| Puru disease is the dysfunction of digestive three fire,it leads to less ground,indigestion,decomposition of food,and excessive mucus accumulation in the stomach,gradually condensed into the liquid,blocking the absorption of nutrition channels,leading to the essence and dross disorder,causing gastric atrophy.In the Western medicine,Puru disease known as "chronic atrophic gastritis",is a digestive disease in western medicine,belongs to “Lhen”,“gastric rust”,“gastric fire failure” etc.,the pathogenesis of the disease is considered as “three fire” dysfunction.Tibetan medicine based on the theory of symdrome differentiation,has a excellent effectiveness,play the advantages and characteristics of Tibetan medicine.However,there are different views for classification of CAG types in Tibetan medicine,it is necessary to use the traditional and modern approaches to further study on classification of CAG,and provide scientific evidence for standardizing diagnosis and treatment.Objective:1.Literature review aims to analyze the historical evolution,pathogenesis,syndromes classification,symptom distribution,efficay and mechanism of Tibetan medicine for CAG.2.Prospective clinical investigation aims to collect 166 patients with CAG,distinguish correlations bewteen macroscopic and microscopic indicators,excavate the clustering characteristics between manifestations and biological markers,and analyze the compatibility of drug use in clinical prescription,the final goal is to provide scientific evidence for the standardization of clinical diagnosis and treatment.Methods:1.In literature search,selecting CAG related classic and modern literature,collected recorded in the “Lhen”,“gastric rust”,“gastric fire failure”and other pathogenesis,syndrome differentiation,symptoms and treatment,and prescriptions record of effective cases reported.2.In clinical investigation,through strict quality control and cross-sectional epidemiological survey to collect clinical manifestations;using 14C-urea breath test,double antibody one-step sandwich enzyme-linked immunosorbent assay,enzyme-linked immunosorbent assay(ELISA)methods to collect microscopic information in patients with CAG;establishing four diagnostic information database,gastroscopic and pathological information database,serum micro-index database,prescriptions database;using SPSS20.0 software for data analysis,and use traditional Chinese medicine inheritage software to ananlyse the patern of prescription.Hypothesis:There is a close correlation between macroscopic representation and microscopic indicators in human life phenomena.The existing data show that microscopic markers of chronic atrophic gastritis are related to the clinical manifestation of macroscopic level.TCM syndrome type classification of chronic atrophic gastritis has shown that the biological basis of different syndromeshas different expression,which opens up a new way for Tibetan medicine to study the syndrome classification and symptom distribution of the disease.Therefore,this subject will draw on the research methods and ideas of TCM Atrophic gastritis syndrome classification and biomarker correlation research,to explore the biological basis of Tibetan medicine classification on CAG.Results:1.literature results: the CAG etiology views are “three factors” disorders,inner and external factors combined,exogenous cold and heat due to misrepresentation,increased phlegm condensed in stomach channels,diet and emotional disorders,“three stomach fire" dysfunction,air and blood blocked in stomach.Syndrome type and scopic category:Weak-failure type,cold type,hot type,phlegm-wind type,phlegm type,scopic category such as gastricfailure,phlegm disease,Puru disease,gastritis.Efficacy and mechanism:the best endoscopic effective rate is 86%,the best pathologic biopsy effective rate is 86.6%,the best symptomic effective is 97.1%,mechanism including increase the blood flow of gastric mucosa,improve microcirculation,inhibit and kill a variety of bacteria(Hp).Compatibility principles:the highest using for tastes such as bitter,followed by sweet,the highest using for the effectiveness such as cold,followed by hot,the highest potency using for single medicinal herbs such as Fructus Amomi Kravanh,Semen Punicae,Fructus Piperis Longi,Radix Inulae Helenii,Gypsum Calcitumrubrum Calcite,and Flos Carthami Tinctorii,etc,the highest using dosage for Tibetan formulae having with Gypsum Calcitumrubrum Calcite,Semen Punicae,Fructus Amomi Kravanh,Fructus Phyllanthi Emblicae,Herba Dracocephali tangutici.2.Clinical four diagnostic characteristics: Wind type related four diagnostic information are fatigue,noisy,weight loss,anxiety,upset,insomnia,depression,constipation,hollow beating,blue urine color,medium urine steam size,medium urine smell,medium urinary sediment,medium urinary coat,urine foam large and blue,tongue color red,tongue color black,thin tongue coating;bile type related four diagnostic information are chest burn,mouth bitter,acid,sternum back pain,hands and feet heart burning,pain,tight beating,quick beating,expanded beting,hard beating,strong beating,rolling beating,urine color yellow,urine color red,urine yellow brown,big urinary steam,urinary smell strong,urinary sediment thickness,urinary coat thickness,quick disappearance of urinary foam,tongue color yellow,tongue color brown,thick tongue coat;phlegm type related four diagnostic information are fullness,lossing appetite,stomach noisy,upper abdominal discomfort,belching,forgetfulness,diarrhea,weak beating,sunken beating,slow beating,loosed beating,decling beating,urine color white,urine steam small,urine smell small,urinary sediment thin,urinary coating thin,urine foam saliva-like,tongue color white,tongue coat medium.3.Association between macroscopic and microscopic indicators(P≤0.05): wind-type four diagnostic information are associated with gastric body erosion,gastric body bleeding,gastric body congestion,gastric bile reflux,large curvature of folds,Hp positive,degree of Hp positive value,neutrophil infiltration degree,pepsinogen I value,gastrin G17 value,degree of hyperplasia,intestinal metaplasia degree;bile-type four diagnostic information are associated with gastric body erosion,gastric mucus attachment,gastric body bleeding,gastric body congestion,gastric bile reflux,large curvature of folds,atrophic degree,hyperplasia degree,intestinal metaplasia degree,Hp positive,Hp positive degree,neutrophil infiltration degree,gastrin G17 value,mononuclear cell infiltration degree;phlegm-type four diagnostic information are associated with gastric mucosal attachment,gastric body erosion,gastric body bleeding,gastric body congestion,large curvature of folds,gastric antral blood vessels revealed,Hp positive,degree of Hp positive value,hyperplasia degree,intestinal metaplasia degree,neutrophil infiltration degree,mononuclear cell infiltration degree,gastrin G17 value,PGI/PGII ratio,pepsinogen II value;blended-type four diagnostic information are associated with gastric body congestion,large curvature of folds,intestinal metaplasia degree;bile and wind type four diagnostic information are associated with gastric body erosion,gastric body congestion,gastric mucosal attachment,Hp positive,gastrin G17 value,hyperplasia degree;bile and phlegm type four diagnostic information are associated with gastric body erosion,gastric body congestion,gastric mucosal attachment,gastric body bleeding,large curvature of folds,Hp positive,atrophic degree,mononuclear cell infiltration degree,gastrin G17 value;phlegm and wind type four diagnostic information are associated with gastric body congestion,gastric mucosal attachment,gastric body bleeding,Hp positive,Hp positive degree,gastrin G17 value.Pulse postions showed that right and left index fingers,right and left middle fingers,and right ring finger.4.Clustering characteristics(P≤0.05): cluster in 6 showed that there are five types such as wind type,bile type,phlegm type,phlegm and bile type,and blended type,indicating that Hp positive is associated with phlegm,phlegm-bile,bile type,gastric mocusal attachment is associated with phlegm-bile,and blended type;cluster in 5 showed that there are four types such as wind,bile,phlegm,and blended types,and indicating that Hp negative is associated with blended type,Hp postivie is associated with phlegm and bile types;cluster in 4 showed that there are four types such as wind,bile,phlegm and blended types,and indicating that Hp negative is associated with blended,phlegm-wind,Hp positive and Hp positive degree are associated with bile type;cluster in 3 showed that there are four types such as wind,bile,phlegm,and blended types,and indicating that Hp negative,Hp positive and Hp positive degree are associate dwith blended type;cluster in 2 showed that there are three types such as wind,bile,and phlegm.Altogether it showed that basically there are wind,bile,phlegm,and blended types,the cluster 3 analysis is typical model to show the characteristics of four diagnostic distribution.In addition,Hp positive is associated with phlegm,bile,phlegm-bile,and blended types,gastric mucosal attachment is associated with phlegm-bile,blended types,Hp negative is associated with blended and phlegm-wind types,Hp positive is associated with bile and blended types.Clustering Charstristics of macroscopic and microscopic indicators(P≤0.05): clustering 3 characteristics showed there are six types such adwind,bile,phlegm,phlegm-bile,phlegm-wind,and blended types,and indicating that Hp degree is associated with wind,phlegm,phlegm-bile,phlegm-weind,bile types,gastric body bile reflux and gastric mucus attachment are associated with phlegm-bile and phlegm types,gastrin G17 and large gastric flattened folds are associated with blended type.5.Prescription pattern of data mining result:the top 10 herbs are Fructus Terminaliae Chebulae,Radix Aucklandiae,Flos Carthami Tinctorii,Fructus Amomi Rotundus,Fructus Piperis Longi,Semen Punicae,Semen Myristicae,Radix Inulae Helenii,Fructus Phyllanthi Emblicae,Moschus;association rules:Semen Punicae≥Fructus Amomi Rotundus,confidence is 0.875,Lignum Aquilariae Resinatum ≥Radix Aucklandiae,confidence is 0.88,Fructus Piperis Longi,Flos Caryophylli ≥Radix Aucklandiae,confidence is 0.88,Lignum Aquilariae Resinatum,Radix Aucklandiae≥ Semen Myristicae,confidence is 0.93,Flos Carthami Tinctorii,Radix Aucklandiae≥Fructus Terminaliae Chebulae,confidence is 0.93,Corydalis impatiens≥ Fructus Phyllanthi Emblicae,confidence is 0.93,Lignum Aquilariae Resinatum≥ Semen Myristicae,confidence is 0.94,Fructus Piperis Longi,Semen Punicae≥Fructus Amomi Rotundus,confidence is1;usage pattern: gets 13 single herbs containing 25 pairs of herbs,these are including Radix Aucklandiae,Fructus Terminaliae Chebulae,Fructus Piperis Longi,Fructus Amomi Rotundus,Flos Carthami Tinctorii,Semen Punicae,Radix Inulae Helenii,Fructus Phyllanthi Emblicae,Semen Myristicae,Radix Aucklandiae,Flos Caryophylli,Moschus,Corydalis impatiens so on,finally the data mining approach extracted 4 new prescriptions.Conclusion:1.Litreture research concluded that CAG affliated“Phlegm type gastric disease” in Tibetan medicine,and “three gastric fire”disfunction is the basic pathogenesis.There are seven kinds of syndrome types such as weak-failure type,cold type,hot type,wind-phlegm type,wind type,bile type and phlegm type,all types can be attributed to wind,bile and phlegm.Tibetan medical therapy showed a unique effectiveness and advantages of Tibetan medicine for CAG.The mechanism of efficacy is mainly to increase the blood flow of gastric mucosa,improve microcirculation,inhibit and kill the role of a variety of bacteria.From the using principle of taste,potency,and dosage.It reveals that the compatibility of formulae has followed Tibetan medical theory.2.Four diagnostic characteristics show that phlegm type related clinical manifestations are most frequent,indicating phlegm type CAG is higher prevalence,which is followed the rule of Tibetan medicine so called “gastric diease is caused by phlegm increasing”.3.The correlation between macroscopic and microscopic indicators showed that there are seven types such as wind type,bile type,phlegm type,wind and bile type,wind and phlegm type,phlegm and wind type,and blended type,wich characteristics in line with Tibetan medical disease classification.4.Clustering of macroscopic and microscopic indicators show that the cluster 3 analysis istypical model to present the characteristics of four diagnostic distribution with syndrome types of CAG in Tibetan medicine.5.Using TCMISS platform software to analyze the prescription data,obtained frequency of herbal usage,association rules,core and new potential formulea,the majority of drugs in line with nourishing stomach and increasing "three digestive fire" to help stomach function,those are main ingredients for treating Phlegm and stomach disease,which also supported the theory of Tibetan medicine to cure CAG with phlegm principle.Innovative Idea:1.It newly discovered the syndrome of CAG in Tibetan medicine divided into seven types such as wind type,bile type,phlegm type,mixed type,wind-bile type,wind-phlegm type,bile-phlegm type,this differentiation is followed the rule of Tibetan medical theory.2.It revealed the correlation between the four diagnostic information and the microscopic index of chronic atrophic gastritis,and provides scientific basis for its diagnosis and treatment.3.It explored the correlation between syndromes and microcosmic indicators of chronic atrophic gastritis,and provide objective basis for the classification of syndromes.4.It concluded that CAG caused by phlegm,and affliates to “Phlegm stomach disease”,“three stomach fire”dysfunction is the basic pathogenesis from Tibetan medical perspective. |
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