Research On The Clinical Experience Of Professor Guoqiang Mei In Differention And Treatment For Heart Disease Based On Data Analyzing And Mining

ObjectiveThis study analyzes the medical cases collected from Guoqiang Mei,a national famous TCM practitioner by utilizing his data and exploring the relationship of disease-syndrome,symptom-syndrome,prescription-syndrome,prescription-symptom,prescription-Chinese medicinal herbs,Chinese medicinal herbs-symptom,and medicine groups under the compatibility rule for the Chinese medicinal herbs mentioned in his medical cases,assisted with charts to concisely outline and summarize his prescription characteristics and clinical experience in differentiating and treating heart disease.The final purpose is to better inherit and glorify Mei’s clinical experience and his academic essence of TCM from a comprehensive and objective perspective.MethodsThe medical cases analyzed in this study were collected by Guoqiang Mei from 1992 to 2015 in differentiating and treating heart disease,which were strictly screened and sorted by using the Access 2010 database in developing the case recording system,while the recording work was carried out in accordance with the inclusion/exclusion criteria,complied under the standardization of TCM terminology,and then imported into the Weka3.6 data mining software.We use frequency analysis,association rules,clusteringanalysis and other methods to analyze the data information then utilize the Pajek2.0 complex network software to draw a complex network map.In this way,the herbal function is distinguished by the color of the nodes.The node connection parameters are calculated based on the analytical results of the association rules.The results in the clustering analysis act as the core circle.Finally,the application laws Chinese medicinal herbs by Professor Guoqiang Mei in treating all kinds of heart diseases are clearly shown in the map.ResultsThe recorded 2553 cases with coronary heart disease such as general heart disease,arrhythmia,hypertension,and rheumatic heart disease are collected and analyzed by data mining.Generally,his treatment rules are as follows:1.Professor Mei’s Differentiation and Treatment Rules for Various Heart Diseases1.1 Professor Mei’s differentiation and treatment rules for coronary heart diseaseThe core syndromes Professor Mei treated for coronary heart disease were the binding syndrome of Turbid Phlegm and Blood Stasis,the Shaoyang syndrome,the deficiency syndrome of both the vital energy and Yin;syndrome of Qi stagnation and Blood Stasis.The core prescriptions that Professor Mei used are as follows:(1)Xiaoxian-xiong decoction to deal with the binding syndrome of phlegm-heat and stagnant blood;(2)Gualuoxie baibanxia decoction to deal with the binding syndrome of turbid phlegm and stagnant blood;(3)Wendan decoction to deal with the syndrome of interior disturbance due to phlegm-heat;(4)Chaihuxian-xiong decoction to deal with pathogenic factors invading Shaoyang and phlegm-heat retention in the chest;(5)Huangqi Shengmai Powder to deal with the deficiency syndrome of both the vital energy and Yin;(6)Xuefuzhuyu decoction to deal with the syndromeof Qi Stagnation and Blood Stasis.The 50 Chinese frequently used medicinal herbs are as follows: angelica;rhizome of sichuan lovage;ground beetle;prepared pinellia;immature bitter orange;curcuma root etc.The core compatibility rules are: angelica is compatible with rhizome of sichuan lovage,ground beetle is compatible with safflower,ground beetle is compatible with sappan wood,cattail pollen is compatible with faces of flying squirrel;astragalus root is compatible with sun-dried ginseng;grass-leaved sweetflag is compatible with polygala root,arisaema with bile is compatible with prepared pinellia;evodia fruit is compatible with Chinese goldthread,cuttlebone is compatible with evodia fruit;corydalis tuber is compatible with turmeric;while corydalis tuber is compatible with chinaberry fruit.1.2 Professor Mei’s differentiation and treatment rules for arrhythmiaThe core syndromes that Professor Mei treated for arrhythmia were the binding syndrome of turbid Phlegm and Blood Stasis,the deficiency syndrome of both the vital energy and Yin,the Shaoyang syndrome,the syndrome of Blood Stasis and Qi Stagnation,the deficiency syndrome of both Heart Yin and Heart Yang.The core prescriptions Mei employed are as follows:(1)Xiaoxian-xiong decoction added with medicinal herbs with the property of soothing Qi and activating blood to deal with the syndrome of phlegm-heat and blood stasis;(2)Huangqi Shengmai Powder added with herbs with the property of activating blood and tranquilizing mind to deal with the deficiency syndrome of both the vital energy and Yin;(3)Chaihu xianxiong decoction to deal with the syndrome of pathogenic factors invading Shaoyang as well as phlegm-heat retention in the chest;(4)Xuefuzhuyu decoction to deal with the syndrome of Qi Stagnation and Blood Stasis;(5)Zhigancao decoction to deal with the deficiency syndrome of both Heart Yin and Heart Yang.The 50 frequently used medicinal herbs are: angelica;rhizome of sichuan lovage;ground beetle;prepared pinellia;immature bitter orange;Chinese gold-thread;mongolian snakegourd;sophora flavescens etc.The core compatibility rules are as follows: mongolian snakegourd is compatible with prepared pinellia,Chinese gold-thread is compatible with prepared pinellia;grass-leaved sweetflag is compatible with polygala root,tangerine peel is compatible with poria;angelica is compatible with rhizome of sichuan lovage,ground beetle is compatible with safflower;calcined keel is compatible with calcined oyster shell;arboruitae seed is compatible with seed of wild jujube;bupleurum is compatible with scutellariac while corydalis tuber is compatible with rhizome of Sichuan lovage etc.1.3 Professor Mei’s differentiation and treatment rules for hypertensionThe core syndromes that Professor Mei treated for hypertension were the syndrome of turbid Phlegm and Blood Stasisthe syndrome of Qi Stagnation and Blood Stasis,the Shaoyang syndrome,the syndrome of wind-phlegm disturbing Heart,the deficiency syndrome of both the vital energy and Yin.The core prescriptions are:(1)Xiaoxian-xiong decoction added with medicinal herbs with the property of soothing Qi and activating blood to deal with the syndrome of phlegm-heat and the Blood Stasis;(2)Xuefuzhuyu decoction to deal with the syndrome of Qi Stagnation and Blood Stasis;(3)Daotan or Wendan decoction to deal with the syndrome of interior disturbance by phlegm-heat;(4)Chaihu Wendan decoction to deal with the syndrome of Shaoyang’s failure to move and interior depression of Liver-fire;(5)Chaihuguizhi decoction to deal with the syndrome of pathogenic factors invading Shaoyang and disharmony between Ying and Wei;(6)Banxiabaizhutianma decoction to deal with the syndrome of disturbance of heart by wind-phlegm;(7)Huangqishengmai Powder to deal with the deficiency syndrome of both the vital energy and Yin.The 50 medicinal herbs with high frequency are as follows: gambirplan;angelica;rhizome of sichuan lovage;motherwort fruit etc.The core compatibility rules are as follows: preparedpinellia is compatible with bamboo shavings,mongolian snakegourd is compatible with prepared pinellia,tangerine peel is compatible with prepared pinellia,tangerine peel is compatible with poria,grass-leaved sweetflag is compatible with polygala root,arisaema with bile is compatible with prepared pinellia;angelica is compatible with rhizome of sichuan lovage,ground beetle is compatible with safflower,red sage root compatibility moutan bark,scorpion is compatible with centipede;parched white atractylodes rhizome is compatible with poria;wihle gambirplan,motherwort fruit,earthworm,gastrodia tuber,bugle,achyranthes root for the decrease of blood pressure.1.4 Professor Mei’s differentiation and treatment rules for rheumatic heart diseaseThe core syndromes that Professor Mei treated the rheumatic heart disease were the deficiency syndrome of both the vital energy and Yin,the binding turbid syndrome of Phlegm and Blood Stasis,the hydroretention with the asthenic Yang of Heart and Kidney;the Shaoyang syndrome;the syndrome of Blood stagnation and Qi deficiency.The core prescriptions used are as follows:(1)Huangqi Shengmai Powder to deal with the deficiency syndrome of both the vital energy and Yin;(2)Xiao xianxiong decoction added with the medicinal herbs with the property of circulating qi,removing phlegm and activating blood to deal with the binding syndrome of phlegm-heat and Blood Stasis;(3)Zhenwu decoction to deal with the syndrome of hydroretention with the asthenic Yang;(4)Chaihu xianxiong decoction to deal with syndrome of pathogenic factors invading Shaoyang and phlegm-heat retention in the chest;(5)Huangqi Guizhiwuwu decoction to deal with the syndrome of Qi deficiency and Blood Stasis.The 40 medicinal herbs with high frequency are as follows: angelica;rhizome of sichuan lovage;ground beetle;astragalus root etc.The core compatibility rules are as follows: angelica is compatible with rhizome of sichuan lovage,ground beetle is compatible with safflower;astragalus root is compatible with sundried ginseng;sundried ginseng is compatible with ophiopogonis radix;aconite is compatible with dried ginger;grass-leaved sweetflag is compatible with polygala root;Chinese gold-thread is compatible with prepared pinellia;longhairy antenoron herb is compatible with lygodium japonicum while calcined keel is compatible with calcined oyster shell.2.Professor Mei’s clinical treatment rules for heart diseaseClinically,the rules that Professor Mei treated heart disease are as follows:2.1 The binding syndrome of turbid phlegm and blood stasisFor this syndrome,therapeutic rules used aim to remove phlegm and dissolve the stagnant blood.The frequently used prescriptions include:Xiaoxuanxiong decoction,Wendan Decoction,Daotan decoction,GualouXiebaiBanxia decoction or Ermiao San.2.2 The shaoyang syndromeFor this syndrome,therapeutic rules used aim to harmonize Shaoyang.The frequently used prescriptions include: Xiao Chaihu Decoction,Chaihuxianxiong decoction,Chaihu-wendan decoction,Chaihu Chaihu add Longgu MuliGuizhi Decoction and Chaihu Siwu Decoction.2.3 The deficiency syndrome of both the vital energy and YinFor this syndrome,therapeutic rules used aim to supplement Qi and nourish Yin.The frequently used prescriptions are Huangqi Shengmai Powder or Shengmai Powder.2.4 The syndrome of Qi stagnation and blood stasisFor this syndrome,therapeutic rules used aim to activate Qi dynamic and promote blood circulation.The frequently used prescription is Xuefuzhuyu decoction.For this syndrome,therapeutic rules used aim to warm the kidney topromote diuresis.The frequently used prescription is Zhenwu decoction.Conclusion1.The clinical experience of professor Mei’s differentiation and treatment for heart disease1.1 Professor Mei differentiates and treats the phlegm and blood stasis syndromes in accordance with the seasonal,geographical and individual conditions.Because of change of the living habits,dietary layouts,body constitutions and local climate over the past ten years,patients were prone to dampness and phlegm.Plagued with dampness and phlegm for a long time,their blood circulation would be affected and blood stasis is formed.Therefore syndromes phlegm and blood stasis are common on patients with heart disease.So Professor Mei proposed to treat heart disease from the angle of phlegm and blood stasis.Phlegm and blood stasis are treated simultaneously in his clinical practice.Based on Xiaoxianxiong decoction,Chaihuxianxiong decoction,Wendang decoction,Daotan decoction,Gualouxiebaibanxia decoction for treating phlegm syndrome,Professor Mei proposed to add different kinds of medicinal herbs with the property of activating blood circulation and removing blood stasis.1.2 Professor Mei expands the application of classical prescriptions by adeptly using them.Professor Mei holds,although the 113 classical prescriptions in the TCM Classic Treatise on Exogenous Febrile Diseases were used to treat the syndrome of exogenous febrile diseases,but they can be flexibly used to treat many more syndromes based on Zhang Zhongjing’s clinical experience.That’s why professor Mei expanded and made good use of classical prescriptions in2.5 The syndrome of hydroretention with the asthenic Yang of heart andkidneytreating heart diseases.(1)Professor Mei highlights the principal syndrome by referring to pathogenesis;(2)Professor Mei cautiously keeps the pathogenesis but rigidly adhering to syndromes;(3)Professor Mei follows the meridians by referring to pathogenesis;(4)Professor Mei reuses classical prescriptions as the new law of treating diseases,because the seasonal,geographical and individual conditions are changed.1.3 Professor Mei is good at using prescriptions with Chaihu.Professor Mei is especially good at using prescriptions with Chaihu in treating various heart diseases with great therapeutic effects.Besides Xiaochaihu decoction,his prescriptions for the treatment of various types of heart disease also include Chaihuxianxiong decoction,Chaihuwendang decoction,Chaihu LongguMuli decoction,Chaihu Guizhi decoction,and Chaihu Siwu decoction.Although they all have the functions of soothing the Liver-qi and harmonizing Shaoyang,they have their own strengths with different numbers of medicinal herbs.1.4 Professor Mei strictly observes the rules of prescribing while flexibly combines different herbs together.Clinically,Professor Mei differentiates and treats heart disease very seriously.He tends to make a list of the core herbs in his prescriptions first,then makes a supplement of other herbs according to the patients’ syndrome patterns.Then finally he adds a single herb or a group of herbs in accordance with the patients’ complex patterns.In a word,the modification of herbs in his prescriptions are fairly flexible.1.5 Professor Mei is good at using the insect medicinals.In his long-term clinic practice,Professor Mei has accumulated rich experience at using the insect medicinals in treating heart disease.He has ever tried approximately 10 kinds insects,like eupolyphaga,earthworm,leech,scorpion,centipede,silkworm,aspongopus,gecko,cicada slough,and vaginalovorum mantidis.Most of them have the effect of calming the Liver to extinguish the Wind,or dissolving Blood Stasis and smoothing collaterals,which proves to be effective on many patients.2.The academic thoughts of Professor Mei’s differentiation and treatment for heart disease2.1 Taking human body as oganic whole,Professor Mei differentiates and treats heart disease from a multi-dimensional perspective.Under the guidance of the concept of overall perpetual motion,Professor Mei combines together the syndrome differentiation of eight principles,the six-channel syndrome differentiation,the syndrome differentiation of Zang and Fu organs,the syndrome differentiation of Qi,Blood and Body Fluids,the syndrome differentiation of sanjiao(triple energizer)in an organic fashion.Mei also attaches great importance to the the consistency of people and the natural environment as well as social environment at the same time and the change of the seasonal,geographical and individual conditions in treating heart disease.2.2 Professor Mei differentiates and treats heart disease based on the syndrome differentiation of six meridians.Based on the theories mentioned in the chapters of Taiyang,Yangming,Shaoyang and Shaoyin in the classic treatise on exogenous febrile diseases,to treat heart disease,Professor Mei differentiates from the connection of the six meridians with Zang and Fu organs,the functional relations of Zang and Fu organs,pathological and physiological relations.He mainly employs the classical prescriptions mentioned in treatise on exogenous febrile diseases,assisted by modified prescriptions.2.3 Professor Mei dialectically differentiates and treats heart disease by combing the academic thoughts in treatise on exogenous febrile diseases and warm diseasesProfessor Mei believes that treatise on exogenous febrile diseases and the science of warming diseases have their own strengths,the two should be combined together to better guide the clinical practice.The treatment of heart diseases reflects professor Mei’s this dialectical thinking.For example,he pays great attention to the change of tongue and tongue coating,takes the result of tongue diagnosis as the key basis for the identification and use of some prescriptions.That’s to say,professor Mei often learns from the academic thoughts of warming diseases in his syndrome differentiation.The results of data mining clearly embodies the characteristics of Professor Mei Guoqiang’s differentiation and treatment of heart disease on the whole.In this sense,his academic thoughts and clinical experience have been supported by data,which provides an objective basis for the clinical practice for the future generations.Meanwhile,the methods and techniques used in the process of this research will surely lay a solid foundation for other experts’ study on the differentiation and treatment of other diseases in the future.