Research On Multi-Dimensional Relationship Between Symptom-Syndrome-Medicine Of Senile Osteoporos Is Based On Electronic Medical Records Of Traditional Chinese Medicine

Objective: To establish a multi-dimensional relationship model among symptoms,syndromes and medicine of senile osteoporosis,so as to provide methodological reference for revealing the law of TCM diagnosis and treatment of senile osteoporosis,then in hope of providing research basis for further constructing TCM diagnosis and treatment knowledge base of senile osteoporosis.Methods: The data came from the clinical diagnosis and treatment information of electronic medical records of inpatients in a specialist hospital from January 1,2019 to December 31,2020.System evaluation and Delphi were used to construct the core outcome set of effectiveness trials of TCM on senile osteoporosis.R studio and Amos 22.0 were used to analyze the data,and cluster was used to mine the core symptoms and medicine.Association rule was used to explore the relationship between symptom-syndrome and drug-syndrome.The implicit structure and structural equation model were used to construct the symptom-syndrome-medicine relationship model.Results:（1）The core index set of TCM clinical research involved 12 outcome indicators in 5 domains,among which 7indicators were related to symptoms,which were lumbago and back pain,generalized weakness,limited activity,soreness and weakness of waist and knees,tongue quality（red tongue,purple tongue,pale tongue）,tongue coating（less fur,slippery fur,white fur）and pulse condition（deep pulse,weak pulse,pulse fine,pulse string）.（2）A total of 1130 patients were included in this study,of which the ratio of male to female was about 1:8,and the average age was 71.Among other diagnoses,knee joint disease was the most（12.97%）.The high-frequency syndromes of patients included spleen-kidney qi deficiency,liver-kidney yin deficiency and qi stagnation and blood stasis.（3）The TCM treatment of senile osteoporosis was mainly divided into oral and external prescription.In the oral prescription,the drug had the highest support for“Dang Shen→ Dang Gui（0.379）”,with the confidence of 0.879;34kinds of high-frequency drugs were grouped into 3 groups by systematic clustering.In the prescription for external use,the drug’s support for “Ru Xiang → Mei Yao” was the highest（0.697）with the confidence of 1.000;36 kinds of medium and high frequency drugs were clustered into 4 categories by systematic clustering.（4）The results of correlation analysis of symptom-syndrome and drugsyndrome showed that among the rules related to spleen-kidney qi deficiency syndrome,the top three symptoms of support were deep pulse（0.17）,weak pulse（0.17）and white fur（0.17）,and the drugs were Yin Yanghuo（0.46）,Ji Xueteng（0.46）and Huang Qi（0.45）.Among the rules related to liver-kidney yin deficiency syndrome,the top three symptoms of support were less fur（0.04）,pulse number（0.04）and red tongue（0.04）,and herbs were Dang Gui（0.21）,Shu Dihuang（0.21）and Tu Sizi（0.21）,while the rules related to qi stagnation and blood stasis syndrome,the top three symptoms of support were lumbago and back pain（0.05）,poor spirit（0.04）,purple tongue（0.04）,and herbs were Dang Shen（0.16）,Yan Husuo（0.16）and Ji Xueteng（0.16）.（5）The results of symptom-syndrome-medicine implicit structure analysis showed that there were 13 implicit variables in model learning,and different implicit variables represented different angles,or a division of explicit variables from different aspects.Considering the Y10,the cumulative information coverage of five obvious variables,such as pulse string,pulse astringent,purple tongue,Bai Biandou and Lai Fuzi,was as high as 95%.If the hidden variable Y10 was interpreted as the syndrome of qi stagnation and blood stasis,the probability of the appearance of the symptom variables pulse string,pulse astringent and purple tongue was 100%,93% and 100% respectively,and the probability of the herb variables Bai Biandou and Lai Fuzi was 88% and 87% respectively.（6）In the structural equation model of symptom-syndrome-medicine,the formation of latent variable spleen-kidney qi deficiency syndrome was influenced by deep pulse,white fur,pale tongue,lumbago and back pain,soreness and weakness of waist and knees,and the influence coefficients were 0.384,0.223,0.251,-0.024,-0.164.At the same time,the core medicine of Yin Yanghuo,Du Zhong,Ji Xueteng,Dang Gui were determined,and the standardized path coefficients were 0.326,0.884,0.959,0.877 and0.710.The formation of liver-kidney yin deficiency was affected by soreness and weakness of waist and knees,lumbago and back pain,less fur,pulse number and red tongue,and the influencing coefficients are 0.063,-0.014,0.197,0.394 and 0.345.Meanwhile,the the core medicine of Dang Gui,Shu Dihuang,Tu Sizi,Shan Zhuyu,Nv Zhenzi were determined,and the path coefficients were 0.587,0.965,0.949,0.881 and 0.871.The formation of latent qi stagnation and blood stasis syndrome was influenced by lumbago and back pain,poor spirit,purple tongue,pulse astringent and limited activity,with influence coefficients of-0.085,0.034,0.422,0.514,and-0.011.At the same time,the core medicine of Ji Xueteng,Dang Gui,Bai Biandou,Lai Fuzi and Qian Shi were determined,and the path coefficients were-0.061,0.049,0.922,0.891 and 0.892.In the overall adaptation index of the model,RMSEA = 0.051,PGFI = 0.536 and PNFI = 0.739.Conclusion: Among all patients,who ofen show（deep pulse,pale tongue and white fur）are mostly spleen-kidney qi deficiency syndrome,and their core drugs are（Du Zhong,Huang Qi and Ji Xueteng）.Patients with frequent symptoms（pulse number,red tongue and less fur）are mostly liver-kidney yin deficiency syndrome and their core drugs are（Shu Dihuang,Tu Sizi and Shan Zhuyu）.Patients who ofen show（pulse astringent,purple tongue and lumbago and back pain）are mostly qi stagnation and blood stasis syndrome,and their core drugs are（Bai Biandou,Qian Shi and Lai Fuzi）.In our study,the classification and discrimination of symptoms,syndromes and medicine and their potential correlations are obtained through the establishment of symptom – syndrome-medicine model.The conclusions obtained are consistent with the diagnosis and treatment rules of TCM,which provides a research basis for the establishment of Chinese medicine clinical diagnosis and treatment knowledge base and a quantifiable scientific basis for the“dialectical treatment” rules of traditional Chinese medicine for senile osteoporosis.The follow-up study will further verify the repeatability of our conclusion by increasing the number of multicenter clinical samples and increasing the TCM medical record documents.