Performance of controlled attenuation parameter measured by FibroScan in the diagnosis of nonalcoholic fatty liver disease and its association with traditional Chinese medicine syndrome types / 临床肝胆病杂志

Objective To investigate the application value of controlled attenuation parameter (CAP) of hepatocyte steatosis measured by FibroScan in the diagnosis and traditional Chinese medicine (TCM) syndrome differentiation of nonalcoholic fatty liver disease (NAFLD). Methods A retrospective analysis was performed for related data of 364 patients with NAFLD who attended The First Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2017 to December 2019, including basic information (age, sex, and body mass index [BMI]), CAP measured by FibroScan, ultrasound findings of the liver, gallbladder, spleen, and pancreas, liver function parameters, and blood lipid parameters. TCM syndrome differentiation was performed based on the information obtained by four diagnostic methods, and then the patients were divided into liver depression and spleen deficiency group, damp turbidity and stagnation group, damp-heat accumulation group, intermingled phlegm and blood stasis group, and spleen-kidney deficiency group. The association of CAP, color Doppler ultrasound findings, liver function parameters, blood lipid parameters, and BMI with TCM syndrome was analyzed. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t -test was used for further comparison between two groups; the Kruskal-Wallis H rank sum test with multiple sets of independent samples was used for comparison of non-normally distributed continuous data between multiple groups and further comparison between two groups. The chi-square test or Kruskal-Wallis H rank sum test was used for comparison of categorical data between multiple groups and further comparison between two groups. A Spearman's rank correlation analysis was used to investigate the correlation between CAP and ultrasound grading. Results Among the 364 patients with NAFLD, 169 had the syndrome of liver depression and spleen deficiency, 71 had the syndrome of damp turbidity and stagnation, 60 had the syndrome of damp-heat accumulation, 41 had the syndrome of intermingled phlegm and blood stasis, and 23 had the syndrome of spleen-kidney deficiency. There was a significant difference in CAP value between the different syndrome types ( F =14.839, P < 0.001), and further comparison between two groups showed that the spleen-kidney deficiency group and the intermingled phlegm and blood stasis group had a significantly higher CAP value than the liver depression and spleen deficiency group, the damp turbidity and stagnation group, and the damp-heat accumulation group (all P < 0.05). There was a significant difference in ultrasound grading between the different syndrome types ( χ 2 =22.947, P < 0.001); the liver depression and spleen deficiency group mainly had a mild grade (40.2%), the damp turbidity and stagnation group and the damp-heat accumulation group mainly had a moderate grade (53.5% and 53.3%, respectively), and the intermingled phlegm and blood stasis group and the spleen-kidney deficiency group mainly had a severe grade (68.3% and 43.5%, respectively). CAP was positively correlated with the severity of fatty liver ( r =0.431, P < 0.001). The spleen-kidney deficiency group and the intermingled phlegm and blood stasis group had significantly higher levels of alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, and BMI than the other three groups (all P < 0.001). Conclusion Association is observed between CAP and the TCM syndrome types of NAFLD, and patients with the syndrome of spleen-kidney deficiency and the syndrome of intermingled phlegm and blood stasis have a higher CAP value than those with the other syndrome types. CAP has similar efficiency to color Doppler ultrasound in the diagnosis of NAFLD.

Traditional Chinese medicine syndrome types and syndrome elements of nonalcoholic fatty liver disease / 临床肝胆病杂志

ObjectiveTo investigate the distribution of traditional Chinese medicine (TCM) syndrome types and syndrome elements of nonalcoholic fatty liver disease (NAFLD). MethodsRelated databases (CNKI, Wanfang Dota, and VIP)were searched for articles on the syndrome differentiation of NAFLD published up to July 2020. Two investigators independently performed literature screening and collection and summarization of syndrome types based on the inclusion and exclusion criteria, and an Excel 2010 database was established after the standardization of syndrome names, re-decomposition of syndrome types, and extraction of syndrome elements. The data were imported into SPSS 25.0 statistical software for the analysis of frequency distribution. ResultsA total of 45 qualified articles were collected, with a total of 8703 cases reported. A total of 14 syndrome types were obtained after standardization, and 10 syndrome elements reflecting the nature of disease and 4 syndrome elements of disease location were obtained after the syndrome types were disassembled. Stagnation of liver Qi and spleen deficiency syndrome (26.47%) and damp-heat accumulation syndrome (22.16%) were the most common syndrome types, followed by stagnation of phlegm dampness, intermingled phlegm and blood stasis, and stagnation of liver Qi and Qi stagnation. Dampness (23.75%), Qi stagnation (19.82%), Qi deficiency (17.12%), phlegm (15.43%), and heat (12.13%) were the most common syndrome elements reflecting the nature of disease, followed by stasis, Yin deficiency, and Yang deficiency, while fire and cold were relatively uncommon. Qi stagnation and Qi deficiency (26.63%), dampness and heat (22.30%), phlegm and dampness (16.17%), and phlegm and stasis (12.19%) were the most common combinations of syndrome elements. The liver and the spleen were the most common syndrome elements of disease location, accounting for 90.95% of the constituent ratio, and the combination of the liver and the spleen with the same disease accounted for 54.01%. The combination of one, two, three, or four syndrome elements was observed, and the combination of two syndrome elements accounted for 76.03%. ConclusionStagnation of liver Qi and spleen deficiency are the basic pathogeneses of NAFLD, and liver, spleen, dampness, Qi stagnation, Qi deficiency, phlegm, and heat are common syndrome elements. Dampness, phlegm, and heat are important factors for the development and progression of this disease.

Association of gene mutations in the pre-C, C, and basic core promoter regions of hepatitis B virus with traditional Chinese medicine syndrome types / 临床肝胆病杂志

ObjectiveTo investigate the association of gene mutations in the pre-C, C, and basic core promoter (BCP) regions of hepatitis B virus (HBV) with traditional Chinese medicine (TCM) syndrome types in patients with chronic hepatitis B (CHB). MethodsA retrospective analysis was performed for the clinical data of CHB patients who were diagnosed and treated at the outpatient service and ward of Spleen, Stomach, and Hepatobiliary Department, The First Affiliated Hospital of Henan University of Chinese Medicine, from November 2014 to June 2018. Related clinical data were collected and recorded, including general information, HBV serological markers, HBV gene mutations, and information obtained by four TCM diagnostic methods. Syndrome differentiation and typing were performed for each patient with reference to the criteria for TCM syndrome differentiation of viral hepatitis, and the association of gene mutation in the pre-C, C, and BCP regions of HBV with TCM syndrome types was analyzed. The chi-square test was used for comparison of categorical data between groups, and the Kruskal-Wallis H test was used for comparison of continuous data between multiple or two groups. ResultsA total of 235 patients with CHB were enrolled, among whom 101 had internal retention of damp-heat, 88 had stagnation of liver Qi and spleen deficiency, 17 had blood stasis obstructing the collaterals, 19 had liver-kidney Yin deficiency, and 10 had spleen-kidney Yang deficiency. There were significant differences in sex, age, and course of disease between the patients with different TCM syndrome types (χ2=17.389, H=173.280, H=86.520, all P＜0.01), and there was a significant difference in age between the CHB patients with gene mutations in the pre-C, C and BCP regions of HBV (H=30.150, P＜0.001). There was a significant difference in the distribution of TCM syndrome types between the CHB patients with gene mutations in the pre-C, C and BCP regions of HBV (χ2=58.117, P＜0.001), and internal retention of damp-heat and stagnation of liver Qi and spleen deficiency were major TCM syndrome types accounting for 80.43%. The patients with internal retention of damp-heat tended to have A1762T and G1764A mutations, and those with stagnation of liver Qi and spleen deficiency tended to have G1896A, A1762T, and G1764A mutations; G1764A mutation was often observed in the patients with blood stasis obstructing the collaterals or liver-kidney Yin deficiency, and I97L mutation was often observed in the patients with spleen-kidney Yang deficiency. ConclusionGene mutations in the pre-C, C, and BCP regions of HBV are associated with TCM syndrome types in CHB patients, and internal retention of damp-heat and stagnation of liver Qi and spleen deficiency are the most common TCM syndrome types. I97L mutation is often observed in patients with spleen-kidney Yang deficiency.

Gut microecology: An important target of traditional Chinese medicine in the treatment of nonalcoholic fatty liver disease / 临床肝胆病杂志

Gut microecology plays an important role in the pathogenesis of nonalcoholic fatty liver disease. With reference to the research on traditional Chinese medicine in regulating gut microecology and treating nonalcoholic fatty liver disease, this article systematically elaborates on the association of nonalcoholic fatty liver disease with intestinal flora, gut bacterial metabolites, and gut barrier function and points out that the regulation of gut microecology and the maintenance of intestinal homeostasis are important measures for traditional Chinese medicine in the treatment of nonalcoholic fatty liver disease.

Research advances in traditional Chinese medicine therapy for cholelithiasis / 临床肝胆病杂志

Cholelithiasis is a common disease in clinical practice. At present, surgery is the primary Western treatment method for this disease, but there are problems such as surgical trauma, a high recurrence rate, and postoperative complications. Various traditional Chinese medicine (TCM) methods for the treatment of cholelithiasis have achieved satisfactory results and have been widely used in clinical practice in recent years. This article summarizes the research advances in TCM therapy for cholelithiasis from the aspects of the understanding of cholelithiasis in TCM, TCM treatment methods for cholelithiasis and their mechanisms, and integrated traditional Chinese and Western medicine therapy. It is pointed out that TCM can significantly improve or inhibit the information of cholelithiasis and has the advantages of reliable therapeutic effect, few side effects, and a low recurrence rate; however, its further application is limited by the unclear mechanism of action of TCM and defects of related clinical research such as low quality and poor repeatability. It is recommended to strengthen basic research and conduct high-level randomized controlled clinical trials in the future to provide scientific and objective evidence for clinical diagnosis and treatment of cholelithiasis and thus improve the clinical effect of TCM in the treatment of cholelithiasis.

CONTINUOUS IMPROVEMENT OF SCIENCE OF TCM--COMBINED WITH THE USE AND QUALITY OF SERVICE PERCEIVED GAP ANALYSIS MODEL / 现代医院

This paper takes the Traditional Chinese Medicine health population science as a social service . From the theoretical perspective .There's a clue that using the models of Perceived Service Quality , Determinants of Quality of Service , 5 Gaps Mode to find out the invisible zone of the continuous improvement of TCM populational sci -ence services.With the further analysis , this zone refers to the 5 gaps of the recognition differential .By minimizing the recognition differential , we form up a strategic program package for TCM populational science , which makes it dif-ferent.Besides, the real case of Guangdong Provincial hospital of TCM has verified that the good TCM populational Science service had demonstrated a positive influence to the Harmonious Relationship of doctor -patient.

Objective research on pulse manifestation in chronic renal insufficiency patients * / 重庆医学

Objective To explore the pulse diagram parameter changes of chronic renal insufficiency patients with five symptoms types(spleen kidney qi deficiency ,spleen kidney Yang deficiency ,kidney liver Yin deficiency and the deficiency of Yin and Yang ) , and to establish the differentiation mode of each symptoms type for assisting the clinical diagnosis .Methods The DS01-C pulse manifestation instrument made by the Shanghai Daosh company was adopted to detect and analyze the pulse manifestations in the healthy control group and the chronic renal insufficiency group .Results The healthy control group was dominated by the normal pulse manifestation .The chronic renal insufficiency group was dominated by the taut pulse and its concurrent pulse .Along with the progress of the disease ,the pulse manifestations also appeared the corresponding changes .The patients with spleen kidney qi defi-ciency and spleen kidney Yang deficiency were dominated by the taut pulse .Comparing the patients with liver kidney Yin deficiency and Qi Yin deficiency ,the taut pulse and concurrent rapid pulse were common ,in addition ,the former also had the deep pulse .The patients with Yin and Yang deficiency showed the slow pulse and the taut pulse or the taut pulse and rapid pulse .Conclusion The pulse manifestation change in the patients with chronic renal insufficiency is dominated by the taut pulse and the concurrent pulse , the pulse manifestation change of various symptoms types are complex .

The harmonious development of TCM science from the view of birth,growth,transformation,harvest,store of five elements theory / 中华中医药杂志

This paper elaborates on the significance of'birth,growth,transformation,harvest,store'from the theory of TCM fi ve elements.Then it mainly discusses the harmonious development of five aspects of TCM science in research,education,market,hospitals and infrastructure from the view of respective functions of'birth,growth,transformation,harvest,store'and the TCM idea that conforming to certain climate can help people keep healthy.Finally,the paper indicates that it is necessary for the government to guide and adjust the development of TCM in different stage from a dynamic view.

Characteristics of TCM Study Methods from the Cognition of TCM for Human Body / 中医杂志

Basic cognition of TCM for human body includes three aspects:(1)Human body is an unify of form,Qi and sprit intrinsically;(2)Human is an unity composed of five solid organs in functions and structures;(3)Form,Qi,sprit and the Zang-and Fu-organs of human body connect together via channels and collaterals.The characteristics of TCM study methods are mainly trialistic nature of study objects,phenomenon analogy,functional leading nature of function and unify of the whole.

Development of TCM Science Depends on Re-understanding of relation between Diseases and Syndromes / 中医杂志

The present paper puts forward that the relationship between differentiation of syndromes and differentiation of diseases ought to be the relation between methods and results. Differentiation of syndromes must presuppose differentiation of diseases. Syndrome has own specificity only when existence of diseases. However, this disease is not the traditional "disease" named by symptoms, but must be a "new" disease with developing law, specific syndromes and syndromes of corresponding stages.