| ObjectiveThe purpose of this study was to explore the characteristics of clinical herbal prescriptions and the medication rules for the treatment of postpartum uterine subinvolution.This study was also wiling to summarize the core herbs for uterine subinvolution treatment,and to explore the clinical effects of the core herbs by clinical addition and subtraction used for hot compress therapy in the involution of postpartum uterus.The goal of this study was to explore new,potent and efficient herb combinations for hot compress therapy to promote the postpartum involution of uterus.We hope the results of this study could provide some valuable experiences for clinical doctors to dialectically prevent and treat uterine subinvolution and provide new options for clinical departments to develop special TCM therapies.Methods1.literature research:the China database of Traditional Chinese Medicine,the China National Knowledge Infrastructure(CNKI),the Chinese BioMedical literature Database(CBM),the VIP database of Chinese Technical Periodicals(VIP)and the WanFang Data(WanFang)were searched for reports related to the herbal treatment of uterine subinvolution.All data involved were collected and standardized to form a database.The search time for each database was limited to the establishment time to January 30,2021.Reports of eligibility were screened by read the title,abstract and full text.The efficient formulae were extracted and tabulated to form standardized database.Frequency analysis was used to summarize the herbal frequency,properties,tastes,meridian tropisms,action category and dosage of all herbs.And then data mining methods including cluster analysis and association rule learning were carried out to explore the prescription rules and core herbs.R studio 1.4.1103 and SPSS 26.0 softwares were chosen for analyses.2.Clinical study:the core prescription obtained from data mining were applied to the traditional hot compress therapy after addition and subtraction.74 cases of women with cesarean section who met the including and excluding criteria were enrolled and randomly divided into the experimental group and control group with 37 cases each;the control group got routine treatment after birth while the experimental group got traditional hot compresses therapy on the basis of the control group.The herbs for hot compress therapy were Chuanxiong Rhizoma(Chuanxiong),Persicae Semen(Taoren),Angelicae Sinensis Radix(Danggui),Zingiberis Rhizoma Preparatum(Paojiang),Leonuri Herba(Yimucao)and Folium Artemisiae Argyi(Aiye).The hot compress therapy were started on the second day after delivery for once a day and lasted for 4 days.Observing the changes and differences the symphysis-fundal distance,the volume of postpartum lochia,the duration of red lochia,and the Visual Analogue Score of uterine pain for contraction before and after the intervention between the experimental and control groups.Data statistics were analyzed using SPSS 26.0 software.Results1.Medication rules of uterine subinvolution treatment(1)Frequency anaysis:a total of 803 effective prescriptions were included in this study and 249 herbs were involved.Frequency analysis showed that the top 6 most frequently prescribed herbs were Angelicae Sinensis Radix(Danggui)(679 times,accounting for 8.71%),Chuanxiong Rhizoma(Chuanxiong)(586 times,accounting for 7.51%),Leonuri Herba(Yimucao)(554 times,accounting for 7.10%),Persicae Semen(Taoren)(509 times,accounting for 6.53%),Zingiberis Rhizoma Preparatum(Paojiang)(318 times,accounting for 4.08%)and Radix Glycyrrhizae Preparata(Zhigancao)(310 times,accounting for 3.97%);The main properties of 249 herbs were warm(3420 times),mild(2311 times)and cold(1865 times);the main tastes is sweet(4468 times),followed by bitter(3912 times)and pungent(3097 times);most of the 249 herbs are attributed to liver(5765)and spleen(3558)meridian tropisms.19 action categories were involved of the 249 herbs and deficiency-tonifying herbs accounted for the largest proportion(34.43%,2685 times),followed by blood-activating and stasis-eliminating herbs(29.98%,2338 times),hemostatic herbs(12.85%,1002 times)and heat clearing herbs(9.26%,722 times).(2)Cluster analysis:through hierarchical clustering,a total of 6 clusters were obtained.Cluster 1 was composed of 9 herbs:Angelicae Sinensis Radix(Danggui),Chuanxiong Rhizoma(Chuanxiong),Persicae Semen(Taoren),Zingiberis Rhizoma Preparatum(Paojiang),Radix Glycyrrhizae Preparata(Zhigancao),Pollen Typhae(Puhuang),Faeces Trogopteri(Wulingzhi),Cyathulae Radix(Chuanniuxi)and Leonuri Herba(Yimucao).Cluster 2 was composed of Herba Taraxaci(Pugongying),Herba Patriniae(Baijiangcao),Rubia Cordifolia(Qiancao),Portulacae Herba(Machixian),Crataegi Fructus(Shanzha)and Aurantii Fructus(Zhike).Cluster 3 was composed of Flos Carthami(Honghua),Cyperi Rhizoma(Xiangfu),Paeoniae Radix Rubra(Chishao),Corydalis Rhizoma(Yanhusuo),Spatholobus Suberectus Dunn(Jixueteng),Cinnamomi Cortex(Rougui),Achyranthis Bidentatae Radix(Niuxi).Cluster 4 was composed of Aisni Corii Colla(Ejiao),Folium Artemisiae Argyi(Aiye),Astragali Radix(Huangqi),Codonopsis Radix(Dangshen),Atractylodes Macrocephala Rhizoma(Baizhu),Bupleuri Radix(Chaihu),Notoginseng Radix Et Rhizoma(Sanqi).Cluster 5 was composed of Glycyrrhizae Radix Et Rhizoma(Gancao),Poria Cocos(Schw.)Wolf.(Fuling).Cluster 6 was composed of Moutan Cortex(Mudanpi),Radix Sanguisorbae(Diyu),Dipsaci Radix(Xuduan),Eucommiae Cortex(Duzhong),Paeoniae Radix Alba(Baishao),Rehmanniae Radix Praeparata(Shudihuang),Rhizoma Dioscoreae(Shanyao),Rehmanniae Radix(Dihuang)and Zingiberis Rhizoma(Ganjiang).Except for Cluster 5,all clusters are of guiding significance for the clinical treatment of postpartum uterine subinvolution.(3)Association rule learning:through the analysis of association rules for 803 formulae and 249 herbs,a total of 78 rules with Support degree greater than 0.2,Confidence level greater than 0.8 and Lift degree over 1 were obtained.Rules {Chuanxiong Rhizoma(Chuanxiong)}=>{Angelicae Sinensis Radix(Danggui)} and {Angelicae Sinensis Radix(Danggui)}=>{Chuanxiong Rhizoma(Chuanxiong)} had the highest Support level of 0.72.{Angelicae Sinensis Radix(Danggui),Chuanxiong Rhizoma(Chuanxiong),Leonuri Herba(Yimucao),Zingiberis Rhizoma Preparatum(Paojiang)}=>{Persicae Semen(Taoren)} had the highest Lift level with 1.52.There were eight association rules consisting of Chuanxiong Rhizoma(Chuanxiong),Leonuri Herba(Yimucao),Persicae Semen(Taoren),Zingiberis Rhizoma Preparatum(Paojiang),Angelicae Sinensis Radix(Danggui),Astragali Radix(Huangqi)and Radix Glycyrrhizae Preparata(Zhigancao)with the highest Confidence level of 1.Besides,herbs Angelicae Sinensis Radix(Danggui),Chuanxiong Rhizoma(Chuanxiong),Persicae Semen(Taoren),Zingiberis Rhizoma Preparatum(Paojiang),Radix Glycyrrhizae Preparata(Zhigancao)and Leonuri Herba(Yimucao)were at the center of all rules and strongly correlated.By synthesizing the results of frequency analysis,cluster analysis and association rule learning,herbs Angelicae Sinensis Radix(Danggui),Chuanxiong Rhizoma(Chuanxiong),Persicae Semen(Taoren),Zingiberis Rhizoma Preparatum(Paojiang),Radix Glycyrrhizae Preparata(Zhigancao)and Leonuri Herba(Yimucao)were found to be not only most frequently prescribed and strongly correlated,but also the components of cluster 1,indicating that these herbs were the core herbs for uterine subinvolution treatment.2.Clinical study(1)The descending of symphysis-fundal distance:The descending of symphysis-fundal distance(cm)in the experimental group and control group on the second to fifth day after delivery was expressed by the mean value and standard deviation(X±s).The descending height on the second postpartum day in the experimental group and control group were 1.32±1.05 and 0.72±0.88,respectively.The descending height on the third postpartum day in the experimental group and control group were 1.48±0.41 and 1.05±0.60,respectively.The descending height on the fourth postpartum day in the experimental group and control group were 1.60±0.39 and 0.79±0.49,respectively.The descending height on the fifth postpartum day in the experimental group and control group were 1.33±0.36 and 0.82±0.38,respectively.The symphysis-fundal distance measured at different postpartum days in the two groups were compared by the Generalized Estimation Equation(GEE).The symphysis-fundal distance in experimental group was 0.24cm lower than that in control group on the second postpartum day,P=0.561>0.05,and the difference was not statistically significant.The symphysis-fundal distance of the experimental group was 0.838cm lower than that of the control group on the 3rd day after surgery,P=0.028<0.05,and the difference was statistically significant.The symphysis-fundal distance of the experimental group was 1.271cm lower than that of the control group on the 4th day after surgery,P<0.001,and the difference was statistically significant.The symphysis-fundal distance of the experimental group was 2.08cm lower than that of the control group on the 5th day after surgery,P<0.001,and the difference was statistically significant.The symphysis-fundal distance of the experimental group was 2.72cm lower than that of the control group on the 5th day after surgery,P<0.001,and the difference was statistically significant.(2)Uterine contraction pain score:The Visual Analogue Scale(VAS)for postpartum uterine contraction pain before the analgesic pump removal in experimental group and the control group were 4.18±1.70 and 4.45±2.19,respectively(X±s),P=0.569>0.05,and there was no statistically significant difference between two groups;the VAS for postpartum uterine contraction pain after removal of the analgesic pump in the experimental group and the control group were 2.25±1.83 and 2.37±1.88(X±s),respectively.P=0.785>0.05,there was no statistical difference between the two groups.(3)Lochia:The amount of lochia(ml)on 2nd postpartum day in experimental group and control group was 65.84±6.16 and 66.56±6.422(X±S),respectively.The amount of lochia on 3rd postpartum day was 28.16±4.68 and 35.11±4.33,respectively.The lochia amount on 4th postpartum day was 12.05±1.944 and 14.61±1.751,respectively.The amount of lochia on 5th postpartum day was 9.68±1.587 and 10.11±1.319,respectively.The P values of lochia in the experimental group and the control group at postpartum 2-5 days were greater than 0.05,and the differences were not statistically significant.There was no significant difference in the duration of postpartum blood lochia between the experimental group and the control group(P>0.05).(4)The time of first defecation after cesarean:the time(h)of the first defecation after cesarean in the experimental group was 68.46±17.54,and that in the control group was 77.12±17.80.The difference between the two groups was statistically significant(P<0.05).Conclusion1.The category of herbs on the treatment of uterine subinvolution is mainly deficiency-tonifying herbs,followed by blood-activating and stasis-eliminating herbs,hemostatic herbs and heat-clearing herbs.Herbs Angelicae Sinensis Radix(Danggui),Chuanxiong Rhizoma(Chuanxiong),Persicae Semen(Taoren),Zingiberis Rhizoma Preparatum(Paojiang),Radix Glycyrrhizae Preparata(Zhigancao)and Leonuri Herba(Yimucao)were high frequently prescribed and strongly correlated together.They are the core herbs in the treatment of postpartum uterine subinvolution.2.Traditional hot compress therapy using herbs Angelicae Sinensis Radix(Danggui),Chuanxiong Rhizoma(Chuanxiong),Persicae Semen(Taoren),Zingiberis Rhizoma Preparatum(Paojiang),Folium Artemisiae Argyi(Aiye)and Leonuri Herba(Yimucao)to the lower abdomen of women with cesarean section can promote the decline of the postpartum uterine fundus,promote gastrointestinal function and shorten the first defecation time after operation. |
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