Medication Regularity Study On Combined Treatment Of TCM And Western Medicine In Cerebral Infarction

In recent years, with the economic rapidly developed and living standards improved, people’s eating habits changed dramatically, significantly increased the proportion of protein and fat intake. At the same times, along with an aging population, urbanization lifestyle, smoking population growth, increasing industrialization process and other factors, cerebrovascular disease incidence rate increased sharply in the country. Among them, the incidence of cerebral infarction accounts for 75%-80% of acute cerebrovascular disease. Therefore, strengthening research on cerebral infarction and reducing the mortality rate have very important significance to improve the quality of life.Cerebral infarction has been one of today’s most common clinical medical emergency, which has a high incidence rate and high mutilation rate. It not only seriously affects the quality of life of patients, but also bring a heavy mental and financial burden to the patient’s family. Currently, the combination of traditional Chinese and Western medicine has done extensive research on basic and clinical research of cerebral infarction, also accumulated a large number of medical literature. These literatures provide a rich data resources for digging the medication regularity of the combination treatment to cerebral infarction. Digging this from literatures can provide a reference for clinical medication, provide data support for the advantages of the combination treatment to cerebral infarction.1. Objective:In this study, the research object is the literatures published in 1984 to 2013 about the combination treatment of TCM and Western medicine to cerebral infarction, the research methods are frequency analysis and text mining methods. This study uses this to explore the medication regularity in combination therapy of cerebral infarction., in order to make clear the usage of diagnostic criteria and efficacy standards, the usage of Western medicine, the usage of Chinese medicine, the co-occurrence of Western medicine and Chinese medicine and the adverse reactions occur. We hope it can provide ideas and data support for future treatment and next clinical medicine of cerebral infarction.2. Methods:(1) Literatures GetIn the CNKI database, use the search term "cerebral" or "cerebral" or "stroke" or "ischemic stroke" or "stroke", the search term election "theme", matching the election "exact query "retrieve deadline for December 31,2013. On the basis, use search terms "Integrative Medicine ", the search term election "text", matching the election" exact query ".Finally, we retrieved a total of 8,321 literatures.In the Wanfang data, use the advanced search in the professional search, retrieve formula is:"theme:(" cerebral"+" cerebral"+" stroke "+" ischemic stroke "+" stroke ")* in Integrative* Date:-2013 ".A total of 5,381 literatures were retrieved.Downloaded all literatures bibliographic, then imported them into noteexpress software.In the software, remove duplicate documents, preliminary sorting get 9563 literatures.Formulating the inclusion and exclusion criteria, secondary screening for these literatures. The final literatures were 1549.(2) Literatures information extractionExtracted the required information in 1549 literatures, mainly including diagnostic criteria, efficacy standards, Western medicine usage, TCM medicine usage, TCM syndrome, the incidence of adverse reactions, and then import them to database.(3) Data standardizationIn original literature, the name of Western medicine and TCM are not unified. The names of Western medicine normalized, reference to the 2010 edition of "People’s Republic of China Pharmacopoeia", the seventh edition of "pharmacology", and the latest data from the National Food and Drug Administration website. The name of TCM normalized reference to the Gao Min edition of "TCM pharmacy". (4) Research MethodsIn this study, the main research methods are frequency analysis and text mining methods, using frequency analysis to count the frequency of diagnostic criteria and efficacy standards usage, the occurrence frequency of Western medicine and TCM, and the frequency of adverse drug reactions. Using the association analysis methods of text mining to analyze the usage of Western medicine and combined medicine, the algorithm is Apriori. Using cluster analysis method of text mining to analysis the usage of TCM in different syndromes, the algorithm is K-MEANS.3. Results:(1) The usage of diagnostic criteria and efficacy standardsThe usage of diagnostic criteria and efficacy standards mainly uses frequency analysis. The results show that: the most frequently used Western diagnostic criteria is 1995 Fourth National Conference on Cerebrovascular Disease. The highest frequency TCM diagnostic criteria is "stroke diagnosis and evaluation standard." The most frequently used efficacy standards is "stroke clinical neurological deficit score (CSS)". In addition, the annual use of all types of standard show that the three most frequently used criteria is almost always the highest standards since the beginning of the use to 2013 in the same type standards.(2) The usage of Western medicineFirst, using frequency analysis, found that the highest amount of medicine is aspirin, followed by citicoline, dextran, mannitol, troxerutin. And then using association analysis, we found frequent combination drugs such as aspirin-citicoline, as citicolin and evitamin and aspirin have a strong correlation.(3) The usage of TCMFirst, using frequency analysis, found that the highest usage of TCM is self-made prescription medicine, followed by Buyanghuanwu decoction, xuesaitong, Shuxuetong injection, Compound Salvia. This is exactly consistent with the characteristics of traditional Chinese medicine. Secondly, using frequency analysis, found that the highest amount of Chinese patent drug is xuesaitong, followed by Shuxuetong injection, Compound Danshen, Ligustrazine, Danhong injection. Again, using frequency analysis to TCM prescription, found Buyanghuanwu decoction is the maximum amount, followed by Tianmagoutengyin, Zhenganxifeng decoction, Daqinjiaotang, Wendantang. Finally, all the herbs of the TCM prescriptions in the statistical analysis, found that herbs which promoting blood circulation for removing blood stasis, tonic herbs and herbs which suppressing hyperactive liver for calming endogenous wind are maximum amount.(4)The medicine usage of different syndromesTreatment based on syndrome differentiation is the cores of TCM, so the literature referred that were analyzed separately. The most frequently occur syndrome is syndrome of blood stasis due to deficient qi, followed by syndrome of wind-phlegm blocking collaterals, syndrome of excessive fu-viscera caused by phlegm-heat, syndrome of stirring wind due to yin deficiency, syndrome of phlegm stasis, syndrome of upper hyperactivity of liver yang, syndrome of hyperactivity of yang due to yin deficiency and etc. And then using cluster analysis to the drug corresponding with various syndromes, found syndrome of blood stasis due to deficient qi commonly used the treatment of benefiting qi for activating blood circulation, commonly used prescriptions for Buyanghuanwu soup; syndrome of wind phlegm blocking collaterals commonly used the treatment of removing phlegm, calming wind and promoting blood, commonly used prescriptions for Banxiabaizhutianmatang and Daqinjiaotang; syndrome of excessive fu-viscera caused by phlegm-heat commonly used the treatment of removing heat-phlegm and purging Heat and purgation, commonly used prescriptions for Xinglouchengqitang; syndrome of stirring wind due to yin deficiency commonly used the treatment of nourishing yin to calm the wind and suppressing hyperactive liver and subsiding yang; syndrome of upper hyperactivity of liver yang commonly used the treatment of calming the liver to stop the wind, commonly used prescriptions for Tianmagoutengyin; syndrome of hyperactivity of yang due to yin deficiency commonly used the treatment of nourishing yin and suppressing hyperactive yang and calming the liver to stop the wind.(5) The usage of co-occurrence medicineAnalyzing the co-occurrence of the Western medicine and TCM, found the highest co-occurrence is self-made prescription and citicoline, followed by Buyanghuanwu decoction and dextran, self-made prescription and aspirin, aspirin and Buyanghuanwu decoction, dextran and self-made prescriptions.Secondly, in Chinese patent drug and western medicine, aspirin and xuesaitong altogether is the highest number, followed by aspirin and Ligustrazine, dextran and Compound Danshen, citicoline and Ligustrazine, edaravone and Shuxuetong injection.Again, using the association analysis, found frequent combination drugs such as Buyanghuanwu decoction and dextran, as Buyanghuanwu decoction and troxerutin and dextran have a strong association rule.(6) Adverse reactions conditionsAdverse reactions reported in the literature, the more common damage is in the digestive system, nervous system damage, skin and accessories damage, local injection site reactions. The drugs which appeared largest number of adverse reactions is Danhong injection and low molecular weight heparin, followed by Xuesetong and low molecular weight heparin, Danshen injection and urokinase, Tongxinluo capsule and Xueshuantong and Buflomedil. The most reported adverse reactions are the same as the Western medicine specification, reported less new adverse reactions beyond the specification.4. Conclusion:Using frequency analysis and text mining methods, we analyzed medication regularity and adverse events for 1549 literature from 1984 to 2013 in the mainstream journals about combination treatment of TCM and Western medicine to cerebral infarction.The results showed that: in the diagnostic criteria and efficacy standards of combination treatment of cerebral infarction, there is a "gold standard". The western diagnostic criterion is 1995 Fourth National Conference on Cerebrovascular Disease. The TCM diagnostic criteria is "stroke diagnosis and evaluation standard." The efficacy standards is "stroke clinical neurological deficit score (CSS)". In medicine, western medicine commonly use aspirin, citicoline and other conventional drugs. For TCM no matter Chinese patent drug or TCM prescriptions, the most commonly usage is blood circulation drugs, corresponded with the vacuity of stroke pathogenesis.Analyzed the literature which taken treatment based on syndrome differentiation to cerebral infarction found that the most common symptoms is syndrome of blood stasis due to deficient qi, followed by syndrome of wind-phlegm blocking collaterals, syndrome of excessive fu-viscera caused by phlegm-heat and etc. At the same time found in syndrome of blood stasis due to deficient qi, commonly used the treatment of benefiting qi for activating blood circulation, commonly used prescriptions for Buyanghuanwu soup.Analyzed the combination therapy of Western medicine and TCM showed that aspirin, citicoline, dextran, self-made prescription, Buyanghuanwu decoction, Xuesetong are critical medicine. Correlation analysis found Buyanghuanwu decoction and troxerutin and dextran have a strong association rule.The adverse reactions reported in the literature, the common damages are in the digestive system, nervous system, skin and accessories, local injection site reactions. The most reported adverse reactions are the same as the Western medicine specification, reported less new adverse reactions beyond the specification.