Study On The Regularity Of Non - Cardiogenic Chest Pain In Gastroesophageal Reflux Disease And The Law Of Tutor

BackgroundGastroesophageal Reflux Disease (GERD) is defined as a condition which develops when the reflux of gastric content causes troublesome symptoms or complications. Clinical subtypes of GERD include Reflux Esophagitis (RE), Barrett Esophagus (BE) and Non-erosive Reflux Disease (NERD). Non-cardiac chest pain (NCCP) is defined as repetitive onset of angina pectoris-like retrosternal pain in the absence of obvious coronary artery disease evidence. GERD related NCCP was included in the 2006 Montreal Consensus on the definition and classification of GERD as reflux chest pain, reflecting the close relationship between both parties. Even so, the prevalence of such patients getting referred to a gastroenterologist is relatively low. The healthcare seeking pattern of patient further highlight the lack of awareness of GERD related NCCP amongst doctors and patients. GERD related NCCP not only bring physical discomfort to patients, but also bring about substantial amount of societal and economic burden. As there is a diverse mechanism causing GERD related NCCP, hence the use of proton pump inhibitors in the treatment of this disease yields limited effect. Hence, a study of this disease from a Traditional Chinese Medicine (TCM) perspective could discover an alternative treatment method for GERD related NCCP.ObjectivesTo arrange and analyze ancient TCM literature associated with GERD related NCCP in the areas of pulse type, materia medica, TCM formulae, and further analyze the pattern of high frequency herbs, thereby deduce the relevant pathomechanism, treatment ideology and disease location, to further discuss the possible basic pattern in the treatment of GERD related NCCP from TCM perspective. To compile the case studies of mentor Professor Zhang Chang in the treatment of GERD related NCCP. By using frequency analysis and cluster analysis method to further analyze the herb use pattern in order to discover the treatment ideology and herb use pattern of Professor Zhang in the treatment of GERD related NCCP.To achieve a basic understanding of the treatment ideologies of GERD related NCCP from TCM perspective, thereby providing a directive role for future TCM studies in GERD related NCCP.MethodsIn the study of ancient literature, the retrieval range was to be any recorded writings of the pulse pattern, herb use or TCM formulae associated with GERD related NCCP from Han dynasty to end of Qing Dynasty. The keywords used are variations of "chest pain" and "acidic reflux". A multiple criteria search was done using Version 5 of "Zhong Hua Yi Dian". A database was established using Microsoft Excel 2010 from the search results. By using frequency analysis and cluster analysis method, the data retrieved were studied. For herbs with a frequency of>40times, the pattern of herb use was illustrated as heat map and network using Python 2.7.2 and Cytoscape respectively.We studied a total of 109 cases of GERD related NCCP encountered in the clinical practice of Professor Zhang. A database was established using Microsoft Excel 2010. The data was analyzed in SPSS 17.0 and the results were further studied using cluster analysis method in Python 2.7.2 and Cytoscape. Heat map and network was produced respectively to illustrate the relationship between herbs used.ResultsA total of 396 ancient literature recordings,192 types,20 different class, with a total frequency of 3320 on material medica used related to GERD related NCCP were recovered. The highest frequency class of herbs belong to qi regulating herbs. The top 25 herbs used consist of mostly qi regulating herbs followed by nourishing herbs. The most frequently used herb was Radix liquiritiae, with a total frequency of 232. The herbs used belong mostly to spleen meridian, followed by stomach meridian, liver meridian and lung meridian. The top 25 herbs used can be classified into 2 types via cluster analysis and 11 types through cluster network analysis. A total of 165 related prescriptions were recovered, with a total frequency of 348. A total of 43 related ancient literature pulse type was recovered, with a total of 30 types.A total of 109 case studies were compiled. A total of 135 herbs were recovered, with a total frequency of 1752. The herbs used mostly belong to spleen meridian, followed by stomach meridian, lung meridian and liver meridian. Frequency analysis found that herbs used with frequency>10% were frequently used herbs, and can be classified into 2 types by cluster analysis. Network analysis derived 3 sets of negatively related herbs and 8 sets of positively related herbs. ConclusionThe study on the pattern of herbs used in treatment of GERD related NCCP in ancient time reflected that the treatment ideologies mainly revolved around adjusting qi and drying dampness, nourishing blood and enhancing blood flow, and warming the middle jiao and nourishing deficiency. The analysis of herbs used reflected their treatment ideologies that GERD related NCCP was related to spleen, stomach, liver and lung meridian.From the study on the pattern of herbs used in treatment of GERD related NCCP by Professor Zhang reflected that the treatment ideology weighs heavily on soothing the liver and regulating qi, cleansing the liver and clearing heat, harmonize the stomach and descend adversely risen qi. The herbs used also reflected that GERD related NCCP was related to spleen, stomach, liver and lung meridian.More emphasis was made in adjusting qi, drying dampness and dissolving phlegm, nourishing blood and enhancing blood flow, and warming the middle jiao and nourishing deficiency when treating GERD related NCCP in the ancient times. Hence, we can deduce that most of the patients suffering from GERD related NCCP suffer from a certain degree of middle jiao spleen and stomach deficiency. From the herb use pattern analysis of the mentor, it is found that the treatment ideology weighs heavily on soothing the liver and regulating qi, cleansing the liver and clearing heat, harmonize the stomach and descend adversely risen qi, and much lesser on warming the middle jiao and nourishing deficiency. This could be due to advances in society, with improved standard of living comes the lower prevalence of individuals with cold deficiency of the middle jiao. However, such advances caused an increase in stress levels from the past to present, thereby resulting in depression of the liver qi that transform into heat.