The Study Of Drug Laws In The Treatment Of Chronic Atrophic Gastritis Of Modern Traditional Chinese Medicine Masters Based On Data Mining

Objective: Chronic Atrophic Gastritis (CAG) is a disease characterizedby the decrease of intrinsic glands with or without fibrosis and metaplasia ofintestinal glands and or pseudopyloric glands, as a result of persistant injurylocated at gastric epithelial. The detection rate of CAG remains at a range of7.5—13.8%since gastroscopy has been implemented in our country.Recognized as one of common and scratching diseases, CAG was labeled asgastric precancerous state by WHO in1978, and precancerous lesions wereidentified if intestinal metaplasia and or dysplasia at a moderate and severegrade occurred.Western Medicine holds that the mechanism of CAG is very complicated,with H.pylori infection as the main contributor. Other related factors inlcudeheredity, immunity, bile reflux, hypersodium diet, age, lack of vitamin,etc.There remains a lack of satisfactory approaches against CAG. Anti-infectionpills against Hp, mucosal protective agents, prokinetic drugs and symptomatictreatment constitute the major therapy until now, but the clinical efficacy isnot stable, with a lot of side effects.CAG could be classified into some diseases in Traditional ChineseMedicine, such as “stomach duct pain”,“feeling of fullness and oppression”,“fullness sensation of asthenia type” and “clamoring stomach”. Modern TCMmasters, guided by the principal of syndrome differentiation and based ontheir hardwon clnical experiences, summaried so many distinctive systemsrelated to diagnosis and treatment of CAG. While revealing and exploring theoccurrence and development of CAG, TCM masters managed to conquer thedisease with their own and inventive prescriptions, which became importantparts of the beautiful treasury of TCM and opened up broad prospects of the treatment of CAG. My tutor, Professor Wang Yangang inherited anddeveloped the theory of “turbid-toxin”, and treated the disease with themethod of “eliminating turbid-evil and removing toxin”. The emergence ofthis method was widely regarded as one of highlights of CAG treatment, withspecial superiority in terms of improvement of symptoms and reversal ofatrophy and intestinal metaplasia.The study, with the help of data mining, such as frequency analysis,cluster analysis and factor analysis, deeply explored classic prescriptions ofmore than100TCM masters when treating CAG, summaried the drug laws ofCAG, and provided practical evidence and directions of CAG; another studyaimed at confirming the science and effectiveness of the theory of“turbid-toxin” with the help of systematic review. The study also focused ondiscussing and revealing the academic connotation and drug laws of themethod of eliminating turbid-evil and removing toxin by data mining of morethan250outpatient prescriptions of tutor Wang Yangang.Methods: With the help of SPSS16.0software, frequency analysis wasimplemented towards the drugs strictly selected in195prescriptions of139articles concerning the treatment of CAG by modern TCM maters, includingthe ranking of frequency, category, nature, nature and flavor, channel entry ofdrugs.59drugs with the frequency of at least10were utilized to carry outcluster analysis.18drugs with the frequency of at least40were utilized tocarry out factor analysis and correlation analysis; Frequency analysis wasconducted among the prescriptions treating CAG of tutor Wang Yangang,including the ranking of frequency, category, nature, nature and flavor andchannel entry.53drugs with the frequency of at least30were utilized to carryout cluster analysis.24drugs with the frequency of at least100were utilizedto carry out factor analysis and correlation analysis. Software RevMan4.2wasused to carry out Meta analysis of the theory of “Turbid-toxin” when treatingCAG.Results(1):1The author collected195prescriptions from139articles, involving202 TCM drugs and2322rates of recurrence concerning the treatment of CAG by modern masters.2Commonly-uesd TCM drugs treating CAG by modern masters were(descending order according to the frequency):RADIX GLYCYRRHIZAE(119) RADIX PAEONIAE ALBA(90) RHIZOMA ATRACTYLODIS MACROCEPHALAE(83) RADIX CODONOPSIS(66)PORIA(65)RHIZOMA PINELLIAE(59)PERICARPIUM(55)FRUCTUS AURANTII(55)RHIZOMA COPTIDIS(49)RADIX ASTRAGALI(49)RADIX BUPLEURI (48)RADIX SALVIAE MILTIORRHIZAE(48)RADIX AUCKLANDIAE(48)RHIZOMA CURCUMAE(47)FRUCTUS CITRI SARCODACTYLIS(43)RHIZOMA CORYDALIS(43)RADIX OPHIOPOGONIS(41)FRUCTUS HORDEI GERMINATUS(41)ENDOTHELIUM CORNEUM GIGERIAE GALLI(36).3The basic prescription against CAG was made up of RADIX SALVIAE MILTIORRHIZAE;RHIZOMA CURCUMAE;RADIX ASTRAGALI;FRUCTUS AURANTII; RHIZOMA PINELLIAE;PERICARPIUM CITRI RETICULATAE;RHIZOMA ATRACTYLODIS MACROCEPHALAE;RADIX CODONOPSIS;PORIA.4Most commonly-used drug combinations were:(1)FRACTUS AURANTII IMMATURUS and SEMEN RAPHANI(2)RHIZOMA BLETILLAE and RHIZOMA ATRACTYLODIS(3)RAMULUS CINNAMOMI and RHIZOMA ZINGIBERIS(4)RADIX NOTOGINSENG and RHIZOMA CHUANXIONG(5)B ULB US and RADIX LINDERAE(6)FRUCTUS CRATAEGI and MASSA MEDICATA FERMENTATA(7)RADIX REHMANNIAE and FRUCTUS MUME(8)RADIX GLEHNIAE and RHIZOMA POLYGONATI ODORATI(9)RADIX AUCKLANDIAE and FRUCTUS AMOMI(10)RADIX BUPLEURI and RADIX CURCUMAE(11)RADIX SALVIAE MILTIORRHIZAE and RHIZOMA CURCUMAE(12)RHIZOMA PINELLIAE and PERICARPIUM CITRI RETICULATAE(13)RHIZOMA ATRACTYLODIS MACROCEPHALAE and RADIX CODONOPSIS(14) RADIX GLYCYRRHIZAE and RADIX PAEONIAE ALBA;①RAMULUS CINNAMOMI and RHIZOMA ZINGIBERIS and FRUCTUS JUJUBAE②CONCHA ARCAE and ENDOCONCHA SEPIAE and BULBUS FRITILLARIAE THUNBERGII③BULBUS LILLI and RADIX LINDERAE and RADIX PAEONIAE RUBRA④RADIX BUPLEURI and RADIX CURCUMAE and RHIZOMA CORYDALIS⑤RADIX SALVIAE MILTIORRHIZAE and RHIZOMA CURCUMAE and RADIX ASTRAGALI⑥PORIA and RADIX CODONOPSIS and RHIZOMA ATRACTYLODIS MACROCEPHALAE. The combinations with relatively high correlation coefficient(absolute value included) were:RHIZOMA ATRACTYLODIS MACROCEPHALAE and RADIX CODONOPSIS (0.491)RHIZOMA ATRACTYLODIS MACROCEPHALAE and PORIA(0.48)RADIX CODONOPSIS and PORIA(0.395)FRUCTUS AURANTII and RHIZOMA CORYDALIS (0.365)RADIX GLYCYRRHIZAE and RADIX PAEONIAE ALBA(0.293)RADIX OPHIOPOGONIS and RHIZOMA PINELLIAE(0.264)RHIZOMA COPTIDIS and RADIX ASTRAGALI(0.254)RADIX AUCKLANDIAE and RHIZOMA ATRACTYLODIS MACROCEPHALAE(0.254)57common factors were discovered in the treatment of CAG. There were:①RHIZOMA ATRACTYLODIS MACROCEPHALAE (0.791) RADIX CODONOPSIS(0.751)PORIA(0.765)②FRUCTUS AURANTII(0.722) RADIX BUPLEURI(0.781)RHIZOMA CORYDALIS(0.469)③RHIZOMA PINELLIAE(0.631)RHIZOMA COPTIDIS(0.726)RADIX ASTRAGALI(-0.632)④RADIX SALVIAE MILTIORRHIZAE(0.681) RHIZOMA CURCUMAE(0.754)⑤RADIX GLYCYRRHIZAE(0.781)RADIX PAEONIAE ALBA(0.762)⑥FRUCTUS CITRI SARCODACTYLIS(0.475)RADIX AUCKLANDIAE(0.405)RADIX OPHIOPOGONIS(0.475)⑦PERICARPIUM CITRI RETICULATAE(0.363) FRUCTUS HORDEI GERMINATUS(0.802) Results(2):1The author collected252outpatient prescriptions concerning the treatment of CAG with the pattern of internal accumulation of Turbid-toxin, including186TCM drugs and6141rates of recurrence.2Commonly-used TCM drugs of the theory of "Turbid-toxin" were: RADIX SCUTELLARIAE(217)、RHIZOMA PINELLIAE(214) RHIZOMA COPTIDIS(197) HERBA ARTEMISIAE SCOPARIAE(189) RADIX BUPLEURI(185) RHIZOMA CYPERI(182) PERICARPIUM CITRI RETICULATAE VIRIDE(175) SEMEN RAPHANI(169) CAULIS BAMBUSAE IN TAENIA(166) ENDOTHELIUM CORNEUM GIGERIAE GALLI(165).3Major prescriptions after cluster analysis were:①HEBRA PATRINIAE;SEMEN COICIS②RHIZOMA ACORI TATARINOWI;RADIX CURCUMAE;HERBA LYSIMACHIAE③RHIZOMA CORYDALIS;RADIX ANGELICAE DAHURICAE④CORTEX MAGNOLIAE OFFICINALIS;FRUCTUS AURANTII IMMATURUS;SEMEN RAPHANI;FRUCTUS TRICHOSANTHIS⑤ENDOTHELIUM CORNEUM GIGERIAE GALLI⑥CAULIS PERILLAE;PERICARPIUM CITRI RETICULATAE VIRIDE;RHIZOMA CYPERI;RHIZOMA PINELLIAE;CAULIS BAMBUSAE IN TAENIA;RADIX BUPLEURI;RADIX GLYCYRRHIZAE⑦HERBA LOBELIAE CHINENSIS;RADIX IS ATIDIS;HERB A ABRI CANTONIENSIS;RADIX SOPHORAE FLAVESCENTIS;RHIZOMA SEU HEBRA GYNOSTEMMATIS;HERBA ARTEMISIAE SCOPARIAE;RADIX SCUTELLARIAE;RHIZOMA COPTIDIS4Most commonly-used drug combinations of my tutor Wang Yangang were:(1)RADIX ISATIDIS and HERBA ABRI CANTONIENSIS(2)RADIX SCUTELLARIAE and RHIZOMA COPTIDIS (3)RADIX GLYCYRRHIZAE and CAULIS PERILLAE(4)RHIZOMA CYPERI and PERICARPIUM CITRI RETICULATAE VIRIDE(5)CAULIS BAMBUSAE IN TAENIA and RHIZOMA PINELLIAE(6)CORTEX MAGNOLIAE OFFICINALIS and FRUCTUS AURANTII IMMATURUS(7)RADIX ANGELICAE DAHURICAE and RHIZOMA CORYDALIS(8)ACORUS GRAMINEUS and RADIX CURCUMAE(9)HEBRA PATRINIAE and SEMEN COICIS(10)OS SEPIAE and FRITILLARIAE THUNBERGII BULBUS(11)GYPSUM FIBROSUM and CONCHA ARCAE(12)PLUMULA NELUMBINIS and RADIX POLYGALAE(13)MOSCHU and HERBA EUPATORII(14)RADIX PAEONIAE ALBA and RADIX ANGELICA(15)FRUCTUS AMOMI and RADIX REHMANNIAE(16)FRUCTUS CITRI and FRUCTUS CITRI SARCODACTYLIS.①HERBA HEDYOTIDIS DIFFUSAE and HERBA SCUTELLARIAE BARBATAE and HERBA LOBELIAE CHINENSIS②HERBA ARTEMISIAE SCOPARIAE and RADIX SCUTELLARIAE and RHIZOMA COPTIDIS③CORTEX MAGNOLIAE OFFICINALIS and FRUCTUS AURANTII IMMATURUS and SEMEN RAPHANI④ACORUS GRAMINEUS and RADIX CURCUMAE and HERBA LYSIMACHIAE⑤RADIX AUCKLANDIAE and MOSCHU and HERBA EUPATORII⑥FRUCTUS HORDEI GERMINATUS and FRUCTUS CRATAEGI and MASSA MEDICATA FERMENTATA⑦RADIX ANGELICA and RADIX PAEONIAE ALBA and RHIZOMA CHUANXIONG⑧CITRUSMEDICA and FRUCTUS CITRI SARCODACTYLIS and RADIX GENTIANAE56common factors of the treatment of CAG by tutor Wang Yangang were:①RADIX ISATIDIS(0.953)RHIZOMA SEU HEBRA GYNOSTEMMATIS(0.925)HERBA ABRI CANTONIENSIS(0.962)RADIX SOPHORAE FLAVESCENTIS(0.923)HERBA ARTEMISIAE SCOPARIAE(0.622)②RADIX B UPLEURI(0.785) RADIX GLYCYRRHIZAE(0.909)PERICARPIUM CITRI RETICULATAE VIRIDE(0.898)RHIZOMA CYPERI(0.897)CAULIS PERILLAE(0.930)③FRUCTUS AURANTII IMMATURUS(0.935)CORTEX MAGNOLIAE OFFICINALIS(0.932)SEMEN RAPHANI(0.549)FRUCTUS TRICHOSANTHIS(0.429)④RHIZOMA COPTIDIS(0.738)RADIX SCUTELLARIAE(0.763)⑤RHIZOMA PINELLIAE(0.814)CAULIS BAMBUSAE IN TAENIA(0.788)⑥FRITILLARIAE THUNBERGII BULBUS(-0.708)RHIZOMA CORYDALIS(0.478)ENDOTHELIUM CORNEUM GIGERIAE GALLI(0.575)Results(3):Nine articles concerning the treatment of CAG using the theory of "Turbid-toxin" were selected in Meta analysis. Clinical efficacy: OR=4.16,95%CI(3.07,5.64),Z=9.18,P<0.00001; Efficacy of endoscopic pathology:OR=2.82,95%CI(2.03,3.92),Z=6.16, P<0.00001.Conclusions:the major drug laws of modern TCM masters when treating CAG are:1General principles of the treatment of CAG include:properly dispatch the drugs with opposite nature; maintain the balance between Qi and blood; simultaneously supplement and attack. In terms of making prescriptions, Drugs with the character of clearing the heat, supplementing, promoting the movement of Qi and quickening the blood and transforming stasis are listed as hugely important. In addition, special priotity is also given to the principle of considering stomach and liver as equally important in the treatment of CAG, and drugs with the function of soothing, emolliating, relaxing and clearing liver are commonly used.2With the thought that Turbid-toxin is a pathological product as a result of the combination of phlegm, dampness, stasis, food accumulation, Qi stagnation and toxin, tutor Wang Yangang has successfully treated CAG with the method of eliminating Turbid evil and removing toxin. He also promotes the pathogenesis of "impassability of waterway" and pathological evolution of "lasted Turbid-toxin leading to welling abscess". The methodology of eliminating Turbid evil and removing toxin is to build a comprehensive treatment network with the character of "six in one":flushing phlegm, dispeling dampness, dissipating stasis, abducting stagnation, resolving toxin and transforming accumulations. Equal priority is also given to the cooperation and coordination when using drugs that distribute Lung, Spleen and Kidney Channels, according to the thought of "Shifting of lung fire to the spleen" and "Acquired constitution being nourished by innate constitution". 3Applying the theory of “Turbid-toxin” in the treatment of CAG isproved effective and scientific according to Meta Analysis, because of itssignificant advantage in terms of clinical and endoscopy efficacy.