Research On TCM Diagnosis And Treatment Rules Of Qi And Yin Deficiency Syndrome In Type 2 Diabetes Based On Medical Record Knowledge Grap

Traditional Chinese medicine(TCM)cases are an important carrier of the doctor’s experience.Learning medical cases can help us to clarify doctors’ diagnosis and treatment ideas and summarize the rules of TCM diagnosis and treatment,which is of great significance for the inheritance and development of doctors’ experience.Our research takes the medical cases of diabetes mellitus type 2(T2DM)with deficiency of both qi and yin syndrome treated by traditional Chinese medicine as the research object,proposes a method framework for discovering the diagnosis and treatment rule of medical cases based on the construction of knowledge graph,discusses how to express the diagnosis and treatment process of TCM based on syndrome differentiation by constructing the knowledge graph of diagnosis and treatment of T2DM with deficiency of both qi and yin syndrome,reflects the diagnosis and treatment ideas of doctors,and visually presents the diagnosis and treatment rule of TCM in treating T2DM with both qi and yin deficiency syndrome.1.ObjectiveThe purpose of this study is to build a knowledge graph based on medical cases to reveal the diagnosis and treatment rules of Chinese medicine in treating T2DM with deficiency of both qi and yin syndrome and present them in a visual form.2.Methods(1)Retrieve CNKI,Wanfang,VIP database(the retrieval time is from January 1,1900 to March 31,2022)and medical cases related T2DM with deficiency of both qi and yin syndrome in diabetes monographs.A total of 182 medical cases related to T2DM with deficiency of both qi and yin syndrome were included,forming a medical case database.(2)The construction of diagnosis and treatment knowledge graph of T2DM with deficiency of both qi and yin syndrome includes knowledge extraction based on UIE(Universal Information Extraction)model,knowledge representation and ontology model construction based on "syndrome element differentiation" theory,knowledge standardization processing and knowledge fusion,knowledge storage and knowledge graph generation based on graph database Neo4j.(3)Visual analysis of the knowledge graph of T2DM with deficiency of both qi and yin,including knowledge query and visualization based on Cypher statement and knowledge discovery based on Neo4j embedded graph algorithm for the diagnosis and treatment knowledge graph of T2DM with deficiency of both qi and yin syndrome.3.Results(1)The knowledge graph of diagnosis and treatment of T2DM with deficiency of both qi and yin syndrome constructed in this study generated 1115 nodes and 6563 relationships,covering the diagnosis and treatment knowledge entities and their relationships of diseases,syndrome types,syndrome elements,symptoms,Chinese herbal medicine,treatment principles and treatment methods,contained in 182 medical cases,and realizing the visual presentation of doctors’ diagnosis and treatment ideas and the diagnosis and treatment rules of T2DM with deficiency of both qi and yin syndrome.(2)Orienting the knowledge graph of diagnosis and treatment of T2DM with deficiency of both qi and yin syndrome,the graph algorithm was used to discover the diagnosis and treatment rules of traditional Chinese medicine in the treatment of T2DM with deficiency of both qi and yin syndrome from the aspects of syndrome types,syndrome elements,symptoms,medication,treatment principles and methods.The results are as follows:①In addition to the deficiency of both qi and yin,the syndrome types related to T2DM with deficiency of both qi and yin syndrome also mainly include Qi and Yin deficiency accompanied by blood stasis syndrome,Qi and Yin deficiency accompanied by dryness-heat flashes syndrome,and Qi and Yin deficiency accompanied by dampness and heat syndrome.Their similarities with the deficiency of both qi and yin are 75%,75%,and 70%,respectively.②The knowledge graph of diagnosis and treatment of T2DM with deficiency of both qi and yin syndrome covers 26 types of syndrome elements.On the sub graph of "syndrome type-syndrome element",the syndrome elements with the highest central degree value are qi deficiency and yin deficiency(degree value is 68).The degree values of spleen,heat,kidney,blood stasis,liver,fluid deficiency,dampness and other syndrome elements are all above 34(50%of the highest degree value).On the sub map of "symptom-syndrome elements",each syndrome element is ranked as yin deficiency,qi deficiency,heat,blood stasis,dampness,liver,spleen,qi stagnation and kidney according to the central order.On the sub map of "Chinese herbal medicine-syndrome elements",the syndrome elements are ranked as heat,yin deficiency,spleen,dampness,liver,kidney,and blood stasis according to the centrality.③The knowledge graph of diagnosis and treatment of type 2 diabetes with deficiency of both qi and yin syndrome involves 329 symptoms.Polydipsia is the symptom with the highest centrality value(degree value is 40)on the sub graph of "syndrome type-symptom";The degree values of fatigue,red tongue and polyuria are all above 32(80%of the highest degree);The degrees of dry mouth,thirst,emaciation,frequent urination,shortness of breath,excessive food and hunger are all above 20(50%of the highest degree).In terms of the relationship between symptoms and syndrome elements,1135 pairs of symptoms,including"numbness of hands and feet,numbness of limbs","lethargy,obesity",are extremely similar(similarity=1);In terms of the relationship between symptoms and syndrome types,1047 pairs of symptoms,such as "fatigue of lower limbs,lumbago","light purple tongue,heavy and astringent pulse",are extremely similar(similarity=1).In the syndrome manifestations of each syndrome type,the tightness scores of six pairs of symptomatic entities,such as"polydipsia,polyuria","polydipsia,asthenia","dry mouth,polydipsia","polyuria,asthenia","polydipsia,red tongue",and "polydipsia,thirst",were above 6.99(70%of the highest score),with significant correlation;In pathogenesis,11 pairs of symptomatic entities,such as"dizziness and headache","dry throat and excessive drinking","dry lips and dry throat",and"eyelid edema and lower limb edema",scored more than 1.33(70%of the highest score)in tightness,showing significant correlation.④The knowledge graph of diagnosis and treatment of T2DM with deficiency of both qi and yin syndrome covers 209 Chinese herbs.Astragalus membranaceus is the most central herbs on the sub graph of "syndrome type-Chinese herbal medicine"(degree value is 49);The degrees of yam,rehmannia glutinosa and ophiopogon japonicus were all above 39(80%of the highest degree);The degrees of poria cocos,trichosanthin,salvia miltiorrhiza,scrophularia,coptis chinensis,kudzu root,cornus officinalis,atractylodes macrocephala and schisandra chinensis are more than 24(50%of the highest degree).99 pairs of Chinese herbs,such as "dried tangerine peel,magnolia officinalis" and "raw place,radix scrophulariae",are extremely similar(similarity=1).In the relationship between the compatibility of the two Chinese herbs,the scores of "astragalus,yam","raw rehmannia,yam","raw rehmannia,ophiopogon","raw rehmannia,astragalus","ophiopogon,yam","poria,yam",and "astragalus,ophiopogon" on the tightness of Chinese herbal medicine were above 8.7(70%of the highest score),with a significant correlation;In terms of the correlation between the efficacy of the two Chinese herbal medicine,10 pairs of Chinese herbs,such as "angelica,caulis spatholobi","yam,ginseng","asparagus,ophiopogon japonicus","rhizoma polygonati,yam",and"ginseng,dendrobium officinale",scored more than 1.448(70%of the highest score),showing significant correlation.On the relationship of symptomatic medication of T2DM with deficiency of both qi and yin syndrome,the graph generated 63 relationships of symptomatic medication.On the correlation of symptomatic medication between symptoms and Chinese herbal medicine,12 pairs of Chinese herbs,such as "yam,polydipsia","rehmannia,polydipsia","astragalus,asthenia","astragalus,polydipsia","yam,polyuria",and"ophiopogon japonicus,polydipsia",scored more than 6(70%of the highest score),with significant correlation.⑤The knowledge graph of diagnosis and treatment of T2DM with deficiency of both qi and yin syndrome covers 92 treatment principles and 67 treatment methods.Qi invigoration is the most central treatment principle(the central degree value is 50),and other treatment principles are respectively yin nourishing(the central degree value is 41),heat clearing,spleen strengthening,yin nourishing,and fluid generating according to the central ranking.From the perspective of the efficacy of Chinese herbal medicine,heat clearing is the most central treatment(the centrality value is 59),and other treatments are respectively kidney tonifying,yin nourishing,spleen invigorating,and fluid generating according to the centrality.From the perspective of the treatment methods corresponding to syndrome elements,the most types of treatment methods are those for blood stasis(the central degree value is 9),followed by those for yin deficiency(the degree value is 7).4.Conclusions(1)T2DM with deficiency of both qi and yin syndrome is easy to transform into dryness and heat or form blood stasis for a long time.It is most likely to transform to the syndrome of deficiency of both qi and yin with dry heat,deficiency of both qi and yin with blood stasis,and deficiency of both qi and yin with damp heat.At the same time,there is also the possibility that deficiency of both qi and yin with dry heat,blood stasis,and damp heat occur simultaneously.(2)Syndrome elements of T2DM with deficiency of both qi and yin syndrome in addition to Qi deficiency and yin deficiency,the important facultative associated syndromes are heat,blood stasis,fluid deficiency and dampness,and the main diseases are located in spleen,kidney,and liver.The syndromic manifestations of T2DM with deficiency of both qi and yin syndrome are mostly caused by deficiency of Yin,Qi deficiency,heat,blood stasis,dampness,and qi stagnation,and the disease location is in the liver,spleen,and kidney;The Chinese herbal medicine for T2DM with deficiency of both qi and yin syndrome are mostly aimed at the treatment of heat,yin deficiency,dampness and blood stasis,and are processed from the spleen,liver and kidney.(3)Polydipsia is the most important characteristic symptom of T2DM with deficiency of both qi and yin syndrome,and fatigue,red tongue,polyuria,dry mouth,thirst,emaciation,frequent urination,shortness of breath,and overeating are the main characteristic symptom groups.According to the significant correlation between the symptoms of polydipsia,polyuria,fatigue,dry mouth,red tongue,thirst,and emaciation,compared with the theoretically typical symptom groups" Polydipsia,polyuria,overeating,emaciation"symptoms,the symptom of T2DM with deficiency of both qi and yin syndrome is mainly manifested in polydipsia,polyuria,and emaciation.(4)Astragalus is the most important Chinese herbal medicine for the treatment of T2DM with deficiency of both qi and yin syndrome.Yam,rehmannia glutinosa,ophiopogon japonicus,poria cocos,radix trichosanthis,salvia miltiorrhiza,radix coptidis,radix puerariae,cornus officinalis,atractylodes,schisandra are the main Chinese herbs for the treatment of T2DM with deficiency of both qi and yin syndrome.Astragalus and yam,raw rehmannia and yam,raw rehmannia and ophiopogon,raw rehmannia and astragalus,ophiopogon and yam,tuckahoe and yam,astragalus and ophiopogon are commonly used pairs of Chinese herbs that have compatibility relationship in the clinical treatment of T2DM with deficiency of both qi and yin syndrome.Angelica and caulis spatholobi,yam and radix codonopsis,radix codonopsis and radix ophiopogonis,rhizoma polygonati rhizoma and rhizoma dioscoreae,radix codonopsis and dendrobium,radix astragali and atractylodes atractylodes,poria and coix seed,rhizoma alismatis and coix seed,poria and rhizoma alismatis can be used in combination to enhance the therapeutic effect or replace each other in the clinical treatment of T2DM with deficiency of both qi and yin syndrome.Yam,raw rehmannia,astragalus membranaceus and ophiopogon japonicus can be used to treat polydipsia;astragalus membranaceus,yam and raw rehmannia can be used to treat fatigue;yam and astragalus membranaceus can be used to treat polyuria;raw rehmannia membranaceus and ophiopogon japonicus can be used to treat tongue redness;raw rehmannia can be used to treat dry mouth.(5)T2DM with deficiency of both qi and yin syndrome is not limited therapeutically to treatment with supplementing qi and nourishing yin.Considering the transformation of syndromes,it will be treated in combination with clearing heat,tonifying the kidney,strengthening the spleen,and promoting fluid production,which reflects the flexibility of clinical treatment of T2DM with deficiency of both qi and yin syndrome.