Research On Disease And Syndrome Differentiation Of Diabetic Cerebral Infarction Through Electronic Medical Record Data

This study relies on special projects of State administration of Traditional Chinese Medicine and Beijing municipal Science and Technology Commission, including literature review and clinical studies.1Literature reviewIt shows from the literature that Diabetic Cerebral Infarction belongs to ’Diabetes’,’Stroke’,’Pian ku’ and ’Diabetic encephalopathy’ in TCM.The important pathogenesis of Diabetic Cerebral Infarction include phlegm,blood stasis,qi deficiency,yin deficiency and oldness,mainly affect the spleen,kidney,liver and brain.For clinical treatment,considering the syndrome elements of wind,fire-heat, phlegm,blood stasis and asthenia,the therapeutic treatment were associated with supplementing qi and activating blood circulation,dispelling pathogenic wind and eliminating phlegm,dispersing blood stasis and dredging collateral,nourishing Yin and suppressing Yang and promoting blood circulation by removing blood stasis,etc. The pathogenesis of Cognitive dysfunction caused by Diabetic Cerebral Infarction have a link with deficiency of spleen and kidney and malnutrition of brain,Kidney-Tonifying and Spleen-Invigorating,Blood-Nourishing and Quickening the blood were the the basic therapy for Cognitive dysfunction.Integrative Disease and Syndrome were the integrative point and the main mode of Traditional and Western Medicine,it would provided a new idea and method for the treatment of diabetes mellitus complicated with cerebral infarction.2Clinical studies2.1Objective:The use of electronic medical record(EMR) data is necessary to improve clinical research efficiency.This research aimed to analyze the data of485cases of patients with Diabetic Cerebral Infarction,and to probe the patterns of Disease-syndrome and treatment.2.2Methods:Clinical information stored in EMRs at our hospital was searched from January2009to Feburary2013.485cases of eligible patients were extracted through the structured query language.Then the data were further sorted out to make it standard.Association rules,complex networks and star model were used to analyze the relation of Disease-syndrome-medicine and treatment.2.3Results:(1)The epidemiologic feature of Diabetic Cerebral Infarction.in the485 cases of patients,95.9%of which were older than50years old,85.7%of which were overweight and64.8%of whose duration of diabetes were more than10years. All of the cases were with a higher comorbidity with Hypertension,Coronary artery disease and Hyperlipidemia.Therefore,age,BMI,course of diabetes,Hypertension,Coronary heart disease and Hyperlipidemia are important factors which influence the progression of cerebral infarction severely.(2)Patterns of Disease and syndrome Differentiation on Diabetic Cerebral Infarction:①There were three fundamental pathogenesis in patients with acute cerebral infarction characterized by dry mouth and dizziness, including Wind-phlegm Syndrome and Stasis,Qi-Yin asthenia syndrome and phlegm stagnation,the prescriptions were Tian Ma Gou Teng Yin,Taohong Siwu Tang,BuyangHuanwu tang,Senqimaiweidihuang decoction,Senqidihuang decoction, Shengmai San,Rehmanniae Decoction of Six Ingredients and Erchen Tang,Banxia Baizhu Tianma Tang,Pingwei San,Wendan Tang respectively.②There were three fundamental pathogenesis in patients with Convalescent Stage of Cerebral Infarction characterized by dry mouth,hypodynamia and dizziness, including Qi-Yin asthenia syndrome,qi deficiency to blood stasis and phlegm stagnation,the prescriptions were Shengmai San,Senqidihuang decoction,Senqimaiweidihuang decoction,Taohong Siwu Tang,Buyang Huanwu Tang,Danshen Decoction,Huangqi Guizhi Wuwu Tang,Siwu Tang,Xuefu Zhuyu Decoction,Tian Ma Gou Teng Yin and Banxia Baizhu Tianma Tang,Wuling Powder,Erchen Tang,Huanglian Wendan Tang,Sijunzi Tang,Gualou Xiebai Banxia Tang respectively.③There were three fundamental pathogenesis in patients with sequel of cerebral infarction characterized by dry mouth and dizziness, including artories and veims stasis,Qi-Yin asthenia syndrome and phlegm stagnation,the prescriptions were Senqidihuang decoction,Senqimaiweidihuang decoction, Shengmai San,Rehmanniae Decoction of Six Ingredients, Danshen Decoction.Buyang Huanwu Tang,Taohong Siwu Tang and Banxia Baizhu Tianma Tang,Decoction of Agastache,Magnolia, Pinellia and Poria,Wuling Powder respectively.Blood stasis and phlegm-dampness were throughout the whole course of Diabetic Cerebral Infarction.The main syndrome of the acute stage were wind, phlegm, blood stasis,and the syndrome of the convalescence were Qi deficiency.blood stasis and phlegm,with greater part of Qi-Yin asthenia syndrome and artories and veims stasis than wet blood stasis and phlegm in the sequelae stage.And the syndrome varied gradually with time.(3)Analysis of the pharmaceutical action:①Traditional Chinese medicine with function of dilated blood vessels, anti-freezing and circulation improvement,such as Achyranthes bidentata, rhizoma chuanxiong, Radix paeoniae Alba and Poria were widely used in the acute stage.②Traditional Chinese medicine associated with increaseing blood flow to the brain and body, improving the body’s ability to resist hypoxic,calming effect on the central nervous system such as Chinese angelica, Astragalus,rehmannia,pseudostellaria heterophylla, rhizoma chuanxiong were used widespreadly in the convalescence.③Traditional Chinese medicine associated with inhibiting platelet aggregation and improving microcirculation,such as Radix salviae miltiorrhizae,alisma,dogwood,schisandra,Radix paeoniae Rubra, Cortex Moutan Radicis were widely used in the sequelae stage.2.4Conclusion:(1)Risk factors of cerebral infarction with diabetes are associated with age,BMI,course of diabetes,Hypertension,Coronary heart disease and Hyperlipidemia, poor glucose control and insulin resistance.(2)The main pathogenesis of Dabetic cerebral infarction are Wind-phlegm Syndrome and Stasis,Qi-Yin asthenia syndrome and phlegm stagnation,artories and veims stasis.Blood stasis was throughout the whole course of Diabetic Cerebral Infarction.(3)The use of Buyang Huanwu Tang,Danshen Decoction,Shengmai San,Taohong Siwu Tang,Senqimaiweidihuang decoction,Tian Ma Gou Teng Yin,Rehmanniae Decoction of Six Ingredients and Banxia Baizhu Tianma Tang are widespread in the Dabetic cerebral infarction. The major therapeutic principles for Diabetic cerebral infarction were dispelling wind and phlegm, promoting blood circulation by removing blood stasis,supplementing qi and nourishing yin and resolving phlegm and removing moisture.(4)The widespread use of Chinese medicine are associated with promoting blood circulation by removing blood stasis, supplementing qi and nourishing yin,for example achyranthes, rhizoma chuanxiong, Radix paeoniae Alba, Poria, atractylodes, Chinese angelica root, Peach kernel, Angelica, Astragalus, rehmannia, pseudostellaria heterophylla, Radix paeoniae Rubra, ophiopogon root and Red Sage root, schisandra, alisma, dogwood, etc. The pharmaceutical action shows that these herbs can be used to improve circulation and microcirculation,increase blood flow to the brain and body, improve the body’s ability to resist hypoxic,calm effect on the central nervous system and inhibit platelet aggregation.