| Objectives:1.Using the Ancient and Modern Medical Case Cloud Platform,we analyse the characteristics of Dr.Yu Xiulan’s medication in the treatment of Climacteric Syndrome and summarize the prescription pattern and clinical experience.2.To investigate the potential mechanism of action of the core drugs used by Director Yu Xiulan in the treatment of Climacteric Syndrome using the network pharmacology method.Methods:1.Medical records of Climacteric Syndrome patients treated by Yu Xiulan in the Department of Endocrinology,Optics Valley Hos pital,Hubei Hospital of Traditional Chinese Medicine from Janu ary 2019 to December 2021 were collected.Microsoft Excel 2016 was used to enter the patients’ basic information and prescript ions and medications,establish the database,normalize the dat a,and then use the Ancient and Modern Medical Case Cloud Platf orm software to process the data.The frequency statistics,ass ociation rule analysis,cluster analysis,complex network analy sis,and other modules in the platform were used to analyze the pattern of medication use and further summarise Director Yu’s clinical experience by combining clinical follow-up studies.2.Using the network pharmacology method,screening the active ingredients and targets of the core drugs,obtaining the disease targets of Climacteric Syndrome,mapping the two,and taking the intersection to obtain the targets of the core drugs for the treatment of Climacteric Syndrome;using Cytoscape 3.9.0 software to construct the "core drug-active ingredient-target" network.the protein interaction network was constructed by using the Sting database;the GO function and KEGG pathway enrichment analysis of the key targets were performed by using the DAVID platform;the potential mechanism of action of the core drug combinations for the treatment of Climacteric Syndrome was explored.Results:1.A total of 222 prescriptions of traditional Chinese medicine were collected,involving a total of 168 herbal medicines.The properties were largely neutral,cold,and warm,most of the tastes were sweet,bitter,and pungent,and the mainly meridian tropism were the liver,lung,and kidney.The top ten common traditional Chinese medicine were rhizome dioscoreae,poria,himalayan teasel root,herba taxilli,radix angelicae sinensis,radix curcumae,rhizoma polygonati,schisandra chinensis,rhizoma anemarrhenae,radix paeoniae rubra.The effects of high-frequency medicines were mostly to nourish the liver and kidney,strengthen the muscles and bones,and calm the heart and mind.The commonly used drug combinations were rhizome dioscoreae and poria,himalayan teasel root and herba taxilli,rhizome dioscoreae and himalayan teasel root,rhizome dioscoreae and rhizome dioscoreae,himalayan teasel root and poria,etc.The drug combinations with high confidence of association were: ecliptae herba and ligustrum lucidum,ligustrum lucidum and ecliptae herba,poria and rhizome dioscoreae,radix curcumae and himalayan teasel root,radix paeoniae rubra and himalayan teasel root.The complex network analysis showed that the core drug combinations were rhizome dioscoreae,poria,himalayan teasel root,herba taxilli,radix angelicae sinensis,and radix curcumae.2.The complex network analysis of the data mining obtained rhizome dioscoreae,poria,himalayan teasel root,herba taxilli,radix angelicae sinensis,and radix curcumae as the core drugs;after screening,54 active ingredients and 655 drug targets were obtained,and 191 therapeutic targets were obtained after intersecting with1081 disease targets,among which the key active ingredients included quercetin,rhamnolipid,etc.The network or protein interaction has 52 nodes and 432 edges,14 key targets can be screened,including AKT1,TP53,IL6,TNF,EGFR,ESR1,CASP3,JUN,SRC,MYC,etc.The GO function enrichment analysis yielded 302 representative biological process entries,29 cell composition entries,and 62 molecular function entries;the KEGG pathway enrichment analysis yielded 93 signaling pathways,of which the key pathways involved three hormone regulation-related pathways（estrogen,thyroid hormone,and prolactin signaling molecular pathways）and six transduction pathways（TNF,Erb B,HIF-1,MAPK,PI3K-Akt,and adhesive patch signaling molecular pathways）.Conclusions:1.Combined with the data mining results to analyze the clinical experience of Director Yu Xiulan,it showed that the disease location of Climacteric Syndrome is mainly in the liver and kidney,involving the heart and spleen,and its core pathogenesis is "the deficiency of liver and kidney yin and imbalance of qi and blood in the viscera and yin and yang";the core combination of medicines used by Director Yu Xiulan for the treatment of Climacteric Syndrome includes rhizome dioscoreae,poria,himalayan teasel root,herba taxilli,radix angelicae sinensis,radix curcumae,etc.To sum up,Yu’s clinical experience: When differentiating disease and syndrome,she emphasized grasping pathogenesis and giving consideration to both pathogenesis and syndrome;when prescribing,she makes good use of harmonious methods,balances the properties of medicines,takes care of the spleen and stomach,and harmonizes the qi and blood;when choosing medicines,she integrates Chinese and Western medicine which is flexible;at the same time,the concepts of treating the body and mind together and preventing illness before it occurs are throughout the treatment of diseases.2.Network pharmacological studies have shown that the mechanism of action of the core drug combination for the treatment of Climacteric Syndrome may be because the active ingredients contained in the core drug combination,such as quercetin and japonine,which act on the core targets of AKT1,TP53,IL6,TNF,EGFR,ESR1,CASP3,JUN,SRC,MYC,etc.to regulate the effects of tumor necrosis factor,estrogen,thyroid hormone,etc.The therapeutic effect is achieved by regulating the signaling pathways of estrogen,thyroid hormone,Erb B,and HIF-1 to act on the pathological aspects of Climacteric Syndrome such as decreased ovarian function,atherosclerosis,osteoporosis,and neurological impairment. |
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