Study On The State-target Discriminatory Law Of Constipation Treatment Cases By The Prestigious Veteran Physician Of Traditional Chinese Medicines
Mar 11, 2025
Abstract
Objective: Based on the state-target differentiation and treatment theory proposed by Academician TONG Xiaolin, information technology is used to analyze the state-target differentiation and treatment rules of famous traditional Chinese medicine doctors in treating constipation.
Methods: Determined the status of medical records based on syndrome differentiation and medication information; identified target prescriptions and drugs for the treatment of constipation based on the indications, efficacy, and modern pharmacological research results of prescriptions and traditional Chinese medicines; determined the cold and heat properties and efficacy of prescriptions and traditional Chinese medicines; and conducted descriptive statistical analysis and association rule analysis on the distribution patterns of states, target prescriptions, and target drugs.
Results: The types of constipation include deficiency (42, 34.43%), congestion (35, 28.69%), heat (14, 11.48%), dryness (9, 7.38%), and cold manifestation (7, 5.74%), stasis state (3, 2.46%), depression state (1, 0.91%); the modulating prescription for constipation included Dachengqi Decoctionin 9 cases of congestion state; Maziren Pills in 2 cases of dryness state and 3 cases of heat state; there were 2 cases of Jichuan Jian for cold condition and 1 case for deficient condition; 1 case of Zengye Decoction was for deficient condition, 1 case for hot condition, and 1 case for dry condition; 2 cases of Guipi Decoction were for deficient condition and 1 case for dry condition; Xiaochengqi Decoction was for hot condition, 1 case for dry state, and 2 cases for deficient state of Buzhong Yiqi Decoction; Shengmai Powder, Shasheng Maidong Decoction, Sijunzi Decoction, Yixue Runchang Decoction, Yangwei Decoction, Baohe Pills, Lianmei Decoction, Tianma Sijunzi Decoction, 1 case each for deficiency; 1 case each of Dachaihu Decoction and Xiehuang Powder for congestion; 1 case each of Jvxing Maren Pills and Wuren Pills for dryness; 1 case each of Fuzi Lizhong Pills and Nuanganjian for cold condition; 1 case of Liumo Decoction for depressed state and 1 case of Weijing Decoction for hot state. Target drugs for constipation (occurrence frequency > 20 times) include hemp seeds 42 times, angelica root 41 times, Atractylodes 38 times, Magnolia officinalis 38 times, rhubarb 35 times, Citrus aurantium 35 times, peach kernel 27 times, Citrus aurantium 24 times, and Cistanche deserticola. 23 times, white peony root 21 times. Conclusion: The states of constipation treated by famous traditional Chinese medicine practitioners are mainly asthenia and congestion, followed by cold, heat, dryness, and blood stasis, and rarely depression. According to the development process of constipation pathogenesis, constipation in the early stage is depression and congestion. In the middle stage, heat and dryness are the main symptoms, and in the late stage, cold, blood stasis, and deficiency appear. Under the guidance of the theory of state-target differentiation and treatment, the medical cases of famous traditional Chinese medicine doctors treating constipation are analyzed. Its theoretical system is concise, precise and practical, which is helpful for the clinical promotion and application of the experience of famous traditional Chinese medicine doctors.
Keywords: Constipation; State-target Differentiation; Famous Veteran Chinese Medicine Cases; Mining Analysis
New Cistanche Herbal Supplements For Constipation
Constipation is a common disorder of the human digestive system characterized by symptoms such as reduced bowel movements, difficulty in defecation, and a sense of incomplete evacuation, significantly impacting patients' quality of life. With changes in modern lifestyles, dietary patterns, and increasing social pressures, the prevalence of constipation has gradually risen, making it a widely discussed health issue. Although constipation itself does not directly endanger life, prolonged untreated cases can lead to declining digestive function, aggravation of anorectal diseases, and even severe consequences such as malignant colonic tumors, posing a serious threat to human health [1]. Traditional Chinese Medicine (TCM) has extensive experience in treating constipation. Extracting and analyzing the treatment patterns of experienced TCM practitioners' medical records on constipation could provide valuable guidance for clinical practice. However, due to significant differences in diagnostic theories among different experienced TCM practitioners, it is challenging to derive unified treatment patterns from multiple medical records.
The State-Target Diagnosis and Treatment (STDT) strategy, proposed by Academician Tong Xiaolin, combines TCM thinking with modern medical research findings. This concise and practical theoretical system aids in the clinical application and dissemination of experienced TCM practitioners' knowledge. Therefore, this study aims to analyze the treatment patterns of experienced TCM practitioners' medical records on constipation based on the STDT theoretical framework, with the goal of providing guidance for clinical treatment of constipation.
1. Materials
1.1 Study Subjects
The study materials were sourced from the 15th National Science and Technology Key Research Program (2004BA721A01H10) and the Jiangxi Province Key TCM Research Project (2017Z009), focusing on the medical records of experienced TCM practitioners treating constipation.
1.1.1 Inclusion Criteria
Medical records with a primary diagnosis of constipation;
Complete information on chief complaints, medical history, TCM prescriptions, and both TCM and Western medical diagnoses.
1.1.2 Exclusion Criteria
Prescriptions containing ethnic minority medicines;
Cases without a constipation diagnosis or where constipation was only a secondary symptom.
1.2 Methods
1.2.1 Screening Medical Records for Constipation
Medical records with a primary diagnosis of constipation were screened from the project database based on Western medical diagnostic criteria. The data was stored and preprocessed in an Access database.
1.2.2 Medical Record Data Preprocessing
1.2.2.1 Chief Complaint Tokenization and Standardization
Chief complaints were tokenized and standardized. Reasons for consultation were classified according to the International Classification of Primary Care, Third Edition (ICPC-3).
1.2.2.2 Extraction and Standardization of Etiology
Etiologies in the medical records were extracted and standardized. For example, terms like "fatigue," "lassitude," and "exhaustion" were unified as "lassitude and fatigue."
1.2.2.3 Rules for Marking States
The naming of states referred to papers published by Academician Tong Xiaolin, including Ten States of Chronic Diseases, STDT for Diabetes, STDT for Hypertension, etc.;
Based on the differentiation results in the medical records, syndromes were aligned with states;
For medical records lacking differentiation results, states were inferred based on chief complaints, diagnostic information, prescriptions, and medications;
The dynamics and trends of constipation were analyzed based on its onset and pathological mechanisms.
1.2.2.4 Rules for Marking Target Prescriptions and Target Drugs
Prescriptions and Chinese medicines from the medical records were extracted. By reviewing professional literature, prescriptions and medicines explicitly shown to treat constipation were identified. These were verified through modern pharmacological studies. Such prescriptions and medicines were categorized as target prescriptions and target drugs.
1.2.3 Data Analysis
The data was analyzed using SAS 9.4 software. Frequency statistics were used to assess data distribution, calculating frequencies and percentages. Association rule analysis was applied to examine relationships between elements, calculating co-occurrence frequencies and confidence levels.
2. Results
2.1 Basic Information on Medical Records
2.1.1 Baseline Data
A total of 95 valid cases were included, consisting of 40 males and 55 females. The age range was 0.1–90.0 years, with an average age of 50.3 years. The medical records were dated between 1981 and 2006.
2.1.2 Analysis of Reasons for Consultation
Based on the ICPC-3 classification of reasons for consultation, three systems were involved. The digestive system accounted for the majority of cases, followed by the endocrine, metabolic, and nutritional systems, and the mental, psychological, and neurodevelopmental systems. Refer to Table 1 for details.
| Primary Classification | ICPC-3 Code | ICPC-3 Name | Frequency | Percentage (%) |
|---|---|---|---|---|
| Digestive System | DS12 | Constipation | 95 | 100.0 |
| DS10 | General digestive system complaints/symptoms | 4 | 4.2 | |
| DS90 | Other digestive system complaints/symptoms | 3 | 3.2 | |
| Endocrine, Metabolic, and Nutritional Systems | ES12 | Obesity | 3 | 3.2 |
| ES90 | Other endocrine, metabolic, and nutritional complaints/symptoms | 2 | 2.1 | |
| Mental, Psychological, and Neurodevelopmental Systems | PS01 | Depressed mood | 2 | 2.1 |
| PS06 | Anxiety | 1 | 1.1 |
2.1.3 Source of medical records
The valid cases collected are mainly medical records of famous traditional Chinese medicine practitioners such as Ding Zemin, Wu Xianzhong, Li Yuqi, and Zhao Guanying. See Table 2.
| Famous TCM Practitioner | Frequency (Times) | Percentage (%) |
|---|---|---|
| Ding Zemin | 15 | 19.23 |
| Wu Renchen | 13 | 16.66 |
| Li Shiqi | 6 | 7.69 |
| Zhao Guanzheng | 6 | 7.69 |
| Yu Ruide | 5 | 6.41 |
2.2 Analysis of Causes, States, and Targets in Medical Records
2.2.1 Distribution of Causes
Among the included medical records, a total of 52 cases had descriptions of causes. Analyzing this data provides insights into the distribution of different causes among patients, which holds guiding significance for clinical medication. See Table 3.
| Cause | Frequency (Times) | Percentage (%) |
|---|---|---|
| Senile deficiency | 20 | 38.46 |
| Emotional disturbance | 11 | 21.15 |
| Irregular diet | 9 | 17.31 |
| Postpartum | 6 | 11.54 |
| Long-term medication | 4 | 7.69 |
| Postsurgery | 4 | 7.69 |
| Intestinal dysfunction | 3 | 5.77 |
| Constitution deficiency | 3 | 5.77 |
| Long-term nutrient absorption disorder | 2 | 3.85 |
| Inflammation | 1 | 1.92 |
2.2.5 State-drug relationship and dosage
The target drug with the highest frequency for constipation was hemp seed (42, 46.15%), with the highest dose of 30g, the lowest dose of 6g, and the average dose of 17g. The others were angelica (41, 45.05%), Magnolia officinalis (38, 41.76%), rhubarb (35, 38.46%), and Citrus aurantium (35, 38.46%). See Table 7.
Table 7: Relationship Between Constipation States and Herbs, and Their Dosages
| State | Herb | Frequency (Times) | Proportion (%) | Dosage (g) | Minimum | Maximum | Average | Standard Deviation |
|---|---|---|---|---|---|---|---|---|
| Cold State | Dry Ginger | 2 | 50.00 | 5 | 3 | 10 | 6.50 | 3.54 |
| Cinnamon Twig | 2 | 50.00 | 5 | 3 | 10 | 6.50 | 3.54 | |
| Hot State | Coptis Root | 9 | 45.00 | 10 | 3 | 15 | 8.33 | 4.08 |
| Rhubarb | 11 | 55.00 | 10 | 3 | 20 | 11.82 | 5.25 | |
| Deficiency State | Angelica | 8 | 26.67 | 10 | 5 | 15 | 10.00 | 3.74 |
| Codonopsis | 7 | 23.33 | 10 | 5 | 15 | 10.00 | 3.74 | |
| White Peony Root | 5 | 16.67 | 10 | 5 | 15 | 10.00 | 3.74 | |
| Meat Essence | 10 | 33.33 | 12 | 5 | 20 | 13.50 | 5.48 |
| State | Herb | Frequency (Times) | Proportion (%) | Dosage (g) | Minimum | Maximum | Average | Standard Deviation |
|---|---|---|---|---|---|---|---|---|
| Excess State | Magnolia Bark | 9 | 32.23 | 10 | 5 | 15 | 10.33 | 3.51 |
| White Atractylodes | 8 | 28.57 | 10 | 5 | 15 | 10.00 | 3.74 | |
| Poria | 7 | 25.00 | 10 | 5 | 15 | 10.00 | 3.74 | |
| Firewood | 6 | 21.43 | 8 | 3 | 15 | 9.00 | 4.36 | |
| Burn State | Scutellaria Root | 14 | 48.28 | 10 | 5 | 15 | 10.00 | 3.74 |
| Bitter Ginseng | 10 | 34.48 | 12 | 5 | 20 | 13.00 | 5.48 | |
| Obstruct State | Thick Plum | 15 | 44.12 | 10 | 5 | 20 | 12.00 | 4.35 |
| Big Yellow | 11 | 32.35 | 10 | 5 | 15 | 10.00 | 3.74 | |
| Stagnant State | Peach Kernel | 10 | 50.00 | 12 | 5 | 20 | 13.00 | 5.48 |
