Based On Data Mining, Professor Lu Renhe's Experience In The Diagnosis And Treatment Of Diabetic Nephropathy

Diabetic kidney disease(DKD)is one of the major chronic microvascular complications of diabetes.Professor Lyu Renhe,who used to study under Shi Jinmo,Qin Bowei and Zhu Shenyu,has been engaged in the clinical and scientific research work for nearly 60 years.In the field of diabetes mellitus and its complications and kidney diseases,especially on prevention and treatment of DKD,professor Lyu has formed unique academic views,accumulated abundant clinical experience and achieved good clinical effect.Therefore,excavation and summarization of professor Lyu’s clinical experience have the great value of guiding traditional Chinese medicine(TCM)clinical practice.Objective:Applying modern information technology and data mining methods on DKD cases of professor Lyu,this study aims to analyze and summarize professor Lyu’s drug using patterns and experiences on DKD,as well as to validate the feasibility of data mining technology on experience inheritance of TCM masters.Methods:This study collected 210 eligible medical records of 102 DKD patients that visited professor Lyu in the outpatient department from June 2012 to December 2017.First,medical records were collated and standardized.Secondly,frequency statistics method was applied to count basic information,TCM diagnosis information,properties of TCM drugs such as four natures,five flavors,channel tropisms,function classifications and doses.Thirdly,Apriori association rule,Cluster analysis and Complex system entropy clustering method were applied to mine the core combinations and compatibility rules of TCM drugs,and to explore the potential new TCM prescriptions.Results:In the DKD patients of this study,the top 10 symptoms are fatigue,urine with foam,soreness of waist,edema,poor sleep,blurred vision,numbness,dry mouth,nocturia and chills.The top 3 classifications of TCM drugs in professor Lyu’s prescriptions are tonic drugs,blood circulation-activating and stasis-dissipating drugs,and heat-clearing drugs.The most frequently used 10 drugs are Danshen,Chishao,Danpi,Zhuling,Taizishen,Chuanxiong,Huangqi,Zelan,Zhizi,Danggui.Major properties are cold,warm and neutral in nature,and bitter,sweet,and pungent in flavors.Channel tropisms of drugs sorted by quantity are liver,spleen,heart,kidney,lung,stomach,gallbladder,bladder,pericardium,large intestine,small intestine and triple burner.Average quantity of drugs in professor Lyu’s prescriptions is 10.5 and mainly in the range of 8-14(91.9%).Doses are often large.When applying the Apriori association rule to analyze all the drugs["confidence"=0.8,"frequent itemsets"≥100("support"≈0.48)],the core drugs are Danshen,Chishao,Danpi,Taizishen and Zhuling.When use Association rule to analyze core drugs in different stages of DKD,the results are:① 16 drugs in early stage:Danshen,Chishao,Danpi,Chuanxiong,Taizishen,Zhuling,Gouji,Xuduan,Niuxi,Yinchen,Zhizi,Gancao,Gouqizi,Nyuzhenzi,Xiangyuan and Foshou;② 13 drugs in middle stage:Danshen,Chishao,Danpi,Chuanxiong,Taizishen,Zhuling,Huangqi,Danggui,Gouqizi,Zelan,Niuxi,Zhizi;③16 drugs in end stage:Danshen,Chishao,Danpi,Chuanxiong,Taizishen,Zhuling,Fuling,Zelan,Lingzhi,Hongjingtian,Yinchen,Zhizi,Huangqi,Danggui,Gancao,Zhishi.From Apriori association rules and cluster analysis algorithm results,a total of 14 strong association drug groups were obtained:Xiangyuan and Foshou,Wuyao and Xiangfu,Yinchen and Zhizi,ripe Dahuang and Zhishi,Baihuasheshecao and Zhuling,Huangqi and Danggui,Lingzhi and Hongjingtian,Zhuling and Fuling,Muxiang and Huanglian,Banxia and Chenpi,Gouqizi and Juhua,Gouqizi and Nyuzhenzi,Chishao Danpi and Danshen,Xuduan,Gouji and Niuxi.Using Complex system entropy clustering method,16 new prescriptions for DKD are deducted,among which the most clinically valuable ones were new prescription 1(Wuweizi,Nyuzhenzi,Gouqizi,Juhua,Muzei),new prescription 2(Qinjiao,Gouji,Shayuanzi,Jiangcan),new prescription 4(Lujiaoshuang,Guijia,Niuxi,Yinyanghuo,Meiguihua),new prescription 5(Longdan,Juhua,Muzei,Lingzhi),new prescription 6(Canghzu,Taizishen,Danggui,Gegen),new prescription 8(Shuihonghuazi,Ezhu,Liujinu,Tubiechong),new prescription 12(Zhuling,Zelan,Baihuasheshecao,Fuling,Tinglizi),new prescription 15(Banxia,Chenpi,Xiyangshen,Sharen,Xuanfuhua,Daizheshi).Conclusion:Through the data ming and analysis of professor Lyu’s DKD medical records,some of his medication experiences can be obtained as below:professor Lyu thinks that treatment should be focused on the pathogenesis,and always uses therapeutic method of replenishing qi,clearing heat,activating blood circulation,dissipating stasis,disinhibiting water and dispelling turbid.Core drugs of professor Lyu’ prescriptions includes Danshen,Chishao,Danpi,Taizishen,Zhuling.On the whole,keeping "unobstructed blood circulating"is the therapeutic key to DKD patients,and "reinforcing the healthy qi" is also important.Furthermore,in the early stage of DKD,treatment should be focused on tonifying liver and kidney,as well as promoting blood circulation and moving qi.In the middle stage of DKD,treatment should be focused on replenishing qi,nourishing blood,activating blood circulation and disinhibiting water.In the end stage of DKD,treatment should be focused on reinforcing the healthy qi and dispelling the turbid by purgation.Professor Lyu attaches great importance to regulating the activity of qi,as well as regulating liver function in DKD treatment.Professor Lyu’s prescriptions are always concise and effective.In conclusion,this study shows objective data of professor Lyu’s medication experience on DKD,which contributes to the inheritance work of TCM masters’ experience,and provides therapy guides for clinicians.