The Medication Regularity Of Professor Shi Dazhuo On The Patient After Percutaneous Coronary Intervention Based On Data Mining

Percutaneous coronary intervention(PCI)is one of the most effective methods for revascularization and myocardial perfusion after coronary artery stenosis or occlusion.PCI was firstly performed in 1984 in China,and up to 2013,there have been 450 thousand patients treated with PCI per year.However,stent implantation in the target coronary artery can only solve the local stenosis,but can't remove the causes of stenosis and atherosclerosis.Meanwhile,PCI may associated with many other problems,such as restenosis,thrombosis and no-reflow of myocardial tissue,which might seriously affect the prognosis of coronary heart disease(CHD).Traditional Chinese medicine(TCM)shows a favorable effect on various pathological changes in patients after PCI,providing a contribution for improving the clinical prognosis.Professor Shi advocates that in the treatment of CHD,the characteristics of both disease and syndrome should be considered at same time.After several decades of clinical practice,he has formed his own characteristics in both diagnosis and treatment of CHD.The present study included following three parts:literature review,experience summary and clinical research.Part 1 Literature review:the progress in treatment with promoting qi to activate blood circulation and resolving toxin after PCIThis review summarized the possible problems after PCI,including stent restenosis,thrombosis and no-reflow of myocardial tissue,etc,and we also reviewed the clinical and experimental progress of promoting qi and activating blood circulation and resolving toxin in the treatment of CHD patients as well as the TCM syndrome type distribution of CHD after PCI.We found that qi deficiency and blood stasis were the main pathogenesis of CHD after PCI,and promoting qi and activating blood circulation is a main therapy of CHD after PCI.Meanwhile,the transformation of toxin from blood-stasis and the combination of toxin and stasis remains throughout the whole process of the cardiovascular disease and may be a main cause that results in cardiovascular events.Thus,it is reasonable to add the detoxification therapy to promoting qi and activating blood circulation therapy.Part 2 Experience summary:The clinical experience of Professor Shi in the treatment of CHD after PCIIn the treatment of CHD after PCI,Professor Shi adept at individu-al macroscopic syndrome differentiation of TCM and CHD patholog-ical changes,as well as the combination of TCM of fever cold properties and the combination of modern pharmacological research results,embodied in the following aspects:(1)promoting yang and relieving stagnation focus on eliminating phlegm,dispersing cold and relieving stagnation;(2)Based on promoting blood circulation to remove blood stasis,combine with the TCM of detoxification;(3)Not only to supplement the heart qi,pectoral qi,but also pay attention to the qi of middle-jiao and qi of kidney.Professor Shi also pay attention to the combination of dredging collaterals,soothe the verves,and invigorate the circulation of the blood and water.Part 3 Clinical research:Shi Dazhuo's prescriptions in the treatment of CHD after PCI based on data mining technologyObjective:To summary the characteristics and principles of dialectical medication of CHD after PCI that diagnosed and treated by Professor Shi in outpatient using the clinical research data platform of Chinese medicine treatment of CHD.Methods:Collecting and storing clinical information were performed with the diagnose and treatment system for aging and famous TCM clinician developed by The Chinese Information Research Academy of TCM;the collected information was managed with ETL tool;statistical analysis was conducted with SPSS 13.0 software;on-line analyzing(OLAP)of flavor and meridian tropism of TCM was made with traditional TCM database of China academy of traditional Chinese medicine;the characteristics of the compatibility of TCM used in clinical practice of Professor Shi for CHD patients was mined and analyzed with WEKA tool.Results:1.In 317 patients,the age was from 23 to 88 years,average age 60.55 years;male accounted for 65.62%,female accounted for 34.38%.The baseline data showed that men had a higher incidence than women in CHD and the age of onset is mainly distributed in between 40 to 80 years old.2.In 317 cases of clinical disease complicated with CHD patients with hyperlipidemia diseases is the most common,accounted for 7.58%;followed by hypertension 5.28%,diabetes mellitus 2.49%,chronic heart failure 1.68%,cerebrovascular disease 1.31%,insomnia 1.18%and so on.The results showed that after the intervention,the patients with CHD is often accompanied with hyperlipidemia disease.3.Distribution of TCM syndromes in patients:The distribution of TCM syndromes are as follows:blood stasis 67.04%,Qi deficiency 10.53%,phlegm and Yin deficiency 6.45%,6.45%,3.29%and 2.50%,Qi stagnation,blood deficiency 0.72%,hyperactivity of liver Yang Syndrome 0.59%.4.1165 prescriptions were collected,involving 250 kinds of Chinese herbs total usage frequency 14334 times.The top ten frequency is salvia miltiorrhiza,chuanxiong hort,radix paeoniae rubra,radix astragali,bulbus allii macrostemi,curcuma zedoaria,honeysuckle,tribulus terrestris,prepared rhizoma cyperi with vinegar,tangerine peel.Classiding to function and effect of Chinese herbs,the first 10 category of herbals are as following 13 kinds:ainly by including invigorating the circulation of blood,relieving pain,harmonizing the blood,clearing heat,soothing the nerves,dispelling the wind,cooling the blood,nourishing the blood,removing blood stasis,clearning boils,disintoxication,eliminating dampness,promoting the circulation of qi,tonifying spleen.The flavor of Chinese herbs used in his prescriptions are as follows:pungent 1192 times,sweet 1191 times,1178 times bitter,slightly cold warm1158 times,1158 times,1129 times of,followed by cold,acid,salt,wet,astringent,heat.The most used Chinese herbs with channel entry in Prof.Shi's prescriptions is heart and Pi channel,followed by lung,liver,stomach,pericardium,gall bladder,large intestine,kidney,bladder,small intestine meridian.5.According to relative rules,defined as SUP>40%,CON>90%,the relationships of Chinese herbs used for CHD patients after PCI were performed,and showed that the common compatibility of Chinese herbs are as follows:curcuma zedoary with salvia miltiorrhiza,radix paeoniae rubra with salvia miltiorrhiza,coptis with salvia miltiorrhiza,curcuma zedoary with radix paeoniae rubra,rhizoma chuanxiong with salvia miltiorrhiza and astragalus with salvia miltiorrhiza,curcuma zedoary with chuanxiong;drug group commonly used are as following:rhizoma chuanxiong,curcuma zedoary,radix paeoniae rubra and salvia;rhizoma curcumae,radix paeoniae rubra and radix salviae miltiorrhizae;rhizoma chuanxiong,rhizoma coptidis,radix paeoniae rubra,and radix salviae miltiorrhizae;rhizoma curcumae,rhizoma chuanxiong,radix salviae miltiorrhiza,rhizoma curcumae,rhizoma chuanxiong,and radix paeoniae rubra;radix paeoniae rubra,radix astragali,rhizoma chuanxiong and radix salviae miltiorrhizae;rhizoma coptidis,rhizoma chuanxiong,and salvia miltiorrhiza,etc.6.Clustering Chinese herbs into 14 categories could present the differentiated characteristics of Prof.Shi.Among them,each category contains some Chinese herbs,in which,the Chinese herbals in the same category have similar effect targeting a main symptom of TCM.The Chinese herbls in the first category is clearing heat and removing turbidity,tonifying qi to activating blood circulation;the herbals in the second is dissipating phlegm and eliminating turbidity,activating blood circulation and removing blood stasis;the herbals in the third category is benefiting qi to activate blood circulation,eliminating stagnation to activate meridians;the herbals in the fourth category is promoting blood circulation for removing blood stasis,regulating qi to stop stagnation;the herbals in the fifth category is activating blood circulation and removing blood stasis,reconciling activities of qi;the herbals in the sixth category is supplementing qi and activating blood to promote diuresis;the herbals in the seventh category is calming the liver and suppressing yang,promoting blood circulation and to detoxification;the herbals in eighth category is supplementing qi and nourishing yin,activating blood circulation and removing blood stasis;the herbals in the ninth category is activating blood circulation and removing blood stasis,cleaning away heat and toxic material,relaxing bowel;the herbals in the tenth category is nourishing liver and kidney,clearing the mind;the herbals in the eleventh category is soothing liver and strengthening spleen,tonifying qi to activate blood circulation;the herbals in the twelfth category is supplementing qi and nourishing yin,promoting blood circulation and detoxificatuin;the herbals in the thirteenth category is nourishing liver and kidney,promoting blood circulation and detoxification;the herbals in the fourteenth category is activating blood circulation and removing blood stasis,cleaning away heat and toxic stasis.7.The complicated network analysis demonstrated that:(1)When the filtering node is not less than 10 with,the compatibility of Chinese hers for CHD treatment could be displayed well.The herbals in proper order of the fitering node based on their number are the root of red-rooted salvia,radices cyathulae,ligusticum wallichii,fructus tribuli,prepared rhizoma cyperi with vinegar,bulbus allii macrostemi,curcuma zedoary,poria cocos,honeysuckle,rhizoma gastrodiae,ramuli umcariae cum uncis,codonopsis pilosula,membranous milkvetch root,pseudo-ginseng powder,the root of kudzu vine,red peony root,safflower,pericarpium citri reticulatae,angelica sinensis,rhizoma pinellinae praeparata,white atractylodes rhizome,radix scutellariae and rhizoma coptidis.When the filtering node is not less than 30,the first relevance Chinese herbs displayed well.The first four correlative Chinese herbals are salvia miltiorrhiza,ligusticum wallichii,root of common peony,milkvetch root.(2)The complicated net-work analysis between TCM syndrome and herbal with the link node score(from high to low)showing that the Chinese herbals corresponding to the blood stasis are root of common peony,salvia miltiorrhiza,rhizoma curcumae,ligusticum wallichii,safflower,panax persudogesing;the Chinese herbals corresponding to qi deficiency are as fellows:milkvetch root,codonopsis pilosula,american ginseng;the Chinese herbals corresponding to phlegm turbidity are as fellows:trichosanthes,bulbus allii macrostemi,pinellia ternata,dried tangerine peel,poria cocos.The Chinese herbals corresponding to heat toxin are as fellows:coptis chinensis,honeysuckle,haikal skullcap.When the filtration node is not less than 32,the distribution of syndrome and Chinese herbs are more clear that the core TCM syndrome of CHD is blood stasis,and the core Chinese herbals are consisting of membranous milkvetch root,ligusticum wallichii,radix paeoniae rubra,radix salviae miltiorrhiza,showing that the core TCM syndrome is consistent to the function of the core herbals,which embodying the medication specialities of Professor shi in clinical practice.(3)When the filtering node is 42 or more,the correlations among the efficacy of Chinese herbs were exhibited well in the analysis of complex network of Chinese herbs efficacy.The efficacy of Chinese herbs contains activating blood circulation,cleaning heat,stopping pain and calming nerves.Conclusions:(1)The common compacibilities of herbs for treating CHD after PCI by Prof.Shi is are salvia miltiorrhiza,radix paeoniae rubra coptis with salvia miltiorrhiza,rhizoma chuanxiong and astragalus with salvia.(2)Prof.Shi takes tonifiting qi,promoting blood circulation,breaking blood,removing phlem and turdity,detoxification and tranquilization as the main therapeutic methods for CHD after PCI.(3)The principle of treating CHD after PCI by Prof.Shi reflected the pathogenetic charecteristics of TCM in CHD patiernts after PCI,which consist of dificiency,blood stasis,phlem and toxin.