Construction And Application Of Structured Medical Records Of TCM Outpatient Endometriosis

Part ⅠConstruction and Optimization of the Structurized Traditional Chinese Medicine Out-patient Record for EndometriosisObjectiveBased on the characteristics of endometriosis and its clinical diagnosis and treatment on TCM, we built up a structurized TCM out-patient record for endometriosis, in order to not only complete the clinic record of patient, but also collect the medical data for clinical scientific research. It laid the foundation for further medical study of endometriosis.MethodsAfter comparing with several different procedures on building the structurized medical record, we finally chose ’the acquisition platform of electronic medical records and clinical research data of TCM’ as the tool. Refer to’the Medical Record Writing Standard of TCM and the combination of TCM and Western Medicine’ promulgated by the State Administration of TCM in 2002, we studied the TCM clinical records of endometriosis and extracting their general and specific characteristics. The structurized medical record designed was also based on the ’the diagnostics of TCM’,’the symptoms diagnosis of TCM’and’the diagnosis and treatment guidelines of endometriosis’.ResultsThe construction of the structurized TCM out-patient record for endometriosis was based on the guidelines of the disease and the health care rules, which could translate those various medical data of the TCM clinic patient, with the descriptive characteristics from the doctors, into an ordered structure. Meanwhile, the monitoring and optimizing were also ensured. ConclusionsThe construction of the structurized TCM out-patient record for endometriosis made a great contribution for doctors making the research through the previous medical records about the diagnosis and treatment standard, and improving the quality and efficiency in clinic. It also laid a foundation to TCM clinical big data study of endometriosis in the future.Part ⅡExplore the Diagnosis and Treatment Characteristics of Endometriosis from Professor Zhao Ruihua Based on the Structurized Traditional Chinese Medicine Out-patient Record for EndometriosisObjectiveClinical data of patients were collected and analyzed from the established structurized TCM outpatient record for endometriosis. Under the guiding concepts of TCM, based on clinical data, and combined with the opinions of Professor Zhao Ruihua, we made a preliminary investigation on the rules of her dialectical differentiation and treatment of endometriosis, and laid a good foundation for the establishment of evidence-based TCM diagnosis and treatment standards of endometriosis, and for the improvement of clinical treatment efficacy of endometriosis.MethodsClinical data of endometriosis patients which were in accordance with the inclusive criteria, were collected by the established structurized TCM outpatient record for endometriosis. The input data of 196 diagnosed endometriosis patients from September 2007 to August 2015 in the gynecology department of Guanganmen Hospital of the TCM Academy were integrated and pretreated. The complex network analysis of the syndromes types, clinical symptoms and signs, prescription herbs and other, were conducted by the TCM Complex Relationship Analysis System Software Liquorice, while clinic data were treated by descriptive statistics in the statistical analysis software SPSS17.0.Results1.127 (64.80%) with qi stagnation and blood stasis as the main syndromes, and 35 women with cold coagulation,28 with qi deficiency; 46 (23.50%) with qi deficiency and blood stasis as the main Syndrome,20 women with cold coagulation and 6 women with kidney deficiency; 13 (6.63%) women with cold coagulation blood as the main syndromes, and 4 women with kidney deficiency syndromes; 8 women (4.08%) with kidney deficiency and blood stasis as the main syndromes.2. The dialectical factors of’qi stagnation and blood stasis’ were:the pelvic mass was the main reason for treatment, small amount of blood clot in the menstrual blood, moderate dysmenorrhea, and abdominal bulge before passing, usually irritability; dark red tongue, white and thin tongue coating; wiry or slippery pulse.3. The dialectical factors of qi stagnation and blood stasis’ were:after the endometriosis surgery as the main reason for treatment, small amount of blood clots in menstrual blood, mild dysmenorrhea, usually fatigue, poor appetite; pink tongue, white tongue coating, tooth mark on tongue side; sunken or slippery pulse.4. The dialectical factors of’cold coagulation and blood stasis’ were:small amount of blood clots in the menstrual blood, severe dysmenorrhea, pain reduction when get warm, usually chilly, limbs cold; dark red tongue, white and thick tongue coating; sunken or wiry pulse.5. The dialectical factors of ’kidney deficiency and blood stasis’ were:infertility as the main reason for treatment, small amount of blood clots in the menstrual blood, usually fatigue, weak waist and knees, dysphoria heat on hands and feet; dark pale tongue, thin and white tongue coating; sunken or thin pulse.6. The dialectical factors of the four kinds of clinical syndromes intersected each other. Closer relationships existed between’qi stagnation and blood stasis’community and’cold coagulation and blood stasis’ community, and between’qi stagnation and blood stasis’ community and’qi deficiency and blood stasis’ community, and between’qi deficiency and blood stasis’ community and’cold coagulation and blood stasis’ community.7. Core recipe to cure endometriosis were:fu ling, fried bai zhu, chai hu, e zhu, dang shen, ji nei jin, gui zhi, raw or fried gan cao, san qi fen, dan shen, chi shao, zao jiao ci, raw yi yi ren, bai shao, sha ren, sheng jiang, da zao.8. Core recipe to treat’qi stagnation and blood stasis syndrome’were:chai hu, fu ling, fried bai zhu, e shu, dan shen, zao jiao ci, chi shao, ji nei jin, xiang fu, raw yi yi ren.9. Core recipe to ’qi deficiency and blood stasis syndrome’ were:fu ling, dang shen, fried bai zhu, fried huang qi, gan cao, e shu, dan shen, sha ren, san qi fen, ji nei jin.10. Core recipe to’cold coagulation and blood syndrome’were:gui zhi, fu ling, fried bai zhu, yan hu lu ba, dang shen, chai hu, gan jiang, rou gui, xiao hui xiang, e shu.11. Core recipe to’kidney deficiency and blood stasis syndrome’ were:nv zhen zi, xu duan, han lian cao, tu si zi, gou qi zi, fu xiao mai, bai he, dang shen, jiu yu rou, shu di huang.12. The characteristics of the patients included in the study were as follow. Patients with an average age of 33.63±6.25 years, married dominated (57.65%). Normal menstrual cycles (93.37% with normal menstrual period; 91.33% with normal cycle), mostly suffering mild dysmenorrhea (50.51%), whose average VAS score was 3.17±1.30 points. Mostly never being pregnant or giving birth (57.65%), mostly after the endometriosis surgery (49.24%). CA125 level average of 59.57±50.59U/ml, primarily in the 200 U/ml or less (97.06%).Conclusion1. The main clinical syndromes of endometriosis by Professor Zhao Ruihua were:qi stagnation and blood stasis, qi deficiency and blood stasis, cold coagulation and blood stasis, kidney deficiency and blood stasis. Qi stagnation and blood stasis syndrome were the major clinical syndromes of endometriosis. Different dialectical clinical syndromes correspond to different dialectical factors.2. Syndromes were accompanied within each other, in which qi stagnation and blood stasis mostly with cold coagulation or qi deficiency, and qi deficiency and blood stasis mostly with cold coagulation.3. The clinical treatment of endometriosis from Professor Zhao Ruihua took’stimulating circulation and removing stasis’as the basic principles, supplemented by herbs to enhance qi and spleen. Different clinical syndromes have different focuses on core medication, with qi stagnation and blood stasis syndrome consistent with the core recipe herbs. Qi deficiency and blood stasis syndrome was better with qi enhancing herbs. Cold coagulation and blood stasis syndrome was better with warmth enhancing herbs, kidney deficiency and blood stasis syndrome was based mainly on clinical actual, with herbs to enhance kidney and fill essence.4. The collecting data from structured clinical medical records and data mining came to the corresponding syndrome diagnosis and treatment contents, which were in line with the basic theory of TCM. This method is an effective means to explore TCM diagnosis and treatment standards of endometriosis.