Knowledge Discovery Of Sequelae Of Contemporary Pelvic Inflammatory Diseases Based On Attribute Partial Order Structure

ObjectiveThe theories and thoughts of traditional Chinese medicine(TCM)are integrated as a whole.The academic thoughts,dialectical thinking and clinical experience of various doctors in treating sequelae of pelvic inflammatory disease(PID)exist in various databases in the form of tacit knowledge.Tacit knowledge is often difficult to qualify and learn,but it is of high medical value.In this paper,using TCM consilia of modern doctors in treating sequelae of PID in China National Knowledge Internet(CNKI),Wanfang,CQVIP,Chaoxing Discovery and other large databases as the source of data,by extracting symptom,auxiliary examination,medical history,tongue coating and pulse,syndrome,therapy,oral TCMs,enema TCMs and other information in a standard and thorough way,we build a “diseasesymptom-syndrome-formula” database,analyze and discover knowledge,with the aid of big data knowledge discovery methods based on attribute partial ordered structure diagram theory and make a comprehensive summary of the treatment of sequelae of PID under the guidance of TCM theory,in the hope of benefiting and enlightening clinical diagnosis and treatment and providing a new modern informative method for inheriting and innovating knowledge.MethodsWe retrieved and collected consilia that met diagnostic criteria of sequelae of PID from 1978 to 2017 in CNKI,Wanfang,CQVIP,Chaoxing Discovery and other large databases standardly.Relevant terms in collected papers were sorted out in a professional and standard manner.We set up a complete consilia database for analysis,formed and optimized a formalcontext,used visual computer algorithm based on attribute partial ordered method,generated a systematic,comprehensive,multi-level attribute partial ordered structure diagram,used the diagram to extract and analyze symptom,auxiliary examination,tongue coating and pulse,syndrome,therapy,oral and enema formulas and dosage of cases,concluded academic thoughts and medication laws of modern doctors in treating sequelae of PID,discovered new knowledge and condensed it into innovations of modern treatment of sequelae of PID.Results1.Characteristics of symptomsSymptoms with high priority included: lower abdominal pain,lower abdominal distension,lower abdominal pricking;lumbosacral pain,lumbosacral soreness;irregular menstruation,hypermenorrhea,irregular vaginal bleeding;abnormal leucorrhea,increased leucorrhea;neurasthenia,fatigue;abnormal stool,dry stool or constipation;abnormal urine.Among them,lower abdominal pain most often concurred with lumbosacral pain,lumbosacral pain with lumbosacral soreness,abnormal leucorrhea with increased leucorrhea,irregular menstruation with hypermenorrhea or irregular vaginal bleeding,neurasthenia with fatigue,abnormal stool with dry stool or constipation.2.Distribution of past historyPast history with high priority included: infertility,acute PID,chronic PID,impure sex,abortion or currettage,ectopic pregnancy,uterine cavity surgery and natural labor.Among them,infertility most often concurred with acute PID,acute PID with chronic PID,chronic PID with abortion or currettage,impure sex with uterine cavity surgery.3.Distribution of auxiliary examinationsAuxiliary examinations with high priority included: positive in bimanual examination,adnexa tenderness,uterine tenderness;B-ultrasonography showing abnormality,B-ultrasonography showing oviduct and ovary mass,abscess or cyst,B-ultrasonography showing oviduct hydrops or thickening,B-ultrasonography showing pelvic mass,B-ultrasonography showing pelvic free fluid;salpingography showing abnormality and salpingography showing entire or partial salpingemphraxis.Among them,positive in bimanual examination most often concurred with B-ultrasonography showing abnormality,B-ultrasonography showing abnormality with B-ultrasonography showing oviductand ovary mass,abscess or cyst,salpingography showing abnormality with salpingography showing entire or partial salpingemphraxis.4.Distribution of tongue coatings and pulsesTongue coatings and pulses with high priority included reddened tongue,dark tongue,petechial tongue;greasy coating,white coating,thin coating,yellow coating;slip pulse,string-like pulse,thin pulse and sunken pulse.Among them,reddened tongue most often concurred with string-like pulse,string-like pulse with dark tongue,dark tongue with greasy coating,greasy coating with white coating,white coating with thin pulse.5.Distribution of syndromesSyndromes with high priority included blood stasis,damp heat,qi stagnation,cold coagulation,damp turbidity,heat,liver depression,qi deficiency and yang deficiency.Among them,blood stasis most often concurred with damp heat,damp heat with heat,qi stagnation with cold coagulation,cold coagulation with damp turbidity.6.Distribution of therapiesTherapies with high priority included: activating blood,clearing damp,clearing heat,relieving pain,tonifying kidney,soothing liver,dredging channels,tonifying spleen,warming meridians,tonifying qi and warming yang.Among them,activating blood most often concurred with clearing damp,clearing damp with clearing heat,relieving pain with dredging channels,tonifying kidney with tonifying spleen.7.Knowledge findings in oral TCMs(excluding dosage)attribute partial ordered structure diagramOral TCMs(excluding dosage)with high priority included 21 drugs,i.e.,red paeony root,angelica,corydalis yanhusuo,poria cocos,salvia miltiorrhiza,radix paeoniae alba,sargentodoxa cuneata,rhizoma cyperi,dahurian patrinia herb,liquorice,cortex moutan,atractylodes,ligustici wallichii,coix seed,bupleurum,cassia twig,peach kernel,rhizoma zedoariae,achyranthes,hedyotis diffusa and lindera aggregate.By classifying the above drugs by efficacy,four natures,five tastes and channel tropism,the results showed that heat-clearing drugs,cold drugs,bitter drugs and liver-channel-tropistic drugs were most widely used,followed by blood-activating and stasis-eliminating drugs,mild drugs,sweet and bitter drugs,spleen-channel-tropistic drugs.8.Knowledge findings in Oral TCMs(including dosage)attribute partial ordered structure diagramOral TCMs(including dosage)with high priority included 6-15 g red paeony root,3-15 g corydalis yanhusuo,6-15 g poria cocos,3-10 g liquorice,5-15 g salvia miltiorrhiza,3-12 g angelica,5-12 g rhizoma cyperi,2-15 g cassia twig,5-15 g bupleurum,5-12 g cortex moutan,5-12 g ligustici wallichii,6-15 g atractylodes,3-12 g peach kernel,6-15 g rhizoma zedoariae,30 g sargentodoxa cuneata and 3-15 g achyranthes.Apart from sargentodoxa cuneata,the dosages of other drugs were within 15 g.Sargentodoxa cuneata was a heat-clearing and detoxifying drug.A dosage with highest priority was 30 g.It was indicated that modern doctors tended to overdose heat-clearing and detoxifying drugs when treating sequelae of PID.9.Knowledge findings in enema TCMs(excluding dosage)attribute partial ordered structure diagramEnema TCMs(excluding dosage)with high priority included dahurian patrinia herb,red paeony root,rhizoma zedoariae,salvia miltiorrhiza,dandelion,sargentodoxa cuneata,corydalis yanhusuo,rhizoma sparganii,golden cypress,spina gleditsiae,angelica,myrrh,astragalus membranaceus,liquorice,spatholobus suberctu,sargentodoxa cuneata and Zanthoxylum bungeanum.By classifying the above drugs by efficacy,four natures,five tastes and channel tropism,the results showed that heat-clearing drugs,blood-activating and stasis-eliminating drugs,warm drugs,bitter drugs and liver-channel-tropistic drugs were most widely used,followed by water-disinhibiting damp-percolating drugs,cold drugs,pungent drugs and spleen-channel-tropistic drugs.Qi-tonifying drugs,sweet drugs and heart-channel-tropistic drugs ranked the third.10.Knowledge findings in enema TCMs(including dosage)attribute partial ordered structure diagramEnema TCMs(including dosage)with high priority included 30 g dahurian patrinia herb,9-15 g rhizoma zedoariae,9-15 g rhizoma sparganii,10-15 g red paeony root,9-15 g golden cypress,30 g dandelion,30-35 g sargentodoxa cuneata and 15-20 g dahurian patrinia herb.The dosage of heat-clearing and detoxifying drug was high,between 15 g and 35 g.The dosages of other drugs were within15 g.11.Knowledge findings in pairwise attribute partial ordered structurediagramsWe analyzed top 20 drugs with high priority in symptom-drug attribute partial ordered structure diagram auxiliary examination-drug attribute partial ordered structure diagram,tongue coating and pulse-drug attribute partial ordered structure diagram,therapy-drug attribute partial ordered structure diagram.From efficacy,heat-clearing drugs and blood-activating and stasis-eliminating drugs were most widely used.From four natures,cold drugs and hot drugs were most widely used.From five tastes,bitter,pungent and sweet drugs were most widely used.From channel tropism,liver-channel-tropistic drugs and spleen-channel-tropistic drugs were most widely used.Conclusion1.When modern doctors diagnose sequelae of PID,they mainly judge and analyze from patients’ lower abdominal pain,lumbosacral pain,menstruation,leucorrhea and auxiliary examination,etc.After sequelae of PID are identified,they lay emphasis on the inquiry and collection of past history,to understand the course of disease and effect of previous therapies.2.Among knowledge findings of modern sequelae of PIDconsilia based on attribute partial ordered structure diagram theory,combined with patients’ symptoms,examination results,tongue coating and pulse,our findings show that sequelae of PID are dominated by sthenia syndrome.But there are also quite a few asthenia syndromes.It is a comprehensive disease with both sthenia and asthenia.3.After identifying specific therapies,modern doctors treat sequelae of PID internally and externally.Oral TCMs with high priority include heat-clearing drugs and blood-activating and stasis-eliminating drugs.Enema TCMs with high priority include water-disinhibiting damp-percolating drugs and qi-tonifying drugs,besides heat-clearing drugs and blood-activating and stasis-eliminating drugs.4.With respect to dosage,among oral TCMs and enema TCMs,the dosage of heat-clearing drugs is high,between 15 g and 35 g.The dosages of other drugs are conventional,mostly within 15 g.A possible reason is that the main pathogenic factor of PID is damp and heat,which remain uncleared in the sequelae stage.So increasing the dosage of heat-clearing drugs can help improve patients’ conditions.5.Among knowledge findings of modern sequelae of PIDconsilia based on attribute partial ordered structure diagram theory,heat-clearing drugs,blood-activating and stasis-eliminating drugs in efficacy,cold and warm drugs in four natures,bitter and pungent drugs in five tastes,liver-channel-tropistic drugs and spleen-channel-tropistic in channel tropism have the highest priorities.