最新刊期
卷 46 ， 期 5 ， 2023
- 摘要：We combine the theory of healthy qi and pathogenic factors in traditional Chinese medicine (TCM) with the theory of immunology in western medicine, and we realized that rheumatic immune disease is predominantly caused by excessive pathogenic factors and declined healthy qi. "Healthy qi" refers to the influencing factors that maintain the normal physiological function of the human body and the optimal state of life, and "pathogenic factors" refers to all pathological factors that cause immune abnormalities, or pathological products that damage the body tissues and viscera due to immune abnormalities. We clarified the biological connotation of pathogenic factors such as wind, cold, and dampness, so as to objectify and modernize the etiology of TCM. In TCM treatment of rheumatic immune disease, the disease condition should first be clarified, and the focus should then be placed on the main contradictions, clearing the order of priority, making use of the respective advantages of both TCM and western medicine. Eliminating pathogenic factors and reinforcing healthy qi is considered as the basic treatment principle of rheumatic immune diseases.关键词：rheumatic immune disease;theory of healthy qi and pathogenic factors;excessive pathogenic factors and declined healthy qi;pathogenesis;treatment principles
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发布时间：2023-06-05 - 摘要：ObjectiveWe aimed to (i) explore the biological basis of rheumatoid arthritis (RA) with liver-kidney deficiency (LKD) pattern using gene set enrichment analysis (GSEA) and weighted gene co-expression network analysis (WGCNA) method and (ii) identify and clinically validate candidate biomarkers.MethodsTranscriptome sequencing was carried out on whole blood samples from RA patients with LKD pattern(3 cases), RA patients with other seven TCM patterns(3 cases each), and healthy volunteers(4 persons). Differentially expressed gene (DEG) sets of RA with LKD pattern were screened using healthy control samples and other TCM patterns as controls. Then, biological functions of DEGs were investigated by enrichment analysis and functional annotation. After that, the gene expression profiles were mined by GSEA and WGCNA to obtain key DEGs as candidate biomarkers for RA with LKD pattern. The expression levels of the candidate biomarkers were experimentally determined by qPCR using an independent clinical cohort (not less than 12 cases/group), and their clinical efficacy was assessed using receiver operating characteristic (ROC)curve analysis.ResultsDEGs of RA with LKD pattern were most significantly enriched in the "inflammation-immune", cell regulation, and metabolic pathways, and also involved in biological processes such as liver and kidney development and metabolism. The GSEA result of the gene expression profiles indicated that the DEGs of RA with LKD pattern were more significantly involved in hepatic function (lipid, blood) metabolic regulation-, renal function (water, salt, hormone) metabolic regulation-, and neurological regulation-related pathways than those of RA with other TCM patterns. The expression profiles of 17 010 genes were categorized into 19 functional modules through WGCNA, three of which were significantly positively correlated with LKD (r>0.300, P<0.05), and their biological functions mainly included "immune-inflammatory" regulation. After integrating the GSEA and WGCNA result, three key genes (ALOX5, PNPLA8, ASF1A) that ranked in the top 50% in terms of coefficient of variation and representativeness of pathway and biological modules were selected as candidate biomarkers for RA with LKD pattern. Further validation of the clinical independent samples and evaluation of the ROC model showed that the sensitivities of ALOX5, PNPLA8, and ASF1A were 88.89%, 100.00%, and 100.00%, their specificities were 84.51%, 76.47%, and 78.69%, their accuracies were 85.00%, 79.49%, and 80.00%, their precision was 88.89%, 100.00%, and 100.00%, and their values of area of ROC curve were 0.860, 0.910, and 0.900, respectively.ConclusionThis study applied the "GSEA-WGCNA-validation" integration strategy to identify novel biomarkers of RA with LKD patterns. The validation result of the independent sample set showed that they have good clinical efficacy, which may help improve the accuracy of clinical diagnosis of core RA patterns and the depth of objective research on the TCM patterns.关键词：rheumatoid arthritis;liver-kidney deficiency pattern;transcriptomics;gene set enrichment analysis;weighted gene co-expression network analysis;ALOX5;PNPLA8;ASF1A
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发布时间：2023-06-05 - 摘要：ObjectiveWe aimed to evaluate whether the Chinese medicine compound Xinfeng Capsule (XFC) is associated with the incidence of endpoint events (readmission, extra-articular lesions, and surgical treatment) in patients with ankylosing spondylitis (AS).MethodsClinical data were retrospectively collected from 1 621 AS patients discharged from the Department of Rheumatology and Immunology of the First Affiliated Hospital of Anhui University of Chinese Medicine between June 2012 and June 2022. XFC users and non-XFC users were defined as the XFC group and non-XFC group, respectively. Propensity score matching was used to match baseline data. A random walk model was used to evaluate the effects of western drugs combined with XFC treatment on the improvement of immunoinflammatory indexes. Association rules were used to analyze the association between XFC and improvement of clinical immunoinflammatory indexes in AS. Multivariate COX analysis including XFC, gender, age, hypertension, diabetes, hyperlipidemia, osteoporosis, hepatic insufficiency, and chronic hepatitis B was performed to determine the risk of readmission, extra-articular lesions, and surgical treatment.ResultsA total of 1 455 patients with AS were included. After propensity score matching, baseline data for XFC users were consistent with those for non-XFC users, with 203 cases in each group. Retrospective data mining showed that XFC significantly reduced clinical immunoinflammatory markers in patients with AS, and random walk result suggested that XFC treatment was associated with long-term improvement in immunoinflammatory markers. The result of association rule analysis showed that XFC was strongly associated with the improvement of immune inflammatory markers. The prognosis of the overall endpoint events was better in XFC users compared to non-XFC users (χ2=11.678, HR=0.65, 95%CI=0.500-0.810, P<0.01). The risk of endpoint events was significantly lower in XFC users with high exposure intensity (HR=0.504, 95%CI=0.357-0.711) and moderate exposure intensity (HR=0.576, 95%CI=0.380-0.873) than in non-XFC users.ConclusionThe herbal compound XFC is associated with a lower incidence of endpoint events (readmission, extra-articular lesions, and surgical treatment) in AS; long-term exposure to XFC may significantly reduce the occurrence of endpoint events.关键词：ankylosing spondylitis;retrospective cohort study;Xinfeng Capsule;endpoint events
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发布时间：2023-06-05
Special Theme: TCM Prevention and Treatment of Rheumatism
- 摘要：Fire is of great significance to human civilization, and its generative nature refers to the important property that fire can only be generated by burning combustible materials. Ancient physicians interpreted disease pathogenesis through metaphorical cognition, mapping the generative nature of fire to the fire pathogen. Generating fire-heat pathogen under the influence of wind, cold, dampness, dryness, traditional Chinese medicine practitioners eventually developed the concept that "six pathogenic factors all can transform into fire". This article first analyzes the formation process of the generative nature of natural fire. We suggest that because the generative nature of fire is deeply rooted in history, ancient physicians tended to place the metaphorical cause of disease, the fire pathogen, in the position of Y when describing the transformation and generation process of pathogenic factors that have the same structure of X∧C→Y, thus constituting the structure of transformation into fire. Then, we discuss the formation and significance of the concept of "six pathogenic factors all can transform into fire", which is a representative pathogenesis, and reveal the specific empirical basis of wind transforming into fire, cold and dampness transforming into fire-heat, and extreme dryness transforming into fire, and we analyze the contribution of each of them to other "transforming into fire" pathogeneses. Finally, we show that the widespread existence of the structure of transforming into fire and the absolute predominance of "transforming into fire" pathogenesis in fire and heat pathogenesis are likely due to the generative nature of fire, which in turn has limited the ability of traditional Chinese practitioners to understand the "transforming into fire" pathogenesis as similar to "six pathogenic factors all can transform into fire" .关键词：fire;fire pathogen;six pathogenic factors all can transform into fire;the structure of "transforming into fire" metaphor
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发布时间：2023-06-05 - 摘要：Through analyzing the views of various experts and collecting the records of testis in ancient and modern literature, this paper summarizes and discusses the visceral manifestation of the testis. The testis is included in the seminal chamber (male cell) and can be attributed to the extraordinary fu-organ. It has the characteristic of "like zang-organ like fu-organ and capable of storing and excreting" .The essence stored in the testis plays a key role in male fertility and female pregnancy, so the testis is also one of the effective organs that reflects the function of the kidney in governing reproduction. Shaped like a ball, the testis is located in the male’s external genitalia, and in ancient times it had names including "egg", "pill", "yin pill", and "drop". Its physiological characteristics are delicate testis, preference for cool and aversion to heat, easy to be susceptible to external forces, temperature, humidity, mood and other factors. Moreover, the testis is yin in property and yang in function, which manifests as follows: the anatomical testis filling with yin essence refers to yin in property, while the testicular functions based on kidney qi refer to yang in function. Based on physiological characteristics, the testis is crucial for the production, storage, and excretion of reproductive essence. It promotes the development of male reproductive organs and thereby ensures male fertility and female pregnancy.关键词：testis;extraordinary fu-organ;reproductive essence;theory of visceral manifestation;seminal chamber
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发布时间：2023-06-05 - 摘要：The theory of "lubricant drugs dredging qiao" is an important clinical theory stating that lubricant drugs are used to open and activate the orifices of the human body and treat the diseases of qiao with adverse body fluid. The modern theory of lubricant drugs is usually regarded as "using lubricant drugs to nourish qiao" and "removing and opening the block". This paper discusses the theory of "lubricant drugs dredging qiao" from the perspectives of theoretical development, promoting qiao, and the application of yinqiao. It is believed that as an important branch of the theory of lubricant drugs, this theory originated from ancient traditional food culture, was influenced by the theory of "qiao", and was gradually improved by the combination of the theory of qiao and the theory of property and taste of drugs. On the one hand, the role of "dredging" should be emphasized in "lubricant drugs dredging qiao", and should be related to "nourishing". In addition, it is also believed that moistening and nourishing means "dredging", rather than nourishing deficiency alone. On the other hand, it is also emphasized that the theory of "qiao" must be classified carefully. With regard to the diseases of yinqiao, lubricant drugs can be used to dredge the water channel so that the qiao can open, so as to effectively treat stranguria and uroschesis. Further clarifying the connotation, formation, and expansion trend of "lubricant drugs dredging qiao" is of great value for improving the theoretical system of modern traditional Chinese medicine, expanding the theory of property and taste of drugs, the clinical application of lubricant drugs, and the treatment of urinary system diseases.关键词：lubricant drugs;lubricant drugs dredging qiao;difficult excretion of yinqiao;theoretical discussion
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发布时间：2023-06-05 - 摘要：Systematic understanding of "flaccidity syndrome" disease in traditional Chinese medicine began with the Huangdi Neijing, which explains very detailedly compared with other diseases. Based on text tracing, combined with medical explanation and clinical thinking, this paper further summarizes the definition and development of "flaccidity syndrome". By combining the origin and flow of flaccidity syndrome in Huangdi Neijing with related descriptions in ancient literature, we point out that the occurrence of "flaccidity syndrome" starts from the lung, is related to the stomach, and is caused by the lung scorched by heart. The etiology of "flaccidity syndrome", which is injured by heat, is closely related to dampness, and the onset is mainly due to the dryness of meridians. The change in flaccidity syndrome, starting from the upper body, is related to the lower body, and eventually leads to exhaustion if not treated. Syndrome differentiation and treatment of flaccidity is based on "taking Yangming alone" with the method of "clearing heart fire and nourishing kidney water". Clinical syndromes also need to be treated by targeting "flaccidity syndrome with symptoms", or later flexible "flaccidity syndrome with arthralgia", in order to correct the causes and symptoms of flaccidity.关键词：flaccidity syndrome;Huangdi Neijing;syndrome differentiation and treatment;thinking;traditional Chinese medicine
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发布时间：2023-06-05 - 摘要：Radiotherapy occupies an important position in comprehensive cancer treatment, and radiation injury is an important bottleneck that limits its development. "Conghua" theory, which originated from Huangdi Neijing, is an important theory of pathogenesis that summarizes the characteristic law of pathological change. Radiation has the characteristics of high speed, high energy, and high lethality, which accords with the category of "toxic pathogen" in traditional Chinese medicine. Toxic pathogen has the obvious characteristic of "conghua" .After the radiation toxin damages the body, according to the yin and yang attributes of the physical difference and invaded site, it transforms into a yang toxin or yin toxin, respectively, which may be a key link in the evolution of radiation injury. The radiation toxin invades the yin-deficient and dry-heat constitutions, or yang fu-organs and exterior sites, which are easy to change from yang to "heat-toxin", "dryness-toxin", and "wind-toxin" ; and it invades the yang-deficient and cold-dampness constitutions, or yin zang-organs and interior sites, which are easy to change from yin to "phlegm-toxin" and "stasis-toxin" .Therefore, in the treatment of radiation injury, it is necessary to distinguish the yin and yang bias of the constitution, the internal and external parts of the viscera, and the slow and urgent stages of the disease to identify the pathological state caused by various kinds of toxic pathogens, examine pathogenesis, and provide treatment according to syndrome differentiation. Based on the connotation of "conghua" theory and the pathogenic characteristics of radiation, this paper discusses the laws of pathological evolution and syndrome change in radiation injury, in order to provide new directions for the clinical treatment of radiation injury.关键词：conghua;radiation injury;toxic pathogen
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发布时间：2023-06-05
Theoretical Studies
- 摘要：ObjectiveWe aimed to summarize the clinical manifestations and traditional Chinese medicine (TCM) patterns of infected patients with SARS-CoV-2 Omicron variant(hereinafter called "COVID-19" ) in Beijing, Hebei, and Shandong in the winter of 2022.MethodsA questionnaire survey was carried out with the "Questionnaire Star" online service among adult COVID-19 patients, and the demographic information, medical history, and clinical symptoms were recorded. The characteristics of TCM patterns were summarized by systematic clustering analysis and factor analysis.ResultsA total of 196 cases were included. Most of the patients were young or middle-aged. More than 40% of the patients were healthcare workers. The most frequently used medicines were Lianhua Qingwen (a traditional Chinese patent medicine and simple preparation), ibuprofen, and acetaminophen. The early symptoms of COVID-19 patients were fever, chilliness, headache, and muscle/joint pain. In the middle stage of COVID-19, the proportion of sore throat and sputum increased. The incidence of cough, chest tightness, and loose stool increased at the late stage of the disease. Factor analysis and cluster analysis showed that COVID-19 was mainly located in the defensive exterior and lung, related to spleen. The nature of the disease was mostly intermingled deficiency and excess. The main patterns were dampness toxin with pathogenic cold on the exterior, internal retention of damp-heat, dampness stagnancy due to spleen deficiency.ConclusionThe pathogenesis of COVID-19 is obstruction of defense yang by dampness-toxin pestilence, with exogenous pathogenic wind cold. With disease progression, the dampness toxin pestilence might transform into heat and dryness or into spleen deficiency with dampness stagnancy. However, some patients show the pattern of internal damp-heat at the beginning of the disease.关键词：coronavirus disease 2019;Omicron variant;TCM pattern;factor analysis;cluster analysis
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发布时间：2023-06-05 - 摘要：ObjectiveWe aimed to explore the syndrome evolution of re-positive COVID-19 patients who were infected with SARS-CoV-2 Omicron variant BA.1 and to provide a reference for Chinese medicine-based treatment of COVID-19.MethodsCollecting the medical records of patients infected with Omicron variant BA.1 from January to March 2022 in Qiboshan Hospital and Port Hospital in Henan Province. Selecting 61 patients who have re-positive after infection as the re-positive group, and 60 normal negative patients admitted at the same time as the control group. The TCM syndromes were diagnosed in 1, 4, 7, 14, 21, and 30 days after hospital admission.ResultsExamination of syndrome evolution in the control group revealed: exterior syndrome, dampness-heat encumbering the lung syndrome, epidemic toxins blocking the lungs, and deficiency syndrome(mainly qi and yin deficiency). Similarly, examination of symptomatic evolution in the re-positive group revealed dampness-heat encumbering the lung syndrome, epidemic toxins blocking the lungs, and deficiency syndrome(mainly qi and yin deficiency). In the re-positive group, the syndrome changed from excess to deficiency in (20.00±8.54) days, and the final successful turning negative occurred after (31.79±7.93) days. Re-positive occurred after (28.27±8.55) days. In the control group, the syndrome type changed from excess to deficiency in (12.89±2.77) days, and finally turned negative after (18.78±6.29) days.ConclusionSyndrome evolution in re-positive patients is as follows: 1-14 days are dominated by dampness and heat encumbering the lung syndrome, which then develops to the extreme stage of epidemic toxins blocking the lung syndrome. The late stage and recovery period of the disease in 14-30 days mainly involve a deficiency syndrome, mostly deficiency of qi and yin. The course of disease in re-positive patients is longer than that in patients with common turning negative conversion.关键词：COVID-19;Omicron variant BA.1;re-positive;syndrome evolution;disease course
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发布时间：2023-06-05
COVID-19 Theme
- 摘要：ObjectiveWe aimed to construct an animal model of combining disease with syndrome of yin deficiency and yang hyperactivity with attention deficit hyperactivity disorder (ADHD) in children, so as to promote the development of new drugs for the treatment of ADHD.MethodsYoung spontaneously hypertensive rats (SHR) were used as ADHD model rats. SHR were randomly divided into four groups according to body mass(n=8): the SHR group, the model group, the Xiaoer Huanglong Granule low dose (XEHL-L) group (1.88 g/kg) and the Xiaoer Huanglong Granule high dose (XEHL-H) group (3.75 g/kg). The WKY group and the Wistar group were also set up (n=8). Rats in the model group, the XEHL-L group and the XEHL-H group were subcutaneously injected with levothyroxine sodium (0.3 μg/g) daily for 14 days, and rats in the other groups were subcutaneously injected with normal saline. From the 11th day, rats in the XEHL-L group and the XEHL-H group were given drugs by gavage for 21 days, and rats in the other groups were given normal saline by gavage. The diet volume, water volume, defecation volume, urine volume, heart rate, respiratory rate, and specific values of the tongue image red vector (R), green vector (G) and blue vector (B) were used as evaluation indicators of the syndrome of yin deficiency and yang hyperactivity. The degree of autonomous activity, the degree of social preference, the ability of attention set transfer and the degree of irritability were used as the behavioral indexes of ADHD to evaluate the model.ResultsCompared with the model group, the heart rate of rats in the other groups was decreased (P<0.05), the respiratory rate of rats in the SHR group and the XEHL-H group was decreased (P<0.05, P<0.01), and the G and B values of tongue images of rats in the WKY group and the XEHL-H group were decreased (P<0.05). The degree of autonomic activity showed that except for the central area residence time, all indexes in the model group were higher than those in the WKY group (P<0.05), and the distance in the central region was higher than that in the SHR group (P<0.05). The degree of social preference showed that compared with the Wistar group, rats in the model group spent less time with strangers and the ratio of time with strangers was lower (P<0.01). The attention set transfer ability test showed that the error rate in the EDS reverse learning stage was lower in the XEHL-L group than in the model group (P<0.05). The irritation experiment showed that the aggressive behavior in the model group was increased compared with that in the WKY group (P<0.05).ConclusionA more stable and reliable model of ADHD syndrome with yin deficiency and yang hyperactivity can be obtained by injecting young SHR with levothyroxine sodium.关键词：attention deficit hyperactivity disorder;yin deficiency and yang hyperactivity syndrome;animal model of combining disease with syndrome;levothyroxine sodium
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发布时间：2023-06-05 - 摘要：ObjectiveTo investigate the attenuating effect of reverse compatibility of psoralea corylifolia on rat liver and the underlying mechanism.MethodsAccording to the random number table method, 80 SD rats were divided into the blank group, the model group, the psoralea corylifolia group, the psoralea corylifolia + polygonum multiflorum 1∶1 group, the psoralea corylifolia + polygonum multiflorum 1∶2 group, the psoralea corylifolia + polygonum multiflorum 2∶1 group, the psoralea corylifolia + rehmannia glutinosa 1∶1 group, the psoralea corylifolia + schisandra chinensis 1∶1 group, with 10 rats in each group. Rats in all groups except for the blank group were subcutaneously injected with hydrocortisone (25 mg/kg) once a day for 14 days to establish a rat model of kidney yang deficiency. After the model of kidney yang deficiency was established, the rats were given corresponding drugs for 4 weeks; the drug dose was 12.6 g/kg in each group. HE staining was used to observe the pathological changes of rat liver tissue. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), direct bilirubin (DBIL) and total bilirubin (TBIL) and the expression levels of superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione peroxidase (GSH-Px) in liver tissue were detected by ELISA. The mRNA expression levels of NF-E2-related factor 2 (Nrf2), Kelch-like epichlorohydrin-related protein 1 (Keap1), heme oxygenase-1 (HO-1), and quinone oxidoreductase NADH1 (NQO1) were detected by real-time PCR. The protein expression levels of phosphorylated AMPK (p-AMPK), phosphorylated GSK-3β (p-GSK-3β), Nrf2, and HO-1, which were involved in the AMPK/GSK-3β/Nrf2 signaling pathway, were determined by Western blotting.ResultsCompared with the psoralea corylifolia group, the structure of hepatic lobules in rats was improved and the inflammatory infiltration cells were reduced after the compatibility of psoralea corylifolia and medicinals for replenishing yin such as polygonum multiflorum, rehmannia glutinosa and schisandra chinensis. Compared with the psoralea corylifolia group, the serum levels of AST, ALT, ALP, DBIL, and TBIL of rats in the psoralea corylifolia+ polygonum multiflorum 1∶2 group, the psoralea corylifolia+ rehmannia glutinosa 1∶1 group, the psoralea corylifolia+ schisandra chinensis 1∶1 group were reduced (P<0.01); the expression levels of SOD, GSH-Px and MDA in liver tissue of rats were improved in psoralea corylifolia+ polygonum multiflorum 1∶2 group (P<0.01); the mRNA levels of Nrf2, HO-1, and NQO1 were up-regulated (P<0.01) and the mRNA level of Keap1 was down-regulated (P<0.01) in the psoralea corylifolia+ polygonum multiflorum 1∶2 group; the protein expression levels of p-AMPK, p-GSK-3β, Nrf2, and HO-1 were increased in the psoralea corylifolia+ polygonum multiflorum 1∶2 group, the psoralea corylifolia+ polygonum multiflorum 2∶1 group, the soralea corylifolia+ rehmannia glutinosa 1∶1 group, and the soralea corylifolia+ schisandra chinensis 1∶1 group (P<0.05, P<0.01).ConclusionThe compatibility of psoralea corylifolia and medicinals for replenishing yin polygonum multiflorum, rehmannia glutinosa and schisandra chinensis can improve the liver injury caused by psoralea corylifolia. The mechanism may be to activate the AMPK/GSK-3β/Nrf2 signaling pathway and inhibit the oxidative stress state to play a protective role in the liver. The compatibility ratio of psoralea corylifolia and polygonum multiflorum 1∶2 has the best attenuation effect.关键词：psoralea corylifolia;reverse compatibility;hepatotoxicity;AMPK/GSK-3β/Nrf2 signaling pathway;rats
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发布时间：2023-06-05
Experimental Studies
- 摘要：Hashimoto disease patients are often accompanied by inherited special constitution, and Hashimoto disease and allergic diseases often coexist. There is a correlation between disease-constitution-pattern. This paper dissects the definition and relationship between allergic diseases, inherited special constitution, and Hashimoto disease and explores the theoretical basis for the treatment of Hashimoto disease based on inherited special constitution, including the consistent formation and pathological characteristics of both. It is proposed that the pathogenesis of Hashimoto disease in allergic patients is due to dysfunction of the lung, spleen, and kidney, with spleen deficiency being the main cause. The treatment is based on invigorating spleen for benefiting qi, anti-allergic effects for regulating constitution, and strengthening vital qi for eliminating goiter. In clinical practice, we use a combination of Guominkang and Fuzheng Xiaoying Decoction with modification. Three steps involved in the treatment of Hashimoto disease. Firstly, to differentiate the constitution of the patients, which is helpful to get the transformation trend of the disease; secondly, to tell the allergic comorbidity by which the exact prescriptions is applied; finally, to distinguish the severity of allergic disease, which decide the strategy of anti-allergic or strengthening vital qi. Allergic constitution-based treatment of Hashimoto disease is a specific application of combined differentiation constiution and disease in the modern treatment of Hashimoto disease, which can help to broaden and inspire the Chinese medical treatment of Hashimoto disease and improve the clinical efficacy.关键词：Hashimoto disease;inherited special constitution;allergic diseases;anti-allergic and regulating constitution;TCM constitution
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发布时间：2023-06-05 - 摘要：ObjectiveWe aimed to determine the minimum clinically important difference (MCID) of three different item versions of the Constitution in Chinese Medicine Questionnaire (CCMQ), to facilitate the clinical application of CCMQ.MethodsIn total, 537 subjects were included in the analysis. All subjects voluntarily completed a comprehensive of traditional Chinese medicine (TCM) constitution intervention (mood, diet, daily living, exercise, and acupoints). The subjects filled out the 60-item CCMQ and the Short Form Health Questionnaire (SF-36) at baseline and 3 months after the intervention. The result of the 41-item and the 30-item CCMQ were scored according to the result of the 60-item CCMQ. An anchor-based approach and a distribution-based approach were used to estimate the MCID of the three versions of the CCMQ. The anchor of the anchor-based approach was SF-36 item 1, and the analysis method were the mean change method and multiple linear regression. The standardized response mean (SRM) was used for the distribution-based approach.ResultsThe mean change method and multiple linear regression estimation result were averaged and rounded to whole numbers. The MCID values of the 60-item CCMQ of balanced type, qi-deficiency type, yang-deficiency type, yin-deficiency type, phlegm-dampness type, dampness-heat type, blood-stasis type, qi-depression type, and special diathesis type were 5, -5, -3, -3, -4, -4, -4, -4, and -2, respectively. The MCID values of the 41-item CCMQ were 4, -6, -4, -2, -4, -4, -4, -4, and -2, respectively. The MCID values of the 30-item CCMQ were 5, -5, -4, -3, -4, -5, -4, -5, and -2, respectively. The MCID values estimated by the anchor-based approach were higher than those estimated when SRM was 0.2, except for the special diathesis type.ConclusionThe MCID values of three different versions of the CCMQ estimated in this study can reflect the minimum score change of the CCMQ considered important and meaningful by patients, which is helpful for doctors in explaining the effect of TCM constitution intervention or setting intervention targets.关键词：TCM constitution;constitution in Chinese medicine questionnaire;minimum clinically important difference;quality of life;clinical evaluation
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发布时间：2023-06-05
TCM Constitutions
- 摘要：In recent years, the application scope of grounded theory research in the field of traditional Chinese medicine (TCM) has gradually expanded, and the various research needs such as "Dao and Shu(doctrines and techniques)" of illustrious senior TCM practitioners can be met. However, this research requires significant time and energy because of too much code, long study period and rework the meaning of code. Therefore, in this paper, on the premise of conforming to coding principles, we creatively propose a method named "cascaded coding" that uses Office Word to code the raw materials and then imports cascaded codes into Office Excel in order to clarify all categories and the concepts at all levels attached to them. Furthermore, mind-map software is used to visualize the cascaded codes. This cascaded process is discussed in this paper, and the grounded theory is taken as an example to analyze the Dao of an illustrious senior TCM practitioner-Prof. Kong Guangyi. Based on the methodology of grounded theory coding principles, we optimize the operation path and simplify the coding process, saving time, ensuring coding efficiency and accuracy, and providing an example for researchers who conduct grounded theory research on illustrious senior TCM practitioners, thus help more TCM qualitative researchers to carry out grounded theoretical research convenienty, accurately and at low cost.关键词：grounded theory;cascaded coding;optimized operation path;illustrious senior TCM practitioners;qualitative research
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发布时间：2023-06-05 - 摘要：By analyzing the physiological characteristics of "liver-blood-heart-vessel" and "liver heart harmony" in traditional Chinese medicine, it can be seen that "disease involving liver and heart" is more common in clinic, which is the core pathogenesis basis for the clinical prevention and treatment of metabolic-associated fatty liver disease (MAFLD) and atherosclerosis (AS). "Stagnation of liver and heart, obstruction of heart vessel", "deficiency of liver and heart, intermingled phlegm and blood stasis", and "disharmony of liver and heart, toxin damaging vessels and collaterals" are the core pathogenesis evolution rules of MAFLD combined with AS, reflecting the transformation process of "stagnation→deficiency→toxin". Combined with the pathological characteristics of cholesterol metabolism disorder and mitochondrial dysfunction and the causal relationship of their cross transformation, the microscopic syndrome differentiation value of the "disease involving liver and heart" in the prevention and treatment of MAFLD combined with AS is observed. The stage-tailored treatment strategies are adopted, such as smoothing liver and regulating qi, regulating heart harmonizing vessel; nourishing liver and protecting heart, resolving phlegm and removing blood stasis; protecting liver and nourishing heart, removing toxicity and dredging collaterals, in order to provide a useful reference for clinical differentiation and treatment of MAFLD combined with AS.关键词：disease involving liver and heart;metabolic-associated fatty liver disease;atherosclerosis;pathogenesis;treatment
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发布时间：2023-06-05
Thought and Method
- 摘要：Among all atypical gastroesophageal reflux disease (GERD)-related symptoms, chest pain is the most important one. The theory of "relevance of stomach and heart" can guide the discussion on traditional Chinese medicine connotation and pathogenesis of GERD-related chest pain. We named GERD-related chest pain as "alimentary epigastralgia". Its pathological mechanism is failure of gastric qi to descend, combined with obstruction of thoracic collaterals. The disease location is the esophagus and stomach, resulting in pain in esophagus and heart. The syndrome can be divided into four types: liver qi affecting the stomach, phlegm dampness obstructing, stagnant blood obstructing the collaterals, and inactivity of thoracic yang. The commonest clinical subtype is inactivity of thoracic yang, which is caused by disordered qi activity, ascending of turbid yin, and obstruction due to phlegm and qi. In clinical practice, the main therapeutic principle is to diffuse blockage and free yang and descend qi to resolve phlegm, and the basic formula is Zhishi Xiebai Guizhi Decoction, with variations according to the symptoms. Modern research suggests that abnormal acid reflux, the esophagus-heart reflex pathway, the brain-gut axis, and other important pathogeneses all reflect the theory of "relevance of stomach and heart" .关键词：relevance of stomach and heart;gastroesophageal reflux disease-related chest pain;traditional Chinese medicine connotation;pathogenesis
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发布时间：2023-06-05 - 摘要：Gastroesophageal reflux disease (GERD) is a common clinical disease of the upper gastrointestinal tract. According to traditional Chinese medicine (TCM) theory, its pathogenesis is not only closely related to the liver, gallbladder, spleen and stomach, but also to the heart and lung. Based on the theory of "the upper jiao is cleared, the fluid is brought down, and the stomach qi is harmonized" in Shanghan Lun, our team propose that by adjusting the functions of the heart and lung in the upper jiao, the qi flow of the spleen and stomach in the middle jiao can be restored, which is ultimately conducive to promoting harmonization and descending of the stomach qi in the middle jiao, that is, "clearing the upper jiao with the aim of harmonizing the middle jiao". If the heart and lung of the upper jiao are malfunctioning, it will easily affect the middle jiao, which is not conducive to the harmonization and descending of the stomach qi, thus easily causing GERD to occur. Further combining clinical practice with relevant researches in western medicine, if the functions of the heart governing the blood vessels and spirit are abnormal or the function of the small intestine is abnormal, the person is prone to esophageal visceral hypersensitivity and small intestinal bacterial overgrowth. Furthermore, if the functions of the lung governing dispersion, descending and respiration are abnormal or the function of the large intestine is abnormal, this may cause esophagogastric junction barrier damage and transient lower esophageal sphincter relaxation. All of these eventually lead to GERD. Therefore, the present paper provides a new direction and theoretical basis for the prevention and treatment of GERD by clarifying the influence of heart and lung on GERD. At the same time, it further enriches the theoretical connotation of "the upper jiao is cleared, the fluid is brought down, and the stomach qi is harmonized" .关键词：gastroesophageal reflux disease;Shanghan Lun;upper jiao;heart;lung;pathogenesis
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发布时间：2023-06-05 - 摘要："Eructation" which is also called belching, is the clinical symptom of gas from the stomach escaping through the mouth and producing sound. Doctors across all dynasties have studied the causes, pathogenesis, and location of belching. In this paper, we trace the discussion of belching in Huangdi Neijing and Shanghanlun and investigate the works of representative doctors of the Tang, Jin, Yuan, Ming, and Qing dynasties, exploring belching based on Huang Yuanyu’s theory of "qi cycle in round, soil pivot four organs". According to this theory, the key pathogenesis of belching is deficiency of the stomach and adverse rising of qi, which can cause stagnation of liver qi, flaming of gallbladder fire, stagnation of lung-qi, dysfunction of heart-qi, other symptoms of yin and yang, qi and blood, and blood imbalance in zang-fuorgans. Treatment of belching should be based on reinforcing qi of the middle-jiao and regulating four organs by regulating the stomach to descend gastric qi in the whole course of the disease and nourishing heart, ventilating lung, soothing the liver, and clearing gallbladder fire, in order to harmonize the function of kidney and liver. In summary, we hope to provide a reference for clinical treatment of belching.关键词：qi cycle in round, soil pivot four organs;belching;theory of traditional Chinese medicine
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发布时间：2023-06-05 - 摘要：ObjectiveWe aimed to explore the distribution characteristics of composite patterns of coronary heart disease with depression (CHDD).MethodsA questionnaire was designed based on the characteristics of traditional Chinese medicine (TCM) patterns of 3 446 CHDD patients, and a cross-sectional survey method was used to recruit CHDD patients in three hospitals in Beijing. A total of 312 CHDD patients were investigated between November 1, 2020 and October 31, 2021. Latent structure analysis was conducted to examine the high-frequency symptoms and tongue-pulse manifestations (frequency > 10%) by the Bridged Islands algorithm.ResultsIn total, 47 high-frequency symptoms and 11 high-frequency tongue-pulse manifestations in 312 CHDD patients were selected, including palpitation, shortness of breath, fatigue, chest pain, and depressed mood. A total of 18 latent variables were obtained by constructing a latent structure (latent tree) model, reflecting the seven disease elements of qi deficiency, qi stagnation, yin deficiency, yang deficiency, blood stasis, qi stagnation, and phlegm-dampness and the five disease locations of heart, liver, gallbladder, spleen, and kidney. A comprehensive cluster analysis of 18 latent variables was conducted, and three TCM composite pattern types were inferred, namely (i) a pattern of qi deficiency of both heart and gallbladder with stagnation of liver qi and blood stasis (72% of the total population), (ii) a pattern of spleen and kidney yang deficiency with phlegm-qi stagnation (62% of the total population), and (iii) a pattern of disharmony of heart and kidney with internal retention of damp-heat (59% of the total population).ConclusionThe clinical pattern types of CHDD patients are not a single TCM deficiency pattern or excess pattern, but present three complex patterns with deficiency, blood stasis, and depression as the core pathogenesis. The pattern of qi deficiency of both heart and gallbladder with stagnation of liver qi and blood stasis is the key pattern of CHDD. The present study provides a reference for further improvement of the clinical TCM treatment of CHDD.关键词：coronary heart disease with depression;latent structure analysis;cross-sectional survey;composite pattern;pattern of qi deficiency of both heart and gallbladder;pattern of stagnation of liver qi and blood stasis
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发布时间：2023-06-05
Clinical Studies
- 摘要：Based on the theory of visceral manifestation in traditional Chinese medicine, this paper explains the correlation between the theory of "the kidney rules bone, generates marrow, and marrow generates blood" in Huangdi Neijing; discusses the pathological relationship with various types of anemia in western medicine; and reviews the origin of the theoretical system of kidney-nourishing therapy in treating anemia, as well as the views and recognition of many famous veteran doctors of traditional Chinese medicine on kidney-nourishing therapy in treating aplastic anemia and other diseases. At the same time, based on the theory of corresponding among prescriptions, syndromes and medicines, and taking the typical Chinese patent medicine Yixuesheng Capsule, which is used to treat aplastic anemia and iron deficiency anemia with kidney-nourishing therapy, as an example, the composition of the prescription is analyzed according to the theory of traditional Chinese medicine, and its modern fundamental research and clinical application effects are summarized. According to the collation and analysis of relevant literature on Yixuesheng Capsule, it is shown that Yixuesheng Capsule has a good effect in treating anemia with few adverse reactions, and it has a good clinical application value, which further proves the scientific and practical nature of the theory of kidney rules bone, generates marrow, and marrow generates blood, and can provide important background information for guiding the clinical treatment of various forms of anemia, such as aplastic anemia, iron deficiency anemia, and pregnancy anemia.关键词：kidney visceral manifestation;kidney rules bone;kidney generates marrow;marrow generates blood;anemia
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发布时间：2023-06-05 - 摘要：The pathogenesis theory of cancer toxin is a system for differentiating and treating cancer toxin established by our team on the basis of the academic thought of cancer toxin proposed by Zhou Zhongying, a master of traditional Chinese medicine. It elaborates the pathogenesis and evolution rule of tumor occurrence and development with cancer toxin as the center, and provides important guidance for clinical tumor differentiation and treatment. According to the pathogenesis theory of cancer toxin, ovarian cancer is located in the uterus and thoroughfare and controlling vessels, and closely related to the liver and kidney. The pathological factors mainly include deficiency, blood stasis, dampness and toxin, among which blood stasis is the focus with toxin contained. The core pathogenesis is deficiency of both liver and kidney and dampness, blood stasis, cancer toxin. The pathogenesis begins with deficiency of the liver and kidney. Then, because of the development of essence, qi and blood deficiency, blood vessels lack nutrition, leading to qi stagnation and blood stasis. As the disease progresses, the body fluid distribution is changed and endogenous dampness combines with blood stasis, which induces the formation of cancer toxin. At last, cancer toxin damages vital qi and aggravates the liver and kidney deficiency. Treatment should focus on the core principle of anti-cancer and detoxification. Removing blood stasis and dispersing dampness are key objective, with nourishment of the liver and kidney as the basis. Based on the pathogenesis theory of cancer toxin and clinical practice, this article explores the pathological factors, core pathogenesis, pathogenesis evolution rules, therapeutic principles and methods of ovarian cancer. This article is mainly aimed at providing new ideas for syndrome differentiation and treatment of ovarian cancer and to further improve the clinical efficacy of ovarian cancer treatment with traditional Chinese medicine.关键词：pathogenesis theory of cancer toxin;ovarian cancer;therapeutic principles and methods;syndrome differentiation and treatment system
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发布时间：2023-06-05
Hematology and Oncology
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