Professor Liu Yanfeng's Experience In The Treatment Of Endometriosis And Clinical Efficacy Observation

Objective1 Through the inheritance research method of "man-machine combination and human-oriented",to expound Professor Liu Yanfeng's understanding of endometriosis(EMT)and the theoretical basis,and to summarize her prescription ideas,compatibility rules and medication characteristics in the treatment of endometriosis.2 Through clinical research,by observing five main aspects including the pain degree,TCM syndrome scores,the size of ovarian ectopic cyst,sex hormone levels and CA-125 level,to evaluate the clinical efficacy of Wenshen Nuangan Sanjie Decoction in the treatment of endometriosis.Methods1 The medical records of patients with endometriosis who visited Professor Liu Yanfeng's clinic from January 2010 to September 2019 were obtained,with a total of 480 patients and 1172 visits.According to the inclusion and exclusion criteria,104 patients were finally screened,with a total of 207 visits."The Ancient and Modern Consilia Cloud Platform(V2.2.1)" was used for the calculation of drug frequency and drug combination frequency,analysis of traditional Chinese medicine attributes,association rule analysis,cluster analysis and complex network analysis in order to mine the core medication,drug combination and drug attributes in the treatment of endometriosis.The mining results was sorted out into manuscript for the mentor to review.Combined with the qualitative research method of semi-structured expert interview,the mentor was invited to discuss around topics of her etiological understanding of the disease,theoretical basis,formula forming ideas,medication compatibility and addition and subtraction rules.According to the content of the interviews,the results of data mining were supplemented and improved.2 A total of 42 patients with endometriosis who visited Professor Liu Yanfeng's clinic from December 2018 to December 2019 were collected.24 patients were screened according to the inclusion and exclusion criteria.The patients were given 12-week oral treatment of Wenshen Nuangan Sanjie Decoction.The prescription included Wuyao,Wuzhuyu,Rougui,Xiaohuixiang,Yuanhu,Yujin,Moyao,Pianjianghuang,etc.The visual analogue scale(VAS)of dysmenorrhea,dysmenorrhea symptom scale(CMSS)and TCM syndrome scores were dynamically observed and recorded at 0,4,8 and 12 weeks.Six items of sex hormones in follicular phase,CA-125 level and the maximum cross-sectional area of ectopic cyst were measured and calculated before and after treatment.The clinical efficacy of Wenshen Nuangan Sanjie method in the treatment of endometriosis was evaluated from five aspects:relieving pain symptoms,improving TCM syndrome scores,reducing lesions,regulating hormone levels and reducing CA-125 level.Results1 Summary of Professor Liu Yanfeng's experience in the treatment of endometriosis based on the "man-machine combination" method(1)Data miningUsing the Ancient and Modern Consilia Cloud Platform,through the frequency statistical analysis and complex network analysis,the core drugs for the mentor to treat endometriosis included Wuyao,Rougui,Huluba,Xiaohuixiang,Hongteng,Yuanhu,Moyao,Jianghuang,Yujin,Danshen,Bajitian,Rendongteng,Wuzhuyu,etc.Through the frequency statistics of drug combinations and association rules analysis,it showed that the most commonly used drug combinations included "Wuyao-Wuzhuyu","Xiaohuixiang-Rougui","Yuanhu-Yujin","Moyao-Jianghuang","Danshen-Biejia",and "Hongteng-Rendongteng".By cluster analysis,the drugs were devided into three major groups of different therapeutic directions:warming and tonifying kidney-yang,warming liver and promoting qi as well as activating blood circulation.The drugs in the group to tonify kidney-yang included Huluba Yuanhu,Rougui,Xiaohuixiang,Wuyao,Moyao,Jianghuang,etc.The drugs in the group to warm liver and to promote qi included Bajitian,Yujin,Wuzhuyu,etc.The drugs in the group to activate blood circulation included Danshen,Biejia and Fuling.With the analysis of drug attributes,it showed that the medicinal properties of the drugs used by the mentor are mainly warm and mild,with acridness and sweetness as major flavors,entering the kidney,liver,and spleen meridians mostly.The drugs were aimed to relieve pain by promoting blood circulation,stimulating qi and warming meridians.(2)Expert interviewThrough a semi-structured expert interview,Professor Liu Yanfeng elaborated that the pathogenesis of endometriosis was a combination of "kidney-yang deficiency,cold stagnation in liver meridian and blood stasis forming mass".She also pointed out that the key locations of the disease were kidney and liver.Based on her understanding of the disease,the mentor proposed the therapeutic principle of warming kidney and liver and dispersing the mass.Guided by this principle,the mentor's prescription composed of Wuyao,Wuzhuyu,Rougui,Xiaohuixiang,Honteng,Yuanhu,Moyao,Jianghuang,Yujin,Danshen,Bajitian,Rendongteng,etc.Mentor used mild dugs mostly and each drug served multiple purposes at the same time.Furthermore,the mentor emphasized the compatibility characteristics of combining drugs of the same or different,or even opposite properties to improve the overall function of the decoction2 Clinical efficacy of Wenshen Nuangan Sanjie Decoction in the treatment of endometriosis(1)Visual analogue scale(VAS)for dysmenorrheaAccording to response evaluation criteria of VAS,after 12-week treatment,4 patients were cured.6 were significantly effective.5 were effective.9 were ineffective.The total response rate was 62.50%and the cure rate was 16.67%.The degree of dysmenorrhea has gradually decreased with the extension of the treatment.The VAS scores at 4 weeks,8 weeks,and 12 weeks of treatment have decreased compared with those before the treatment.The differences were statistically significant(P=0.002,P<0.001,P<0.001)(2)COX menstrual symptom scale(CMS S)The overall scores,frequency and degree of the symptoms of dysmenorrhea and its accompanying symptoms at 4 weeks,8 weeks,and 12 weeks have decreased compared with those before treatment.The differences were statistically significant(P<0.05).According to the structural items of the CMSS scale,it was divided into gastrointestinal symptoms,emotional symptoms,somatic symptoms as well as craniofacial symptoms for further analysis.?Gastrointestinal symptomsWith the extension of the treatment,the frequency and degree of gastrointestinal related symptoms have gradually decreased.Among them,the overall scores of gastrointestinal symptoms at 8 and 12 weeks of treatment have decreased compared with those before treatment,and the differences were statistically significant(P=0.001,P<0.001).The frequency scores of gastrointestinal symptoms at 8 and 12 weeks of treatment have decreased compared with those before treatment,and the differences were statistically significant(P=0.002,P=0.001).The degree scores of gastrointestinal symptoms at 4,8,and 12 weeks of treatment have decreased compared with those before treatment,and the differences were statistically significant(P=0.026,P=0.001,P<0.001).?Emotional symptomsWith the extension of the treatment,the frequency scores and degree scores of emotional symptoms have gradually decreased.Among them,the overall scores of emotional symptoms at 8 weeks and 12 weeks of treatment have decreased compared with those before treatment,and the differences were statistically significant(P=0.007,P=0.001).The frequency scores of emotional symptoms at 8 weeks and 12 weeks of treatment have decreased compared with those before treatment,and the differences were statistically significant(P=0.021,P=0.004).The degree scores of emotional symptoms at 4 weeks,8 weeks,and 12 weeks of treatment have decreased compared with those before treatment,and the differences were statistically significant(P=0.036,P=0.003,P<0.001).?Somatic symptomsThe overall score,frequency score and degree score of somatic symptoms at 4 weeks,8 weeks and 12 weeks of treatment have decreased compared with those before treatment,but the differences were not statistically significant(P>0.05).?Craniofacial symptomsThe overall scores of craniofacial symptoms at 4 weeks,8 weeks,and 12 weeks of treatment have decreased compared with those before treatment,and the differences were statistically significant(P=0.009,P=0.017,P=0.004).The frequency scores of craniofacial symptoms at 8 weeks and 12 weeks of treatment have decreased compared with those before treatment,and the differences were statistically significant(P=0.042,P=0.017).The degree scores of craniofacial symptoms at 4 weeks,8 weeks,and 12 weeks of treatment have decreased compared with those before treatment,and the differences were statistically significant(P=0.008,P=0.005,P=0.001).(3)TCM syndrome scoresAccording to the response evaluation criteria of TCM syndrome scores,after 12 weeks of treatment,3 patients were significantly effective,with an effective rate of 12.50%.12 patients were effective,with an effective rate of 50%.The overall response rate was 62.50%.TCM syndrome scores have decreased gradually with the extension of treatment.The scores of yang deficiency,cold coagulation and blood stasis syndrome of patients at 4 weeks,8 weeks and 12 weeks of treatment have decreased compared with those before treatment,and the differences were statistically significant(P=0.001,P<0.001,P<0.001).(4)Maximum cross-sectional area of ovarian ectopic cystsThere was no statistically significant difference in the maximum cross-sectional area of cysts before and after treatment(t=-0.180,P=0.859).(5)Sex hormonesThere were no statistically significant differences in E2,P,PRL,FSH,LH and T levels before and after treatment(P>0.05).(6)CA-125There was no statistically significant difference in serum CA-125 before and after treatment(Z=-0.052,P=0.959).Conclusion1 Professor Liu Yanfeng has a unique understanding of the pathogenesis and the location of endometriosis,focusing on warming yang and dispersing cold to cure the disease,and activating blood circulation to eliminate the disease.Based on the acknowledgement of the pathogenesis of the disease,the mentor practiced syndrome differentiation and provided treatment correspondingly.The mentor attached importance to prescribing mild drugs,protecting yin and blood,focusing on multi-use drugs as well as drug compatibility.2 The method of "human-computer combination and human-oriented" has advantages in summarizing the academic experience of the mentor to certain extent.Qualitative expert interview could better supplement and improve the quantitative mining data and therefore,the research results could reflect the academic viewpoints of mentors more truly and comprehensively.3 Wenshen Nuangan Sanjie Decoction could effectively mitigate endometriosis-related dysmenorrhea and its accompanying symptoms,shorten the duration and frequency of the symptoms,and to improve syndrome of yang deficiency,cold coagulation and blood stasis.The efficacy was lasting and stable.In addition,while controlling the size of the lesion,Wenshen Nuangan Sanjie Decoction did not inhibit ovarian endocrine function.