Based On Data Mining Technology Research On Treating Primary Dysmenorrhea By Two Generation Inheritors Of Lingnan Luo's Gynecology:A Retrospective Study

ObjectiveThis study using data mining technology by the use of inhc ritance of traditional Chinese medicine inheritance support system(TCMISS)and EXCEL,the syndrome distribution and drug law of primary dysmenorrhea treated by]ingnan Luo' s school of gynecology were retrospective]y analyzed,and the,similarities and differences in the diagnosis and treatment of primary dysmenorrhea were compared between the third generation i nheri tors of Luo' s school of gynecology and the f'ourth generation inheritors.It is expected to summarize the dialectical thinking and medication rules of Luo' s school of gynecology f'or primary dysmenorrhea through statistical analysi s of data,so as to inheri t i ts academic thought,be the guidance of clinical prescription,give play to the characteri stics and advantages of tradi tional Chinese medieine,and explore the possible changes in the inheritance of Luo ' s school of' gynecology.MethodWith the use of EXCEL and TCMISS,this study collected and sorted out the clinical cases of professors ofluo songping,zhang yuzhen,zhu ling,zhao ying and liao huihui in the gynecological outpatient department for the treatment of primary dysmenorrhea from January 2016 to December 2018.The treatment in clinical cases was divided into two stages:ordinary phase and premenstrua]phase.The data about general informatin of primary dysmenorrhea patients,TCM syndromes and prescriptions was recorded in the EXCEL,and then manually entered them into TCMISS.The above data entry process was after two people check.The adoption of TCMISS carried out statistical analysis on the statistics and data analysis module.Based on clinical experience gained from outpatient service,this study summarized the clinical experience of the third and the main fourth generation inheritors of Luo' s school of gynecology in the diagnosis and treatment of primary dysmenorrhea,and compared their similarities and differences.ResultsIn this study,a total of 727 cases met the inclusion criteria of primary dysmenorrhea,including 211 cases from the third generation inheritors and 516 cases from the fourth generation inheritors.A total of 1525 prescriptions,including 379 prescriptions from the third generation inheritors and 1146 prescriptions from the fourth generation inheritors were statistically analyzed with the mentioned software,and the results are as follows.1.Basic information of the cases included in the study:Among the cases,the youngest patients are 12 years old and the oldest patients are 35 years old.The patients of the two generation inheritors are mostly females between 18 and 30 years old,accuouting for more than 70%of the total.Among the thitrd generation inheritors' cases,the average age of the patients is 25.33 years old;among the fourth generation inheritors'cases the average age of the patients is 23.74 years old.2.Syndrome distribution characteristics:qi stagnation and blood stasis stood the first on the list in the third generation inheritors'cases,followed by kidney deficiency and blood stasis and blood stasis only.In the fourth generation inheritors' cases,deficiency-cold syndrome was the main syndrome,qi stagnation and blood stasis and cold coagulation and blood stasis were the second and the third respectively.It can be seen that blood stasis is generally mentioned in the top three syndromes,and the two generation of inheritors believe that blood stasis is an important cause of primary dysmenorrhea,while the fourth generation inherjtors also believe that primary dysmenorrhea is mostly caused by deficiency and cold.3.Analysis of the law of clinical medication:Luo' s gynecology inheritors divided the primary dysmenorrhea into two stages for treatment:ordinary phase and premenstrual phase.So this study also divided the prescriptions into two stages for analysis.3.1 Herb use frequency analysis3.1.1 The third generation inheritors have 257 prescriptions at ordinary phase,shared 127 kinds of medicinal herbs.The top 10 herbs are CYPERI RHIZOMA(6.67%),PAEONIAE RADIX ALBA(5.79%),ANGELICAE SINENSIS RADIX(5.27%),PORIA(5.14%),ATRACTYLODIS MACROCEPHALAE RHIZOMA(4.46%),SALVIAE MILTIORRHIZAE RADIX ET RHIZOMA(4.10%),ASTRAGALI RADIX(3.58%),CUSCUTAE SEMEN(3.26%),GLYCYRRHIZAE RADIX ET RHIZOMA(3.09%)and DIPSACI RADIX(3.03%)respectively.The fourth generation of main inheritors prescribe 684 prescriptions at ordinary times and share 172 kinds of herbs,among which the top 10 herbs are ANGELICAE SINENSIS RADIX(5.89%),PAEONIAE RADIX ALBA(5.19%),CODONOPSIS RADIX(4.79%),MOUTAN CORTEX(4.15%),EUODIAE FRUCTUS(4.12%),CHUANXIONG RHIZOMA(4.00%),PINELLIAE RHIZOMA(3.88%),ATRACTYLODIS MACROCEPHALAE RHIZOMA(3.64%),OPHIOPOGONIS RADIX(3.61%)and DIPSACI RADIX(3.54%)respectively.3.1.2 The third generation inheritors' cases include 122 premenstrual prescriptions and shared 83 kinds of herbs.The first 10 most frequently used herbs at premenstrual phase are CYPERI RHIZOMA(8.10%),SALVAE MILTIORRHIZAE RADIX ET RHIZOMA(7.42%),CORYDALIS RHIZOMA(7.35%),NOTOGINSENG RADIX ET RHIZOMA(6.66%),PAEONIAERADIX RUBRA(6.11%),LINDERAE RADIX(6.11%),ANGELICAE SINENSIS RADIX(5.98%),LEONURI HERBA(5.36%),PERSICAE SEMEN(4.74%)and PAEONIAE RADIX ALBA(4.53%)respectively.There are 462 prescriptions at premenstrual times and 167 kinds of herbs are shared in the fourth generation inheritors' cases at premenstrual phase,and the top 10 herbs are ANDELICAE SINENSIS RADIX(6.48%),CORYDALIS RHIZOMA(5.96%),CHUANXIONG RHIZOMA(5.82%),FAECES TROGOPTERPRI(5.09%),ASTRAGALI RADIX(3.75%),LINDERAE RADIX(3.69%),CYPERI RHIZOMA(3.57%),PAEONIAERADIX RUBRA(3.50%),CeNNAMoMI CORTEX(3.48%)and TYPHAEPOLLEN(3.38%).3.2 Analysis on the four qi,five flavors and meridian of herbs:3.2.1 Analysis of the four qi:In terms of the four qi,the first three properties of herbs in the third generation inheritors' cases are warm,smooth and cold at both ordinary and premenstrual phases.The results of the four qi analysis in the fourth generation inheritors' cases at ordinary and premenstrual phases are similar to those of the third generation inheritors',which are also dominated by warm,smooth and cold.No matter in ordinary or premenstrual period,warm herbs are the first choice of.herbs in both generation inheritors.3.2.2 Analysis of five flavours:As for the analysis of five flavor,both generation inheritors' herbs are given priority to with spicy,sweet and bitter herbs,just each generation inheritors have emphasize on particular flavors.The third generation inheritors' cases are with sweet,spicy and bitter herbs being the top three flavors in ordinary phase and with bitter,spicy and sweet herbs being the top three flavors in premenstrual phase respecti,ely,while the fourth generation inheritors'cases are with sweet,bitter and spicy herbs in the top three flavors in turn in ordinary phase and with spicy,bitter and sweet herbs ranked the top three flavors in the premenstrual phase respectively.It can be seen that the two generations of inheritors usually focus on the sweet herbs in ordinary period and bitter and spicy herbs in premenstrual period.3.2.3 Analysis of meridians of herbs:The meridian of herbs of the third and the fourth generation inheritors' prescriptions is the same.At ordinary phase,the top three meridians of herbs are liver,spleen and kidney,while the top three meridians of herbs at premenstrual phase are liver,spleen and heart.3.3 Association rule analysis:In this study,the rules of herb use can be clearly and concisely demonstrated.The appropriate support degree and confidence degree will be set for the analysis of prescription rule of two generations and two stages.By analyzing the medication rules of the third generation inheritors,the support degree and confidence degree of prescriptions are set as 35%(the nuober of support degree is 90)and 0.9 respectively in ordinary period.Getting the herb combinations that are often used at ordinary times are PAEONOAE RADIX ALBA,PORIA,ANGELICAE SINENSIS RADIX;ATRACTYLODIS MACROCEPHALAE RHIZOMA,ANGELICAE SINENSIS RADIX,CYPERI RHIZOMA,PORIA;ATRACTYLODIS MACROCEPHALAE RHIZOMA,PAEONIAE RADIX ALBA,PORIA,ANGELICAE SINENSIS RADIX;PAEONIAE RADIX ALBA,PORIA,CYPERI RHIZOMA,ANGELICAE SINENSIS RADIX;ATRACTYLODIS MACROCEPHALAE RHIZOMA,ANGELICAE SINENSIS RADIX,PORIA,etc.The premenstrual support degree and confidence degree are set as 65%(support degree number:79)and 0.9,respectively.The analysis results show that the commonly used herb combinations are CORYDALIS RHIZOMA,NOTOFINSENG RADIX ET RHIZOMA,SALVIAE MILTIORRHIZAE RADIX ET RHIZOMA;CORYDALIS RHIZOMA,NOTOGINSENG RADIX ET RHIZOMA,CYPERI RHIZOMA;PAEONIAERADIX RUBRA,NOTOGINSENG RADIX ET RHIZOMA,CYPERI RHIZOMA;SALVIAE MILTIORRHIZAE RADIX ET RHIZOMA,NOTOGINSENG RADIX ET RHIZOMA,CYPERI RHIZOMA;PAEONIAERADIX RUBRA,SALVIAE MILTIORRHIZAE RADIX ET RHIZOMA,NOToGINSENG RADIX ET RHIZOMA,CORYDALIS RHIZOMA,etc.The herb use law of the fourth generation inheritors' cases is analyzed.The support degree and confidence degree of prescriptions are set as 35%(support degree number:240)and 0.9 respectively in ordinary phase.The commonly used herb combinations are CHUANXIONG RHIZOMA,CODONOPSIS RADIX,ANGELICAE SINENSIS RADIX;CHUANXIONG RHIZOMA,EUODIAE FRUCTUS,ANGELICAE SINENSIS RADIX;CHUANXIONG RHIZOMA,ANGELICAE SINENSIS RADIX;PINELLIAE RHIZOMA,OPHIOPOGONIS RADIX,EUODIAE FRUCTUS,ANGELICAE SINENSIS RADIX;PINELLIAE RHIZOMA,OPHIOPOGONIS RADIX,ANGELICAE SINENSIS RADIX,etc.The support degree and confidence degree of prescriptions in premenstrual period are set as 40%(the number of support degree is 185)and 0.9 respectively.Getting the herb combinations that are often used are CHUANXIONG RHIZOMA,CINNAMOMI CORTEX,ANGELICAE SINENSIS RADIX;TYPHAEPOLLEN,CHUANXIONG RHIZOMA,ANGELICAE SINENSIS RADIX;CORYDALIS RHIZOMA,CHUANXIONG RHIZOMA,FAECES TROGOPTERPRI,ANGELICAE SINENSIS RADIX;CHUANXIONG RHIZOMA,FAECES TROGOPTERPRI,ANGELICAE SINENSIS RADIX;PAEONIAERADIX RUBRA,ANGELICAE SINENSIS RADIX,etc.It can be known from the analysis of commonly used herbs that the third generation of inheritors usually pay attention to regulating qi,blood and water to keep harmony in ordinary stage,while before menstruation,they attach importance to promoting blood circulation,removing blood stasis,regulating qi and relieving pain.Base on this basis,the fourth generation of inheritors also pay attention to warming and nourishing yang qi with the treatment method of warming meridian,relieving cold and pain.3.4 Analysis of prescription composition rules of herb association degree based on improved mutual information method and entropy clustering:In this study,the correlation degree is set as 8 and the punishment degree is set as 2.Getting results are as follows.(1)the herb pairs coumonly used by the third generation inheritors in the ordinary stage are CUSCUTAE SEMEN,MOUTAN CORTEX;DIOSCOREAE RHIZOMA,CYPERI RHIZOMA;CUSCUTAE SEMEN,PORIA;CUSCUTAE SEMEN,CODONOPSIS RADIX and so on.The commonly used premenstrual herb pairs are PERSICAE SEMEN,PUERARIAE LOBATAE RADIX;SPATHOLOBI CAULIS,PUERARIAE LOBATAE RADIX;ANGELICAE SINENSIS RADIX,PUERARIAE LOBATAE RADIX;PERSICAE SEMEN,NOTOGINSENG RADIX ET RHIZOMA.For the core combinations of commonly used herbs,there are 18 pairs in the ordinary phase and 6 pairs in the premenstrual phase.Through hierarchical clustering,it is concluded that there are 9 new prescriptions in ordinary time and 3 in premenstrual stage.(2)the herb pairs commonly used in ordinary time by the fourth generation inheritors are EUODIAE ERUCTUS,CUSCUTAE SEMEN;OPHIOPOGONIS RADIX,CODONOPSIS RADIX;OPHIOPOGONIS RADIX,BUPLEURI RADIX;OPHIOPOGONIS RADIX,ALISMATIS RHIZOMA,etc.The commonly used premenstrual herb pairs are TYPHAEPOLLEN,ATRACTYLODIS MACROCEPHALAE RHIZOMA;TYPHAEPOLLEN,CHUANXIONG RHIZOMA;TYPHAEPOLLEN,MOUTAN CORTEX;CINNAMOMI CORTEX,etc.In the ordinary stage 8 pairs of core herb combinations and 10 pairs of c.ore herb combinations in the premenstrual stage are commonly used.4 new prescriptions in ordinary stage and 5 in premenstrual stage are gained from the analysis.According to the results of commonly used herb combinations,it can be inferred that the two generation inheritors are treating primary dysmenorrhea based on syndrome differentiation in the ordinary stage and pay attention to the regulation and harmonization of' liver,spleen and kidney.Whi]e in premenstrual stage the two generation inheritors are to make good use of the treatment of promoting blood circulation and removing blood stasis.Conclusion1.According to the characteristics of qi and blood changes in the menstrual cycle,the inheritors of lingnan Luo' s school of gynecology treat the primary dysmenorrhea in two stages,namely,at ordinary times and premenstrual times.Luo' s gynecology inheritors treat primary dysmenorrhea based on knowing the cause and syndrome differentiation.The treatment attaches importance to the liver,spleen and kidney at ordinary times and the symptoms are treated by regulating qi and blood to make vascular patency before menstruation.Several menstrual cycles of overall treatment are required to curing dysmenorrhea.2.Lingnan Luo' s gynecology inheritors consider that blood stasis is the importance factor of primary dysmenorrhea,hence promoting blood circulation to remove blood stasis and pain is the main treatment for dysmenorrhea.Considering the climatic characteristics of lingnan region,the medicine should better use plain one than strong one.In clinical practice,the medicine should be mainly used to harmonize qi and blood and be adjusted constantly according to the change of patients' condition.3.The characteristics of syndrome differentiation and herb use law of primary dysmenorrhea are similar between the third generation and the fourth generation inheritors,while the latter also attaches more importance to yang qi and usually adds yang warming and cold dispersing herbs on the basis of using herbs that regulating qi and blood.