Research On Diagnosis And Treatment Of Diabetic Lower Limb Arteriosclerosis Obliterans Under The Combination Of Disease And Syndrome Based On The Structured TCM Hospital Records

This study relies on the Science and Technology Plan Project of Beijing Science and Technology Commission---"Mining and Validation Research of TCM Clinical Diagnosis and Treatment of Type â…¡ Diabetes" (project number:D08050703020802) and National High Technology Research and Development Program (863 Plan) Project---"Research and Development of Digital TCM Information System" (project number:2012AA02A609)Objective:Investigating the disease and syndrome of diabetic lower limb arteriosclerosis obliterans combing with TCM treatment rules, and summarizing features and advantages of TCM, so as to provide effective herbs and ideas for clinical study.Methods:1. Data collection:The study collects the medical history of diabetic lower limb arteriosclerosis obliterans in endocrinology department of Guang An Men Hospital of CACMS, and applies "the collecting system of diabetes structural TCM hospital history", collates information of 935 cases meeting the inclusion criteria, being divided into text data package, which includes basic information, complaints, carved disease, personal history, medical history, tongue and pulse diagnosis, diagnosis, prescription, medicine; the numerical data package includes physical and chemical index, which is made to information table. Make overall verification of all the data and total number of sample cases, and make additional recording of the related missing information based on the paper medical history, improve the patient cased during the hospital situation and then randomly select sample for verification.2. Data processing:unify the standard nouns, terms and formats. The Chinese and Western medicine symptoms and the disease name should be regulated or substituted in accordance with current national standards and industry standards; in particular cases without ambiguity, it may adopt the expert consensus or suggestion to regulate or substitute.3. Data mining analysis:(1) The SPSS 19.0 statistical analysis software is used for general information descriptive statistics, with frequency and constitutes for expression, multi-index joint statistics apply multi-classification frequency cross table method. (2) The computer technology is used to judge the common symptoms and tongue and pulse of all the cases, determine the TCM syndrome of diabetic lower limb arteriosclerosis obliterans and objectively investigate the evolution rules. (3) Make research of the relationship of compatibility of medicines and complication and evidence using the association rules in data mining platform. (4) As to the measurement data not meeting the above conditions, it applies two independent samples for non-parametric test, i.e. rank sum test; P<0.05 has the related research of statistically different symptoms and physical and chemical index. Using Fisher exact test, P<0.05 has statistically different, compare the relevancy of physical and chemical examination and symptom. Use unconditional Logistic Regression (i.e. set of information about Logistic Regression) for the syndrome and physical and chemical index of diabetic lower limb arteriosclerosis obliterans, explore the relationship between TCM syndrome and symptom, physical and chemical index.Results:1. The risk factors for diabetic lower limb arteriosclerosis obliterans include: gender, age, smoking history, drinking history, high blood pressure and blood sugar, elevated blood lipids, mainly concerned with carotid atherosclerosis of vascular complications.2. The basic syndrome rules of diabetic lower limb arteriosclerosis obliterans include:the weight of deficiency of qi and yin through weight calculation is 1414, followed by phlegm and blood stasis, with weight of 845, the weight of blood stasis in vessel is 757, the weight of yin deficiency and internal heat is 302, among the accompanied symptoms, stasis and dampness have the highest rate. It finds that deficiency of qi and yin, phlegm and blood stasis, blood stasis in vessel, yin deficiency and internal heat in diabetic lower limb arteriosclerosis obliterans is the core syndrome, the deficiency of qi and yin is the inside, the consistent blood stasis, and phlegm, dampness and heat are the surface.3. The general symptoms of diabetic lower limb arteriosclerosis obliterans are dry mouth, weakness, numb limb and pain limb. The deficiency of qi and yin includes dry mouth, weakness, dizziness, chest distress, numb foot, numb limb, dark red and pale dark tongue, white furred tongue, and fine pulse; blood stasis in vessel has the symptoms of dry mouth, weakness, dizziness, chest distress, pain limb, numb limb, dark red and pale dark tongue, fine and tart pulse; phlegm and blood stasis has the symptoms of dry mouth, weakness, dizziness, chest distress, pain limb, numb limb, numb foot, phlegm, limb edema, numb finger, dark red and pale dark tongue, yellow furred tongue, fine and tart pulse; yin deficiency and internal heat has the symptoms of dry mouth, dizziness, dry stool, pain limb, numb foot, numb limb, thirst, numb finger, sweating, pain foot, pain limb, weight loss, heat intolerance, palpitations, feverishness in palms and soles, dark red and pale dark tongue, yellow furred tongue, fine string pulse.4. Prescription rules of diabetic lower limb arteriosclerosis obliterans: deficiency of qi and yin uses Shenqi Dihuang decoction to supplement qi and nourish yin, the medicines include poria, wine dogwood meat, safflower, rehmannia, and moutan bark, the compatibility mostly uses poria+wine dogwood meat; blood stasis in vessel uses Shenqi Dihuang decoction and Taohong Siwu decoction to supplement qi and nourish yin, and to activate blood and remove stasis, the medicines include safflower, peach kernel, angelica sinensis, ligusticum wallichii, and caulis spatholobi, the compatibility mostly uses peach kernel+safflower; safflower+angelica sinensis; phlegm and blood stasis uses Taohong Siwu decoction and Erchen decoction to reduce phlegm and dampness, and to activate blood and remove stasis, the medicines include poria, rehmannia, ligusticum wallichii, angelica sinensis, and caulis spatholobi, the compatibility mostly uses moutan bark+wine dogwood meat, yarm+moutan bark; yin deficiency and internal heat uses zhibaidihuang pills to nourish yin and lower fire, the medicines include safflower, caulis spatholobi, poria, anemarrhenae, moutan bark, the compatibility mostly uses safflower+ peach kernel, caulis spatholobi+safflower.5. The relationship analysis of syndrome-index:deficiency of qi and yin is associated with carotid artery occlusion; blood stasis in vessel is related with blocked carotid CDFI and hyperglycemia; phlegm and blood stasis is associated with blocked carotid CDFI, carotid artery occlusion and large are of carotid artery plaque, large number of unusual PPG and unusual low-density lipoprotein; yin deficiency and internal heat is related with carotid artery occlusion and hypoglycemia.Conclusion:1. The risk factors for diabetic lower limb arteriosclerosis obliterans include: gender, age, smoking history, drinking history, high blood pressure and blood sugar, elevated blood lipids, mainly concerned with carotid atherosclerosis of vascular complications.2. The major syndromes of diabetic lower limb arteriosclerosis obliterans include deficiency of qi and yin, phlegm and blood stasis, blood stasis in vessel, yin deficiency and internal heat the four core syndromes, the deficiency of qi and yin is the inside, more stasis and dampness, and phlegm, dampness and heat are the surface, the consistent blood stasis during diabetic lower limb arteriosclerosis.3. The symptoms of diabetic lower limb arteriosclerosis obliterans mainly include dry mouth, weakness, dizziness, numb limb and pain limb, etc.4. The treatment of diabetic lower limb arteriosclerosis obliterans mainly includes supplementing qi and nourishing yin, activating blood and removing stasis, reducing phlegm and dampness, and nourishing yin and lowering fire.5. The representative prescriptions of each syndrome of diabetic lower limb arteriosclerosis obliterans mainly include Shenqi Dihuang decoction, Taohong Siwu decoction, Erchen decoction, and zhibaidihuang pills.6. The most common use herb is wine dogwood meat; the pairing herbs include wine dogwood meat+ moutan bark; the compatibility of three herbs includes wine dogwood meat+ moutan bark+ astragalus; the compatibility of four herbs includes dogwood meat+ moutan bark+ astragalus+ poria; the commonly used TCM include: safflower, peach kernel, angelica sinensis, ligusticum wallichii, saulis spatholobi, wine dogwood meat, and moutan bark, etc.