Research of Cistanche Treating Impotence

FANG Yi-Rong1， HUANG Jie-Long1， WANG Jun2， CHEN Chi-Wei2，

ZHU Lu-Jun1， ZENG Hai-Ping1（AdvisorCUI Xue-Jiao2）

1. The First Clinical Medical School of Guangzhou University of Chinese Medicine， Guangzhou 510006 Guangdong， China

2. The First Affiliated Hospital of Guangzhou University of Chinese Medicine， Guangzhou 510405 Guangdong， China

Contact: joanna.jia@wecistanche.com / WhatsApp: 008618081934791

Abstract： Objective To explore the medication regularity of Professor CUI Xue-Jiao in treating impotence based on the Traditional Chinese Medicine Inheritance Support Platform System. Methods Medical record data of the effective cases of impotence patients treated by Professor CUI Xue- Jiao from May 2017 to May 2019 in the outpatient department of surgery（andrology）of the First Affiliated Hospital of Guangzhou University of Chinese Medicine was collected. The medication frequencies of the herbs， the properties, and tastes, as well as the action classification of the enrolled herbs, were calculated. Moreover, the prescription regularity and candidate recipes for impotence were mined. Results The prescriptions for 138 patients were screened and analyzed， and a total of 116 herbs were used， with the accumulative medication frequency being 5 593. The top 3 herbs used frequently were Herba Epimedii， Radix Morinda Officinalis， and Herba Cistanches. The properties of the enrolled herbs were dominated by warm and neutral properties， the tastes of the herbs were dominated by sweet， pungent， and salty flavors， and the leading categories after-action classification were tonics， astringents, and herbs for activating blood to resolve stasis. After the association rule, analysis, and cluster analysis，15 core herbal combinations and 5 new candidate recipes for impotence were obtained. Conclusion Professor CUI Xue- Jiao believes that deficiency of liver and kidney， and Qi stagnation and blood stasis are the fundamental pathogenesis of impotence， and impotence can be mainly treated by the herbs for warming kidney and tonifying liver， assisting by herbs for activating blood to resolve stasis and unblock meridians.

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Impotence refers to a disease in which the penis is not soft or erect but not firm or firm and so long that it cannot maintain a normal sexual life. With the accelerating pace of modern life, changes in living environment, changes in dietary structure, and increased mental stress, the incidence of impotence continues to increase, and the population tends to be younger, which has a negative impact on communication, life, and spirit of male compatriots. Traditional Chinese medicine treats impotence. Before the Ming and Qing Dynasties, physicians mostly believed that impotence was related to kidney deficiency, and mostly focused on invigorating the kidney. Starting from the Ming Dynasty, various physicians recognized impotence from different angles and believed that depression of fire, damp heat, and emotion were all important factors in the onset of impotence. In the Qing Dynasty, doctors suggested that the syndrome differentiation of impotence should first distinguish between deficiency and excess, and it is not advisable to blindly replenish and treat impotence through soothing the liver and regulating emotions. Professor Cui Xuejiao is the instructor of the third batch of national veteran traditional Chinese medicine experts in the succession of academic experience, professor of Guangzhou University of Chinese Medicine, and doctoral tutor. Professor Cui Xuejiao teaches the ancients, and he is unique in the treatment of impotence. This study uses data mining methods to analyze the characteristics of Professor Cui Xuejiao's medication for treating impotence, in order to provide a basis for clinical treatment of impotence.

1 Material and methods

1.1 Source of medical record data

Collect medical record data of effective cases of impotence diagnosed and treated by Professor Cui Xuejiao in the Outpatient Department of Surgery (andrology) of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2017 to May 2019.

1.2 Diagnostic criteria for patients with medical records

1. 2. 1 Western medicine diagnostic criteria refer to "Diagnosis and Treatment of Andrology" [1],

"Guidelines and Expert Consensus for the Diagnosis and Treatment of Andrology Diseases in China" (2016 Edition) International Questionnaire for Impotence and Erectile Function-5 (IIEF-5) score [2]: The penis continues to fail to achieve or maintain sufficient erections to obtain a satisfactory sex life, And the course of the disease is more than 3 months; the IIEF-5 score is less than 22 points.

1. 2. 2 TCM syndrome differentiation refers to the "Guiding Principles for Clinical Research of New Chinese Medicines: Impotence" [3] and the "Tenth Five-Year Plan" National Planning Textbook "Traditional Chinese Internal Medicine" (2011 Edition) [4] for general higher education, and according to Cui Xuejiao The professor has many years of clinical experience and has formulated four basic syndrome types: kidney-qi deficiency syndrome, kidney-yang deficiency syndrome, kidney-yin deficiency syndrome, and liver-qi stagnation syndrome.

1.3 Inclusion criteria for medical records

(1) Meet the diagnostic criteria of Chinese medicine and Western medicine for impotence and have been in Cui therapy from May 2017 to May 2019; (3) Good compliance and normal sex drive of the spouse, able to cooperate with treatment; ( 4) In order to ensure the validity of prescriptions, collect patients who have not less than two follow-up visits and collect no more than 5 prescriptions for each patient.

1.4 Exclusion criteria for medical records

(1) Those who do not meet the inclusion criteria;

(2) Those with incomplete data; (3) Those with poor compliance, abnormal spouse's sexual desire, and unable to cooperate with treatment.

1.5 Standardization of the names of Chinese medicines

"Chinese Pharmacopoeia"), for example, "Wine Cornus" is entered as "Fructus Corni", "Wine Cistanche" is entered as "Cistanche", "Salt Morinda" is entered as "Morinda" and so on.

1.6 Data analysis

This study mainly uses the "Traditional Chinese Medicine Inheritance Auxiliary System (V2.5)" to collect statistics on the frequency of medication, the four qi, and five flavors, and the classification of efficacy, as well as the analysis of prescription rules, and the discovery of new prescriptions.

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2 results

2.1 Analysis of the frequency of medication use

After the screening, the prescriptions of 138 patients were collected, and 116 Chinese medicines were used cumulatively, a total of 5,593 times. There are 15 medicines with a frequency higher than 120 times, among which the first 3 medicines are Epimedium, Morinda Officinalis, Cistanche.

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Analysis of the frequency of meridian return of the four qi and five flavors of medicines, using the "Statistical Reports" module in the "Statistical Reports" in the "Traditional Chinese Medicine Inheritance Auxiliary Platform (V2.5)" to count 138 patients with Qi used in prescriptions mainly based on temperature and peace. The frequency of the main, warm and moderate medications were 2 584 (53.8%) and 1 361 (28.3%) times respectively; cold, hot, and cold.

The frequency of medication is significantly less, 799 (16.6%), 47(1.0%), 10 (0.2%) times. The five flavors have the sweetest medicines, totaling 3 514 times, accounting for 45.3% of the total frequency of medicines; spicy medicine followed. The frequency of medication was 1 404 times, accounting for 18.1%; the salty medicine was 1 111 times, accounting for 14.3%. Bitter medicines, sour medicines, and astringent medicines are used less frequently, 722, 598, and 403 times, respectively, accounting for 9.3%, 7.7%, and 5.2% respectively.

2. 2 Classification of drug efficacy

According to the classification of the textbook "Chinese Materia Medica" (2011 Edition)[5], "Chinese Pharmacopoeia" and "National Chinese Herbal Medicine Collection"[6], the textbooks used in the prescriptions of 138 patients The 116 traditional Chinese medicines are classified into 10 categories in terms of their efficacy. They are ranked from high to low in the order of frequency of use. The top 3 drugs are tonic drugs, astringent drugs, and blood stasis-removing drugs.

2. 3 Analysis of the prescription rule based on the analysis of association rules

Use the function of "Prescription Analysis" in the "Data Analysis" module of the "Traditional Chinese Medicine Inheritance Auxiliary Platform (V2.5)" to analyze the prescription rule, and set the number of support degrees to 250. Confidence ≥ 0.9, 15 drug combination patterns were obtained, involving 6 drugs. The results are shown in Table 3.

3. New prescription analysis

The above-mentioned core combination is further analyzed using the unsupervised entropy hierarchical clustering algorithm, and 5 new prescriptions for the treatment of impotence are obtained. Kidney stores essence embeds yin and yang, governs reproduction, resuscitates the yin organs, in order to be a strong official, skills are produced; the liver stores blood governs venting. Adjust the Qi machine, Si Zongjin. Dongjin, one refers to the tendons of one body, and the other refers specifically to the front yin of men. Kidney essence and liver blood are the material basis for the physiological activities of sexual organs. Kidney Qi is the driving force, and the dredging of liver Qi makes the Qi smooth and blood filling. Professor Cui Xuejiao believes that liver and kidney deficiency and qi stagnation and blood stasis are the main pathogenesis of impotence, and the treatment of impotence should start from regulating the liver and kidney.

3.1 Exploring the characteristics of prescriptions based on the statistical results of drug properties

The results of this study show that the four Qi of the drugs used by Professor Cui Xuejiao to treat impotence is mainly warm and calm. Warming medicine mainly has the functions of dispelling cold, warming liver and dispelling stagnation, replenishing fire and assisting yang, warming yang and distilling water, warming meridian and dredging collaterals, stimulating fire and returning to the origin, returning yang to rescue adversity, and so on. Although the boundary between cold and heat is not obvious, the medicine is gentle in nature, moderate in effect, can regulate the yin and yang of qi and blood, and it is not easy to show the bias of cold and heat in the process of tonic. It is suitable for patients with unobvious cold and heat and chronic diseases. Compatibility can exert different medicinal effects.

3.2 The five flavors of the drugs used by Professor Cui Xuejiao to treat impotence are mainly sweet, pungent, and salty in nature.

Sweet medicines "can disperse, harmonize, and relieve", and have the effects of tonic, harmonization, reconciliation, and pain relief; "Able to do, to disperse", has the function of divergence, promoting Qi and promoting blood. It is mostly used for manifestation and qi-blood block; salty medicine "can be used, can soften", and has the effect of purging and laxative, softening and resolving lumps. Professor Cui Xuejiao's treatment of impotence usually uses warming yang to nourish the kidney, promoting blood circulation and removing blood stasis. The warming medicine and sweet medicine are partial tonics. If the kidney is too strong, it will easily affect the operation of the qi. After adding the pungent medicine, the effect of promoting qi and blood circulation can be strengthened and smoothed. Air machine. The kidney is water, and salty enters the kidney. The salty medicine can be introduced to the diseased place to better exert its efficacy.

3.2 Discussing the principles of treatment from the distribution of medication frequency and classification of drug efficacy.

The statistical results of medication frequency suggest that Epimedium, Morinda Officinalis, and Cistanche are the top 3 medications. Epimedium has a pungent and sweet taste, is warm in nature, returns to the kidney and liver meridian, invigorates the kidney and yang, expels wind and dampness." Rihuazi's Materia Medica" believes that Epimedium "cures all cold winds, nourishes the waist and knees, strengthens the heart, and the husband cannot afford it." Morinda Officinalis has a pungent and sweet taste, mild in nature, and returns to the kidney and liver meridian. "Materia Medica Biology" proposes that Morinda officinalis can "tonify the kidney and nourish essence, cure five labors and seven injuries, and relieve rheumatism". Cistanche, sweet, sour, salty, warm in nature, returns to the kidney and large intestine meridian, nourishes the kidney and boosts yang, moisturizes the intestines, and relaxes bowel movements. "Rihuazi's Materia Medica," said Cistanche deserticola "does no harm to men" Warm the waist and knees, the man has an ejaculation, hematuria, and leakage. "These medicines all have the effect of invigorating the kidney and yang, embodying Professor Cui Xuejiao's therapeutic principles of warming and invigorating the kidney and yang. In the specific clinical treatment, the patient's physical signs and symptoms must be combined with the addition and subtraction according to the syndrome.

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The statistical results of the frequency of drug efficacy show that Professor Cui Xuejiao usually uses tonic drugs, astringent drugs, and blood stasis-removing drugs for the treatment of impotence. In addition, astringent medicines and medicines for promoting blood circulation and removing blood stasis are used more frequently. In modern society, due to excessive life and mental stress and irregular diet, it is easy to lose liver yin and kidney yin; chronic illness consumes qi, and qi deficiency can promote normal physiological activities; chronic illness will cause blood stasis, and blood stasis will block qi and blood. normal operation. Therefore, Professor Cui Xuejiao added astringent drugs to treat impotence to invigorate the kidneys and invigorate qi. At the same time, insect drugs such as centipedes and earthworms were often added. Because insect drugs belong to the "blood and blood" products, they correspond to the human body's qi and blood. , Soxie Tongluo effect. As Ye Tianshi put it, disease "long time will cause the evil and righteous to be mixed in the meantime, and the vegetation will not be effective, and the insects and ants should be used to eliminate the evil" [7].

3. 3 New prescription analysis

Professor Cui Xuejiao, based on years of clinical experience, treats impotence from four syndrome types: kidney qi deficiency, kidney yang deficiency, kidney yin deficiency, and liver qi stagnation. But in clinical practice. The symptoms complained by patients are often not as simple as the type of appeal syndrome and are often mixed with more or less other different symptoms, which affect the development of the disease. For these combined symptoms, other drugs need to be compatible with the treatment of impotence. Therefore, in the 5 new prescriptions for the treatment of impotence, the composition of drugs is not limited to the above 4.

The basic syndrome type is a compound syndrome type that combines four basic syndrome types with other syndrome elements. For example, in the new prescription 1 (oyster, epimedium, anemarrhena, peony skin, keel), oysters and keel can nourish yin and suppress yang, condense and consolidate the essence; anemarrhena and peony skin are good at nourishing yin and clearing heat, cooling blood and invigorating blood. It can nourish heat and nourish yin while invigorating the kidney and yang, and treat impotence caused by yin deficiency and fire. New prescription 3 (raspberry, dodder, white peony, Cynomorium, centipede, mulberry) Take five-zi Yanzong pills consisting of raspberry and dodder to invigorate the kidney and strengthen the essence, white peony and mulberry to nourish blood and yin; centipede to relieve pain, relieve pain and invigorate the kidney At the same time, soothing the liver and nourishing the liver, it can treat impotence and infertility of kidney deficiency and liver depression. The Schisandra in the new prescription 4 (cistanche, Schisandra, ginseng, calcined keel, lotus, Morinda officinalis, mulberry) in the new prescription 4 is astringent and astringent, nourishes the kidney, and calms the heart; ginseng and lotus are nourishing the kidney and strengthening the essence; the keel is astringent and astringent, calcined After the preparation, the strength of astringent and astringent is more special; the mulberry cuticle consolidates the essence and reduces the urine, nourishes the kidney and promotes the yang. The whole prescription can nourish the kidney and consolidate the essence at the same time.

4 Examples of medical records

Patient Li, male, 40 years old, presented to the doctor on December 20, 2018, due to a weak erection for one year. The patient can get an erection and have sex, but he is not firm and feels pain in the perineum during erection. Self-reported that she feels heavy mental stress, he is too restful, full of chest and flanks, poor sleep absorption, bowel movements once a day, and normal urination. On physical examination, the appearance of the penis is normal; the tongue is dull, the coating is thin and white, and the pulse is stringy. TCM diagnosis: impotence, the syndrome is liver-qi stagnation. Cure to soothe the liver and relieve depression, invigorate the kidney and promote blood circulation. Prescription: Epimedium 20 g, Morinda officinalis 20 g, Bupleurum 15 g, Turmeric 15 g, White Peony 20 g, 10 g of licorice soak ground dragon, 3 centipedes, 30 g of wool holly,15 g of Sophora japonica, 15 g of Rehmannia glutinosa. Prescription 14 doses, 1 dose per day, water, Fry to 200 mL and take it warmly.

The second consultation on January 10, 2019: The erection status was the same as before, the fullness of the chest and flanks was better than before, the sleepiness was good, the perineal pain was still felt, and the acacia flowers were still removed from the top, and 15 g of cork and 15 g of Tribulus were added. , Hot water Leech 10 g. 14 doses are prescribed, 1 dose a day, decocted to 200 mL, and taken warmly. On January 25, 2019, the third visit, self-reported that the symptoms were better than before transfer and continue to take 10 doses of the second consultation prescription. After a telephone follow-up, she complained that her symptoms had improved and her life was normal.

According to lifestyle changes and irregular sleep can easily deplete the yin of the liver and kidney, resulting in liver and kidney deficiency; high mental pressure, unsuccessful wishes, stagnation of the liver and qi stagnation, poor blood circulation, impotence if the muscles are not used. Professor Cui Xuejiao used Bupleurum, Turmeric, Sophora japonica to soothe the liver and clear away heat, and added insect medicines such as earthworm and centipede to activate the meridians. During the second consultation, according to the prominent symptoms of the patient, the effect of insect medicines for promoting blood circulation and menstruation was aggravated, and clinical trials were more effective. [8-10].

In summary, this study uses data mining methods to study Professor Cui Xuejiao's clinical medication rules for impotence and initially reveals the general medication characteristics of Professor Cui's clinical treatment of impotence. Due to the relatively long course of the disease of impotence patients, the deficiency of liver and kidney is likely to cause qi stagnation and blood stasis. Therefore, during treatment, while invigorating the kidney and promoting yang, it does not forget to soothe the liver and promote qi, promote blood circulation and remove blood stasis, so that the liver meridian can be adjusted and the veins will be improved. Ventilation, unobstructed ventilating, full of blood, when it is lifted, lifted [8].

references:

[1] Deng Chunhua, Xin Zhongcheng, Li Hongjun. Diagnosis and treatment of andrology [M]. Guangzhou: Yangcheng Evening News Publishing House, 2004.

[2] Andrology Branch of Chinese Medical Association. Guidelines and expert consensus on diagnosis and treatment of andrological diseases in China [S]. Beijing: People's Medical Publishing House, 2016.

[3] Zheng Xiaoyu. Guidelines for clinical research of new Chinese medicines [M]. Beijing: China Medical Science and Technology Press, 2002.

[4] Zhou Zhongying. Internal Medicine of Traditional Chinese Medicine (Tenth Five-Year National Planning Textbook for General Higher Education) 2nd edition. Beijing: China Press of Traditional Chinese Medicine, 2011.

[5] Gao Xuemin. Chinese Materia Medica [M]. Beijing: China Press of Traditional Chinese Medicine, 2007.

[6] Compilation Group of "National Chinese Herbal Medicine Collection". National Chinese Herbal Medicine Collection [M]. Beijing: People's Medical Publishing House, 1975.

[7] Wang Xiaoxian, Liu Jinwei, Li Enkuan, etc. Professor Li Enkuan's clinical experience in using Zhuyu Tongluo insect drugs [J]. Chinese Folk Medicine, 2019, 28 (6): 57-58, 64.

[8] Meng Hao, Chen Ming, Cui Xuejiao. Cui Xuejiao’s experience in treating impotence by warming the kidney, removing blood stasis, and clearing menstruation [J]. Journal of Guangzhou University of Traditional Chinese Medicine, 2018, 35(6): 1104-1106.

[9] Zhang Renrong. Based on data mining and analysis of Professor Cui Xuejiao’s medication experience in the treatment of male infertility［D］. Guangzhou: Guangzhou University of Traditional Chinese Medicine, 2018.

[10] Li Tuxuan, Huang Anhao, Xie Jianxing, etc. Professor Cui Xuejiao's experience in treating impotence［J］. Herald of Chinese Medicine, 2018, 24(3): 52-53.