| Gout is an ancient and widespread disease.It was recorded in the medical history of BC,and its prevalence is declining globally and increasing year by year.The latest data shows that gout is an independent risk factor for chronic kidney disease,hypertension,diabetes and other diseases and an independent predictor of premature death,and belongs to the category of "Bi syndrome" in traditional Chinese medicine(TCM).TCM has a long history and unique advantages in the treatment of gout.In recent years,with the development of modern TCM,it has been proposed to establish a clinical evidence classification and standardized recommendation system with Chinese medicine characteristics,among which ancient books and medical records are important sources of evidence.At present,the inheritance of TCM has been changed from generation to generation,and the research on ancient Chinese medicine for gout has done a large amount of literature excavation work,which is helpful to find the common laws.However,the systematic combing and longitudinal grasp of the theoretical understanding of gout need further work.If the theoretical text can be quantified,and the empirical understanding of gout in the past can be compared and analyzed,so as to discover the changes and differences,it will help to sort out the development context and change process of disease understanding.Inherit the essence,and maintain integrity and innovation.This study has used the similarity calculation method to compare the similarity of the TCM theory of gout in the past generations.While systematically combing the gout theoretical theory in ancient books,it is hoped to discover the law of change and explore the evolution process of the inheritance and development of the TCM theory of the disease.ObjectiveSystematically sort out the records about gout from the Qin and Han Dynasties to the Qing Dynasty,establish a database,longitudinally grasp the theoretical thoery of gout in TCM in different historical periods,summarize commonalities,find differences,and show the inheritance and development of the theoretical thoery of gout in TCM.Explore research methods that are suitable for the theoretical characteristics of TCM and present the process of disease.MethodThis study used the similarity calculation method to quantify the TCM theories of gout in the past dynasties,compared the differences in theoretical understanding of different periods,and presents the evolution process of the theoretical understanding of gout in different periods.Content1.Systematically collate the theoretical thoery of TCM literature about gout from Qin and Han to Qing Dynasty1.1 Clarify the ancient Chinese medical names of gout.1.2Develop the inclusion and exclusion criteria in accordance with the "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China(2019)",and systematically sort out the symptoms,etiology,pathogenesis and medications of gout according to the selected ancient Chinese medical names,and divide the Qin and Han Dynasties according to dynasties,Jin,Southern and Northern Dynasties,Sui and Tang Dynasties,Song,Yuan,Ming,Qing,7 periods.1.3Carry out the standardized preprocessing of the collected data in different periods and establish a database.2.Test and selection of similarity algorithmAfter testing the Euclidean distance,space vector and ontology concept similarity of symptoms and etiology and pathogenesis,the ontology concept similarity that can reflect the level of TCM terminology is selected as the similarity algorithm of symptoms and etiology and pathogenesis between dynasties.A literal comparison of medications in different periods was carried out,and the commonly used set similarity coefficients,Jaccard similarity coefficients and Dice similarity coefficients were tested,and the Dice similarity coefficients with more obvious numerical differences were selected as the comparison method of medication similarity.Through the test,finally determine the similarity algorithm of the ontology concept similarity and Dice similarity coefficient suitable for this research.3.Comparison of the similarity of gout symptoms,etiology and pathogenesis,and medicationQuantify the symptoms,etiology,pathogenesis and medication of gout from Qin and Han to Qing dynasties after standardization.It compares the similarity of symptoms,etiology and pathogenesis through the similarity of ontology concept,and further compares the similarity of main symptoms,etiology and disease location among them.Dice similarity coefficient is used to compare the similarity of medication between dynasties.Outcome1.Basic dataGout is an ancient disease.In the history of the inheritance and development of Chinese medicine,the names of TCM diseases that cover the characteristics of gout include gout,Lijie,Baihufeng,Tongbi,Fengbi,Arthralgia,Arthralgia and Arthralgia.This study finally included the theoretical data of Chinese medicine related to gout in 143 traditional Chinese medicine works,including traditional Chinese medicine treatises,prescriptions,herbal medicines,and medical records.The time span ranges from Qin and Han,Jin,Southern and Northern Dynasties,Sui,Tang,Song,Yuan,to Ming and Han Dynasties.clear.2.Gout comprehensive similarity comparisonThe similarity of ontology concepts was used to calculate the similarity of symptoms and etiology and pathogenesis between dynasties,and the Dice similarity coefficient was used to calculate the similarity of medications between dynasties.The similarity values of symptoms,etiology,pathogenesis,and medications are each set to 33%weighted calculation,and the comprehensive similarity of the gout theory between dynasties is obtained.The results show that the comprehensive similarity between dynasties shows a gradual upward trend.The similarity between the Qin and Han Dynasties is the lowest(29.4%),the similarity between the Jin,Southern and Northern Dynasties to the Ming is between 30%and 35%,and the similarity is the highest during the Ming and Qing Dynasties(47.8%).3.Comparison of similarity of gout symptomsThe comparison of symptom similarity between dynasties showed that the similarity of doctors' understanding of gout symptoms showed a process from increasing to decreasing.Before the Song and Yuan Dynasties,the symptom similarity was relatively high,and the understanding of the symptoms was more concentrated,mainly due to joint swelling and pain;in the Song Dynasty,joint redness,swelling,heat,pain,severe pain,dramatic nights and nights,and intermittent symptoms were recorded;Yuan Dynasty Afterwards,it was gradually improved,and there were records of fixed pains and joint pains.The Song and Yuan dynasties were a turning point.In the Ming and Qing Dynasties,the understanding of symptoms was more comprehensive,and the main joint symptoms related to modern gout were involved.4.Comparison of similarity in etiology and pathogenesis of goutThe comparison of the similarity of etiology and pathogenesis between dynasties showed that the similarity of etiology and pathogenesis between the Jin,Southern and Northern Dynasties and the Sui and Tang Dynasties was the highest(56%),and the similarity between the Song and Yuan Dynasties was the lowest(28.5%).Before the Sui and Tang Dynasties,the main knowledge about the cause of gout was exogenous wind,cold and dampness.Later,there was a transition from exogenous to internal injuries,and the understanding of the etiology and pathogenesis was more diverse.Song Dynasty believed that gout was closely related to stagnation of qi,blood stasis,phlegm-dampness,and yin deficiency.,There is a prescription for alcoholic dampness,phlegm and gout,pay attention to dietary internal injuries and dietary drinking taboos;Yuan Dynasty put forward the theory of "blood heat" for gout,and it is closely related to phlegm,dampness,heat,and stasis.The Ming and Qing Dynasties have been further improved.The overall disease is in the liver,kidney,spleen and stomach.The etiology and pathogenesis include external sensation and internal injury.The external sensation is mainly caused by wind,cold and dampness.Internal injuries include phlegm and dampness and blood stasis,qi stagnation and blood stasis,damp heat,blood deficiency,internal heat,yin deficiency,Stomach fever and internal injuries to eating and drinking.5.Comparison of similarity of gout medicationThe results showed that the medicines used in Ming and Qing Dynasties had the highest similarity(76%),and the similarity of medicines used in other periods was below 30%.Efficacy of the medication was divided.Before the Song Dynasty,it was mainly used for warming Li,dispelling wind and cold;in the Song Dynasty,the flavors of replenishing the liver and kidney,clearing heat and removing blood stasis increased;in the Yuan Dynasty,drugs were added for clearing heat and dampness,promoting qi,cooling blood,and expelling phlegm..In the Ming and Qing Dynasties,the inherited treatment experience was mainly based on replenishing liver and kidney,clearing heat and dampness,promoting qi,activating blood and dredging collaterals,and records of medical records and preventive medication regimens in the remission period of gout can be seen.Conclusion1.Theoretical Research1.1 Systematically sort out the history of traditional Chinese medicine theory of goutThrough the comparison of similarity,it is found that the theoretical understanding of gout among physicians of the past dynasties has shown an overall upward trend.Among them,the similarity of symptoms increased from increased to decreased;the similarity of etiology and pathogenesis showed a high similarity before the Sui and Tang Dynasties,and began to decrease in the Song and Yuan Dynasties,and gradually tended to flatten.In terms of medication,the similarity of Ming and Qing medications was the highest.Summarize the syndrome of gout-based deficiency and standard-excess,based on liver,spleen and kidney deficiency,damp heat,phlegm and blood stasis,blood heat and qi stagnation as indicators,which are often induced by exogenous feelings or dietary internal injuries;the treatment plan is mainly based on staged treatment,and the acute stage is to clear heat,detoxify,and diarrhea The methods of turbidity and stasis,dispelling wind and dampness,supplemented with products for replenishing qi,caring for the spleen and stomach,focusing on improving physical fitness in the non-acute phase,cultivating the source and clearing the source,strengthening the spleen and qi,replenishing liver and kidney,and nourishing blood and yin.At the same time,controlling diet and preventing recurrence is the key.1.2 Gout is the evidence of deficiency and excess1.2.1 Deficiency of liver,spleen and kidney is basedDuring the Qin and Han Dynasties,the "Huangdi Neijing" said:"The deficiency of the spleen and stomach is the beginning of all diseases..." Zhang Zhongjing's "The Synopsis of the Golden Chamber" contains "the spleen is prosperous in the four seasons to prevent evil",and it is proposed that insufficient liver and kidney yin and blood is the onset of gout.The internal cause of the disease.Later generations of physicians further realized and exerted on this basis.In the Sui Dynasty,Chao Yuan Fang explained Zhong Jing's point of view in "Theories on the Sources of Diseases" that the limb pain and inflexibility were caused by the lack of qi and blood,and the wind and the blood.The Song Dynasty,"The "Sanji Zonglu" explains in detail that the liver and kidney are insufficiency,the qi and blood are weak,and the blood is stagnant due to wind and cold,and the tendons are not nourished.In the Ming Dynasty,Gong Tingxian pointed out in the "Shou Shi Bao Yuan" that the blood is weak in the afternoon.The deficiency was even worse;in the Qing Dynasty,You Yi clarified the view that the deficiency of the liver and kidney was the root of the pathogenesis in the "Golden Chamber Synopsis".Later generations of physicians gradually realized that the onset of gout is also closely related to the spleen and the spleen in the spleen and the water dampness.The Qing Dynasty put forward the theory of the weakness of the spleen and the stomach causing gout,and the "Prescriptions for Use" proposed that the spleen and kidney deficiency caused gout.Insufficient natural endowment,or prolonged course of disease,weakness of liver and kidney essence and blood,dystrophy of muscles and bones,especially in the later stages of the course,symptoms such as joint pain and joint deformity,gout,liver and kidney yin and blood deficiency have been used today,and are used by modern physicians.Recognized.In modern times,many doctors treat gout from the spleen,stomach or spleen and kidneys.For example,Professor Lu Zhizheng proposed that the pathogenesis of this disease is "the source of the disease is the focal point,and the flow resistance is under the focal point."1.2.2 Damp heat,phlegm and blood stasis,blood heat and qi stagnation as the standardIn the Song Dynasty,people began to realize that damp-heat phlegm and blood stasis were closely related to the onset of gout,and "Renzhai Zhizhi Prescriptions" first published a prescription for alcoholic gout.Later generations further developed on this basis.The Yuan Dynasty "Danxi Therapeutic Heart Medicine" contained a prescription for drinking gout,and on the basis of the prescription for dampness and phlegm and gout in the Song Dynasty,peony,licorice,yin,relief and pain relief were added;in the Ming Dynasty,"Rejuvenation of All Diseases" for gout The article further explained and pointed out that gout is closely related to "phlegm";in the Qing Dynasty,in the"Syndrome and Treatment",it was believed that gout patients had deficiency of qi and blood,phlegm,dampness and blood stasis,stagnation in the meridians or limbs.In the"Differentiation of Syndrome",there is a record of the formation of damp phlegm and blood stasis,which is similar to the modern understanding of phlegm dampness cementation and the accumulation of tophus over time.Chaoyuan Fang in the Sui Dynasty put forward the theory of gout fever and poison;in the Tang Dynasty,Sun Simiao inherited the theory of heat toxin and founded Xijiao Tang;after that,later generations of physicians developed and deepened the theory on the basis of this theory.In the Yuan dynasty,Zhu Danxi embodied heat toxins and put forward the theory of gout and blood heat.He elaborated on the pathogenesis of gout as the accumulation of heat in blood,and exposure to cold and dampness.The turbid evils stagnated in the blood veins,and the turbidity and astringency caused the disease.In the Ming Dynasty,yes.Danxi's blood-heat theory has a further explanation,proposing that blood-heat is due to liver fire and blood heat,fire and liver blood deficiency;in the Qing Dynasty,You Yi inherited the previous experience and deepened it on the basis of Zhongjing's theory.Yin-blood deficiency is the root,and heat toxin flows into the joints to cause the disease.The combination of dampness,heat,phlegm,and blood stasis is the basic pathogenesis of the onset of gout,which is recognized by later physicians and is still used today.Today,the theory of turbidity,stasis,heat and toxin has been recognized and promoted by modern physicians.For example,Professor Zhu Liangchun,based on Danxi's theory of "dirty,condensed,astringent",has further developed and proposed to treat gout from "turbid blood stasis".1.2.3 Exogenous and dietary injury inducedThe "Huangdi Nei Jing" says:"The three qi of wind,cold and dampness are mixed together,and they become arthralgia." Gout is closely related to exogenous wind,cold and dampness.Zhong Jing inherited the theory of wind,cold and dampness caused by the "Huangdi Neijing",and proposed that exogenous wind and cold is an important cause of gout.factor.In this regard,later generations of physicians have a better understanding.In the Tang Dynasty,it was recognized that gout and joint pain were caused by physical weakness and the feeling of wind,cold,heat,and dampness.In the Qing Dynasty,it was explained in more detail that the wind,cold,dampness and dampness stagnated the qi and blood meridians,and Rongwei's qi was blocked,which caused the onset of gout.In the Han Dynasty,the "Golden Chamber Synopsis" contains a record of the painful hair of the alcoholic during the festival;later generations have further developed,the Ming Dynasty "Wan Bing Huichun" has a record of the gout caused by rheumatism caused by wine color;in the Qing Dynasty,Wang Mengying explained in more detail The theory of the thick flavor of the ointment and the heat-induced arthralgia.Today,we have realized that gout is closely related to the body's purine metabolism disorder,and it can easily induce acute arthritis if it encounters external feelings or careless diet.1.3 The evolution of gout treatment1.3.1 Exorcise evil in the acuteIn the Han Dynasty,Zhang Zhongjing used Guizhi Shaoyao Zhimu Decoction in the "Golden Chamber Synopsis" to treat the swelling and pain of the calendar joints caused by physical weakness and exogenous cold;in the Tang Dynasty,Sun Simiao treated gout from heat toxin and set Fangji Decoction and Rhinoceros Decoction;Wang Tao from rheumatism In the treatment of wind and poison,Dafeng Yintang was established;further developed in the Song Dynasty,"Renzhai Zhizhi Prescriptions"contained a formula for dampness,phlegm and gout,using cork and atractylodes to clear heat and dampness,powerful spirits,Qianghuo for dispelling wind and cold,and tangerine peel for health Spleen dryness and dampness;"Taiping Shenghui Recipe"contains Polygonum cuspidatum powder to treat intractable pain;In Yuan Dynasty,Zhu Danxi founded upper,middle and lower gout prescriptions to dispel'wind and cold,eliminate phlegm and stasis,and use gout prescription to clear heat and dry dampness;In the Qing dynasty,Sanbi Decoction was included in the "Key Points of Miscellaneous Diseases and Hearts" to treat gout with exorcism and invigoration;in the "Trends of Medicine" it was recorded that Jiawei Sanmiao Pills were used to treat gout with pain in both feet.In the acute stage of gout,damp-heat and turbidity accumulate,fight between evil and righteousness,resistant to attack,use heat-clearing and detoxification,purging turbidity and removing blood stasis,dispelling wind and dampness as methods,supplemented with products for replenishing qi and caring for the spleen and stomach;can cooperate with qi,Dredging meridian and dredging collaterals and other medicinal flavors,dynamic and static;for intractable pain,pay attention to the addition of expectorant and turbidity,blood stasis and pain relief.1.3.2 Cultivating the source during the remission periodThe medical records of arthralgia during the remission period recorded in the Ming and Qing Dynasties,as well as the medication plan of preventing the disease before the remssion period after the acute phase of the damp-heat arthralgia syndrome in "Zhang Shiyitong",are worthy of further study in the treatment of gout in the remission period.For example,in the "Famous Medical Cases" to treat joint pain caused by damp-heat injury of the tendons,spleen and lungs,phlegm fire,after the acute phase of joint pain,use Qingqi Huatan Pills plus corrugated Zi,Cangzhu,Citrus aurantium,turmeric,Zhu Lek,Shenqu Pill conditioning;"Sun Wenyuan Medical Records" records that after the pain relieves swelling and disappears,Guishao Liujunzi plus coix seed,salvia,safflower,dendrobium,and bauhinia bark are used for conditioning;in "Zhang Shiyitong",for alcoholics,body damp and heat During the remission period,use Liujunzi plus Coptis,Aloes,Alisma to regulate qi and dampness,and adjust the medication according to the season.Use Qingzao Decoction in summer and autumn,and Chunze Decoction plus ginger juice and bamboo leeks in spring and summer.For those with long-term disease and insufficient liver and kidney,pay attention to replenishing the liver and kidney,strengthening the bones and strengthening the muscles.In the Song Dynasty "Sanji General Record",Qianghuowan was used to treat waist and foot failure,five labors,seven injuries,and six poles;the Ming Dynasty"Ancient and Modern Medical System" treats kidney qi deficiency and leg and knee joint pain caused by wind,cold and dampness,and oral administration of Guizhi Wuwu Decoction harmonizes Rongwei and helps the meridians and collaterals;"Concise Medicine" treats swollen joints with insufficient qi and blood,and uses the four gentlemen to add gui,attached and white peony roots;in the Qing Dynasty,"Feng's Jinbao Secret Record" was used for liver and kidney yin.Deficiency internal heat,rheumatic internal attack caused by gout,low back and knee cold pain,treat with Duhuo Jijie Decoction;in "Cheng Fang Cut Use" for gout and limb arthralgia caused by insufficient Yuanyang,overwork or insufficient congenital endowment,use Yougui Pill treatment.Damp-heat turbidity and stasis are blocked for a long time,the body is not full of qi and blood,and it turns from actual to insufficiency.This stage is the remission period of gout,which is a key period for improving physical fitness and cultivating the source of the source.According to the specific situation,choose to invigorate the spleen and replenish qi and replenish the liver.Kidney,nourishing blood and restraining yin,etc.1.3.3 Prevention after illnessThe first record of joint pain in the "Tai Ping Sheng Hui Fang" in the Song Dynasty did not eat cold fish and greasy products;the Ming Dynasty "Shou Shi Bao Yuan"proposed prohibition of alcohol,seafood,and fat,sweet,thick and greasy;"Puji Fang"mentioned taboo Eat pork and cold water;in the Qing Dynasty,the "Syndrome and Treatment Huibu" clearly contained the taboo for gout,stating that "meat is a fire,and performance aids the fire." For those who suffer from phlegm fire,they should be fasted and have a strong taste.Dietary taboos and restriction of high purine intake are an important part of preventing the onset of gout.The view of focusing on diet and recurrence prevention has been used since ancient times.2.Exploring research methods suitable for the theoretical characteristics of Chinese medicineTaking the disease of gout as the starting point,using the similarity algorithm to quantify the traditional Chinese medicine theories related to gout in the past dynasties,compare the theoretical understanding of different periods,and sort out the evolution process of the theory of gout Chinese medicine.This method can maintain the original characteristics of TCM theory and is feasible in exploring the evolution of disease TCM theory.Innovation1.Systematically sort out the theories about gout differentiation and treatment from the Qin and Han Dynasties to the Qing dynasty,and visually and systematically show the context and changes of the inheritance and development of gout TCM theory through similarity algorithms.2.The similarity algorithm was first applied to the study of TCM theory of gout,to explore comparative research methods that conform to the characteristics of TCM texts,and to provide reference and reference for the study of the evolution of TCM theory of disease. |
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