Analysis of tongue appearance,syndrome types,and Chinese herbal prescription data in patients with gouty arthritis treated in the Affiliated Hospital of Jiangxi University of Chinese Medicine from 2014 to 2024

WU Dongyu; CHENG Ling; LI Huanan; SUN Weikang; YUAN Qipeng; LIU Jing

doi:10.3969/j.issn.1002-266X.2025.06.009

Abstract：Objective To analyze the tongue appearance,syndrome types,and Chinese herbal prescription data in patients with gouty arthritis(GA)treated in the Affiliated Hospital of Jiangxi University of Chinese Medicine from 2014 to 2024.Methods A total of 8,344 GA patients with complete clinical data were included.Their tongue features,syn-drome distribution,and the frequency,types,efficacy,and indications of Chinese herbs in prescriptions were analyzed.R language and Cytoscape software were used to examine the properties(Four Qi,Five Flavors,Meridian Tropism)and as-sociation rules of Chinese herbs,including strongly associated herb pairs,corner herbs,and herb quartets.Phi correlation analysis was conducted using the pheatmap package for the top 30 frequently used herbs,and hierarchical clustering analy-sis was performed using the ggtree package to summarize new herbal combinations.Results Among the 8,344 patients,tongue appearance mainly showed red tongue(3,315 cases,39.73%),tongue coating was mostly yellow greasy(4,357 cases,52.22%),pulse conditions were predominantly slippery-rapid(2,656 cases,31.83%),and the most common syndrome type was damp-heat accumulation(6,157 cases,74.01%).A total of 62,571 prescriptions containing 512 kinds of herbs were collected.The top five herbs with high frequencies included Gancao(Glycyrrhizae Radix)of 27,525 times(3.46%),Fuling(Poria)of 20,516 times(2.58%),Danggui(Angelicae Sinensis Radix)of 18,204 times(2.29%),Baizhu(Atractylodis Macrocephalae Rhizoma)of 16,294 times(2.05%),and Danshen(Salviae Miltiorrhi-zae Radix et Rhizoma)of 13,925 times(1.75%).A total of 57 herb types,1,458 therapeutic effects,and 3,153 indica-tions were identified.Most herbs were characterized as cold,warm,or neutral in nature,with bitter,sweet,or pungent taste,and mainly targeted the liver,spleen,or lung meridians.A total of 530 association rules were generated,including 230 herb pairs,268 corner herb rules,and 32 herb quartet rules.Phi correlation analysis showed high correlations among herbs such as Dahuang(Rhei Radix et Rhizoma),Cangzhu(Atractylodis Rhizoma),Niuxi(Achyranthis Bidentatae Ra-dix),Yiyiren(Coicis Semen),and Huangbai(Phellodendri Cortex).Hierarchical clustering analysis identified four new herbal combinations:Formula 1:Dahuang,Tufuling(Smilacis Glabrae Rhizoma),Huangbai,Cangzhu,Chishao(Pae-oniae Radix Rubra),Mudanpi(Moutan Cortex),Guizhi(Cinnamomi Ramulus),Niuxi,Yiyiren,and Zexie(Alismatis Rhizoma);Formula 2:Baixianpi(Dictamni Cortex),Kushen(Sophorae Flavescentis Radix),Fangfeng(Saposhnikoviae Radix),Jinyinhua(Lonicerae Japonicae Flos),Huanglian(Coptidis Rhizoma),Huangqin(Scutellariae Radix),Chaihu(Bupleuri Radix),and Dihuang(Rehmanniae Radix);Formula 3:Dangshen(Codonopsis Radix),Shanyao(Dioscoreae Rhizoma),Huangqi(Astragali Radix),Baishao(Paeoniae Radix Alba),Chuanxiong(Chuanxiong Rhizoma),Danshen,and Danggui;Formula 4:Baizhu,Fuling,Chenpi(Citri Reticulatae Pericarpium),and Banxia(Pinelliae Rhizoma).Conclusions From 2014 to 2024,GA patients treated in the Affiliated Hospital of Jiangxi University of Chinese Medi-cine predominantly exhibited red tongue,yellow greasy coating,and slippery-rapid pulse;the main syndrome type was damp-heat accumulation;treatment strategies focused on clearing heat and detoxifying,strengthening the spleen and re-moving dampness,and promoting blood circulation to resolve stasis.Fuling was identified as the core herb,with extensive application of"Simiao powder"-derived formulas.Four new herbal combinations were derived through hierarchical cluster-ing analysis,corresponding respectively to damp-heat stasis type,damp-heat excess type,spleen deficiency with blood sta-sis type,and spleen deficiency with dampness accumulation type during remission.