| Background and objectiveGastroesophageal reflux disease(GERD)is a common gastrointestinal disease with high incidence,complex symptoms,difficulty in diagnosis,difficulty in treatment and easy recurrence.In recent years,with the change of lifestyle,the incidence of GERD has been increasing year by year and is becoming younger.Although the understanding of GERD in modern medicine is gradually deepening and new drugs and technical means are emerging in the clinic,the treatment method is still single.Chinese medicine has certain characteristics and advantages in improving the clinical symptoms and prognosis of patients.The aim of this study is to investigate the distribution pattern of TCM evidence patterns in GERD patients by analysing their basic information,clinical manifestations and other characteristics,and then to clarify the correlation between each TCM evidence pattern and its influencing factors,with a view to providing a basis for improving the accuracy of TCM identification.At the same time,the data mining method was used to analyse the clinical experience of instructors in the treatment of GERD,with a view to providing new ideas for the clinical prevention and treatment of GERD.Methods1 In this research,a cross-sectional clinical study was conducted on 192 patients with GERD who attended the outpatient clinic of Guang’ an men Hospital of the Chinese Academy of Traditional Chinese Medicine from January 1,2022 to January 1,2023,and general information,GerdQ scale and Hospital Anxiety and Depression Scale were collected by filling out questionnaires.Combining the four consultations of the patients and the requirements of the Consensus Opinions on Combined Chinese and Western Medicine Treatment of GERD,the GERD patients were classified into liver-stomach disharmony syndrome,liver-stomach depression-heat syndrome,middle deficiency-qi rebellion syndrome,qi-depression-phlegm obstruction syndrome,qi-stagnation-blood stasis syndrome and cold-heat mismatch syndrome.The results were collated using SPSS25.0,and the correlation between the TCM evidence of GERD and its influencing factors was tested by the χ2 test,and variables with P<0.10 in the analysis results were subjected to binary logistic regression analysis.2 Collecting the prescription information of the tutor’s outpatients with GERD,a total of 107 cases,and mining the data using Excel,SPSS Modeler 18.1 and SPSS 25.0,including frequency statistics,drug association rule analysis and cluster analysis,etc.,to summarize the tutor’s experience in treating GERD with medication.Results1 Study on the distribution of TCM evidence of gastroesophageal reflux and the correlation between its influencing factors1.1 Basic information:(1)Of the 192 patients included,89 were male and 103 were female,with a male to female ratio of 1:1.16.The youngest age was 22 years old and the oldest was 80 years old,with a mean age of 47.3±13.283 years.Middle-aged people were the most numerous,with 91 cases.(2)The greatest number of GERD patients were in the normal weight range,with 55 cases(28.6%)above the normal range and only 3 cases(1.6%)were wasted.(3)The largest number of patients with education level were undergraduates and college students,and the largest number of occupational distribution were general employees,followed by retirees.(4)The number of non-smokers and non-drinkers was higher than the number of smokers and drinkers in the history of smoking and alcohol.(5)Among the poor eating habits,irregular meals,eating too quickly and eating out frequently are more common,and some people combine multiple poor eating habits.(6)A survey of the patients’ past medical history revealed that some of them had a combination of hypertension and hyperlipidaemia.1.2 Clinical manifestation:The clinical manifestations of GERD in this group were acid reflux in 174 patients(90.6%)and heartburn in 166 patients(86.4%).In addition to the typical symptoms,bloating(74.0%),retrosternal discomfort(71.4%),feeling of blockage(67.7%)and belching(66.7%)were also more common.Irregular bowel movements were present in some patients,with irregular bowel movements being more common.A total of 109 patients with previous gastroscopy were included,with patients with reflux oesophagitis being the most common,followed by those with chronic atrophic gastritis.A total of 87 patients were diagnosed with RE at endoscopy and had clear grading results,with degree grading:grade A>grade B>grade C>grade D.1.3 TCM syndrome:Combining the data from the four consultations of the 192 patients with GERD included in the study,the distribution of the TCM evidence types was as follows:liver and stomach disharmony(27.1%)>liver and stomach stagnation and heat(26.6%)>middle deficiency and qi rebellion(23.4%)>qi stagnation and phlegm obstruction(12.5%)>qi stagnation and blood stasis(7.3%)>cold and heat mismatch(3.1%).1.4 Correlation analysis of the TCM evidence of GERD and its influencing factors:(1)Gender:There was a negative correlation between women and the TCM evidence of Liver and Stomach Stagnant Heat;the risk of developing Liver and Stomach Stagnant Heat in women with GERD was only 50.4%of that in men[OR=0.504,95%CI(0.263,0.965),P=0.039].(2)Age:Older adults were positively associated with hepatic and gastrointestinal heat symptoms,and older adults with GERD were 5.10 times more likely to have hepatic and gastrointestinal heat symptoms than younger adults[OR=5.100,95%CI(2.036,12.778),P=0.001];middle-aged adults were positively associated with middle deficiency and qi rebellion symptoms,and middle-aged adults with GERD were 2.385 times more likely to have middle deficiency and qi rebellion symptoms than younger adults[OR=2.385,95%CI(2.036,12.778),P=0.001].[OR=2.385,95%CI(1.063,5.355),P=0.035].(3)Weight:Overweight and obese patients were positively correlated with cold-heat mismatch,with overweight and obese patients with GERD being 10.231 and 24.182 times more likely than normal to have cold-heat mismatch,respectively[OR=10.231,95%CI(1.035,101.144),P=0.047;OR=24.182,95%CI(2.029,288.174),P=0.012].(4)Lifestyle habits:history of smoking and alcohol consumption were positively correlated with the evidence of liver and stomach stagnation and heat,patients with GERD who smoked were 1.986 times more likely to develop the evidence of liver and stomach stagnation and heat than those who did not smoke[OR=1.986,95%CI(1.034,3.812),P=0.039],patients who drank alcohol were 3.558 times more likely to develop the evidence of liver and stomach stagnation and heat than those who did not drink[OR=3.558,95%CI(1.800,7.031),P=0.000];history of smoking and alcohol consumption was negatively correlated with the evidence of middle deficiency qi rebellion,with patients with GERD who smoked 40.3%more likely to have evidence of middle deficiency qi rebellion than those who did not smoke[OR=0.403,95%CI(0.185,0.875),P=0.022].Patients who drank alcohol were 13.0%more likely to have evidence of deficiency in the middle and Qi than those who did not drink alcohol[OR=0.130,95%CI(0.039,0.442),P=0.001];Patients who drank alcohol were 2.112 times more likely to have evidence of liver and stomach disharmony than those who did not drink alcohol[OR=2.112,95%CI(1.075,4.149),P=0.030].Irregular meals were positively correlated with the evidence of middle deficiency and qi rebellion,and patients with irregular meals in GERD were 2.2 times more likely to have evidence of middle deficiency and qi rebellion than those who were regular[OR=2.200,95%CI(1.093,4.427),P=0.027].(5)Anxiety and depression:anxiety was positively correlated with liver and stomach disharmony.7.921 times more likely to be found in anxious people than in those without anxiety[OR=7.921,95%CI(3.467,18.097),P=0.000];and negatively correlated with the deficiency in the middle and rebellious Qi evidence,with anxious people 5.2%more likely to have the deficiency in the middle and rebellious Qi evidence than those without anxiety.[OR=0.052,95%CI(0.018,0.153),P=0.000].Depression was positively correlated with liver and stomach stagnation and heat symptoms,with those with GERD depression 3.336 times more likely to have liver and stomach stagnation and heat symptoms than those without depression[OR=3.336,95%CI(1.675,6.644),P=0.001];and with qi and phlegm obstruction symptoms,with those with depression 3.545 times more likely to have qi and phlegm obstruction symptoms than those without depression.[OR=3.545,95%CI(1.341,9.376),P=0.011];depression was negatively correlated with the evidence of middle deficiency and qi rebellion,with depressed people 4.3%more likely to have the evidence of middle deficiency and qi rebellion than those without depression.[OR=0.043,95%CI(0.013,0.144),P=0.000].2 Tutor medication pattern researchA total of 107 prescriptions were screened in this research,involving 133 Chinese herbal medicines.Of these,≥10%were identified as high-frequency herbal medicines,with a total of 45 Chinese medicines.The core medicines include Atractylodes Macrocephala,Pinellia ternata,Magnolia officinalis,Curcuma zedoary,Cuttlebone.The main medicinal properties are "warm",followed by "cold and flat",and the taste is mainly"pungent and bitter".They are mainly distributed in the"spleen,lung,stomach and liver meridians".The drugs can be classified into 18 categories according to their efficacy,among which the most frequently used drugs are those for resolving phlegm,relieving cough and asthma,followed by those for activating blood circulation and resolving blood stasis,and those for tonic deficiency.A total of 73 drug pairs were obtained from the analysis of the high-frequency drug association rules,of which Pinellia ternate-Magnolia officinalis was the most frequent,appearing 103 times,followed by Cuttlebone-Fritillaria thunbergii.The clustering analysis yielded three categories of drugs:the first:Codonopsis pilosula and Poria cocos;the second:Atractylodes Macrocephala;and the third:Cuttlebone,Fritillaria thunbergii,Predictor,oroxylum indicum,Turmeric,Clematis,Curcuma zedoary,Salvia miltiorrhiza,Magnolia officinalis,Perilla stems,and Pinellia ternata.Conclusion1 GERD patients are equally prevalent in both sexes,with a higher prevalence in the middle-aged and elderly population,and their poor eating habits are dominated by those who do not eat regularly,eat too quickly,and eat out frequently,Hypertension,hyperlipidaemia and chronic atrophic gastritis are the most common co-morbidities in patients with GERD.2 The clinical presentation of GERD is characterised by acid reflux and heartburn,accompanied by a variety of non-specific manifestations such as gastric discomfort,and a discrepancy between the severity of the gastroscopic findings and the actual clinical presentation of the patient.3 Factors influencing the TCM pattern:in terms of gender,men are a risk factor for the development of liver and stomach stagnation-heat symptoms.In terms of age,middle-aged people are more likely than young people to develop symptoms of deficient Qi and older people are more likely than young people to develop symptoms of liver and stomach stagnation and heat;in terms of weight,overweight and obese patients are risk factors for developing symptoms of cold and heat;smoking and alcohol consumption are risk factors for developing symptoms of liver and stomach stagnation and heat,and alcohol consumption is also a risk factor for developing symptoms of liver and stomach disharmony;irregular meals are a risk factor for symptoms of deficient Qi;anxiety is a risk factor for symptoms of liver and stomach disharmony and liver and stomach stagnation and heat,and depression is a risk factor for symptoms of liver and stomach stagnation and heat and Qi and phlegm blockage,both of which are protective factors for symptoms of deficient Qi.4 Treatment of GERD is based on tonifying the spleen and stomach,together with draining the liver and lung,and adding blood-boosting products when appropriate,taking into account the duration of the disease and the patient’s condition.Commonly used medicines are Atractylodes Macrocephala,Pinellia ternate,Magnolia officinalis,Curcuma zedoary,Cuttlebone and Fritillaria thunbergii,etc.Common prescriptions are Erzhu Yuling Dan and Wu Bei San. |
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