Distribution of traditional Chinese medicine syndromes and related influencing factors in colorectal cancer comorbid with metabolic dysfunction-associated fatty liver disease

Zhiyao Shi; Zhiyang Zhao; Ruofei Yan; Yu Gao; Xixing Wang

doi:10.12449/JCH260915

Volume 42 Issue 9

Sep. 2026

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Article Navigation > Journal of Clinical Hepatology > 2026 > 42(9): 2106-2115

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Distribution of traditional Chinese medicine syndromes and related influencing factors in colorectal cancer comorbid with metabolic dysfunction-associated fatty liver disease

DOI: 10.12449/JCH260915

Zhiyao Shi^{1, 2},
Zhiyang Zhao^{2, 3},
Ruofei Yan²,
Yu Gao^{2
,
,
,},
Xixing Wang^{1, 2
,
,
,}

1.
The First School of Clinical Medicine，Guangzhou University of Chinese Medicine，Guangzhou 510405，China
2.
Department of Oncology，Shanxi Provincial Institute of Traditional Chinese Medicine，Taiyuan 030012，China
3.
The First Clinical College，Shanxi University of Chinese Medicine，Taiyuan 030024，China

Research funding:

The Fourth National Master of Traditional Chinese Medicine Inheritance Studio (Letter No.245 ［2022］ from the National Office of Traditional Chinese Medicine and Human Resources Education);

Construction of the National Traditional Chinese Medicine Inheritance and Innovation Center (202203);

Shanxi Provincial Hospital of Traditional Chinese Medicine Administration Bureau Project (zyytd2024001);

Shanxi Provincial Hospital of Traditional Chinese Medicine Administration Bureau Project (zyyyjs2024001)

More Information

Corresponding author: Gao Yu， ggyy552716@163.com （ORCID： 0000-0001-6342-1142）; Wang Xixing， wangxx315@163.com （ORCID： 0000-0003-2444-7248）
Received Date: 2026-02-13
Accepted Date: 2026-04-09
Published Date: 2026-09-25

Abstract

Abstract

Objective To investigate the distribution and characteristics of traditional Chinese medicine （TCM） syndromes in patients with colorectal cancer and metabolic dysfunction-associated fatty liver disease （CRC-MAFLD）， to explore the correlation between influencing factors and syndrome distribution， and to provide a reference for clinical syndrome differentiation. Methods A total of 319 patients who were admitted to Shanxi Provincial Institute of Traditional Chinese Medicine and The Affiliated Hospital of Shanxi University of Chinese Medicine from January 2021 to December 2025 and were diagnosed with CRC-MAFLD based on pathology and radiological examination were enrolled as subjects， and TCM syndrome differentiation was performed for all subjects. A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between multiple groups. The indicators with statistical significance in the univariate analysis were incorporated into the unordered multinomial Logistic regression model， and the syndrome of liver depression and spleen deficiency was set as the reference group to identify the independent influencing factors for each TCM syndrome. Results The main clinical symptoms of CRC-MAFLD included fatigue （78.06%）， abdominal distension （64.26%）， poor appetite （61.13%）， loose stool （57.05%）， and costal pain （52.04%）. The syndrome of liver depression and spleen deficiency showed the highest distribution frequency， followed by intermingled phlegm and blood stasis， internal retention of dampness turbidity， damp-heat accumulation， deficiency of liver and kidney， and deficiency of spleen and kidney. Comparison between groups with different TCM syndromes showed significant differences in the distribution of body mass index （χ²=42.216， P<0.001）， the clinical stage of colorectal cancer （χ²=11.666， P=0.040）， liver metastasis （χ²=19.279， P=0.002）， degree of hepatic steatosis （χ²=71.085， P<0.001）， diabetes （χ²=12.486， P=0.029）， chemotherapy （χ²=21.920， P<0.001）， fasting plasma glucose （FPG）（F=10.367， P<0.001）， glycosylated hemoglobin （HbA1c）（F=3.696， P=0.003）， albumin （Alb）（F=3.302， P=0.006）， alkaline phosphatase （ALP）（H=34.350， P<0.001）， gamma-glutamyl transferase （GGT）（H=41.679， P<0.001）， and triglyceride （TG）（H=28.826， P<0.001）. An unordered multinomial Logistic regression model was constructed with the syndrome of liver depression and spleen deficiency as the reference， and the results showed that overweight/obesity was a common independent risk factor for intermingled phlegm and blood stasis （odds ratio ［OR］=4.468， P=0.002）， internal retention of dampness turbidity （OR=2.944， P=0.024）， and damp-heat accumulation （OR=5.651， P=0.001）； clinical stage Ⅳ was an independent risk factor for deficiency of liver and kidney （OR=6.746， P=0.003） and deficiency of spleen and kidney （OR=10.074， P=0.001）； presence of liver metastasis was an independent risk factor for intermingled phlegm and blood stasis （OR=5.145， P=0.001）； severe fatty liver disease was an independent risk factor for intermingled phlegm and blood stasis （OR=5.201， P=0.007） and internal retention of dampness turbidity （OR=7.412， P=0.001）， and moderate fatty liver disease was an independent risk factor for intermingled phlegm and blood stasis （OR=2.643， P=0.045）， internal retention of dampness turbidity （OR=3.182， P=0.029）， and damp-heat accumulation （OR=3.073， P=0.036）； diabetes was an independent risk factor for internal retention of dampness turbidity （OR=5.133， P=0.003） and damp-heat accumulation （OR=3.716， P=0.031）. As for continuous variables， elevated FPG was an independent risk factor for internal retention of dampness turbidity （OR=2.375， P=0.003） and damp-heat accumulation （OR=2.701， P=0.005）； elevated HbA1c was an independent risk factor for intermingled phlegm and blood stasis （OR=2.029， P=0.032） and deficiency of liver and kidney （OR=3.308， P=0.010）； elevated ALP was an independent risk factor for damp-heat accumulation （OR=1.053， P=0.019）； elevated GGT was an independent risk factor for intermingled phlegm and blood stasis （OR=1.029， P=0.026） and damp-heat accumulation （OR=1.030， P=0.047）； elevated TG was an independent risk factor for intermingled phlegm and blood stasis （OR=2.931， P=0.006） and internal retention of dampness turbidity （OR=2.449， P=0.019）； elevated Alb was a protective factor against deficiency of spleen and kidney （OR=0.756， P=0.005）. Conclusion Body mass index， the clinical stage of colorectal cancer， liver metastasis， degree of hepatic steatosis， diabetes， chemotherapy， FPG， HbA1c， Alb， ALP， GGT， and TG are the main influencing factors for TCM syndromes in CRC-MAFLD.
- Colorectal Neoplasms,
- Metabolic Dysfunction-Associated Fatty Liver Disease,
- Symptom Complex,
- Root Cause Analysis

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Distribution of traditional Chinese medicine syndromes and related influencing factors in colorectal cancer comorbid with metabolic dysfunction-associated fatty liver disease

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Distribution of traditional Chinese medicine syndromes and related influencing factors in colorectal cancer comorbid with metabolic dysfunction-associated fatty liver disease

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