Research On Diagnosis And Treatment Of Elderly Diabetes Mellitus Under The Combination Of Disease And Syndrome Based On The Structured TCM Hospital Records

This research is based on the Beijing Committee of science and technology project "Mining and verification of type2diabetes of TCM clinical diagnosis and treatment regularity"(Topic number:D08050703020802)and State administration of traditional Chinese medicine industry special topics"Study on clinical diagnosis and treatment of clinical research integration technology platform based on traditional Chinese medicine in type2diabetes mellitus"(Topic number:200707001)Objectives:To study syndrome characteristics of elderly diabetes mellitus and principle of syndrome and treatment,and to explore the relationship between senile diabetes "disease-card-square-medicine" based on clinical data of the diabetes structured TCM hospital records by method of data mining.Methods:1.Data gathering:Gather clinical data of elderly diabetes mellitus based on the system. Selectting hospital medical records in accordance with the inclusion criteria by writing the SQL statement, divided into11main data table,including the basic information, complaints, carved, past history, personal history, pulse and tongue diagnosis, diagnosis, prescription, Chinese medicine, physical and chemical indicators.By checking all the data and the number of samples, randomly sample for verification.2.Data processing:Specification for symptoms, diagnosis, traditional Chinese medicine and tongue-pulse treatment through the way of man-computer combination. Data processing principles:Generally in accordance with the current national standards and industry standards specification for symptoms of traditional Chinese medicine and of Western medicine.3.Data mining analysis:(1)Using SPSS19.0statistical analysis software for General descriptive statistics.Describe the mean, standard deviation, of the qualitative data quantitative data which are corresponded with normal distribution.Using frequency, composition ratio to describe the Qualitative data.Use multi-frequency number of cross-table method in Multiple Indicator Combined Statistical classification.(2) Determine the syndrome of elderly diabetes by computers decision and objective study on it.(3)Analysis occurrence frequency and occurrence rate of complications in various age section,then analysis complication rule.(4)Discuss frequency of commonly used drugs of each age section and analysis medication rule of Chinese native medicine.(5)Statistics frequencies of symptoms of all age groups, combined with a commonly used formulae, physical and chemical indicators according to the group. Using Baye network analysis, discuss relations of Chinese medicine card and symptom, physics and chemistry target.Results:11009cases of elderly diabetic patients, people over the age of70has476cases, accounting for47.2%in the number of the group;631cases of women, accounting for62.5%;405patients had a family history of diabetes, accounting for40.1%; smoking history of patients with202cases, accounting for20.02%;129cases of patients with history of drinking, accounted for12.6%. In the775cases of patients with BMI records,overweight and obese patients have443cases, accounting for57.2%. In the joint analysis of multiple indicators, the abnormal rate of blood glucose, HbAlc, IR increased with age increasing and the extension of course.2The main TCM syndromes of Elderly diabetic patients in different periods are:(1)<5years:Yin deficiency and heat syndrome (25,11.8%), Qi and yin deficiency (53,25%), deficiency of both qi and Yin and blood stasis syndrome (31,14.6%);(2)6-15years:Qi-Yin deficiency and blood stasis (92,21.4%), phlegm-dampness and blood stasis syndrome of deficiency of both Qi and Yin (60,14%), blood stasis syndrome of deficiency of both yin and Yang (40,9.3%);(3)>15years:Yin and yang deficiency and blood stasis syndrome (49,18.9%), Yin and Yang phlegm and blood stasis syndrome (43,16.6%), deficiency of both qi and Yin and blood stasis syndrome (28,10.8%). Observing the evolution and changes of TCM Syndromes of senile diabetes mellitus with the extension of course, TCM Syndromes change from intense heat due to Yin deficiency, deficiency of both Qi and yin into deficiency of both yin and Yang gradually overall, and main mixture card inclusion Phlegm, stasis and phlegm and resistance.3Elderly diabetic complications in hypertension, cardiovascular and cerebrovascular disease, peripheral vascular disease, diabetic neuropathy. This suggests that the elderly diabetic complications with large lesions. Statistical results of variety of complications concurrent shows that the proportion of elderly diabetic patients with less than or equal to one kind of complications decreased with the extension of course and more than three kinds increased significantly. This shows that the elderly diabetes duration longer, more complications, multi system damage is more obvious, the illness is more serious.4The following rule of diagnosis and treatment of elderly diabetes syndrome combination:4.1The group of60-65-year-old:The group mainly syndrome with Yin deficiency. Clinical manifestations include dry mouth, drink, palpitation. Yin deficiency and Heat syndrome has62cases (25.31%), prescriptions are zhibaidihuangtang, xiaokewan. Deficiency of both qi and Yin and blood stasis syndrome has82cases (33.47%), prescriptions are shengmaisan, danshenyin, shenqimaiweidihuangtang. Yin deficiency of Liver and kidney and blood stasis has37cases (15.1%), prescriptions are liuweidihuangtang, taohongsiwutang. Treatment is nourishing yin and clearing heat,supplementing Qi, nourishing yin,and activating blood circulation and removing blood stasis mainly.4.2The group of66-70-year-old: The group mainly syndrome with deficiency of both Qi and yin. Clinical manifestations include dry mouth, Fatigue.Deficiency of both qi and Yin syndrome has56cases (19.4%), prescriptions are shengmaisan, qijudihuangtang. Deficiency of both qi and Yin and blood stasis syndrome has55cases (19.1%), prescriptions are shengmaisan, dangguiliuhuangtang, siwutang, xuefuzhuyutang. Deficiency of both qi and Yin and blood stasis and phlegm-dampness syndrome has61cases (21.18%), prescriptions are shengmaisan, wulingsan, dangguiliuhuangtang. Treatment is supplementing Qi and nourishing yin, strengthening spleen and eliminating dampness,promoting blood circulation and removing blood stasis mainly.4.3The group of more than70-year-old:The group mainly syndrome with deficiency of both Yin and Yang. Clinical manifestations include the night to urinate, chest tightness.Deficiency of both Yin and Yang syndrome has42cases (8.82%), prescriptions are shengmaisan, shenqiwan, shenqidihuangtang, jishengshenqiwan. Deficiency of both Yin and Yang and blood stasis syndrome has87cases (18.28%), prescriptions are buyanghuanwutang, liuweidihuangtang, dangguiliuhuangtang. Deficiency of both Yin and Yang and blood stasis and phlegm-dampness syndrome has104cases (21.85%), prescriptions are shenqiwan, wulingsan, dangguishaoyaosan, danshenyin. Treatment is mainly nourishes yin warm positive, promoting blood circulation and removing blood stasis and dispels the wet phlegm reduction.5Senile diabetes medication rule:The group of60-65-year-old:A single drug for nourishing yin and clearing heat, inclusion gegen, shengdihuang, zhimu,eg; Connection medication inclusion taizishen+maidong+danshen+shengdihuang,eg, mainly to supplementing Qi and nourishing yin, promoting blood circulation. The group of66-70-year-old:A single drug for strengthening spleen and eliminating dampness, inclusion fuling, taizishen, shanyao, yiyiren,eg; Connection medication inclusion zexie+shengdihuang+fuling,wuweizi+taizishen+maidong,eg,mainly to supplementing Qi and nourishing yin, strengthening spleen and eliminating dampness, promoting blood circulation and removing blood stasis. The group of more than70-year-old:A single drug mainly inclusion danggui, huanxiong, huangqi, sharen,eg; Connection medication inclusion huangqi+chuanxiong+danggui+shengdihuang, eg, mainly to promoting blood circulation and removing dampness, warming Yang.6Based on Association rules:60-65-year-old age group related complications, high license to Yin deficiency and Heat syndrome,deficiency of both qi and Yin and blood stasis syndrome.66-70-year-old age group related complications, high license to deficiency of both qi and Yin and blood stasis and phlegm-dampness syndrome, deficiency of both qi and Yin syndrome, deficiency of both qi and Yin and blood stasis syndrome. The group of more than70-year-old related complications, high license to deficiency of both Yin and Yang and blood stasis and phlegm-dampness syndrome, deficiency of both Yin and Yang and blood stasis syndrome.Conclusion:1The related risk factors of diabetes in elderly patients include BMI index, family history of diabetes, age, gender, smoking and alcohol consumption.2The evolution law of TCM syndrome type of senile diabetes:TCM Syndromes change from intense heat due to Yin deficiency, deficiency of both Qi and yin into deficiency of both yin and Yang gradually, and main mixture card inclusion Phlegm, stasis and phlegm and resistance.3The principle of treatment of senile diabetes mainly include nourishing yin and clearing heat, supplementing qi and nourishing Yin, nourishing Yin and tonifying Yang, promoting blood circulation and removing blood stasis, eliminating dampness and phlegm.4The most commonly used prescriptions of senile diabetes mellitus have shengmaisan, danshenyin, liuweidihuangtang; The representative prescriptions of main syndromes based on Bias network analysis have shenqimaiweidihuangtang,zhibaidihuangtang, xuefuzhuyutang, shenqiwan, wulingsan, buyanghuanwutang,eg.5The most commonly used Traditional Chinese Medicine of senile diabetes mellitus have taizishen, huangqi, shengdihuang, fuling, danshen,eg; The most common drugs used in combination have taizishen, maidong, wuweizi, fuling, fabanxia, baizhu, chenpi, danggui, chuanxiong,eg.