| Objective Diabetic lower extremity vasculopathy refers to lower extremity atherosclerotic disease(LEAD)complicating or accompanying diabetes mellitus,involving large,medium,small,and microvascular damage to the lower extremities,which can lead to lower extremity loss ulcers and amputations,in addition to increasing the risk of cardiovascular disease and increasing mortality in patients.In this study,the aim of this study was to collect and organize the medical case data related to diabetic lower extremity vascular lesions treated by Professor Shentao Wu,the chief physician of the Department of Endocrinology,and apply modern information technology and data mining methods with the help of TCMISS V2.5 platform.The purpose of the study is to summarize and discuss the rules and experiences of Professor Shentao Wu in the treatment of diabetic lower extremity vascular lesions,so as to inherit and carry forward the academic ideas of famous veteran Chinese medicine practitioners,provide new ideas for the treatment of diabetic lower extremity vascular lesions in Chinese medicine,provide new treatment ideas and methods for the majority of medical workers,and provide new Chinese medicine paths for young medical workers.Methods This study included 300 patients who were treated and prescribed by Professor Shentao Wu’s outpatient clinic between January 2017 and October 2020 who met the inclusion and exclusion criteria,collected a total of 544 medical cases,and standardized the medical case data(four diagnostic information,Chinese medicine names,laboratory tests,etc.),applied the statistical reporting system to basic information,drug frequency,four qi and five tastes,attribution,and The statistical report system was applied to the basic information,frequency of drugs,four qi and five tastes,attribution,affiliation,etc.The association rule analysis,complex system entropy cluster analysis and unsupervised system entropy cluster analysis were applied to dig out the common symptoms,tongue and pulse frequency,common herbs and doses,common drug combinations,drug use pattern of each evidence type and new prescription analysis of the medical cases of Professor Wu for diabetes combined with heart disease.Results 1.A total of 300 patients were included in this study,including 175 females and 125 males;the age distribution was mainly between 50 and 79 years old.The age distribution mainly focused on 50-79 years old,including 64 patients aged 50-59 years old,accounting for21.33%;131 patients aged 60-69 years old,accounting for 43.67%;and 73 patients aged70-79 years old,accounting for 24.33%.2.Through the analysis of 544 medical cases,it can be concluded that the symptoms of diabetic lower limb vasculopathy are mostly systemic,among which dry mouth and thirst(465)and frequent urination(300)are common symptoms of diabetes,and lower limb pain(437),lower limb numbness(349)and lower limb weakness(242)are symptoms of lower limb vasculopathy.The main types of tongue texture were dark tongue(140),red tongue(107),dark purple tongue(81),and light red tongue(91),and the main types of tongue coating were thin white coating(187),white coating(114),thin coating(86),and yellow greasy coating(79).The main pulse signs were sunken pulse(103),sunken and astringent pulse(100),and slippery pulse(72).The main lower extremity arterial color Doppler findings were lower extremity atherosclerosis with plaque formation(300),luminal stenosis of the anterior tibial artery(31),incomplete occlusion of the anterior tibial artery(32),incomplete occlusion of the dorsalis pedis artery(31),and slowed blood flow in the dorsalis pedis artery(42).3.In this study,a total of 544 prescriptions were recorded,and 305 drugs were used to treat diabetic lower limb vasculopathy.The top 30 drugs were: Angelicae Sinensis(401),Achyranthes Bidentatae(307),Radix Paeoniae Alba(303),Radix Glycyrrhiza Uralensis(291),Radix Cinnamomi(285),Radix Ginger(244),Radix Astragali(225),Radix Papaya(194),Radix Chrysanthemum(189),Radix Zhi Mu(181),Radix prunus ginseng(172),Radix Scutellariae(170),Rhizoma Chuanxiong(165),Pericarpium Citri Reticulatae(151),Radix Paeoniae Alba(151),Hossein(145),Poria(137),Chai Hu(136),Radix Rehmanniae(121),Salviae Miltiorrhiza(118),Atractylodes Macrocephala(116),Eucommia(114),Salviae Miltiorrhiza(112),Phellodendron(102),Radix Rehmanniae(100),Tongcao(99),Safflower(93),Huang Lian(88),Tian Ma(87),and Locking Yang(87).4.Professor Wu’s statistics on the four gases of drugs used in the treatment of diabetic lower limb vasculopathy: warm drugs(41.44%),cold drugs(30.17%),flat drugs(22.14%);five tastes statistics: sweet taste(33.57%),bitter taste(29.09%),and Pungent taste(23.94%);statistics of meridians: liver meridian(20.00%),spleen meridian(16.37%),lung meridian(14.69%),kidney meridian(13.43%)Kidney meridian(13.43%),Heart meridian(13.36%).5.In this study,according to the number of flavors in the categories: 47 tonic drugs for deficiency,46 heat-clearing drugs,and 30 drugs for dispelling wind-dampness;statistics of the categories to which the drugs belonged: tonic drugs for deficiency(27.02%),blood-stasis activating drugs(13.54%),heat-clearing drugs(12.92%),drugs for dispelling wind-dampness(10.92%),drugs for relieving superficiality(9.66%),drugs for diuresis(4.43%),drugs for warming the lining(4.42%),and qi-regulating drugs(3.68%).6.The frequency of drug combinations in 544 prescriptions for diabetic lower extremity vasculopathy by Professor Wu was counted,and a total of 76 groups of drug combinations with a frequency of use ≥ 100 were analyzed by association rules(as shown in Table 15-1),and the support level was set at 20%.In general,the ratios of the commonly used pairs were based on benefiting qi and nourishing yin,invigorating blood circulation,warming the meridians and opening the veins,which was in line with the academic thought of Wu’s treatment of diabetic vascular lesions of the lower extremities to support the positive and dispel the evil.The main drug pairs based on the association rule are:White peony-angelica,licorice-angelica,angelica-cinnamon stick,white peony-cinnamon stick,angelica-fine spice,white peony-fine spice,angelica-cinnamon stick-fine spice,licorice-angelicawhite peony,angelica-white peony-cinnamon stick-fine spice,white peony-dried ginger,cinnamon stick-dried ginger,astragalus-licorice,astragalus-white peony,astragaluscinnamon stick,astragalus-licorice-angelica,cow’s knee-angelica,chuanxiong-angelica,prince’s ginseng-angelica,cow’s knee-salvia,Niu Knee-Du Zhong,Niu Knee-AngelicaeSalviae,Bai Shao-Niu Knee,Niu Knee-Licorice,Mugua-Bai Shao,Niu Knee-Licorice-Bai Shao,Xuan Shen-Angelicae,Angelicae-Licorice,Xuan Shen-Angelicae-Licorice,Gui ZhiChuan Wu,Tu Fu Ling-Sheng Ma etc.7.Referring to the diagnosis of the Chinese medical evidence of paralysis of thirst disease formulated by the Department of Endocrinology of Tianjin University of Traditional Chinese Medicine,according to the clinical manifestations of diabetic lower limb vasculopathy,the four diagnoses were combined to classify diabetic lower limb vasculopathy into five types of evidence,ranked from highest to lowest according to frequency and percentage.(1)Qi deficiency and blood stasis(24.62%),(2)Qi and yin deficiency and strain on the veins(23.09%),(3)Cold clotting and blood deficiency(20.42%),(4)Damp-heat internalization and stasis in the veins(17.82%),and(5)Dampness and turbidity blocking the veins(14.05%).The core drugs for different types of evidence are:(1)Qi and Yin deficiency and strain on the Governor’s Vessel: mistletoe,eucommia,ginger,angelica,rehmannia,white peony,cow’s knee,Zhi Mu,tortoise board,cypress,locking yang,Chen Pi,etc.(2)Commonly used drugs for Qi deficiency and blood stasis are: Gui Zhi,Licorice,Radix et Rhizoma,Radix Angelicae Sinensis,Radix Astragali,Radix Rehmanniae,Radix Paeoniae Alba,Radix Achyranthes bidentatae,Papaya,Rhizoma Chuanxiong,Rhizoma Di Long,Radix et Rhizoma Hessian,Radix et Rhizoma Tongcao,Radix et Rhizoma Ginger,Radix et Rhizoma Hong Hua.(3)Commonly used drugs for blood deficiency and cold clotting are: Radix et Rhizoma Chuan Wu,Radix Paeoniae Alba,Radix Paeoniae Alba,Radix Achyranthes Bidentatae,Radix Angelicae Sinensis,Radix Papaya,Radix et Rhizoma Pseudostellariae,Radix Astragali,Radix Ginger,Radix Cinnamomi,Rhizoma Chuanxiong,Radix Rehmanniae,Radix et Rhizoma Tongcao,Radix Ephedra,etc.(4)Commonly used drugs for damp-heat and stagnant veins are:Zhi Mu,Jiang Huang,Sheng Di,Gan Jiang,Huang Lian,Ge Ge Gen,Angelica Sinensis,Poria,Bai Shao,Fried Citrus Aurantium,Scutellaria,Licorice,Shu Da Huang,Fried Atractylodes Macrocephalae,Radix Achyranthes Bidentatae,Chai Hu,Gui Zhi,Silkworm,etc.(5)Commonly used drugs for dampness obstruction are: Chuanxiong,Guahu,Chen Pi,Gui Zhi,Chai Hu,Fried Citrus Aurantium,Niubizi,Zhi Mu,Radix Angelicae Sinensis,Glycyrrhiza Uralensis,Fructus Anemarrhena,Radix et Rhizoma Gastrodiae,Poria,Ginger,Fried Atractylodes Macrocephalae,Perilla,Qiang Wu,Scutellariae,Muxiang,Semen Coix,Hou Pu,Fa Xian Xia,etc.8.Based on complex system entropy clustering and unsupervised entropy hierarchical clustering,we analyzed the correlation coefficients among 305 commonly used herbal medicines of Professor Wu for the treatment of diabetic lower limb vascular disease,and came up with 54 core combinations and 27 new prescriptions of Master Wu for the treatment of diabetic lower limb vascular lesions.This result is basically consistent with the pattern of medicine used by Professor Shentao Wu for the treatment of diabetic lower limb vasculopathy.Conclusion 1.The "Traditional Chinese Medicine Inheritance Support Platform" realizes the entry,management and analysis of famous doctors or clinical typical medical cases,and through the platform,the statistical analysis of the composition pattern of prescriptions,the study of their intrinsic rules of medication and academic thinking,and then also the excavation of new combinations of TCM treatment.Drug combination analysis based on association rules and unsupervised data mining technology,analysis of Professor Shentao Wu of clinical treatment of diabetic lower extremity vascular disease prescription drug use pattern,to provide clear clues and research directions for basic experiments and clinical applications,but the clinical evidence still needs to be combined with the patient’s actual situation on the basis of evidence to achieve the desired results.2.According to the communication with the tutor and the tutor’s academic thinking,one of the main pathogenic mechanisms of the paralysis of the veins in the disease of thirst is the failure of the middle jiao to ascend and descend the turbidity,the internal growth of turbidity and stagnation,the downward injection of blood into the meridians,the obstruction of the flow of qi and blood,and the lack of qi and blood in the limbs;or the deficiency of the liver and kidney,the deficiency of qi and yin,and the loss of nourishment of the veins;or the deficiency of the spleen qi,the deficiency of the camp and guard,the difficulty of warming and transportation,the invasion of cold evil,and the stagnation of the blood veins.In this study,by counting the commonly used drugs,drug classes and meridians,we found that clinical use was dominated by tonic drugs,with spleen meridians taking the guiding position;followed by blood activators and blood stasis relievers.It is in line with the clinical treatment of strengthening the spleen,promoting clearing,activating blood circulation and resolving blood stasis,as well as nourishing the liver and kidney,warming the meridians and opening the veins,drying dampness,resolving turbidity and clearing heat and detoxification.It is in line with the core idea of Master Wu in treating this disease: one is to pay attention to the pivot of the spleen and stomach to strengthen the blood circulation and ascend and clear it,and the other is that the disease is prolonged in the blood in the ligaments,so eliminating stasis and removing turbidity should be done throughout the disease. |
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