Study On The Real World Medication Rule Of Traditional Chinese Medicine For Vascular Dementia Based On Data Mining

ObjectiveThe Ancient and Modern Medical Case Cloud Platform was used to analyze the medication use of patients with vascular dementia（Vascular Dementia,VD）in the inpatient and outpatient departments of the Sleep and Memory Clinic of the National Medical Hall of the Hubei University of Chinese Medicine,the Department of Brain Diseases of Hubei Provincial Hospital of Traditional Chinese Medicine,and the Department of Brain Diseases of Xiangyang Hospital of Traditional Chinese Medicine,affiliated to the Hubei University of Chinese Medicine,to uncover potential patterns in the treatment of Vascular Dementia in real-world Chinese medicine and to provide assistance in the clinical use of Chinese medicine in the treatment of Vascular Dementia.MethodIn this study,we collected data on VD patients treated in outpatient and inpatient settings at the Sleep and Memory Clinic of the National Medical Hall of Hubei University of Traditional Chinese Medicine,the Department of Brain Diseases of Hubei Provincial Hospital of Traditional Chinese Medicine,and the Department of Brain Diseases of Xiangyang Hospital of Traditional Chinese Medicine affiliated to Hubei University of Traditional Chinese Medicine between December 2020 and December 2021,and screened 167 patients treated using traditional Chinese medicine prescriptions in strict accordance with the diagnostic criteria,inclusion criteria and exclusion criteria,with a total of 203 visits recorded The patients’ general information,consultation time,past medical history,main symptoms,tongue and tongue,pulse,Chinese and Western medicine diagnosis,prescribed medication,etc.were recorded,and the names of the Chinese medicines were standardized with reference to the Pharmacopoeia of the People’s Republic of China（2020 Edition）and Traditional Chinese Medicine,while a database of Chinese medicines was established.The data from patients’ medical records were entered into the Ancient and Modern Medical Case Cloud Platform developed by the Chinese Academy of Traditional Chinese Medicine,structured electronic medical records,and data mining analysis was conducted to analyze patients’ gender,age,past medical history,main symptoms,tongue and moss,pulse,TCM evidence,treatment methods,TCM prescriptions,and drug attributes（four qi and five tastes,attribution and efficacy）,and further use association rules and hierarchical clustering analysis for TCM.The potential associations between drugs are uncovered to explore the core drugs and formulae dispensing rules for the realworld treatment of VD.Result1.A total of 167 patients with a cumulative total of 203 consultations were included in this study.Gender and age statistics showed a male to female ratio of approximately 1.98:1,with the youngest being 37 years old and the oldest 93 years old.The largest number of patients were between 70 and 90 years old,accounting for 64.67% of the total number.The age range of 30-39 years accounted for 1.80%,40-49 years for 3.59%,50-59 years for 13.17%,60-69 years for 14.97%,70-79 years for 37.13%,80-89 years for 27.54% and 90-99 years for 1.80%.2.The main symptoms of the patient include forgetfulness,unresponsiveness,poor speech,insomnia,dizziness,poor body movement,fatigue,poor appetite,dry stools and frequent nocturnal urination.The patient’s past medical history statistics showed that the most common were stroke（85.03% cerebral infarction,14.97% cerebral hemorrhage）,hypertension（72.46%）,and hyperhomocysteinemia（50.90%）.3.Statistics on tongue color showed that the common tongue textures were dark red,light red,and red,86 times（42.36%）,50 times（24.63%）,and 46 times（22.66%）respectively;statistics on tongue coating showed that thin white,white and yellowish mosses were more frequent,72 times（35.47%）,70 times（34.48%）and 23 times（The top 3 pulse signs in terms of frequency were thin pulse,slippery pulse,and stringent pulse,with 45（22.17%）,39（19.21%）and34（16.75%）times respectively.）4.The evidence patterns of VD patients are often not single.The frequency statistics showed that the most common types of symptoms were blood stasis obstruction,phlegm obstruction,qi and blood deficiency,spleen and kidney deficiency,and kidney essence deficiency,which occurred 105 times,91 times,72 times,59 times,and 31 times,respectively.The frequency of the single evidence type was 59 times（29.06%）,with spleen and kidney deficiency evidence and kidney essence deficiency evidence being the most common.The frequency of the combination of the two types of evidence was 118 times（58.13%）,with the most frequent cases being Qi and Blood deficiency + Blood stasis blocking the ligaments and Blood stasis blocking the ligaments + Phlegm blocking the orifices.The frequency of the combination of the three types of evidence was 26 times（12.81%）,with the evidence of deficiency of qi and blood + blood stasis blocking the ligaments + phlegm clouding blocking the orifices,and the evidence of deficiency of both spleen and kidney + blood stasis blocking the ligaments + phlegm clouding blocking the orifices.5.Multiple treatments were commonly used in VD prescriptions.Statistics on the treatments of VD patients showed that the most frequent treatments were activating blood circulation,resolving phlegm and opening orifices,benefiting qi and blood,tonifying kidney and spleen,and tonifying kidney and filling essence,which were 105 times（51.72%）,91 times（44.83%）,72 times（35.47%）,59 times（29.06%）,and 31 times（15.27%）,respectively.6.A total of 198 Chinese medicines were involved in this study,with a cumulative medication frequency of 3384 times and 30 medicines with a medication frequency ≥ 40.The top 10 drugs in terms of drug frequency were Acorus calamus,Astragalus,Chuanxiong,Yuanzhi,Angelica Sinensis,Fructus Fructus,Poria,Niubizi,Scorpion,Radix Rehmannia.The results of the four qi showed that they were warm,flat,slightly cold,slightly warm,cold,cool,hot,and very hot in that order;the results of the five taste statistics showed that they were sweet,pungent,bitter,sour,salty,slightly bitter,light,astringent,slightly pungent,slightly sweet,and slightly sour in that order;the 198 flavors of drugs used were attributed to all 12 meridians,the most frequent of which were the liver,spleen,lung,heart,and kidney meridians.7.The frequency statistics of the efficacy of the drugs were,in descending order,laxative,nourishing the blood,strengthening the muscles and bones,calming the mind and educating the mind,resolving dampness and opening the stomach,opening the orifice and dispelling phlegm,awakening the mind and educating the mind,tonifying the liver and kidneys,regulating menstruation and relieving pain,and promoting water retention and reducing swelling.Statistics on the frequency of medicine categories showed that tonic medicines were used the most frequently,with 1179 times（34.84%）,of which Astragalus,Angelicae,Fructus Rehmanniae,and Radix Rehmanniae were the most commonly used,followed by blood invigorating medicines（12.88%）,heat-clearing medicines（7.06%）,liver calming medicines（6.20%）,tranquilizing medicines（5.67%）,phlegm relieving coughs and asthma（5.44%）,water dipping medicines（5.14%）,and body opening medicines（5.14%）.5.14%),and enlighteners（4.40%）.8.The frequency statistics of herbal medicine pairs showed that the 10 pairs with the highest frequency were Shi Calamus and Yuan Zhi,Shi Calamus and Chuanxiong,Huang Qi and Chuanxiong,Shi Calamus and Huang Qi,Huang Qi and Angelica,Shi Calamus and Angelica,Angelica and Chuanxiong,Shi Calamus and Ji Ren,Huang Qi and Yuan Zhi,and Shi Calamus and Fu Ling.9.The Chinese herbal medicine pairings were analyzed by the association rule method,selecting the frequency of occurrence ≥ 60 times,confidence ≥0.70,support ≥ 0.30,and enhancement > 1.00,which resulted in 14 pairs of association rules,in order of confidence,as follows: Yuan Zhi → Shi Calamus,Quan Scorpion → Huang Qi,Quan Scorpion → Shi Calamus,Puzzle Ren →Shi Calamus,Angelica → Huang Qi,Shu Di Huang → Shi Calamus,Chuan Xiong → Shi Calamus.Angelica → Shi Calamus,Poria → Shi Calamus,Niubizi → Shi Calamus,Angelica → Chuanxiong,Niubizi → Chuanxiong,Chuanxiong → Huangqi,Niubizi → Huangqi.10.Hierarchical cluster analysis was performed on the Chinese herbal medicines,and then according to the results of the hierarchical cluster analysis,six-core Chinese medicine combinations were obtained when the number of clusters was 10: Poria,Puzzle Nut,Calamus,Yuan Zhi;Niubizi,Dan Shen;Chuanxiong,Huang Qi,Angelica;Shu Di,Wolfberry,Yam,Bai Shao,Prince’s Ginseng,Hawthorn,Liu Shen Qu,Tian Ma,Roasted Licorice,Ginseng;Atractylodes,Allium,Safflower,Red Peony;Han Xia,Bamboo Roo,Codonopsis,Cistanches,raw licorice,raw earth,and mailing.11.The results of the correlation analysis between the main clinical symptoms of VD patients and the herbs in their prescriptions showed that Acorus calamus,Astragalus and Rhizoma Chuanxiong were mostly used for proximal amnesia;Acorus calamus,Yuanzhi and Astragalus were mostly used for unresponsiveness;and Astragalus,Yuanzhi and Angelica were mostly used for insomnia.ConclusionThrough data mining,it was concluded that the treatment of VD mostly used drugs of calamus,astragalus,Chuanxiong,Yuanzhi,angelica,and puzzle nut to dissolve phlegm and open the orifice,tonify qi and nourish blood,move qi and blood,tonify kidney and spleen,mostly used warm and flat drugs,sweet and pungent drugs,and six groups of core Chinese medicine combinations were obtained by correlation clustering analysis among drugs,which can be helpful for the treatment of VD in Chinese medicine.