poria cocos(50),saposhnicovia divaricata(45),ginger(43),licorice(48),angelica pubescens(34),aconite seed(33),almond(30),ginseng(32),atractylodes macrocephala(3 7),angelica sinensis(36),ligusticum chuanxiong(3 0),ephedra(27),as arum(29),gentiana macrophylla(22),dried ginger(28),peony(23),orange peel(24).Commonly used medicines can be roughly divided into following groups including dispelling wind group,clearing heat group,tonifying qi and invigorating spleen group,nourishing blood and promoting blood circulation group,tonifying liver and kidney group,reducing qi and regulating qi group,water-disinhibiting and damp-percolating group,etc.Conclusions:1.A variety of nervous-system-related symptoms or syndrome groups often highly indicate the diagnosis of "wind diseases" which can be treated with "wind prescriptions" such as XuMing decoction or Hou’s black powder under the guidance of the theory of Yin and Yang.Clinical characteristics with sudden or acute onset suggest the diagnosis of "wind diseases".Because "wind diseases" overlaps with nervous system diseases,medical imaging examination and laboratory examination are of certain value in helping to further clarify the diagnosis of "wind diseases".Due to the lack of specificity,accompanied symptoms,tongue and pulse are generally not considered as the main points of diagnosis of "wind disease".Accompanied symptoms,tongue and pulse play a role when it comes to making prescription.2.In terms of diagnosis of Feng-Du jiaoqi,sudden weakness of lower limbs is the specific symptom of the diagnosis of the disease.If accompanied by body pain,spasm,hypaesthesia,edema,zonesthesia,or even polypnea,it further supports the diagnosis of this disease.Some modern medical diseases overlap with the concept of Feng-du jiaoqi and suggest the diagnosis of Feng-du jiaoqi.In summary,the characteristics of acute onset,the syndrome of Feng-du Jiaoqi,and diagnosis of some specific modern medical diseases are the three key points in the diagnosis of Feng-du jiaoqi.On the basis of clear diagnosis of Feng-Du jiaoqi,we can choose to use the prescriptions in Essential Recipes for Emergent Use Worth a Thousand Gold and Medical Secrets from the Royal Library for treatment.The methods for Feng-Du jiaoqi treatment include expelling wind and clearing away heat and toxin,nourishing blood,activating blood,invigorating qi and tonifying kidney.