Data Mining Of TCM Syndrome And Treatment Regularity Of Psoriasis And Differential Protein Study Of Common Syndromes

[Background]Psoriasis is a common chronic relapsing erythematous scaly skin disease,Traditional Chinese Medicine(TCM)called "white pimple","skin pimple" and so on.The etiology of psoriasis is complex and the exact pathogenesis is unknown.The existing treatments can only relieve or control the symptoms and can not prevent recurrence.The rash has huge negative impact on the patient's quality of life and psychology.Psoriasis has always been the one of the key diseases in the field of dermatology.Treatment based on syndrome differentiation is the main feature of TCM treatment system.TCM treatment of psoriasis has become one of the important methods for the disease.In recent years,there has been an increase in literature reports on the treatment of psoriasis with TCM,which suggests that Chinese medicine has achieved remarkable results in this area.However,due to the complex pathogenesis of the disease,different doctors have different opinions on the pathogenesis of the disease and treatment experience.Therefore,there are problems such as complicated classification,inconsistency of prescribing medications,and lack of standardization of therapeutic effects,resulting in treatment experience is difficult to repeat and popularize,to some extent,affect the advantages the disease in TCM treatment,which restricts the standardization of clinical diagnosis and TCM treatment and the development of related scientific research.Therefore,it is imperative to further dig out and sort out these literature resources,discuss the syndrome differentiation and medication laws,and systematically analyze and evaluate clinical research literature.Syndrome differentiation is the basis of TCM treatment.TCM syndromes are pathological generalizations in the course of disease development.The modern biological basis of different syndromes is of great significance for revealing the modern scientific connotations of TCM syndrome and treatment.After reviewing the literature and summarizing the previous studies,we found that the differentiation and treatment of psoriasis is based on multiple targets and multiple links.However,the current research on syndromes is mostly focused on point-based studies.Comprehensive and systematic Biological mechanism study is still required.[Objective]1.Through the collection and data mining on TCM clinical research of psoriasis,the disease type characteristics,therapeutic methods and medication rules for the TCM treatment of psoriasis has been analyzed,which can provide method,prescription and medicine reference for differentiation treatment,and to provide theoretical basis for the relevant scientific research;2.To evaluate the clinical efficacy of modification of Xijiaodihuang Decoction in the treatment of psoriasis blood-heat syndrome,which can provides a more scientific basis for the efficacy of Chinese medicine in the treatment of psoriasis;3.The preliminary analysis of the biological basis of psoriasis blood-heat syndrome and blood-stasis syndrome from the level of protein is conducted,which can reveal the proteinological basis for the formation of different syndromes of psoriasis and provide basis for the study of psoriasis syndrome and intervention target of herbal medicine.[Method]1.Through the literature search of Chinese full-text database,collect the clinical research literature of psoriasis TCM syndrome differentiation and treatment,and use the TCM inheritance auxiliary platform(V2.5)software system of the Institute of Chinese Medicine Academy;,a clinical research database for psoriasis treatment of TCM was established.The criteria of syndrome differentiation for regularity and overall convergence,potential drug use patterns,core drug combinations,and potential new-party combinations were explored.2.Computer-based search of CNKI(1956-2018),VIP full-text database(1989-2018),Wanfang Database(1990-2018),and PubMed,EMBASE,Medline.All randomized controlled trials on the treatoment of blood-heat syndrome of psoriasis with modification of Xijiaodihuang Decoction were conducted.The JADAD score scale was used to evaluate the quality of the included studies by two reviewers,and a meta-analysis was performed by using RevMan5.3.3.Using a protein chip that can detect the expression levels of 507 human proteins at a time,detect the serum samples of the two most common psoriasis syndromes-blood heat syndrome,blood stasis syndrome in 3 cases and 3 healthy controls.The differential proteins representing different syndromes were detected;51 clinical serum samples were detected by ELISA to verify the predominant differential proteins of blood heat syndrome and blood stasis syndrome.[Result]1.The study included 91 articles,including 103 prescriptions,170 Chinese herbs and 1185 flavors.The first three syndromes types were blood heat syndrome,blood stasis syndrome,and blood deficiency syndrome;17 kinds of drugs were used more than 20 times,and the main types of drugs used were Rehmannia glutinosa,licorice root and peony bark;the mostly used drugs were cold,warm,neutral in nature,bitter,sweet,pungent in flavor,mainly to liver,heart-based;the most commonly used group of drugs were Rehmanniae and Cortex moutan,Rehmanniae Radix and Radix Paeoniae Rubra,Radix Scutellariae and Rehmannia glutinosa,Radix Rehmanniae,and Radix Glycyrrhiza.Clearing heat and cooling blood drug pair is the the most commonly used drugs for blood heat syndrome and Xijiaodihuang Decoction is the most frequently used prescription for the syndrome.Activating blood and removing stasis medicine is is commonly used for blood stasis syndrome.Blood tonifying and Qingre Liangxue pairs is commonly used for blood deficiency syndrome.A total of 11 new prescriptions has been found.The new potential treatment of blood heat and blood stasis by 10,and there are three potential new prescriptions for blood deficiency syndrome.2.336 articles in the initial examination were included,and 6 articles were eventually included by using the inclusion and exclusion criteria.In 4 of the 6 studies,the 95%CIs contained 1,so the results were not statistically significant;in 2 studies,95%CI did not include 1,and the results were statistically significant.3.There are significant differences in protein expression between different syndromes of psoriasis and between disease and normal controls.Compared with the blood stasis syndrome,all the differential proteins were down-regulated in serum of patients with blood heat syndrome.Four main differential proteins representing the characteristics of blood heat syndromes were found:B7-1/CD80,PDGF-AB,and MIP-lb,FGF-9,and six major differential proteins representing blood stasis syndrome were found:Smad 1,GRO-a,NCAM-1/CD56,IL-23 R,IL-23,TMEFF1/Tomoregulin-1.Elisa validation results in clinical specimens showed significant differences between FGF-9,GRO-a,IL-23,and NCAM-1 between the two syndromes.[Conclusion]1.At present,the TCM etiology and differentiation treatment of psoriasis are still focused on syndrome differentiation of blood.At the same time,other types of syndrome differentiation are used.Blood heat,blood stasis,and blood deficiency are the main types.Blood heat syndrome is the most common type of syndromes.Clearing heat and cooling blood treatment is the main rule,drugs mainly used are Rehmannia glutinosa,peony skin,Smilax glabra and Radix Paeoniae Paeoniae,such as these types of cooling blood and detoxifying herbs.Xijiaodihuang Decoction is the main prescription for the treatment of blood heat syndrome.Blood stasis syndrome with blood circulation as the main rule,blood deficiency and wind dryness syndromed mainly with blood,clearing heat and cooling blood as the main rule.2.The treatment of psoriasis Vulgaris with modification of Xijiaodihuang decoction was clinically effective[RR 1.09,95%CI(1.03,1.18)].However,it has not been proved that Xijiaodihuang Decoction is superior to western medicine group in treating psoriasis blood-heat syndrome.It also requires large-sample,multi-center,randomized double-blind,placebo-controlled clinical trials with rigorous scientific design.3.The two common TCM syndromes of psoriasis,blood heat syndrome and blood stasis syndrome,have significant differences in protein expression.The differentially expressed proteins of blood heat syndrome are mainly involved in biological processes such as inflammatory reaction,cell chemotaxis,cell proliferation and differentiation,and all have reduced expression differential proteins characteristic of blood stasis syndrome are involved in negative regulation of cell proliferation,autoimmune The biological processes such as inflammatory response and neutrophil chemo taxis showed up-regulation expression,which suggests that there are differences in the immune imbalance among different syndromes.