TCM Diagnosis And Treatment Of Non-alcoholic Fatty Liver Disease Combined With Diabetes Mellitus Based On Structured Hospitalization Data Of TCM

Background:Type 2 Diabetes Mellitus(T2DM)and Non-alcohlic fatty liver disease(NAFLD)have become a high incidence of today’s society.The incidence rates of the two cases have reached 9.7%and 20-30%,and the concurrence rate of the two is also very high.With more and more basic and clinical studies,more progress has been made in the pathogenesis,clinical manifestations,physical and chemical indicators,disease diagnosis and prognosis of the two.Although the pathogenesis of the two is not completely clear,according to previous studies,it is believed that the incidence of T2DM is mainly related to insulin resistance,insufficient insulin secretion and excessive isogenesis.The etiology of NAFLD is most widely accepted by the "two strike" theory,which is liver fatty degeneration caused by insulin resistance and liver inflammation and fibrosis caused by oxidative stress.At the same time,a large number of studies have confirmed that the two common pathophysiological basis is insulin resistance.The results of a large number of basic studies have shown that the mechanisms of insulin resistance are glycolipid toxicity,mitochondrial dysfunction,endoplasmic reticulum stress response,oxidative stress reaction,and some cytokines,whether in the pathological mechanism of Type 2 Diabetes Mellitus or nonalcoholic fatty liver,mitochondria and interleukin-1 beta(Interleukin-1 beta,IL-1 beta),interferon-gamma(Interferon-gamma,IFN-gamma)and TNF-alpha,leptin,adiponectin,mammalian rapamycin target protein(Mammalian Target of Rapammclin,mTOR),and mitogen activated protein kinase(Mitogen-activated Protein)pathway are all research in recent years.Study the results.At the same time,in clinical studies,the physical and chemical characteristics of Type 2 Diabetes Mellitus combined with non-alcoholic fatty liver are characterized by metabolic disorders such as dyslipidemia,changes in liver enzymes,and the increase in the risk of osteoporosis in the two.Chinese medicine is also striving for a breakthrough in Type 2 Diabetes Mellitus and non-alcoholic fatty liver disease.According to the study of the ancient literature and the summary of the clinical work,it is believed that the two people are all caused by excessive eating fat and sweet taste,greedy and easy movement or excessive thinking,leading to the imbalance of Qi and blood body fluid,the three focus air machine is lost to smooth,the cause of qi stagnation,phlegm dampness and blood stasis is not only the cause,but also the pathological product,which can induce and promote Type 2 Diabetes Mellitus mellitu together.The development and development of nonalcoholic fatty liver.At the same time,modern Chinese scholars have proposed that phlegm dampness or dampness of the spleen caused insulin resistance,and that phlegm dampness plays an important role in the pathogenesis of Type 2 Diabetes Mellitus and non-alcoholic fatty liver disease.In the treatment of traditional Chinese medicine,it is mainly based on the syndrome differentiation and treatment.At the same time,achievements have been made according to the previous research.It has been developed in Chinese patent medicine,single drug and other treatment of traditional Chinese medicine.At present,the study of diabetes combined with non-alcoholic fatty liver in TCM is limited to the limitation of sample size and can not meet the needs of the rule of summary.In the era of big data outbreak,Chinese medicine should seize the opportunity to excavate the existing case resources better,sum up experience in a large number of clinical data,excavate and formulate the combination of Type 2 Diabetes Mellitus as soon as possible.The diagnosis and treatment of nonalcoholic fatty liver disease serve clinical practice.Objective:Based on the clinical data collected by the "diabetes structured Chinese medical record collection system",the characteristics of TCM diagnosis and treatment of Type 2 Diabetes Mellitus with non-alcoholic fatty liver were discussed.Method:1 Data collection:Based on "diabetes structured Chinese medical record collection system" screening cases,through the compilation of SQL sentence screening,screening out 497 cases of "type 2 diabetes" and the abdominal ultrasound indication "fatty liver" patients during hospitalization,while preserving the case information in the form of Excel table,including patients.Name,sex,age,complaint,engraved disease,past history,personal history,family history,tongue and pulse diagnosis,physical examination,traditional Chinese medicine diagnosis,western medicine diagnosis,prescription,Chinese medicine,Physicochemical index,abdominal ultrasound examination and the first rounds,the first chief director of rounds information.2 Data processing:verification of all data,missing data,incomplete information,according to the paper medical records and outpatient information to supplement,if the information is too large,then the corresponding cases are eliminated.Cases of viral liver disease,alcoholic liver disease,autoimmune liver disease and drinking beyond the standard were excluded.At the same time,for the screening cases of symptoms,tongue,personal history,history,history,family history,diagnosis,prescription,Chinese medicine and other inforamation national standards and expert opinion consensus on the unified standard.The physical and chemical indicators and other quantitative data are converted into hierarchical grouping data.3 Data mining analysis:(1)using SPSS19.0 statistical analysis software to carry out descriptive statistics of general data,and use frequency and constituent ratio of measurement data.Multi index joint statistics adopts multi classification and variable number crossover table.(2)statistical analysis was made on symptoms,tongue images,moss,pulse and prescription drugs in all data,and the disease syndrome type was sorted out,and multiple regression analysis was made for different syndromes and physical and chemical indexes.(3)use association rule analysis to analyze the internal relationship between syndrome type symptom physiochemical index formula.Finally,through statistical analysis,summed up the Type 2 Diabetes Mellitus patients with non-alcoholic fatty liver disease syndrome-prescription drug relationship.Result:1 According to the frequency of symptoms,dry mouth,fatigue,blurred visual substance,and numbness of the limbs were the main symptoms at all stages of the disease.In the early stage,the symptoms of insomnia insomnia,sweat,polyphagia and astriction were the main symptoms.Gradually,the symptoms of cold,such as sleep poor,urination,chest tightness,cold,dizziness and stool were gradually increasing..In the early and middle stages of the disease,the tongue appeared mostly dark red tongue and red tongue.The early and middle stages of the disease were mainly thin yellow and Bo Baitai.In the early stage of the pulse appearance,there are many chord veins in the early stage.In the middle of the period,the chord slippery and the fine veins are the main ones,and the later period of the disease is fine and the pulse is the most common pulse.From this,it can be seen that the development process of the disease is gradually increased from shallow to deep,from early thermal image to later phlegm dampness,more complex manifestation of the disease is characterized by gradual increase,such as Qi deficiency,yin deficiency,Yang deficiency and blood stasis.2 In the use of drugs,diabetes combined with non-alcoholic fatty liver disease in the early use of Da Chai Hu decoction,Ban Xia Xie Xin decoction,Xiao Ke Yin,Zhi Bai Di Huang decoction,drugs with Poria,Pinellia ternata,Radix Scutellariae,Salvia miltiorrhiza,stir frying Baizhu,Rhizoma Coptidis,Codonopsis,stir fiying Fructus aurantii.The medium-term use of Xiao Ke Yin,Zhi Bai Di Huang decoction,Da Chai Hu decoction,Ban Xia Xie Xin decoction,medicine with Poria,pinellia,peach kernel,raw Astragalus and other Qi,invigorating Qi,activating blood to remove stasis and other drugs.After the selection of prescription,the prescription of Xiao Ke Yin,Shen Qi Mai Wei Di Huang decoction,peach red four material decoction and Wu Ling powder,and other prescription for nourishing qi and nourishing yin and activating blood and eliminating phlegm,are the main drugs for filling gas and activating blood with Poria,Ophiopogon,peach kernel,Salvia miltiorrhiza and Astragalus Astragalus.3 Through statistical analysis of the symptoms,tongue veins,physicochemical indexes and prescriptions of patients with Type 2 Diabetes Mellitus with non-alcoholic fatty liver,the disease was divided into five types of syndromes,namely,liver and stomach heat syndrome,spleen deficiency stomach heat syndrome,yin deficiency and fire prosperity syndrome,Qi Yin two deficiency syndrome and Qi deficiency and blood stasis and phlegm syndrome.Main results were as follows:1)The main manifestations of liver and stomach heat syndrome were dry mouth,blurred visual substance,tongue red,yellowish fur,pulse chords or chords or chords,often accompanied by high HbAlc,high TG and GGT abnormalities.Most of them appeared in the early stage,such as Chaihu Decoction,Radix Scutellariae,Scutellaria baicalensis,Rhizoma Coptidis,Pinellia ternata and poria cocos,such as liver soothing,clearing away heat,dampness and dampness.2)Yin deficiency and fire hyperactivity syndrome:mostly manifested as dry mouth,poor sleep,red tongue and thin yellowish fur.In terms of physical and chemical indicators,AST and LDL were not up to standard,and often accompanied by higher HbA1c levels.Most of the syndromes appeared in the early stage.Drug selection:Rhizoma Anemarrhenae,Phellodendri chinensis,raw land,Cortex Moutan,Fructus aurantii Immaturus,clearing heat and promoting fluid,regulating qi and strengthening spleen.3)Spleen deficiency stomach heat syndrome:with dry mouth,fatigue,blurred visual substance,dizziness and stool thin as the main symptoms,lingual dark,or tongue red,yellowish greasy or white greasy,most of the pulse image,mainly HbAlc,GGT is not the main standard.Banxia Xiexin Decoction,mainly pinellia,tuckahoe,this type of syndrome in the early and late more patients,and the early use of Scutellaria,Coptis,and the later combination of Codonopsis,cinnamon branch and other drugs.4)Qi Yin two deficiency syndrome:mainly with dry mouth,fatigue,sweating as the main symptoms,tongue quality dark red,pulse chord,physical and chemical indexes with TG and HbAlc is not the main standard.More common in the middle and later period of the disease,the use of Xiaoke drink,more use of Poria,raw Astragalus,radix ginseng,Ophiopogon,Schisandra,Salvia miltiorrhiza,angelica and other Qi Nourishing Yin,and the product of blood circulation.5)Qi deficiency and blood stasis syndrome of phlegm syndrome,manifested as fatigue,sweat,Na stay,sticky and greasy symptoms,dark red tongue,dim or dark dark,white greasy,yellow and greasy,vein chords slippery,thin and slippery,and many of the TG,LDL,HbA1c is not the main standard.In the late stage of the disease,Fang mainly uses five Ling powder,and medicinal herbs such as Poria cocos,Poria cocos,etc.are used to relieve dampness and dissipate phlegm,and cooperate with peach kernel,safflower and Salvia miltiorrhiza to promote blood circulation and remove stasis.Conclusion:1 The risk factors for Type 2 Diabetes Mellitus with nonalcoholic fatty liver are sex,age,BMI,family history of diabetes and hyperlipidemia.In patients with Type 2 Diabetes Mellitus with non-alcoholic fatty liver disease,the rate of triglyceride and LDL was less than 50%in patients with non-alcoholic fatty liver disease,and there was liver enzyme abnormalities in patients with 10-25%.2 Type 2 diabetes Mellitus combined with non-alcoholic fatty liver with the duration of the course of disease,in symptoms,tongue coating,pulse manifestation,the early manifestation of heat image,with the duration of the disease,phlegm dampness,Qi deficiency,yin deficiency,Yang deficiency,blood stasis and other more complex symptoms gradually increase.In the early stages of the disease,the common liver and stomach heat syndrome,yin deficiency and fire syndrome and spleen deficiency stomach heat syndrome were treated with the liver clearing and diarrhea fire,nourishing yin and clearing heat and strengthening the spleen dampness.We used Dachai Hu decoction,Zhi Bai Dihuang decoction and Banxia Xiexin Decoction,the common Qi Yin two deficiency syndrome in the middle of the disease,treatment with Yiqi nourishing Yin,Fang Xiao Yin decoction,and the common spleen deficiency stomach heat syndrome in the later period of the disease.And Qi deficiency,blood stasis and phlegm syndrome,treated with strengthening spleen and dampness,removing stasis and eliminating phlegm,Ban Xia Xie Xin Decoction and Wu Ling powder.