High-risk human papilloma virus (HPV) infectious cervicitis is the main cause of cervical cancer and has become an important public health problem in China. Traditional Chinese Medicine(TCM) syndrome differentiation and treatment is of great significance for preventing, delaying or even blocking the further development of high-risk HPV infection, but there are few relevant studies at present, and there is a lack of standardized pattern determination and standardized treatment plans.

To explore the TCM syndromes, distribution and evolution of TCM syndromes, pattern elements and evolution patterns in the transformation of HPV infection with cervicitis, cervical intraepithelial neoplasia (CIN) and cervical cancer (CC).

A retrospective analysis was performed for 288 cases of high-risk HPV infection diagnosed by hysteroscopy and pathological tissue biopsy in Shanxi Institute of Traditional Chinese Medicine from January 2023 to June 2024. EpiData 3.1 was used to establish a database to record the general information of patients, auxiliary examination results and information of the four diagnoses of traditional Chinese medicine. The principal component analysis method was used to extract the common factors. The cumulative variance contribution rate and eigenvalue were comprehensively considered. The cumulative variance contribution rate≥70 or the eigenvalue ≥1 was selected as the common factor, and the maximum variance method standardized by Kaiser was used for factor rotation. The K-means clustering method was used for cluster analysis.

Taking the information of the four diagnoses with a frequency of ≥20% as the factor analysis items, 17 pieces of information on the four diagnoses of cervicitis-cancer malignant transformation of high-risk HPV infection were obtained, including 13 symptom information and 2 tongue information, 2 pulse information. There were significant differences in symptoms, tongue image and pulse in high-risk HPV patients with cervicitis, CIN and CC (P<0.001). The results of principal component and factor cluster analysis showed that the TCM syndromes of high-risk HPV infected patients with cervicitis, CIN and CC were divided into 6 types: spleen and kidney yang deficiency pattern, qi stagnation and blood stasis pattern, spleen deficiency and dampness pattern, damp-heat betting pattern, damp-toxin accumulation pattern and yin deficiency and dampness pattern. The pattern distribution of cervicitis patients was dominated by damp-heat betting pattern (28.47%). The distribution of pattern elements was mainly wet (71.18%) and hot (28.47%).The main location of the disease was in the uterus (77.43%), followed by liver (58.33%). The pattern distribution of CIN patients was mainly damp-heat betting pattern (24.65%). The distribution of pattern elements was mainly wet (69.18%) and hot (24.65%). The main disease location was in the uterine (67.81%), followed by liver (60.27%). The pattern distribution of CC patients was mainly spleen deficiency and dampness pattern (25.16%). The distribution of pattern elements was mainly dampness (69.88%) and qi deficiency (25.16%). The main location of the disease was the uterus (56.52%), followed by the spleen (55.59%). There were statistically significant differences in distribution of TCM syndromes, pattern elements and disease locations among patients with high-risk HPV infection cervicitis, CIN and CC (P<0.001).

High-risk HPV infection cervicitis-carcinoma is mainly located in the uterus during the malignant transformation, which is related to the liver in the early stage and often involves the spleen and kidney in the later stage. With the progress of the disease, the evolution of syndromes and pattern elements is generally characterized by "the mixture of virtual and real, from real to virtual, and damp and evil throughout".