| ObjectiveTo mine the data which includes practitioner Zheng's prescriptions for nearly a decade of treatment of hemorrhoids through the statistical analysis,it could discuss the characteristics of prescriptions and compatibility based on different syndrome types and may provide certain reference value and the basis in treating hemorrhoids based on syndrome differentiation.Methods1.Cases source: the cases of this paper are from the clinical treatment of hemorrhoids in Australia from January 2006 to December 2016,with 315 cases and 386 frequencies of visit in total.2.Inclusion criteria:(1)Diagnostic criteria: with reference to the Chinese medicine new medicine clinical research guiding principles(the ministry of health of the People's Republic of China with release,Chinese medicine science and technology press,2002)and the anorectal branch general meeting of China association of Chinese medicine and 2011 academic exchange meeting proposed guidelines of hemorrhoids(draft).(2)Inclusion criteria: the patients should meet diagnostic criteria.They are conscious,without aphasia and intelligent disorder,and can understand and cooperate with clinical treatment.Age is above 18 and under 65.(3)Exclusion criteria: patients do not meet the above diagnostic criteria and inclusion criteria;Unable to cooperate with the treatment plan and related requirements;Pregnant or lactating patients;Unable to obtain complete medical records;Patients' previous histories had some serious disorders such as rectal or anorectal lesions,or severe defecation disorder,or severe dysfunction of the heart,brain,liver and kidney.3.Research methods: Excel was used to establish database for medical record contents.We collected patients' general conditions(including name,gender,age)and medical histories,as well as each prescription's specific drugs with syndrome of information.Then,we entry relevant data according to the following principles:(1)Through the study of the syndrome differentiation of hospitalized patients,hemorrhoids was mainly divided into the following four TCM syndrome type: patterns of excessive heat toxin,fire excess from yin deficiency,downward flow of damp-heat,and deficiency of qi and blood.Then we count up of Chinese medicines each TCM syndrome type.However,if they were same to other syndrome types of prescription drugs,these herbs should count into the corresponding TCM syndrome type.(2)If a modified prescription could treat 2 types and more,the main prescription should be viewed as the corresponding main TCM syndrome type.(3)The standardized process of drug name and efficacy is referred to Chinese medicine and the pharmacopoeia of the People's Republic of China to distinguish different herbal medicines.(4)Dichotomous is used for traditional Chinese medicine using or not.4.Statistical method:SPSS 20.0 statistical software was conducted for statistical analysis.For different syndrome types of prescription drugs,the frequency of traditional Chinese medicine with more than 1% was conduct for the factor analysis.And based on factor scoring,we perform clustering analysis.If the factor analysis did not meet the requirements,Chinese herbs can be directly to cluster analysis.The principal component method is applied to factor analysis.The average method is applied to cluster analysis.Euclidean distance is applied to the distance measurement of continuous variables.Jaccard method is applied to the distance measurement of classification variables.Results1.General condition.A total of 315 cases of hemorrhoids were included in this study,including 209 male patients and 106 female patients.Among all the patients,the youngest was 12 years old.The oldest was 93 years old.The mean age was 51.78 ± 15.67 years old.The shortest duration of illness was one day and the longest that was more than five years.About half of all patients were treated for one month,followed by patients who had been hospitalized for more than five years.Above all,it was potentially prompted that the patient's importance to hemorrhoids was not enough until seriously affecting the study,work and life.Therefore,we should vigorously promote the knowledge of hemorrhoids in the population.In terms of gender and age level distribution,the numbers of male patients were more than those of female patients.Meanwhile,the numbers of patients aged between 50 and 80 were more than half of total patients,followed by aged between 30 and 50 patients.It could be concluded from these results that hemorrhoids was easily occurred in the middle aged and elderly people,accompanied by the increment of incidence with age.In this study,TCM syndromes were divided into four categories,namely,pattern of excessive heat toxin,fire excess from yin deficiency,downward flow of damp-heat,and deficiency of qi and blood.Seventy-seven cases of pattern of excessive heat toxin were accounted for 20.10%.One hundred and thirty-seven cases suffering from the downward flow of damp-heat were accounted for 35.77%.A total of 155 cases suffering from fire excess from yin deficiency were accounted for 40.47%.Fourteen cases suffering from deficiency of qi and blood were accounted for 3.66%.From the above all,it can be seen that the frequency of fire excess from yin deficiency is the highest,followed by the downward flow of damp-heat.It is suggested that practitioner Zheng's prescriptions in treating hemorrhoid is the main function of nourishing Yin and suppressing Yang,clearing away heat and removing dampness.At the same time,considering that most of the patients are middle-aged and elderly,the body situation of these people was deficient,so the prescriptions should be used to supplementary herbal medicines.In addition,the stronger pesticide effect of herbs should be taken seriously.In addition,as for constipation,hemafecia,anal fissure or anal fistula,the constituent ratio of hemafecia was higher than that of the other two,accounting for 76.76 percent,followed by constipation accounting for 22.46 percent and anal fissure or anal fistula accounting for 0.78 percent.Thus it can be seen that the patients with hemorrhoids with the symptoms of hemafecia were not in the minority.Therefore,it was potentially suggested that the practitioners should pay attention to the treatment of hemorrhoids as well as the corresponding syndromes.However,for constipation and anal fissure or anal fistula,although the proportion of patients who went to a doctor was less,it should be also taken seriously.2.The data mining results of the practitioner Zheng's prescriptions were analyzed based on cluster analysis.Three hundred and fifteen cases with a total of 386 doctor-seeing times were included in this study,using1384 prescriptions.Prescriptions mainly have 8 classes,add and subtract involved 113 Chinese herbal medicines.Prescription frequently used in more than 10% has five types: prescription E-(sanguisorba 12 g + sophora japonica 15 g),prescription F-blood tonic(mulberries 15 g + jujube four),D-stanching carbon agent(carbonized cacumen platycladi 12 g+ carbonized gardenia 12 g),prescription A – modified Zeng Ye Cheng Qi decoction(radix rehmanniae 15 g + radix scrophulariae 12 g + Radix Ophiopogonis 15 g + rheum officinale 10 g + magnolia officinalis 10 g +fructus aurantii 10 g),G-heat agent(honeysuckle 15 g + forsythia 12g).The effects of the first 3 prescriptions mainly involved bleeding,cooling and nourishing blood.The effects of the rest 2 prescriptions were mainly composed of nourishing Yin,purgation and clearing heat.Therefore,the practitioner Zheng's prescriptions treating hemorrhoids based on syndrome differentiation were treated the blood as the center,supplemented by to cooling,nourishing and purgation.In the frequency statistics of drug addition and subtraction,the traditional Chinese medicine in the top 10 is licorice,radix saposhnikoviae,fructus aurantii,purslane,jujube,radix paeoniae alba,pericarpium citri reticulatae,mangnolia officinalis,carbonized gardenia,radices trichosanthis.It could be seen that the practitioner Zheng treated hemorrhoids based on the basic of blood,which accompanying symptoms were mainly used for invigorating the spleen and invigorating the blood,clearing,dispelling wind and eliminating dampness,and nourishing Yin and Yang.There were77 frequency times involving 69 Chinese traditional Chinese medicines on the pattern of excessive heat toxin.The numbers of these herbs whose use frequency were over 1% were 25.According to the analysis of factor analysis,KMO value is 0.834 and Bartlett spherical test P < 0.001,which is suitable for factor analysis.Six factors of characteristic root > 1were extracted through variance largest orthogonal rotation and the cumulative contribution rate was 84.790%.We performed clustering analysis combined with clinical practice.It can be concluded that herbal medicines in treating hemorrhoids of the pattern of excessive heat toxin were appropriately divided into six types.The results were as follows:Type 1,sanguisorba officinalis,sophora flower bud.Type 2,rhizome of rehmannia,radix scrophulariae,radix ophiopogonis,fructus aurantii,mangnolia officinalis,rheum officinale,liquorice.Type 3,jujube,mulberry.Type 4,carbonized cacumen platycladi,carbonized gardenia.Type 5,honeysuckle,forsythia.Type 6,lalang grass rhizome,cortex moutan,rhizoma phragmitis,portulaca oleracea,radices trichosanthis,bamboo leaf,peach kernel,radix paeoniae rubra,scutellaria baicalensis,radix saposhnikoviae.In this pattern,the higher use frequency was mainly concentrated in type 1 and type 5.Therefore,on the basis of Chinese herbs including the two types,treating hemorrhoids of the pattern of excessive heat toxin can be added other types of high frequency herbs such as rhizome of rehmannia,radix scrophulariae,radix ophiopogonis,fructus aurantii,mangnolia officinalis,rheum officinale,liquorice,which were composed of modified Zeng Ye Cheng Qi decoction.In pattern of fire excess from yin deficiency,there were 155 frequency times which involved 77 herbs.The numbers of these herbs whose use frequency were over 1% were 24.However,due to the combination of the fructus oryzae germinatus and fructus hordei germinatus in the use of the two herbs,the factor analysis was performed as a herb in order to avoid the high correlation between the variables.According to the analysis of factor analysis,KMO value is 0.806,Bartlett spherical test P < 0.001,which was suitable for factor analysis.Six factors of characteristic root > 1 were extracted through variance largest orthogonal rotation and the cumulative contribution rate was 85.048%.We performed clustering analysis combined with clinical practice.It can be concluded that herbal medicines in treating hemorrhoids of the pattern of fire excess from yin deficiency were appropriately divided into seven types.The results were as follows: Type1,rhizome of rehmannia,radix scrophulariae,radix ophiopogonis,rheum officinale.Type 2,fructus aurantii,mangnolia officinalis,radix saposhnikoviae,portulaca oleracea,liquorice.Type 3,honeysuckle,forsythia.Type 4,rhizoma phragmitis,radices trichosanthis,fructus oryzae germinatus,fructus hordei germinatus,scutellaria baicalensis,lalang grass rhizome,pericarpium citri reticulatae.Type 5,carbonized cacumen platycladi,carbonized gardenia.Type 6,jujube,mulberry.Type7,sanguisorba officinalis,sophora flower bud.In this pattern,the higher use frequency was mainly concentrated in type 7 and type 6.Therefore,on the basis of Chinese herbs including the two types,treating hemorrhoids of the pattern of fire excess from yin deficiency can be added other types of high frequency herbs such as fructus aurantii,mangnolia officinalis,rheum officinale,radix saposhnikoviae.There were 137 frequency times involving 93 Chinese traditional Chinese medicines on the pattern of the downward flow of damp-heat.The numbers of these herbs whose use frequency were over 1% were 28.According to the analysis of factor analysis,KMO value is 0.863 and Bartlett spherical test P < 0.001,which is suitable for factor analysis.Six factors of characteristic root > 1were extracted through variance largest orthogonal rotation and the cumulative contribution rate was 82.365%.We performed clustering analysis combined with clinical practice.It can be concluded that herbal medicines in treating hemorrhoids of the pattern of the downward flow of damp-heat were appropriately divided into six types.The results were as follows: Type 1,fructus aurantii,mangnolia officinalis,radix saposhnikoviae,portulaca oleracea,liquorice.Type 2,radix paeoniae alba,poria cocos,pericarpium citri reticulatae,scutellaria baicalensis,cortex moutan.Type 3,radices trichosanthis,Angelica sinensis,semen coicis,bamboo leaf,golden cypress,rhizoma atractylodis,mulberry,jujube.Type 4,honeysuckle,forsythia.Type 5,radix scrophulariae,radix ophiopogonis,rhizome of rehmannia,rheum officinale.Type 6,sanguisorba officinalis,sophora flower bud,carbonized cacumen platycladi.In this pattern,the higher use frequency was mainly concentrated in type 2 and type 3.Therefore,on the basis of Chinese herbs including the two types,treating hemorrhoids of the pattern of the downward flow of damp-heat can be added other types of high frequency herbs such as sanguisorba officinalis,sophora flower bud, carbonized cacumen platycladi,carbonized gardenia.In pattern of the deficiency of qi and blood,there were 14 frequency times which involved40 herbs.The numbers of these herbs whose use frequency were over 1% were26.However,because of the strong correlation between variables,it was not suitable for factor analysis.Therefore,the clustering analysis was directly carried out.Meanwhile,combined with clinical practice,it can be concluded that herbal medicines in treating hemorrhoids of the pattern of the deficiency of qi and blood were appropriately divided into six types.The results were as follows: Type 1,cortex albiziae,cortex moutan,schizonepeta,rhizoma zingiberis preparata,forsythia,Angelica sinensis.Type 2,radix saposhnikoviae,platycladi seed,lalang grass rhizome,portulaca oleracea,radix pseudostellariae,radix paeoniae alba.Type 3,carbonized gardenia,carbonized cacumen platycladi,sophora flower bud,sanguisorba officinalis.Type 4,liquorice.Type 5,radix scrophulariae,radix ophiopogonis,rhizome of rehmannia,rheum officinale,mangnolia officinalis,fructus aurantii.Type 6,astragalus membranaceus,jujube,mulberry.In this pattern,combined with the higher use frequency of herbal medicines,treating hemorrhoids of the pattern of the deficiency of qi and blood can be added other types of commonly basic used herbs such as liquorice,lalang grass rhizome,rhizome of rehmannia,radix scrophulariae,radix ophiopogonis,radix saposhnikoviae,portulaca oleracea,sophora flower bud,platycladi seed,fructus aurantii,jujube,radix paeoniae alba,which were composed of modified Zeng Ye Cheng Qi decoction.ConclusionsIn the diagnosis and treatment of hemorrhoids,the practitioner Zheng had eight common prescription agents.Based on clustering analysis for clinical cases diagnosing and treating hemorrhoids,we took piles of these medical records to make statistics,data mining and analysis.Furthermore,we had drawn a conclusion,after finishing sorting these successful cases,that for most patients,in addition to the drug treatment,it should also popularize scientific knowledge of hemorrhoids in the population to eliminate all kinds of concerns of patients,and actively seek consultations with the correct attitude.For the hemorrhoids of pattern of excessive heat toxin,practitioner Zheng's attention was mainly focused on clearing heat and stoping the hemorrhage,and supplemented with Chinese traditional medicine such as rhizome of rehmannia,radix scrophulariae,radix ophiopogonis,fructus aurantii,mangnolia officinalis,rheum officinale,liquorice.For the hemorrhoids of fire excess from yin deficiency,practitioner Zheng's attention was mainly to nourish Yin and blood and to stop the hemorrhage,supplemented by Chinese traditional medicine such as fructus aurantii,mangnolia officinalis,rheum officinale,radix saposhnikoviae.In the case of hemorrhoids of downward flow of damp-heat,practitioner Zheng attached great importance to invigorating the spleen and removing dampness,clearing heat,invigorating and nourishing the blood,and also supplemented with Chinese medicine such as sanguisorba officinalis,sophora flower bud,carbonized gardenia,carbonized cacumen platycladi.For hemorrhoids of pattern of deficiency of qi and blood,practitioner Zheng's value was given priority to with nourishing the qi and blood,at the same time complementary with liquorice,lalang grass rhizome,rhizome of rehmannia,radix scrophulariae,radix ophiopogonis,radix saposhnikoviae,portulaca oleracea,sophora flower bud,platycladi seed,fructus aurantii,jujube,radix paeoniae alba.In addition,by screening and combining the results of data mining and clinical findings,the practitioner Zheng believed that herb pairs played a key role in the treatment of hemorrhoids.Among of them,the herb pairs composed of clearing heat,cooling blood and nourishing yin were: rhizome of rehmannia and radix scrophulariae;the herb pairs composed of promoting digestion and relieving stasis were: rheum officinale and mangnolia officinalis;the herb pairs composed of cooling blood and hemostasis were: sanguisorba officinalis and sophora flower bud,carbonized gardenia and carbonized cacumen platycladi;the herb pairs composed of nourishing blood and producing body fluid were: jujube and mulberry;the herb pairs composed of heat-clearing and detoxifying,evacuating wind and heat were:honeysuckle and forsythia;the herb pairs composed of dispelling wind to relieve exogenous were: schizonepeta and radix saposhnikoviae;the herb pairs composed of heat-clearing and producing body fluid were: rhizoma phragmitis and radices trichosanthis;the herb pairs composed of inducing diuresis to alleviate edema were: poria cocos and semen coicis;the herb pairs composed of ascending up spleen-qi and yang were: radix bupleuri and rhizoma cimicifugae.In the treatment of hemorrhoids,the practitioner Zheng had a remarkable effect on the treatment of hemorrhoids by making full use of the theory between herb pairs and the property flavors attributive channel of traditional Chinese medicine.At the same time,the herb pairs which the practitioner Zheng usually used for the treatment of hemorrhoids were found by the utilization of data mining.Furthermore,it had certain reference value and certain learning significance to some extent for the future guidance in the clinic. |
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