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

This study on the Beijing municipal science and technology commission of science and technology plan project "of traditional Chinese medicine (TCM) in type2diabetes clinical diagnosis and treatment regularity of mining and validation studies"(project number D08050703020802) and the state administration of traditional Chinese medicine industry subject "based on clinical scientific research integrated technology platform for type2diabetes clinical diagnosis and treatment of traditional Chinese medicine research"(project no.200707001).Objective:With diabetes of TCM diabetic hypertension clinical data structured in hospital medical records system, form a structured database, application of data mining methods, explore the rule combined hypertension and diabetic diagnosis and treatment.Methods:1.Data collection:based on the structured "diabetes hospital medical record collection system of traditional Chinese medicine" gathering the gate hospital from2004to2004diabetic patients with high blood pressure cases information, through the data storage, processing, data warehouse is established. Screening by professionals to write SQL statements, and the original data structured cases are derived, save in the form of Excel form, the summary into standard hospital records, divided into13, summarized the main data tables, including basic information, medical information, all information, past medical history, personal history, the chief complaint, engraving, tongue and pulse diagnosis, western medicine, prescription, Chinese medicine, the physical and chemical index. Participants included1287cases study standard. For overall check of all the data table and the verification of the total sample cases, according to add papery medical records into, for missing data, and random samples for verification.2.Data processing:the data with the man-machine combination of standardization. Data organizing principle:the symptoms of symptoms of traditional Chinese medicine, western medicine, disease commonly carried out in accordance with the current national standard and professional standard specification or alternative, standardized nomenclature and format; Under the premise of special circumstances without causing ambiguity, adopt expert consensus or Suggestions for specification or alternative. Data collected include text data sorting, digital data sorting. The textual data sorting involves symptoms, diagnosis, name, name of prescription of TCM, the basic information, tongue, pulse condition, personal history, past medical history, etc., digital data sorting, including all kinds of physical and chemical index, height, weight, etc. Textual data of complex trival, digital data according to the hierarchical classification, blood pressure into a hierarchical variable.3.The data mining analysis:(1) using SPSS19.0software to the descriptive statistical analysis and research course of general data distribution, high blood pressure classification; Use frequency and form than the diabetic hypertension patients age, gender, history of alcohol, tobacco, BMI and other basic information;(2) from the common symptoms of all cases, inductive diabetic hypertension judgment rules, the discriminant analysis by computer, determine the justification of diabetes hypertension, a study on objectivity to justify.(3) using the factor analysis method to analyze all symptoms of crowd, seek for diabetic hypertension syndrome distribution.(4) according to the data characteristic and the research question, adopts the Clementine study traditional Chinese medicine association rules in data mining platform compatibility relation, the statistical frequency of symptoms at all levels, in accordance with the commonly used formula, physical and chemical indexes and hypertension combined classification. Using bayesian network research syndrome and the relationship between the physical and chemical indicators, symptom, prescription.Results:1. The related factors of diabetes hypertension disease The effective cases in1287cases, this study the cases of319people in50～60years old,60～70years,70people, more than70,429people, more than50years old accounted for87.8%, course≦5years the number of patients was381, duration>≦5years10years the number of patients was342, duration>10years the number of patients is564. That the longer the duration of diabetes, age, the greater the incidence of diabetes with hypertension. Known cases, being overweight, obesity and very obese patients (64.72%), shows the onset of diabetes hypertension increased BMI may have close relationship with the patient. Results show that more than10years course of duration of diabetes hypertension disease has the highest probability. Hospital to check blood lipids was abnormal in707, accounting for72.8%of the number of known; Triglyceride was abnormal in545, accounting for56.128%of the number of known; And smoking history, drinking history, total cholesterol, high-density lipoprotein cholesterol (hdl-c), low density lipoprotein cholesterol (hdl-c) are to a certain extent affect diabetes with hypertension. With the development of hypertension, the higher the blood pressure series, complications such as coronary heart disease, diabetes, kidney disease and has a tendency to increase gradually.2. The syndrome factors factor analysisThis article USES the factor analysis method to all of the engraving sample analysis,13factors were extracted, respectively, can be summarized as:lung qi and Yin deficiency syndrome, liver and kidney Yin deficiency syndrome and phlegm turbidity syndrome, Yin deficiency and blood stasis resistance hand syndrome, liver and kidney Yin deficiency with blood stasis syndrome, qi and TanNing, lungs kidney Yin deficiency syndrome, spleen kidney Yang deficiency syndrome, Yin deficiency fire, qi and Yin deficiency syndrome, Yin deficiency heat syndrome, lung and kidney Yin deficiency, Yang deficiency and blood stasis syndrome. To extract factor according to the disease classification, finally classified into7types of syndrome factors, namely, qi deficiency, Yin deficiency and Yang deficiency, hand, hot, wet phlegm, blood stasis, etc. Reference factor analysis, when these symptoms variables together, helps us to grasp the pathogenesis in patients with clinical.3. The diagnosis rule combined diseaseThrough data mining and the man-machine combination, finally summarized below:(1) hypertension1level of this group of patients according to the frequency from high to low, respectively, Yin deficiency, Yang deficiency and blood stasis, blood stasis and hand Yin deficiency and blood stasis, hotness main symptoms of dizziness, dry mouth, weakness, numbness, body pain, blurred vision. Yin hand and blood stasis on behalf of the prescriptions with gastrodia elata uncaria drink, town liver extinguish wind tonga subtraction; Yang deficiency and blood stasis on behalf of prescriptions have kidney shot, Yang has five tonga subtraction; Yin deficiency and blood stasis hotness representative prescription for know earth when, qi chrysanthemum when parker, increase fluid tonga decreases. Collateral is the basic pathogenesis of Yin deficiency and heat as the standard, the local in the renal.Hypertension grade2of the symptoms of this group of patients is mainly fatigue, dry mouth, chest tightness, palpitations, dizziness, limb pain, edema, card type according to the frequency from high to low were two deficiency and blood stasis, Yin and Yang, Yang deficiency and blood stasis, Yin hand and humid heat and blood stasis. Yin deficiency and blood stasis on behalf of the prescriptions for kidney shot, ginseng and astragalus wheat flavour when add and subtract. Yang deficiency and blood stasis on behalf of fill prescriptions for Yang also drink soup, salvia miltiorrhiza and subtract5; Yin hand, blood stasis and damp and hot representative prescription for gastrodia elata uncaria drink, increase fluid tonga decreases.Hypertension level3of the symptoms of this group of patients with chest tightness, palpitation, edema, limbs cold, dizziness, fatigue, card type according to the frequency from high to low were two deficiency and blood stasis, Yin and Yang, Yin and Yang deficiency and dampness and blood stasis, Yang deficiency and blood stasis. Yin deficiency and blood stasis (23.43%), on behalf of prescriptions for huangqi guizhi wuwu tang, salvia miltiorrhiza drinks add and subtract. Yin deficiency, blood stasis and damp and hot representative prescription for kidney shot, ginseng and astragalus wheat flavour when add and subtract. Yang deficiency and blood stasis on behalf of the prescriptions for five tonga fill kidney pills or Yang also decreases.(2) the relation between medicine combined disease certificateThrough the main parties corresponding master card, had formed the basic framework of grading, staging treatment, in view of the complex symptoms, medication rule according to the association rules analysis and induction.Diabetic patients with hypertension course≦5years to the Yin hand, qi and Yin deficiency, phlegm, carry blood stasis is given priority to, often appear the symptom of on the basis of fatigue, dry mouth, at the same time there will be a numbness, blurred vision, dizziness, the symptom such as insomnia, commonly used traditional Chinese medicine association is atractylodes+tuckahoe, astragalus membranaceus, poria cocos, dwarf lilyturf+fructus schisandrae, radix pseudostellariae and rhizoma chuanxiong+Chinese angelica, astragalus membranaceus. Duration>≦5years to 10years in patients with liver and kidney deficiency, phlegm and blood stasis resistance network is given priority to, often in addition to the symptoms of fatigue, dry mouth symptoms, and symptoms such as dizziness, insomnia, night to urinate, commonly used traditional Chinese medicine association is salvia miltiorrhiza+astragalus root, dried tangerine or orange peel, poria cocos, cornus, alisma and poria cocos, pinellia+dried tangerine or orange peel, poria cocos.>10years disease duration is given priority to with two deficiency, phlegm turbidity stasis resistance of Yin and Yang, often appear symptoms of fatigue, dry mouth, dry stool, drink more, symptoms such as chest tightness, night to urinate, commonly used traditional Chinese medicine association is atractylodes+tuckahoe, astragalus membranaceus, poria cocos, pseudostellaria root+fructus schisandrae, radix ophiopogonis, rhizoma ligustici wallichii+Chinese angelica, astragalus membranaceus.Commonly used hypertension1level of qi and blood circulation TCM associated with wet:for astragalus membranaceus, poria cocos, dried tangerine or orange peel and pinellia+poria cocos+atractylodes, astragalus membranaceus plus salvia miltiorrhiza, dwarf lilyturf, salvia miltiorrhiza and astragalus membranaceus+twotooth achyranthes root, angelica, etc. High blood pressure level2common associated:tonifying qi, promoting blood circulation to remove blood stasis of TCM with wet atractylodes+poria cocos, angelica, astragalus, angelica and salvia miltiorrhiza+astragalus, angelica, salvia miltiorrhiza and astragalus membranaceus, poria cocos,etc.Hypertension level3commonly used Yin association of TCM for activating blood, spleen wet:atractylodes+poria cocos, twotooth achyranthes root, poria cocos, fructus schisandrae+radix ophiopogonis, radix pseudostellariae+angelica sinensis, radix paeoniae rubra, rhizoma ligustici wallichii and astragalus membranaceus, etc.Conclusion:(1) diabetes hypertension related factors:age, BMI, diabetes duration, smoking, hyperlipidemia, poor blood sugar control.(2) according to the principle of combined disease, diabetes, hypertension disease in hypertension diagnosis classification standard is divided into three, each level can be divided into three certificates.(3) diabetic hypertension syndrome type of traditional Chinese medicine mainly for Yin hand syndrome, phlegm wet block evolved into the Yang deficiency syndrome, Yin deficiency, blood stasis runs through diabetic hypertension.(4) diabetic hypertension symptoms mainly dry mouth, fatigue, dizziness, headache, with chest tightness, heart palpitations, numbness, body pain, edema, and appear.(5) diabetic hypertension on behalf of the formula is:gastrodia elata uncaria drink, pinellia atractylodes rhizoma gastrodiae decoction and ginseng and astragalus wheat flavour when, therapeutic and kidney shot to add and subtract.