Medication Guidelines For The Treatment Of Benign Prostatic Hyperplasia Based On Data Mining Research
Apr 01, 2025
1. Materials and Methods
1.1 Data Source and Retrieval Method
Data was sourced from the China National Knowledge Infrastructure (CNKI) database.
The search targeted studies on the use of traditional Chinese medicine (TCM) for the treatment of benign prostatic hyperplasia (BPH). The search was conducted using the following terms:
Chinese: "良性前列腺增生" ("benign prostatic hyperplasia") AND "中药" ("Chinese medicine")
English: "benign prostatic hyperplasia" AND "Chinese medicine."
The search period spanned from the database's inception to December 31, 2022.
The inclusion criteria were as follows:
Clinical studies on TCM treatment for BPH conducted in China.
Articles published in Chinese or English.
The exclusion criteria were as follows:
Reviews, theoretical discussions, or case studies lacking clinical data.
1.2 Data Extraction and Pre-Processing
The retrieved studies were screened and selected based on the inclusion and exclusion criteria.
The data was pre-processed to standardize terminology, eliminate duplication, and correct errors.
1.3 Analysis Method
Microsoft Excel 2022 was used for data collation and descriptive statistical analysis.
The Chinese Medicine Systems Pharmacology Database (TCMSP) was utilized for data verification and cross-referencing.
2. Research Process
Log in to the Traditional Chinese Medicine Inheritance Computing Platform V3.5, upload the Excel table, and click Statistical Analysis and Prescription Analysis, respectively to proceed.
New Herbal Cistanche Extract Pills
Table 2.1 Frequency Statistics of Medicinal Usage
| No. | Medicinal Herb | Frequency | No. | Medicinal Herb | Frequency |
|---|---|---|---|---|---|
| 1 | Astragalus (Huangqi) | 120 | 31 | Coix Seed (Yiyiren) | 33 |
| 2 | Alisma (Zexie) | 119 | 32 | Water Chestnut (Biandou) | 30 |
| 3 | Poria (Fuling) | 110 | 33 | Seaweed (Haizao) | 30 |
| 4 | Cinnamon Bark (Rougui) | 91 | 34 | Moutan Bark (Mudanhua) | 30 |
| 5 | Peach Kernel (Taoren) | 89 | 35 | Job's Tears (Yiyiren) | 30 |
| 6 | Phellodendron Bark (Huangbai) | 84 | 36 | White Peony Root (Baishao) | 22 |
| 7 | Red Peony Root (Chishao) | 83 | 37 | Summer Cypress (Xiajiucao) | 21 |
| 8 | Cooked Rehmannia Root (Shudi) | 73 | 39 | 22 |
Table 2.1 Frequency Statistics of Medicinal Usage (Continued)
| No. | Medicinal Herb | Frequency | No. | Medicinal Herb | Frequency |
|---|---|---|---|---|---|
| 9 | Angelica Sinensis (Danggui) | 72 | 22 | Moutan Bark (Danzaipi) | 56 |
| 10 | Achyranthes Root (Niuxi) | 70 | 23 | Amber Resin (Hupo) | 54 |
| 11 | Cinnamon Twig (Guizhi) | 67 | 24 | Cuscuta Seed (Tusizi) | 54 |
| 12 | Mountain Yam (Shanyao) | 64 | 25 | Plantain Seed (Cheqianzi) | 50 |
| 13 | Chinese Yam Rhizome (Baizhu) | 63 | 26 | Peony Root (Baishao) | 48 |
| 14 | Bitter Orange (Zhishi) | 62 | 27 | Sichuan Pepper (Chuanjiao) | 47 |
| 15 | Ginseng (Renshen) | 58 | 28 | Chinese Ginseng (Danshen) | 47 |
| 16 | Perilla (Zisu) | 57 | 29 | Dandelion (Pu) | 44 |
Table 2.2 Frequency Statistics of Medicinal Effects
| No. | Medicinal Effect | Frequency | No. | Medicinal Effect | Frequency |
|---|---|---|---|---|---|
| 1 | Hemostatic category | 858 | 11 | Detoxifying category | 47 |
| 2 | Qi and Blood Boosting Effect | 858 | 12 | Invigorating |
3. Research Results
3.1 Literature Screening Results
In this study, Search Query ① retrieved 1,019 articles, and Search Query ② retrieved 459 articles, for a total of 1,478 articles. After reviewing the articles and excluding those that did not meet the inclusion criteria, 378 articles were included.
3.2 Statistical Analysis
3.2.1 Frequency of Medicinal Use
A statistical analysis of the 378 included prescriptions revealed a total of 262 traditional Chinese medicines, with an overall usage frequency of 3,839. Table 2.1 lists the medicines with a usage frequency greater than 20. The top 10 most frequently used medicines, in descending order, are Astragalus (Huangqi), Alisma (Zexie), Poria (Fuling), Cinnamon Bark (Rougui), Peach Kernel (Taoren), Phellodendron Bark (Huangbai), Red Peony Root (Chishao), Cooked Rehmannia Root (Shudihuang), Angelica Sinensis (Danggui), and Achyranthes Root (Niuxi). Among these, Astragalus (Huangqi) was the most frequently used, with 120 occurrences.
3.2.2 Statistical Analysis of Medicinal Effects
Among the 262 traditional Chinese medicines involved in the study, the effects of the medicines were classified and counted according to the 2020 edition of the Pharmacopeia of the People's Republic of China and the categorization in "Pharmacology of Traditional Chinese Medicine" (1st edition, edited by Gao Xue-min). A total of 19 categories of medicinal effects were identified. The top four categories, far exceeding others, were as follows:
Promoting Blood Circulation and Removing Stasis – 858 occurrences
Tonifying and Replenishing – 813 occurrences
Clearing Heat – 529 occurrences
Promoting Diuresis and Eliminating Dampness – 471 occurrences
Refer to Table 2.2 and Figure 2.1 for details.
3.2.3 Statistical Analysis of Four Properties, Five Tastes, and Meridians
The four properties, five tastes, and meridian affiliations of the medicines were categorized and statistically analyzed according to the 2020 edition of the Pharmacopeia of the People's Republic of China.
Four Properties
The properties were unified as follows:
Slightly warm was categorized as warm,
Extremely hot as hot,
Slightly cold and extremely cold as cold,
Slightly cool as cool.
The frequency of the four properties was as follows:
Cold – 1,285 occurrences
Warm – 1,150 occurrences
Neutral – 945 occurrences
Hot – 165 occurrences
Cool – 75 occurrences
Five Tastes
Only the following tastes were recorded due to their significant occurrence: sour, bitter, sweet, pungent, and salty. Tastes such as bland and astringent were not recorded due to their low frequency.
The frequency of the five tastes was as follows:
Sweet – 1,902 occurrences
Bitter – 1,712 occurrences
Pungent – 1,231 occurrences
Salty – 341 occurrences
Sour – 250 occurrences
Table 2.3 Frequency Statistics of Four Properties and Five Tastes of Medicines
| No. | Four Properties | Frequency | No. | Five Tastes | Frequency |
|---|---|---|---|---|---|
| 1 | Cold | 1,285 | 1 | Sweet | 1,902 |
| 2 | Warm | 1,150 | 2 | Bitter | 1,712 |
| 3 | Neutral | 945 | 3 | Pungent | 1,231 |
| 4 | Hot | 165 | 4 | Salty | 341 |
| 5 | Cool | 75 | 5 | Sour | 250 |
Table 2.4 Frequency Statistics of Meridian Affiliations of Medicines
| No. | Meridian | Frequency | No. | Meridian | Frequency |
|---|---|---|---|---|---|
| 1 | Liver | 2,059 | 7 | Bladder | 523 |
| 2 | Kidney | 1,595 | 8 | Gallbladder | 334 |
| 3 | Spleen | 1,338 | 9 | Large Intestine | 294 |
| 4 | Lung | 1,029 | 10 | Small Intestine | 151 |
| 5 | Heart | 993 | 11 | Pericardium | 45 |
| 6 | Stomach | 749 | 12 | Triple Burner | 20 |
3.3 Association Rule Analysis
In the software, the following steps were performed sequentially: Data Analysis → Prescription Analysis → Association Rules. The parameters "Support" and "Confidence" were set as follows:
Support: Refers to the frequency of co-occurrence of medicinal combinations (including pairs, triplets, or larger groups of medicines) in the prescription data.
Confidence: Refers to the probability that a specific medicine (or combination of medicines) appears after a preceding medicine or combination.
The Support was set to 40, and the Confidence was set to 0.8. As a result, 40 core medicinal combinations were identified, involving a total of 18 medicinal herbs (see Table 2.5). The relationships among these combinations were visualized using a network topology diagram (see Figure 2.3). Medicines with an association confidence > 0.8 were highlighted.
3.4 Clustering Analysis
The software employed the K-means algorithm for unsupervised clustering analysis of the prescription data. The number of clusters was set to 6.
After analysis, 6 groups of medicinal combinations were identified (see Table 2.7). A K-means clustering diagram for the use of Chinese medicine in the treatment of BPH is provided in Figure 2.4.
4 Discussion
4.1 Analysis of Medicinal Frequencies and Effects
A statistical analysis of 378 prescriptions revealed a total of 262 medicinal herbs, with Astragalus (Huangqi), Alisma (Zexie), Poria (Fuling), Cinnamon Bark (Rougui), Peach Kernel (Taoren), Phellodendron Bark (Huangbai), Red Peony Root (Chishao), Cooked Rehmannia Root (Shudihuang), Angelica Sinensis (Danggui), and Achyranthes Root (Niuxi) being the most frequently used. Astragalus was the most frequently used, reflecting its importance in prescriptions.
Astragalus, as the primary herb, is known for its Qi-tonifying effect and has anti-inflammatory, immunomodulatory, and diuretic properties. Alisma promotes water metabolism and reduces dampness. Cinnamon Bark has warming and Yang-tonifying properties, often used in combination with other herbs to enhance efficacy. Peach Kernel and Red Peony Root are commonly used for promoting blood circulation and resolving stasis, which aligns with the treatment principles of benign prostatic hyperplasia (BPH).
Numerous studies have demonstrated the pharmacological effects of these herbs:
Astragalus can regulate the immune system and may activate the AMPK pathway to protect against oxidative stress-induced cellular damage. It has also shown potential in inhibiting fibrosis in prostate tissue and reducing the proliferation of prostate cells.
Alisma and Poria have diuretic and dampness-reducing effects, often used to alleviate urinary symptoms associated with BPH.
Cinnamon Bark and Angelica Sinensis have blood circulation-promoting properties, which may improve local microcirculation and reduce inflammation.
4.2 Mechanisms of Action of Key Herbs in BPH Treatment
The mechanisms of action for these herbs in BPH treatment can be summarized as follows:
Anti-inflammatory and Anti-oxidative Effects
Many herbs, such as Astragalus and Phellodendron Bark, exhibit strong anti-inflammatory properties via pathways like MAPK and AMPK, reducing oxidative stress and inflammation in prostate tissue.
Regulation of Hormonal Pathways
Herbs such as Cinnamon Bark and Alisma influence androgen receptor signaling and inhibit the overexpression of enzymes like 5α-reductase, which are crucial in the pathogenesis of BPH.
Improvement of Urinary Symptoms
Herbs like Poria and Alisma enhance diuresis and promote water metabolism, alleviating urinary retention and frequency.
Inhibition of Proliferation and Fibrosis
Herbs such as Astragalus, Peach Kernel, and Red Peony Root have been shown to inhibit fibroblast proliferation and reduce the deposition of extracellular matrix proteins, which play a role in prostate fibrosis.
4.3 Clinical Applications and Integration with Western Medicine
The use of these herbs in BPH treatment reflects the principles of traditional Chinese medicine (TCM), focusing on tonifying deficiency, promoting blood circulation, resolving stasis, and clearing heat. The integration of TCM with Western medicine shows promise, especially in cases where conventional treatments such as α-blockers and 5α-reductase inhibitors are insufficient or cause side effects.
Research supports the combination of herbal therapy with standard Western treatments, enhancing therapeutic outcomes and reducing adverse effects. For example:
Astragalus has been shown to protect prostate tissue by reducing oxidative damage and inflammation.
Cinnamon Bark may enhance the efficacy of 5α-reductase inhibitors by modulating androgen signaling pathways.
4.4 Future Research Directions
Future studies should focus on:
Exploring the synergistic effects of herbal combinations to optimize treatment efficacy.
Investigating the molecular mechanisms underlying the beneficial effects of these herbs.
Conducting large-scale, randomized controlled trials to establish standardized treatment protocols.
This study showed that the most frequently used medicinal effect categories were Promoting Blood Circulation and Resolving Stasis (858 occurrences), Tonifying and Replenishing (813 occurrences), Clearing Heat (529 occurrences), and Promoting Diuresis and Eliminating Dampness (471 occurrences), far exceeding other categories. This aligns with the core therapeutic principles for benign prostatic hyperplasia (BPH).
From the perspective of TCM, BPH is caused by kidney deficiency leading to Qi stagnation and blood stasis, which obstructs the urinary tract and causes inflammation in the prostate. In the elderly, the deficiency of kidney Qi cannot nourish the bladder, causing difficulty in urination. Prolonged stagnation of Qi and blood can lead to the formation of phlegm and dampness, further exacerbating the condition. Thus, most of the medicines used in this study were aimed at promoting blood circulation, resolving stasis, clearing heat, and promoting diuresis.
4.2 Analysis of Medicinal Properties and Meridian Affiliation
For medicinal properties, BPH-related prescriptions primarily consisted of herbs with warm and bitter properties. The treatment principles are based on tonifying kidney Qi and regulating the urinary tract. The warming property complements kidney Yang, while the bitterness helps drain dampness and clear heat.
Four Properties Analysis:
The herbs commonly used included those with warm and neutral properties, which tonify deficiency without causing excessive heat. For example, Astragalus (Huangqi) and Poria (Fuling) tonify and promote urination, while Cinnamon Bark (Rougui) warms kidney Yang.
Meridian Affiliation Analysis:
The most commonly targeted meridians were the Liver Meridian, Kidney Meridian, and Spleen Meridian, which reflects the TCM understanding of the pathology of BPH. Herbs such as Achyranthes Root (Niuxi) and Angelica Sinensis (Danggui) regulate the Liver and Kidney meridians, promoting blood circulation and resolving stasis in the lower body.
4.3 Analysis of Core Medicinal Combinations
Using association rule analysis, 6 core medicinal combinations were identified, grouped into 4 categories:
Combination 1:
Core herbs: Ginseng, Cinnamon Bark, Huangbai, Achyranthes Root, Alisma, Poria, Angelica Sinensis, and Coix Seed.
This group focuses on tonifying Qi and Yin, promoting urination, and resolving stasis. It is effective for patients with kidney Qi deficiency and dampness obstructing the lower body. Herbs such as Alisma promote diuresis, while Cinnamon Bark warms kidney Yang.
Combination 2:
Herbs: Astragalus, Phellodendron Bark, Red Peony Root, and Cooked Rehmannia Root.
These herbs tonify Qi, promote blood circulation, and clear heat. This combination is suitable for patients with Qi deficiency and stagnation in the prostate.
Combination 3:
Herbs: Peach Kernel, Red Peony Root, Cinnamon Twig, and Achyranthes Root.
This group focuses on promoting blood circulation and resolving stasis, clearing inflammation, and improving urinary flow.
Combination 4:
Herbs: Angelica Sinensis, Poria, Huangbai, and Coix Seed.
This combination targets clearing heat and dampness, promoting urination, and reducing inflammation.
4.4 Analysis of Clustering Results
The clustering analysis divided the 6 groups of core medicinal combinations into 4 therapeutic categories:
Tonifying Qi and Yang:
Herbs: Astragalus, Ginseng, Cinnamon Bark.
This category focuses on addressing kidney Qi deficiency and warming Yang.
Clearing Heat and Resolving Dampness:
Herbs: Phellodendron Bark, Alisma, Poria, Coix Seed.
This category is aimed at reducing damp-heat accumulation and promoting urination.
Promoting Blood Circulation and Resolving Stasis:
Herbs: Peach Kernel, Red Peony Root, Achyranthes Root.
This group targets blood stasis and inflammation in the prostate.
Balancing Yin and Yang:
Herbs: Angelica Sinensis, Cooked Rehmannia Root, Huangbai.
This combination restores the balance of Yin and Yang, alleviating urinary symptoms and reducing prostate inflammation.
