| Purpose of the studyBased on data mining technology,this paper made a multi-angle analysis of Professor Zou Yanqin's clinical cases in the diagnosis and treatment of chronic renal failure(CRF),so as to summarize Zou's clinical experience and academic theory about CRF.According to the network pharmacological technology,the core prescription of Zou in the treatment of CRF was studied,the action mechanism of the prescription was analyzed,and the scientific connotation of the prescription was explained,in order to provide positive reference and effective guidance for the clinical practice of traditional Chinese medicine(TCM)in the treatment of CRF.Research methods(1)First of all,we collected and sorted out the medical records of patients with CRF treated by Professor Yan-qin Zou in the outpatient department of Jiangsu Provincial Hospital of Chinese Medicine from July 2017 to December 2020,screened all the collected clinical cases strictly according to the admission and arrangement standards,included 150 cases(a total of 456 medical records),and established the database.Secondly,with the help of frequency statistics,association rules and cluster analysis,the four diagnosis information,pathogenesis,treatment and prescription in CRF medical records were excavated from multiple angles.Finally,combined with my teacher's related works on differential diagnosis and treatment of CRF and the clinical guidance of daily outpatient clinic,the experience and academic thought of CRF were extracted from the results of data mining.(2)Using the TCM system pharmacology analysis platform(TCMSP)and BATMAN-TCM database,the main active components and action targets of Zou's core prescription for CRF were screened and collected.Then the Genecards database was searched,and the related targets of CRF were integrated.The core prescription target and chronic renal failure target were intersected to get compound treatment target,and the prescription-active compound-treatment target network map was constructed.The protein-protein interaction network map of compound treatment target was constructed by String database,and the core target was screened.In the end,with the help of David database,the common targets obtained from the core intersection of target and CRF target were analyzed by Gene Ontology(GO)function enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis.Research results(1)data mining research:? General condition:among the 150 patients with CRF,89 were male,accounting for 59.33%;61 were female,accounting for 40.67%,the age span was 17-85 years old,the average age was 52 years old,and the incidence rate was the highest in patients aged 40-59 years old,accounting for 46.50%.A total of 145 cases(96.67%)were diagnosed with primary disease,among which diabetic nephropathy(29 cases,19.33%)ranked the first in primary disease of CRF.Among the 456 visits of CRF,according to CKD staging,CKD 3 accounted for 60.75%CKD 4 accounted for 24.78%,and CKD 5 accounted for 14.47%.?Four diagnostic information:In 456 cases of CRF,the high-frequency clinical manifestations with a frequency of more than 15%were frequent nocturnal urination(30.70%),urinary foam(30.04%),soreness of waist(29.82%),fatigue(25.88%),loose stools(24.34%),poor sleep(23.90%),dry mouth(15.79%),swollen lower limbs(15.57%),thin yellow and greasy tongue coating(43.64%),thin yellow tongue coating(33.33%),yellow and greasy tongue coating(26,97%),tooth marks on the tongue(16.89%),fine pulse(85.75%),stringy pulse(25.00%).? Pathogenesis:in 456 visits,the main pathogenesis of CRF was compound,involving multiple disease sites and different pathogenic factors.The high-frequency pathogenesis was as follows:damp turbid stasis(80.70%),spleen and kidney Qi deficiency(66.45%),spleen deficiency(20.39%),damp turbid internal accumulation(13.38%),kidney deficiency and liver hyperactivity(11.18%),deficiency of both Qi and Yin(8.55%).The main pathological factors were kidney(94.52%),spleen(92.54%),venation(89.25%)and liver(17.54%).The main pathological factors were damp-heat(98.68%),Qi deficiency(97.59%),turbid toxin(96.71%),blood stasis(89.04%),wind-Yang(11.84%)and Yin deficiency(8.55%).? Treatment:In 456 cases of CRF,my teacher mainly used the compound treatment,and the high-frequency treatment was as follows:activating blood,clearing heat,promoting dampness and purging turbid(81.14%),tonifying kidney,tonifying Qi and invigorating spleen(66.45%),tonifying Qi and invigorating spleen(19.74%),clearing heat and dampness and relieving turbid(13.38%),tonifying kidney and calming liver(11.18%),tonifying Qi and nourishing Yin(8.55%).? Prescription drugs:Among all the cases of CRF,the drugs with more than 80%occurrence frequency included Himalayan Teasel Root,Chinese Taxillus Twing,Raw Astragalus membranaceus,Fried Rhizoma Atractylodis Macrocephalae,Salvia miltiorrhiza,Oriental Wormwood,Rhizoma Smilacis Glabrae,Raw pollen Typhae,Centella asiatica,Flying Squirrel's droppings,Seed Plantago,and cooked Rheum officinale.These high-frequency drugs were consistent with the drugs in the core formula obtained by K-means cluster analysis,and they are the core prescription drugs for the treatment of the most common syndrome type(Qi deficiency of spleen and kidney,dampness,turbidity and blood stasis)of CRF.In all cases,the most commonly used combinations of three,five,seven and nine herbs were:Oriental Wormwood+Raw pollen Typhae+Flying Squirrel's droppings;Oriental Wormwood+Rhizoma Smilacis Glabrae+Raw pollen Typhae+Flying Squirrel's droppings+Seed Plantago;Himalayan Teasel Root+Chinese Taxillus Twing+Oriental Wormwood+Rhizoma Smilacis Glabrae+Raw pollen Typhae+Flying Squirrel's droppings+Seed Plantago;Himalayan Teasel Root+Chinese Taxillus Twing+Raw Astragalus membranaceus+Oriental Wormwood+Rhizoma Smilacis Glabrae+Raw pollen Typhae+Flying Squirrel's droppings+Seed Plantago+cooked Rheum officinale.(2)Network pharmacology research:The 166 active ingredients(including quercetin,kaempferol,luteolin,tanshinone IIA,etc.)in the core prescription acted on 306 targets of CRF(mainly involving PTGS2,PTGS1,NCOA2,SCN5A,STAT3,JUN,etc.).GO functional enrichment analysis showed that there were 1728 items of biological process,88 items of cellular composition and 118 items of molecular function,which were mainly related to the response to steroid hormones,RNA polymerase ? transcription factor complex,nuclear receptor activity and so on,and 177 pathways were obtained by enrichment analysis of KEGG signal pathway,which were mainly related to AGE-RAGE signal pathway in diabetic complications,TNF signal pathway,IL-17 signal pathway and so on.Research conclusion(1)Research on academic inheritanceWhen Professor Zou treated CRF,she emphasized that deficiency of kidney was the root cause of the disease,internal accumulation of dampness and turbidity was the sign of the disease,Qi deficiency of spleen and kidney,dampness and blood stasis were the basic pathogenesis,and the location of the disease were mainly in the kidney,spleen or venation,and secondary in the liver,lung,heart or throat.Lesions involved multiple systems of the whole body.The main pathological factors were damp-heat,turbid toxin and blood stasis,while wind-Yang and phlegm-heat were secondary.Because of the complex etiology and the deficiency and excess of the disease,my teacher took strengthening the body and dispelling evil as the basic treatment principle,and tonifying kidney,tonifying Qi and invigorating spleen,activating blood,clearing heat,promoting dampness and purging turbid as the fundamental therapy,and nourishing Yin,nourishing the liver,calming the liver,nourishing the heart,clearing the lungs and pharynx as the assistant.The treatment of CRF is mainly based on the core prescription,often with the changes of primary and secondary syndrome and pathogenesis,and flexibly add or subtract drugs.(2)Network pharmacological researchProfessor Zou's core prescription for the treatment of CRF contains a variety of bioactive components,with the characteristics of multi-components,multi-targets and multi-pathways,which accords with the holistic view and system theory of TCM.The active components of the core prescription have the effects of anti-oxidation,anti-inflammation,anti-fibrosis and anti-apoptosis,which can exert biological functions by affecting the response of steroids,RNA polymerase ? transcription factor complex,nuclear receptor activity and so on,and regulate many inflammatory and cancer-related signal pathways by acting on a range of gene targets.On the whole,it plays a systematic role in the mechanisms of renal tissue injury,such as inflammatory injury,fibrosis injury,oxidative stress injury and apoptosis,so as to delay the deterioration of renal function in patients with CRF. |
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