| ObjectiveTraditional Chinese Medicine(TCM)is the wisdom and crystallization of the Chinese nation’s practice for millennia.In order to promote the innovation and development of Traditional Chinese Medicine,it is necessary to discuss and solve the problem of how to inherit the medical experience of famous doctors.Based on the principle of non-statistical attribute partial order,a more complete and comprehensive knowledge discovery was made on Professor Li Saimei’s clinical experience in the treatment of middle-aged and elderly type2 diabetes,and a concise summary of the academic thoughts of Professor was made,in order to excavate the potential tacit knowledge and transform it into valuable and inheritable knowledge.By comparing the similarities and differences between middle-aged and elderly patients with diabetes,we can find the characteristics of differentiation and treatment rules of different ages.It has certain positive promoting significance for exerting the advantages of Traditional Chinese Medicine in the treatment of diabetes mellitus,improving the level of clinical efficacy,and providing new reference ideas for the modernization,precision and standardization of Traditional Chinese Medicine in the future.Methods(1)Collection and entry of medical records: This study collected and collated the cases of middle-aged and elderly patients with type 2 diabetes mellitus from January 2016 to January 2020 in the clinic of Professor Li Saimei in the South Building of the Clinic of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine.All cases were screened in accordance with the criteria for inclusion and exclusion.A total of 300 cases were included,including 150 cases of middle-aged type 2 diabetes mellitus and 150 cases of elderly type 2 diabetes mellitus.In order to ensure the veracity of the analysis results,the complete medical records are collected as far as possible,and the collection and entry process of medical records is strictly controlled.(2)Construction of Formal Background: The basic information,syndrome type,symptom,tongue image,pulse image,main prescription,Chinese medicine and medicine dosage of patients were entered into TXT database.Take Diabetes in Middle Age Group as an example: 1.Take Case as an Object,Symptom as an Attribute,generate Case-Symptom form background;2.Take Case as an Object,the Syndrome Type as an Attribute,generate Case-Syndrome form background;3.Take Case as an Object,the Tongue Image as an Attribute,generate Case-Tongue Image form background;4.Take Case as an Object,Pulse as an Attribute,generate Case-Pulse form background;5.Take Case as an Object,Prescription as an Attribute,generate Case-Prescription form background;6.Take Case as an Object,Chinese medicine as an Attribute,generate Case-Chinese medicine form background;7.Take Case as an Object,Dose as an Attribute,generate Case-Dose form background.Diabetes in the elderly group is constructed in the same way as the corresponding formal background.(3)Attribute Partial Order Map Generation: Based on the mathematical attribute partial order representation principle of formal concept analysis,this study establishes formal background,hierarchical optimization of formal background,and generates attribute partial order map.(4)Knowledge Discovery and Clinical Research: Knowledge discovery methods include,first,levels and nodes,second,branch lines,and third,clusters.Mainly read the attribute map from top to bottom and left to right.Based on the knowledge discovery method of mathematical attribute partial order representation,the experience of Professor Li Saimei in treating type 2 diabetes mellitus was collated and summed up.Results(1)Syndrome Distribution:Syndromes involve six meridians,in particular,it is most common to show that the middle-aged diabetic patients are mainly in Yangming syndrome and Taiying syndrome.Liver,spleen and kidneys are the main organ affected by disease.The most common is damp heat syndrome.In addition,it also includes Qi deficiency syndrome,deficiency cold syndrome,Qi stagnation syndrome,blood deficiency syndrome,Qi deficiency and cold coagulation syndrome,phlegm and heat interconnection syndrome.Syndromes involve six meridians,in particular,it is most common to show that the elderaged diabetic patients are mainly in Taiyang syndrome and Shaoyang syndrome.In terms of differentiation of viscera,the liver,spleen and kidney are mainly three viscera.The most common is Kidney Qi deficiency syndrome,accompanied by damp heat syndrome.In addition,it includes deficiency of liver and kidney syndrome,kidney Yang deficiency syndrome,liver stagnation of Qi stagnation syndrome,Yin deficiency syndrome,phlegm and heat mutual association syndrome,blood stasis and heat mutual association syndrome,gallbladder heat and spleen cold syndrome,spleen and stomach Qi deficiency syndrome.(2)Symptom characteristics: Based on the 150 cases of middle-aged diabetes,the most representative of seven symptoms,followed by dry mouth,insomnia,fatigue,bitter taste in the mouth,afraid of cold,sweating and numbness.Among them,dry mouth and insomnia occupy the larger cluster.The most common tongue image is yellow and greasy on tongue.The yellow and greasy tongue indicates that most middle-aged type 2 diabetes patients have the manifestation of dampness-heat,suggesting that dampness-heat is the main pathogenic factor in middle-aged diabetes patients,which is obviously closely related to the syndrome of dampness-heat.The most common pulse image is stringlike pulse and slippery pulse.Therefore,it is suggested that mainly syndrome is heat syndrome and dampness heat syndrome.Based on the 150 cases of elder-aged diabetes,the most representative of seven symptoms,followed by nocturia,insomnia,dry mouth,sweating,bitter taste in the mouth,numbness and fatigue.The most common tongue image is white and greasy on tongue.White greasy tongue suggests that the elderly type 2 diabetes patients with Deficiency syndrome is more common,and mostly with phlegm damp or phlegm heat.While pulse image same as middle-aged patients.Stringlike pulse and slippery pulse also suggested the syndrome of liver stagnation of Qi stagnation syndrome,phlegm damp and phlegm and heat interconnection syndrome.Middle-aged and elderly patients with type 2 diabetes mostly have mixed manifestations of cold and heat,which generally occur at the same time.Middle-aged patients tend to have both appearance and interior as well as deficiency and excess.The elderly patients are mostly on the basis of deficiency syndrome,with dampness and heat accumulation.Therefore,middle-aged and elderly patients always occur mixed excessiveness and deficiency at the same time.(3)Characteristics of the main formula:Based on the middle-aged diabetes patients,the most commonly used prescription is Gegen Qinlian decoction.Gegen Qinlian decoction usually combines with Si Junzi decoction,Guizhi decoction,Lizhong decoction,Xiao Chaihu decoction,Si Nisan,Zengye decoction,Liu Wei Di Huangwan.When Gegen Qinlian decoction is used simultaneously with Si Junzi decoction,it is often combined with Lizhong decoction(Li Saimei’s Self-created prescription).While based on the elder-aged patients,the most common used prescription is Guizhi decoction.Guizhi decoction usually combines with Shen Siwei,Xiao Chaihu decoction,Si Nisan,Lizhong decoction,Guizhi and Gegen decoction,Guizhi and Fuzi decoction.The most common is the combination of Guizhi decoction and Xiao Chaihu decoction.(4)Herbal prescription: Based on the middle-aged diabetes patients,the sequence of this group of attributes are as follows:Huangqin,Zhigancao,Chishao,Chaihu,Yinyanghuo,Guizhi,Gegen,Huanglian,Dangshen,Shengjiang,Fabanxia.While based on the elder-aged patients,as follows as Zhigancao,Chishao,Guizhi,Chaihu,Huangqin,Heizao,Fuling,Shengjiang,Fabanxia.(5)Dosage law:Extract prescriptions containing Gegen,Huangqin,Huanglian.In middle-aged type 2 diabetes,the most common dosage used is Gegen 45 g,Huangqin and Huanglian 15g-20 g,followed by Huangqin and Huanglian 30g-40 g.The sequence of this group of attributes are as follows:Chishao 20 g,Gegen 45 g,Yumixu 30 g,Huangqin 15g-20 g,Huanglian 15g-20 g,Tianyeju 2g,Yinyanghuo 30 g,Ganjiang 10 g,Dangshen 30 g.While based on the elder-aged patients,the most common dosage used same as middle-aged patients,but no application of large dose of Huangqin and Huanglian 30g-40 g.The sequence of this group of attributes are as follows:Yumixu 30 g,Huangqin 15g-20 g,Huanglian 15g-20 g,Chishao 20 g,Gegen 45 g,Fuling 20 g,Dangshen 30 g,Tianyeju 2g,Sheng Dihuang 20 g,Chaihu 10 g.ConclusionA summary of the academic features and clinical experiences of Professor Lee Saimei in the diagnosis and treatment of type 2 diabetes in old age are as follows:(1)Using six meridians syndrome differentiation method as the basic system and merging multiple syndrome differentiation methods in one.Instead,we combine the syndrome differentiation of viscera and the syndrome differentiation of Qi,Blood and Body fluid.Professor Li Saimei believes that the six meridians are often involved,and the six meridians are related to each other,and the common manifestation is two or three meridians of cooperation.Professor Li Saimei emphasized the treatment from the three organs of liver,spleen and kidney in the treatment of syndrome differentiation.(2)Concerning about the main symptoms,curative effect is the gold standard.Professor Li Saimei stressed that the clinical diagnosis and treatment should be based on symptom characteristics and analyze the pathogenesis and the evolution of the disease.Six meridians syndrome differentiation combined with viscera and Qi,Blood and Body Fluid syndrome differentiation in the treatment of diabetes has achieved satisfactory curative effect.(3)Following the idea of“harmony”,combination usage of ancient prescription with modern prescription.Professor Li Saimei stresses the importance of harmony in clinical treatment and follows this idea in treatment differentiation.The ultimate goal of treating various diseases is to balance and regulate body’s Yin and Yang.Professor Li Saimei is good at using the combination of cold and warm prescription method,for the adjustment of the Yin and Yang relationship of disharmony.Based on the practice of ancient and modern,Professor Li Saimei attaches great importance to the application of ancient prescription in clinical practice,and often combines it with modern prescription.Professor Li Saimei believes that the combination of two ancient prescription or combination of ancient prescription and modern prescription can be applied clinically.(4)Emphasize the flexible adjustment of herbs dosage and skillfully using pairs of herbs.Changing of herbs and varying the dosages of herb in accordance with the symptoms.Professor Li Saimei often emphasizes that the herbs dosage is accurately measured according to the evolution of different ages,conditions and diseases.Herbs dosage is often the key to determine clinical efficacy.(5)It is necessary to adjust the “Shu”and concerning about the psychological quality of diabetic patient.The movement of the Qi can be reconciled,so that the Yin and Yang can be restored to peace.This also reflects the idea of “harmony”,Professor Li Saimei encouraged patients to have the confidence to overcome the disease and maintain a peaceful and comfortable mind.The balance of Yin and Yang is the internal power of disease healing.(6)Emphasize the importance of curing the disease and protecting stomach Qi.Professor Li Saimei believes that the six meridian syndrome differentiation and the rules of applying principles,methods and prescriptions in the Shanghan’s theory,it embodies the spirit of prevention of diseases.First,prevent diseases before become ill.Professor Li Saimei believes that prevention is very important and often stresses the importance of mental health care.In the high-risk population of diabetes,pay attention to prevention and health,just to achieve the balance of Yin and Yang.Second,early treatment of existing diseases.Professor Li Saimei believes that in the early stage of diabetes,abnormal blood glucose indexes are found in physical examination,but there are no special discomfort symptoms.Some patients already have insulin resistance or insufficient insulin secretion,so clinical diagnosis and detection indicators of Western are used as a guide,combined with the six meridians syndrome differentiation system,give the most suitable treatment plan indicators as a guide.Thirdly,the prevention and hypoglycemia of the disease is the basic treatment,but the most important thing is to prevent the occurrence of vascular complications.At the same time,the use of Chinese Medicine can improve clinical symptoms,provide individual treatment,to improve the quality of life.Early detection and treatment can effectively prevent the transmission between the viscera and prevent the spread of the disease.Professor Li Saimei believes that in the course of the onset of diabetes,blood sugar fluctuations often occur,and the disease recurs,so timely treatment of the inducement should be taken to restore the blood sugar to a stable level.Professor Li Saimei attaches great importance to taking care of the stomach and spleen Qi,and stresses the importance of taking care of the stomach and spleen Qi no matter in the treatment of middle-aged or elderly type 2 diabetes mellitus.Professor Li Saimei has put forward that the care of spleen and stomach of Qi runs through the whole treatment of diabetes with the good use of cold and warm prescription adjustment method. |
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