Syndrome Characteristics And Pathological Features Of Simple Obesity Patients,and The Mechanism Of Warm-Yang And Dissipating-Turbidity Formula In Preventing And Treating Simple Obesity

Objective: 1.Investigate TCM syndrome patterns in obese patients in Changchun to guide clinical treatment and validate the "Yang transforming Qi,Yin forming substance" theory and preventive medicine concept.2.Explore the effects of warming yang and resolving turbidity decoction on obesity in mice,including its protective role,regulation of adipose tissue browning,and impact on gut microbiota.Methods: 1.Clinical Study: Utilizing the information collection form designed based on Professor Zhu Wenfeng’s "Theory of Syndrome Differentiation," we collected Traditional Chinese Medicine(TCM)four diagnostic information from patients with simple obesity in Changchun from December 2022 to December 2023.Based on the diagnostic criteria of "Theory of Syndrome Differentiation," we extracted patient syndrome information,established a syndrome database,and conducted statistical analysis.2.Experimental Study: Ten C57BL/6 male mice were randomly assigned to the control group(Control).Simple obesity mouse models were induced by a high-fat diet.After modeling,mice were randomly stratified by weight into the model group(Model),simvastatin group(XFTT),and low,medium,and high-dose groups of warming yang and resolving turbidity decoction(WYHZY-L,WYHZY-M,WYHZY-H),with 10 mice in each group.After12 weeks of intervention,the general condition,body weight,weights of white and brown adipose tissues,and blood lipid levels of mice were observed.HE staining was performed to observe morphological changes in inguinal white adipose tissue.q RT-PCR and Western Blot were used to detect the m RNA and protein expression of uncoupling protein 1(UCP-1),peroxisome proliferator-activated receptor gamma coactivator 1-alpha(PGC-1α),peroxisome proliferator-activated receptor gamma(PPARγ),and PR domain containing 16(PRDM16)in inguinal white adipose tissue of obese mice.Changes in gut microbiota were assessed using16 S r DNA sequencing.Results: 1.Clinical Study: This study included a total of 325 patients with simple obesity.Statistical analysis revealed symptoms and signs comprising more than 15% of the cases,including "slippery pulse","fatigue","tongue sublingual collateral vessels tortuosity","shortness of breath","string-like pulse","heaviness in the body","arrow qi","sticky mouth",and "spontaneous sweating." Regarding the distribution of syndrome elements,the ranking of affected organs included the spleen,liver,kidney,stomach,and lungs,while the ranking of pathogenic factors included dampness,qi deficiency,qi stagnation,yang deficiency,phlegm,blood stasis,retention of fluids,heat,and food accumulation.Combination of syndrome elements revealed a higher prevalence with 6 or 7 elements,accounting for 22.46% and15.69%,respectively.Through cluster analysis,the patients were categorized into five types:the first type comprised qi stagnation and liver patterns;the second type comprised blood stasis,gastric patterns,food accumulation,and heat patterns;the third type included fluid retention,lung patterns,and phlegm patterns;the fourth type involved yang deficiency and kidney patterns;and the fifth type comprised qi deficiency,dampness,and spleen patterns.2.Experimental Study:(1)Regarding body weight,post-treatment comparisons with the Model group showed significant reductions in body weight for both the XFTT group and various Chinese herbal medicine groups(P<0.05);(2)In terms of fat wet weight,compared to the Control group,the Model group exhibited significant increases in abdominal,epididymal fat,and brown adipose tissue content(P<0.05).However,compared to the Model group,the XFTT group and various doses of WYHZY showed significant reductions in abdominal,epididymal fat,and brown adipose tissue content(P<0.05);(3)Blood lipid levels showed significant increases in triglycerides(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)in the Model group compared to the Control group(P<0.05).However,compared to the Model group,the XFTT group and various doses of WYHZY showed significant decreases in TG,TC,HDL-C,and LDL-C levels(P<0.05),with similar reductions in TC levels observed in the XFTT and WYHZY-H groups;LDL-C levels in the WYHZY-H group were significantly lower than those in the XFTT and WYHZY-L groups(P<0.05);(4)Compared to the Control group,the Model group showed significant increases in lipopolysaccharide,interleukin-6,and tumor necrosis factor-alpha levels(P<0.05),whereas the WYHZY-H group exhibited significantly lower levels than the Model,XFTT,and WYHZY-L groups(P<0.05);(5)Morphologically,white adipose tissue in the Control group exhibited tightly arranged and smaller adipocytes,while the Model group showed a significant increase in adipocyte volume.The XFTT group showed a slight reduction compared to the Model group,and the cell volume in the WYHZY groups was significantly reduced compared to the Model group,with WYHZY-M and WYHZY-H groups showing cell volumes closer to those in the Control group;(6)Gene expression of thermogenic genes in the white adipose tissue of the groin showed significant decreases in UCP-1,PRDM16,and PGC-1α levels in the Model group compared to the Control group(P<0.05),whereas the WYHZY-H group showed significantly higher levels of UCP-1,PRDM16,PPARγ,and PGC-1α m RNA than the Model group(P<0.05);(7)In terms of related protein expression,UCP-1,PRDM16,and PGC-1α levels were significantly decreased in the Model group compared to the Control group(P<0.05),while PPARγ levels were significantly increased(P<0.05).Compared to the Model and XFTT groups,the WYHZY-M and WYHZY-H groups showed significantly higher levels of UCP-1,PRDM16,and PGC-1α(P<0.05);(8)Regarding intestinal microbiota,compared to the Control group,the Model group showed an increase in the Simpson index and a decrease in the Shannon index(P<0.05),whereas the WYHZY-H group showed a decrease in the Simpson index and an increase in the Shannon index compared to the Model group(P<0.05).PCo A and NMDS analysis showed that the microbiota structure of all WYHZY dose groups tended toward that of the Control group.At the phylum level,the Firmicutes level increased and the Bacteroidetes level decreased in the Model group,while after WYHZY treatment,the Bacteroidetes level increased and the Firmicutes level decreased.At the genus level,Desulfovibrio levels were significantly increased in the Model group,while Akkermansia and Bifidobacterium levels were significantly increased in the WYHZY-M and WYHZY-H groups,respectively.Conclusion: 1.Clinical Study: The main affected organs(Bingwei)and pathogenic factors(Bingxing)in the enrolled patients with simple obesity were found to be spleen,liver,kidney,dampness,qi deficiency,qi stagnation,and yang deficiency.This aligns well with the treatment approach proposed by the supervisor based on the theory of "transforming yang qi and nurturing yin essence" and the concept of treating obesity with the principle of preventing disease before it occurs.2.Experimental Study: Further animal experiments revealed that the Wenyang Huazhuo Decoction could improve the general condition of obese mice,resist weight gain induced by high-fat diet,lipid accumulation,and expansion of white adipose tissue in the groin.It also decreased the levels of TC,TG,and LDL-C;induced browning of white adipose tissue by upregulating the expression of UCP-1,PRDM16,PPARγ,and PGC-1α in the groin white adipose tissue;resisted the disruption of gut microbiota structure and abundance induced by high-fat diet;and increased the abundance of beneficial bacteria.