Research On The Regularity Of The Medication Of Professor Zhao Ruihua In The Treatment Of Adenomyosis

Objective:To summarize and analyze the medication rule of Professor Zhao Ruihua in the treatment of adenomyosis in order to provide reference for the clinical diagnosis and treatment of adenomyosis with traditional Chinese medicine.Methods:Collect the medical records of patients with adenomyosis in Professor Zhao Ruihua’s outpatient clinic from January 1,2014 to June 30,2019 and complete structured medical records input,data collection and data preprocessing by using the "Clinical Scientific Research sharing data Collection system of Guang’anmen Hospital of Chinese Academy of traditional Chinese Medicine ".After deriving the data,SPSS25.0 statistical analysis software was used for descriptive statistics of general data.For symptom and drug data,association rules were analyzed by SPSS Modelerl8.0 software,community analysis was carried out by Gephi0.9.2 software,multi-layer core subnet analysis was carried out by liquorice software,and symptom-drug association analysis was carried out by point-to-point information method.Summarize the characteristics,compatibility and syndrome differentiation of drugs used by Professor Zhao Ruihua in the clinical treatment of adenomyosis.Results:1.A total of 245 patients with adenomyosis were enrolled in the study,including 1237 effective diagnoses and 1235 effective prescriptions of traditional Chinese medicine2.The general condition of the patients:the age distribution was mainly childbearing age,the minimum was 21 years old,the maximum was 56 years old,and the average age was 39.07±6.25 years old.On the body mass index,54.9%belong to normal weight while 29.45%are overweight.95.9%often live in the north,93.3%of the patients are married,and 76.2%have received higher education.The main complaints were dysmenorrhea(69.2%)and menorrhagia(3 1.8%),followed by infertility(14.7%)and chronic pelvic pain(9.4%).67.3%of the patients had a clear history of uterine cavity operation,including artificial abortion,cesarean section,hysteroscopic curettage,hysteroscopic endometrial excision and so on.Some patients have family history of gynecological diseases such as uterine leiomyoma,dysmenorrhea,adenomyosis and endometriosis,and most of them are first-degree relatives3.The distribution of high-frequency drugs and their efficacy,taste and meridians:a total of 1235 prescriptions of traditional Chinese medicine were used,including Poria cocos(1193),cassia twig(1019),bran fried Atractylodes macrocephala(1017),white peony(1004),vinegar chicken gold(974),etc.The main efficacy are deficiency drugs(1235),diuresis drugs(1224),table relieving drugs(1189),digestion drugs(1012),hemostatic drugs(861),promoting blood circulation and removing blood stasis drugs(836).The distribution of qi and flavor was mainly warm(4576),flat(3459),Gan(2946)and Xin(5019),and the drugs mostly related to spleen meridian(8412),lung meridian(6350)and stomach meridian(5056).4.The use of drug pairs:29 pairs of drugs were obtained when the co-occurrence frequency was more than 600 times,and 40 pairs were obtained by association rule analysis.After comparing with Professor Zhao Ruihua ’s prescription writing habits,17 groups of drug compatibility were selected,including soap horn thorn-zedoary,bran fried Atractylodes macrocephala-Poria,jujube-ginger,raw Coix seed-vinegar chicken gold,patchouli-Amomum and so on.5.Core prescription:the core prescription of adenomyosis was obtained by multi-layer core subnet analysis,including cassia twig,white peony,Panax notoginseng powder,Poria cocos,bran fried Atractylodes macrocephala,chicken gold,raw Codonopsis,Codonopsis pilosula,raw licorice,salt fenugreek and so on.The main compatibility relationships are Rhizoma Zedoariae-Zaojiao thorn,rose-Salvia miltiorrhiza and so on.The secondary compatibility relationship is Angelica sinensis-Ligusticum chuanxiong-alisma-Polyporus umbellatus-tangerine peel,dried ginger-black shun tablet,Ligustrum lucidum-Dipsacus-dodder-wolfberry and so on6.Classification of prescription societies:through community analysis of 1235 prescriptions,five module prescriptions were obtained,and the number of module 2(39.11%)was the most,followed by module 3(31.58%),module 1(16.52%),module 0(8.26%)and module 4(4.53%).The main drugs of module 2 include Poria cocos,Codonopsis pilosula,ginger,cassia twig,bran fried Atractylodes macrocephala,jujube,white peony,raw licorice,vinegar chicken internal gold,Panax notoginseng powder,salt fenugreek,Amomum villosum,etc.,the main complaints of the patients include pain(27.9%),assisted pregnancy(26.1%),pain with menorrhagia(25.0%),menorrhagia(14.3%),etc.,the core symptoms are clot in menstrual blood,pulse like strings,pink tongue,fatigue,thin pulse,etc.;The main drugs in module 3 include vinegar chicken gold,white peony,Poria cocos,raw Coix seed,Panax notoginseng powder,cinnamon twig,bran fried Atractylodes macrocephala,raw licorice,ginger charcoal,turmeric,Salvia miltiorrhiza,vinegar Xiangfu,salt fenugreek,etc.,the main complaints of related patients are pain with menorrhagia(50.5%),core symptoms are fear of cold,pain relieved by heat,menorrhagia,clot in menstrual blood,sparse stool,pink or light dark tongue,etc.;The main drugs of module 1 include Poria cocos,vinegar chicken inner gold,vinegar zedoary,raw Coix seed,soap horn thorn,cassia twig,bran fried Atractylodes macrocephala,Salvia miltiorrhiza,Panax notoginseng powder,vinegar Bupleurum,salt fenugreek,etc.,and the main complaints of related patients are pain(63.2%).The core symptoms are pulse like string,dark red tongue,purple spots or ecchymosis on the tongue,clot in menstrual blood,premenstrual breast distension,anal distension and so on.The main drugs of module 0 include Chinese wolfberry,dodder,Poria cocos,Dipsacus,wine Ligustrum lucidum,Codonopsis pilosula,fried Atractylodes macrocephala,raw licorice,ginger,jujube,Amomum villosum and so on.The main complaints of related patients are assisted pregnancy(52.0%)and fetal protection(45.1%).The core symptoms are soreness of the waist,thin pulse,deep pulse,anorexia,fatigue,nausea and so on.Module 4 main drugs include Ligusticum chuanxiong,cassia twig,white peony,Poria cocos,bran fried Atractylodes macrocephala,Angelica sinensis,Polyporus umbellata,alisma alisma,vinegar chicken gold,raw Coix seed,ginger,tangerine peel,etc.,the main complaints of related patients are assisted pregnancy(48.2%)and irregular vaginal bleeding(28.6%).The core symptoms are clot in menstrual blood,deep pulse,slippery pulse,thick tongue coating,fat tongue,sticky stool,sweat,purple spots or ecchymosis on the tongue and so on.7.Changes of drug use in menstrual cycle:331 visits with complaints of "assisted pregnancy" were collected,and 331 effective prescriptions were obtained,including 158 prescriptions in pre-ovulation and 173 prescriptions in post-ovulation.Compared with the distribution of prescription types,module 2 prescriptions were the most in pre-ovulation(35.44%),followed by module 1(25.95%)and module 3(23.42%).In the post-ovulation,the proportion of module 0 prescription increased significantly,module 1 and module 4 decreased significantly,and the proportion of module 2 and module 3 did not change significantly Compared with the frequency of drug use,the use frequency of Panax notoginseng powder,Salvia miltiorrhiza,Ligusticum chuanxiong,Curcuma vinegar,Gleditsia sinensis,Pinellia ternata decreased significantly,while the frequency of Chinese wolfberry,dodder,Dipsacus,wine Ligustrum lucidum,Morinda officinalis and other drugs increased significantly Compared with the attribute distribution of traditional Chinese medicine,in the aspect of four qi classification,warm(37.28%),flat(26.54%)and slightly cold(14.05%)were dominant in the pre-ovulation and 33.96%in the post-ovulation.The frequency of warm,slightly cold and cool drugs decreased,and the frequency of mild and mild drugs increased.In the classification of five flavors,there were mainly gan(38.17%),Xin(27.12%),bitter(15.07%)and light(12.67%)in the pre-ovulation period,but there was no significant change in the later stage of ovulation.In terms of meridians,spleen meridian(24.26%),lung meridian(19.12%),heart meridian(15.61%)and stomach meridian(14.82%)were the main meridians in the pre-ovulation.The frequency of drug use of the kidney meridian increased slightly in the pre-ovulation,and there was no significant change in the rest.8.Addition and subtraction of drugs with symptoms:23 symptoms-traditional Chinese medicine correlation rules were obtained by point mutual information method,including menorrhagia->Panax notoginseng powder,thin pulse->Codonopsis pilosula,fear of cold->cassia twig and so onConclusion:Professor Zhao Ruihua’s use of drugs in the treatment of adenomyosis is characterized by streamlined prescription,peaceful use of drugs,and emphasis on spleen,stomach and Yang Qi The compatibility of drugs is mostly taken from classical prescriptions of traditional Chinese medicine.The clinical prescription is mainly treated based on syndrome differentiation,combined with disease differentiation and periodic medication,plus or minus with symptoms There are four syndrome types:qi deficiency and blood stasis,cold coagulation and blood stasis,qi stagnation and blood stasis,phlegm-dampness and blood stasis.She also pays attention to the correlation and transformation between syndrome types.The type of qi deficiency and blood stasis was treated with Sijunzi decoction and Guizhi decoction,cold coagulation and blood stasis type with self-made Wenyang Huoxue decoction,qi stagnation and blood stasis type with self-made Huoxue Xiaoyi decoction,and phlegm-dampness stasis type with Danggui Shaoyao San and Wuling San.All syndrome types are compatible with cassia twig,white peony,Panax notoginseng powder,Poria,bran fried Atractylodes macrocephala,chicken gold,raw Codonopsis,raw licorice,salt huling and other core medicines.For patients with pregnancy needs,in the later stage of ovulation,strengthen the spleen and replenish qi,tonify the kidney and assist pregnancy,reduce blood circulation and disperse knots,and use Shoutai pills and Sijunzi decoction in the early stage of pregnancy to tonify the kidney and protect the fetus.