| Background:Diabetes mellitus(DM)is a metabolic syndrome mainly characterized by sugar,fat,and protein disorders,which is a common endocrine and metabolic disease.With changes in people’s lifestyle and dietary habits,the prevalence of type 2 diabetes mellitus(T2DM)is increasing year by year.At present,western medicine mainly uses lifestyle intervention combined with drugs to treat T2DM.Although there are many types of hypoglycemic drugs that can better control blood glucose,it has many complications and high disability rate,causing heavier burden on social economy.There are some advantages for traditional Chinese medicine(TCM)prevention and treatment of T2DM.Professor Zhao Jinxi has been engaged in the clinical,scientific research,teaching and research work of endocrinology for many years.He has a profound understanding of T2DM,and has accumulated a wealth of clinical knowledge and experience.His work has made a large contribution to TCM in the treatment of T2DM.Thus,it is important to pass down this knowledge with all the experiences he has of treating T2DM with TCM.Objective:To analyze and count Professor Zhao Jinxi’s experience in the diagnosis and treatment of T2DM by data mining,summarize Professor Zhao Jinxi’s academic thoughts on the treatment of T2DM by syndrome differentiation method of three yin and three yang,evaluate the accuracy of constitution identification software,and provide reference for the diagnosis and treatment of T2DM by TCM.Methods:In this study,the medical records of 141 patients who were diagnosed with T2DM and prescribed by Professor Zhao Jinxi at the Nephrology Endocrinology Clinic of Dongzhimen Hospital,Beijing University of Chinese Medicine between June 2019 and December 2019 were collected.The research tools such as "Ancient and Modern Medical Record Cloud Platform(V2.2.1)",SPSS 26.0 and Force Atlas map layout algorithm were used to perform frequency statistics,association analysis,cluster analysis,complex network graph layout of the symptoms,syndromes,constitution,medication,etc.The results were studied and summarized,and the experience of syndrome differentiation method of three yin and three yang in the treatment of T2DM was explored.Three yin and three yang constitution identification software was used to automatically determine the patient’s constitution,and the system results were compared with the expert clinical judgment results to evaluate the accuracy of constitution identification software.Results:A total of 141 patients with T2DM were included in this study.The total number of male and female patients were 78 and 63,with the age range of 40-69 years old,accounting for 73.759%of all patients.The majority of the age distribution results were middle-aged and elderly.In patients with T2DM,symptoms included fatigue,irritability,dry mouth,soreness and weakness of waist and knees,dry eyes,increased eating with rapid hungering and spontaneous sweating.Tongue examination showed enlarged and purple dark tongue,enlarged tongue with white tongue coating,greasy tongue coating and purple and extended sublingual collaterals.Pulse examination showed deep pulse,stringy pulse,slippery pulse,fine pulse,deep and fine pulse,slippery and rapid pulse.The comprehensive frequency of the four examinations from more to less was irritability,dry mouth,soreness of waist,weakness of knees,dry eyes,enlarged tongue,deep pulse and increased eating with rapid hungering.The most common statistical result of TCM syndrome was blood stasis syndrome(81.560%),followed by yin deficiency syndrome,depressed heat syndrome,stagnant heat syndrome,phlegm-dampness syndrome and phlegm-heat syndrome.The distribution results of three yin and three yang constitution were ranked from high to low,and the top three were Jueyin constitution(40.430%),Shaoyang constitution(39.010%),and Yangming constitution(14.180%).Among the distribution of subtypes of three yin and three yang constitution,Shaoyang B(24.110%)was the highest,followed by Jueyin A,Shaoyang C,Yangming A,and Jueyin B.Professor Zhao Jinxi’s most commonly used drugs for the treatment of T2DM were Radix Salviae Miltiorrhizae,Radix Puerariae,Radix Scutellariae,Semen Litchi,Faeces Bombycis,Radix Bupleuri,Radix Paeoniae Alba,Euonymus Alatus,Cortex Lycii,Rhizoma Coptidis and Herba Agrimoniae.In terms of medicinal properties,cold,slightly cold and warm drugs were more selected among the four nature.Bitter taste,sweet taste and pungent taste were more selected among the five flavors.In terms of meridians,the frequency of drug use was highest in the liver meridian,followed by the lung,spleen,kidney and stomach.Among the effects of Chinese materia medica,drugs with clearing heat and drying dampness and purging fire and detoxification were the most selected.The most common symptom of Jueyin constitution was irritability,followed by fatigue,dry mouth,soreness of waist and dry eyes.The results showed that irritability was most closely related to Jueyin constitution.The most common symptoms of Shaoyang constitution were fatigue,followed by enlarged tongue,depressed mood,depressed mood or upset.Among them,the confidence of both depressed mood and depressed mood or upset was higher than that of fatigue and enlarged tongue,showing a strong relationship with Shaoyang constitution.The most common symptoms of Yangming constitution were deep pulse,slippery pulse,limb numbness,localized tingling or aggravation at night,nocturia,burning sensation of five centers and abdominal fullness and distension.The results showed that Yangming constitution was closely related to deep pulse and slippery pulse.Among them,Yangming constitution had a strong relationship with limb numbness,localized tingling or aggravation at night and abdominal fullness and distension.In the relationship between constitution and syndrome,the most common syndromes of Jueyin constitution were phlegm-dampness syndrome,damp-heat syndrome,blood deficiency syndrome and liver-yang syndrome.Among them,liver-yang syndrome had the highest confidence(0.470),showing a strong relationship with Jueyin constitution.The most common syndromes of Shaoyang constitution were depressed heat syndrome,yin deficiency syndrome,stagnate heat syndrome,qi deficiency syndrome,phlegm-heat syndrome and qi stagnation syndrome.Among them,the confidence of qi stagnation syndrome was higher(0.530),showing a strong relationship with Shaoyang constitution.The most common syndromes of Yangming constitution were blood stasis syndrome,damp-heat syndrome,blood deficiency syndrome,water dampness syndrome and dampness turbid syndrome.The confidence of water dampness syndrome was higher(0.260),showing a strong relationship with Yangming constitution.It was shown in the complex network diagram of constitution-syndrome-Chinese materia medica that some symptoms were more prominent in constitution,and there was a certain tendency between symptoms and constitution.Professor Zhao Jinxi’s core drugs for the treatment of T2DM included Radix Bupleuri,Radix Scutellariae,Radix Glehniae,Rhizoma Pinelliae,Pericarpium Citri Reticulatae,Radix Puerariae,Radix Salviae Miltiorrhizae,Spica Prunellae,Rhizoma Atractylodis,fried Rhizoma Atractylodis Macrocephalae,Poria,Radix Astragali seu Hedysari,Rhizoma Ligustici Chuanxiong,Radix Angelicae Sinensis,Radix Paeoniae Alba,Euonymus Alatus,Fructus Arctii,Faeces Bombycis,Cortex Lycii,Rhizoma Coptidis,Radix Glycyrrhizae,etc.The most commonly used drug pairs were Radix Dipsaci slice and Herba Taxilli,Semen Persicae and Flos Carthami,Os Draconis and Concha Ostreae,Rhizoma Polygonati Odorati and Herba Siegesbeckiae,etc.The most commonly used medicine strings were Rhizoma Smilacis Glabrae,Yam Rhizome,Folium Pyrrosiae,and Rhizoma Dioscoreae Nipponicae;Bombyx Batryticatus,Rhizoma Curcumae Longae,Radix et Rhizoma Rhei,and Periostracum Cicadae;Semen Persicae,Flos Carthami,Hirudo,and Lumbricus.In the evaluation of the small program performance of three yin and three yang constitution,the accuracy of judging Shaoyang constitution was 82.432%.The accuracy of Jueyin constitution judgment was 81.091%.The accuracy of Yangming constitution judgment was 82.432%.However,the accuracy rates of Taiyin constitution,Shaoyin constitution and Taiyang constitution were 98.469%,95.946%and 97.297%,respectively.Although the accuracy rate was high,the values of positive likelihood ratio or negative likelihood ratio showed NA value or 0.000 value.This is a lack of sample size,which can be confirmed again after increasing the sample size.In the evaluation of three yin and three yang subtype constitution,the accuracy of Shaoyang A constitution judgment was 90.541.The accuracy of Shaoyang B constitution judgment was 74.324%.The accuracy of judging Shaoyang C constitution was 85.135%.The accuracy of Jueyin A judgment was 78.378%.The accuracy of judging Jueyin B constitution was 89.189%.The accuracy of judging Jueyin C constitution was 94.595%.The accuracy of Yangming A constitution judgment was 83.784%.The accuracy of judging Yangming B constitution was 94.595%.The accuracy of judging Yangming C constitution was 98.649%.Conclusion:(1)In the medical records of this study,for three yin and three y ang constitutions of T2DM,there are more constitutions of Jueyin,Shaoyang and Yangming.(2)Based on the medical records of this study,Professor Zhao Jinxi attaches great importance to the combination of disease differentiation and syndrome differentiation in the treatment of T2DM,and commonly uses heat-clearing drugs and blood-activating and stasis-reducing drugs,which reflects Professor Zhao Jinxi’s emphasis on the use of drugs for pathogenesis.(3)The accuracy of three yin and three yang constitution identification software is relatively satisfactory,and the accuracy of the determination of constitution subtypes needs to be collected for further evaluation. |
