Analysis Of Clinical Evidence On Autoimmune Hepatitis Diagnosed And Treated By TCM According To Evidence-based Medicine

ObjectiveTo provide basis for the establishment of TCM scheme, clinical pathway, guideline by finding evidence, organizing literature, and then expert consulting survey with Delphi method in view of diagnosis and treatment of TCM about autoimmune hepatitis(AIH).MethodsTo retrieval and consult literature using key words as "autoimmune hepatitis", "name", "clinical", "clinical characteristics", "famous Chinese medicine", "experience", "Chinese medicine", "Chinese and western medicine" with retrieval tool under full understanding of latest research progress in Integrative Medicine of AIH. And then, evaluating literature with Jadad scale, assessment items of MINORS, classification standard of TCM literature. To get the literature information of TCM disease name, clinical characteristics of Chinese patients, treatment of TCM through frequency statistics, cluster analysis, complex networks technology, etc.To compare, analyze, screen the result of literature research and after discussion of experts, formulate the expert questionnaire "Chinese medicine for the treatment of autoimmune hepatitis expert questionnaire" according to the method of Delphi expert investigation. Consult to the nationwide 26 Chinese experts of medicine or integrated medicine on liver disease. Based on the results of questionnaire, format the expert consensus on TCM diagnosis and treatment of autoimmune hepatitis initially. Results1. Literature research results:To statistic analyze the frequence of TCM disease name after literature study of TCM disease name.The results showed that it involves 18 TCM disease name, a high frequence of TCM disease name:Jaundice, Hypochondriac pain.According to literature research of clinical features in Chinese patients of autoimmune hepatitis, Chinese female patients have a higher ratio;The common symptoms are fatigue, jaundice, anorexia, abdominal distension, common signs are jaundice, signs of chronic liver disease.According to TCM syndrome and therapeutic principles of autoimmune hepatitis related medical records, it involves 5 disease location of TCM, mainly concers liver, spleen and kidney, involves 13 character of TCM, mainly concers wet, heat, blood stasis, qi stagnation, Qi deficiency, yin deficiency, involves 13 TCM syndrome types, mainly concers blood stasis of collaterals, damp heat syndrome, liver-depression and spleen-deficiency, deficiency of liver-yin and kidney-yin,the stagnation of liver Qi, involves 169 Chinese Medical Herbs,28 prescriptions of TCM, mainly concers Yinchenhao Tang, self-developed TCM prescription, chaihushugan powder, Xiaoyaosan, Xiaochaihu Tang, Yiguan Decoction after frequency analysis, mainly concers Yinchenhao Tang, Xiaoyaosan after cluster analysis. It found that the common used Chinese medicine are wormwood, liquorice, radix paeoniae rubra,Radix Bupleuri, Atractylodes, Poria, radix salviae miltiorrhizae, Radix Scutellariae, Radix Paeoniae Alba, Radix Astragali, angelica, rhubarb, madder, peach, peony bark after frequency analysis, the commonly used classification Medicine of TCM are Tonic drug, antipyretic, diuresis medicine, drugs for promoting blood circulation and removing blood stasis,the core drug therapy for autoimmune hepatitis without jaundice are Bupleurum, white atractylodes rhizome, white peony root, tuckahoe, liquorice, angelica, astragalus after the analysis of the complex network, the core drug therapy for autoimmune hepatitis with jaundice are wormwood, rhubarb, radix paeoniae rubra, Radix Scutellariae, etc.2. Expert survey results:According to Expert consultation of Delphi method, we found the following results, First, disease name of TCM:consulting experts suggest that the TCM disease name as hypochondriac pain, jaundice, but the full mark ratio of expert opinion is low, suggesting that the concentration of expertise is not high. Second, the TCM etiology:the contribution of congenitally deficient is great in the TCM etiology. Further study is needed for Damaged by excess of seven emotions, improper diet as the common etiology of TCM, although the concentration degree of expert opinion is good, the coordination degree of expert opinion is bad. Third, the clinical manifestations of this disease:the common symptoms are mental fatigue, fatigue, anorexia, common signs are splenomegaly, common tongue are the tongue with ecchymosis, moss thin, yellow moss, pulse string. Fourth, the TCM syndrome: Traditional Chinese medicine dialectical method is syndrome differentiation of zang-fu viscera, mainly concers liver, spleen and kidney, the character of TCM mainly concers Qi deficiency, yin deficiency, qi stagnation and blood stasis, damp heat, blood stasis, phlegm, the Constitution of TCM mainly concers blood stasis constitution, damp heat constitution, qi stagnation constitution, Qi deficiency constitution, yin deficiency constitution, further study is needed for phlegm dampness constitution, intrinsic quality constitution as the common constitution of TCM, although the concentration degree of expert opinion is good, the coordination degree of expert opinion is bad. Fifth,the treatment:Chinese medicine has certain advantages in the treatment of this disease, to shorten the hormone treatment or reducing the dose of hormone, hormone or hormone therapy in patients with contraindications to intolerance, individualized treatment, alleviating the side effects of hormone, liver protection, reduce recurrence, improve the clinical symptoms, improve the quality of life of patients. Pure Chinese medicine treatment is recommended in mild patients, TCM and Western medicine is recommended in Severe patients. Common TCM Syndromes of this disease is liver stagnation and spleen deficiency, deficiency of liver-yin and kidney-yin, further study is needed for blood stasis of collaterals, damp heat syndrome, phlegm dampness, although the concentration degree of expert opinion is good, the coordination degree of expert opinion is bad. Common prescriptions of TCM of liver stagnation and spleen deficiency syndrome are Chaishao Liujunzi Decoction, Xiaoyao Powder, Chaihu Shugan powder, common TCM prescriptions of liver-yin and kidney-yin deficiency is Yiguan Decoction.Conclusion1. Autoimmune hepatitis can be attributed to the "hypochondriac pain", "jaundice"of TCM, further study is needed as they are not generally recognized.2. The TCM etiology of autoimmune hepatitis is complex, the common etiology in TCM is congenitally deficient.3. The clinical manifestations of autoimmune hepatitis are various, the common symptoms and signs are fatigue, mental fatigue, loss of appetite, splenomegaly, the common tongue and pulse are tongue with ecchymosis, moss thin, yellow moss, pulse string.4. Traditional Chinese medicine dialectical method of AIH is syndrome differentiation of zang-fu viscera, mainly concers liver, spleen and kidney, the character of TCM mainly concers Qi deficiency, yin deficiency, qi stagnation and blood stasis, damp heat, blood stasis, phlegm.5. The common TCM Constitution of autoimmune hepatitis are blood stasis constitution, damp heat constitution, qi stagnation constitution, Qi deficiency constitution,yin deficiency constitution.6. Liver stagnation and spleen deficiency, deficiency of liver-yin and kidney-yin are common syndromes of autoimmune hepatitis.