| ObjectiveThe purpose of this study is to summarize and analyze Professor Li’s experience,including academic thoughts,prescriptions used and clinical experience in treating infertility caused by polycystic ovary syndrome.Data mining including cluster analysis and association rules,and numerical statistics method were used to examine the correlation betweens the drugs and the causes of this disease,proven that the treatment of spleen is the main treatment principle of the disease.Methods1.This study collected the medical records prescribed by Prof.Li Kunyin’s in the illness of PCOS-induced infertility cases;from June 2016 to July 2019.Data were organized in a database format by using Microsfot Excel: data cleasing,standardation and sorting were prefromed accordingly the data and sort out exclusion cases,then entered the screened prescriptions into Excel.Analyzed data by using Microsoft Excel,IBM SPSS Statistics 27.0and R Studio(Version 4.0.2).1.1 Analyzed the frequencies of corresponding aspects by using Microsoft Excel.Corresponding aspects included syndrome classification,uses of Chinese herbs,Meridian belongings of Chinese herbs,four natures and five tastes of Chinese herbs etc.1.2 The statistical software SPSS was used as the analysis platform.“Between-groups linkage” was chosen as Cluster method,Squared Euclidean distance was chosen.By analyzing 25 most frequently used herbs,graphs for hierarchical cluster were shown.1.3 The statistical software R Studio was used as the analysis platform.The support degree was set to 10% and the confidence degree was set to 80%.Association rules were used to analyze the "drug-drug" relationship and the compatibility between drugs.The results were sorted in accordance with their(a)Support,(b)Confidence and(c)Lift orders.Images,figures and graphs in the report were produced by SPSS Modeler 18.2.2.This study collected medical records regarding Prof.Li Kunyin ’s treatment of PCOSinduced infertility cases from June 2016 to July 2019,through studying and analyzing Prof.Li’s medical records,also following and taking notes throughout his medical consultation to patients,we obtained the valuable clinical experience from Prof.Li,his academic thought and clinical experience in treating infertility caused by PCOS were proposed,summarized and analyzed in this research.Results1 Basic information: 356 medical records were included in this study.107 kinds of Chinese herbs were used in a total of 4624 times.6-17 kinds of herbs were used in single prescription which 12.99 kinds of herbs were used in average.3-14 days of herbs were prescribed to patients and the average number of days prescribed to patients was 7.38 days.2 Statistical resultsThe commonest herbs used are: Fuling,Chenpi,gancao,Zhuru,Sangjisheng,Baiziren,Baizhu,Shanyao,Shanzhuyu,Xuduan,Shudihuang.Depended on the frequencies of herbs used,restorative herbs were used 1562 times,distributed to 33.78%,qi-regulating herbs were used 443 times(9.58%),damp clearing herbs were used 342 times(7.40%),blood-activating and stasis-dissolving herbs were used 334 times(7.22%),expectorant cough suppressant herbs were used 329 times(7.12%).And among them,qi-restorative herbs were used most frequently,in a total 815 times,then were yang-restorative herbs(345 times),bloodrestorative herbs(267 times)and yin-restorative herbs(135 times).Herbs used in this study were belonged to spleen meridian(2317 times),liver meridians(1942 times)or kidney meridian(1975 times).12.08% caused by kidney-yang deficiency,20.79% caused by Dificiency of both yin and yang of Kidney,5.90% caused by dificiency of spleen qi,4.49%caused by sinking of qi due to spleen deficiency,15.17% caused by spleen and kidney yang deficiency,13.76% caused by exuberant phlegm-damp,19.66% caused by liver stagnation causing heat and 8.15% caused by qi stagnation and blood stasis.When these syndromes were re-orgainzed,32.87% caused by deficiency of kidney,39.32% caused by deficiency of spleen,whereas 27.81% caused by qi stagnation.3 Statistical results of each syndrome classification3.1 Kidney-yang insufficiency: The commonest 10 herbs used were Fuzi,Guizhi,Dihuang,Shanzhuyu,Shanyao,Mudanpi,Zexie,Fuling,Chenpi,Zhuru.Addition and subtraction of Jingui Shenqi Pill were the results for cluster analysis.According to association rules,many herbs consisted of 98% support and 100% confidence,included Fuzi,Dihuang,Zexie,Mudanpi,Fuling,Chenpi,Zhuru,showing strong relationships between these herbs.3.2 Deficiency of both yin and yang of Kidney: The commonest 10 herbs used in this type were Gancao,Fuling,Sangjiseng,Shudihuang,Shanyao,Yinyanghuo,Shanzhuyu,Baiziyan,Zhuru.Addition and subtraction of Youguiyin were the results for cluster analysis.Association rules proofed there were strong relationships between Gancao,Shanyao,Sangjiseng,Shudihuang,Yinyanghuo and Chenpi.3.3 Deficiency of spleen qi: The commonest 10 herbs in this type were Dangshen,Fuling,Gancao,Baizhu,Chenpi,Baibiandou,Huangqi,Lianzi,Chaihu,Buzhaye.Addition and subtraction of Shen Ling Bai hu San were the results for cluster analysis.Association rules showed Baibiandou,Gancao,Buzhaye and Fuling had the strongest relationships among the others.3.4 Sinking of qi due to spleen deficiency: The commonest herbs were Shanyao,Gancao,Xuduan,Baizhu,Dangshen,Longgu,Puhuang,Yimucao and Qiancao.Addition and subtraction fof Gu Chong Tang were the results for cluster analysis.Strongest relationships were showed within Shanyao,Puhuang,Xuduan and sanqi.3.5 Spleen and kidney yang deficiency: 10 commonest herbs used were Tushizi,Baizhu,Gancao,Sangjiseng,Xuduan,Fupenzi,Dangshen,Heshouwu,Fuling,Chenpi.Addition and subtraction of Sijunzi Pills and Shoutai Pills were the results for cluster analysis.Association rules showed Shudihuang,Xuduan,Sangjiseng and Tushizi had a stronger relationship among others.3.6 Exuberant phlegm-damp: Commonest herbs used were Banxia,Chenpi,Zhishi,Fuling,Gancao,Baiziren,Huangqi,Hehuanpia and Yejiaoteng.Addition and subtraction of Wendan Decoction were the results for cluster analysis.Among these,Fuling,Zhuru,Gancao,Zhishi and Banxia had stonger relatonships in association rules.3.7 Liver stagnation: The commonest herbs used were Fuling,Maiya,Chenpi,Zhebeimu,Yujin,Jineijin,Chaihu,Fangfeng,Wuyao,Huangqi.Addition and subtraction of self-made PCOS decoction were the results for cluster analysis.Result of association rules showed Jineijin,Yujin,Zhebeimu and Maiya had strong relationships.3.8 Qi stagnation and blood stasis: Commonest 10 herbs were Shudihuang,Chuanziong,Danggui,Chishao,Yimucao,Wuyao,Gancao,Baiziren,Yujin,Jixueteng.Addition and subtraction of Si wun Tang were the results for cluster analysis.From the fourth graded association rules,there were strong relationships between three groups: Shudihuang,Jixueteng,Wuyao and Yujin;Baiziren,Chishao,Wuyao and Gancao;Chishao,Jixueteng,Yujin and Wuyao.Conclusion1.From cluster analysis associated with association rules,some syndrome-prescription relations were found in this study.Commonly used drugs for kidney-yang deficiency syndrome could be formulated into Jingui Shenqi Pill,in this formula,spleen restorative drugs were seldom used,indicating kidney-yang deficiency was not affecting spleen.Commonly used drugs for deficiency of both yin and yang of Kidney could be formulated by Yougui Yin,in between drugs that have claming and strengthening the spleen were used,to strengthen the effect of nourishing kidney.Commonly used drugs for deficiency of spleen qi could be formulated into Shen Ling Bai hu San.Most drugs used were treating spleen,indicating this pathogenesis was only spleen deficiency.Commonly used drugs for spleen deficiency could be formulated into Gu Chong Tang,drugs were including restorative,claming and hemostatic,showing the purpose of prescription was invigorate the spleen and kidney,and could reduce blood flow during menstruation.Commonly used drugs for spleen and kidney yang deficiency could be formulated as sijunzi Pills and Shoutai Pills,showing both spleen and kidney were emphasized in the treatment.Commonly used drugs for exuberant phlegm-damp could be formulated wendan Decoction,drugs were mainly used to exbell the phlegm.Commonly used drugs for liver stagnation could be formulated into selfmade PCOS decoction,purpose was to regulate qi and eliminate extra..Commonly used drugs for qi stagnation and blood stasis could be formulated into siwu Tang,drug-drug interaction showing the core of treatment is to regulate qi and restoring yin.2.When Prof.Li Kunyin treats patients,he first distinguishes the cause of disease,summarizes the disease symptoms,diagnoses the disease,then classifies and treats the disease hence cures the infertility.Prof.Li Kunyin believed the pathogenesis of polycystic ovary syndrome should be related to the deficiency of kidney yang,and mostly related to deficiency of spleen also,so during the treatment,herbs that can strengthen the spleen and reduce phlegm were always used,throughout all syndromes.Prescription for Kidney yang deficiency used Jingui Shenqi Pill.Prescription for deficiency of both yin and yang of Kidney used Yougui Yin.Prescription for deficiency of spleen qi used Shen Ling Bai hu San.Prescription for sinking of qi due to spleen deficiency used Gu Chong Tang.Prescription for spleen and kidney yang deficiency used sijunzi Pills and Shoutai Pills.Prescription for exuberant phlegm-damp used Wendan Decoction.Prescription for liver stagnation used self-made PCOS decoction.Prescription for qi stagnation and blood stasis used siwu Tang. |
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