Clinical Experience Of Professor Wang Gang In Treating Chronic Renal Failure Based On Data Mining

Objective:Based on years of the medical records of diagnosis and treatment of chronic renal failure by professor Wang Gang,we aimed to establishing a database of medical cases to overall study the clinical data of professor Wang Gang in treating chronic renal failure using the data mining technology,systematically review the clinical syndrome differentiation and drug application in the treatment of chronic renal failure by professor Wang Gang,summarize the clinical experience and academic thought,making it more comprehensive to be inherited and providing experience for traditional Chinese medicine(TCM)application for delaying the progression of chronic renal failure.Methods:(1)The literature of TCM on chronic renal failure since the founding of the People’s Republic of China and the literature of professor Wang Gang’s own clinical experience were analyzed using the method of literature research.(2)The research status of diagnosis and treatment of chronic renal failure by TCM and the application of data mining technology in the field of TCM were reviewed.(3)Using frequency analysis,association rules,cluster analysis and other methods of data mining technology,data mining was conducted on 1000 standard medical records of inpatients with chronic renal failure diagnosed and treated by professor Wang Gang from July 1,2017 to June 30,2019,especially the information of sex,age,symptoms,tongue coating,pulse condition,primary disease,pathogenesis and prescription in the medical cases,and the excavation results were analyzed and summarized combined with professor Wang Gang’s clinical experience.(4)Stratified data mining analysis and typical medical record analysis were combined to discuss professor Wang Gang’s thinking of distinguishing and treating 5 different primary diseases.(5)The experience and ideas of professor Wang Gang in the treatment of chronic renal failure were further summarized by interview transcripts.Results:(1)Results of data mining:Among 1000 consultations,254 male patients saw a doctor 604 times and 156 female patients saw a doctor 396 times in total.The average age was 54.2 years old.The core clinical symptoms were fatigue,lumbar acid,foamy urine,lower extremity swelling and nocturnal urination.The core manifestation of tongues were light,red and dark.The core manifestation of coatings on the tongue were thin yellow,white greasy and thin white.The core manifestation of pulses were thin,smooth,sunken and stringy.The core pathogenesis were deficiency of spleen and kidney,deficiency of spleen and kidney,dampness and turbidity,,blood stasis in collaterals,and dampness and heat accumulation.There are 32 drugs which were frequently utilized,including glabrous greenbrier rhizome,capillary wormwood herb,cattail pollen,trogopterus dung,plantain seed,areca peel,ternate buttercup root,sophora japonica,serissa japonica,radix glycyrrhiza,aster,hiraute shiny bugleweed herb,coptis chinensis,poria peel,honeysuckle flower,rhubarb,Atractylodes rhizome,fructus aurantii,Betel nut,dandelion,polygonum multiflorum,jujube,oxknee,astragalus membranaceus,phellodendron,tusk seed,kiwat,chuxiong,radix pseudostellariae,atractylodes rhizome,eucommia ulmoides,corn beard.The core components:①Radix pseudostellariae root,astragalus root,liquorice root,chinese jujube,eucommia ulmoides,ox knee,chinese atractylodes rhizome,poria cocos,zea glabra,rhizoma atractylodis rhizome,corn beard,plantaginis,locust flower,tuckahoe root,rhubarb,fructus aurantii,beareca,wormwood,wulingzhi,cattail yellow;polygonum multiflorum,dodder,chuxiong,turmeric,honeysuckle,coptis chinensis,aster,dandelion,emisk emisk,june snow,kiwat,feltwort;atractylodes atractylodes,dogwood,angelica,purple river cart,centella asiatica.(3)Medication for complications:①Treatment of chronic renal failure with dampness-heat syndrome of proteinuria:silkworm,scorpion,longkui,mushroom,gordon euryale seed,shiwei,burdock seed,scutellaria baicalensis,nephritis grass,sichuan sunflower.②Treatment of chronic renal failure with diabetic proteinuria:chinese wolfberry,chrysanthemum,millet essence,cuttlebone,ovum,auropitis,pangolin,polygonum polygonum,polygonum polygonum,auropium mantis,auropium mantis,auropium mantis,auropium mantis,auropium mantis.③Treatment of chronic renal failure with edema:salvia miltiorrhiza,peach kernel,safflower,leech,motherwort,poring,calabash,radix tetrandra,yellow essence,cinnamon,tiger ear herb.④Treatment of chronic renal failure with pharyngitis,cough,phlegm and dampness:radix aucklandiae,radix platycodonis,rabdosia rubescens,rhizoma parisiae,mint,wood fragrance,pinellia ternata,tangerine peel.⑤Treatment of chronic renal failure with stomach upside-down:huoxiang,peilan,bamboo ru,wuzhuyu,ocher,ginger,wax gourd skin,mulberry white skin,forsythia.⑥Treatment of chronic renal failure complicated with hyperuricemia and skin pruritus:radix chinariae,gentiana macrophylla,radix spatholaeae,luffa luffa,cortex moutan,and cortex dipterygiana.⑦ Treatment of chronic renal failure combined with poor sleep,edema,disharmony of spleen and stomach,hematuria,albuminuria:albizia,suanzao kernel,daba rhizoma,longtooth,baiziren,pepper nemorosa,perilla stem,bairenzi,shilianzi,diverse wormwood herb.(4)Stratified data analysis results:①For chronic renal failure whose primary disease was membranous nephropathy,the drug of replenishing-Qi and tongyang was major used.②The primary disease is IgA nephropathy of chronic renal failure mainly used drugs with functions of heat clearing pharynx,Yang Yin benefiting pharynx,spleen invigorating kidney medicine.③The primary disease was chronic renal failure with hyperuricemia mainly used drugs with functions of reusing blood-activating collaterals,heat-clearing water and uric acid lowering drugs.④The primary disease for systemic lupus erythematosus chronic renal failure mainly used drugs with functions of clearing heat and detoxify,melt wet benefit water.⑤ The primary disease was chronic renal failure of type 2 diabetes mainly used drugs of nourishing Yin and clearing heat,dispelling wind and clearing collaterals,and promoting Yang and blood circulation is reused.Conclusion:According to the study,professor Wang Gang considered that chronic renal failure is located in kidney,and the core pathogenesis is spleen and kidney deficiency,intrinsic dampness,collateral resistance by blood stasis,dampness and heat accumulation.Kidney deficiency is the underlying pathogeny.Dampness,turbidity and blood stasis run through the whole course of the disease,and dampness and heat are the important pathological factors to cause repeatition and aggravation of the disease.In combination with data mining,professor Wang Gang’s ideas for the differentiation and treatment of chronic renal failure were summarized as follows:centering on "kidney fatigue",the etiology is changeable and the syndrome should be differentiated in deficiency and excess.The nephron should be maintained,the main pathogenesis should be gently treated,and multiple organs should be nursed concurrently.Invigorate the circulation of blood is the key point of treatment.Clear the blood stasis and the turbidity should throughout the treatment.Combined with the interviews and discussions,the author summarized Professor Wang Gang’s experience in the treatment of chronic renal failure as follows:emphasizing the view of dialectical treatment,suit the remedy to the case,and making good use of the compound.Be proficient at compatibility and drug pair utilization.Attention should be paid to the treatment of complications,multi-pathway and multi-target treatment.Emphasis on the combination of treatment and adjustment:pay attention to the primary disease,diet therapy,prevention of infection,stabilization on the situation and avoid the use of nephrotoxic drugs.