Academic Inheritance And Innovation Of Treating Tic Disorders Based On Viscera Theory Based On Data Mining Technolog

Objective:1 Tic disorder(TD)is a neuropsychiatric disorder of unknown etiology that begins in childhood with tics as its main clinical symptom.In this study,we analyzed a large number of local and foreign related literature,then used systematic Meta-analysis as the main research method to investigate the risk factors for the development of Tic disorder and to provide a basis for the prevention and treatment of tic disorder.2 There are many renowned pediatricians in Dongfang hospital,including Professor Liu Bichen,one of the nine tenured Traditional Chinese Medicine(TCM)professors in China;Professor Wang Sumei,tutor for the inheritance of academic experience of famous TCM experts;and Professor Wu Liqun,tutor for the inheritance of academic experience of the second batch of famous TCM experts in Fengtai District,Beijing.After years of clinical and experimental research,these three professors have put forward their academic viewpoints of"treatment from the lung","treatment from the spleen" and "treatment from the liver wind"respectively.There is evident clinical efficacy and a vast number of medical records have been accumulated.In order to better inherit and develop the clinical experiences and academic ideas of the renowned TCM veterans,this study was conducted to verify and summarize the treatment principles of these famous TCM veterans through literature collation and data mining.This study was aimed to further clarify the lineage of inheritance between the three professors,so as to provide ideas for modern research on the experiences of these famous pediatricians.Methods:1 PubMed,EMBASE,The Cochrane Library,Web of Science,CNKI,CBM,VIP,and Wanfang Data databases were searched.The literature retrieval date was from the time of establishment of the database to 28 February 2022.This study included case-control studies,cohort studies,and cross-sectional studies.Two researchers independently screened the literature,extracted data and evaluated the risk of bias of the included studies,and performed a Meta-analysis using the RevMan 5.3 software.2 Using the literature research method,the previous literature and materials on tic disorders of Professor Liu Bichen,Professor Wang Sumei,and Professor Wu Liqun were analyzed and summarized.The academic opinions of the three professors on the treatment of tic disorders were summarized,and were used as the theoretical basis of the medical case research.3 Based on the inclusion and exclusion criteria,the outpatient medical records of Professor Liu Bichen from 1993 to 2008,Professor Wang Sumei from 2013 to 2022,and Professor Wu Liqun from 2019 to 2022 for the treatment of tic disorders were collected to form a database.It was then uploaded onto the "Knowledge Management and Service Platform for the Inheritance of Experience of Famous Experts" developed by Guang’anmen Hospital.All three professors’ treatment protocols were derived using methods including frequency analysis,complex network analysis,community analysis and other methods to explore the herb usage frequency and the characteristics of the prescriptions.Combined with in-depth interviews,the structural characteristics of syndromes and treatment prescriptions were amended,and the diagnosis and treatment prescriptions of the three professors were obtained respectively.The results obtained from the literature research and data mining of the three professors’ literature research were compared longitudinally to summarize the similarities and differences,and to discover the lineage of inheritance for innovation and future developments.Results:1 Meta-analysis of risk factorsA total of 32 studies with 556,560 children in 9 countries were included in the study,inclusive of English and Chinese literature.The study yielded a total of 19 risk factors for tic disorders,namely:male sex,premature birth,low birth weight,history of neonatal pathological jaundice,other adverse factors in the perinatal period,poor dietary habits,prolonged use of electronic devices,history of febrile convulsions,recurrent respiratory infections,chronic tonsillitis,rhinopathy,Attention Deficit Hyperactive Disorder(ADHD),reduced blood iron levels,family history of tic disorders,family history of psychiatric disorders,maternal mental disorders during pregnancy,alcohol consumption during pregnancy,smoking or passive smoking during pregnancy,educational methods of beating and scolding corporal punishment.Parity is a protective factor for the development of tic disorders.2 Literature DocumentationA total of 44 Chinese literature related to the treatment of tic disorders by Professor Liu Bichen,87 literature related to the treatment of tic disorders by Professor Wang Sumei,and 13 Chinese literature related to the treatment of tic disorders by Professor Wu Liqun were retrieved.Literature included case experiences,clinical studies,academic theories and clinical experiences,and animal experiments.The professors and their students have conducted multi-dimensional research on their prescriptions "Xifeng Jingning Decoction","JianPi ZhiDong Decoction" and "Yangxue Xifeng Decoction",through clinical trials,animal experiments,network pharmacology,and other methods to verify the effectiveness and safety of the formulas,as well as to explore their mechanisms of action.3 Clinical Case Data Mining3.1 Basic information of the patientsThe study included 745 outpatient cases,with 3274 consultations,and 3399 prescriptions of children with TD treated by Professor Liu Bichen,Professor Wang Sumei,and Professor Wu Liqun.The children were predominantly male,with blinking,throat clearing,and shoulder shrugging as the initial symptoms.The tic symptoms were complex and variable,showing 66 common tic symptoms.The tics classification was dominated by multiple tics,followed by transient tic disorder.Children often suffer from coexisting medical conditions like ADHD,enuresis,and obsessive-compulsive disorder,as well as respiratory tract infections and allergic rhinitis.3.2 Analysis of Professor Liu Bichen’s formula for treating ticsA total of 317 cases of children with TD by Professor Liu Bichen were included,with a total of 567 consultations,involving 189 Chinese herbs.Most of the herbs manifest their therapeutic effects in the liver,stomach,lung and spleen meridians.Most of the herbs used were cold,warm,and sweet in nature,and most of the drugs were bitter,pungent and sweet in taste.The core formula of Xifeng Jingning Decoction contains xinyi,cangerzi xuanshen,banlangen,beidougen,huanglian,quanxie,gouteng,juhua,zhi baifuzi,fabanxia,mugua,and shenjincao.Professor Liu Bichen commonly classifies the symptoms as an internal movement of liver wind,liver wind with phlegm,internal disturbance of phlegm-heat,obstruction of wind-phlegm in collaterals,and phlegm-fire disturbing the mind.Commonly used formulas include Xincang Wuwei Decoction,Xifeng Jingning Decoction,Changpu Yujin Decoction,Sinisan,and Chaiqin Wendan Decoction.3.3 Analysis of Professor Wang Sumei’s formula for treating ticsA total of 302 cases of children with TD by Professor Wang Sumei were included,with a total of 1998 consultations.Most of the herbs manifest their therapeutic effects in the liver,spleen,lung,and stomach meridians.Most of the herbs used were warm,balanced and cold in nature,and most of the herbs were pungent,sweet and bitter in taste.The core formula of Jianpi Zhidong Decoction contains chenpi,fabanxia,fangfeng,gujingcao,mugua,gegen,gouteng,shenjincao,taizishen,fuchao baizhu,filing,shanyao,baishao,chuanxiong,shichangpu.Based on different syndromes,different formulas are used accordingly.For those with spleen deficiency and liver hyperactivity as the main syndrome,Jianpi Zhidong Decoction is used.For those with internal movement of liver wind as the main syndrome,a combination of Tianma Gouteng Decoction and Xieqingwan is used.For those with spleen deficiency and phlegm accumulation as the main syndrome,Wendan Decoction is used.For those with phlegm-fire disturbing the mind as the main syndrome,Mengshi Guntan Decoction is used.For those with obstruction of wind-phlegm in collaterals as the main syndrome,Zhijingsan is used.Comparison of the analysis results with previous data mining results shows that Professor Wang Sumei considers spleen deficiency and liver hyperactivity as the core pathogenesis,with an emphasis on protecting the spleen and stomach during treatment.In recent years,due to changes in social living habits,the prejudiced states of "spleen deficiency"and "liver hyperactivity" constitution have become more prominent.Furthermore,there is a higher tendency to classify under the syndromes of spleen deficiency and liver hyperactivity,internal movement of liver wind,and phlegm-fire disturbing the mind.There is a greater focus on clearing heat in the viscera during treatment and increased usage of animal products.3.4 Analysis of Professor Wu Liqun’s formula for treating ticsA total of 126 cases of children with TD by Professor Wu Liqun were included,with a total of 709 consultations.Most of the herbs manifest their therapeutic effects in the lung,liver,spleen,and stomach meridians.Most of the herbs used were warm,cold,and balanced in nature,and most of the drugs were sweet,pungent and bitter in taste.The core formula of the combined Liujunzi Decoction and Yangxue Xifeng Decoction contains danggui,baishao,chuanxiong,dangshen,fuchao baizhu,fuling,shanyao,chenpi,banxia,beichaihu,fangfeng,gegen,juhua,xinyi,gouteng,chantui,jiangcan,quanxie,wugong,mugua,shenjincao,jixueteng and yujin.A combination of Liujunzi decoction and Sinisan is used for the syndrome of spleen deficiency and liver hyperactivity.Wendan Decoction is used for the syndrome of spleen deficiency and phlegm accumulation.A combination of Yinqiaosan and Cangerzisan is used for the syndrome of trigger by external wind.A combination of Tianma Gouteng Decoction and Yangxue Xifeng Decoction is used for the syndrome of the internal movement of liver wind.A combination of Dadingfengzhu and Siwu Decoction is used for the syndrome of yin deficiency and internal wind.Adjustments were made to the prescription based on the presenting clinical symptoms and comorbidities.The efficacy evaluation of YGTSS in 126 children showed that the effective rate was 88.10%.There were no drug-related adverse effects and abnormalities in liver and kidney function after medication,and high safety levels were achieved.3.5 Inheritance and InnovationProfessor Wang Sumei and Professor Wu Liqun have both inherited Professor Liu Bichen’s theory of "liver wind",and both believe that the liver is the root organ of tics,and"wind" and "phlegm" are the pathological factors of tics.In terms of treatment,Professor Liu Bichen believed that the lungs are the root organ of tics,and he emphasized the importance of treatment from the lungs,hence he established the treatment perspective of "regulating the lungs".Professor Wang Sumei believes that liver disease is most easily transmitted to the spleen,and treatment should be focused on both the liver and the spleen,by suppressing the liver and supporting the spleen,hence forming the academic perspective of treating tic disorders from the spleen.Professor Wu Liqun believes that liver wind forms the basis for tic disorders.She combined the characteristics of allergic diseases and "wind" to expand the extension of liver wind,and she proposed the treatment of tic disorders by nourishing blood and expelling wind.Professor Wang Sumei and Professor Wu Liqun have inherited Professor Liu Bichen’s treatment perspective from the lungs,and have paid attention to external wind inducing internal wind.They often used relieving external syndrome herbs and antipyretic herbs to dispel the lungs and open the orifices,expel wind and prevent further progression of the disease.Professor Wu Liqun has also integrated Professor Wang Sumei’s academic perspective of treatment from the liver and spleen,especially for children who present with fatigue,sallow complexion,and a loss of appetite.The main treatment principle for such children is strengthening the spleen,calming the liver,and harmonizing the liver and spleen.All three professors have many overlapping clinical syndromes and the herbs used have many similarities,which reflects the inheritance and development of the treatment from the visceral organs.Conclusions:1 This study integrated domestic and foreign literature on risk factors and concluded that the incidence of tic disorder was related to gender,family history of psychiatric disorders,mothers’ pregnancy habits,perinatal history,chronic respiratory diseases,abnormalities in trace elements,strict educational methods and other factors.This corresponds to the congenital deficiency,deficiency in the lungs and spleen,stagnation of liver qi,and stagnation of qi generating wind in the study of TCM etiology.2 The team has conducted previous clinical trials and animal experiments to verify the efficacy of Xifeng Jingning Decoction,Jianpi Zhidong Decoction,and Yangxue Xifeng Decoction,and has conducted a preliminary study on their mechanism of action from the aspects of immune function and neurotransmitters.3 Through the data mining of clinical medical records,we have verified that all three professors’ syndrome differentiation and treatment revolves around their understanding of the disease’s pathogenesis,and we have improved and supplemented each professor’s syndrome differentiation and medication patterns.4 The diagnosis and treatment features of all three professors are treatment from the lung,treatment from the spleen,and treatment from the liver respectively.There is an inheritance lineage in terms of their understanding of the pathogenesis,and there are many similarities in terms of their syndrome differentiation and herb usage.This reflects the academic inheritance and innovation of treating tic disorder from the viscera organs.