Study On The Rule Of Syndrome Differentiation And Treatment Of Systemic Lupus Erythematosus Based On Network Pharmacology

ObjectiveBased on the network pharmacology method,the literature and clinical retrospective investigation data of systemic lupus erythematosus(SLE)were analyzed to reveal the rules of TCM syndrome differentiation and treatment of SLE disease;the network analysis results were compared with the existing standards,which was SLE TCM clinical syndrome differentiation and treatment provide guidance.Method1,Literature system evaluation:Through the computer search method,the literatures on Chinese medicine treatment SLE in CNKI,VIP,Wan Fang Data and PubMed databases were searched,and 134 SLE literature system evaluation data were obtained.2,Clinical retrospective survey:The medical records of 322 patients with SLE were included in the medical record room of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from January 2011 to May 2017.3,Using the method of network pharmacology:construct a network of SLE medical records and literature data,calculate topological property parameters,and analyze the compatibility of core symptoms,tongue images,pulse and prescriptions of SLE disease syndromes.ResultI.General data results of SLE literature system evaluation and overview of network analysis results(Ⅰ)A total of 134 qualified research literatures were included in the study.The frequency of common clinical manifestations of SLE disease was graded from high to low,followed by red tongue,joint pain,fatigue,low fever,weak waist,hair loss,pulse breakdown,etc.149 Clinical manifestations,in which the frequency of tongue red appeared the highest,the proportion was 55.34%;the frequency analysis of TSE syndrome of SLE,from high to low,followed by heat poisoning stagnation syndrome,Yin deficiency internal heat syndrome,spleen and kidney yang deficiency syndrome,liver and kidney yin There are 19 kinds of syndromes such as deficiency syndrome and qi and yin injury syndrome.The first 5 syndromes account for 80.24%of the total number of syndromes,of which the heat toxicity stagnation syndrome accounts for the largest proportion,accounting for 28.46%.(Ⅱ)Network analysis results of SLE literature system evaluation data1,Network analysis results of clinical manifestations of SLE disease:clinical characteristic symptoms:joint pain,hair loss,dizziness,muscle pain,skin erythema,lower extremity edema,mouth sores,fever,waist and knees,five upsets,irritability,palpitations Core Chinese medicine:Rehmannia glutinosa,licorice,peony bark,red peony root,medlar,salvia miltiorrhiza,radix Scutellariae,angelica,sorghum,white peony,Alisma,Atractylodes,Scrophulariaceae,comfrey,Hedyotis diffusa.2,SLE literature data,the main rules of the syndrome,the corresponding law,network analysis results(1)Hot poison stagnation syndrome:clinical core performance is high fever,red tongue,urine yellow,thirst,cold drink,loose knot,facial red butterfly erythema,red tongue,joint pain,fatigue,dizzy,tongue Sore,moss yellow,limb convulsions,irritability,skin erythema;common prescription for rhinoceros radix rehmanniae;core Chinese medicine has rehmannia,peony bark,red peony,honeysuckle,licorice,buffalo horn,comfrey,scrophularia,artemisia,Hedyotis diffusa,Anemarrhena,Forsythia,White peony,Astragalus,Gypsum,Salvia.(2)Yin deficiency heat syndrome:clinical core manifestations include red tongue,pulse breakdown,low fever,night sweats,thirst,five upset heat,less moss,fatigue,thirst,cold drink,dry throat,loose knot,skin erythema Rash;commonly used prescriptions are Liuwei Dihuang Pill,Zhibai Dihuang Pill,Erzhi Pill,and Artemisia annua L.;the core Chinese medicines include Rehmannia glutinosa,Cortex Moutan,Ligustrum lucidum,Licorice,Gentiana,Zhimu,Chishao,Salvia,Scrophulariaceae,Artemisia annua,Hedyotis diffusa,Cork,armor.(3)spleen and kidney yang deficiency syndrome:clinical core manifestations of limb edema,fine pulse,oliguria,abdominal distension,cold limbs,fatigue,pale tongue,thin teeth,thin white,sticky notes,anorexia,gas Promote,face edema,backache;common prescriptions for Zhenwu Tang,Jinqi Shenqi Pill,Jisheng Shenqi Pill,Fuzi Lizhong Decoction,Shenqi Pill;core Chinese medicine has Poria cocos,Astragalus,Atractylodes,Licorice,Codonopsis,Ze Diarrhea,aconite,yam,epimedium,peony bark,salvia,psyllium,hawthorn,ginseng,rehmannia.(4)Liver and kidney yin deficiency syndrome:The core clinical manifestations of the sputum are pulse count,weak waist,red tongue,low fever,hair loss,dizziness,five upset heat,less moss,tinnitus,night sweats,thirst,dark red rash,Dazzling;common prescription is Liuwei Dihuang Pill;the core Chinese medicine has Radix Rehmanniae,Peony,Ligustrum lucidum,Chinese wolfberry,licorice,hawthorn,comfrey,white peony,Chinese yam,Gentiana,Polygonum,and Alisma.(5)Qi and Yin two injuries:clinical core performance is fatigue,red tongue,low fever,thin white fur,spontaneous sweating,pulse breakdown,shortness of breath,less moss,thirst,weak waist,night sweats,hair loss,five upset The common prescriptions are Liuwei Dihuang Pills and Shengmai Powder;the core Chinese medicines include Astragalus,Ophiopogon japonicus,Atractylodes Rhizome,Licorice,Cortex Moutan,Poria,Gentiana,Radix Rehmanniae,Angelica,Radix Pseudostellariae,Schisandra,Ligustrum lucidum and Salvia miltiorrhiza.II.General data results and network analysis results of SLE clinical retrospective investigation(I)Results of general analysis of SLE clinical patientsThe average age was 33.52±13.03 years old:293 female patients(90.99%)and 29 male patients(9.01%);the average duration of disease was 40.23±50.29 months;the average length of hospital stay was 11.25±7.18 days;103 cases(31.99%).(II)the results of clinical manifestations and syndrome frequency analysis of SLE patientsThe frequency of clinical manifestations of SLE clinical patients were as follows:178 kinds of clinical manifestations such as red tongue,fatigue,joint pain,thirst,sleepi ness,erythema,etc.,the highest frequency of tongue red appeared,the proportion was 35.09%.The order of frequency of syndromes from high to low is:heat poison stagnation syndrome,rheumatic fever syndrome,qi and blood deficiency syndrome,liver and kidney yin deficiency syndrome and spleen and kidney yang deficiency syndrome,among which the heat toxicity stagnation syndrome accounted for the largest proportion.28.88%.(Ⅲ)SLE clinical retrospective survey network analysis results1,clinical characteristics of SLE patients:joint pain,hair loss,dizziness,muscle pain,skin erythema,lower extremity edema,mouth sores,fever,chest tightness,joint swelling and pain,red rash,headache,Raynaud’ s phenomenon,shortness of breath,mouth pain,abdominal pain,muscle soreness;core Chinese medicine:licorice,wolfberry,coix seed,peony bark,red peony root,rehmannia root,atractylodes,white peony,pinellia,scutellaria,salvia,tangerine peel,Codonopsis.2,SLE clinical medical record data,the main rules of the syndrome,the corresponding law,the network analysis results(1)Hot poison stagnation syndrome:The core clinical manifestations of sputum are red tongue,joint pain,thirst,hair loss,erythema of limbs,yellow moss,slippery pulse,fatigue,poor sleep,dizziness,anorexia,cough,red rash,The number of pulse strings and mouth sores;the common prescriptions for rhinoceros are Dijiao Dihuang Decoction and Si Miao Yong An Decoction;the core Chinese medicines include licorice,peony bark,red peony root,rehmannia root,coix seed,alfalfa,buffalo horn,scutellaria,forsythia,Honeysuckle,Pinellia,Tangerine,Zhimu,Artemisia,Scrophulariaceae,and armor.(2)spleen and kidney yang deficiency syndrome:clinical core manifestations of fatigue,hair loss,lower extremity edema,cough,joint pain,chest tightness,thin white fur,pale tongue,anorexia,skin erythema,shortness of breath,poor sleep,red rash,white greasy moss,dizziness;commonly used prescriptions for Jinqi Shenqi Pill,Wuling Powder,Shenqi Baizhu Powder;core Chinese medicine has licorice,medlar,peony bark,Atractylodes,yam,Alisma,hawthorn,cassia twig,jaundice,aconite,salvia,white peony,rehmannia,coix seed,Amomum.(3)liver and kidney yin deficiency syndrome:clinical core manifestations of thirst,fatigue,red tongue,skin erythema,hair loss,poor sleep,red rash,facial red butterfly erythema,anorexia,headache,fever,palpi tations;The prescriptions are Liuwei Dihuang Pills and Artemisia annua L.Soups;the core Chinese medicines include licorice,wolfberry,rehmannia root,peony bark,coix seed,pinellia,artemisia,yam,red peony,armor,scutellaria,white peony,salvia,Alisma,Zhimu,Suanzaoren.(4)Rheumatic fever syndrome:The core clinical manifestations of sputum are joint pain,poor sleep,fatigue,thirst,red tongue,pale red tongue,anorexia,fever,red rash,joint swelling and pain,yellow greasy moss,cough,lower limbs Puffiness,dizziness;commonly used prescriptions for Si Miao San,Guizhi Peony Zhizhi Decoction,Xiao Chai Hu Tang;clam core Chinese medicine has licorice,coix seed,medlar,white peony,Atractylodes,Pinellia,Astragalus,Atractylodes,Phellodendron,Guizhi,Bupleurum,turmeric,red peony.(5)Qi and blood deficiency syndrome:clinical core performance is fatigue,joint pain,dizziness,pale tongue,poor sleep,cough,sore throat,thirst,thin white fur,pale tongue,sputum,headache,chest tightness,Hair loss,anorexia;common prescription for Guipi Decoction;core Chinese medicine has licorice,wolfberry,Atractylodes,Astragalus,Codonopsis,Coix Seed,Angelica,Angelica,Chenpi,Salvia,Pinellia,Suanzaoren,Ophiopogon japonicus,Astragalus.Ⅲ.Comparison of network analysis results of SLE’ s various syndromes of the literature system evaluation and clinical retrospective investigation research with current SLE standards(Ⅰ)Comparison of the literature and clinical medical record data of SLE diseaseThe clinical manifestations of SLE disease obtained by SLE literature review and clinical retrospective survey were basically the same,and there were 8 clinical features in common.There were 8 common core Chinese medicines.(Ⅱ)Comparison of network results between SLE disease literature and clinical medical record dataThere are three common syndromes in the literature and clinical medical records,namely,heat poisoning stagnation syndrome,spleen and kidney yang deficiency syndrome,liver and kidney yin deficiency syndrome.The clinical manifestations of these three core syndromes are basically the same.The hot poison sacred syndrome:the two core clinical manifestations are 20;the commonly used prescri ption is rhino horn yellow soup;the core Chinese medicine has 18.Spleen and kidney yang deficiency syndrome:There are 14 clinical core manifestations of the two;the commonly used prescription is Jinqi Shenqi Pill;there are 17 core Chinese medicines.Liver and kidney yin deficiency syndrome:There are 15 clinical core manifestations of the two;the commonly used prescription is Liuwei Dihuang Pill;there are 15 core Chinese medicines.(Ⅲ)Comparison of network analysis results of SLE’ s various syndromes with current SLE standards1,hot poison blazing syndromeThe same:facial red butterfly-shaped erythema,high fever,thirst,dizziness,joint pain and other 9 clinical manifestations;sputum prescription:rhinoceros radix rehmanniae;sputum Chinese medicine:buffalo horn,rehmannia root,peony bark,scutellaria,artemisia,etc.traditional Chinese medicine.Different:network analysis results and standard than 21 fatigue,hair loss,mouth sores,mouth pain,red rash and other 21 clinical manifestations.The results of the network analysis did not have the skin purple spots listed in the standard;Huanglian Jiedu Decoction;Huanglian and Alisma.2,spleen and kidney yang deficiency syndromeThe same:clinical manifestations:lower extremity edema,fine pulse;radix rehmanniae,hawthorn,yam,peony bark,medlar and other 7 traditional Chinese medicine.Different:network analysis results and standard than 10 fatigue,stool,anorexia,shortness of breath,hair loss and other 10 clinical manifestations;Astragalus,licorice,Atractylodes,Guizhi,Salvia and other 10 Chinese medicine.The results of the network analysis did not have the surface heat listed in the standard,and the urine was long.3,liver and kidney yin deficiency syndromeThe same:8 kinds of clinical manifestations such as hair loss,dizziness,low fever,fatigue,and dry mouth.Different:The network analysis results and the standard have 10 clinical manifestations such as fatigue,shortness of breath,hair loss,joint pain,and skin erythema.4,Yin deficiency heat syndromeThe same:fever,low fever,five upset hot,night sweats,face floating red and other 10 clinical manifestations;sputum prescription:Liuwei Dihuang Pill,Erzhi Pill;Chinese medicine:Rehmannia glutinosa,Artemisia annua,comfrey,Zhimu,Cork,etc.11 Chinese medicine.Different:network analysis results and standard than 22 other clinical manifestations such as thirst,less moss,fatigue,dry throat,red rash on the skin;Artemisia scoparia soup,Zhibai Dihuang Wan;licorice,Gentiana,Radix Paeoniae Alba,Salvia 19 Chinese herbal medicines such as Scrophulariaceae.The results of the network analysis did not include the standard spotted dark red,heel pain,and thin moss;Dabuyin Pill,Qinggu Powder;Houttuynia cordata and Motherwort.5,rheumatic fever syndromeThe same:7 kinds of clinical manifestations such as joint pain,joint swelling,rash,muscle soreness and fever.Different:The network analysis results and the standard have 24 clinical manifestations such as poor sleep,fatigue,thirst,anorexia,and yellow greasy moss.The results of the network analysis did not include the diffuse swelling of the two fingers listed in the standard,the joint pain of the extremities,the wind,the joint stiffness,the number of slips,and the number of pulses.6,qi and blood deficiency syndromeThe same:7 kinds of clinical manifestations such as fatigue,sweating,palpitations,shortness of breath and dizziness.Different:network analysis results and standard than 21 other clinical manifestations of joint pain,pale red tongue,poor sleep,cough,sore throat.The results of the network analysis were not as standard as pale,tinnitus,less menstrual flow or amenorrhea,and weak pulse.7,Qi and Yin two injuries syndromeThe same:low fever,five upset heat,irritability,fatigue,spontaneous sweating,night sweats,joint pain and other 13 clinical manifestations.Different:The network analysis results and standards are 18 kinds of clinical core performances such as shortness of breath,less moss,thirst,waist and knees,hair loss,palpitations and sleepiness.The results of the network analysis did not include the standard dark red spots and red face.Conclusion:1,Literature systematic evaluation data and clinical retrospective survey:The medical pharmacology analysis results of the medical records indicate that the clinical manifestations of the SLE diseases and the clinical manifestations and the prescriptions of the main syndromes are basically the same.2,The results of network pharmacology analysis revealed that there are 3 core syndromes of SLE for the syndrome of heat poisoning,the syndrome of liver and kidney yin deficiency,and the syndrome of spleen and kidney yang deficiency.(1)Hot poison blazing syndrome:clinical core manifestations:joint pain,thirst,hair loss,erythema of limbs,fatigue,poor sleep,dizziness,etc.;core Chinese medicine:rehmannia,licorice,peony,red peony,Poria cocos,buffalo horn,scutellaria,etc.18 flavors;core formula:rhino horn radix rehmannia soup;core taste traits:bitter,sweet,cold,return to the lungs,liver.(2)Liver and kidney yin deficiency syndrome:clinical core manifestations:thirst,fatigue,skin erythema,hair loss,skin red rash,anorexia,fever,etc.;core Chinese medicine:licorice,medlar,rehmannia,peony bark,Artemisia annua,yam,white peony and other 15 flavors;core formula:Liuwei Dihuang Wan;core taste of the classics:bitter,sweet,cold,liver,kidney.(3)spleen and kidney yang deficiency syndrome:clinical core manifestations of sputum:fatigue,hair loss,lower extremity edema,joint pain,anorexia,skin erythema,shortness of breath,etc.;core Chinese medicine:licorice,medlar,peony bark,atractylodes,yam,Zexie,hawthorn and other 17 flavors;core prescription:Jinqi Shenqi pill;core taste of the classics:sweet,warm,spleen,kidney.3,Compare the results of network pharmacology analysis of SLE’ s various syndromes with the current SLE syndrome differentiation criteria,and find that there are different degrees of difference.For example,the common syndromes of rheumatic fever and phlegm and blood stasis syndrome in network analysis results need to be further improved.Prospective studies confirm the reference for standard revisions.