Treatment Principles of Obesity with Chinese Herbal Medicine: Literature Analysis by Text Mining

doi:10.4236/eng.2013.510B002

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Engineering, 2013, 5, 7-11

http://dx.doi.org/10.4236/eng.2013.510B002 Published Online October 2013 (http://www.scirp.org/journal/eng)

Treatment Principles of Obesity with Chinese Herbal

Medicine: Literature Analysis by Text Mining

Yunyu Huang1*, Lianjie Wang1*, Shidong Wang1, Feng Cai2, Guang Zheng3, Aiping Lu2,4,

Xiuchen Yu1#, Miao Jiang2#

1Beijing Dongzhimen Hospital affiliated to Beijing University of Chinese Medic i ne, Beijing, China

2Institute of Basic Research in Clinical Medi c ine, China Academy of Chinese Medical Sciences, Beijing, China

3School of Information Science-Engineering, Lanzhou University, Lanzhou, China

4Hong Kong Baptist University School of Chinese Medicine, Kowloon, Hong Kong, China

Email: #[email protected], #miao_jm@126.com

Received September 2012

ABSTRACT

Obesity represents a social health prob lem worldwide, associated with serious health r i sk s and increased mortality. The

prevalence of obesity is reported to be increasing in both developed and developing countries. Obesity is associated

with a significant range of comorbidities and is linked with increases in mortality, thus the treatment of obesity is very

important. Chinese herbal medicine (CHM) has been used for we ight management both in China and in western coun-

tries for many years, the effectiveness and safety of CHMs in obesity have been prov ed. Yet the principles of treating

obesity with CHMs are hard to manage due to the complexity of TCM theory. In this study, a novel text mining method

was developed based on a comprehensive collection of literatures in order to explore th e treatment principles more in-

tuitively. Networks of TCM patterns and CHMs w hich are most frequently used in obesity treatment are built-up and

analyzed, two major principles are explor ed in treating obesity: one is resolving phlegm and dampness, the other is

clearing heat and reinforcing deficiency. These findings might guide the clinicians in treatment of obesity.

Keywords: Obesity; Chinese Herbal Medicine; Pattern; Traditional Chinese Medicine; Te x t Mining

1. Introduction

Obesity [defined as a body mass index (BMI) ≥ 30 kg/m2]

represents a considerable worldwide health problem,

associated with serious health risks and increased mortal-

ity. The prevalence of obesity is reported to be increasing

worldwide [1]. At present, 35.5% among adult men and

35.8% among adult women in the United States are con-

side red to be obese [2], in England the prevalence of ob-

esity is reported to have increased between 1993 and

2004 from 13.6% to 24.0% among men and from 16.9%

to 24.4% among women. Some minority groups, such as

Hispanic and African Americans, have higher overweight

and obesity rate s t han th e white population [3]. In line

with the global trend, the rate of obesity in China con-

tinues to i ncreas e , overweight and obesity also pose a

challenge to public health in China. According to Ch i -

nese definition, 303 million Chinese are over-weight

(body mass index, BMI ≥ 24 kg/m2). Among them, 73

million are clinically obese (BMI ≥ 28 kg/m2) [4].

Obesity is associated with a significant r ange of com-

orbidities and is linked with increases in mortality, w hich

is usually the result of the combination of genetic factors

and an inappropriate lif e style, characterized by inade-

quate nutrition and lack of regu l ar physical activity. It is

closely associated with the development of type 2 di-

abetes, hypertension, dyslipidemia, and cardiovascular

disease, among other medical problems [5].

Expert panels spons or e d by both the World Health

Organization and the National Institutes of Health have

recommended that obese adults, as well as those who are

overweight and have comorbid conditions, lose 10% of

their initial weight [6,7]. A comprehensive program of

lifestyle modification is conside r ed the first option for

achieving this goal [7]. Lifestyle modification, also re-

ferred to as behavioral we ight control, includes 3 primary

components: diet, exercise, and behavior therapy [8].

For obese patients who cannot achieve or maintain a

healthy weight by non-pharmacological means, drug

therapy is recommended in combination with non-ph a r-

macological interventions such as dietary modifications

and exercise [9]. Yet the costs are high. Compared with

lifestyle advice, the mean incremental cost-effectiveness

ratio for orlistat (sibutramine, rimonabant) ranged be-

tween £970 (£6941, £9303) and £59,174 (£10,042,

*Equal contributions to this work.

#Correspondi ng author.

Y. Y. HUANG ET AL.

£35,876) [9].

Despite these conditions, patient surveys indicate that

less than one-half of obese individuals are advised by

their physicians to lose weight [10], the reason is possi-

bly lying in that physicians feel ill-equipped to provide

treatment or that the available treatments for obesity are

ineffective [11].

Chinese herb al medicine (CHM) has been used for

weight management both in China an d in western co un-

tries, traditional Chinese medicine (TCM) has a distinc-

tive and systematic cognition of obesity according to the

specific theory framework. Randomized, controlled clin-

ical trials published on CHMs for weight management

have proved the effectiveness and safe t y of some CHM

formulae [12,13]. A number of animal studies support

the use of CHM formulas for treating obesity and have

shown other beneficial effects [14-16], the potential me-

chanism of actions of many Chinese herbs that are tradi-

tionally used for weight management has also b een ex-

plored.

Howeve r , due to the complexity of TCM theory, the

treatment principles of obesity are complicated a nd mys-

terious. In order to exp lore the treatment principles more

intuitively, a novel text minin g method was developed

based on a comprehensive collection of literatures [17].

The study would provide an accessible way for under-

standing the treatment principles for obesity with CHM s.

2. Material and Methods

2.1. Data Collection

The dataset were downloaded from SinoMed

(http://sinomed.cintcm.ac.cn/index.j sp) with the query

term of “obes ity” on Jane 22, 2012. Thi s dataset contains

38,051 recor d s of litera tures on clinical practices or

theoretical research on obesity. In th is dataset, each

record/paper is tagged with an unique ID. These recor ds

contain the title, keywords, and abstract of published

papers [17].

2.2. Data Filtering

1) TCM Patter: Pattern (also called as Syndrome, or

Zheng) differentiation is regar ded as the key ro le in the

clinical practise of TCM traditional Chinese medicine

[18]. Usually, pattern identification is the basis of the

prescription of herb formulae, CHMs, or other TCM

therapies. Thus it is natural and intuitive to filter out the

pattern and then tr y to find the association rules b etw een

pattern and CHMs. The top TCM patterns in obesity are:

pulmonary stagnation of phlegm (Tan shi zu fei), fol-

lowed with stagnation of liver qi (Gan qi yu jie) and kid-

ney yin deficiency (Shen yin xu).

2) Chinese herbal medicine: Based on the keyword list

of CHMs (b oth legal names and other popular names are

included for calculation), we filtered the CHMs in the

plain text format, and then co nv erted a ll popular names

into legal names. All the CHMs were tagged with th eir

unique paper ID. Based on the unique paper ID, we could

construct the pairs of co-existed CHMs as they do coe x -

isted in literature. F or example, in one paper, CHMs of

Huangqi (Radix Astragali seu Hedysari), Rens hen (Radix

Ginseng), and Shengdihuang (Radix Rehmanniae Recens)

are mentioned. Then, the pairs of co-existed CHMs of

“Huangqi-Renshen”, “Huangqi-Shengdihuang”, and “Ren -

shen -Shengdihuang” are constructed.

3. Results

In this paper, fo cused on obesity, we explo red the prin-

ciples of pattern diffe rentiation and CHMs prescription

and the association between the two aspects under the

framework of TCM theory from 38,051 literatures. Th e

network con s truction is based on the analysis of net-

works of pattern and CHM correlated with obesity in

literature. The conn ections a mong thes e networks are

built-up under the professional knowledge of TCM.

3.1. Major TCM Patterns in Obesity

Pattern identification is regarded as the first step during

TCM clinical practice procedure. After the pattern is ap-

proved, the treatment principle can be determined. For

example, when the pattern of blood stasis is approved,

then the treatment principle of active blood and resolve

stasis is determined. In our results, 122 TCM patterns are

detected to be related with obesity, and the top 10 TCM

patterns in obesity are presented in Figure 1.

3.2. Most Frequently Prescribed CHMs in

Obesity Treatment

Altogether 174 CHMs are mined from the literature in

treatment of obesity. As herbal formulae are composed

by the CHMs, the list of mos t frequently used CH M s can

certainly provide the information of TCM treatment

principles more effectively due to the stablity and uni-

queness of each CHMs rather than formulae which can

be renamed easily after slight regulation. The top 10 fre-

quently prescribed CHMs are shown in Figure 2.

3.3. Networks of the Pattern and CHMs in

Obesity

The networks of patterns and CHMs in obesity treatment

can be constructed based on the co-existence frequency

among patterns or CHMs, respectively. By checking

these two networks, the correlation between TCM pat-

terns and CHMs can be analyzed and explored. In order

Y. Y. HUANG ET AL.

Figure 1. Top 10 TCM patterns in obesity.

Figure 2. Top 10 frequently prescribed CHMs in treatment

of obesity.

to achieve better visualization, the CHM network is sim-

plified to preserve 11 CHMs which are the most fre-

quently used in combination in treating obesity. The net-

works of pattern and CHMs with their correlation on

obesity is demonstrated in Figure 3. The major correla-

tion between TCM patterns identification and CHMs are

demonstrated with arrows.

4. Conclusions and Discussion

Based on the analysis described in previous section, it

naturally comes to the point that TCM treatment prin-

ciples of a disease can be reasonably mined out and pre-

sented from dataset downloaded from SinoMed which

contains 38,051 records. Compared with th e knowledge

of obesity in textbook, most knowledge is covered by the

si mple and succinct networks demonstrated in Figure 3

which can be summarized with the following points and

their internal connections.

1) TCM networks of patterns and CHMs can be

constructed and analyzed

In this study, through mass calculation on dataset on

obesity, the main aspects of TCM networks were built-up.

The main TCM organs (different from modern medical

concept) involved in ob esit y development are lung,

spleen, liver, kidney and stomach. The pathogenesis re-

lated with obesity includes Dampness-Phlegm, Qi-de-

pression, Deficiency of Qi/Yin/Yang, and Pathogenic fire.

To follow the matter of course, CHMs most frequ ently

pre s cribed in obesity treatment can be grouped into 2

major classes, one group is responsible for resolving

phlegm and dampness, the other is for clearing heat and

reinforcing deficiency. These major principles might

Figure 3. The network of TCM patterns and CHMs in treatment of obesity. Network of patters is shown in the upper part,

network of CHMs in lower part. Bigger shape represents higher frequencies. The lines between the shapes represent the

co-existent correlations between the two patterns/CHMs. Arrows represent the correlation between the TCM patterns and

CHMs.

050100 150

Qi deficiency in splee n

Y in de fi ci e ncy i n Li ver a nd …

Excessiv e Hea t in Stoma ch an d …

Yang deficiency in Kidn ey

S t ag na t ion of QI due t o …

D efi c ie ncy of bot h qi and yin

D efi c ie ncy of bot h yi n a nd yang

Y in de fi ci e ncy i n ki d ney

S t ag na t ion of li ve r qi

P ul monary st ag nat i o n of ph l egm

Frequency

020 40 60 80100

BAI ZHU (Rhizoma Atra ctylodis …

FU LING (Poria)

SHAN ZHA (Fructus C ratae g i)

HUANG LIAN (R hizoma C optid is )

W ANG BU LIU XING (Semen …

DAN SHEN (Radix Salviae …

HUANG QI (Radix Astr ag ali se u …

TIAN DONG (R adix Asp aragi )

BAI JI (Rhizoma Bletillae)

DA HUANG (Radix et Rhizoma

…

Frequency

Y. Y. HUANG ET AL.

guide the clinicians in treatment of obesity.

2) Internal connections among networks

Through directed text mining, the internal connections

among TCM networks were also found. These internal

connections can be group e d into two major hierarchical

clusters. Each cluster is associated with one major kind

of patterns. The major treatment principles of TCM

treatment of obesity can be explored by text mining me-

thod and summarized in a succinct figure.

3) TCM Network might be useful in both TCM

clinical practices and scientific researches

The ne tw ork demonstrated in Figure 3 can be tak en as

a high level of abstraction on the treatment of obesity out

of dataset containing 27,442 recor ds. From the view point

of clinicians, it can be tak e n as a kind of refer e nce. F rom

the view point of basic researchers, this re sult might be

useful to illuminate some further studies in obesity.

5. Acknowledgements

This work was partially su pported by National Science

Foundation of China (No. 30902003 and 81072982).

2012' Traditional Chinese medicine Professional project

(No. 201207012).

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