Study On The Treatment Of Ascites Caused By Liver Cirrhosis Due To Spleen Deficiency And Water Retention By The Method Of "cultivation, Recruitment And Disbanding" And Network Pharmacolog

OBJECTIVE:The purpose of this study is to investigate the clinical efficacy of the"nourishing,raising,and dispelling" method in treating cirrhotic ascites of the spleen-deficiency and water-stagnation type.The study aims to explore the effects of this method on improving liver function,reducing ascites,alleviating clinical symptoms,and promoting the regression of liver fibrosis.In addition,this study aims to investigate the potential mechanisms of Lagenaria siceraria in treating cirrhotic ascites based on network pharmacology.METHODS:A single-arm clinical trial was conducted with inclusion and exclusion criteria established.This study aimed to recruit 45 patients with cirrhotic ascites of the spleendeficiency and water-stagnation type as clinical research subjects.From February 2022 to October 2022,45 patients diagnosed with cirrhotic ascites of the spleen-deficiency and waterstagnation type who received treatment at the outpatient clinic of Professor Xu Chunjun of Beijing Traditional Chinese Medicine Hospital affiliated to Capital Medical University were collected.They were given a customized prescription based on the "nourishing,raising,and dispelling" method called "Shengyang Sangu Decoction" for treatment.The treatment course was 12 weeks,during which traditional Chinese medicine symptoms,weight,waist circumference,urine volume,liver function,liver fibrosis indicators,abdominal ultrasound,and other evaluation indicators were measured and collected before and after treatment.After the treatment course,data were statistically analysed to evaluate the efficacy and safety of using the "nourishing,raising,and dispelling" method as the basis for the customized prescription"Shengyang Sangu Decoction" for treating patients with cirrhotic ascites of the spleendeficiency and water-stagnation type.The clinical effective rate was selected as the observation index for efficacy evaluation,and the improvement of clinical manifestations,biochemical indicators,and ascites volume of the patients was observed to assess the effectiveness and safety of treatment based on this method and its generalizability,providing a basis for further clinical and mechanism research.Finally,based on network pharmacology research methods,a network pharmacology analysis was conducted to investigate the potential mechanisms of Lagenaria siceraria in treating cirrhotic ascites.Results:1.Overall efficacy:the total effective rate after treatment was 88.89%;2.Improvement in liver function:compared with before treatment,the AST,ALT,TBIL,and ALB indicators were improved significantly after treatment(P<0.05);3.Improvement in coagulation function:compared with before treatment,the PT indicator was significantly decreased after treatment(P<0.05);4.Improvement in ascites:the 24-hour urine volume,body weight,and ascites grade of the patients improved significantly after treatment compared with before treatment(P<0.05).The 24-hour urine volume increased significantly,while the body weight and ascites grade decreased significantly;5.Improvement in TCM syndrome:the TCM syndrome score of the patients decreased significantly after treatment compared with before treatment(P<0.05);6.Improvement in liver fibrosis:compared with before treatment,the liver fibrosis index was significantly decreased after treatment(P<0.05);7.Safety:during the treatment period,the three routine indicators of the patients and electrocardiogram were normal,and no obvious adverse reactions were found.8.A total of 18 active ingredients and 97 predicted targets were obtained by screening the chemical composition of Lagenaria siceraria.9.A total of 2563 related targets of cirrhotic ascites were obtained by search,and 54 common targets between drugs and diseases were found.10.It involves multiple signalling pathways,such as the MAPK signalling pathway,oestrogen signalling pathway,IL-17 signalling pathway,relaxation factor signalling pathway,cancer pathway,progesterone-mediated oocyte maturation pathway,GnRH signalling pathway,Th17 cell differentiation,prolactin signalling pathway,Thl and Th2 cell differentiation,FoxO signalling pathway,and sphingolipid pathway,etc.11.The main active ingredients,such as cucurbitacin and ALB,EGFR,ESR1 and other target proteins,may be closely related to the therapeutic mechanism of Lagenaria siceraria in treating hepatic cirrhosis with ascites.Conclusion:The prescription "Shengyang Sangu Decoction" based on the "nourishing,raising,and dispelling" method effectively promotes the regression of ascites,improves liver function and coagulation function in patients with cirrhotic ascites of the spleen-deficiency and water-stagnation type,and significantly improves symptoms and quality of life.The treatment plan has definite therapeutic effects and is worth promoting and applying in clinical practice.Additionally,no significant adverse reactions were observed during the treatment,demonstrating that the treatment plan has a high level of safety.The mechanism of Lagenaria siceraria in treating cirrhotic ascites may be related to controlling inflammation,regulating immune response,anti-tumour,protecting liver cells,improving the function of related nutrients such as protein,inhibiting fibrosis,regulating apoptosis and regeneration of liver cells.