| Objective:Retrospective study was carried out on the case data of 616 patients with primary liver cancer in xiangyang hospital of traditional Chinese medicine by using data mining method,and to explore the relationship between disease-syndrome-treatment and prescription-syndrome-treatment contained in the medical record by analyze the medical cases,this paper explored the characteristics of TCM syndrome differentiation and classification and the law of TCM differentiation and treatment in patients with primary liver cancer.By analyzing the relationship between TCM syndromes and age,gender,clinical stage,past medical history,complications and related laboratory biochemical indexes of primary liver cancer,to summarize the law of drug use based on syndrome differentiation of different TCM syndromes of primary liver cancer and the law of TCM differentiation and treatment of common complications.The aim is to provide objective basis for the diagnosis of primary liver cancer and provide certain reference and guidance for the differentiation and treatment of clinical primary liver cancer using traditional Chinese medicine.Methods:Medical records of patients with primary liver cancer diagnosed in xiangyang hospital of traditional Chinese medicine from January 2008 to December 2017 were retrieved.After screening according to the corresponding inclusion criteria and exclusion criteria,the original medical records of patients with primary liver cancer that meet the standard are obtained.Using Access 2010 software to setup a collective information database of medical record of primary liver cancer patient,the database will also logging the data of 616 cases that meet the inclusion criteria and exclusion criteria,item by item,including the basic data,four diagnostic information,clinical stage,medical history,symptoms,signs,complications,relevant laboratory examination,hospitalization diagnosed Chinese medical syndromes and traditional Chinese medicine prescribed,etc.SPSS19.0 statistical analysis software was used to conduct descriptive analysis.The counting data are statistically described by frequency(composition ratio)and analyzed by chi-square test or rank sum test.MeanąSD was used for statistical description of the measurement data,anova was used for comparison between multiple groups,LSD was used for pair-wise comparison when the variance was homogenous,rank-sum test was used for comparison between groups when the variance was homogenous,and one-way anova was used for comparison between groups.Test level =0.05,P<0.05 was considered statistically significant.Q test(newrnan-keui s algorithm)was used for pairwise comparison between each group.By using Weka3.6 software to conduct condition analysis and bayesian analysis and to summarize the symptoms,signs and tongue veins of primary liver cancer with syndrome differentiation significance,study its combination rules and principles,and summarize the relationship between TCM syndromes and laboratory indicators,imaging signs and pathological stages of primary liver cancer.The association rule analysis function of Weka3.6 software was used to analyze the association rules of high-frequency drugs with different syndromes.The fp-growth algorithm was adopted,and the parameters were set as support degree of 10%,confidence degree of 80%,and the number of frequent item sets was set as 2 to obtain the association results of drug pairs with clinical value.Using the clustering function of Weka3.6 software,the Simple k-means algorithm was selected.The test set was set as 20,and 550 iterations were performed,high-frequency drugs were analyzed by clustering.Using Pajek 2.0 complex network analysis software,node connection parameters are calculated on the basis of the drug pair analysis results of association rules,and the cluster analysis results are used as the core ring drugs to draw the complex network diagram,summarizing the medication law of traditional Chinese medicine for primary liver cancer.Results:Through data mining and analysis of the medical records of 616 patients with primary liver cancer,the distribution and differentiation of treatment rules of syndromes are as follows:1 Distribution of TCM syndromes of primary liver cancer1.1 The relationship between the distribution of TCM syndromes and age and gender1.In this study,among the 616 patients with primary liver cancer,the distribution of syndrome types in male patients are more with type of accumulation of damp-heat,liver depression,spleen deficiency,liver depression and qi stagnation,and in female patients are more with liver depression and qi stagnation,liver depression,spleen deficiency and liver and kidney Yin deficiency.The liver stagnation and qi stagnation(54.76%)is the majority type in patients aged 40 years old and above.The liver depression and spleen deficiency type(25.96%)and damp-heat accumulation type(24.38%)are the majority types among the people aged 41-70 years.Liver depression and spleen deficiency type(28.24%)is the most common type in the population aged 71 years old and above.1.2 Relationship between distribution of TCM syndromes and clinical stages616 cases of primary liver cancer patients are mainly in middle and late clinical stage,patients with stage ?and above make up to 94.3% of all cases.Liver depression constitute the major part in ? period(57.14%);while?period with liver depression and qi stagnation type(52.13%),Liver depression and spleen deficiency type(22.34%)comes in second;in ? period the majority is accumulation of damp-heat(31.27%),the second is Liver depression and spleen deficiency(20.85%)and liver depression and qi stagnation(19.87%);in? period,Liver depression and spleen deficiency(39.44%)and liver and kidney Yin deficiency(22.78%)take up the most part.1.3 Relationship between distribution of TCM syndromes and imaging test Imaging of 616 patients with primary liver cancer showed that nodular liver cancer was the most common(44.81%),followed by massive liver cancer(43.67%),and diffuse liver cancer was the minority(11.53%).Among which,liver stagnation and qi stagnation type is mainly shown as nodular type;Nodular type was the most common type,followed by massive liver cancer.The type of damp-heat accumulation and the type of qi stagnation and blood stasis are mainly shown as massive liver cancer.Yin deficiency of liver and kidney is the most diffuse liver cancer.The results showed that there was a certain correlation between different TCM syndromes and imaging signs of primary liver cancer.To a certain extent,it can reflect the development trend that the early stage of primary liver cancer is mainly nodular type and the late stage is mainly shown as diffuse liver cancer.Among the patients with primary liver cancer of qi stagnation and blood stasis type,portal vein carcinoma suppository is found to be the most,and the formation of portal vein carcinoma suppository is closely related to qi stagnation and blood stasis in traditional Chinese medicine.1.4 Relationship between distribution of TCM syndromes and liver function indexes The AST,GGT and ALP values of primary liver cancer patients with Liver depression and qi stagnation are lower,while the ALT,GGT and ALP values are higher.The results showed that the liver function of primary liver cancer patients with liver stagnation and qi stagnation is relatively good,the liver function of the patients with damp-heat accumulation type and qi stagnation and blood stasis are relatively poor,and the liver function of the patients with liver and kidney Yin deficiency are the worst.1.5 Relationship between distribution of TCM syndromes and tumor markers AFP and CEA Among the 616 patients,Among the five basic syndromes of primary liver cancer,no significant difference is shown among CEA.AFP indicators of different TCM syndromes showed certain differences.The comparison among the syndromes revealed that AFP was manifested as damp-heat accumulation > qi stagnation and blood stasis > liver and kidney Yin deficiency > liver stagnation and spleen deficiency > liver stagnation and qi stagnation.Among them the AFP value of damp-heat accumulation type was significantly higher than that of other syndromes,indicating that AFP is most sensitive to the damp-heat differentiation of primary liver cancer.1.6 Relationship between distribution of TCM syndromes and PLT and blood coagulation index Among the five basic syndromes of primary liver cancer,PLT value and FIB value of qi stagnation and blood stasis type are higher than those of other syndromes,while PT,APTT and TT values are lower than other syndromes.The PT value of liver-kidney Yin deficiency type was higher than that of other syndromes.The FIB of liver and kidney Yin deficiency was lower than liver stagnation and qi stagnation,damp-heat accumulation,qi stagnation and blood stasis type,while the TT level was higher than liver stagnation and qi stagnation and qi stagnation and blood stasis type.Patients with liver and kidney Yin deficiency type of primary liver cancer have a high risk of gastrointestinal bleeding in clinical practice,while patients with qi stagnation and blood stasisr are most likely to develop portal venous carcinoma thrombi.2 Regularity of TCM differentiation and treatment of primary liver cancer2.1 Rules of TCM syndrome differentiation for different clinical stages of primary liver cancer Study of 616 cases of primary liver cancer indicate that main symptoms of stage???are abdominal pain and depression of modern,common TCM syndrome of liver depression and qi stagnation type;the main symptoms of stage ? are liver pain,jaundice,edema,etc.,which the majority are accumulation of damp-heat qi and blood stasi;the main symptoms of stage?are night sweats,lumbar debility,the common type is liver and kidney Yin deficiency.Common typical symptoms of primary liver cancer in the early stage is distension,mainly qi stagnation of the pathological characteristics;after the middle stage,the pathogenic factors of blood stasis and water dampness intermingled with each other.In the late stage of primary liver cancer,the deficiency of qi and blood Yin fluid is the main cause,and the change of deficiency and fatigue occurs.The change of typical symptoms reflects the change process of the disease from solid to deficiency.2.2 Differentiation and treatment of primary liver cancer in different TCM syndromes2.2.1Differentiation and treatment of liver depression and spleen deficiency syndrome In terms of treatment,it focuses on treating liver and spleen deficiency, attaching importance to invigorating qi and strengthening spleen,and treating liver and spleen depression,eliminating phlegm by qi and hemostasis by syndrome differentiation.Spleen-invigorating and qi-invigorating traditional Chinese medicine is the most frequently used,followed by liver-soothing and qi-regulating drugs.Common core of Chinese traditional medicine combinations are: codonopsis poria cocos-extracted by amomum villosom-semen coicis pinellia,radix bupleuri,radix bupleuri,radix scutellariae-method-dangshen-method of atractylodes,radix glycyrrhizae,radix bupleuri,radix scutellariae,pinellia poria cocos-orange-combination,dangshen tuckahoe large-headed atractylodes-semen coicis-radix bupleuri,radix scutellariae,etc.In the case of upper gastrointestinal bleeding,Chinese herbs such as radix bupleurae-radix scutellariae charcoal-poria cocos-herba Agricola-radix notoginseng powder-ulmus ulmus charcoal are used to stop bleeding.Commonly used prescriptions for small chaihu soup,small chaihu soup and Xiangsha Liujunzi decoction2.2.2Differentiation and treatment of liver stagnation and qi stagnation syndrome In terms of treatment,the most frequently used traditional Chinese medicine treatment is regulating Qi and soothing live.Qi stagnation can lead to blood stasis,and blood stasis can cause liver pain.In order to improve the curative effect of liver disease and spleen,traditional Chinese medicines such as invigorating qi and spleen,invigorating dampness and receding jaundice were selected.The commonly used core drug combinations are: bupleurum-orange peel-white peony-chuanxiong-turmeric-raw malt,bupleurum-citron-chuanxiong-orange peel-fructus aurantii-rhizoma,radix bupleurum-orange peel-chuanxiong-liquorice-turmeric,Yin Chen-atractylodes macrocephala-coicis-citron-glossy ganoderma,etc.The commonly used prescription is Sini powder. 2.2.3The law of differentiation and treatment of damp-heat accumulation syndrome The treatment focuses on clearing away heat and detoxification,removing dampness and receding jaundice,providing a way out for pathogenic factors so as to dispel pathogenic factors and make them healthy.Cooperating with traditional Chinese medicine to strengthen spleen and qi,dispel evil and never forget to strengthen the body.Common core of Chinese traditional medicine combination for: herba artemisiae-gardenia-rhubarb-giant knotweed-radix et rhizoma rhei and radix bupleuri,radix scutellariae,wormwood--gardenia red paeony root-spreading hedyotis herb acid-insoluble ash,herba artemisiae atractylodes-gardenia-rhubarb,radix bupleuri,radix paeoniae alba,herba artemisiae atractylodes-China root-semen coicis-ganoderma lucidum,dandelion,etc.The commonly used formulae are wormwood decoction,wormwood decoction,wormwood decoction and wormwood decoction,wormwood powder and so on.The commonly used formulae are Dachaihu decoction,wormwood decoction,wormwood decoction with Dachaihu decoction decoction,wormwood decoction with Wuling powder and so on.2.2.4Differentiation and treatment of syndrome of qi stagnation and blood stasis The treatment focuses on activating qi and activating blood circulation,removing blood stasis and relieving pain by removing blood stasis.The liver is used to store blood,regulate the main body,Yin is used to remove blood stasis and Yang is used to promote Yin.The commonly used core TCM combinations are: bupleur-angelica sinensis-radix paeoniae-panax notoginseng powder-radix trichosanthis-radix trichosanthis-radix trichosanthes-radix notoginseng powder,radix bupleur-angelica sinensis-radix rhizome-rhizoma curcumae-red flower-hirudo,radix angelica sinensis-peach kernel-red flower-pangolin-radix trichosanthes-radix bupleurum.The commonly used prescription is Gexiazhuyu decoction.2.2.5Differentiation and treatment of syndrome of liver and kidney Yin deficiency The treatment should focus on nourishing Yin of liver and kidney,and invigorating spleen and qi with traditional Chinese medicine.The commonly used core traditional Chinese medicine combinations are: radix rehmanniae-northern ginseng-Chinese wolfberry-Chinese neem-tortoise shell-tortoise shell,raw-ripe-north ginseng-radix ophiopogonis codonopsis,radix rehmanniae-Chinese ginseng-radix ophiopogonis-lycii-neem-danpi,acorus gramineus-poria cocos-gastrodia elata-habitat-radix salviae-radix ophiopogoniss.The commonly used prescription is yiguan decoction.2.3The law of TCM differentiation and treatment of common complications of primary liver cancer Cancer fever is often manifested as typical symptoms of the six-channel diseases,according to clinical differentiation of the six-channel diseases flexible use of "treatises on typhoid miscellaneous diseases" by the treatment of cancer fever significant effect;The treatment of primary liver cancer jaundice based on syndrome differentiation of six-channel diseases,combined with syndrome differentiation of eight principles and etiology can control the complexity.The treatment of cancer ascites can effectively control the ascites and alleviate the pain of patients.Based on the syndrome differentiation of zang-fu organs and meridians,a comprehensive analysis of etiology and pathogenesis was made.The treatment of hepatic encephalopathy with the combination of disease differentiation and syndrome differentiation can improve the cure rate and quality of life of patients.Conclusion:1.Primary liver cancer liver depression and qi stagnation type patients seen in people under age 40,more women than men,more clinical stage belongs to the stage?or?,liver function and blood coagulation function in patients with relatively well,radiographic signs is given priority to with nodular type.Traditional Chinese medicine treatment is promoting Qi flow and soothing liver,the commonly used prescription for four inverse powder.The commonly used anti-tumor medicines are: guanyuanza,banbanlian,shanci mushroom,litchi stone,green sepal plum,etc.2.Liver depression and spleen deficiency typetype found in stage ?,primary liver cancer patients blood coagulation function is poorer,the risk of upper gastrointestinal bleeding is larger,radiographic signs in the majority with nodules and giant block;Traditional Chinese medicine focuses on the treatment of liver and spleen deficiency,attaches great importance to qi and spleen,the commonly used prescription for small chaihu soup,small chaihu soup and six gentlemen soup.The commonly used anti-tumor medicines are:rhodiola rosea,ganoderma lucidum,bittersweet herb,American ginseng,ginseng,etc.3.The accumulation of damp-heat type is found in stage ? primary liver cancer,liver function in patients is poor,prone to complications such as jaundice,ascites,the tumor markers AFP value increased significantly,radiographic signs is given priority to with giant piece of type.Traditional Chinese medicine focuses on clearing away heat and detoxification,and benefiting dampness and reducing jaundice.The commonly used prescriptions are dashaihu decoction,artemisia annua decoction,artemisia annua decoction and dashaihu decoction,and yinchenwuling powder.The commonly used anti-tumor medicines are : giant knotweed,emblic leafflower fruit,swollen section wind,spreading hedyotis herb,mountain,the stone arrowhead,fresh mushroom,pride,glabrous greenbrier rhizome,parker lyratum thunb,under the Chinese sage,leaf beads,dandelion,etc.4.The primary liver cancer with qi stagnancy and blood stasis is commonly seen at stage ?,patients are found with high PLT,blood high condensation state,and portal vein tumor thrombus,with massive hepatocellular carcinoma as the most common radiographic sign.Traditional Chinese medicine focuses on the differentiation and treatment of qi and blood circulation and relieve the pain,the commonly used prescription is Gexiazhuyu decoction.The commonly used anti-tumor medicines are:chiton bug,chiton shell,pangolin,shanci mushroom,shijianchuan,raw oyster and so on.5.Primary liver cancer patients with liver and kidney Yin deficiency type is found in stage ?,imaging manifestations mainly hepatocellular carcinoma,liver function and blood coagulation dysfunction,prone to hepatic encephalopathy,upper gastrointestinal bleeding and other complications,the prognosis is poor.Traditional Chinese medicine treatment emphasizes on nourishing Yin of liver and kidney,the commonly used prescription is Yiguan decoction.The commonly used anti-tumor medicines are:turtle shell,turtle shell and calcined oyster. |
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