Research On Core Knowledge Of SLE Syndrome Of Xuan Guowei Based On Multiple Fusion Optimization Strategy

Objective1.The research on the modern inheritance of illustrious senior traditional Chinese medicine practitioners is an important direction of the inheritance and innovation of traditional Chinese medicine theory.As a large number of famous herbalist practitioners and clinicians gradually enter old age,it is particularly urgent to adopt rich and diversified technologies and means to effectively inherit the experience of them.The purpose of this study is to construct core knowledge system of SLE Infective syndrome of TCM Master Professor Xuan Guowei by integrating multiple strategies such as complex network analysis and expert interview etc and combining with comparative analysis of teacher-inheritor relationship,thus providing methodological reference for experts’ clinical thinking,diagnosis and treatment rules and experience inheritance,and accumulating foundation for mining and analyzing invisible clinical knowledge of TCM.2.The research on TCM prevention and treatment of major diseases is the key work of TCM modernization.SLE has been the focus of clinical attention and research with its persistent and recurrent course and life-threatening cases.This study will provide some references for the clinical innovation of SLE and the inheritance of Lingnan medicine by searching literatures related to SLE treatment experience of other famous TCM practitioners in China.3.The knowledge map of "SLE clinical experience of famous TCM" will be constructed based on Neo4j to provide some reference methods for effective use of experts experience data,knowledge visualization and knowledge reasoning,and lay some foundation for future large-scale and high-accuracy ontology construction and storage methods of TCM.MethodsThis study is relies on the national key research and development program of the Ministry of Science and Technology:Innovative research on experience inherit ance of illustrious senior traditional Chinese medicine practitioners based on the id ea of "intergration of Tao and Shu" and multi-integration method(project number:2018YFC1704100),and sub-project:Study on academic views,characteristic diagnos is and treatment methods and experience of major disease prevention and treatmen t of illustrious senior TCM practitioners in eastern China(project number:2018YF C1704102).This research studied SLE clinical core knowledge of professor Xuan Guowei by the following methods:1.Analysis of Xuan ’s SLE experience and inheritance:From May 2007 to August 2021,electronic medical records from SLE patients outpatient professor Xuan and 3 inheritors from Guangdong Hospital of Traditional Chinese Medicine are collected,and medical records are screened and collated according to the inclusion and exclusion criteria formulated,and data extraction and classification as well as medical records terms are normalized by Microsoft Excel to form a database for archiving.IBM SPSS Statistics 26.0 software was used for correlation analysis,COOC12.6 and DMKD8.9 were used for similarity and average clustering coefficient calculation.Ancient and Modern Medical Case Cloud Platform was used for frequency analysis,association rules,clustering analysis,complex network analysis,etc.Gephi was used for community testing and analysis and data visualization.We analyzed the clinical thinking and core prescription-core syndrome of SLE from Professor Xuan,and explored relevant implicit knowledge of diagnosis and treatment,and compare Xuan with the inheritances to further analyze the characteristics of experience inheritance.2.Expert interview research:Based on the analysis of data of outpatient service,we adopted the semi-structured interview method and purposeful sampling to professor Xuan and his three disciples about SLE clinical thinking and understanding of disease for a preliminary discusses.Then we used the Iflytek Heard to convert the interview recordings into text,summarized and refined the interview content and formed an interview report.These means complemented and improved professor Xuan SLE clinical core knowledge points,and discussed the characteristics and rules of SLE experience inheritance and innovation.3.Comparative analysis of literature on the treatment of SLE among illustrious senior TCM practitioners in other regions of China:Keywords combined with titles were used to search literatures on the experience of SLE diagnosis and treatment of illustrious senior TCM practitioners in China during the period from the establishment of Chinese databases such as CNKI,WanFang,VIP and CBM to December 31,2021.Endnote X9 software was used for literature management.The classified frequency statistics of the included practitioners and SLE related pathogenesis,treatment,prescription and medication were conducted to analyze the experience of senior Chinese medicine practitioners in lingnan and other different regions in the treatment of SLE.4.Construction and application demonstration of knowledge map and graph database of SLE about illustrious senior TCM practitioners:The above data content was sorted into a data set of knowledge map.The knowledge map of SLE diagnosis and treatment of illustrious senior TCM practitioners was constructed by using Neo4j Desktop and its application was displayed,so as to explore the methodological optimization of experience inheritance and innovation of illustrious senior TCM practitioners by using knowledge map technology.Results(2)Data and information analysis from the included professor Xuan and his 3 disciples to treat SLE outpatient electronic medical record:1.General situation:a total of 260 patients were enrolled with 3263 treatment times,of which 1041 were treated by professor Xuan,1098 were treated by F physician,881 were treated by L physician and 243 were treated by W physician.2.Demographic information:There were 241 female patients and 19 male patients,female:male=12.68:1.The average age of initial diagnosis was over 30 years old,the average number of visits was more than 15,and the average treatment span was more than 32 months.The number of visits was negatively correlated with age at first diagnosis in male patients,and the time span of visits was negatively correlated with age at first diagnosis in female patients.A total of 90 syndromes were collected from all patients,with a maximum of 4 syndromes and a minimum of 0 syndromes in a single patient,with an average of 0.30 and a median of 1.3.Phi correlation analysis:(1)Professor Xuan corresponding drugs SLE patients’key clinical symptoms were:poor sleep-yam,joint pain,radix gentianae macrophyllae,god eight,motherwort,etc.Facial erythema-Ground bone skin,rehmannia glutinosa,thin cover ganoderma lucidum,anemarrhena,etc.Hair loss-dandelion,radix rehmanniae,yam,thin ganoderma lucidum,etc.Oral cavity ulcer-purple pearl grass,to skin and bones,god eight,etc.(2)The drugs corresponding to the main tongue veins were:Red tongue-god eight,coastal glehnia root,etc.Tongue reddish-dwarf lilyturf,ink dry lotus,etc.Dark red tongue-Herba Siegesbeckiae,lily,chicken Spatholobus,etc.White moss-raw land,vinegar,etc.Yellow moss-yam,dragon tooth,etc.Greasy moss-salvia miltiorrhiza,scutellaria baicalensis,etc.Stringer pulse-Ophiopogon,caulis spatholobi,etc.Taut pulse-Rehmannia glutinosa,cortex moutan,etc.Quick pulse-Vinegar fragrance,zhimu,etc.4.Association analysis of-symptom set and drug set:Analysis of symptoms and drugs from Xuan’ SLE patients showed:poor sleep,facial erythema,joint pain,hair loss,itching,dizziness and poor appetite-licorice;Poor sleep,facial erythema,joint pain,hair loss,pruritus,giddy-josephine,artemisia annua;Poor sleep,facial erythema,joint pain,hair loss-raw rehmannia glutinosa,cortex moutan,cooked rehmannia glutinosa;Poor sleep,facial erythematosis,joint pain,hair loss,skin itching-thin cover ganoderma lucidum,caulis spatholobus;Poor sleep,facial erythema,joint pain-Radix Aristophorae;Facial erythema,joint pain-Poria cocos.5.Analysis of drugs use in different sex and special groups:Specialty medicines of Xuan’s male SLE patients included cornus meat,astragalus membranaceus,nooyi kernel,hinteytuynia and henijin,etc.Female patients included cornus meat,astragalus membranaceus,Hinteytuynia and henithol.Children patients included radix ophiopogonis,rhizoma corydalis,and dandelion.Old patients included cannabis,platycladi seed,Jiang Houpiao,glandularstalk st.paulswortherb/common st.paulswort herb,radix polygoni multiflori cane,fleece-flower root,fructus alpiniae oxyphyllae,etc.Pregnant patients included scutellaria baicalensis,perilla perilla leaf,amomum amomum,atractylodes macrocephala,gentiana macrophylla,sophoginseng and corus officinalis.Postpartum patients included tribulus teristus.6.Analysis of effective prescriptions:The prescriptions of Xuan and F have higher stability and lower dispersion;L tended to be stable over time,and the types of prescriptions became more prominent.7.According to the dose statistics of TCM taste,the top 10 frequently used TCM medicines were glycyrrhiza glycyrrhiza,Artemisia annua,Meringite,Lucidum lucidum,Caulis spatholobus,cooked rehmannia glutinosa,rehmannia glutinosa,Radix Pellariae,Semen euryales,Radix paeoniae alba,Chinese yam and Anemone.The top 5 in the analysis of four qi of Traditional Chinese medicine are flat,mild cold,cold,warm and warm.Five taste analysis ranked the top 5 are sweet,bitter,spicy,slightly bitter,light;The top 5 are liver,kidney,spleen,lung and heart.The top 5 efficacy analysis include clearing heat and cooling blood,clearing heat and detoxifying,cutting malaria,tonifying spleen and invigorating qi,and relieving pain.8.Core prescription-Core syndrome analysis:Professor Xuan extracts two core prescription-core syndrome.Core prescription-core syndrome A:josephine,licorice,artemisia annua,glossy ganoderma lucidum,caulis spatholobus,cooked rehmannia glutinosa,radix aristophanaeformis,cortex moutan,raw rehmannia glutinosa,white peony root,ferox eurales,radix pseudostellariae,poria cocos,fu shen,chinese yam;Thin pulse,thin coating,low complement,poor sleep,dark red tongue,erythematous face,positive urine occytic blood,dizziness,joint pain,positive urine protein,hair loss,dry stool.Core prescription-core syndrome B:josephine,licorice,artemisia annua,caulis spatholobi,glossy ganoderma lucidum,cooked rehmannia glutinosa,raw rehmannia glutinosa,tuckahoe,cortex moutan,radix euryales euryales,radix pseudostellariae,paeonia root,chinese yam,anemone;Thin pulse,low complement,thin coating,joint pain,red tongue,positive urine occultation blood,positive urine protein,telangiectasia,hair loss,facial erythematosis,poor appetite,sour muscles.(2)Interview analysis of Xuan Guowei and disciplesThree disciples has inherited professor Xuan’s main understanding and treatment principles for SLE,and has different insights and uses from the basic framework of SLE diagnosis and treatment built by him.This is mainly reflected in Doctor F’s preference for syndromes and xuan’s emphasis on inheritance as well as innovation from the experience of famous TCM practitioners.L doctors often cooperate with traditional Chinese medicine prescriptions,and have much experience in adding or subtracting drugs;Doctor W paid attention to the treatment of SLE and the treatment of special cases,and believed that Xuan’s thought exploration and conversion should be further strengthened.(3)Literature analysis of SLE diagnosis and treatment experience of illustrious senior TCM practitioners in other regions of China1.The basic information:A total of 92 literatures were included,and the experience of 54 famous TCM practitioners was collected,including 5 TCM masters,4 famous doctors with high achievements in the field of lupus erythematosus,and 14 representatives or successors of different TCM schools.The included literatures were distributed from 1980 to 2021.The specialties mainly come from rheumatology,internal medicine,dermatology,nephrology,etc.2.Etiology and pathogenesis of SLE:Deficiency syndrome mainly includes kidney-yin deficiency,liver-yin deficiency,kidney deficiency,Yin deficiency,congenital deficiency,etc.,and the empirical evidence mainly includes heat poison,blood stasis,stasis poison,poison evil,wind-poison obstruction,etc.3.Statistical analysis of common Chinese medicine:Poria cocos,Cortex moutan,Atractylodes macrocephala,Rehmannia glutinosa,salvia miltiorrhiza,etc.Commonly used prescriptions were:Xijiao Dihuang soup,Zhenwu soup,Liuwei Dihuang pills,etc.The main syndromes included excessive heat,deficiency of spleen and kidney Yang,deficiency of qi and Yin,etc.The main treatment included clearing heat and detoxifying,promoting blood circulation and removing stasis,nourishing qi and nourishing Yin,etc.4.Analysis of prescription used in SLE with different organ damage:Kidney disease:Zhenwu soup,Zhibai Dihuang soup,Xijiao Dihuang soup,etc.Encephalopathy:Tianma Gouteng soup,Ditan soup,Dingcxian soup,etc.Pulmonary hypertension:Zhenwu soup,Shengmai soup,Xuefu Zhuyu soup,etc.Fever:Xijiao Dihuang soup,Liuwei Dihuang pill,Qingying soup;Lung interstitial disease:Maxing Shigan soup,Qingzao Jiufei soup,Maimendong soup,etc.Raynaud’s sign:Tongmai Sini soup;Skin lesions:Xijiao Dihuang soup.5.Analysis of addition and subtraction of Chinese medicine:Edema-grifola,alisma,semen plantaginis,urine protein-Cherokee rose,Gordon euryale seed,radix astragali,ery-cogongrass rhizome,field thistle,thistle,lupus-borage,buffalo horn,trumpet creeper,joint pain,radix clematidis,cassia twig,notopterygium,heat-gypsum powder,antelope,buffalo horn,low thermal fingernails-bone skin,artemisinin,turtle,headache,chaff,radix angelicae,rhizoma ligustici wallichii,etc.Reynolds’ signs-radix paeoniae,Caulis spatholobus,weakness-astragalus,ginseng,atractylodes atractylodes,red ginseng,alopecia-polygonum multiflorum,ligustrum lucidum,black sesame seed.6.Practitioners in other regions of China have different understanding of SLE pathogenesis,differentiation and treatment types,but their academic ideas and clinical treatment also learn from each other.Professor Xuan differs from other masters in that:Xuan pays more attention to nourishing Yin as the prerequisite for treatment;Attach importance to the modern expression of the concept of balance and advocate microcosmic syndrome differentiation on the basis of restoring immune imbalance;Commonly used liuwei rehmannia flavoring;Affected by the characteristics of Lingnan region,although SLE has an attack stage,stable stage,different damaged organs,and changeable and complex disease conditions,in fact,kidney Yin deficiency and blood stasis and toxin accumulation are the main line throughout the whole process.Commonly used raw ground,artemisia annua,Motherwort,ganoderma lucidum,centella asiatica,euryale seed,etc.Commonly used five fingers peach,patchouli,spring arenaceous kernel and other southern medicine;Drug characteristics of "gentle,sweet,light,slow" than strong herbs;More advocate "treatment of drugs and diet" equal emphasis,integration of Chinese and Western medicine.(4)Knowledge map construction and visualization analysis of "Illustrious senior TCM practitioners with SLE clinical experience" based on Neo4jData from the above three parts were imported into the Neo4j map database to build"Xuan Guowei Professor SLE empirical knowledge atlas","SLE knowledge Atlas" and"SLE empirical knowledge of illustrious senior TCM practitioners Atlas".Conclusion1.Based on the research results of medical record data mining,expert interview and literature analysis,five characteristics of professor Xuan were summarized in this study:①From the perspective of system theory,follow "One Center" in cognition:take kidney as the prerequisite;②Thinking adhere to the "two balance":restore the balance of Yin and Yang,qi and blood,restore the balance of viscera function;③In terms of disease model,"three stages evolution" was proposed:kidney deficiency,toxic stasis and positive failure,namely,kidney deficiency was the origin of the disease,heat and toxic stasis was the cause of progress,and positive qi deficiency and failure was the root of the end.④The practice emphasizes four principles:"in physiology,peace is the criterion,in pathology,poison and blood stasis is the disease,in the treatment of fu Heng to remove disease,in the care of the body and spirit to raise together";⑤Pay attention to the "five factors" in treatment:cases,local conditions,disease,time and needs.Drug characteristics of "gentle,sweet,light,slow" than strong herbs,advocate "treatment of drugs and diet" equal emphasis,and integration of Chinese and Western medicine.Professor Xuan has proposed the basic framework for SLE diagnosis and treatment,and the three inheritance students have inherited and used it in concrete practice.2.Other practitioners in China had different understanding of SLE pathogenesis,differentiation and treatment types,but they also learned from each other,mainly focusing on fever,toxin,stasis and deficiency,and treating SLE in multiple stages..3.This study used data mining,complex network analysis,semi-structured qualitative interview and knowledge map platform to comprehensively and systematically analyze professor Xuan’s clinical core knowledge of SLE.On this basis,the construction of the knowledge map of SLE diagnosis and treatment of illustrious senior TCM practitioners can help accumulate some foundation for the analysis of hidden knowledge,provide some methodological reference for experience inheritance and innovation,and provide some reference for the modernization of Chinese medicine.