Distribution Of Qi - Yin Deficiency And Blood - Stasis Syndrome In Early Diabetic Nephropathy And Its Syndrome Diagnosis

ObjectiveThe research is about deficiency of Qi-Yin and blood stasis syndrome of early diabetic nephropathy syndrome diagnostic criteria, focusing on the literature research, clinical medical data mining and clinical syndrome scale research, this three part to carry out the research. Establishment syndrome diagnostic scale of deficiency of both qi and Yin and blood stasis syndrome of early diabetic nephropathy by means of the modern mathematical technology, in order to present syndrome diagnostic criteria in clinical diagnosis and treatment. To create conditions for the development of standardized treatment for early diabetic nephropathy in Thailand.Method1 Literature research:Literature Study on syndrome distribution characteristics of early diabetic nephropathy. Retrieve Chinese periodical CNKI and Wanfang database from 1st January 2000 to 30th September 2015) obtain the target literature, carries on analysis the literature, collected 15 years literature about traditional Chinese medicine or integrated traditional Chinese and Western medicine combined which contained reports of staging syndrome differentiation and typing of early diabetic nephropathy and clinical statistics for each syndrome frequency, rate and percentage.2 Data mining:Medical data mining based on the study of medical treatment records of early diabetic nephropathy by Professor Zhao Jinxi about differentiation of syndrome distribution and drug characteristics of which analyzed by TCM inheritance aided analysis system. Collected treatment of early diabetic nephropathy patients medical records of Professor Zhao Jinxi at Beijing University of traditional Chinese medicine Dongzhimen Hospital of from January 2011 to December 2015, analyzed the medical records by "TCM inheritance auxiliary system" which developed by the Chinese Academy of Sciences chinese medicine new drug design project team. Data mining analysis of symptoms, syndrome elements, syndromes and prescription drugs, to study the characteristics syndrome of early diabetic nephropathy, and to explore the characteristics of drug use in early diabetic nephropathy.3 The study on syndrome diagnosis standardization:Initially establishment the syndrome differentiation scale of blood stasis syndrome of early diabetic nephropathy.According to the literature research and the use of Delphy method to establish expert questionnaire. A questionnaire survey was conducted on 44 experts from 14 provinces,3 municipalities, cities, Hongkong and Singapore, and carries on the data analysis At the same time,50 cases of early diabetic nephropathy patients in Dongzhimen Hospital of Beijing University of Chinese Medicine were investigated, using modern statistical methods to screen the syndrome differentiation. Such as the survey of the distribution of items, the Krone Bach coefficient method, discrete trend method, correlation coefficient method, factor analysis method, etc. The initial establishment of early diabetic nephropathy and syndrome differentiation scale. The reliability and validity of the questionnaire were assessed, and the syndrome score table was established.Results1 Literature research:Inclusion of 21 papers in accordance with the requirements of the literature, a total of 2592 patients with early diabetic nephropathy were investigated, and 47 kinds of syndromes were collected. After the combination and classification,21 types of early diabetic kidney disease syndrome types were collected. The most common deficiency syndromes are Qi-Yin deficiency (80.9%), Yin asthenia generating intrinsic heat (71.4%) and Yin-Yang deficiency (57.1%). The most common of excess syndrome is blood stasis syndrome (38.1%). Main syndrome elements are Yin deficiency (60.1%), Qi deficiency syndrome (42.7%) and blood stasis syndrome (17.1%). Main disease positions are in kidney (72.2%), spleen (38.9%), liver (22.2%).2 According to Professor Zhao Jinxi in the treatment of early diabetic kidney disease in 144 cases of data mining, the results showed that the rate of use of prescription drugs was classified as high to low is:liver and spleen, lung, heart, stomach, kidney, bladder, colon, bladder, small intestine. Four natures of medicine statistics show, cool drugs is the most common, followed by warm, mild, cold and heat.Five flavor of medicine statistics show, bitter and sweet is the most common, followed by chill, sour, salty, light and astringent taste.Involves 213 kinds of traditional Chinese medicine, were used more than 44 times were Salvia miltiorrhiza, Radix Astragali, radix puerariae, Radix Angelicae sinensis, Radix Scutellariae, Radix Bupleuri, liquorice, Rhizoma Chuanxiong, Radix Paeoniae Alba, tangerine peel, Poria, Poria, radix paeoniae rubra, Rhizoma Dioscoreae hypoglaueae, radix rehmanniae, Fructus Arctii, Achyranthes root, Achyranthes root, Salvia miltiorrhiza was the most frequently used, was used 124 times. Drug rules support more than 65 of the drugs were, Salvia miltiorrhiza,Astragalus root, Angelica sinensis, Ge Gen. Among them, the first 5 combinations were " Salvia miltiorrhiza and Astragalus root", "Salvia miltiorrhiza and Ge Gen", " Angelica sinensis and Astragalus root", " Salvia miltiorrhiza and Angelica sinensis ", " Salvia miltiorrhiza, Angelica sinensis and Astragalus root". Use association rule support degree more than 50 times, commonly be used traditional Chinese medicines are:Salvia miltiorrhiza, Astragalus root, Angelica sinensis, Ge Gen, Rhizoma Chuanxiong, Radix Scutellariae, Radix Glycyrrhizae, Poria, Radix Bupleuri, Bixie. Commonly be seen symptoms are:dry throat, dry eye, vertigo, fatigue, dizziness, dry stool, limb numbness, poor sleep, foamy urine, spontaneous perspiration, bitter taste of mouth, hand and foot fever, skin armour fault, chest tightness, less words, backache.Common tongue:dark tongue with ecchymosis, dark yellow and greasy fur, slippery pulse, moss thin yellow, white and greasy fur, red tongue, thin pulse. One of the most common symptoms are dry throat, lassitude, dark tongue with ecchymosis.Description deficiency of both Qi-Yin with blood stasis syndrome is the most common syndrome of early diabetic nephropathy, so commonly used Supplanting Qi, Nourishing Yin and Promoting Blood Circulation in clinical treament,used Salvia miltiorrhiza, Astragalus root, Ge Gen and other drugs.3 According to the literature research of early diabetic nephropathy and data mining results, this research and integration through standard retrieval, formed 3 dimensions and 25 of item pool of the four methods of diagnosis, respectively:Qi deficiency dimensions: ① fatigue,② less words, ③ shortness of breath,④spontaneous sweating. ⑤ easy to get a cold, ⑥ eat less, loose stools, ⑦ fat big tongue edge dimension with teeth marks; Yin deficiency dimensions: ①heat intolerance, ② night sweats, ③ dry throat, ④dry eyes and have blurred vision, ⑤dry lips, ⑥thirst with no desire for drink,⑦feverish palms and soles, ⑧ dry stool, ⑨ soreness and weakness of waist and knees,⑩ emisson and preature ejaclation, 11 thin tongue with crack, 12 less tongue coating; Blood stasis dimensions: ①tingling, ② numbness and pain in the limbs,③ scaly dry skin,④ dark purple lip and tongue,⑤ dark red tongue and ecchymosis, ⑥ sublingual vessel engorgement. Using two rounds of questionnaire of subjective screening method (Delphi method) selected the items, Preliminary form the scale which contains 3 dimensions and 10 items. Qi deficiency dimensions:① fatigue, ② less words, ③ spontaneous sweating; Yin deficiency dimensions: ① dry throat, ② dry eyes and have blurred vision, ③ feverish palms and soles, ④ dry stool;Blood stasis dimensions: ① numbness and pain in the limbs, ② scaly dry skin, ③ dark red tongue and ecchymosis. Using objective screening method, the final form contains 10 symptom items. The internal correlation coefficient and Krone Bach coefficient were used to study the reliability of the scale. The results showed that:the internal correlation coefficient Qi deficiency dimension:0.919, Yin deficiency dimension:0.941, Blood stasis dimension:0.965. Krone Bach coefficient:Qi deficiency dimension:0.821; Yin deficiency dimension:0.885; Blood stasis dimension:0.836. The reliability of the scale is good. Through the examination and evaluation of the correlation coefficient of the symptom items and dimensions, each dimension and the total dimensions to achieve, the correlation coefficient is between 0.808-0.912, have statistical significance. Shown early diabetic nephropathy of deficiency of both Qi-Yin and blood stasis syndrome scale has good reliability and validityConclusion1 Early diabetic nephropathy duration is longer, the symptom is not typical. Different experts have different views on early diabetic nephropathy. The results of this study show that early diabetic nephropathy with both Qi-Yin deficiency and blood stasis is the most common.2 Using TCM inheritance system platform for data mining research about medical information of Professor Zhao Jinxi in the treatment of early diabetic nephropathy, statistics on symptoms, syndrome elements and syndromes, organized association of commonly used drugs, drugs and drugs.Acquire new knowledge by new way of association. Professor Zhao Jinxi in the treatment of early diabetic nephropathy often use Supplanting Qi, Nourishing Yin and Promoting Blood Circulation, because in early diabetic nephropathy, the one with deficiency of both qi and Yin and blood stasis syndrome is the most common. The medical data mining, prescription analysis to understand the characteristics of syndrome distribution of innovation3 The establishment of early diabetic nephropathy with both Qi-Yin deficiency and blood stasis syndrome scale by this study have high feasibility, internal consistency and high reliability, internal validity is good. Application of modern mathematical statistics method on the basis of expert questionnaire and on the basis of definite clinical stages to the study of syndrome standardization.In the early stage of diabetic nephropathy, the syndrome standardization research field is still the first time.To provide evidence for the clinical and scientific research of traditional Chinese medicine for early diabetic nephropathy.4 This scale is based on the research and development of China, how to guide the Thailand traditional Chinese medicine clinical needs to be further studied.