The Study On The Medical Cases Of The Celebrated Physicians In Qing Dynasty Through ’Treating Diseases By Regulating Kidney Function’

Purpose：All the medical cases about‘treating diseases by regulating kidneyfunction’in the10medical records of the celebrated physicians in Qing Dynastywere taken to classification research in all the aspects, like etiopathogenisis,pathogenesis, disease name, syndrome name, symptom, therapeutic principal,treatment, prescription, herbs, acupuncture therapy, constitution,regimens,convalescence, etc.al, by using the technique of statics and data mining. Inthis way, to conclude the celebrated physicians’ rules and characteristics oftreating diseases by regulating kidney function in Qing Dynasty, this will guideclinical practice and enrich the theory of kidney visceral manifestation.Material and method：We picked up10medical records of the celebratedphysicians in Qing Dynasty from Encyclopedia of Chinese Medicine, produced byHuman Electric Audiovisual Publisher, as the origin information source.From themwe screened the medical cases of ‘treating diseases by regulating kidneyfunction’.The medical cases were proofread based on the versions which werereleased by People’s Medical Publishing House, Shanghai Scientific and TechnicalPublishers, China Press of Traditional Chinese Medicine and People’s MilitaryMedical Press and imported to the database of ‘The Kidney Stores the Essence’knowledge management platform.1. Screening of the medical cases of the celebrated physicians in Qing Dynasty about‘treating diseases by regulating kidney function’1.1The selection criteria of the medical records of Qing DynastyA.The medical records were published between1644and1912.B.The writers of the works died before1912.C.Prefaces of the medical records were written before1912.We selected53medical records by eliminated36other works which were writtenin Ming Dynasty, Republican period or written by Japanese. We built up a databank, and variates were listed as book name, writer, the date of birth and deathof the writer, the contents of the medical records, the number of volume, thenumber of page, the number of the medical cases and the press of works.1.2The selection criteria of the medical records of the celebrated physiciansin Qing DynastyA.The medical records were written by the celebrated physicians with theacademic influence in Qing Dynasty.B.There were the corresponding paper publications of the medical records toproofread Encyclopedia of Chinese Medicine.C. The contents of the medical records included concrete cases, notpurely theory analysis of TCM or prescription analysis.We selected10medical records of the celebrated physicians in Qing Dynasty.1.3The selection criteria of the medical cases of the celebrated physiciansin Qing Dynasty about‘treating diseases by regulating kidney function’1.3.1The inclusive criteria of the medical cases of the celebrated physiciansin Qing Dynasty about‘treating diseases by regulating kidney function’A.The contents were closely related to ‘kidney’ in at least one item offollowing: etiopathogenisis, pathogenesis, disease name, syndrome name, symptom,therapeutic principal, treatment, prescription, herbs, acupuncture therapy,constitution, regimens and convalescence.B.The contents were purely medical cases, not theory analysis of TCM.1.3.2The exclusion criteria of the medical cases of the celebrated physicians in Qing Dynasty about‘treating diseases by regulating kidney function’A.The contents of the medical cases were not related to kidney, thoughmentioned of word of ‘kidney’.B.‘Treating diseases by regulating kidney function’ was not the core idea,because of the complicated contents and the variety of principle in treatingcourses.We used the key words:‘kidney’,‘ShaoYin’,‘MingMen’,‘MingHuo’,‘storing essence’,‘LiuWei’, and ‘BaWei’, to search the Encyclopedia ofChinese Medicine thoroughly.635medical cases were involved automatically,14cases were picked out by artificial checking. Finally, there were621cases oftreating diseases by regulating kidney function in total.2. Building up the data bank and data miningThe621cases were saved in txt format and imported to the database of ‘TheKidney Stores the Essence’ knowledge management platform. Data mining was basedon the platform.3. Data standardization of academic terminology of TCMEtiopathogenisis, pathogenesis, disease name, syndrome name, symptom,therapeutic principal, treatment, prescription, herbs, acupuncture therapy,constitution,regimens, convalescence, etc al used in our research werestandardized according to Chinese government standard term in clinic diagnosisand treatment of TCM, Dictionary of TCM prescription, Dictionary of TCM syndromename, Synonym Dictionary of Chinese herb, Internal medicine of TCM, Surgeryof TCM, Gynecology of TCM, Ophthalmology and otorhinolaryngology of TCM andConstitution classification and decision of TCM etc,al, and labeled withdifferent colour.4. Presenting results and conclusionAfter comprehensively and systemically organizing and collecting the itemsin those10medical records, we extracted more information hidden in the contextand concluded more by frequency analysis and clustering analysis. Results：1. Etiopatho genisisRelated6kinds of etiopathogenisises, recorded in the180cases, were listedas follows, overstrain (51), six exogenous factors (45), degeneration (32),emotional damage (24), eating and drinking without temperance (15), unfittreatment (13). Overstrain included physical strain, mental strain, sexualstrain。Among the medical cases of emotional damage, there were11cases relatedto rage,6cases related to panic,4cases for anxiety and1case for sadness.Results of six exogenous factors were7cases for dampness,6cases for coldness,5cases for fire,4cases for wind,4cases for summer-heat,2cases for Pathogenicwarm,1case for dryness,5cases for damp-hot,3cases for cold-damp,2casesfor wind-heat,2cases for wind-damp,1case for wind-cold,1case forwind-cold-damp and2cases for exogenous-factor.2. PathogenesisAll21kinds of pathogenesises were collected from525cases and listed asbelow, deficiency of kidney yin(146), deficiency of kidney qi(40), deficiencyof kidney yang(24), damage of kidney essence(24), pathogenesis of kidneymeridian (17), exogenous-factor-caused sthenia syndrome in kidney(5),disharmony between liver and kidney(134), disharmony between spleen andkidney(39), disharmony between heart and kidney(24), disharmony between lungand kidney(20), disharmony between stomach and kidney(8), disharmony betweenkidney and bladder(5),disharmony of multiple organs(18), rising of liver yang(7),deficiency of liver blood(4),agitation of liver wind (1), deficiency of spleenyang(4), deficiency of spleen qi(2), disharmony between liver and spleen,dampness-heat in large intestine(1), unconsolidation of Thoroughfare andconception Channels(1),3. Disease nameAfter thoroughly searching the621medical cases we got55disease names,referred to535internal cases,26surgical cases,22gynecological cases,37 cases of ophthalmology and otorhinolaryngology diseases,and1paediatric cases.Ranked by the frequency, the top20were fatigue(113), hemorrhagic disease(54),spermatorrhoea(42), phlegm and fluid retention (33), dyspnea(29), vertigo(28),coughing(27), difficulty in micturition(27), stroke(25), diarrhea(18),uroschesis(15), dropsy(14), dysentery (13), diabetes(10), male urologicaldisease(10), postpartum(10), ear disease(10), low back pain(9), eye disease(9),throat disease(9).4. Syndrome nameOnly one syndrome name was searched out from the621medical cases.5. Symptom563kinds of symptoms were calculated out from the621medical cases. Rankedby the frequency, the top20were coughing(99), dyspnea(71), spermatorrhoea (55),dizziness(44), poor appetite(37), emaciation(36), diarrhea(36), excessivephlegm(33), abdominal distension(27), odynuria(26), low back pain(25),insomnia(23), palpitations(22), lusterless complexion(22), cold feet(21),hemorrhage(21), dropsy (20), sweating(19), rapid pulse(18),difficulturination(18)。6. Therapeutical principleJust2items of therapeutical principle were collected: support healthy energy(1) and supporting vital qi to eliminate pathogens (1).7. Treatment41kinds of treatments were quoted350times in total in the621medical casesas follows, nourising liver and kidney(65), nourishing yin for suppressinghyperactive yan(39), nourishing kidney yin(35), warmly invigorating and holdingqi down(24), warmly invigorating kidney yang(24), tonifying spleen andkidney(21), nourishing yin for restraining hyperactive yang(21), nourishingheart and kidney(18), nourishing kidney essence(16), nourishing lung andkidney(15), warmly invigorating spleen and kidney(10), nourishing yin foreliminating dampness(9), warming kidney for resolving fluid retention((7), clearing vacuity-heat(6), tonifying kidney qi(6), dispelling cold for resolvingfluid retention(3), tonifying qi and blood(3), tonifying heart and kidney(2),warming kidney to promote diuresis(2), warming kidney for consolidatingThoroughfare Vessel(2), warming kidney for holding qi down(2), restoring normalcoordination between heart and kidney(1), nourishing yin and tonifying yang(1),tonifying yang for eliminating dampness(1), eliminating the bump for relievingpain(1), clearing damp-heat in low energizer(1), warming spleen for resolvingfluid retention((1), holding qi down and reducing phlegm(1), nourishing yin forcalming wind(1), warming yang for resolving fluid retention((1), smoothing theliver for regulating qi-flowing(1), eliminating dampness and relieving exteriorsyndrome (1), promoting the circulation of qi and resolving dampness(1), warmingcold-damp(1), nourishing blood for tonifying meridian(1), nourishing yin andcalming liver(1), nourishing yin for clearing heat and reducing phlegm(1),clearing heat and nourishing yin(1), warming kidney for reducing phlegm(1),relieving dysentery with astringents(1), warming middle energizer for resolvingdampness(1),8. Prescription91prescriptions were quoted310times in the621medical cases. Ranked bythe frequency, the top22were Liuwei Rehmaniae Pill(54), Kidney-qi-tonifyingPill(46), Duqi Pill(27), Pill for nourishing kidney(13), Huqian Pill(10),Rehmaniae Potion(8), Pulse-restoring Decoction(6), Zhenwu Decoction(6),Gold-water six-gentleman Fried(5), Black Rehmaniae Pill(5), Decoction forinvigorating the spleen(5), Yigong Powder(5), Pill of Four Miraculous Drugs(5),Guben Pill(4), Greatly tonifying yin Pill(4), Tonifying Pulse Powder(4), DaigePowder(3), Guilingwuweigancao Decoction(3), Two fairy Concentrated Decoction(3),Qingge Powder(3), Double Chen Decoction(3), Aconite Decoction forregulating Middle Energizer(3).9. HerbsThe calculation of herbs was according to the exact origin records in those medical cases.If the records like prescription plus herbs, only herbs werecounted in.305kinds of herbs were quoted4093times in the621medical cases.Thetop20were Poria(194), Rehmaniae(156), Fructus Schisandrae(151), Poria withHostwood(122), Rhizoma Dioscoreae(113), Fructus Lycii(101), Dride RehmanniaRoot(98), Tortoise Plastron(97), Radix Angelicae Sinensis(91), Radix Ginseng(85), Colla Corii Asini(85), Emen Nelumbinis(83), Radix Ophiopogonis(83), RadixPaeoniae Alba(81), Semen Astragali Complanati(77),Radix Achyranthis Bidentatae(68), Concha Ostreae(64),Fructus corni(64), Radix Asparagi(63), Semen Euryales(61).The property of herbs was listed as follows, neutral-natured (1551),warm-natured (1526), cold-natured (929), cool-natured (46) and heat-natured(41).The flavor of herbs were listed as below, sweet (2342), bitter (875), acrid(664), salted (279), sour (255), flat (51), astringent (47).Channel tropism of herbs were listed as below, Kidney Meridian(1449), LungMeridian(1005), Liver Meridian(924), Spleen Meridian(854), Stomach Meridian(767), Heart Meridian(714), Large Intestine Meridian(292), Bladder Meridian(265), Gallbladder Meridian(111), Small Intestine Meridian(71), TripleEnergizer Meridian(69), Pericardium Meridian(21).22kinds of herb efficacy were quoted4093times in total in the621medicalcases, tonifying yin(514), clearing damp and promoting diuresis(464), tonifyingblood(455), tonifying yang(421), tonifying qi(410), inducing astringency(392),clearing heat(385), eliminating phlegm for relieving cough and asthma(183),calming nerves(172), interior-warming(135), regulating qi(130), subduing liverand pacifying wind(102), promoting blood circulation to remove blood stasis(101),exterior-releasing(80), removing wind-damp(49), dissolving damp(36),anastaltic(21), digesting food(17), inducing Resuscitation(15), purgating(8),antidote and anthelmintic and damp-drying and antipruritic(2) and vermifuge(1).10. Acupuncture pointsOnly one case could be found in the621medical cases: plastering on Yongquan with Evodiarutaecarpa.11. ConstitutionWe found32medical cases mentioned constitution, accounted for5.2%of all,14cases for yin deficiency,13cases for congenital deficiency,3cases forphlegm-damp and2cases of yang deficiency.12. RegimensThe results of regimens were quoted42times, as follows, health preservativewith spiritual cultivation(14), health preservative with diet(10), healthpreservative with sexual intercourse(10), health preservative with dailylife(8).13. Results of data mining13.1Cluster analysis of high-frequency used symptomsCombined with the theories of TCM, we analysed the top50high-frequency usedsymptoms by cluster analysis and24symptoms were formed11significativeclustering combinations.C1: spermatorrhoea, dizziness, soreness and weakness of waist and knees,tinnitus, dryness of the throatC2: low back pain, soreness and weakness of waist and knees, frequent urinationC3: dizziness, tinnitus, hypochondriac painC4: coughing, blood in phlegm, hoarseness, spermatorrhoea, soreness andweakness of waist and kneesC5: palpitations, insomnia, spermatorrhoeaC6: coughing, blood in phlegm, dryness of the throatC7: excessive phlegm, coughing, dyspnea, emaciation, distensionaC8: tinnitus, dizziness, foot weak and feeble, Inability to walkC9: poor appetite, abdominal distension, emaciation, diarrheaC10: abdominal distension, poor appetite, dropsy, difficult urinationC11: palpitations, severe palpitation, insomnia13.2Cluster analysis of high-frequency used herbs Combined with the theories of TCM, we analysed the top50high-frequency usedherbs by cluster analysis and37herbs were formed significative clusteringcombinations.C1: Rehmaniae，Rhizoma Dioscoreae，Cortex MoutanC2: Semen Nelumbinis, Semen Astragali Complanati, Concha Ostreae, SemenEuryales, Semen CuscutaeC3: Radix Ophiopogonis, Ophiopogon JaponicusC4: Fructus Schisandrae, Rhizoma Dioscoreae, Radix Ginseng, Semen JuglandisC5: Rehmaniae, Fructus Lycii, Radix Angelicae Sinensis, DendrobeC6: Herba Cistanches, Eucommia Ulmoides, Radix Aconiti Carmichaeli, CollaCorni CerviC7: Dried Tangerine Peel, Prepared Radix Glycyrrhizae, Pinellia TernataC8: Concha Ostreae, Radix Asparagi, Fossil Fragments, magnetiteC9: Bighead Atractylodes Rhizome, Prepared Radix Glycyrrhizae, Codonopsis PilosulaC10: Radix Achyranthis Bidentatae, plantago seed, Rhizoma AlismatisC11: Poria with Hostwood, Radix Polygalae, Colla Corii AsiniC12: Tortoise Plastron, Golden Cypress, Rhizoma AnemarrhenaeConclusion：1. The most common pathogenic factor was internal damage, followed by exogenousfactors described in the621medical cases of the celebrated physicians in QingDynasty.2. The key pathogenesises of the involved cases were deficiency of kidney-yinand yin deficiency of five visceral.The entire body and all the organs of thebody need kidney-yin and kidney essence in order to thrive.Thus kidney visceralmanifestation theory was enriched by these ideas.3. The high-frequency symptoms were not directly related to kidney, but embodiedcharacteristics of‘treating diseases by regulating kidney function’andmanifested the disharmony between lung and kidney, liver and kidney. 4. The presentation about therapeutic principle was not found in the621medicalcases of the celebrated physicians in Qing Dynasty, which indicated thattherapeutic principle was highly abstract concept.5. Nourishing kidney yin was widely applied in treatment by the celebratedphysicians in Qing Dynasty. The idea of nourishing kidney-yin to balance yin-yangand reconcile the five internal organs was manifested fully.6. The prescriptions in the621medical cases of the celebrated physicians inQing Dynasty were not drastic supplementation and based on Shang Han Lun andJin Kui Yao Lue. The preferred prescriptions were Liuwei Rehmaniae Pill fornourishing kidney-yin and Kidney-qi-tonifying Pill for tonifying kidney-yang.7. The tonic herbs were the most frequent application. The flavor of herbs wasbased on sweet. Channel tropism of herbs was primarily kidney, lung and liver.