The Study Of Professor Nie Lifang’s Treatment Experience Of Chronic Renal Failure Based On Data Mining Methods

Chronic renal failure refers to a clinical syndrome composed of a series of symptoms and metabolic disorder, which results from progressive impairment of renal function because of various kinds of primary or secondary chronic kidney diseases,and leads to end stage renal disease eventually.The disease is a serious threat to human health. For the early and middle stage CRF patients, symptomatic treatment effect of western medicine is limited;for patients with ESRD,the application of replacement therapy is restricted due to the high cost and other reasons.Chinese medicine has certain advantages and characteristics in the treatment of chronic renal failure, which will help improving symptoms,protecting residual renal function and improving life quality of patients.This study uses data mining methods of support vector machines, complex networks and chi-square correlation coefficient to analyze tutor’s treatment experiences of diagnostic rule, therapeutic principles and methods,prescription and medication,which will enrich the theoretical system of diagnosing and treating the disease of TCM and provide some effective ideas and methods,in order to better guide clinical work,promote the efficacy.Literature researchBy collation and the analysis of ancient and modern Chinese medicine literature,we explore the understanding of ancient physicians about the disease from the relevant description of "edema","Longbi" and "Guange","Shenlao","Shenfeng,""Niaodu",etc, and then summarize recent developments of pathogenic factors, pathogenesis, therapeutic principles and methods, treatment based on syndrome differentiation. Through review of western medicine literature, we elaborate research progress of the disease concering epidemiology, etiology, pathogenesis and treatment.Professor Nie Lifang’s cognition and basic ideas on diagnosis and treatment of chronic renal failure.The name of disease:my supervisor think it more appropriate to call the disease as "Guange", because it highlights the clinical features of end-stage chronic renal failure and plays an important role in judging the prognosis.Pathogenic factors and pathogenesis:my supervisor considers that the pathogenic factors includes main and induced causes.The former is mostly owed to the deficiency of spleen and kidney,the latter is caused by external evil and overwork.Its pathogenesis lies in healthy energy deficiency and evil excess, meanwhile,deficiency can cause excess.Healthy energy deficiency is oftenly differentiated by qi,blood,yin and yang. Among them,qi-yin deficiency is the mostly common. evil excess includes external evil,water stop, turbid damp,blood stasis,stirring wind,phlegm, accumulation of dryness in stomach and intestine,etc.Basic ideas on diagnosis and treatment:(1)Grasping main symptoms and differentiating syndrome flexiblely.(2)Treating the disease according to deficiency or "Guange" stage so as to distinguish principal and secondary aspects.(3)In the deficiency stage,it’s important to supplement qi and nourish yin,in the "Guange" one,it’s should be paid attention to regulating spleen and stomach and purging fu-organs to eliminate the turbid.(4)Emphasis on nursing the vital qi.General characteristics of casesThe cases are CRF hospitalized and clinic patients diagnosed and treated by my supervisor from2007to2013, a total of380cases,636visits.The ratio of male to female is1.235:1, with the mean age53.20±15.24years.In primary disease,unknown causes acount for22.37%,followed by chronic glomerulonephritis and diabetic nephropathy. The number is respectively20.79%and18.42%.To laboratory examinations, serum creatinine379.30±233.22μmol/l,blood urea nitrogen17.82±8.06mmol/l, hemoglobin103.38±20.19g/l.To stage of chronic renal failure,the patients of decompensation are the most acounting for197cases,followed by75cases of renal dysfunction,73cases of compensation and35ones of uremia or end-stage renal failure.To stage of CKD,the cases of stage5are the most,amounting to138,followed by137of stage4and100of stage3.Stagel and2have the least cases.Analysis on TCM syndromeThe symptoms that occurrence frequency is more than20%are in order: spiritlessness and fatigue,anorexia,constipation,bitter taste,edema,dry mouth,insom- nia,lumbago, easy to catch cold,feeble waist and knees,dizziness,nausea.The signs that be indicated by tongue and pulse of which occurrence frequency is more than20%are as follows:pale dark tongue,reddened tongue,pink tongue,yellow greasy moss,deep thin puls.Among TCM syndrome types, qi-yin deficiency is the most common accounting for52.83%,followed by deficiency of both spleen and stomach,damp-heat stagnation in middle-jiao.Of the secondary TCM syndrome,damp-heat pattern is the most common,followed by water wet, blood stasis and turbid damp patterns.Analysis on prescriptions and herbsPrescriptions that using frequency is more than10%in this study are in order:Shenqidihuang decoction(37.58%),Xiangshaliujunzi decoction(19.81%), Huanglianwendan decoction(19.18%), Shengmai drink(16.82%).Herbs that using frequency is more than50%are as follows:Poria(Fuling)(89.62%),Radix Pseudostellariae(Taizishen)(82.39%),Flos Lonicerae(Jinyinhua)(75.79%),Radix Angelicae Sinensis(Danggui)(66.04%),Radix Astragali seu Hedysari(Shenghuangqi)(62.74%),Radix Salviae Miltiorrhizae(Danshen)(59.91%),Rhizoma Coptidis(Huang-lian)(55.19%).Data miningApplying support vector machine,complex network and chi-squared correlation coefficient methods to research supervisor’s diagnose and treatment experiences on chronic renal failure.Summary of supervisor’s experience(1)Diagnosis regularity:for qi-yin deficiency syndrome,the main symptoms are as follows:spiritlessness and fatigue, palpitation,feeble waist and knees,feverish sensation over the palm and sole,etc.For deficiency syndrome of both spleen and stomach,the main symptoms include anorexia,spiritlessness and fatigue,etc.For damp-heat stagnation in middle-jiao syndrome,the main symptoms consist of anorexia,bitter taste,etc.For deficiency syndrome of both liver and kidney yin,the main symptoms involve dizziness and other symptoms.Meanwhile,my tutor emphasizes comprehensive analysis through the four examination methods.(2)Therapeutic principles and methods:in acute conditions,it’s important to treat the prominent symptoms firstly,in chronic ones,treatment should be mainly focused on strengthening healthy qi.Based on it, it should be also considered to eliminate pathogenic factors.(3)Law of prescription and medication:①treatment in different phases and emphasis on spleen and kidney:Liuweidihuang decoction is flexiblely used when tonifying kidney, Xiangshaliujunzi, Huanglianwendan decoction and Shenlingbaizhu powder can be often used when regulating spleen and stomach, meanwhile, it’s important to purge fu-organs to eliminate the turbid and make an outlet for evil.ゝive viscera are linked with each other,so heart,liver and lung should be also taken into account to achieve the purpose of treat the whole.③asping the main symptoms,electing prescriptions based on syndromes differentiation and adjusting medication according to clinical symptoms,④medication is mild,emphasis on the practical effect.⑤tonifying should be combined with dredging in order to avoid stagnation.Innovation:1.Using support vector machine method to analyze the main symptoms information of TCM syndromes types and mine Professor Nie Lifang’s diagnosis laws of CRF.2.Using complex network method to analyze the core prescriptions and herbs’ compatibility;using chisquare correlation coefficient to analyze the relationship between herbs and symptoms and mine Professor Nie Lifang’s treatment character-ristics and medication experience of CRF.