Experience Summary On Diagnosis And Treatment Of Diabetic Peripheral Neuropathy Of ZiXiao Wei Based On Literature Evaluation And Data Mining

Object:To evaluate the efficacy of traditional Chinese medicine for diabetic peripheral neuropathy(DPN); To mine and summarize the academic experiences on diagnosis and treatment of DPN of professor ZiXiao Wei, practising the use of data mining in inheriting the experiences of famous TCM doctors. Method:Randomized controlled trials of TCM or combination of Chinese traditional and western medicine versus western medicine were identified from china hospital knowledge database (1994-2009), Wan fang database (1994-2009), Pubmed(1970-2009). These datas were analyzed according to the criteria of the cochrane handbook.88 cases diagnosed and treated by professor Wei, including 103 clinical datas, were collected by structural clinical data collection system designed by Xiyuan Hospital of China Academy of Chinese Medical Sciences. Data mining methods such as descriptive statistics, association rules, cluster analysis were used to mine the distribution of syndrome elements, relations of diseases, syndromes and and Chinese medicinal herbs, compatibility law of traditional Chinese medicine. Finally, the academic experiences on diagnosis and treatment of DPN of professor ZiXiao Wei were summerised by human-computer cooperation.Result:Thirteen RCTs involving 1247 patients were included, with all trials of low methodological quality. Meta-analysis indicated TCM or combination of Chinese traditional and western medicine was more effective than western medicine on improving clinical symptoms, physical signs and nerve conduction velocity of DPN (OR合并=5.65,95%CI=4.16-7.67, P<0.00001).TCM was more effective than western medicine on improving sensory and motor nerve conduction velocity of median nerve(MD=2.24,95%CI=1.19-3.30, P=0.02; MD=2.24,95%CI=1.19-3.29, P<0.0001),tibial nerve(MD=2.70,95%CI=2.22-3.18, P<0.00001; MD =3.51,95%CI=2.17-4.85, P<0.00001) and common peroneal nerve(MD=4.65, 95%CI=3.58-5.72, P<0.00001; MD=3.89,95%CI=2.44-5.34, P<0.00001), the difference had statistical significance. Combination of Chinese traditional and western medicine was more effective than western medicine only on improving sensory and motor nerve conduction velocity of median nerve(MD=4.79,95%CI=2.36-7.23, P=0.0001; MD=6.35,95%CI=3.95-8.76, P<0.00001), tibial nerve(MD=1.78, 95%CI= 1.23-2.32, P<0.00001; MD=2.42,95%CI=1.91-2.92, P<0.00001)and common peroneal nerve(MD=2.72,95%CI=2.32-4.12, P=0.0001; MD=5.01, 95%CI=2.94-7.08, P<0.00001), the difference had statistical significance.Data mining results of 103 clinical datas indicated the main symptoms were numbness, coldness and pain of limbs, weakness and dry mouth, account for 87.38%, 42.72%,37.86%,29.13%,24.27% respectively.Abnormal tongue picture of cases mainly appeared enlarged and tooth-marked tongue, dull tongue, white and greasy tongue coating, yellow and greasy tongue coating, account for 40%,63.33%,12.22%, 23.33% respectively, thready pulse account for 46.67%.The main syndrome elements were blood stasis, qi deficiency, blood deficiency, collaterals obstruction, kidney deficiency, yin deficiency, account for 88.35%,63.11%,55.34%,39.81%,27.18%, 10.68% respectively.The cases included 165 Chinese medicinal herbs, the top 15 were safflower, earthworm, peach kernel, caulis spatholobi, astragalus, red peony root, tangerine peel, cyathula officinalis, angelica sinensis, white peony root, ligusticum wallichii, shorthorned epimedium herb, semen coicis, the root of kudzu vine, atractylodes.The core prescription was safflower, peach kernel, earthworm, caulis spatholobi, astragalus and tangerine peel.The common drug pairs were safflower and peach kernel, safflower and earthworm, peach kernel and caulis spatholobi, safflower and caulis spatholobi, earthworm and earthworm, safflower and angelica sinensis, peach kernel and angelica sinensis, red peony root and safflower, astragalus and tangerine peel, astragalus and caulis spatholobi, astragalus and ligusticum wallichii, eucommia ulmoides and parasitic loranthus, shorthorned epimedium herb and common fenugreek seed. Peach kernel and safflower, eucommia ulmoides and parasitic loranthus, shorthorned epimedium herb and common fenugreek seed were often used together with the same quantity. Through human-computer cooperation, the academic experiences on diagnosis and treatment of DPN of professor ZiXiao Wei were summerised as follows:treated diseases according to the main symptoms and degree of diseases, paid more attention to tongue diagnosis, qi, xue, spleen, kidney and the prognosis of diseases.The patients with DPN, with numbness of limbs as the main symptoms, should be treated with Buyang Huanwu Decoction according to blood-arthralgia; with coldness, swelling and pain as the main symptoms, should be treated with Jiming Dan according to wet beriberi.Conclusion:①TCM or combination of Chinese traditional and western medicine are more effective for DPN according to the present evidences. However, the evidence is not strong enough due to the general low methodological quality.②Professor Wei thinks that qi deficiency, xue deficiency and yang deficiency are the basis of the DPN, phleym dampness and blood stasis are the signs of the DPN.The location of disease is blood vessels and closely related to spleen and kidney.He argues that DPN should be treated according to blood-arthralgia and wet beriberi; numbness, coldness, pain, swelling of limbs are the main symptoms of DPN; blood stasis, qi deficiency, blood deficiency, collaterals obstruction and kidney deficiency are the common syndrome elements of DPN. It should be treated by supplying qi and xue, promoting blood circulation, warming kidney and removing dampness. Buyang Huanwu Decoction and Jiming Dan are the most common used prescriptions; safflower and peach kernel, safflower and earthworm,s spatholobi, safflower and caulis spatholobi, earthworm and earthworm, root of common peony and white paeony root, astragalus and tangerine peel, shorthorned epimedium herb and common fenugreek seed, eucommia ulmoides and parasitic loranthus are the common drug pairs.③Data mining based on human-computer cooperation will play a great role in the inheritation of the experiences of famous TCM doctors.