Study On The Mechanism Of Bidirectional Regulation Of Intestinal Flora In Female Patients’ Deficiency-excess Abdominal Obesity With The Intervention Of Shu-Mu Acupoint Catgut Embedding

Objective:To explore the bilateral regulation mechanism of the treatment of female deficiency-excess AO by using 16 S r DNA high-throughput sequencing technology to investigate the effect of Shu-Mu ACE on the structure and diversity of intestinal flora in female AO patients with deficiency-excess.Methods:1.A total of 40 female AO patients were divided into 2 groups of deficiency and actual according to TCM symptoms,20 cases in each group;Both groups were treated with Shu-Mu ACE once in 2 weeks for 12 weeks,for a total of 6 times.Another 10 cases of healthy volunteers were recruited as the Healthy group.2.Body weight(BW),body mass index(BMI),waist circumference(WC),TCM symptom scale,visual analogue scale(VAS),and Gastrointestinal Symptom Rating Scale(GSRS)were selected to compare the difference of clinical symptoms before and after treatment.Faecal samples were collected 2 times at the time of enrollment and 1 week after treatment,respectively.The fecal samples of the Healthy group were collected once at the time of enrollment.The changes in the structural composition and diversity of the intestinal flora of the two groups before and after treatment were compared with those of the Healthy group using 16 S r DNA high-throughput sequencing technology.Results:1.A total of 37 cases completed this study: 19 cases in the Pi Xu group,18 cases in the Wei Re group,and 10 cases in the Healthy group.2.Comparison of clinical dataAfter treatment,there was a statistically significant difference between the two groups before and after treatment in each comparison(P < 0.05),while there was no significant difference between groups in BMI,WC and BW in the Pi Xu and Wei Re groups(P > 0.05).At the beginning of the 4th week of treatment,significant differences began to be observed in BMI,WC and BW between the two groups compared to the pre-treatment period(P <0.05).After treatment,the TCM symptom scores decreased significantly in both groups(P< 0.05),and the decrease was more pronounced in the Wei Re group(P < 0.05).For GSRS scores,there was a significant decrease in both groups after treatment(P < 0.05),and the difference between groups was not significant(P > 0.05).For GSRS scores,the Wei Re group showed a significant decrease at week 2(P < 0.05)after treatment,followed by significant differences from before treatment at weeks 4,8,10,and 12(P < 0.05);and there was no significant change in the Pi Xu group before and after treatment(P > 0.05).3.Comparison of intestinal flora.(1)The Pi Xu group,Wei Re group and Healthy group: Both Pi Xu group and Wei Re group were dominated by Lachnospiraceae(Trichophytonaceae),Bacteroidaceae(Bacteroidaceae),Prevotellaceae(Prevotellaceae)and Oxalobacteraceae(Oxalobacteraceae)at the family level,and the difference species in the Pi Xu group is Moraxellaceae(Moraxellaceae),and the differential species of the gastric fever group is Ruminococcaceae(Rumenococcaceae).There is a decrease in the presence of Ruminococcaceae(Ruminococcaceae)in the Pi Xu group and Moraxellaceae(Moraxellaceae)in the Wei Re group.(2)Comparison of treatment in the Pi Xu group and the Wei Re group: the difference species at the family level before and after Pi Xu treatment was Weeksellaceae(Weeksellaceae),and in the Wei Re group was Turicibachateraceae(Zurichiaceae).The key flora at the family level for the regulation of intestinal flora in female AO patients with Pi Xu was Weeksellaceae and the key flora at the family level for the regulation of intestinal flora in female AO patients with Wei Re was Turicibachateraceae.Alpha diversity analysis showed no significant differences between the healthy,Pi Xu and Wei Re groups,before and after treatment in the spleen-deficiency group,and before and after treatment in the Wei Re group(P < 0.05).The scatter plot of Beta diversity analysis showed that the flora of patients in the Pi Xu and Wei Re groups were discrete and crossed with that of the Healthy group.(3)Correlation analysis between intestinal flora and clinical efficacy: the results of correlation analysis showed that the difference strains of Klebsiella(Klebsiella spp.)before and after treatment in the spleen deficiency group showed a significant positive correlation with BW,BMI and WC(P < 0.05),and the difference strains of Turicibacter(Turinibacter spp.)before and after treatment in the Pi Xu group showed a significant positive(P < 0.05).There was no significant correlation between the differential strains and appetite VAS scores in both groups(P < 0.05).Conclusion.1.Shu-Mu ACE were effective in treating female AO patients with Pi Xu and Wei Re types,and both had significant effects on the improvement of TCM symptoms and gastrointestinal symptoms.Shu-Mu ACE showed a bidirectional regulation effect on appetite.2.There are obvious differences in intestinal flora between female AO patients with Pi Xu type and Wei Re type and normal people,and Shu-Mu can treat female AO patients with Pi Xu type and Wei Xu type by regulating the different intestinal flora.3.The mechanism of the bidirectional regulation of appetite in female AO patients by Shu-Mu ACE may be related to the adjustment of intestinal flora composition,which needs further study.