The Correlation Between The Distribution Of TCM Syndromes Elements And Biochemical Indexes Of CARAS And The Clinical Evaluation Of Wenyang Tongqiao Formula

Object: To explore the characteristics of the TCM evidence of CARAS and its correlation with clinical biochemical indices,and to establish the basic evidence of CARAS;to explore the bioinformatics basis,clinical efficacy and safety of the treatment of allergic rhinitis-asthma syndrome with Wenyang Tongqiao formula and its effect on relevant laboratory indices,and to provide a reference basis for the clinical diagnosis and treatment of CARAS from the perspectives of molecular mechanism,TCM diagnosis and treatment,theory and prescription and safety.Methods: Evidence element study: A retrospective study was conducted to collect patients with CARAS who met the inclusion criteria,develop the evidence element identification scale and collect relevant data from the patients into an Excel database,calculate the weight of the evidence elements corresponding to each symptom and sign of the patients,conduct corresponding statistical analysis using SPSS 26.0,explore the distribution of the evidence elements,summarize the common types of CARAS according to the results of the cluster analysis combined with expert discussion,and correlate the evidence elements with general data and the evidence elements with physical and chemical indicators.The results of the clustering analysis were combined with expert discussions to identify the common types of TCM symptoms in CARAS,and correlations were made between the evidence elements and general data,and between the evidence elements and physical and chemical indicators.Bioinformatics study: TCMSP and Swiss Target Prediction were used to obtain relevant drug targets.We searched and collected human disease targets of allergic rhinitis and asthma in OMIM,Dis Ge NET,Drugbank and TTD databases,and intersected them with drug targets to obtain potential targets for the treatment of CARAS with Wanyang Tongqiao Formula.Clinical study: CARAS patients who met the inclusion criteria were collected and treated with budesonide formoterol powder inhaler and montelukast sodium tablets in the control group,and the Wenyang Tongqiao were given additional warm yang and tonics formula.Pulmonary ventilation function,ACT score value,total CARAS symptom score,CARAS nasal symptom score,total effective rate,peripheral blood eosinophils,serum Ig E and other laboratory indexes were observed in both groups before and after treatment after 4 weeks of continuous medication,and SPSS26.0 was applied for corresponding statistical analysis.Results:Evidence study: CARAS is mainly located in the lung and spleen,and in the long term,the kidney and heart.The main pathogenic factors are wind,cold,qi deficiency,yang deficiency and phlegm-drink.The combination of multiple pathogenic factors is more common clinically,and most of them are mixed with deficiency and reality.As age increases the renal elements are more likely to be diagnosed,and men are more likely to be diagnosed than women.The kidney elements are less likely to be diagnosed in spring,summer and autumn than in winter;the spleen elements are more likely to be diagnosed with age and more likely to be diagnosed in winter;the superficial elements become less diagnostic with age and are more likely to be diagnosed in spring than in winter;the cold elements are more likely to be diagnosed in winter than in the other three seasons;the qi deficiency elements are less pronounced with age;and the yang deficiency elements are more likely to be diagnosed in spring than in winter.The Yang deficiency element is more likely to be diagnosed in winter.By Spearman’s correlation analysis,eosinophils were statistically positively correlated with external wind and qi deficiency,and statistically negatively correlated with phlegm;total cholesterol was statistically positively correlated with phlegm and qi deficiency,and statistically negatively correlated with external wind;lg E was not significantly correlated with any of the evidence elements;lung function FEV1/FVC was statistically positively correlated with yang deficiency,and statistically negatively correlated with external wind and cold.Cluster analysis showed that the common TCM evidence types of CARAS were: wind and phlegm blocking the lung,lung spleen qi deficiency,cold drinks vaporizing the lung,phlegm-heat stagnating the lung,spleen deficiency and dampness trapping,and kidney yang weakening.Bioinformatics study: The core targets of Wanyang Tongqiao Formula for CARAS are ALB,IL6,TNF,AKT1 and IL1β,and the key pathways are TNF,PI3K-Akt,calcium ion,Toll-like receptors and HIF-1.Molecular docking showed that kaempferol,β-sitosterol and lignocaine were able to bind stably to the core targets.Clinical study: The Wenyang Tongqiao group outperformed the control group in terms of pulmonary function FEV1/FVC(%),total PEF(L/S),total CARAS symptom score,nasal symptom score and ACT score.Conclusion:1.The initial stage of CARAS is located in the lung and spleen,while the disease is prolonged and injures the kidney and heart;qi and yang deficiency are the basis of the pathogenesis of CARAS,phlegm is a potential pathological factor throughout the pathogenesis of CARAS,wind and cold are the main triggers of CARAS,and the pathological factors are mostly mixed with deficiency and reality.2.Common TCM symptoms are: wind and phlegm blocking the lung,lung spleen qi deficiency,cold drinks in the lung,phlegm and heat in the lung,spleen deficiency and dampness,and kidney yang weakness.3.Smoking is an extrinsic risk factor for CARAS,and allergic skin disease can be considered a common concomitant of the disease.4.Patients with spring onset of CARAS have a predominance of exogenous wind and superficial evidence,while patients with winter onset have more clinical manifestations of cold attack and(qi)yang deficiency;elevated eosinophils can be used as a secondary diagnostic factor for yang deficiency;pulmonary function FEV1/FVC(%)can be used clinically as a secondary diagnostic factor for qi and yang deficiency,and patients with elevated total cholesterol tend to have pathological manifestations of phlegm and dampness.5.The core targets of the effective active ingredients of Wen Yang Tongqiao Fang are ALB,IL6,TNF,AKT1 and IL1β,which may play a role in the treatment of CARAS through multiple signaling pathways such as TNF signaling pathway,calcium ion signaling pathway and PI3K-Akt.6.The clinical efficacy of this formula is significant and can be applied in the clinical treatment of CARAS.