Identification Of The Distribution Characteristics Of Traditional Chinese Medicine Syndrome Elements Of Ulcerative Colitis And The Medication Pattern By Professor Wei Wei

Objectives:Ulcerative colitis(UC)is characterized by long-term and recurrent episodes,and the Traditional Chinese Medicine(TCM)evidence-based treatment and chronic disease management model have certain advantages and development potential for it.In this study,the clinical and TCM syndrome elements information of patients with UC was collected and summarized by cross-sectional survey based on the holistic concept of TCM basic theory and evidence-based research viewpoint of therapy with syndrome differentiation.Patients were then divided into groups according to clinical characteristics,and the differences in the distribution of syndrome elements between different groups were compared.We also collected patient prescription data to excavate the medication pattern of clinical diagnosis and treatment of UC by Professor Wei Wei,a QIHUANG scholar.In addition to further summarizing the distribution characteristics of TCM syndrome elements in UC and passing on the clinical experience of famous TCM doctor,we aimed to provide reference for TCM evidence-based treatment and personalized chronic disease management of UC patients.Methods:The published literature explicitly mentioned the TCM clinical symptoms or syndromes of UC were searched in CNKI,Wanfang,and VIP databases,and relevant references were manually reviewed and supplemented.Under the guidance of TCM Syndrome Elements Identification and Criteria for Diagnosis and Efficacy of Chinese Medical Evidence,the results of the literature search and clinical experience were integrated to extract and summarize the information about the TCM symptoms,syndromes and syndrome elements of UC,and the Clinical and TCM syndrome elements information collection list for patients with UC was then developed.A total of 128 patients with UC who visited the outpatient and inpatient departments of the Department of Gastroenterology,Wangjing Hospital,China Academy of Chinese Medical Sciences between December 2020 and December 2022 were collected,and the questionnaires were organized and completed by uniformly trained investigators.The clinical information collected was transformed into TCM syndrome elements information according to the methods and criteria mentioned in TCM Syndrome Elements Identification,and the distribution of common TCM syndrome elements in UC patients was derived,as well as clustering of TCM syndrome types.The differences in the distribution of syndrome elements between patients with different clinical characteristics were also compared and summarized by multi-dimensional grouping according to gender,age,body mass index(BMI),disease duration,disease stage,and lesion extent.The prescription data of patients were also collected,from which the medication pattern was summarized,and cluster analysis and association analysis of high-frequency drugs were performed.Results:1.A total of 128 patients with UC who met the requirements were included in this study,including 66 males and 62 females,with a male-to-female ratio of about 1.06:1.The age range was 20-72 years old,with a mean age of 46.21 years old.The mean BMI was 22.04 kg/m2.The mean disease duration was 59.49 months.The disease extent was mainly E3(extensive colon),accounting for 50.00%.There were 22 patients had extra-intestinal manifestations,including 10 involved in joints,8 in skin,3 in eyes and 1 in hepatobiliary system.There were 24 patients had a history of smoking and 14 had a history of alcohol consumption.There were 2 patients had a family history of inflammatory bowel disease,and 2 had a family history of colorectal cancer.A total of 425 prescriptions of 128 patients were recorded,involving 57 kinds of Chinese herbs,and the cumulative frequency of occurrence of all herbs was 5836 times.2.According to the first part of the questionnaire,Causes(i.e.factors that trigger or aggravate UC),careless diet,emotional disorders and activity or exertion were the top three frequently occurring factors of UC.In comparison with previous studies,we found that the influence of emotional disorders on the onset of the disease increased.3.The statistical analysis of the collected syndrome elements showed that there were 18 location syndrome elements and 32 nature syndrome elements among 128 UC patients.The common syndrome elements was determined by the percentage of patients number greater than or equal to 50%.The 6 common location syndrome elements in this study were spleen,liver,stomach,large intestine,small intestine,and kidney in descending order of frequency.And the 11 common nature syndrome elements were dampness,qi stagnation,qi deficiency,yang deficiency,blood deficiency,blood stasis,Yin deficiency,phlegm,cold,food stagnation and heat in turn.There were four main types of TCM syndrome types in patients:liver and stomach qi stagnation,yang and qi deficiency of spleen,yin deficiency of kidney,and intestinal stagnation.4.Comparing the study population by gender groups,the common location syndrome elements of male UC patients were spleen,liver,large intestine,etc.,the nature syndrome elements were dampness,qi stagnation,qi deficiency,etc.In female UC patients,the common location syndrome elements were spleen,liver and stomach,etc.,and the common nature syndrome elements were qi deficiency,yang deficiency,dampness and so on.The results showed that there were differences in the distribution of syndrome elements of heat,blood stasis and cold in UC patients by gender(P<0.05).According to the criteria of young people(age≤44 years),middle age(age 45-59 years),elderly(age≥60 years),the UC patients included in this study were divided into three groups:youth(67),middle-aged(36),and elderly(25)for further comparison.The results showed differences in the syndrome elements distribution of small intestine,stomach,kidney,and lung in different age groups of UC patients(P<0.05).According to the criteria of underweight(BMI<18.5),normal weight(18.5≤BMI<24),overweight(24≤BMI<28)and obese(BMI≥28),the UC patients included in this study were divided into three groups:thin(16),normal(80),overweight and obese(5)for further comparison.The results showed that the syndrome elements distribution of blood stasis,blood deficiency,phlegm and yin deficiency differed among the UC patients with different BMI(P<0.05).The patients with UC included in this study were divided into three groups according to the disease duration:0-5 years(82),6-10 years(29),and more than 10 years(17)for further comparison.The results showed that there were differences in the location syndrome elements distribution of kidney(P<0.05)and the nature syndrome elements distribution of qi trap and external wind(P<0.05)among the UC patients with different disease duration.According to the stage of disease,the patients with UC included in the study were divided into four groups:remission(28),active-mild(66),active-moderate(30)and active-severe(4)for further comparison.The results showed that there were differences in the location syndrome elements distribution of large intestine(P<0.05)and the nature syndrome elements distribution of blood deficiency,qi trapping,toxicity and blood stirring(P<0.05)among the UC patients with different disease stages.According to the lesion extent,the UC patients included in the study were divided into three groups:E1(28),E2(36)and E3(64)for further comparison.The results showed no statistically significance in the distribution of syndrome elements in the UC patients with different lesion ranges(P>0.05).5.In this study,there were 30 high-frequency herbs used by Professor Wei Wei in clinical diagnosis and treatment of UC,with a cumulative frequency of 4726 times,accounting for 80.98%of the total frequency of all drugs.The medicinal properties of the high-frequency herbs were mainly warm,flat and cold,the taste of the herbs were mainly bitter,pungent and sweet,and the normalization channels were mainly spleen,stomach,liver and large intestine,covering the common location syndrome elements.In addition,efficacy of these herbs covered the corresponding effects against the common nature syndrome elements.The top 15 herbs in terms of frequency were:fried macrocephalae rhizoma,fried rhizoma atractylodis,booor’s mustard herb,dark plum fruit,heterophylly falsestarwort root,milkvetch root,fried white paeony root,curcumae radix,psoraleae fructus,nutmeg,fructus schisandrae chinensis,coptis root,pinellia tuber,milkvetch root,tetradium ruticarpum.Three major clusters were obtained after cluster analysis of the 30 high-frequency herbs,including a cluster with Sishen Wan as the core,a cluster with Wumei Baijiang Fang combined with Banxia Xiexin Tang,and a cluster with Chaihu Shugan San combined with Shaoyao Gancao Tang.And eight combinations of commonly used herbs were formed:fried macrocephalae rhizoma and fried rhizoma atractylodis,booor’s mustard herb and dark plum fruit,psoraleae fructus and nutmeg and fructus schisandrae chinensis,coptis root and pinellia tuber,corydalis rhizoma and sichuan lovase rhizome,immature trifoliate and orange fruit-mangnolia officinalis,herba agastaches and eupatorium,herba sarcandrae and forsythiae fructus.The results of association analysis showed that the clustered herbs were strongly associated with each other.The results of the correlation analysis between syndrome elements and drug pairs showed that in the case of yang deficiency and phlegm,the prescription preferred the pair of fried macrocephalae rhizoma and fried rhizoma atractylodis;in the case of blood stasis and heat,the prescription preferred to use booor’s mustard herb and dark plum fruit;in the case of yin deficiency,the prescription prefers to use the pair of soraleae fructus and nutmeg and fructus schisandrae chinensis;in the case of food accumulation,the prescription preferred to use the pair of coptis root and pinellia tuber.Conclusion:1.The common location syndrome elements of 128 patients with UC were spleen,liver,stomach,large intestine,small intestine,and kidney,and the common nature syndrome elements were dampness,qi stagnation,qi deficiency,yang deficiency,blood deficiency,blood stasis,yin deficiency,phlegm,cold,food stagnation,and heat.The pathology could be best summarized by Professor Wei Wei’s theory of deficiency,stagnation,stasis and depression,which involved deficiency of qi,blood,yin and yang;stagnation of dampness,qi,phlegm,cold and food;stasis of blood,and depression of emotional disorders.Compared with previous studies,this study found that the importance of the location syndrome element liver has increased.It is suggested that more attention should be paid to the treatment methods related to liver,and the physical and mental status of patients in the process of clinical diagnosis and treatment as well as chronic disease management.We also added small intestine and food accumulation as common syndrome elements,which further supported and enriched the possibilities of the location and causative factors of UC in TCM treatment.The distribution of heat in male UC patients was higher,while the distribution of blood stasis and cold in female UC patients were higher.In elderly patients with UC,distribution of essence deficiency was higher.In overweight and obese patients,the distribution of phlegm was higher.In patients with more than 5 years of disease,the distribution of kidney and qi trapped were higher.There were higher distributions of large intestine and blood deficiency in active patients;qi trapping,toxic and blood stirring in moderate and severe active patients.It is suggested that individualized treatment and management plan should be formulated in accordance with the physiopathological characteristics and physique factors of the patients.2.Professor Wei Wei’s common prescriptions for the clinical treatment of UC are Sishen Wan,Wumei Baijiang Fang combined with Banxia Xiexin Tang,and Chaihu Shugan San combined with Shaoyao Gancao Tang,and several other herb pairs.Combined with the results of syndrome element research,the results showed that the channel distribution of herbs were spleen,stomach,liver and large intestine,which were consistent with the most common location syndrome elements of UC.In addition,efficacy of these herbs covered the corresponding effects against the common nature syndrome elements.In the case of yang deficiency and phlegm,the prescription preferred the pair of fried macrocephalae rhizoma and fried rhizoma atractylodis;in the case of blood stasis and heat,the prescription preferred to use booor’s mustard herb and dark plum fruit;in the case of yin deficiency,the prescription prefers to use the pair of soraleae fructus and nutmeg and fructus schisandrae chinensis;in the case of food accumulation,the prescription preferred to use the pair of coptis root and pinellia tuber.It was generally a very accurate medicine for the identification and treatment of UC.The above distribution characteristics and the summary of clinical experience of famous TCM practitioners are of far-reaching reference and guidance for clinical diagnosis and treatment as well as chronic disease management of UC.