| 1.BackgroundFatty liver disease(FLD)is a clinicopathological syndrome of lipid metabolism disorder and dynamic imbalance in the liver caused by various etiologies,resulting in lipid accumulation in hepatocytes and steatosis of hepatocytes.At present,the incidence of fatty liver disease is increasing year by year.and it has become the most important chronic liver disease in the world.Up to now.the pathogenesis of this disease is not very clear in Western medicine,and there is no recognized effective treatment drugs in clinic.In contrast,under the guidance of the overall concept and the theory of syndrome differentiation,TCM has less adverse reactions to prevent and treat fatty liver disease,showing greater advantages.In recent years.Chinese medicine has done a lot of research on fatty liver disease,and the academies have basically reached a consensus on the understanding of fatty liver disease.They have formulated relevant guidelines and norms for the diagnosis and treatment of Chinese medicine for clinical reference.However,these opinions still have many shortcomings and problems,which are not conducive to the full play of the advantages and characteristics of traditional Chinese medicine,and need to be further explored and studied after a lot of clinical practice.On the other hand,as the leader of TCM,famous veteran TCM doctors represents the highest academic level of contemporary TCM,is an expert with rich clinical experience and the main force to solve difficult disease problems.Therefore,it is of great significance to systematically study the rules of TCM treatment of fatty liver disease for improving the theoretical understanding of TCM treatment of fatty liver disease and enriching the thinking of diagnosis and treatment.2.AimThis paper is an in-depth study based on the project of clinical experience and academic thought inheritance of veteran TCM doctors in the 10th Five-Year Plan,11th Five-Year Plan,and the Project of "Heritage of Famous Doctors" of Chinese Academy of Traditional Chinese Medicine.On the basis of studying the ancient literature and the research progress of modern Chinese and Western medicine on fatty liver disease.this paper systematically summarizes the rules of syndrome and treatment of fatty liver disease in contemporary famous veteran TCM doctors based on the literature,clinical medical records of more than one hundred famous veteran TCM doctors and the analysis of academic characteristics and clinical medical cases of Professor Yao Naili in treating fatty liver disease.Summary of common experience and comparative analysis of individual experience in the treatment of fatty liver disease.In order to improve the level of syndrome differentiation and treatment of fatty liver disease,the knowledge atlas of famous and veteran TCM doctors was constructed and explored3.Methods(1)The understanding of fatty liver disease in traditional Chinese medicine,combined with the relevant literature and ancient books from the theory of Chinese medicine and clinical treatment of fatty liver disease.(2)This paper summarizes 137 documents and 493 clinical cases of 1469 cases of Fatty Liver Disease treated by more than one hundred famous veteran TCM doctors.The experience of Fatty Liver Disease treated by famous veteran TCM is analyzed by using various data analysis and mining methods,man-machine combination,and human-centered,in order to summarize its common law and individual experience,including name,etiology and pathogenesis,syndrome.Characteristics,prescription law,etc.(3)ProfessorNaili Yao’s academic opinions on the treatment of fatty liver disease and 340 patients of628 clinicary medical records were summarized.Data mining method was used to summarize the characteristics of differentiation and treatment of fatty liver disease and the law of differentiation and medication.(4)To explore the application of knowledge map in the study of the inheritance of the experience of famous veteran TCM doctors and the rule of disease syndrome and treatment,and to explore the construction of famous veteran TCM doctors treatment of fatty liver disease,in order to better inherit the experience of TCM and improve the clinical level of TCM.4.Results4.1 Literature study on the regularity of syndrome and treatment of fatty liver disease treated by famous veteran TCM doctorsThe results are as follows:(1)Name of disease:there are 25 kinds of TCM names discussed in the literature of famous veteran TCM doctors’ clinical experience in treating fatty liver disease,among which the first five are "xietong"."jiju","tanzheng","ganpi" and "jizheng",with "xietong”as the most common.However,"xietong"."jiju","tanzheng","jizheng"belong to a group of diseases that represent a wide range of specificity is too poor to be named properly.Among them,"hepatopathy" has a strong specificity,but its recognition is not high enough,which indicates that there is no consensus on the name of fatty liver disease in TCM.(2)Etiology and pathogenesis:understanding of the etiology,basically reached agreement,with inappropriate diet emotional disorders,heavy drinking,loss of work and leisure,chronic illness and body deficiency as the main causes.Pathogenesis:spleen deficiency,liver failure,phlegm and blood stasis,liver depression and spleen deficiency,blood stasis.(3)Syndromecharacteristics:there are many clinical syndromes of fatty liver disease in literature.The common syndromes are liver depression and spleen deficiency,damp-heat accumulation,phlegm-blood stasis,phlegm-dampness internal obstruction,liver depression and Qi stagnation,liver and kidney insufficiency,Yin deficiency of liver and kidney,spleen deficiency and dysfunction of liver and spleen,etc.(4)Therapeutic methods:invigorating the spleen,promoting blood circulation,soothing the liver,resolving phlegm,regulating qi,clearing away dampness and heat,removing dampness,removing dampness,removing turbidity and Invigorating Qi are the basic therapies of famous veteran TCM doctors in treating fatty liver disease.among which invigorating the spleen is the most frequently used.In clinical application,famous and veteran Chinese medicine is often combined with many therapies.For example,the combination of two therapies of invigorating spleen and soothing liver,invigorating spleen and activating blood,soothing liver and activating blood,activating blood and resolving phlegm;the combination of three therapies of invigorating spleen,soothing liven activating blood,invigorating spleen,resolving phlegm and activating blood;the combination of the four therapies of the most common is invigorating spleen,soothing liver,resolving phlegm and activating blood.in order to achieve the purpose of treating the disease in many aspects and synthetically differentiating(5)Characteristics of using herbal:A total of 155 kinds ofprescription were used,including 102 self-made prescriptions,53 time prescriptions and classical prescriptions.The use of self-made prescriptions mainly reflected that personalized treatment was more prominent in the treatment of fatty liver disease with traditional Chinese medicine.These self-made prescriptions are based on syndrome differentiation and treatment,according to their own experience,according to the combination of additions and subtractions of related agents.In addition to self-made prescriptions,commonly used prescriptions are Erchen Tang.Xiaoyaosan,ChaihuShugan San.consistent decoction,Yinchenhao Tang.Sinisan,Xiaochaihu Tang.XuefuZhuyu Tang.LonsdanXiegan Tang,FuyuanHuoxue Tang and so on.(6)Characteristics of using herbs:208 kinds of traditional Chinese medicine were used,1674 times.Commonly used Chinese medicines are Ze Xi,Dan Shen.FuLing,Chai Hu,Chao Jue Ming Zi,Sheng Shan Zha,Chao Shan Zha,Bai Shao,Chen Pi,Yu Jin,Fa Ban Xia.Yin Chen,Huang Qi,Chi Shao,Dang Gui,Cu E Zhu,Hu Zhang,etc.Drugs are widely used in 16 categories,the most of which are tonifying deficiency and diuresis,followed by activating blood circulation and removing blood stasis,digesting and clearing away heat.The regularity of medication reflects the pathological characteristics of spleen deficiency in fatty liver disease.(7)Core Drugs:Core medicines of therapeutic agents includeZe Xi,Dan Shen,Chai Hu.Chao Jue Ming Zi,Sheng Shan Zha,Chao Shan Zha.Bai Shao,Chen Pi,Yu Jin,Fa Ban Xia.Yin Chen.Huang Qi,Chi Shao,Dang Gui,Cu E Zhu,Hu Zhang,He Ye,Chao ZhiQiao,Zhi He Shou Wu,Chao Cang Zhu,Chao Zhi Shi,Gan Cao,ChuanXiong.Jiang Hou Pu.Dang Shen,Hai Zao,Mu Xiang.According to the different syndromes,these drugs constitute the core prescriptions.Their effects are eliminating dampness and promoting blood circulation,invigorating spleen and soothing liver,eliminating accumulation and resolving phlegm,clearing away dampness and heat,which reflects the basic pathogenesis and complexity of the disease,and can not be treated with drugs such as invigorating spleen and soothing liver alone.On the other hand,we should pay attention to the application of related therapies such as dispelling dampness and activating blood circulation,resolving phlegm and eliminating accumulation,clearing away dampness and heat.4.2Clinical medical case study on the regularity of syndrome and treatment of fatty liver disease treated by famous veteran TCM doctorsThe results are as follows:(1)Clinical features:the common clinical manifestations are fatigue,right flank pain,loose stool.bitter mouth,dry mouth,abdominal distention.stupor,yellow urine,poor sleep and dizziness.The tongue is white,red,yellow,dark,dark red,greasy,dull and toothed on the edge of the tongue.The pulse pattern is mainly composed of strings,fine,sinking and slippery pulses.(2)Syndrome characteristics:common TCM syndromes include phlegm and blood stasis,liver collateral disharmony,heat and toxicity.liver and spleen disharmony,dampness and heat accumulation,liver depression and spleen deficiency.liver Yang hyperactivity.Yin deficiency and Yang hyperactivity,phlegm turbidity.liver and gallbladder dampness and heat.etc.(3)Name of disease:there are 64 kinds of TCM diseases related to fatty liver disease.The top five diseases are:hepatic rubella,hypochondriac pain,vertigo,hepatopathy and hepatopathy.Because "rubella" and "addiction" are often used interchangeably,the number of "hepatopathy" and "hepatopathy" can be counted together,accounting for 33%of all cases recorded(977 times).Hypochondriac pain and vertigo contain more diseases and lack of them.Specificity,it is difficult to consider as a disease name.Liver is the traditional name of disease.As the name of"liver accumulation" of the five Zang organs,it should be considered from the overall name of the disease.From the above analysis,it shows that there is no unified understanding of the name of fatty liver disease,but most doctors consider that hepatopathy or hepatic rubella is more appropriate,hepatopathy is also in the scope of consideration,while other names are less recognized.So the name of fatty liver disease needs further study.(4)Including Western Medicine Diseases:174 kinds of concurrent Western medicine diseases are involved,which are widely distributed,but generally speaking,the main concurrent diseases have obvious regularity.The top 10 concurrent Western medicine diseases are hyperlipidemia,hypertension,diabetes,chronic hepatitis B,chronic gastritis,gallbladder polyp,abnormal liver function,impaired glucose tolerance,hepatic cyst,high blood pressure,diabetes,chronic hepatitis B,chronic gastritis,gallbladder polyp,abnormal liver function,abnormal glucose tolerance.hepatic cyst Uracidemia.(5)Therapeutic methods:Common therapies include activating blood circulation,soothing liver,resolving phlegm,invigorating spleen,clearing away heat,detoxifying,removing turbidity,clearing away dampness and heat,regulating qi and removing dampness.Because the pathogenesis and syndromes of fatty liver disease are intertwined,the treatment should also be multi-method.The two treatments are most commonly used in soothing liver and promoting blood circulation,promoting blood circulation and resolving phlegm,soothing liver and resolving phlegm,clearing heat and activating blood circulation,clearing heat and detoxifying.The three therapies are used to soothe the liver,remove phlegm,promote blood circulation.detoxify,promote blood circulation,clear heat,remove phlegm.promote blood circulation,clear heat,dissolve phlegm,detoxify,promote blood circulation,dissolve phlegm,detoxify and clear heat.The most common combination of the four therapies is detoxification,phlegm-resolving.blood-activating and heat-clearing,followed by detoxification,liver-soothing,blood-activating and heat-clearing.(6)Characteristics of using herbal:a total of 182 kinds of agents were used,of which 107 were self-made prescriptions,75 were time prescriptions and classical prescriptions.The ten most frequently used prescriptions are Xiaoyao San,Sijunzi Tang,Wendan Tang,ChaihuShugan San,Erchen Tang.Liujunzi Tang,Xiaochaihu Tang.DangguiShaoyao San.TianmaGouteng Yin and Sini San.(7)Characteristics of using herbs:456 kinds of traditional Chinese medicine were used.19106 times.Commonly used Chinese medicines are Dan Shen,Yu Jin,FuLing,Ze Xi,Chao Jue Ming Zi,Gan Cao,Bai Shao,Chen Pi,Chai Hu,Yin Chen,Chao Bai Zhu,Chi Shao.He Ye,Huang Qin,Fa Ban Xia.Lai Fu Zi,Dan Gui.Sheng Shan Zha,Chao Shan Zha,Bai Shao,Fa Ban Xia,Huang Qi,Chi Shao.Dang Gui,Cu E Zhu.Huang Lian,Chao ZhiQiao.etc.Drugs are widely used in 16 categories,the most of which are diuresis and tonifying deficiency,followed by activating blood circulation and removing blood stasis,clearing away heatanddigesting.The distribution order of the flavor of the Chinese medicines used was slightly cold.flat.warm,cold and slightly warm.The distribution order of the meridians of Chinese medicines used is liver meridian,spleen meridian,stomach meridian and lung meridian.The characteristics of medication reflect the regularity of medication in the treatment of fatty liver disease by famous veteran TCM doctors,that is."invigorating the spleen and soothing the liver,promoting blood circulation and resolving phlegm.clearing away dampness and heat",which is consistent with the basic pathogenesis of the aforementioned fatty liver disease.(8)Core Drugs:Core medicines of therapeutic agents includeDan Shen,Yu Jin,FuLing,Ze Xi,Chao Jue Ming Zi,Gan Cao,Bai Shao.Chen Pi.Chai Hu.Yin Chen.Chao Bai Zhu.Chi Shao,He Ye.Huang Qin,Fa Ban Xia.Lai Fu Zi.Dan Gui,Sheng Shan Zha.Chao Shan Zha.Bai Shao.Fa Ban Xia.Huang Qi.Chi Shao.Dang Gui.Cu E Zhu.Huang Lian,Chao ZhiQiao.Chui Pen Cao,Sheng Shan Zha,Huang Qi.Hu Zhang.Hai Zao,Lian Qiao,Liu Yue Xue.4.3Professor Naili Yao’s Clinical medical Cases analysis of the regularity of syndrome and treatment of Fatty Liver DiseaseThe results are as follows:(1)Clinical features:Fatigue,fecal runny,poor sleep,dry mouth,belching,epigastric fullness,bitter mouth,right side rib pain,abdominal distention,acid reflux are common.Among them,fatigue occurs most frequently,which is consistent with the statistical analysis of the medical records of famous veteran TCM doctors in the treatment of fatty liver disease,reflecting the key role of the spleen in the pathogenesis of fatty liver disease.The tongue picture is moss dark red,tongue dim and moss yellow greasy.The frequency of pulse appearance is the highest in string pulse,followed by string-fine pulse.(2)Syndrome characteristics:Liver and spleen imbalance,dampness and heat accumulation,dampness stagnation,spleen deficiency,liver depression and spleen deficiency,spleen and stomach weakness,phlegm turbidity,turbid pathogen stagnation,turbid pathogen stagnation,liver and blood deficiency,etc.Among them,the proportion of liver and spleen disorders is much higher than other syndromes.The common TCM syndromes are liver-spleen imbalance and dampness stagnation,liver-spleen imbalance and phlegm turbidity,liver-spleen imbalance and turbidity pathogenic stagnation,liver-spleen imbalance and turbidity pathogenic stagnation,liver-spleen imbalance and turbidity pathogenic stagnation,liver-spleen imbalance and dampness-heat accumulation.It reflects the mentor’s understanding of the basic pathogenesis of fatty liver disease,emphasizing that liver and spleen imbalance is its basic pathogenesis.(3)Name of disease:t There are 19 kinds of TCM diseases related to fatty liver disease.The tutor thinks that the name of fatty liver disease "Gan Pi" can reflect the characteristics of the disease and is more appropriate.(4)Including Western Medicine Diseases:There are 116 kinds of diseases involved in Western medicine.The top 10 diseases are hyperlipidemia,chronic gastritis,hypertension,hepatic cyst,abnormal liver function,diabetes mellitus.impaired glucose tolerance,gallbladder polyp,chronic viral hepatitis B and gastric polyp.The results of the analysis are basically consistent with the medical records of famous veteran TCM doctors in the treatment of fatty liver disease.(5)Therapeutic methods:Common therapies include Invigorating spleen,harmonizing liver and spleen,removing turbidity,removing dampness,soothing liver,clearing dampness and heat,promoting blood circulation,regulating qi,resolving phlegm,etc.The two treatments are mostly used to remove turbidity and invigorate the spleen,remove turbidity and harmonize the liver and spleen,invigorate the spleen and soothe the liver,promote blood circulation and remove turbidity.The three treatments are often combined to remove turbidity,harmonize liver and spleen,promote blood circulation,remove turbidity,soothe liver,invigorate spleen,remove turbidity,invigorate spleen and invigorate blood circulation.(6)Characteristics of using herbal:a total of 27 kinds of agents were used The main clinical prescription is self-made prescription,which is related to the complex and diverse pathogenesis of fatty liver disease,involving multiple viscera,and the mixture of deficiency and excess,cold and heat.Therefore,.the selection of parties should also be based on specific circumstances.The 10 most frequently used Chinese prescriptions in the classical prescriptions are:Sijunzi decoction,Xiaoyao powder,Pingwei powder,DangguiShaoyao powder,ChaihuShugan powder,Erchen decoction,Wendan decoction,Xianglian pill and Sinisan.(7)Characteristics of using herbs:The tutor used 312 kinds of traditional Chinese medicine for the treatment of fatty liver disease,10767 times.Commonly used Chinese medicines are FuLing,Chao Bai Zhu,Dan Shen,Gan Cao,Cu E Zhu,Fa Ban Xia,Chi Shao,Tai Zi Shen,Bai Shao,Dang Gui,Huang Lian,Dou Kou,Jiao Shan Zha,Chai Hu,Mu Xiang,Yin Chen,Chen Pi,Xia Ku Cao,Jiang Hou Pu,Hou Pu Hua,Dang Shen,Ji NeiJing.The most common categories of traditional Chinese medicine are tonifying deficiency and diuresis,followed by clearing away heat,promoting blood circulation and removing blood stasis,phlegm-resolving,cough-relieving and asthma-relieving.The distribution order of the flavor of the Chinese medicines used is sex temperature,flat,slightly cold,cold,slightly warm,etc.The distribution order of meridians of traditional Chinese medicine used is spleen meridian,liver meridian,lung meridian,stomach meridian,etc.(8)Core formula:FuLing,Chao Bai Zhu,Dan Shen,Cu E Zhu,Fa Ban Xia,Chi Shao,Tai Zi Shen,Bai Shao,Dang Gui,Huang Lian,Dou Kou,Jiao Shan Zha,Chai Hu,Mu Xiang,Yin Chen,Gan Cao,etc.4.4Analysis of common law and individual experience of fatty liver disease treated by famous veteran TCM doctorsIn order to explore the common experience and rules,more than one hundred famous veteran TCM doctors’ literatures and medical records on fatty liver disease were selected and summarized and analyzed by different methods.These famous veteran TCM doctors,regardless of their geographical location,professional level.time span and the information provided.can not fully represent all aspects of academic and experience,but basically reflect the current experience of famous veteran TCM doctors in the treatment of fatty liver disease,so the rule of treatment can be learned and improved for us.On this basis,three famous veteran TCM doctors with the largest number of medical records in the medical records database were selected to conduct personality experience analysis and comparison on treatment,prescription selection and traditional Chinese medicine.Through analysis and comparison,we can see that the famous veteran TCM doctors have basically the same understanding of the pathogenesis of fatty liver disease.It is believed that the pathogenesis of fatty liver disease lies in the liver,which is closely related to the liver and spleen,and is the syndrome of deficiency and deficiency.However,they have their own unique opinions and understandings with different emphasis,either on the false or on the evil.As far as the treatment is concerned,the emphasis is on the deficiency,commonly used methods of invigorating the spleen and soothing the liver.Focus on the evil,commonly used methods such as promoting blood circulation,resolving phlegm,clearing away dampness and heat.As far as prescriptions are concerned,self-made prescriptions are the main ones,reflecting that personalized treatment is more prominent in the treatment of fatty liver disease with traditional Chinese medicine.As far as medication is concerned,it reflects the regularity of medication in the treatment of fatty liver disease by famous veteran TCM doctors,that is,"invigorating the spleen and soothing the liver.promoting blood circulation and resolving phlegm,clearing away dampness and heat",which is consistent with the basic pathogenesis of the aforementioned fatty liver disease.Of course,it also includes the particularity of personal medication habitsTherefore,the analysis,excavation and comparison of personalized experience of famous veteran TCM doctors are helpful for us to further understand the characteristics of individualized diagnosis and treatment and find out and summarize their common experience,so that the experience of famous veteran TCM doctors can be continuously inherited,developed and innovated,and can open up clinical ideas,and inject fresh blood into TCM theory.4.5Exploration on knowledge map construction of fatty liver disease treated by famous veteran TCM doctorsIn this part,we use Neo4j in the graphical database as the database to store the knowledge of famous veteran TCM doctors in the treatment of fatty liver disease,explore and construct the knowledge map of famous veteran TCM doctors in the treatment of fatty liver disease,and take famous veteran TCM doctors as an example to show preliminarily.From the relevant map,we can intuitively understand the relationship between the various information,the relationship between etiology,disease,treatment,prescription and medicine can be clear at a glance,on this basis,we can further theoretical analysis,for learning and inheriting the experience of famous and veteran TCM add a new method,for inheriting the academic ideas of famous and veteran TCM has important significance.However,the method of knowledge atlas is still in the exploratory stage and needs to be further improved in order to increase its visibility,importance and achieve the purpose of solving practical problems in clinical practice,and strive to improve the clinical level of traditional Chinese medicine. |
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