Constructasystem Of Differentiation And Treatment Of Primary Insomnia Based On "Evidence-Syndrome-Prescription"

purposeJudging from the results of our country’ s epidemiological survey,the number of patients with primary insomnia in our country is showing an upward trend every year.At present,it has reached 31.2%.Traditional Chinese medicine has rich experience and good curative effects in the diagnosis and treatment of primary insomnia.However,in the face of many patients,experienced and senior experts are relatively scarce and cannot meet people’s health needs.The diagnosis and treatment system of disease diagnosis and treatment at the expert level in the field can improve the efficacy of insomnia diagnosis and treatment of young doctors at the grassroots level to a certain extent,and meet the needs of the majority of insomnia patients.The previous research on expert diagnosis and treatment experience differentiation and treatment system is limited to rule reasoning or case reasoning,both of which have their own shortcomings.This study introduces the concept of "syndrome" and proposes a reasoning scheme that integrates rule reasoning and case reasoning.The integration of the two,to a certain extent,improves the efficiency and effectiveness of knowledge reasoning in the expert diagnosis and treatment experience differentiation and treatment system.methodsFirstly,construct the case reasoning logic of primary insomnia,and use the case data of authoritative senior experts in the diagnosis and treatment of insomnia as the research object."Miao Fang" "Insomnia TCM Diagnosis and Treatment Experience Collection" extracts,summarizes its clinical symptoms,syndromes,drugs,and unified and structured,and determines the attributes and attribute weights of each field.And combined with data analysis,calculate and speculate on the similarity of each stage,and finally match the analyzed acquaintance results,display and recommend them.Secondly,construct the rule reasoning logic of primary insomnia.On the basis of the above-mentioned primary insomnia case library,through logistics regression analysis and association rule analysis,a relationship model of"symptoms and signs"-"symptoms" is formed,"symptoms".-The relationship model of "drugs" is finally summarized into a logical table of conditional reasoning.Finally,with "syndrome element" as the core,the model of syndrome differentiation and treatment based on rule-based reasoning and case-based reasoning is integrated,and the relationship model between the two is developed into a syndrome differentiation and treatment system for insomnia.resultThe construction of case reasoning logic for primary insomnia.A 合计 of 363 medical records from 4 books were entered.There were 3 fields of general demographic information of patients,including age,gender,and condition(including:chief complaint symptoms,main complaint duration,incentives);Clinical information has a of 259 fields,including 211 symptoms,48 tongue and pulse characteristics;29 fields for syndrome elements;309 fields for traditional Chinese medicine;and 2 fields for curative effect description(including:number of medications and curative effect records).Case-based reasoning for the discovery of symptoms of primary insomnia-the reasoning rules for the formation of syndrome elements are:syndrome element heart and yellow complexion,difficulty falling asleep after waking up,upset and irritable;spleen and difficulty falling asleep,dreaming,anxiety;liver and pulse string,Rib swelling and pain,little or no fur on the fur;sore kidney and waist and legs,little or no fur on the fur,pale tongue;noisy stomach and acid reflux,epigastric pain,greasy fur;bile and yellowish fur,Dry cough,addiction to spicy food;heat-related stuffiness,swelling and irritation,red or crimson tongue,loose stools;dryness and tongue cracks,hot flashes,dry cough;dampness and pulse,throat blockage,pain Unfixed place;slippery sputum and pulse,greasy moss,thick sputum;stagnation of qi and blue or dark red tongue,dry lips,pulse knots;blood stasis and depression;qi deficiency and strong pulse,joint pain,weak pulse;Blood deficiency and poor complexion,shortness of breath,upset and irritability;the top 3 symptoms related to impotence are moisturizing moss,sore throat,and cold limbs;deficiency of yin and five upsets,fever,impotence,and green tongue;kidney and spirit Fatigue,weight loss.Case-based reasoning for the discovery of primary insomnia.The reasoning rules for the formation of drugs are:heart and wild jujube seed,angelica,jizihuang,etc;The medicines related to the syndrome element kidney include oysters and Bupleurum;stomach and magnolia,agrimony,grain sprouts,etc.;gallbladder and bamboo,bitter almond,keel,etc.;gallbladder and pinellia,Tianzhuhuang,Chuanxiong,etc.;Heat and Pinellia,Tianzhu Huang,Chuanxiong,etc.;Wet and Coix Seed,Dried Ginger,Black Bean,etc.;Phlegm and Pinellia,Peppermint,Lotus Seed Heart,etc.;Qi Stagnation and Safflower,Platycodon,Shouwu Vine,etc.;Blood Stasis and Red Peony,safflower,orange red,etc.;Qi deficiency and astragalus,purple shellfish,southern adenophora,etc.;blood deficiency and Fushen,hemp seed,white ginseng,etc.;Yin deficiency and Taizi ginseng,raw rehmannia,dendrobium,etc.;Jin deficiency and wheat Winter,soft-shelled turtle.Combining the above two inference rules,summarizing them into a logical table,using relevant technical methods,developed a primary insomnia differentiation and treatment system and used it in clinical patients with good results.conclusionThis research is the first domestic case study of high-quality clinical cases to construct knowledge rules based on evidence elements,and then apply the modified rules to form an automatic quantitative evidence dialectical system and drug recommendation.Since there is the objectivity of case reasoning,there is a certain degree The early advancement of TCM clinical thinking overcomes the lack of early TCM case studies and the time limitation of large sample case studies.It also overcomes the rigidity of TCM knowledge rules in the development process,forming a dynamic TCM knowledge base.Improve the knowledge reasoning efficiency and effect of the expert diagnosis and treatment experience differentiation and treatment system,and through the clinical use of a small number of samples,it has a good clinical effect,provides new ideas for the clinical diagnosis and treatment of primary insomnia,and has a certain clinical auxiliary decision-making value.At the same time,there are also some supplements for the diagnosis and treatment of traditional Chinese medicine for primary insomnia and the syndrome differentiation system,supplementing the lack of the original"clinical evidence-syndrome" differentiation system in the clinical medication association,which is used in primary insomnia.The establishment of a "syndrome-medicine" rule model in this disease will lay a methodological basis for the future use of this method in other diseases to organize the experience of TCM experts and the future TCM big data-assisted diagnosis and treatment.