The Research On The Experience Of Professor WANG Shouchuan In Syndrome Differentiation And Treatment Of Pediatric Tonsillitis Based On Data Mining

Objective:Taking the medical records of pediatric tonsillitis diagnosed and treated by Professor WANG Shouchuan,which were collected from the outpatient department as the research object,the data mining method was used to understand the clinical characteristics of pediatric tonsillitis in Real World Study and explore the medication regularity,further to summarize Professor WANG Shouchuan’s academic thought and clinical experience on the treatment of pediatric tonsillitis and provide an objective evaluation basis by observing the clinical efficacy.Methods:Clinical records of pediatric tonsillitis treated by Professor WANG Shouchuan,dating from August 2018 to February 2021,were collected from the expert outpatient department.Meanwhile,The ’questionnaire of pediatric tonsillitis’ and ’syndrome rating scale of pediatric tonsillitis’ were developed and filled in.The relevant data were inputted into Excel for establishing the medical record database after unification and standardization,and then the mining results were analyzed and summarized with the theory of TCM,through frequency analysis,cluster ananlysis,association rules and efficacy ananlysis by using SPSS 26.0 and SPSS Modeler 18.0 software.Results:161 patients were included,with a total of 466 visits.The ratio of boys to girls was 1.88:1,and the ratio of boys to girls visits was 3.20:1.The average age was 6.6±3.0 years old,and the age of most children were 1-9 years old.There were many factors that could lead to pediatric tonsillitis,the most common including temperature imbalance and inappropriate diet.The season of onset was all year round.Most patients often suffer from other diseases in the same time,most of which were respirtory diseases,such as adenoidal hypertrophy,chronic pharyngitis and recurrent respiratory tract infection.Allergic diseases were also common,among which allergic rhinitis accounted for the largest proportion.The prognosis of the disease was relatively good with few serious complications.The primarily affected organs were the lung and stomach.The 13 kinds of pathogenesis syndrome could be classified into 5 categories:heat,wind,deficiency,phlegm and blood stasis,among which lung heat and qi deficiency accounted for the highest proportion.Among the clinical syndromes,there were 53 cases of wind heat attack and lung throat heat syndrome,12 cases of lung stomach heat and throat disorder syndrome,32 cases of throat heat toxic and tonsil suppuration syndrome,35 cases of phlegm heat accumulation and lung throat disorder syndrome,128 cases of throat lingering heat syndrome,157 cases of lung qi non-consolidation and throat heat syndrome,6 cases of Wei Yang deficiency and throat heat syndrome,16 cases of lung spleen qi deficiency and throat heat syndrome,19 cases of qi yin deficiency and throat heat syndrome,8 cases of phlegm blood stasis and lung throat disorder syndrome.153 herbals were utilized in 461 prescription,counting 6090 times,with an average of 13.21 herbals per prescription.There were 19 types of herbals totally,among which heat-clearing herbals were used the most frequently.The heat-clearing herbals mainly included heat-clearing and toxin-removing herbals and heat-clearing and fire-purging herbals,which were often combined with heat-clearing and blood-cooling herbals.The tonic herbals were mainly qi-tonifying herbals,followed by yin-tonifying herbals.The top 30 herbals used in high frequency were:Dandelion(87.85%),Reed rhizome(62.04%),Platycodon grandiflorum(59.87%),Polygonum cuspidatum(56.40%),Cortex Mori(56.18%),Lonicera japonica Thunb(53.36%),Astragalus(51.63%),Chinese violet(49.24%),oysters(45.99%),Patriniae Herba(45.55%),Os Draconis(41.43%),Spinea Gleditsiae(38.61%),Magnoliae Flos(38.39%),Saposhnikovia divaricate(37.09%),Atractylodes macrocephala(36.88%),Mint(36.23%),Atractylodes macrocephala(31.24%),Forsythia suspensa(30.37%),Angelica dahurica(23.64%),Massa Medicata Fermentata(19.31%),Crataegi Fructus(19.09%),Cortex Moutan(17.57%),Fructus Arctii(17.14%),Scrophulariae Radix(15.40%),Glycyrrhizae radix et rhizoma(14.97%),Sterculia lychnophora Hance(14.32%),Cicadae Periostracum(13.67%),Trichosanthis Pericarpium(13.02%),Lycii Cortex(12.15%)and Salvia miltiorrhiza(11.50%).The cluster analysis reached three categories:Cl:Lonicera japonica Thunb,Forsythia suspensa,Mint,Angelica dahurica,Fructus Arctii,Platycodon grandiflorum,Dandelion,Chinese violet,Patriniae Herba,Spinea Gleditsiae,Cortex Moutan,Reed rhizome;C2:Astragalus,Atractylodes macrocephala,Saposhnikovia divaricate,Os Draconis,oysters,Magnoliae Flos;C3:Cortex Mori,Lycii Cortex,Trichosanthis Pericarpium,Atractylodes macrocephala,Cicadae Periostracum,Sterculia lychnophora Hance,Scrophulariae Radix,Salvia miltiorrhiza,Polygonum cuspidatum,Crataegi Fructus,Massa Medicata Fermentata.Association rules showed that the correlation between Lonicera japonica Thunb and Forsythia suspensa,Cortex Mori and Lycii Cortex,Astragalus and Rhizoma Polygonati,Os Draconis and oysters,Crataegi Fructus and Massa Medicata Fermentata were higher.The correlation amomg three herbals showed that lung-reinforcing and exterior-consolidating herbals included Astragalus,Atractylodes macrocephala and Saposhnikovia divaricate,wind-dispelling and heat-clearing herbals included Lonicera japonica Thunb,Forsythia suspensa and Mint,toxicity-removing and carbuncle-eliminating herbals included Dandelion,Chinese violet and Spinea Gleditsiae.It demonstrated that Professor WANG Shouchuan’s main treatment method of pediatric tonsillitis was reinforcing lung to consolidate the exterior and clearing the throat.The curative effect of the disease showed that 98 cases were cured,90 cases were improved and 0 case without improvement.The total efficiency was 100%.The efficacy of traditional Chinese medicine(TCM)syndrome at the 1st week,2nd week among acute tonsillitis patients,3th month,6th month,9th month and 12th month among chronic tonsillitis patients was statistically different from that before treatment(P<0.01)·Compared with the 12th month and 9th month,9th month and 6th month,6th month and 3th month among chronic tonsillitis patients,2nd week and 1st week among acute tonsillitis patients,the syndrome scores were improved in different degrees,with statistical significance(P<0.01),which demonstrated that it was necessary for children with recurrent tonsillitis to receive long-term conditioning with TCM.Conclusion:This project studied the clinical case of pediatric tonsillitis by means of data mining,which enriched the clinical data of the disease and realized the objectification and standardization of the academic experience of famous TCM doctors.Meanwhile,this project proved the definite efficacy of TCM in the treatment of pediatric tonsillitis.Professor WANG Shouchuan’s clinical experience and academic thought in treating pediatric tonsillitis could be summarized as understanding the disease from the aspect of‘heat,wind,deficiency,phlegm and blood stasis’ and focusing on the relationship between‘lung heat’ and‘qi deficiency’,with the clinical application of syndrome differentiation divided into three stages:acute attack stage,intermission stage and chronic protracted stage.Generally speaking,the method of clearing throat run through each stage,and blood-cooling and stasis-dispelling herbals were often used compatibly by Professor WANG Shouchuan,as well as phlegm-removing and stagnation-resolving herbals,which had been proved to be safe and effective,and worthy of promotion.