| ObjectiveTo sort out the relevant of senile dementia(SD)in ancient Chinese medicine(CM)books,and to explore the characteristics of syndrome differentiation treatment of senile dementia in CM,including etiology,pathogenesis and treatment rules,so as to enrich the concept of treatment of SD,in order to provide reference for treatment of CM in future.To collect the clinical reports of modern CM in the treatment of senile dementia during the last 20 years from 1999 to 2019,and to summarize the clinical prescription rules of modern CM.To compare the similarities and differences between ancient and modern CM in the treatment of senile dementia,and to find the regularity and common drug rules,then to put forward the future clinical recommendation of CM.MethodsThe literature was collected in the fifth edition of "Zhonghua Yidian","Hantang collection database" and "super star books",in which the key words were searched,such as "Forgetfulness","Dementia","Stupor","Deities" and "Ignorance".The literature was collected in CNKI database,during the last 20 years from 1999 to 2019,in which the key words were searched,such as "senile dementia+clinical" and "Chinese medicine+treatment","SD+clinical" and "Chinese medicine+treatment","Alzheimer's diseases+clinical" and "Chinese medicine+treatment","AD+clinical" and "Chinese medicine+treatment","vascular dementia+clinical" and "Chinese medicine+treatment","VD+clinical"and"Chinese medicine+treatment".Those were collected,sorted out and filtered,which related literatures of ancient senile dementia and clinical reports and studies of senile dementia in 20 years.Then the three databases of ancient medical cases,ancient medical science and modern clinical were established respectively,to extract relevant materials,standardize and data.The research results of the three databases were compared one by one.Qualitative analysis was carried out on the general data such as tongue image,pulse image,complexion,dosage,diagnosis times and prognosis,and mathematical statistics and mining were carried out on the frequency,dispersion,similarity,factor analysis and cluster analysis of the selection of traditional Chinese medicine,the functional classification of selected traditional Chinese medicine,and the meridian classification.Finally,the data were analyzed,compared and discussed to explore the drug use rule and trend of senile dementia.ResultsThe pulse pattern in medical cases suggested that senile dementia is mostly related to phlegm,deficiency of qi and blood,qi stagnation,blood stasis,Yang qi decline and other factors.Tongue diagnosis indicated that the disease has phlegm,blood stasis and deficiency of qi and blood and other pathological changes.The complexion indicated that there are blood deficiency,spleen deficiency,phlegm dampness,Yin deficiency and Yang hyperactivity in SD.The ancient medicine records showed that the key disease location of SD was "heart",and the disease was related to "kidney","liver","lung" and "spleen",too.The nature of disease of SD was deficiency syndrome,and the pathogenesis of this disease included insufficiency of heart,non-interaction between heart and kidney,phlegm-fire harassing heart,kidney yin deficiency,phlegm-fire harassing the upper body,essence-marrow depletion,water failing to moisten wood,phlegm-retained fluid obstructing,heart qi deficiency,deficiency-fire blazing upward,and so on.Mean-while,"phlegm" is also a key component of alzheimer's disease.Part one of this study obtained 192 sorts of herbs which were divided into 20 categories and 47 subclasses according to the functional classification.The top 5 of the total frequency were tonic medicinal,antipyretic medicinal,antipyretic medicinal,regulating qi medicinal,resolving phlegm and relieving cough and asthma medicinal.Among the tonic medicinal,the qi tonic medicinal appeared the most frequently,followed by blood tonic,Yin tonic and Yang tonic.The meridian entry of all of the herbs above-mentioned involved five depots and six palaces,especially lung.The herbs combination for tonic and resolving phlegm appeared more,supplemented by the combination of astringing,orifice-opening,tranquillizing and qi-regulating,in the results of factor analysis and cluster analysis.According to part tow,it was speculated that SD etiology relate to anxiety and pensiveness,heart fire,insufficiency of heart qi,insufficiency of heart blood,phlegm-retained fluid,accumulated heat in stomach,stagnant blood.In terms of treatment,according to the functions of herb,it belonged to the 14 categories of tonic medicinal for deficiency,activating blood and removing stasis,calming medicinal,water infiltration and dampening medicinal,and heat-clearing medicinal,involved the heart,kidney,liver,lung,spleen,stomach,gallbladder,large intestine,pericardium,small intestine and bladder.Part three of this study obtained 214 sorts of herbs which were divided into 17 categories and 39 subclasses according to the functional classification.The top 5 of the total frequency were tonic medicinal,active blood and resolving stasis medicinal,astringing medicinal,orifice-opening medicinal,heat-clearing medicinal.Among the tonic medicinal,the qi tonic medicinal appeared the most frequently,followed by blood tonic,Yang tonic and Yin tonic.The meridian entry of all of the herbs above-mentioned involved five depots and six palaces,especially spleen.The herbs combination for tonic and active blood and resolving stasis appeared more,supplemented by the combination of antipyretic,orifice-opening and heat-clearing,in the results of factor analysis and cluster analysis.Comparing ancient medical records with ancient medical records,the tongue and pulse indications collected in the two parts indicated the same clinical significance.The collected complexion records was more abundant in medical literature.In terms of the usage of prescriptions,the compatibility of well-known prescriptions was not high,and the prescriptions recorded in medical theory were more than those collected in ancient medical records.The comparison of ancient medical records and modern CM clinical reports showed that 118 herds such as Rhizoma Acori Tatarinowii,Rhizoma Ligusticli chuanxiong and polygala tenuifolia willd and so on overlap in the range of medication.The meridian entry of herbs in the tow studies above involved five depots and six palaces all.Compared with modern,there were more attacks toxin medicinal,vermifugal medicinal and emetic medicinal in ancient CM clinic.The tonic medicinal was to used as a dominant and orifice-opening medicinal,astringing medicinal and regulating qi medicinal were to used as assistant in CM treatment of SD either in Ancient or in modern.The difference lied in that modern CM clinic lay stress on active blood and resolving stasis medicinal while ancient CM records lay stress on astringent medicinal and phlegm-resolving medicinal.There were 30 sorts of herbs in ancient medical literature,ancient medical records and modern CM clinic all.ConclusionSenile dementia is mostly related to phlegm,deficiency of qi and blood,qi stagnation,blood stasis,Yang qi decline and other factors.The nature of disease of SD was deficiency syndrome,and the pathogenesis of this disease included insufficiency of heart,non-interaction between heart and kidney,phlegm-fire harassing heart,kidney yin deficiency,phlegm-fire harassing the upper body,essence-marrow depletion,water failing to moisten wood,phlegm-retained fluid obstructing,heart qi deficiency,deficiency-fire blazing upward,and so on."Phlegm" is also a key component of senile dementia.The ancient medicine records showed that the key disease location of SD was "heart",and the disease was related to "kidney”,"liver","lung" and "spleen",too.There are two significant characteristics of senile dementia in the prescription.The one is that location of the disease is the heart mostly but the meridian entry of all of the herbs involved lung mostly.The other is that the nature of disease of SD is deficiency syndrome while the qi tonic medicinal appeared the most frequently.Tonic medicinal is ranked the first both in ancient CM records and in modern CM clinic.Qi tonic and Yang tonic are more than Blood tonic and Yin tonic.Tranquillizing and heat-clearing medicinal have been paid more attention in clinical practice.The ancient clinical practice paid more attention to the use of phlegm-resolving medicinal and astringent medicinal,while the modern clinical practice lay particular stress on the application of active blood and resolving stasis medicinal.In the future,we can continue to use tonic medicinal,tranquillizing medicinal,astringing medicinal,regulating qi medicinal and try to dialectical use of phlegm-resolving medicinal and astringent medicinal.There were 30 sorts of herbs in ancient medical literature,ancient medical records and modern CM clinic all.These are Rhizoma Acori Tatarinowii,Rhizoma Ligusticli chuanxiong and polygala tenuifolia willd etc. |
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