The prescription rule analysis of the New Theory on Spleen Dampness Syndrome by Academician TONG Xiaolin

Objective To analyze the basic characteristics,drug features,prescription rules,and drug-symptom relationships of patients in the splenic deficiency and impairment stage,by data mining of medical records under the New Theory on Spleen Dampness Syndrome(Pi Dan Xin Lun,《脾瘅新论》).Methods Medical records listed in the“New Theory on Spleen Dampness Syndrome-Under-standing and Treatment of Metabolic Syndrome from the Perspective of Traditional Chinese Medicine”,and which were diagnosed with the spleen dampness syndrome at the splenic de-ficiency and impairment stage,during January 2004 and December 2016 were selected.These patients’data,including basic information,clinical symptoms,laboratory examination res-ults,traditional Chinese medicine(TCM)and western medicine diagnoses,treatment meth-ods,prescriptions,etc.,were collected.The collected data were subsequently compiled into a medical record database using the Epidata 3.1 data management software,followed by the use of Apriori algorithm provided in the SPSS Modeler 14.2 statistical software to investigate the association rules between drug-drug,drug-symptom,and drug-western medicine indices.Results(i)A total of 51 medical records were included,involving 17 types of syndromes.Among them,the top three with frequency≥3 included“Phlegm and blood stasis,and thoracic obstruction”“Deficiency-weakness of the spleen Qi,and static blood blocking collat-erals”,and“Deficiency-weakness of the spleen Qi,and static blood blocking collaterals”.Al-ternatively,of the 14 treatment methods,the top three treatments with frequency of≥3 in-cluded“Activating Yang and eliminating turbidity,and removing phlegm and dredging chan-nel blockage”“Strengthening the spleen and benefiting Qi,and eliminating phlegm to activ-ate the channels”,and“Warming Yang and benefiting Qi,and expelling cold to remove ob-structions”.Among the 15 prescriptions,the top three used with frequency≥3 included Huangqi Guizhi Wuwu Tang(黄芪桂枝五物汤),Gualou Xiebai Banxia Tang(瓜蒌薤白半夏汤),and Ganjiang Huangqin Huanglian Renshen Tang(干姜黄芩黄连人参汤).Lastly,of the 83 drugs used for a total of 476 times,those with frequency≥15 included Huanglian(Coptid-is Rhizoma),Huangqi(Astragali Radix),Jiudahuang(Wine-processed Rhei Radix et Rhizoma),Jixueteng(Spatholobi Caulis),Shengjiang(Zingiberis Rhizoma Recens),Huangqin(Scutellariae Radix),and Guizhi(Cinnamomi Ramulus).(ii)For the drug-drug associations,under the criteria of support≥15%and confidence=100%,seven second-order association rules,seven third-order rules,and six fourth-order roles were identified.The top-ranking rule of each was“Huangqin(Scutellariae Radix)→Huanglian(Coptidis Rhizoma)”“Ganjiang(Zingiberis Rhizoma)+Huangqin(Scutellariae Radix)→Huanglian(Coptidis Rhizoma)”,and“Baishao(Paeoniae Radix Alba)+Guizhi(Cinnamomi Ramulus)+Jixueteng(Spatho-lobi Caulis)→Huangqin(Scutellariae Radix)”,respectively.Alternatively,the drug-symptom associations were analyzed under the criteria of support≥5%and confidence=100%,which derived eight second-order association rules,31 third-order rules,and 30 fourth-order rules.The top-ranking association rule of each order was“Huangqi(Astragali Radix)→Limb ed-ema”“Guizhi(Cinnamomi Ramulus)+Jixueteng(Spatholobi Caulis)→Limb numbness and pain”,and“Guizhi(Cinnamomi Ramulus)+Jixueteng(Spatholobi Caulis)+Huangqi(As-tragali Radix)→Limb numbness and pain”,respectively.Similarly,the drug-western medi-cine index associations were investigated under the criteria of support≥5%and confidence=100%,and five second-order association rules,16 third-order rules,and 16 fourth-order rules were identified.In this category,the top-ranking association rule of each order was“Qinpi(Fraxini Cortex)→Uric acid”“Huanglian(Coptidis Rhizoma)+Ganjiang(Zingiberis Rhizoma)→Glycated hemoglobin”,and“Huanglian(Coptidis Rhizoma)+Ganjiang(Zing-iberis Rhizoma)+Huangqin(Scutellariae Radix)→Glycated hemoglobin”,respectively.Conclusion Through association rule mining,this study objectively and quantitatively demonstrated the drug-drug,drug-symptom,and drug-physicochemical index associations of patients with the spleen dampness syndrome at the splenic deficiency and impairment stage treated by Academician TONG Xiaolin.The results indicated that treatment for these patients adopted the“state-target”syndrome differentiation method.The drug combination was characterized by“small prescriptions”,targeting both the patient’s symptoms and signs(syndrome target)and western medicine indices(treatment target).This study could provide references for future research on the academic thoughts and medical experience of Academi-cian TONG Xiaolin.

Abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type

Objective:To explore the abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type.Methods:The 30 healthy individuals included in the method were from the Physical Examination Center of Anhui Provincial Hospital of Traditional Chinese Medicine,and the 60 rheumatoid arthritis patients included were from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine.The disease activity score of patients with rheumatoid arthritis was evaluated using VAS score and DAS28 score,joint symptoms and spleen deficiency syndrome score were evaluated using graded quantification method,immune inflammation indicators were detected using relevant instruments,inflammatory cytokines were detected using ELISA method,macrophage markers were detected using FCM method,and pathway gene expression was detected using RT-qPCR;Evaluate the predictive effect of circ-CBLB and miR-486-5p on disease activity in rheumatoid arthritis using ROC curves.Results:(1)miR-486-5p,CD14^(+)CD86^(+),ESR,CRP,RF,Anti CCP Ab,IL-6,TNF in patients with rheumatoid arthritis-αThe levels of circ-CBLB,CD14^(+)CD163^(+),IL-4,and IL-10 were significantly higher than those of healthy individuals;(2)The expression level of circ-CBLB in patients with rheumatoid arthritis is positively correlated with CD14^(+)CD163^(+),and negatively correlated with miR-486-5p and CD14^(+)CD86^(+);The expression level of miR-486-5p is negatively correlated with CD14^(+)CD163^(+)and positively correlated with CD14^(+)CD86^(+);There is a negative correlation between CD14^(+)CD86^(+)and CD14^(+)CD163^(+);ESR is negatively correlated with circ-CBLB,and positively correlated with miR-486-5p,CD14^(+)CD86^(+),CRP;CRP is negatively correlated with circ-CBLB,CD14^(+)CD163^(+),and positively correlated with CD14^(+)CD86^(+),ESR;(3)The expression level of circ-CBLB in patients with rheumatoid arthritis is negatively correlated with joint tenderness,morning stiffness,lack of qi and lazy speech,and postprandial abdominal distension score;The expression level of miR-486-5p is positively correlated with the scores of joint tenderness and decreased appetite.(4)The ROC curve shows that in terms of circ-CBLB,ESR,CRP,VAS,and DAS28 AUC are 0.662(P=0.032),0.658(P=0.035),0.516(P=0.830),and 0.791(P=0.000),respectively.In terms of miR-486-5p,ESR,CRP,VAS,and DAS28 AUC were 0.566(P=0.385),0.511(P=0.883),0.592(P=0.223),and 0.727(P=0.003),respectively.Conclusion:The abnormal expression of circ CBLB and miR-486-5p in peripheral blood mononuclear cell of patients with rheumatoid arthritis of spleen deficiency and dampness excess type is related to inflammatory polarization markers,immune inflammation,disease activity,joint symptoms and spleen deficiency syndrome of rheumatoid arthritis,and the low expression of circ CBLB and high expression of miR-486-5p have certain predictive value for disease activity of rheumatoid arthritis.

Exploration and Study of Jianpi Qushi Powder Combined with Standard Anti HP Quadruple Therapy in the Treatment of HP Infectious Gastritis of Spleen Deficiency and Dampness Stagnation Type

Objective: To explore the therapeutic effect of traditional Chinese medicine Jianpi Qushi powder combined with standard anti-HP quadruple therapy in the treatment of HP infectious gastritis with spleen deficiency and dampness stagnation. Methods: From January 2020 to December 2021, 223 patients with laboratory-confirmed HP infection who were admitted to the Outpatient and Inpatient Department of Internal Medicine in our hospital were selected as the research objects and randomly divided into two groups. 101 patients in the control group were given standard anti HP quadruple therapy;122 cases in the treatment group were given traditional Chinese medicine Jianpi Qushi powder combined with standard anti HP quadruple therapy. The two groups were rechecked carbon breath test after the designed course of treatment, and the curative effects of the two groups were compared. Results: 113 cases in the treatment group were cured by traditional Chinese medicine Jianpi Qushi powder combined with standard anti HP quadruple therapy, and the cure rate was 92.62%. 84 cases in the control group were cured by standard anti HP quadruple therapy, and the cure rate was 83.17%, χ2 = 4.7955, P = 0.0285, the difference was statistically significant (P < 0.05). Conclusion: Traditional Chinese medicine Jianpi Qushi powder combined with standard anti HP quadruple therapy in the treatment of HP infectious gastritis with spleen deficiency and dampness stagnation is one of the best treatment schemes for HP infection. The results of this study achieve the best clinical treatment effect, and provide a more valuable and reliable method for the treatment of gastropathy in clinical internal medicine, which is worthy of popularization and application.

Research Progress of Jianpi Qushi Powder Combined with Standard Anti Hp Quadruple Therapy in the Treatment of Hp Infectious Gastritis with Spleen Deficiency and Dampness Stagnation

Stomach Helicobacter pylori infection is one of the common gastric diseases. Helicobacter pylori infectious gastritis of spleen deficiency and dampness stagnation is a relatively intractable chronic disease. In recent years, traditional Chinese medicine methods have emerged one after another in the treatment of gastric Helicobacter pylori infection. By collecting references, the author reviewed the clinical characteristics of gastric Helicobacter pylori infection and the new progress of traditional Chinese medicine treatment.

Screening the effective components in treating dampness stagnancy due to spleen deficiency syndrome and elucidating the potential mechanism of Poria water extract

Poria is an important medicine for inducing diuresis to drain dampness from the middle energizer.However,the specific effective components and the potential mechanism of Poria remain largely unknown.To identify the effective components and the mechanism of Poria water extract(PWE)to treat dampness stagnancy due to spleen deficiency syndrome(DSSD),a rat model of DSSD was established through weight-loaded forced swimming,intragastric ice-water stimulation,humid living environment,and alternate-day fasting for 21 days.After 14 days of treatment with PWE,the results indicated that PWE increased fecal moisture percentage,urine output,D-xylose level and weight;amylase,albumin,and total protein levels;and the swimming time of rats with DSSD to different extents.Eleven highly related components were screened out using the spectrum-effect relationship and LC-MS.Mechanistic studies revealed that PWE significantly increased the expression of serum motilin(MTL),gastrin(GAS),ADCY5/6,p-PKAα/β/γcat,and phosphorylated cAMP-response element binding protein in the stomach,and AQP3 expression in the colon.Moreover,it decreased the levels of serum ADH,the expression of AQP3 and AQP4 in the stomach,AQP1 and AQP3 in the duodenum,and AQP4 in the colon.PWE induced diuresis to drain dampness in rats with DSSD.Eleven main effective components were identified in PWE.They exerted therapeutic effect by regulating the AC-cAMP-AQP signaling pathway in the stomach,MTL and GAS levels in the serum,AQP1 and AQP3 expression in the duodenum,and AQP3 and AQP4 expression in the colon.

Modulating effects of Astragalus polysaccharide on immune disorders via gut microbiota and the TLR4/NF-κB pathway in rats with syndrome of dampness stagnancy due to spleen deficiency

The syndrome of dampness stagnancy due to spleen deficiency(DSSD)is relatively common globally.Although the pathogenesis of DSSD remains unclear,evidence has suggested that the gut microbiota might play a significant role.Radix Astragali,used as both medicine and food,exerts the effects of tonifying spleen and qi.Astragalus polysaccharide(APS)comprises a macromolecule substance extracted from the dried root of Radix Astragali,which has many pharmacological functions.However,whether APS mitigates the immune disorders underlying the DSSD syndrome via regulating gut microbiota and the relevant mechanism remains unknown.Here,we used DSSD rats induced by high-fat and low-protein(HFLP)diet plus exhaustive swimming,and found that APS of moderate molecular weight increased the body weight gain and immune organ indexes,decreased the levels of interleukin-1β(IL-1β),IL-6,and endotoxin,and suppressed the Toll-like receptor 4/nuclear factor-κB(TLR4/NF-κB)pathway.Moreover,a total of 27 critical genera were significantly enriched according to the linear discriminant analysis effect size(LEfSe).APS increased the diversity of the gut microbiota and changed its composition,such as reducing the relative abundance of Pseudoflavonifractor and Paraprevotella,and increasing that of Parasutterella,Parabacteroides,Clostridium XIVb,Oscillibacter,Butyricicoccus,and Dorea.APS also elevated the contents of short-chain fatty acids(SCFAs).Furthermore,the correlation analysis indicated that 12 critical bacteria were related to the body weight gain and immune organ indexes.In general,our study demonstrated that APS ameliorated the immune disorders in DSSD rats via modulating their gut microbiota,especially for some bacteria involving immune and inflammatory response and SCFA production,as well as the TLR4/NF-κB pathway.This study provides an insight into the function of APS as a unique potential prebiotic through exerting systemic activities in treating DSSD.

Clinical research on using acupuncture to treat female adult abdominal obesity with spleen deficiency and exuberant dampness

OBJECTIVE： To observe the curative effect of acu- puncture at hour-prescriptive points, a method of midnight-noon ebb-flow, to treat female adult ab- dominal obesity with spleen deficiency and exuber- ant dampness. METHODS： Seventy-two patients with adult ab- dominal obesity with spleen deficiency and exuber- ant dampness were randomly divided into a treat- ment group and a control group with 36 patients in each group. Patients in the treatment group were treated with acupuncture at hour-prescriptive points from 9 to 11 AM every day on the principle of taking points along channels in time. Patients in the control group were treated with acupuncture at any time beyond 9 to 11 AM. Patients in both groups were treated for three courses of treatment.treatment group and 78.8% in the control group. The total curative effect in the treatment group was significantly better than that in the control group in reducing body weight, body mass index, waistline, obesity level, and clinical symptoms （P〈0.05）. After treatment, t-test was used on two independent samples to analyze the ratio of waistline to hipline and hipline. A value of 0.01〈P〈0.05 expressed a weaker outcome and similar curative effect be- tween the two groups in reducing ratio of waistline to hipline and hipline of patients. This value indi- cates that the treatment group has no obvious su- periority to that of the control group for curative effect. CONCLUSION： Because it was superior in reducing waistline and body weight of female adult pa- tients suffering from abdominal obesity with spleen deficiency and exuberant dampness, acu- puncture at hour-prescriptive points, a method of midnight-noon ebb-flow, is an effective method to treat obesity.

Chinese Drugs That Invigorate Spleen to Remove Dampness and Activate Blood Circulation to Eliminate Turbid for Retarding Progression of Chronic Renal Failure

Objective: To investigate the effect of Chinese drugs (CD) that invigorate Spleen to remove Dampness and activate the blood circulation to eliminate Turbid for retarding progression of chronic renal failure (CRF).Methods: Thirty-nine patients with CRF were divided into two groups at random: the 18 patients in group A (the control group) were treated with low protein diet and controlling blood pressure and 21 patients in group B (the treatment group) were treated similarly with that of the control group and additional CD. Levels of serous creatinine (SCr), blood urea nitrogen (BUN), blood albumin (Alb), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL) and hemoglobin (Hb) were checked every two months and the rate of progression of CRF was estimated by slope of the creatinine reciprocal (1/SCr) with time (months).Results: Levels of SCr and BUn in group B were lower and HDL higher than those in group A significantly,P < 0.05. Mean slopes of the creatinine reciprocal with time in the two groups were markedly different,P < 0.01.Conclusion: Additional CD treatment based upon the low protein diet and controlling blood pressure could retard the rate of progression of CRF evidently.

Interleukin-12 and interferon-γacting on damp-heat of spleen-stomach syndrome triggered by helicobacter pylori

OBJECTIVE: To investigate the expression of and interleukin-12(IL-12) and interferon-γ(IFN-γ) in relation to the pathology of damp-heat of spleen-stomach syndrome(DHSS) induced by Helicobacter pylori(H. pylori) infection.METHODS: In total, 114 individual gastric mucosal specimens including 83 DHSS, 19 spleen-qi deficiency syndrome(SQD) and 12 from healthy volunteers(CON) were collected by gastroscopy. To explore the relationship between the two syndromes and H. pylori infection, individual samples were tested using rapid urease and methylene blue tests. Hematoxylin and eosin stained sections were examined to grade for the degree of inflammation and inflammatory activity, and expression of IL-12 and IFN-γ was investigated by immunohistochemistry.RESULTS: Statistically significant differences in the degree of inflammation and inflammatory activity were observed between the groups of specimens:DHSS, SQD and CON(P < 0.05). Additionally, greater intestinal metaplasia(IM) and dysplasia were observed in the DHSS group, especially those with H.pylori infection. Expression of both IFN-γ and IL-12 was higher in DHSS samples infected with H. pylori than in uninfected samples and in the CON(P <0.05) but not in the SQD(P > 0.05) groups. Intriguingly, in gastric specimens exhibiting IM and dysplasia, IL-12 translocated from the nucleus into the cytoplasm.CONCLUSION: Our findings suggest that IL-12 and IFN-γ are involved in DHSS pathology, but not in SQD, acting as healthy-Qi. DHSS is not just the consequence of those two cytokines but results from the cross-talk between a number of cytokines and/or other proteins, which may warrant further investigation in DHSS patients infected with H. pylori.

Comparison of the effect of low-frequency electroacupuncture on serum leptin and NPY contents of male and female patients with simple obesity

Objective To explore the difference of low-frequency electroacupuncture in regulating serum leptin and neuropeptide Y（NPY） of male and female patients with simple obesity due to spleen deficiency and damp exuberance. Methods Eighty patients with simple obesity, including 37 males and 43 females, were included in this study. In both groups（male group and female group）, Yīnlíngquán（阴陵泉 SP 9）, Sānyīnjiāo（三阴交 SP 6）, Zúsānlǐ（足三里 ST 36）, Fēnglóng（丰隆 ST 40）, Qūchí（曲池 LI 11）, Tiānshū（天枢 ST 25）, Zhōngwǎn（中脘 CV 12）, Shuǐfēn（水分 CV 9）, Qìhǎi（气海 CV 6）, and Guānyuán（关元 CV 4）. were selected, and low-frequency electroacupuncture treatment was applied. Needles were retained for 30 min. The treatment was conducted once a day, and 10 times were considered as one course of treatment. Two courses were needed. The changes of weight, BMI（body mass index）, F%（fat percentage） and serum leptin and NPY contents of patients in the two groups before and after treatment were observed and analyzed comparatively. Results After treatment, in male group, the weight lost（9.24±2.55） kg, BMI reduced by 4.19±2.30, F% reduced by 3.98±2.13, serum leptin level reduced by（0.66±0.23） ng/m L, and serum NPY level reduced by（18.56±2.89） pg/m L; in female group, the weight lost（6.77±2.31） kg, BMI reduced by 2.65±0.93, F% reduced by 4.98±2.30, serum leptin level reduced by（3.49±1.09） ng/m L, and serum NPY level reduced by（11.21±1.97） pg/m L. The results reduced significantly when compared with the level before treatment（P〈0.05, P〈0.01）. The loss of weight, BMI and serum NPY content in male group was more obvious than that in female group（all P〈0.01）, and the loss of F% and serum leptin content in female group was more obvious than that in male group（both P〈0.01）. Conclusion Low-frequency electroacupuncture can significantly regulate the weight, BMI, F% and serum leptin and NPY contents of male and female patients with simple obesity, and there are gender differences. In terms of reducing weight, BMI and serum NPY content, the efficacy of low-frequency electroacupuncture in males is superior to that in females, while in terms of reducing F% and serum leptin content, the efficacy in females is superior to that in males.