The Research Of Professor You Songxin’s Clinical Experience In Differentiating And Treating Chronic Hepatitis B

Research Objectives:To conduct an in-depth study on the clinical experience,diagnosis and treatment ideas of professor You Songxin in treating chronic hepatitis B(CHB)and further conclude his academic ideas by taking the medical cases of CHB patients who received professor You Songxin’s outpatient treatment as the starting point and taking the case analysis and statistic analysis of data as the research methods.Research Methods:To retrospectively collect part of the CHB cases that received the professor You Songxin’s outpatient treatment from May 2017 to December 2018 and construct a database by screening and organizing the 1258 outpatient record data of 115 medical cases according to the preset data standards.To analyze the data from multiple dimensions such as symptoms,tongue and pulse conditions,pathogenesis,therapy,and traditional Chinese medicines by starting from the clinical practice and resorting to different data statistic analysis methods.At last,to objectively and systematically conclude professor You Songxin’s clinical experience and academic thoughts in diagnosing and treating CHB by combining the tutor’s guidance with the author’s personal understandings.Research Results:(1)General Information:A total of 115 medical cases were selected,containing 1258 times of visit,with 80 males(879 times of visit)and 35 female(379 times of visit).The average age was 42.68 and the average times of visit was 10.94.(2)Symptom Distribution:The number of symptom types involved was 224,and 102 of them were witnessed for or over six times,which were distributed in six departments,including internal medicine,gynecology department,anorectal branch,dermatology department,otolaryngology department and ophthalmology department.The top ten symptoms in terms of frequency were successively:insomnia,deep-colored urine,right hy:pochondriac pain,fatigue,inappetence,loose stool,gingival bleeding,painful abdominal mass,frequency of bowel movement and gastric cavity,which were the main symptoms of CHB concluded in this paper.(3)Tongue and Pulse Conditions:A total of 22 kinds of tongue coating condition were discovered and those with frequency being over 10%were thin and whitish fur,thin and dirty fur,and thin and yellow fur;And ten types of pulse condition were noticed and the leading two types were small pulse and wiry pulse.(4)Pathogenesis Distribution:There were 75 kinds of pathogenic factors and the Top 20 that described for or over 20 times were successively:liver-kidney yin deficiency,incoordination between gallbladder and stomach,intrinsic heat of gallbladder and stomach,liver-spleen disharmony,deficiency of liver blood,stagnated heat of liver channel,stagnated heat of liver and stomach,liver and gallbladder damp-heat,kidney deficiency and liver sthenia,liver depression and spleen deficiency,spleen jeopardized by damp-heat evils,retention of damp-heat in the interior,heart and kidney deficiency,incoordination between liver and stomach,spleen deficiency and liver sthenia,malnutrition of liver meridian,liver is blocked inwards,spleen deficiency and damp obstruction,qi and yin deficiency,and kidney deficiency and damp-heat.(5)Therapies Distribution:A total of 91 therapies have been described and the Top 20 types of therapies that have been depicted for or over 35 times were:liver-regulating,heat clearing and neutralization,removing heat from the liver,clearing heat,nourishing blood,reinforcing the spleen,tonifying the kidney,draining dampness,harmonizing stomach,nourishing kidney,tonifying liver,resolving depression,invigorating the spleen,resolving dampness,activating the spleen,nourishing the liver,purging off the internal heat,harmonizing meridian,clearing gallbladder,and soothing the liver.(6)Commonly-used Medicines Distribution:There were 280 kinds of traditional Chinese medicines involved,40 of them were described for or over 90 times,and the medicines with a frequency over 71.00%were regarded as the commonly-used medicines.Among others,12 most frequently used medicines included liquorice,poria cocos,pericarpium citri reticulatae,scutellaria baicalensis,rhizoma pinellinae praeparata,wheat germ,fructus aurantii,radix paeoniae alba,oriental wormwood,caulis bambusae in taeniam,sweet wormwood,and prunella vulgaris,all of which turned up over 400 times and were labelled as the core medicines.(7)Association Rules Distribution:Twelve traditional Chinese medicines with the highest degree of association with the following six symptoms,seven pathogenic factors,and seven therapies were concluded.The six symptoms were insomnia,deep-colored urine,right hypochondriac pain,fatigue,inappetence,and loose stool;The seven pathogenic factors were liver-kidney yin deficiency,incoordination between gallbladder and stomach,intrinsic heat of gallbladder and stomach,liver-spleen disharmony,deficiency of liver blood,liver depression and spleen deficiency,and spleen deficiency and liver sthenia;The seven therapies were liver-regulating,clearing heat to reach harmony,removing heat from the liver,clearing heat,nourishing blood,reinforcing the spleen,and tonifying the kidney.Besides,26 types of medicine combinations and 16 kinds of compatibility of medicine were worked out by analyzing the association rules among the 280 medicines involved in prescriptions.(8)Medicine Factors Distribution:The common factor was calculated by combining factor analysis and principal component analysis,and nine kinds of traditional Chinese medicine compatibility were formulated by analyzing the 60 medicines that turned up over 60 times among the 280 medicines involved in the medical cases.(9)Medicine R-type Clustering Analysis:The R-type clustering analysis was conducted on all involved traditional Chinese medicines by taking advantage of SPSS 26.0 analysis system,and the medicines with a frequencies of over 60 times were analyzed after comparison.In the end,20 core medicine pairs and 7 core medicine combinations were concluded.Analysis conclusions:(1)The commonly-seen symptoms and tongue and pulse conditions in the treatment of CHB by professor You Songxin include:insomnia.deep-colored urine,right hypochondriac pain,fatigue,inappetence,loose stool,gingival bleeding,painful abdominal mass,and gastric cavity discomfort;thin white moss,thin greasy moss and thin yellow moss;thready pulse and taut pulse and thread-taut pulse.(2)In the view of professor You Songxin,the external pathogenic factors consist of the invasion of damp heat and the internal pathogenic factors include the deficiency of healthy Qi;The lesions are mainly caused by the deficiencies of liver,spleen,and kidney;The mixture of deficiency and excess,and the deficient root and excessive superficial are the characters of the disease;The dominant pathological factors are damp-heat,qi stagnation,blood deficiency,deficiency of yin,which are supplemented by phlegm evil and blood stasis;The commonly-witnessed pathogenic changes have liver-kidney yin deficiency,incoordination between gallbladder and stomach,intrinsic heat of gallbladder and stomach,liver-spleen disharmony,deficiency of liver blood,and retention of damp-heat in the interior;The key pathogenesis for the constant progress of disease is liver-kidney deficiency and persistent damp-heat.(3)The most frequently-applied therapies adopted by professor You Songxin in diagnosing and treating CHB are:clearing heat and drain dampness,tonifying the kidney and nourishing the liver,regulating vital energy and reinforcing the spleen,reducing phlegm and removing blood stasis.For the heat-clearing drugs,scutellaria baicalensis,sweet wormwood,prunella vulgaris,indigo naturalis,moutan bark,radix rehmanniae recen,jasmine,etc.,are often employed;For damp-clearing drugs,poria cocos,oriental wormwood,talc,semen coicis,rhizoma alismatis,poria with hostwood,fructus kochiae,black soybean,lygodium japonicum,and so on are frequently applied;For drugs of tonifying deficiency,radix paeoniae alba,angelica sinensis,atractylodes macrocephala koidz,Chinese yam,codonopsis pilosula,fructus broussonetiae,etc.;For qi-regulating drugs,pericarpium citri reticulatae,fructus aurantii,pericarpium citri reticulatae viride,etc.,are often used;For drugs of reducing phlegm,rhizoma pinellinae praeparata and caulis bambusae in taeniam are usually applied;For drug of invigorating blood circulation and eliminating stasis,radix curcumae,achyranthes root,and herba lycopi are commonly utilized.(4)The medical prescriptions often used by professor You Songxin in diagnosing and treating CHB are:haoqin qingdan decoction,Jiawei Landoufeng zhu decoction,decoction of Rehmanniae,pinelliae decoction for purging stomach-fire,xiaochaihu decoction,chaihu shugan powder,spleen-clearing decoction,the pill of six ingredients with rehmannia,xiaoyao powder,pipaqingfeiyin,decoction of four drugs,water-enriching and liver-clearing decoction,Erchen peptic powder,pain and diarrhea formula,radix rehmanniae decoction,etc.In clinical practice,professor You Songxin will flexibly combine these prescriptions to truly realize drawing on the existing knowledge,yet getting free from its limitations.(5)The academic ideas of professor You Songxin in diagnosing and treating CHB contain:Balancing between liver regulating and gallbladder clearing,liver tonifying and spleen reinforcing,and gallbladder clearing and harmonizing stomach,and sticking to the therapeutic principle of simultaneously nourishing the kidney and liver.And his treatment thoughts involve putting evil elimination first in clearing and draining damp-heat;Taking the healthy Qi reinforcement as the core in harmonizing and regulating qi and blood;Making constant innovation in removing blood stasis and dissolving phlegm.