| Objective:This paper uses R language data mining to study Professor Piao Bingkui(a renowned traditional Chinese medicine doctor)Chinese herbs medication for post-surgery colorectal cancer patients,in order to enrich Piao’s clinical experience and academic ideas,as well as to enlarge data for advanced treatment of colorectal cancer.Methods:A retrospective analysis was the focus of this study.Professor Piao Bingkui’s medical records of colorectal cancer patients at Guang ’anmen Hospital and Beijing Yiqingtang Chinese Medicine Clinic were gathered and organized from January 1st,2002 to February 31th.The sum of 642 patients,2226 consultations,and 180 TCM prescriptions was acquired.With the help of R language data mining tools,Linquorice technology,mathematical thoughts,theoretical thoughts of basic theory of traditional Chinese medicine,clinical thoughts of traditional Chinese medicine,the trinity was used to analyze the characteristics and compatibility rules of Piao’s medication for patients with colorectal cancer.Results:1.Patient basic informationOf the 642 cases,376 were male(59%)and 266 were female(41%).The highest incidence of colorectal cancer was between 50 and 70 years old,with a total proportion of more than 50%.The common symptoms were fatigue,poor sleep,frequent or loose stool,dry stool,abdominal distension,anorexia,etc.The tongue,a pale red and slightly dark colour,was coated in thin white or yellow.The pulse pattern was mainly string slip pulse.Spleen and kidney deficiency accounted for the highest proportion in the distribution of syndromes,followed by six main syndromes such as dampness and heat,phlegm and blood stasis.2.Single Traditional Chinese Herb statistics2.1 High frequency drugs,classifications and dosages.There were 12 drugs with a frequency of more than 2.90%,a frequency of more than 1000,and more than 50%of the prescriptions were used,including astragalus,Fructus fructus,yam,salt Yizhiren,etc.Among 180 drugs,the most commonly used drugs were deficiency tonic drugs with 39.98%of the total,followed by digestion drugs at 13.90%,heat clearing drugs at 13.50%,qi regulating drugs at 10.42%,water and moisture enhancing drugs at 6.34%,etc.The common dosage was 10g to 20g,with a minimum of 1g and a maximum of 40g.According to the frequency of occurrence,an average of 18 kinds of drugs were counted in each first prescription.Based on the classification of drugs,each first prescription consisted of 7 kinds of drugs for filling deficiency,3 kinds of drugs for digesting food,2 kinds of drugs for clearing heat,2 kinds of drugs for regulating qi,1 kind of drugs for promoting water and wetting,and 3 kinds of other categories.2.2 Property of Chinese herbsThe four qi drugs were commonly used as warm(lukewarm)medicine(43.98%)and mild medicine(29.49%),followed by cold(slightly cold)medicine(16.18%)and cool medicine(8.63%).Each four-qi formula consisted of 8 warm(slightly warm),5 mild,3 cold(slightly cold),2 cool medicine,and 0.3 heat and big heat.The most commonly used five flavors were sweet flavor(45.07%),followed by spicy flavor(23.18%)and bitter flavor(21.69%).The use of acid and salt was less,and each prescription of five flavors was composed of 14 flavors(slightly)sweet(light)+7 flavors spicy+7 flavors(slightly)bitter+3 flavors sour(astringent)+0.3 flavors salty;The first meridian-attributing prescription was spleen and stomach(47.33%),followed by lung(18.09%),liver(12.99%)and kidney(10.45%).The prescription for each meridian-attributing was comprised of 21 spleen and stomach,8 lung,6 liver,5 kidney,3 heart,6 spleen and stomach,and 2 pericardium.The use frequency of rising and floating medicine(51.73%)was higher than that of settling medicine(42.09%),and the duality was 6.18%.The composition of rising and floating medicine for each prescription was about 8 kinds of rising and floating medicine+7 kinds of settling medicine+1 kind of duality.The drug belonged to non-toxic was 97.02%.2.3 Yin and Yang,five elements of Chinese herbsThe frequency of yang-reinforcing drugs(67.79%)was much higher than that of yinreinforcing drugs(32.21%),and there were about 11 yang-reinforcing drugs and 5 yinreinforcing drugs for each prescription.The five elements commonly belonged to earth medicine(33.29%),followed by gold(23.92%),wood(18.27%),water(17.15%)and fire(7.38%).The composition of the five elements in each prescription was about 11 flavors of earth+8 flavors of gold+6 flavors of wood+6 flavors of water+2 flavors of fire.3 Mutiple groups of Traditional Chinese Herbs statistics3.1 Pair drugsThe correlation coefficient was more than 90%.The commonly used pair drugs were astragali astragalus with Fructus aurantii,yam,gluten-fried Atractylosum,Tangerine peel,Tuckaia cocos and Radix radix;Fructus aurantii with yam,Tangerine peel,salt Yizhiren and gluten-fried Atractylosum,respectively;Yams were compatible with Radix radix,Yizhiren,Tuporia cocos,Tangerine peel,Tangerine peel and Radix radix cocos,Yizhiren and Tangerine Cocos,respectively,the total statistics were 21 pairs.3.2 Groups of drugsTwo sets of stability clusters were obtained by cluster analysis.One cluster was the core formula cluster commonly used by Piao Bingkui,namely Astragalus,Tuckaia coporia,bran fried Fructus aurantii,Radix pseudostellata,salt Yizhiren,Tangerine peel,bran fried Atractylodes atractylodes,and yam.The other cluster was Angelica,cardamom,coix seed and Perilla peduncle.4 "Three discrimination" medication statistics4.1 Medication for disease differentiationMedication for colorectal cancer.This study revealed that 141 drugs were prescribed for colorectal cancer,with little disparity in the overall drug intake.However,the frequency of the same medication was distinct between the two illnesses,demonstrating the disparity in the utilization of drugs in each prescription.The use frequency of the two drugs was ≥1.00%,involving the top 24 drugs.Among them,23 drugs were the common use,and there were 2 different drugs,colon cancer with honey licorice,rectal cancer with raw atresia respectively.Different treatment means of medication.A total of 139 flavors of postoperative medication,127 flavors of chemotherapy,100 flavors of radiotherapy and 75 flavors of targeted medication were used.Each treatment method was composed of basic formula plus or minus different drugs.For postoperative,chemotherapy,radiotherapy and targeted drugs,the top 24 drugs with drug frequency greater than 1.00%were selected.The frequency of the same drug varied between treatment stages,yet there was not much disparity in the general drug consumption.4.2 Medication for symptoms of pattern differentiationAccording to Piao’s idea,the symptoms of pattern differentiation of postoperative patients with colorectal cancer mainly presented six types:qi-deficiency in spleen and kidney,mutual accumulation corresponding to dampness and heat,others were phlegm and blood stasis,deficiency of qi and blood,liver depression and qi stagnation and deficiency of spleenkidney Yang.Taking spleen-kidney deficiency and damp-heat interaction symptoms as an example,a total of 118 flavors were employed to illustrate spleen-kidney deficiency and 101 flavors to illustrate damp-heat interaction symptoms.Significant disparities were generally observed between the two indications.The drug frequency of the top 24 could reach approximately more than one percent,including the basic formula and medlar fruit,loboulifera,liquor-ligurea and other 19 flavors,the two different use of drugs,spleen and kidney deficiency with angelica,cardamom,tulip and other 5 flavors,and damp and heat interaction with vinegar ginger magnolia officinalis,vine pear root,ginger pinellia and other 5 flavors;For the same drug,there were 7 flavors of tangerine peel,radix radix,wolfberry and cinnamon with higher frequency of spleen-kidney deficiency than that of damp-heat deficiency,while 12 flavors of drugs with higher frequency of damp-heat deficiency included fructus aurantii,tuckaia coix,bungei and rhizoma atractylodes.Professor Piao also attached great importance to microscopic symptoms differentiation,especially to the tongue and pulse.The results of this research demonstrated that the typical tongue covering was a light red,dark,thin white,thin yellow,and thick yellow tongue.The drug use was as follows:For slightly dark tongue(30.51%),rhodiola rosea,spathophora spathophora,tulip,etc.For thin yellow coat(25.36%),atractylodes atractylodes,tangerine peel,coix seed,gynostema rhizoma,etc.For thick yellow coat(16.01%),Tuckaia coix,forsythe,tangerine peel,etc.The common pulse conditions were as follows:weak pulse,smooth pulse and slow pulse,and the corresponding drug conditions were as follows:Weak pulse(21.37%)used poria cocos,astragalus,bran stir-fried white rhizoma and licorice,etc.String-like pulse and slippery pulse(20.93%)used Chinese herbs such as angelica sinensis,Scutellaria scutellaria,radix rehmanniae,bupleurum,alisma alisma and gardenia,etc.For moderate pulse(18.06%)used such as codonopsis,safflower,ban stir-fried white fungus,astragalus membranaceus,radix aucklandiae and angelica sinensis,etc.4.3 Medication for syndromes differentiationThe results showed that of the total syndromes of postoperative colorectal cancer patients,70%were identified:fatigue,lack of sleep,frequent stool,loose stool,dry stool,abdominal distention,lack of appetite,perspiration,abdominal pain,numbness of limbs,dizziness,blood in stool,dry mouth,coughing,and fear of cold,totally 15 kinds.According to the main syndromes of the patients,different drug treatment schemes were adopted,such as fatigue(9.01%)can use astragalus,bran fried atractylops,poria cocos and other drugs.Poor sleep(8.20%)can use poria cocos,Bai Zi kernel,fried jujube kernel and other drugs.For the frequency of stool(8.07%)and loose stool(7.42%),drugs such as stewed nutmeg,fried Atractylodes with bran,vinegar schisandra and salt psoralpa could be used.When the stool was dry(5.37%),traditional Chinese medicine such as fire sesame seed,Angelica,bran fried fructus aurantii,raw atractylodes and cistanche can be used.While abdominal distension(5.10%)can use wood incense,bran fried divine comedy,fried malt and burnt hawthorn and other traditional Chinese medicine to relieve syndromes.5 Changes in the characteristics of Piao Bingkui’s medicationTaking January,2012 as the time point,this paper tried to analyze differences of medication used in the prescriptions of Piao Bingkui for ten years before and after.In the last decade,Piao’s utilization of tonic deficiency drugs,liver-soothing drugs,calming drugs,dampness drugs and warm inside drugs increased in comparison to the preceding decade,while water-enhancing drugs and heat-clearing could be seen an increase,and the use of traditional Chinese medicine,with its effects of invigorating spleen and detoxifying,invigorating qi and promoting qi,regulating qi and relieving pain,eliminating phlegm and promoting body fluid,stopping diarrhea and digesting food,saw a decrease in drug use.It suggested that Professor Piao paid more attention to the deficiency of the patients with colorectal cancer after operation,and often made qi stimulation while strengthening the upright position.And in the use of detoxification products still needed to consider the situation of deficiency,so as to strengthen body resistance without leaving evil,and vice versa.Conclusion:1.Through data mining,this paper summarized the basic etiology and pathogenesis of Professor Piao Bingkui’s understanding of colorectal cancer:deficiency of body energy qi,imbalance of viscera,internal invasion of evil poisons,negative emotions,improper diet,deficiency of viscera;The specific etiology and pathogenesis were spleen and stomach inharmony.Dereliction of duty of spleen and stomach was the foundation,damp accumulation,heat and poison,qi stagnation,phlegm stagnation,blood stasis and other mutual factors were superficial,which showed deficiency in origin and enrichment in symptom two aspects.2.Professor Piao,in his treatment of post-operation colorectal cancer patients,opted to investigate the source of the illness,bolster the health and vanquish the wickedness,elevate the spleen and stomach,adjust the qi apparatus,and foster Yin and Yang harmony.Warm spleen to aid Yang-qi,attend to the spleen and stomach,warm but not to ignite,cold yet not to harm Yang.The treatment was nourishing and dispelling evil,detoxifying and anticancer,tonifying and benefiting qi,invigorating spleen and kidney,clearing heat and detoxifying,drying dampness and phlegm,and detoxifying qi and dispersing.Focused on attack and slow use,to slow attack.And emphasized its discord,different,dispelling poison,attenuation,or coexistence,or prevention during segmented treatment.3.Piao Bingkui’s drug feature showed 8 basic prescriptions as the core,flexible drug selection,payed attention to compatibility.Flexible use,one way was to strengthen the body,such as deficiency drugs,qi drugs,blood drugs,etc,another was to eliminate pathogenic drugs,such as drugs activating blood stasis,digestion,heat,surface,water and moisture,etc.Additionally,in terms of drug compatibility,it could benefit qi and fill deficiency,dispel pathogenic factors.Paying attention to Yin and Yang,also the spleen and stomach,lung,liver and kidney care.Qi and blood are in tune,with qi as the main;warm mild slight spicy,seeking qi and flavor together.Multi-use of rise medicine,good use of rise and fall.Five elements of health,considered in soil-based.Drug preference,emphasized in processing method.Light and small prescription,observed flat through strange.The way of three talents followed by the characteristics of drug selection and prescription.4.Piao Bingkui advocated the treatment of colorectal cancer.On the basis of "four combination",according to the characteristics of colorectal cancer,"three differentiation"medication,warm Yang,filled the deficiency and reduced the solid,divided dampness and heat,so as to achieve "treating middle jiao as balance",and achieved mild level. |
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