| BackgroundThe era of 4P medicine(Personalized,Predictive,Preventive and Participatory)which emphasized individualization is now coming.The personalized clinical diagnosis and treatment is becoming the mainstream of clinical practice and research.Traditional Chinese medicine(TCM)has always been practicing the individualized diagnosis and treatment since ancient times and "abidance by the TCM pathogenesis" is the significant bond of theoretical basis and clinical practice of TCM.TCM pathogenesis embodies the original thinking of TCM clinical diagnosis,analysis and establishment of a mature treatment program.At present,the research that still stays in the stage of clinical experience summary and thinking discussion is far away from satisfying the demand of individualized practice application and evaluation analysis of TCM.The systematic study on excavating the essential connotation of TCM pathogenesis and individualized clinical diagnosis and treatment mode is lacking.Our study is to establish the theory and practice system of clinical individualized diagnosis and treatment mode dominated by TCM pathogenesis.ObjectivesExcavate the essential connotation of TCM pathogenesis to construct knowledge graph of TCM pathogenesis and explore the establishment of TCM pathogenesis theory system.Analyze the internal relations and laws of the diagnosis,TCM pathogenesis and treatment in-depth in the process of clinical individualized diagnosis and treatment to construct the clinical individualized diagnosis and treatment mode dominated by TCM pathogenesis and explore the methodology research of standardized TCM clinical practice.Develop and verify the clinical diagnosis and treatment decision support system dominated by TCM pathogenesis to apply the clinical individualized diagnosis and treatment mode into clinical practice.Methods1.The knowledge graph of TCM pathogenesisSystematically searched CNKI and included relevant papers of TCM pathogenesis.We read,sorted out and analyzed the relevant elements TCM pathogenesis,and determined the connotation elements of TCM pathogenesis through revising the relevant elements and consulting with experts.We identified,extracted and labeled the detailed information of each TCM pathogenesis connotation element and then constructed the knowledge graph of TCM pathogenesis using Gephi 0.9.2 software.At last,we carried out the entity analysis with collection of retrospective clinical data of cardiovascular disease.2.Clinical individualized diagnosis and treatment mode dominated by TCM pathogenesisWe conducted the research of clinical individualized diagnosis and treatment mode based on proven clinical reports of TCM in treating cardiovascular disease.Relevant case repots were systematically retrieved through CNKI and the basic information of which were analyzed..We evaluated the reporting quality of the included case reports using the Consensus-Based Recommendations for Case Report in Chinese Medicine(CARC 2016).The diagnostic information,TCM pathogenesis and treatment strategies of the case reports were read,analyzed and extracted.We used the structural equation model to build the individualized diagnosis and treatment mode and constructed the clinical structure model with IBM SPSS Amos 24 software.3.Clinical diagnosis and treatment decision support system dominated by TCM pathogenesis Based on the knowledge graph of TCM pathogenesis and the clinical individualized diagnosis and treatment mode,we applied the Drupal CMS to develop the clinical diagnosis and treatment decision support system dominated by TCM pathogenesis.The basic function of the system is to input clinical information,analyze TCM pathogenesis and report the treatment and prescription.Our system used natural language processing techniques,including Chinese word segmentation tools,forward maximum matching algorithm,word representation to analyze and process clinical data.4.Application examples of the systemWe collected clinical cases of TCM in treating cardiovascular disease as the application examples through outpatient service.The clinical information were pre-processed with the rules and unified text set built-in the system to simplify the input,analysis,processing and report.Then we discussed the application results compared with the real diagnosis,treatment and prescription from the physicians,found problems and put forwand improvement measuresResults1.Construction of knowledge graph of TCM pathogenesis1)Basic frame of connotation elements of TCM pathogenesis:We searched 810 papers related to TCM pathogenesis published from 2017 to 2019.A total of 412 studies were included and read,47 relevant elements of TCM pathogenesis were extracted.We finally determined 10 TCM pathogenesis connotation elements through text standardization and expert consultation,which are the nature of disease,the course of disease,basic TCM pathogenesis,the cause of disease,the location of disease,the situation of disease,TCM pathogenesis evolution,the condition of disease,TCM pathological factors and constitution.We conducted co-occurrence analysis of the 10 connotation elements of TCM pathogenesis and constructed the basic frame,in which the basic TCM pathogenesis is the core closely related to the other 9 connotation elements.The basic frame of TCM pathogenesis provided a thinking composition for TCM pathogenesis identification and summarized the comprehensive,important information and key points of TCM pathogenesis.2)Knowledge graph of TCM pathogenesis:We constructed the knowledge graph of TCM pathogenesis through the identification and extraction of detailed information of each connotation element.The knowledge graph of TCM pathogenesis was a knowledge network centered on basic TCM pathogenesis,the cause of disease and TCM pathogenesis evolution,which built the knowledge system of comprehensive and systematic summary and analysis of TCM pathogenesis.3)Entity analysis of clinical data:A total of 334 retrospective cases of TCM in treating cardiovascular diseases were collected,with 130 male cases and 204 female cases.The mean age of the patients was 75.6±10.2 years and the most cases were in the 75-84 age group.Among 334 patients,89.2%were diagnosed with coronary heart disease,and 79.9%with hypertension,66.8%with heart failure.The most TCM diagnosis were Chest Pain and Heart Failure.We made the knowledge graph of TCM pathogenesis of the retrospective cases and showed the structure and trend of TCM pathogenesis of 334 cases intuitively.2.Clinical individualized diagnosis and treatment mode dominated by TCM pathogenesis1)Basic information of the case reports:A total of 4,504 papers published between 2016 and 2019 were retrieved and we finally included 159 papers with 211 clinical cases of TCM in treating cardiovascular diseases.Within the 211 cases,there were 120 male and 91 female cases and the average age of the patients was 58±14,88 years,the number of the 55-64 and 65-74 age group was the most.The diagnosis included 21 disease types like coronary heart disease,dilated cardiomyopathy and heart failure etc.TCM diagnosis were heart failure,palpitation,chest pain,true heart pain and dizziness.2)Evaluation of reporting quality:Clinical data and the information of the four TCM diagnosis was basically complete(97.6%),while the report on the TCM treatment(83.4%),Chinese herbal formulas(177),the information of subsequent visit(89.6%)and the discussion(85.8%)was relatively complete.The reporting of height,weight,occupation and the follow-up information was poor.Generally,reporting quality of 211 case reports was relatively high.3)Diagnosis and treatment of the case reports:Ten items of clinical information including gender,age,western medicine diagnosis,TCM diagnosis,clinical symptoms,signs,tongue,pulse,the cause of disease and medical history were comprehensively extracted.With the outline of 10 connotation elements of TCM pathogenesis,we analyzed and excavated TCM pathogenesis of 211 cases.The treatment of the 211 cases was all focusing on the root of the disease,enriching the deficiency of zang-fu organs and removing TCM pathological factors.4)Construction of the individualized diagnosis and treatment mode:We excavated and analyzed the corresponding relations between clinical information and TCM pathogenesis,and TCM pathogenesis with the treatment.The associated structural model of the four diagnostic information with TCM pathogenesis as well as TCM pathogenesis with treatment were built to form the thinking link between clinical information and TCM pathogenesis essence and the analysis framework of diagnosis and treatment.We constructed the clinical individualized diagnosis and treatment mode dominated by TCM pathogenesis.3.Clinical diagnosis and treatment decision support system dominated by TCM pathogenesis 1)System architecture:The system consisted of the background technology and the system-running area.System-running area included the user management and business operation layer and the background technology area with the basic data and data processing layer.The user management layer was to manage user accounts,maintain the information security and data under the supervision of the system administrator.The business operation layer was the main interface of the system which users could input information and get the report.The basic data layer was the original knowledge base of the system,including the rules of structured information collection and unified text set,knowledge graph of TCM pathogenesis and.clinical individualized diagnosis and treatment mode.The data processing layer was to comprehensively analyze and process clinical information to achieve data interaction with the application of natural language processing.2)System function:Standardized collection and input of TCM clinical information and support of treatment decision dominated by TCM pathogenesis could be achieved through the system architecture and the connection of corresponding technology and algorithm.The system could be applied in the clinical analysis and decision support of TCM in treating cardiovascular diseases.4.Application examples of the system1)Information of real clinical cases:A total of 48 real clinical cases from outpatient service were collected,including 26 males and 22 females.The number of patients aged 55-64 years was the most.Chest pain and dizziness were the most TCM diagnosis,both were 19 patients.We conducted stratified random sampling of 48 patients and a total of 10 cases were included in the application analysis of the system.2)Analysis results from the system:Processing of the system was relatively close to the real clinical diagnosis and treatment on the whole with certain rationality and practicality of clinical application.The basic TCM pathogenesis of some cases were complicated so that the identification from the system could not meet the requirement of clinical diagnosis and treatment.We discussed that the patient's individual clinical characteristics and complexity of TCM pathogenesis as well as the construction technology and analysis,processing capacity of the system were the main causes.It is necessary to further expand the clinical practice data,improve the system performance,and strengthen the practical value in clinical application.ConclusionsWe constructed the clinical individualized diagnosis and treatment mode system dominated by TCM pathogenesis combining the theory and practice on the basis of knowledge graph of TCM pathogenesis,clinical individualized diagnosis and treatment mode and the clinical diagnosis and treatment decision support system.The mode system was aimed to optimize TCM individualized diagnosis and treatment strategies and increase efficiency,to lay certain methodology foundation for innovative TCM individualization researches. |
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