Investigation On Lifestyle-related Risk Factors And TCM Syndrome Elements Distribution In Young Male Patients With Erectile Dysfunction

This paper consists of two parts:literature research and clinical investigation.The first part is literature research,which compares ancient literature with periodical literature in the past 10 years on erectile dysfunction(ED),analyzed and compared the syndromes of traditional Chinese medicine(TCM),and expounded the respective syndrome characteristics of ancient and modern treatment of ED.The second part is the clinical investigation,which makes a cross-sectional survey on the life style related risk factors and the distribution of TCM syndrome elements in young ED patients aged 2244,and explores the correlation between them,in order to provide a basis for TCM clinical diagnosis and treatment of young ED patients.Objective:Comparative analysis of ancient and modern literature,clear ED TCM syndrome characteristics;investigate the distribution of lifestyle-related risk factors in young male ED patients,analyze the correlation between lifestyle-related risk factors and TCM syndrome elements,and summarize the core TCM syndrome pathogenesis of young ED patients with different lifestyle-related risk factors,in order to provide a basis for TCM diagnosis and treatment of clinical young ED patients.Methods:The combination of literature research and clinical investigation.1.Literature research:use "impotence","muscle impotence" as the key words to search the articles about the treatment of ancient physicians on ED contained in the Chinese Medical Code,and search for the experience of contemporary doctors on the treatment of ED in the past 10 years in China knowledge Network Database(CNKI),Wanfang Database and VIP Database with the keywords "erectile dysfunction","impotence",and "experience".The standard template of ED syndrome type was compiled with reference to textbooks and guidelines.According to this template,the syndrome types of ED in the ancient and modern literature on treatment of ED were summarized and extracted,the degree of agreement between the ED syndrome type of ancient and modern literature and the standard template was analyzed respectively,and the characteristics and similarities and differences of ancient and contemporary doctors’understanding of the pathogenesis of ED syndrome were compared.2.Clinical investigation:develop the ED lifestyle related risk factors questionnaire,collect the basic information of young ED patients and sleep quality,BMI,tobacco and alcohol,stress,etc.;make the four diagnosis information collection table,collect TCM syndrome elements,and statistically analyze the life-related risk factors and TCM syndrome element distribution of young ED patients,and further analyze the distribution and correlation of syndrome elements among different risk factors.Results:1.Literature research results.1.1 The ancient books database of Chinese Medical Code was searched.Finally,402 articles in accordance with the standard were included,27 syndrome types were extracted,and the total frequency of syndrome types was 465.The top 10 syndromes with higher frequency were kidney qi deficiency syndrome(12.69%),kidney yang deficiency syndrome(12.04%),liver depression and qi stagnation(10.54%),room fatigue and tendon injury(9.46%),heat engendering tendons(6.67%),liver heat injuring tendons(6.45%),panic injuring kidney(6.02%),damp-heat of liver meridian(4.30%),kidney essence deficiency(4.09%),and thinking(3.23%).The order by disease position is as follows:kidney syndrome(43.87%),viscera and viscera syndrome(16.77%),muscle disease syndrome(16.13%),liver disease syndrome(15.05%),phlegm,dampness,blood stasis and other syndromes(4.73%),lower jiao syndrome(2.37%).1.2 Retrieval of the experience journals of contemporary physicians about ED treatment in China knowledge Network Database(CNKI),Wanfang Database and VIP Database in the past 10 years,and finally included 126 journal literatures.A total of 29 syndrome types were extracted,with a total frequency of 261 times.The top 10 syndrome types with the highest frequency are:liver depression and qi stagnation syndrome(11.10%),blood stasis syndrome(10.34%),lower jiao dampness-heat syndrome(9.96%),kidney deficiency and blood stasis syndrome(5.75%),liver depression and kidney deficiency syndrome(5.36%),heart and spleen deficiency syndrome(4.98%),liver depression and kidney deficiency syndrome(4.60%),kidney yang deficiency syndrome(4.60%),phlegm stasis syndrome(16.39%),Panic injury kidney syndrome(3.45%).The order by disease position is as follows:viscera syndrome(27.59%),nephropathy syndrome(22.99%),phlegm,dampness,blood stasis and other syndromes(20.69%),liver disease syndrome(17.62),lower jiao syndrome(9.96%),lung disease syndrome(1.15%).1.3 Ancient doctors treat ED based on kidney deficiency,with damaged tendon and liver depression as the standard,with relatively single syndrome type and few syndromes:modern doctors treat ED mainly on liver and kidney,and liver depression and kidney deficiency are the main causes of ED.ED often shows multiple viscera and syndrome,multi-disease and multi-disease at the same time,pathological factors are also more complex,blood stasis is the most common pathological factor.By comparing the syndrome types extracted from ancient and modern literature with the standard template of ED syndrome type,it is found that 62.15%of the syndrome types extracted in ancient literature are consistent with the standard template of ED syndrome type,and there are 15 abnormal syndrome types which are not consistent with 37.85%.Among the syndrome types extracted in modern literature,89.25%are consistent with the standard template of ED syndrome type,and there are 11 unconventional syndrome types which are not consistent with 10.75%.2.Results of clinical study:2.1 General information121 patients were surveyed and based on the IIEF-5 score,72.73%had mild ED,16.53%had moderate ED and 10.74%had severe ED.79.34%had morning erections,56.20%had nervous sex,33.88%had heterosexual or frequent travel with their partner and 85.12%had sex ≤4 times/The frequency of sexual intercourse was less than 4 times/month in 85.12%of ED patients.According to the BMI≥24kg/m2 is considered overweight,of which 51.24%of overweight ED patients.2.2 Distribution of risk factors related to ED lifestyle.Risk factors for sleep:late sleepers accounted for 41.32%of patients,using 23:00 as the cut-off point.40.50%of patients did not get enough sleep,using 7 hours of sleep as the standard.The PSQI scale was used to assess the quality of sleep of patients,with PSQI>6 being poor sleep,and 34.71%of patients had poor sleep quality.Anxiety and stress risk factors:anxiety accounted for 38.84%of patients,of which 33.06%had mild anxiety,4.13%had moderate anxiety and 1.65%had severe anxiety;perceived dangerous stress was present in 25.62%of patients,as defined by a CPSS score of ≥26 on the stress perception scale.The percentage of patients with a sedentary work life was 76.86%,71.9%of patients who did not exercise regularly,22.31%of patients who smoked and 19.83%of patients who drank alcohol regularly.2.3 Evidence distribution of young ED patientsA total of 19 evidence elements were obtained,including 5 pathogenic elements,in order of frequency:kidney,liver,spleen,mind and heart;and 14 pathogenic elements,in order of frequency:qi deficiency,yang deficiency,dampness,yin deficiency,qi stagnation,essence deficiency,heat,phlegm,yang hyperactivity,blood stasis,blood deficiency,disintegration,qi trapping and cold.2.4 Relationship between lifestyle-related risks and evidence elementsThe pathogenic evidence elements in the overweight youth ED patients were predominantly Kidney,Spleen and Liver,and the pathogenic evidence elements were predominantly Qi deficiency,Dampness,Yang deficiency and Qi stagnation;compared to the normal weight group,the prevalence of evidence elements Spleen and Dampness was higher in the overweight ED patients(p<0.05).In the deviant sleep quality group,the pathogenic evidence elements were mainly Kidney,Liver and Heart-Shen,and the pathogenic evidence elements were mainly Yang deficiency,Dampness,Qi deficiency and Yin deficiency;compared with the normal sleep quality group,the evidence elements Heart-Shen and Yang deficiency were more prevalent in the poor sleep quality group(P<0.05).The pathogenic evidence elements in anxious young ED patients were mainly liver,kidney and spleen,and the pathogenic evidence elements were mainly qi deficiency,qi stagnation,yang deficiency,essence deficiency and yin deficiency;compared with the non-anxious young ED group,the evidence elements liver and qi stagnation were more prevalent in the anxious group(P<0.05).The common pathogenic evidence elements in stress youth ED patients were liver,kidney and spleen in order,and the pathogenic evidence elements were predominantly qi deficiency,yin deficiency,qi stagnation,yang deficiency and dampness;the evidence elements liver,yin deficiency and qi stagnation were more prevalent in the stress group(P<0.05).The common pathogenic evidence elements in the inactive patients were kidney,liver,spleen and heart and mind in that order;the common pathogenic evidence elements were qi deficiency,yang deficiency,qi stagnation,yin deficiency,dampness and essence deficiency in that order,and the evidence elements liver,qi deficiency,yang deficiency and qi stagnation were found to be more prevalent in the inactive young ED patients compared to the frequent exercise group(P<0.05).The pathogenic evidence elements of the kidney,spleen and liver were predominant in young ED patients who drank regularly,and the pathogenic evidence elements of dampness,qi deficiency,yang deficiency,heat and yin deficiency were predominant,with a higher incidence of evidence elements of spleen,dampness and heat compared to the infrequent drinker group(P<0.05).The common pathological elements in young ED patients who smoked were kidney,liver and spleen;the common pathological elements were qi deficiency,yang deficiency,dampness,essence deficiency,yin deficiency and qi stagnation,and the prevalence of essence deficiency was found to be higher in the smoking group compared to the non-smoking group(p<0.05).Conclusion:1.Conclusion of literature research.1.1 The evidence patterns in the treatment of ED by ancient and modern medical practitioners coincide for the most part with those based on modern textbooks and guidelines extracted from the ED evidence criteria template,suggesting that modern medical practitioners’ understanding of ED originates from ancient traditional theoretical understanding and is innovative and developed on the basis of the experience of their predecessors.1.2 Both ancient and modern medical practitioners have many unique and unconventional symptoms of ED,which need to be explored in depth and applied in the context of modern clinical practice.2.Conclusion of clinical study.2.1 The common lifestyle-related risk factors for young ED patients are,in order.sedentary,little exercise,overweight,sleep disturbance,anxiety and stress,and excessive smoking and alcohol.2.2 The common pathogenic evidence factors in young ED patients are,in order,kidney,liver,spleen and heart and mind,and the common pathogenic evidence factors are,in order,qi deficiency,yang deficiency,dampness,yin deficiency,qi stagnation and essence deficiency.2.3 Overweight ED patients have a higher incidence of spleen and dampness,suggesting that the treatment of such patients should be based more on the spleen theory of treatment,with dampness being the main focus;ED patients with poor sleep quality have a higher incidence of mind and yang deficiency,suggesting that the treatment of such patients should regulate the mind and yang into yin;inactive ED patients have a higher incidence of liver,qi deficiency,yang deficiency and qi stagnation,suggesting that the treatment of such patients should be based on draining the liver and tonifying yin and yang.The main focus;frequent alcoholic ED patients,evidence of spleen,damp,heat incidence is higher,suggesting that the treatment of such patients should clear damp heat;smoking ED patients evidence of essence deficiency incidence is higher,treatment to nourish the essence as the main;anxiety and stress ED patients evidence of liver,qi stagnation incidence is higher,treatment to dredge the liver to relieve depression,in addition to stress patients evidence of yin deficiency incidence is also higher,treatment should also nourish yin.