Research On Zhao Jinxi's Experience In Treating Chronic Kidney Disease Based On Data Mining Based On Physical Constitution, Disease Differentiation And Syndrome Differentiation

Background:chronic kidney disease(CKD)is a progressive clinical syndrome with multiple etiologies.End-stage renal disease,which requires dialysis and kidney transplantation,poses a great threat to human life and health.Professor Zhao Jinxi has been engaged in the prevention and treatment of CKD and endocrine and metabolic diseases with traditional Chinese medicine for a long time.It is of great significance to summarize the experience of experts in treating CKD in order to find an effective scheme for prevention and treatment of CKD with traditional Chinese medicine.Objective:To study and summarize professor Zhao Jinxi’s experience in diagnosis and treatment of CKD with trinity model of constitution differentiation,disease differentiation and syndrome differentiation.Methods:To collect medical records of patients with CKD diagnosed and prescribed by Professor Zhao Jinxi from September to February 2020 in the Department of Nephrology and Endocrinology of Beijing University of Chinese Medicine Dongzhimen Hospital.Using SPSS26.0 and Ancient and modern medical records cloud platform(V2.2.1),and research tools such as Force Atlas layout algorithm,the frequency statistics of the four diagnostic information,syndrome,constitution,medication and stage,the cluster analysis of drugs,the application of complex network graphic layout to explore the relationship between stages,constitution,syndrome,symptoms and medication,to explore the experience of diagnosis and treatment of CKD with trinity model of constitution differentiation,disease differentiation and syndrome differentiation.Results:345 cases of CKD were included in this study.There were 111 cases in CKD1 stage and 54 cases in 2 stage,70 cases in stage 3,53 cases in stage 4,57 cases in stage 5.In the past,the definite pathological diagnosis was mainly pathological diagnosis,and in the past,the non-pathological examination was mainly clinical diagnosis.IgA nephropathy,as previously defined pathologically,is not included in chronic glomerulonephritis.The primary diseases were chronic glomerulonephritis,diabetic kidney disease(DKD),IgA nephropathy,etc..The results showed that Shaoyang Constitution was the most,followed by Taiyin Constitution,Jueyin Constitution,Shaoyin Constitution,Yangming Constitution and Taiyang Constitution.The distribution of symptoms included:frequent nocturnal urination,cold limbs,edema.Patients with chronic glomerulonephritis mainly have frequent nocturnal urination,chills,cold limbs,edema,while those with DKD mainly have edema,dry stool,shortness of breath.IgA nephropathy for the primary disease is more common loose stools,frequent urination at night,dry pharynx.The results of symptom distribution in different stages were as follows:in Stage 1,cold limbs,loose stools,dry stools,In stage 2 frequent urination at night,loose stools,edema;In stage 3,more frequent nocturnal urination,loose stools,cold limbs.In stage 4,more edema,dry stools,shortness of breath.In stage 5,more frequent nocturnal urination,less frequent stools.The results showed that sore throat was common in Taiyang constitution,frequent nocturnal urination and dry stool in Yangming constitution,depression and upset in Shaoyang Constitution.The most common symptoms in Taiyin constitution were loose stools.The most common symptoms in Shaoyin constitution was nocturnal frequent urination,and the most common symptoms in Jueyin constitution was acute irritability.The results of tongue distribution were:purple tongue,greasy tongue coating.Pulse condition was usually pulse sinking,weak pulse.The distribution of comprehensive information of CKD patients included deep pulse,purple and dark tongue,greasy tongue coating,frequent nocturnal urination,cold limbs,edema were the most common.The distribution of TCM syndromes was:blood stasis syndrome was the most common,followed by water-dampness syndrome,dampness-turbidity syndrome.The results of syndrome distribution of different primary diseases and different stages were as follows:the primary diseases were blood stasis,yin deficiency,water dampness in chronic glomerulonephritis;blood stasis syndrome,water dampness syndrome and dampness-turbidity syndrome were more common in patients with DKD;IgA nephropathy is mainly caused by blood stasis syndrome,Qi deficiency syndrome and stagnation-heat syndrome.The distribution results of different stages were as follows:1 stage of blood stasis,yin deficiency,stagnation of heat,2 stage of blood stasis,water-dampness,stagnation of heat.3 stage of blood stasis,dampness,4 stage of blood stasis,water-dampness,dampness,5 stage of dampness,blood-stasis,water-dampness.The result of syndrome distribution of CKD patients with different constitution is:blood stasis syndrome is the most common syndrome,besides blood stasis syndrome,Taiyang constitution is common Qi deficiency syndrome,Yang Ming constitution is common dampness turbidity syndrome;Shaoyang constitution common stagnation of heat syndrome;Taiyin constitution common qi deficiency syndrome,water dampness syndrome;Shaoyin constitution common yin deficiency syndrome,wet turbidity syndrome;Jueyin constitution common liver yang syndrome.Professor Zhao Jinxi’s most commonly used drugs for treatment of CKD were Huang Qi,Dan Shen,Dang Gui,Tu Fu ling,Cuan Xiong etc.From Stage 1 to stage 5,Chan Tui,Jiang Can,Jiang Huang,Shu Da huang,the utilization rate basically shows the trend of gradual increase.However,the utilization rate of Huang Qin,Lian Qiao,Bai Hua she she cao,was on the whole declining trend.Drug flavor to cold(cold,slightly cold)-based,bitter,dry,pungent drug-based flavor.The most frequently used drugs were liver meridian,followed by lung,spleen,stomach and kidney.The efficacy of drugs to wind,heat,detoxification,water-based.The drug dose statistics showed that some of the drug doses were relatively fixed,such as 30g of Shi Wei,6g of Fang Feng.Some drugs have a large dosage span,for example,Huang Qi 15-150g,Shu Da huang 3-30g,the average dose of Huang Qi and Shu Da huang increased with the increase of stages.Association rule-based analysis showed that patients with chronic glomerulonephritis were associated with frequent nocturnal urination,chills,dry stools,red tongue and yellow fur,the patients with primary diabetic nephropathy had a close relationship with deep pulse,purplish and dark tongue,edema.Stage 1 is closely related to cold limbs,loose stools,thin veins,and stage 2 is closely related to heavy pulse,frequent nocturnal urination,loose stools,red tongue and yellow fur,stage 3 was closely related to frequent nocturnal urination,weak waist and knees,red tongue and yellow fur,stage 4 was closely related to dark and purple tongue,deep pulse and edema,and stage 5 was closely related to greasy tongue coating,deep pulse,dark and purple tongue,edema and food deficiency.The Taiyang constitution is closely related to sore throat,the Yangming constitution is closely related to stool obstruction,the Shaoyang constitution is closely related to the symptoms of melancholy,melancholy and upset,and the Taiyin Constitution is closely related to lose stools,Shaoyin constitution is closely related to frequent nocturnal urination,Jueyin constitution is closely related to acute irritability.The patients with chronic glomerulonephritis disease had a close relationship with yin deficiency,stagnation of heat and damp-heat syndrome,and the patients with DKD had a close relationship with blood stasis syndrome,water dampness syndrome and damp-turbidity syndrome.Stage 1 is closely related to yin-deficiency,stagnation of heat,yang-deficiency and damp-heat,stage 2 is closely related to stagnation of heat,damp-heat and yin-deficiency,and stage 3 is closely related to blood stasis,yin-deficiency and damp-turbidity,stage 4 is closely related to blood stasis syndrome,water dampness syndrome and wet turbidity syndrome,stage 5 is closely related to wet turbidity syndrome,water dampness syndrome and Qi deficiency syndrome.Yangming constitution is closely related to damp-heat syndrome,Shaoyang constitution is closely related to depression-heat syndrome,Taiyin constitution is closely related to Qi deficiency syndrome,and Shaoyin constitution is closely related to yin deficiency syndrome,Jueyin constitution is closely related to liver-yang syndrome.The result of correlation analysis between syndromes and drugs showed that the drugs closely related to blood stasis syndrome were Huang Qi,Dang Gui,Dan Shen,Chuan Xiong,Tu Fu ling,Chan Tui,etc.,the drugs closely related to the syndrome of water-dampness were Huang Qi,Chan Tui,Dan Shen,Mian Bi xie,Chuan Xiong,Tu Fu ling etc.,the drugs closely related to the syndrome of dampness and turbidity are Huang Qi,Chan Tui,Jiang Huang,Chuan Xiong,Dang Gui,Dan Shen,Shu Da huang,etc.,the drugs closely related to Qi deficiency syndrome were Huang Qi,Shi Wei,Chan Tui,Mian Bi xie,Chuan Shan long,Fu Ling.The drugs closely related to yin deficiency were Dan Shen,Huang Qin,Chi Shao,Bai Shao,Chai Hu,Shan Yu rou,etc.The drugs closely related to stagnation-heat syndrome were Huang Qin,Chai Hu,Fa Ban xia,Chen Pi,Bai Shao,Fu Ling,the drugs closely related to Yang deficiency syndrome are Fang Feng,Shan Yu rou,Fu Ling,Chao Bai zhu,Zhu Ling,Fa Ban xia,Chao Cang zhu,Chen Pi,Wu Yao,etc.The drugs closely related to damp-heat syndrome were Chi Shao,Jiang Huang,Bai Shao,Chao Cang zhu,Chao Bai zhu,Shan Yu rou,Jin Qian cao,etc.,the drugs closely related to Qi stagnation syndrome are Chai Hu,Fa Ban xia,Chen Pi,Wu Yao,Zi Su ye,etc.The drugs closely related to phlegm-heat syndrome are Huang Qin,Fa Ban xia,Chan Tui,Chai Hu,Chen Pi etc.,the drugs closely related to yin-stopping syndrome were Huang Qin,Ting Li zi,Sang Bai pi,Zhi Mu,Chai Hu and so on.Patients with Taiyang constitution were closely related to Huang Qin,Lian Qiao,Huang Qin,Fang Feng.While patients with Yangming constitution were closely related to Mian Bi xie,Tu Fu ling,Shi Wei,Chan Tui,Shu Da huang.Patients with Shaoyang constitution had a close relationship with Chai Hu,Fa Ban xia,Bai Shao,Chen Pi.Patients with Taiyin constitution had a close relationship with Mian Bi xie,Dang Gui,Chuan Xiong,Shi Wei.The patients with Shaoyin constitution were closely related to Huang Qi,Dan Shen,Chan Tui,Tu Fu ling,Chuan Xiong.The patients with Jueyin constitution were closely related to Dan Shen,Dang Gui,Chuan Xiong,Huang Qi,Chan Tui.Patients with chronic glomerulonephritis are closely related to Jiang Huang,Jiang Can,Shu Da huang,Fa Ban xia,Chen Pi,Chai Hu.The patients with DKD were closely related to Huang Qi,Shi Wei,Chuan Shan long,Mian Bi xie,Tu Fu ling,Chuan Xiong.The patients with IgA nephropathy were closely related to Fang Feng,Shi Wei,Mian Bi xie,Tu Fu ling,Huang Qi,Zi Su ye,Bai Hua she she cao.In the network diagram of constitution,syndrome,stage,symptom and medicine,there is a certain tendency between stage and syndrome,the related syndromes gradually transform from stagnation-heat syndrome,yin-deficiency syndrome,damp-heat syndrome,Qi stagnation syndrome to Qi deficiency syndrome,yin-stop syndrome,damp-turbidity syndrome and blood deficiency syndrome.There are some prominent symptoms in different constitution,different constitution related syndromes,drugs are also different,congener constitution plays an important role in syndromes and symptoms of CKD patients.The results of drug clustering showed that professor Zhao Jinxi’s commonly used drugs for treatment of CKD were San Qi,Shui Zhi;Sang Bai pi,Ting Li zi;Gui Jian yu,Niu Bang zi,etc.The commonly used drugs include Mian Bi xie,Tu Fu ling,Chuan Shan long,Shi Wei;Dang Gui,Chuan Xiong,Dan Shen;Jiang Huang,Shu Da huang,Jiang Can,Chan Tui and so on.Analysis of complex networks shows that,professor Zhao Jinxi’s core prescription for treatment of CKD is Huang Qin,Dang Gui,Dan Shen,Chuan Xiong,Tu Fu ling,Mian Bi xie,Chan Tui,Chuan Shan long,Shi Wei,Fang Feng,Chi Shao,Jiang Can,Jiang Huang,Shu Da huang,Huang Qin,Fu Ling,Bai Shao,Zhu Ling,Chen Pi,Fa Ban xia,Niu Bang zi.Different stages of the core prescription,each drug has its own characteristics.Conclusion:The patients with different constitution,different primary diseases and different stages of chronic kidney disease have their own characteristics of symptoms,syndromes and medication.In chronic kidney disease syndrome,Qi deficiency syndrome is more common,and blood stasis,water dampness and dampness turbidity are more common.Blood stasis,water dampness,yin deficiency,stagnation of heat,damp-heat syndrome are more common in the early stage,while dampness,blood stasis,water dampness,Qi deficiency,fluid retention and blood deficiency syndrome are more common in the late stage.Professor Zhao Jinxi’s core drugs for treating chronic kidney disease are Huang Qin,Dang Gui,Dan Shen,Chuan Xiong,Tu Fu ling,Mian Bi xie and so on.The usual drug combination are Mian Bi xie,Tu Fu ling,Chuan Shan long,Shi Wei;Jiang Huang,Shu Da huang,Jiang Can,Chan Tui and so on.Professor Zhao Jinxi emphasized the "Trinity"of body constitution differentiation,disease differentiation and syndrome differentiation in the treatment of chronic kidney disease,internal and external co-treatment,upper and lower co-treatment,pre-and post co-treatment,emphasizing the harmony of stomach discharge and turbidity,distinguishing diseases from primary diseases and differentiating stages,on the basis of grasping the basic pathogenesis,differentiation of constitution and prescription were carried out.