| ObjectiveDecocted Extract (GaoFang) is one of the forms of drug in Chinese medicine manufacturing, which has been popularly used by the high official, noble and wealthy class in ancient time of China. As the society continues to progress and the economics improves, nowadays civilian become more and more aware of their quality of life, and seek ways for health preservation. In particular, decocted extract becomes a desirable way for common people to pursue health maintenence.In the life time of a woman she will go through the process of menstruation, pregnancy, birth giving, breast feeding, resulting in adverse significant impact to her vital blood. In order to recover from this condition and to reinforce the vital essence and strengthen the primordial qi, decocted extract could be applied. It is believed to have general health replenishing and diseases alleviating properties. Some of the advantages are as follows: recruiting a large combination of herbs in a recipe with a wide variety of treatment purposes, mild efficacy but durable, easier ingestion for a long-term treatment. It is particularly applicable to the treatment of various chronic gynecological diseases.Alongside with the increased interest in the use of decorted extract, this study aims to investigate the prevalence of decorted extract usage in different gynecological diseases categories, as well as gynecological disorders & conditions; and to discover the related herbal usage characteristics. Statistical analysis is applied on miscellaneous herbal usage in the recipe. Hopefully the result of the study could then be employed as practical reference of decorted extract usage in clinical gynecology.MethodologyThe objective of this study is to focus on the clinical cases of using decorted extract in gynecology. Medical case studies of using decorted extract came from different Chinese medicine periodical journals and books. The collected data was then input into a Microsoft Access database to perform further analysis. The source of the literatures was taken from the CNKI and the WanFang database. Category of "medical care and medicine" was selected, and the search keywords, namely“膏方”、“膏滋”'”煎膏”were used. Articles from the last 30 years matching the keywords above, with date ranged from year 1981-2015 (cut-off date January 2015) were being filtered out and used in the study. Regarding to the books in this study, they were recruited from the library collection of Guangzhou University of Chinese Medicine and Dr. Stephen Riady Chinese Library of the Hong Kong Baptist University. Other book sources were self-purchased for reference, most of which were published recently.Since Chinese medicine practitioners originate from different regions and share a variety of cultural backgrounds, their representations on symptoms records somehow show their own styles. In addition, their recordings of herbs also exhibit regional and habitual differences. In order to carry out an objective and logical mathematical analysis, most of the terminology should be standardized first. For instance reference materials like textbooks of "Gynaecology in Chinese Medicine" and "Chinese Materia Medica" were adopted before entrying the data into Microsoft Office Excel tables. After the terminology standardisation, the processed data was then entered into Microsoft Access, and a database for clinical cases of decorted extract usage in gynecology was built finally. The rich frequency and statistical features of Microsoft Access was utilized to create different investigation queries (and related criterion) to process the result. Base upon the result the combination characteristics of the decorted extract in gynecology recipes could be explored.This study also performed cluster analysis through the varclus function in Hmisc package of the R-programming environment. Varclus cluster analysis attempts to analyze a set of observations with distinct variables, and groups them together base on the characteristic and similarity of those variables. Focusing on three predominant diseases in terms of high popularity in decorted extract application, our study made effort to find out their corresponding decorted extract’s high frequency herbal usage (using a cumulative herbal frequency of 50% as filtering and herbal reduction), and applied the varclus algorithm for cluster discovery. It tried to seek if there were any hidden herbal usage patterns and drug combinations, so as to study the basic rules of designing decorted extract recipe in those diseases.ResultsThe database in this research gathered 728 recipes, which matched the corresponding search criteria. They were recruited from a total of 17 books, comprised of writings on medical case studies of famous gynecological specialists, and bibliographies of decorted extract; plus another 26 periodical articles related to clinical cases of decorted extract. They were based on the experiences of 79 experienced Chinese medicine practitioners, with a total of 57 types of gynecological conditions & disorders being studied. The statistical results could be categorized into 3 parts as follows:1. Age distribution of decorted extract usage in patients with gynecological diseases:major age group ranged from 30-39 years old, and the next major group ranged from 40-49 years old and 20-29 years old (this included 684 clinical cases with patient’s age being recorded)2. Result analysis for gynecological diseases and their symptoms frequency distribution:. Ranking of gynecological disease categories in descending order: menopathy as the major category (55.36%), followed by miscellaneous diseases in gynecology (20.47%), leukorrheal diseases (8.65%), health preserving (7.69%), postpartum disease (6.04%), and diseases of pregnancy (1.79%).. Ranking of the 10 out of 57 types of gynecological disorders & conditions in descending order as:postmenopausal syndrome (12.24%), infertility (9.49%), abdominal mass (8.80%), hypo-menorrhea (6.33%), advanced menstruation (5.50%), delayed menorrhea (5.23%), dysmenorrheal (5.09%), menorrhagia (4.95%), amenorrhea (4.81%), and leukorrheal diseases (4.54%), etc.; accumulation of above has nearly reached 70% of total number of clinical cases being studied.. Symptoms mentioned in the clinical cases of decorted extract were grouped into 23 categories, consisting of 5670 symptoms and medical signs in total. Within those the symptoms of menstrual irregularities (regarding to changing schedule, menstrual blood volume, color and texture) were the major group (19.49%), and the next 9 ranks were as follows in descending order:whole body symptoms (9.42%), mental, emotional & sleep symptoms (9.26%), cold & hot sweat symptoms (7.51%), back & waist symptoms (7.30%), stomach & abdomen symptoms (6.53%), head, neck & shoulder symptoms (5.98%)、 excrement symptoms (5.61%), leukorrheal symptoms (4.67%), head, face & body medical signs (4.36%)3. Result analysis for herbs usage in decorted extract recipe in general gynecology:. The number of herbs per decorted extract recipe being included in this study ranged from 9 to 76 herbs. The average herbs per recipe was 38.52, within that the group of "30-39 herbs per recipe" gathered the most, which contained 380 recipes, and constituted 52.20% of the total number of recipes under analysis. Among the herbs, medicinal slices was the major component of decorted extract recipe at 82.68%, which constituted more than 80% over all the materials. The next group was fine material at 8.81%, followed by gelatin material at 5.01%, and finally sugar based material at 3.50%.. The total number of herb usage frequency is 28044, consisting of 525 different kinds of herb. The design of decorted extract recipes tended to use tonic drugs as the basis; mainly with neutral and warm in nature; sweet, bitter and pungent in taste; and exhibited affinity to liver, kidney and spleen. Almost half of the herbs were tonic ones. Meanwhile, toxic drugs and insect (& insect-derived) drugs were rarely applied in the recipes. The most frequently used herbs were EJiao (Colla corii asini), DangGui (Angelica sinensis), HuangQi (Radix Astragali), BaiShao (radix paeoniae alba)、 BaiZhu (Rhizoma Atractylodis)、DangShen (Codonopsis pilosula) and ShouDiHuang (Radix Rehmanniae Praeparata); all with confidence stayed above 70%.. The decorted extract database recorded a total of 40 kinds of fine material herb. Within the group of "both food & medicinal material", walnut was being the mostly used (59.07%), then followed by Fructus Jujubae (49.73%), Longan Aril (38.87%), Black Sesame (30.91%) and Semen Nelumbinis (27.47%). RenShen (ginseng) was the mostly used in the group of "precious medical material", which constituted 53.02% in that group.. EJiao was the mostly used in the group of "gelatin material", with confidence stayed high at 95.05%, constituted as the major material type over all herbs usage. EJiao sometimes associated with the use of other gelatin materials like GuiBanJiao (tortoise-plastron glue) and Lujiaojiao (deer-horn glue). Therefore, it was noted that most of the decorted extracts in gynecology belonged to non-vegetarian type.. Rock sugar was the most frequently used "sugar based material", with a confidence of 81.87%. Its usage was much higher than the second and the third most used items, i. e. honey and maltose, by over two times. On the other hand, artificial sweeteners were rarely used for taste adjustment purpose in the studied cases.4. Herbal usage pattern and drug combination (by varclus cluster analysis) in the three predominant diseases:. perimenopausal syndrome:the uses of yin-supplementing drugs and mind relaxing drugs were slightly frequent than in other diseases. To treat spleen-kidney-qi-deficiency type, one could make reference to group C7(杜仲、续断、赤芍、黄精).To treat liver-kidney-yin-def iciency type, one could make reference to group C8 (旱莲草、女贞子、丹参、牛膝)；to treat kidney-yin-yang-deficiency type, one could make reference to group C9(淮山药、山茱萸、淫羊藿、黄柏、知母),group C2(人参、党参、北耆)and groupC4(白术、白芍、甘草)；to treat significant symptoms of hot-flushes and sweating, one could make reference to group Cl(茯苓、淮小麦)；to treat symptoms of dried-intestine-induced constipation, one could make reference to group C3(麦门冬、何首乌、生地黄)；to treat symptoms of dry mouth polydipsia, one could make reference to group C6(五味子、西洋参)；to treat symptoms of head toasted, one could make reference to group C5(桑寄生、橘皮、牡丹皮).. Infertility:the uses of qi-, blood-, yang-supplementing drugs and diuretic drugs were slightly more frequent than in other diseases. On the treatment of liver & kidney nourishment, one could make reference to group C1(杜仲、菟丝子、续断、覆盆子、山茱萸),group C2(牡丹皮、生地黄、巴戟天、黄芪、淫羊藿)and group C5(肉苁蓉、熟地黄、何首乌、黄精).For the purposes of dredging liver-qi and promoting blood circulation, one could make reference to group C3(甘草、香附、丹参、白术、白芍、枸杞子).In order to nourish spleen-blood, one could make reference to group C4(鸡血藤、川芎、当'、党参、茯苓)and group C6(赤芍、橘皮、人参、淮山药、龙眼肉).. Abdominal mass:the uses of qi-regulating drugs and blood circulation-promoting drugs were slightly more frequent than in other diseases. The clustered recipes contained both supplementation and attack approaches. For the purposes of dredging liver-qi, promoting blood circulation and eliminating mass, one could make reference to group Cl(香附、川芎、当'、赤芍、丹参、牡丹皮、人参)and C2(莪术、三棱、菟丝子、川楝子、延胡索).If targeting on calming the liver and nourishing the yin of liver and kidney, one could make reference to group C5(夏枯草、甘草、何首乌、柴胡、枸杞子、橘皮)and group C7(郁金、黄精、'皮、白芍、生地黄、熟地黄).For the purpose of strengthening health by spleen & kidney tonifying, one could make reference to group C3(桑寄生、杜仲、莲肉、西洋参),group C4(党参、桃仁、旱莲草、女贞子、茯苓、淮山药)and group C6(黄芪、山茱萸、白术、杜仲).The Chinese PingYin names and Latin names of the drugs are listed below:-(1) Varclus result for perimenopausal syndrome:C1：茯苓、淮小麦FuLing (Poria cocos), HuaiXiaoMai (Triticum)C2：人参、党参、黄芪 RenShen (Ginseng), DangShen (Codonopsis pilosula), HuangQi (Radix Astragali)C3：麦门冬、何首乌、生地黄MaiMenDong (Radix ophiopogonis),HeShouWu (Radix Polygoni Multiflori), ShengDiHuang (Radix Rehmanniae)C4：白术、白芍、甘草BaiZhu (Rhizoma Atractylodis), BaiShao (radix paeoniae alba), GanCao (Glycyrrhiza uralensis)C5：桑寄生、橘皮、牡丹皮SangJiSheng (Herba Taxilli), JuPi (Exocarpium Citri Leiocarpae), MuDanPi (Cortex Moutan)C6：五味子、西洋参WuWeiZi (Schisandra chinensis), XiYangShen (Radix Panacis Quinquefolii)C7：杜仲、续断、赤芍、黄精DuZhong (Eucommia), XuDuan (Radix Dipsaci), ChiShao (Radix Paeoniae Rubra), Huangjing (rhizoma polygonati)C8：旱莲草、女贞子、丹参、牛膝HanLianCao (Herba Ecliptae), NvZhenZi (fructus ligustri lucidi), DanShen (Radix Salviae Miltiorrhizae), NiuXi (Achyranthes bidentata)C9：淮山药、山茱萸、淫羊藿、黄柏、知母HuaiShanYao (Rhizoma Dioscoreae), ShanZhuYu (Cornus officinalis), YinYangHuo (Herba Epimedii), HuangBai (Phellodendron amurense), ZhiMu (Anemarrhena)C10：熟地黄、川芎、当'ShouDiHuang (Radix Rehmanniae Praeparata), ChuanXiong (Ligusticum wallichii), DangGui (Angelica sinensis)C11：合欢皮、夜交藤、枸杞子、酸枣仁HeHuanPi (cortex albiziae), YeJiaoTeng (Tuber Fleeceflower Stem), GouQiZi (Fructus Lycii), SuanZaoRen (Semen Ziziphi Spinosae)(2) Valclus result for infertility:C1：杜仲、菟丝子、续断、覆盆子、山茱萸DuZhong (Eucommia), TuSiZi (Cuscuta), XuDuan (Radix Dipsaci), FuPenZi (Rubus idaeus), ShanZhuYu (Cornus officinalis)C2：牡丹皮、生地黄、巴戟天、黄芪、淫羊藿MuDanPi (Cortex Moutan), ShengDiHuang (Radix Rehmanniae), BaJiTian (Morinda officinalis), HuangQi (Radix Astragali), YinYangHuo (Herba Epimedii)C3：甘草、香附、丹参、白术、白芍、枸杞子GanCao (Glycyrrhiza uralensis), XiangFu (rhizoma cyperi), DanShen (Radix Salviae Miltiorrhizae), BaiZhu (Rhizoma Atractylodis), BaiShao (radix paeoniae alba), GouQiZi (Fructus Lycii)C4：鸡血藤、川芎、当'、党参、茯苓JiXueTeng (Suberect Spatholobus Stem), ChuanXiong (Ligusticum wallichii), DangGui (Angelica sinensis), DangShen (Codonopsis pilosula), FuLing (Poria cocos)C5：肉苁蓉、熟地黄、何首乌、黄精RouCongRong (herba cistanche), ShouDiHuang (Radix Rehmanniae Praeparata), HeShouWu (Radix Polygoni Multiflori), Huangjing (rhizoma polygonati),C6：赤芍、橘皮、人参、淮山药、龙眼肉ChiShao (Radix Paeoniae Rubra), JuPi (Exocarpium Citri Leiocarpae), RenShen (ginseng), HuaiShanYao (Rhizoma Dioscoreae), LongYanRou (longan aril)(3) Valclus result for abdominal mass:C1：香附、川芎、当'、赤芍、丹参、牡丹皮、人参XiangFu (rhizoma cyperi), ChuanXiong (Ligusticumwallichii), DangGui (Angelica sinensis), ChiShao (Radix Paeoniae Rubra), DanShen (Radix Salviae Miltiorrhizae), MuDanPi (Cortex Moutan), RenShen (ginseng)C2：莪术、三棱、菟丝子、川楝子、延胡索EZhu (Curcuma zedoaria),SanLing (rhizoma sparganii),TuSiZi (Cuscuta), ChuaLianZi (Fructus Toosendan), YanHuSuo (Rhizoma Corydalis)C3：桑寄生、杜仲、莲肉、西洋参SangJiSheng (Herba Taxilli), DuZhong (Eucommia), LianRou (Semen Nelumbinis), XiYangShen (Radix Panacis Quinquefolii)C4：党参、桃仁、旱莲草、女贞子、茯苓、淮山药DangShen (Codonopsis pilosula), TaoRen (semen persicae), HanLianCao (Herba Ecliptae), NvZhenZi (fructus ligustri lucidi), FuLing (Poria cocos), HuaiShanYao (Rhizoma Dioscoreae)C5：夏枯草、甘草、何首乌、柴胡、枸杞子、橘皮XiaKuCao (Prunella vulgaris), GanCao (Glycyrrhiza uralensis), HeShouWu (Radix Polygoni Multiflori), ChaiHu (Radix Bupleuri), GouQiZi (Fructus Lycii), JuPi (Exocarpium Citri Leiocarpae)C6：黄芪、山茱萸、白术、杜仲HuangQi (Radix Astragali), ShanZhuYu (Cornus officinalis), BaiZhu (Rhizoma Atractylodis), DuZhong (Eucommia)C7：郁金、黄精、'皮、白芍、生地黄、熟地黄Yujin (Radix Curcumae), Huangjing (rhizoma polygonati), QingPi (Citri reticulatae viride), BaiShao (radix paeoniae alba), ShengDiHuang (Radix Rehmanniae), ShouDiHuang (Radix Rehmanniae Praeparata)Conclusion1. Decorted extract is a good option for achieving holistic wellness. Gyncological decorted extract is effective in treating or alleviating chronic illnesses. The three most predominant gynecological disorders & conditions are perimenopausal syndrome、infertility and abdominal mass, followed by hypomenorrhea, advanced menstruation, delayed menorrhea, dysmenorrheal, menorrhagia, amenorrhea, leukorrheal diseases, etc.2. The design of decorted extract recipe tends to use tonic drugs as the basis; mainly with neutral and warm in nature; sweet, bitter and pungent in taste; and exhibits affinity to liver, kidney and spleen. The most frequently used herbs are EJiao (Colla corii asini), DangGui (Angelica sinensis), HuangQi (Radix Astragali), BaiShao (radix paeoniae alba), BaiZhu (Rhizoma Atractylodis), DangShen (Codonopsis pilosula) and ShouDiHuang (Radix Rehmanniae Praeparata). Renshen (ginseng), walnet and EJiao (Colla corii asini) are the mostly used in the groups of "precious medical material", "both food & medicinal material" and "gelatin material", respectively. Qi-regulating drugs and blood circulation-promoting drugs, usually served in the recipe according to the medical necessity, are often found to be pungent in taste for exhibiting the effects of dispersing and activating qi-blood circulation. Others like clearing heat & cooling blood drug, astringent drug, mind relaxing drug and diuretic drug are also commonly used. The usage of warm-nature drug is higher than cold-nature ones. Drugs with extremely hot or cold in nature are rarely applied.3. Varclus analysis was used to investigate the herbal usage characteristics for the three predominant diseases:88 cases of perimenopausal syndrome results in 11 drug combinations; 69 cases of infertility results in 6 drug combinations; and 64 cases of abdominal mass results in 7 drug combinations. This can preliminarily reflect on the drug pattern amid decorted extract recipes. |
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