| PurposeIn-depth discussion of the law of the syndrom of the syndrome of dampness disease in the Essentials of the Golden Chamber,and empirical research on "damp flow joints"(objective evidence,biological mechanism).Method1 Use philological research methods to collect historical materials,sort out the analysis of the meaning of the word "dampness" in the non-medical literature and medical historical materials from the pre-Qin to Western Han dynasties and the theoretical origin of dampness diseases.2 Adopt the research method of combining literature and theory to discuss the diagnosis and treatment outline of Zhang Zhongjing' s dampness disease,the rule of concurrent treatment of dampness diseasepulse syndrome and the analysis of its dynamic evolution.3 Empirical research method is used,according to the "dampness attack people,they must first have internal dampness ness and then feel external dampness ness."Inner Evil"("Jin Kui's Outline of the Heart"),to explore the objective evidence and biological mechanism of "dampness flow joint" in "The Golden Chamber".A collagen-induced joint model of CIA rats was constructed,and external dampness intervention was used.At the same time,normal rats were used as controls for CIA rats.First,observe the effect of external dampness on joint swelling,cartilage damage,immune inflammation,urine output,etc.of each group of rats,and explore the objective evidence and occurrence conditions of "dampness flow joints".Experimental methods such as metabolomics and 16S rRNA high-throughput sequencing explore the biology of "dampness flow joints" from the three perspectives of C5a-C5aR driving inflammatory cell-directed joint chemotaxis,fecal metabolomics and intestinal microbiome mechanism.The result1 Pre-Qin to Western Han documents on "dampness" and "dampness disease"1.1 Analysis of the word "dampness" in the non-medical literature from the pre-Qin to the Western Han Dynasty:The word "dampness" has contained the meanings of"dampness is inferior" and "dampness ness is slow" in the process of the evolution of the shape and the richness of semantics1.2 Medical Unearthed Documents Unearthed from Pre-Qin to Western Han"Fifty-two disease prescription" uses warm covering method to treat infantile spasm;Wuwei Han Dynasty medical notes use "Qinzi five points,aconite one piece" to treat dampness and swollen hands and feet.1.3 "Shen Nong's Materia Medica":The book clearly records 53 kinds of drugs for the treatment of diseases related to "dampness",the above products and attack products are mostly,and the medicinal properties are mostly Kuping,Xinwen,Kuhan,Ganhan.Covers most symptoms of dampness.There are 24 kinds that are still commonly used in later generations.1.4 "Inner Canon of the Yellow Emperor":? The physiology of moisture can moisten all things;?The pathology of dampness is "dampness injury in the next" and"dampness injury in the spleen";?The site of dampness disease can be divided into dampness on the table,In the lungs,in the spleen,and in the kidney;?The treatment of dampness and evil include internal treatments such as taking Alisma drink,chicken yam,and blue grass soup,and external treatments such as massage,sitz bath,and acupuncture.1.5 "Dysmenorrhea":Under the principle of the Five Elements Kesheng concept,"dampness evil hurts the kidney" is regarded as "stricken self-disease" of dampness evil.In the concept of "five evils damage",dampness evil is the thief of the heart,and It is clear that the main vein of dampness diseaseis the vein.2 Discussion on the Syndrome of Dampness Diseases in "An Outline of Jinkui"2.1 Zhong Jing's diagnosis and treatment decision-making model of "combination of disease and syndrome"Each article in "Treatise on Febrile Diseases and Miscellaneous Diseases" is titled"Diagnosis and Treatment of Disease Vessel Syndrome",showing that "Diagnosis and Treatment of Disease Vessel Syndrome" is Zhong Jing' s unique clinical diagnosis and treatment decision-making model.The highlight of the "disease syndrome and treatment"is to attach importance to the concept of hierarchy in the classification of diseases.This diagnosis and treatment model prompts clinical diagnosis and treatment to first distinguish between "disease",on the basis of distinguishing the mother classification of "disease",Ping "mai" to distinguish "mai",and then to carry out fine classification(sub-category)according to "zheng"--Dialectical."Disease syndrome and treatment" is Zhong Jing's"gradual classification" diagnosis and treatment model for diseases.The ranks of "disease"and "vein" are higher than that of "syndrome".The classification of "Pulse" precedes"Syndrome",and "Treatise on Febrile Diseases" begins with "Pingmai Method" and "Pulse Identification Method".It can be seen that pulse diagnosis has a profound meaning in the diagnosis and treatment mode of "disease syndrome and treatment".The gradual classification and evidence-based reasoning of the diagnosis and treatment decision-making model of "disease syndrome and treatment" is a concentrated expression of Zhong Jing's wisdom,which reflects Zhong Jing' s overall view and precision in diagnosis and treatment,and is also important for precise diagnosis and clinical efficacy basis.The thinking logic of diagnosis and treatment of "disease syndrome and treatment" is"disease?pulse?syndrome?treatment".And each link is based on the evidence-based reasoning of clinical evidence,that is,"observe its pulse,know what is wrong,and treat it with the syndrome"(certification:refers to both symptoms and evidence or evidence),rather than "measure by prescription" The explanation of"reason-law-prescription-medicine" and "cause-machine-syndrome-treatment" is simply a change from explanation to evidence-based reasoning.The diagnosis and treatment model of "disease syndrome and treatment" is a high-level summary of the clinical diagnosis and treatment process.It not only emphasizes the entire process of clinical diagnosis and treatment,but also reflects the dynamics or complexity of clinical diagnosis and treatment decisions.2.2 The Outline of Diagnosis and Treatment of dampness disease s in "A Brief Introduction to the Golden Chamber":? The common diseases of dampness disease are due to the lack of moral virtue.?The common diseases of dampness are listed as"dampness injury underneath" and "dampness flow joint",and the spleen should be inside.? The external features of dampness mainly include fever and sweating;weight and body pain;urination is unfavorable,and stool is quick;yellow body,blood first,then stool,red eyes,dark canthus;swollen feet and other symptoms.?The main pulse of dampness is Shenyang pulse,which can also see fine vein,virtual pulse,astringent pulse,and pulse pulse.?The treatment of dampness is mainly sweating and urination.At the same time,external treatments such as "soaking feet" can also be used to assist treatment.? Prohibition of dampness:Prohibit sweating,fire attack,and careful attack.2.3 Discussion on the Syndrome of Dampness Diseases in "A Brief Introduction to the Golden Chamber"2.3.2 Dynamic Analysis of Syndrome Treatment of Dampness Disease in "The Essentials of the Golden Chamber"Mahuang Jiazhu Decoction,Ma Xingyi Barley Decoction?all based on Mahuang Decoction for addition and subtraction,for the main manifestation of Yang disease;Fangji Huangqi Decoction?for the deficiency of Yang disease;Guizhi Fuzi Decoction,Atractylodes macrocephala Tang and Gancao Fuzi Decoctions are all based on Guizhi Decoction,aiming at the manifestation of yang disease and Yin syndrome caused by water and dampness;Guizhi Shaoyao Zhimu Decoction?for patients with "body kili" Table deficiency is accompanied by yin and dysfunction caused by flooding and dampness.3 Based on the C5a-C5aR axis and omics "dampness flow joint" demonstration3.1 Objective evidence of "dampness flow joints":? joint score:external dampness energy significantly aggravated the degree of ankle joint swelling and deformation in CIA rats,and the external dampness energy to a certain extent made the red feet of normal rats red;?histopathology:external Humidity can directly induce or aggravate the damage of articular cartilage in rats;?urine volume:external moisture can reduce the urine volume of CIA rats and normal rats.3.2 The biological mechanism of "dampness flow joints" based on the C5a-C5aR axis driving the directional chemotaxis of inflammatory cell joints:?External dampness energy significantly increases the content of C5a and inflammatory factors in peripheral blood of CIA rats and normal rats;?External dampness energy Significantly increase the expression of C5aR in articular cartilage of CIA rats and normal rats.3.3 Explore the biological mechanism of "dampness flow joints" based on the detection of fecal metabolites by GC-MS metabolomics:?The KEGG results show that dampness evil significantly disturbs 50 metabolic pathways,of which the representative pathways are:1.Sphingolipid signaling pathway;2.Glutathione metabolism;3 cyclic adenosine signaling pathway;4.Aminoacyl tRNA biosynthesis;5.Amino acid biosynthesis.?Screening results of differential metabolites:55 differential metabolites have significant differences in the comparison of normal rats with dampness evil and CIA rats and normal rats.13 metabolites in the top 20 metabolites coincide,among which Representative common metabolites related to RA are:carnitine,valine,and adenosine.3.4 Explore the biological mechanism of "dampness flow joint" based on 16S rRNA high-throughput sequencing detection of intestinal flora:? In the comparison of the types and numbers of intestinal flora in four groups of rats,bacteria such as Eubacterium,Mycoplasma,Bacteroides,etc.The difference in genus level is more significant;?Dampness intervention of normal rats and CIA rats and normal rats can make Proteobacteria,Desulfovibrio,Bacteroides,Prevotella abundance in species There are significant differences.These microorganisms are associated with inflammation,which can trigger an inflammatory response and damage the joints.Conclusion1 Early literature in the pre-Qin period,"Shen Nong's Materia Medica","Huang Di Nei Jing" and "Difficult Sutra" provide the theoretical basis,pharmacology,physiopathology and other aspects for the improvement of Zhongjing dampness diseasediagnosis and treatment.2 The diagnosis and treatment mode of "disease syndrome and treatment" is a high-level summary of the clinical diagnosis and treatment process.It not only emphasizes the entire process of clinical diagnosis and treatment,but also reflects the dynamics or complexity of clinical diagnosis and treatment decisions.3 The diagnosis and treatment of Zhongjing dampness diseasetakes the dynamic of"dampness flow joint" as the clue,and the "micro-sweat method" and "little urine" as the general treatment principle.4 "Dampness flow joint" exists objectively,dampness evil can directly induce joint damage.5 C5a-C5aR axis drives inflammatory cell joint chemotaxis is one of the biological mechanism of "dampness flow joint".6 Dampness can disturb the content of carnitine in rats,destroy the redox reaction,increase the content of valine,and cause a large amount of ROS release,thus affecting the endoplasmic reticulum's role in removing fat-soluble wastes and metabolites,by disturbing adenosine The metabolism affects the secretion of osteoclasts and adenylate cyclase to aggravate cartilage damage,and make the metabolic function of amino acids abnormal,thereby inducing or aggravating joint damage.The above links involve amino acids,lipids,nucleotides and glutathione.Glycopeptide metabolism.It can be seen from this that dampness evil causes joint damage by affecting amino acid metabolism,lipid metabolism,nucleic acid metabolism,glutathione metabolism,and is one of the biological mechanisms of "dampness flow joints".7 Dampness can significantly increase the species and abundance of inflammation-associated bacteria such as Proteobacteria,Vibrio desulfurius,and destroy the species abundance of Prevotella,thereby inducing immune inflammation and damaging rat joints.Dampness pathogens increase the types and number of inflammation-related bacteria,causing inflammation and inducing joint damage is one of the biological mechanisms of "dampness flow joints". |
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