| ObjectiveWe evaluated the clinical efficacy and safety of the treatment of ADHD with the method of earth-supported and wood-suppression by Meta-analysis;at the same time,we also used the ancient and modern medical case cloud platform to analyze the data mining of the medication pattern of the ADHD cases with spleen deficiency and liver hyperactivity in the clinic of Associate Professor Chen and summarized the treatment ideas and medication pattern of the treatment of this disease with the method of earth-supporting and wood-suppressing,so as to provide more ideas and methods for the clinical treatment of ADHD,and lay the foundation for further clinical and experimental research.MethodA search strategy was developed.Two researchers independently searched the published literature until March 2023 in six Chinese and international databases.The obtained literature was imported into EndNote,and the literature was screened according to the developed nadir criteria,and Excel was used to complete the data extraction and other tasks.The extracted data were evaluated for quality and Meta-analysis by Revman and Stata,combined with descriptive analysis,and the results were obtained and then discussed.The ADHD cases with spleen deficiency and liver hyperactivity evidence who attended the clinic of Associate Professor Chen at Dongfang Hospital of Beijing University of Traditional Chinese Medicine from September 2020 to February 2023 were collected,and the case data of 73 cases meeting the nadir criteria with a total of 238 consultations were obtained.After standardizing the general information,four diagnostic data and medication data of the patients,they were entered into the ancient and modern medical case cloud platform,and statistical analysis was performed on the gender ratio,age distribution,and drug taste and ascription,etc.Through statistical analysis,correlation analysis,cluster analysis and complex network analysis,the four diagnostic and drug frequencies,drug correlation,commonly used drug types and core Chinese medicine composition in the case data were analyzed.Finally,we obtained the medication guidelines and core prescriptions of our supervisor,Associate Prof.Chen,for the treatment of ADHD with spleen deficiency and liver hyperactivity,thus summarizing our supervisor’s understanding of this disease and the treatment ideas and medication rules.Results 1.Meta analysis resultsA total of 7 articles were included in this study,with a total of 580 cases.The results of the Meta-analysis are as follows.(1)In terms of efficacy,the total effective rate of the method of supporting earth and suppressing wood in treating ADHD[RR=1.04,95%Cl(0.96,1.13),P=0.29]and the effective rate of traditional Chinese medicine syndrome[RR=1.08,95%Cl(1.00,1.17),P=0.05]is equivalent to the control group;The control and apparent rate in the treatment of ADHD of spleen deficiency and hyperactivity of liver with traditional Chinese medicine using the method of supporting soil and suppressing wood is better than that in the control group[RR=2.17,95%Cl(1.14,4.13),P=0.02<0.05].(2)In terms of symptom improvement,both the traditional Chinese medicine group and the control group showed a significant decrease in SNAP-Ⅳ scale scores compared to before treatment(P<0.05).The traditional Chinese medicine group with earth-reinforcing and woodredcing method was lower in SNAP-Ⅳ scale symptom improvement than the Western medicine group(P=0.001<0.05),and better than traditional Chinese medicine group without earthsupporting and wood-suppressing method(P=0.001<0.05);the improvement of hyperactivity index in the traditional Chinese medicine group was comparable to that in the western medicine group(P>0.05)or lower than that in the western medicine group(P=0.001<0.05);the traditional Chinese medicine treatment of ADHD of spleen deficiency and liver hyperactivity with the method of supporting earth and suppressing wood has an impact on the total score of traditional Chinese medicine syndromes[MD=-5.58,95%Cl(-7.52,-3.63),P<0.00001],poor attention score[MD=-0.93,95%Cl(-1.39,-0.47),P<0.0001],hyperactivity and restlessness score[MD=-0.89,95%Cl(-1.30,-0.48),P<0.0001],irritability score[MD=-0.93,95%Cl(1.39,-0.47),P<0.0001],and poor memory score[MD=-0.53,95%Cl(-0.77,-0.29),P<0.0001]The score of irregular bowel movements[MD=-0.64,95%Cl(-0.88,-0.39),P<0.0001],facial complexion without appearance score[MD=-0.64,95%Cl(-0.87,-0.41),P<0.0001],appetite loss score[MD=-0.53,95%Cl(-0.78,-0.27),P<0.0001],and body weight loss score[MD=-0.94,95%Cl(-0.69,-0.19),P=0.0004<0.05],which were significantly better than the control group.(3)In terms of improving serum DA levels,one study showed that there was no significant difference in serum DA levels between the traditional Chinese medicine group and the western medicine group before and after treatment(P>0.05).The other study showed that both the traditional Chinese medicine(TCM)group with supporting earth and suppressing wood and the non-TCM group could improve serum DA levels(P<0.05),and the TCM group with supporting earth and suppressing wood was superior to the TCM group without supporting earth and suppressing wood in improving serum DA levels(P=0.004<0.05).(4)In terms of safety evaluation,the adverse reactions observed in the Chinese medicine group included nausea(2 cases),abdominal pain(2 cases),insomnia(1 case),drowsiness(6 cases),anxiety and tension(1 case),decreased appetite(1 case),and increased appetite(1 case).The adverse reactions observed in the Western medicine group included aversion(16 cases),headache(4 cases),abdominal pain(12 cases),insomnia(10 cases),anxiety and tension(5 cases),dizziness(4 cases)Decreased appetite(20 cases),increased appetite(4 cases),and hallu cinations(1 case).(5)Publication bias:There was no significant publication bias in the studies included in the total effective rate analysis of diseases(P=0.334>0.05)and the studies included in the effective rate analysis of traditional Chinese medicine syndromes(P=0.762>0.05).2.Drug Discovery Results(1)A total of 73 children were included in this study,including 51 males(69.9%)and 22 females(30.1%),with a male to female ratio of approximately 2.3:1;The age of the patients is mainly concentrated between 6 and 11 years old(84.93%).(2)There are a total of 46 clinical symptoms with a frequency of ≥5 in this study.The top 12 symptoms are Shensi laxity(218 times,91.60%),frequent small movements(133 times,55.88%),irritability(119 times,50.00%),poor complexion(101 times,42.44%),procrastination(69 times,28.99%),loss of appetite(65 times,27.31%),picky eating(54 times,22.69%),poor sleep(52 times,21.85%),constipation(51 times,21.43%),restlessness(31 times,13.03%),excessive sweating(28 times,11.76%),and emotional instability(23 times,9.66%);The common tongue veins are red tongue(138 times,57.98%),white fur(124 times,52.10%),thin fur(109 times,45.80%),and thin pulse(163 times,68.49%).(3)Tutor Associate Prof.Chen used a total of 159 Chinese herbal medicines in the clinical treatment of ADHD with spleen deficiency and liver hyperactivity,with a total frequency of 4100 times.The top 10 traditional Chinese medicines with the highest frequency were Rhizoma Acori Tatarinowii(204 times,85.71%),Alpiniae oxyphyllae Fructus(197 times,82.77%),Polygalae Radix(188 times,78.99%),Pinelliae Rhizoma(156 times,65.55%),Citri Reticulatae Pericarpium(152 times,63.87%),Glycyrrhizae Radix et Rhizoma(151 times,63.45%),Ossa Draconis(131 times,55.04%),Bupleuri Radix(111 times,46.64%),Atractylodis Macrocephalae Rhizoma(109 times,45.80%),Poria cum Radix Pini(102 times,42.86%).(4)Nature,flavour and channel tropism:the main nature is warm(1433 times,34.95%)Flat(1025 times,25.00%),slightly cold(675 times,16.46%),and cold(560 times,13.66%),while the main flavour is sweet(2020 times,49.27%),spicy(1734 times,42.29%),and bitter(1640 times,40.00%).The meridians mainly belong to the heart meridian(1992 times,48.59%),spleen meridian(1865 times,45.49%),lung meridian(1659 times,40.46%),liver meridian(1481 times,36.12%),stomach meridian(1229 times,29.98%),and kidney meridian(1220 times,27.32%).(5)The results of correlation analysis showed that Pinelliae Rhizoma&Citri Reticulatae Pericarpium had the highest lifting degree,while Polygalae Radix&Rhizoma Acori Tatarinowii had the highest confidence.The overall drug combination was centered around Rhizoma Acori Tatarinowii,Polygalae Radix,Alpiniae oxyphyllae Fructus,Pinelliae Rhizoma,and Citri Reticulatae Pericarpium.(6)Cluster analysis results showed that Associate Prof.Chen commonly used four groups of traditional Chinese medicines to treat ADHD caused by spleen deficiency and hyperactivity of the liver using the method of supporting the earth and suppressing the wood,which were respectively beneficial to intelligence and calming the nerves(Rhizoma Acori Tatarinowii,Polygalae Radix,Guijia,Ossa Draconis,Glycyrrhizae Radix et Rhizoma,Poria cum Radix Pini,Alpiniae oxyphyllae Fructus),and beneficial to spleen and qi(Longan Arillus,Astragali Radix,Pseudostellariae Radix,Ziziphi Spinosae Semen,Atractylodis Macrocephalae Rhizoma,and Angelicae Sinensis Radix),calming and relaxing the liver(Bupleuri Radix,Uncariae Ramulus cum Uncis,Gardeniae Fructus,Moutan Cortex,Lilii Bulbus,Gastrodiae Rhizoma)and clearing heat and eliminating phlegm(Poria,Pinelliae Rhizoma,Citri Reticulatae Pericarpium,Forsythiae Fructus,Curcumae Radix,Caulis Bambusae in Taenia,Aurantii Fructus Immaturus).(7)The complex network analysis results show that the core prescription of Associate Prof.Chen for treating hyperactivity disorder in children with spleen deficiency and liver hyperactivity syndrome consists of 11 traditional Chinese medicines,including Rhizoma Acori Tatarinowii,Polygalae Radix,Alpiniae oxyphyllae Fructus,Pinelliae Rhizoma,Citri Reticulatae Pericarpium,Glycyrrhizae Radix et Rhizoma,Ossa Draconis,Atractylodis Macrocephalae Rhizoma,Bupleuri Radix,Danggui,and Poria cum Radix Pini.Conclusions1.The efficacy and safety of earth-supporting and wood-suppressing method in treating ADHD with spleen deficiency and liver hyperactivity are clear,and it has obvious advantages in improving the total symptoms of TCM and individual symptoms such as laxity,hyperactivity,impatience,poor memory,loss of appetite,irregular bowel movements,dull complexion,and emaciation,etc.Further research is needed to study the mechanism of action.2.Commonly used herbal medicines reported in the literature for the treatment of ADHD by the method of supporting earth and suppressing wood include Rhizoma Acori Tatarinowii,Ossa Draconis,Paeoniae Radix Alba,Glycyrrhizae Radix et Rhizoma,Uncariae Ramulus cum Uncis,Jujubae Fructus,Atractylodis Macrocephalae Rhizoma,Polygalae Radix,and Concha Margaritifera Usta.3.Associate Prof.Chen believes that the basic pathogenesis of ADHD in children with spleen deficiency and liver hyperactivity is the dysfunction of the internal organs,with spleen deficiency producing phlegm,liver yang hyperactivity,and phlegm blocking qi depression.4.Associate Professor Chen applied the method of supporting earth and suppressing wood to treat ADHD with spleen deficiency and liver hyperactivity,with "balancing the yin and yang of the internal organs,strengthening the spleen and pacifying the liver,and resolving phlegm and qi" as the basic treatment principle.The main herbal medicine are sweet,hard,and warm,and they mainly belong to the heart,spleen,liver,and kidney meridians.5.The core herbal medicines prescribed by Associate Professor Chen for treating ADHD with spleen deficiency and liver hyperactivity are Rhizoma Acori Tatarinowii,Polygalae Radix,Alpiniae oxyphyllae Fructus,Pinelliae Rhizoma,Citri Reticulatae Pericarpium,Glycyrrhizae Radix et Rhizoma,Ossa Draconis,Atractylodis Macrocephalae Rhizoma,Bupleuri Radix,and Poria cum Radix Pini. |
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