Studies On The Modern Famous Lingnan Physicians’ Clinical Records Of Lung Disease And Studies On Diagnosis And Treatment Regularity Of Lung Distension And Clinical Observation

ObjectiveThe purpose of this research is to build a database about the modern (since 1949) famous Lingnan physicians’clinical records of lung disease, than systematically studied the clinical records of lung distension through Data Mining technology, to summary the treatment rules of the modern famous Lingnan physicians about lung distension disease, mean to save and inherit the clinical experience of famous Lingnan physicians specializing in TCM.In addition, with the herbal formula extracting from the Data Mining of the research, a randomized clinical research was performed in patients with acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), aiming at supporting the effectiveness and safety of the treatment of AECOPD with Chinese Traditional Medicine, and to promote the development of Lingnan traditional Chinese medicine and the treatment of AECOPD.Methods1. We collected and categorized a large number of clinical records of many Guangdong’s senior Physicians specializing in TCM since 1949. This information is obtained from two sources:major libraries in Guangzhou and online information via search engines, than we build a database of clinical records after categorized the information by using the Epidata3.1 data management software. After that, we systematically studied the data of clinical records of lung distension disease, include frequency analysis, factor analysis, system cluster analysis and association rules by the use of SPSS17.0 and SPSS Modeler14.1, to summary the regular pattern of syndrome and treatment of the modern famous Lingnan physicians about lung distension disease.2. A clinical research is performed with the herbal formula extracting from the Data Mining of the research,33 cases of the patients were treated with Jianpi Jiangqi Huatan Decoction on the basis of routine therapy as treatment group and 33 cases of patients were treated with routine therapy as control group, than compared the result of two groups by analyzing clinical symptom and sign, white blood count and blood gas analysis.Results1. Collection of clinical records50 relevant books and 112 related literatures from 77 physicians were found after an extensive library search. Among the related literatures,106 are from journals,3 are from dissertations,2 are from paper assembly,1 is from electronics. A total of 392 clinical records and 743 effective prescriptions are collected, Among the effective prescriptions,111 are cold related,166 are cough related,86 are asthma related,74 are Panting Syndrome related, 21 are lung abscess related,10 are consumptive lung disease related,94 are lung distension disease related,38 are tuberculosis related,56 are hemoptysis related,87 are lung cancer related. Though this, we established a database of Lingnan physicians’ clinical records about lung disease.2. Data mining results of clinical records about lung distension diseaseBy the analysis of clinical information from 94 visits of lung distension cases, we founded that:there are 90 kinds of symptoms that appeared in this study, the total frequency was 6708 times, and the major symptoms are in order: expectoration, shortness of breath, cough, white sputum, sticky sputum, loss of appetite and so on; there are 20 kinds of tongue pictures that appeared, the total frequency was 318 times, and the major tongue pictures are in order: pale tongue, white fur, red tongue, dark tongue, greasy fur, yellow fur and so on, among them, pale tongue is most commonly appeared, accounting for 17.61%; there are 16 kinds of pulse conditions that appeared, the total frequency was 159 times, and the major pulse conditions are in order:thready pulse, rapid pulse, slippery pulse, wiry pulse, deep pulse, slow pulse and so on, among them, thready pulse is most commonly appeared, accounting for 22.64%; there are 21 kinds of patterns of Syndromes that appeared, the total frequency was 349 times, the major fundamental patterns are in order:lung qi deficiency syndrome, spleen qi deficiency syndrome, kidney yang deficiency syndrome and so on, and the major incidental patterns are in order:phlegm obstructing the lung, phlegm and blood stasis, water overflow syndrome, phlegm heat obstructing the lung and so on.We got 151 drugs out of 94 prescriptions, the total frequency was 1049 times. There are 35 kinds medicine that common used, cumulative frequency up to 72.16%, are the primary drugs for treating lung distension disease, the major drugs are in order:Licorice, Pinellia, Poria, Atractylodes, orange peel, bitter almond, Radix Codonopsis, Schisandra, Perilla and so on. Among them, the major drugs of genuine medicinal materials in Lingnan are in order:orange peel, cinnamon, pummelopeel, Radix Fici Hirtae, Lumbricus, Nerviliafordii and so on. As for medicine category:tonifying, antitussive and antiasthmatic, heat-clearing, exterior-releasing, damp-clearing, energen-regulating are common. The general principles for famous Lingnan physicians to treat lung distention disease is strengthening the body resistance to eliminate pathogenic factors.Factor analysis and cluster analysis were carried out within the 35 drugs. Through those two methods, we obtained 11 and 8 drug combinations, which embodied the clinical prescription principles of famous Lingnan physicians and the pathogenesis of the disease.35 common medicine pairs including Ginger+Radix Paeoniae Alba, Fructus aurantii+Pinellia and so on,15 groups of three medicines including Ginger +Pinellia+asarum, semen Raphani+white mustard+Perilla and so on. Others different connection were found by the association rules, reflect the regular pattern of syndrome and treatment of the modern famous Lingnan physicians about lung distension disease.The result of data mining showed that:characteristics of lung distension disease in lingnan region are as follows:deficiency-excess mixing, spleen deficiency damp obstruction, disorder of qi activity, phlegm-blood stasis, coldness and heat mixing. The experience of famous lingnan physicians in treating lung distension disease:strengthening the body resistance to eliminate pathogenic factors, relieing both primary and secondary symptoms; invigorating spleen for eliminating dampness, strengthen metal by way of reinforcing earth; regulating activities of qi; regulating qi-flowing for eliminating phlegm, promoting circulation and removing stasis;combined therapy of cooling with warming; make good use of genuine medicinal materials.3. Clinical research results:The clinical study shows that:Integrated effect of the two groups were compared, the treatment group total effective rate was 93.55%, the control group was 80.65%, the difference was statistically significant (P< 0.05), indicating that the total effect of the treatment group is better than that of control group. Symptoms and signs, white blood cell count, blood gas analysis index were obviously improved both two groups compared with pre-treatment. Symptoms and signs such as cough, expectoration, panting, anorexia and abdominal distension, PaO2/FiO2 and PaC02 were improved obviously, there were statistically significant differences (P< 0.05), compare to control group. Two groups of drugs were no obvious side effects. Conclusion1. Aided by the Data Mining technology, the herbal prescription law therapeutic principles and methods of famous physicians treating lung disease could be summarized. For example, through frequency analysis, most commonly used drugs included the following kinds:drugs for tonifying, for resolving Phlegm and relieving cough and asthma. Through cluster analysis, commonly used drug combinations for treating lung distension disease could be concluded. Through association rules analysis, compatibility law of Chinese herbal drugs for famous Lingnan physicians treating lung distension disease could be concluded.2. Aided by Data Mining, valuable experience became visual and easy to understand, at the same time it became verifiable. By the analysis of the mass of TCM diagnosis and treatment, some implied key association and law among syndrome differentiation of traditional Chinese medicine, prescription drugs, thus could promote the inheritance, development and innovation of traditional Chinese Medicine, also accelerate the process of modernization of traditional Chinese Medicine.3. Clinical records reflect the integrated applications of theory, rule, prescription and drugs of TCM, the research of Clinical records is extremely important for the inheritance of academic experience in TCM, and it is an effective way to inherit clinical experience of famous physicians.4. The Jianpi Jiangqi Huatan method could improve the clinical symptoms and sign, remedied the state of anoxia and carbon dioxide retention of AECOPD patients with syndrome of phlegm-dampness accumulated in the lung. The clinical effectiveness is distinct, and no bad reaction. It provides the clinical foundation to the AECOPD and QI deficiency and blood stasis, and provides new treatment to the AECOPD.In a word, using data mining technology, famous physicians’clinical records can be analyzed objectively on a multi-dimensional and multi-perspective level, some objective and referential conclusions for clinical work can also be obtained. Clinical research have found that the clinical efficacy of AECOPD with Jianpi Jiangqi Huatan Decoction is definite.