Exploring The Syndrome-treatment And Medication Rules Of The Ming Dynasty Warm-tonic School In The Treatment Of Ulcerative Colitis Based On Data Minin

ObjectiveTo explore the medication rules and treatment of ulcerative colitis(UC)by the Warm-recuperation School of Ming Dynasty through data mining.MethodsWe collected 192 prescriptions and 146 traditional Chinese medicines from the works of five representative physicians of the Warm-recuperation School,Xue Ji,Sun Yikui,Zhao Xianke,Zhang Jiebin,and Li Zhongzi,related to UC.After recording and standardizing the data,a database was established.Data mining was conducted through the Traditional Chinese Medicine Inheritance Calculation Platform(V3.0),including the frequency of medicine use,classification by four properties(cold,cool,warm,hot),five flavors,and meridian tropism,as well as prescription association rules and clustering analysis.Based on the data mining results,we summarized the medication rules and core prescriptions for treating UC by the Warm-recuperation School physicians.Representative core prescriptions were selected,and randomized controlled trials of the core prescriptions treating UC were collected by searching the CNKI,Wanfang,VIP,CBM,PubMed,Cochrane Library,and WOS online databases from inception to February 2023.After data organization and classification,a Meta-analysis was conducted using Revman 5.3 software for clinical efficacy,traditional Chinese medicine syndrome scores,colonoscopy scores,and adverse reaction rates as four outcome indicators.Results(1)Medicine frequency statistics:The most frequently used medicine was White Atractylodes Rhizome(75times,5.49%),followed by Ginseng(67 times,4.91%),White Peony Root(63 times,4.62%),Prepared Licorice Root(61 times,4.47%),Coptis Rhizome(61 times,4.47%),Costus Root(58 times,4.25%),Licorice Root(56 times,4.10%),Chinese Angelica Root(54 times,3.96%),Poria(54 times,3.96%),Tangerine Peel(48 times,3.52%),and Dried Ginger(41 times,3.00%).(2)Four properties,five flavors,and meridian tropism statistics:Warm medicines were the most frequently used(605 times,45.22%),followed by cold(345 times,25.78%)and neutral(251 times,18.76%)medicines.Bitter flavor medicines were the most frequently used(730 times,34.66%),followed by sweet(635 times,30.15%)and pungent(567 times,26.92%)medicines.The spleen meridian had the highest frequency(1032 times,23.63%),followed by the stomach(652 times,14.93%),lung(591 times,13.54%),heart(545 times,12.48%),liver(424 times,9.71%),and kidney(415 times,9.51%)meridians.The top four categories of medicines were tonifying(454 times,33.93%),regulating qi(167 times,12.48%),clearing heat(135 times,10.09%),and warming the interior(127 times,9.49%).(3)Association rule analysis:With the screening criteria of support count≥20 and confidence≥0.7,17 groups of medicine combinations were obtained.The top three combinations in terms of confidence were "Ginseng,Prepared Licorice Root,Tangerine Peel→White Atractylodes Rhizome","White Atractylodes Rhizome,Prepared Licorice Root,Tangerine Peel→ Ginseng",and "White Atractylodes Rhizome,Prepared Licorice Root→Ginseng".(4)Clustering analysis:Using the K-means algorithm and setting the number of clusters to 3,three core prescription groups were obtained:Group 1 consisted of "White Atractylodes Rhizome,Poria,Dried Ginger,Ginseng,Prepared Licorice Root"(which can be considered as Li Zhong Wan-like prescriptions);Group 2 consisted of "Ginseng,White Atractylodes Rhizome,Prepared Licorice Root,Tangerine Peel,Chinese Angelica Root"(which can be considered as Yi Gong San,Bu Zhong Yi Qi Tang,and other modified prescriptions);Group 3 consisted of "White Peony Root,Coptis Rhizome,Costus Root,Chinese Angelica Root,Licorice Root"(which can be considered as Shao Yao Tang,Xiang Lian Wan,and other modified prescriptions).(5)Meta-analysis:Compared with the conventional Western medicine group,the use of Li Zhong Tang-like prescriptions alone or in combination with Western medicine for treating ulcerative colitis significantly improved patients’ traditional Chinese medicine syndrome scores(SMD=-1.00,95%CI=-1.47～-0.53,Z=4.13,P<0.0001),increased the clinical efficacy rate(OR=3.45,95%CI=2.51～4.74,Z=7.63,P<0.0001),and improved patients’colonoscopy scores(SMD=-1.12,95%CI=-1.46--0.78,Z=6.41,P<0.0001).There was no significant difference in the incidence of adverse reactions compared with the Western medicine group(RR=0.50,95%CI=0.22～1.17,Z=1.59,P=0.11).ConclusionBased on the data mining results,we summarized the characteristics of the Warm-recuperation School physicians in treating UC:①Treating the root cause,focusing on warming and tonifying the spleen and kidney.②Emphasizing sweet and warm medicines,using cold,cool,pungent,and hot medicines cautiously.③Differentiating syndromes and treating them accordingly,not being rigid in using warm-tonifying medicines.The Meta-analysis results confirmed that Li Zhong Tang-like prescriptions have good effects on treating ulcerative colitis,and also confirmed the feasibility of using the Warm-recuperation School physicians’ approach for modern traditional Chinese medicine treatment of UC.