The Combination Of Quantitative And Qualitative Data Mining On The Study Of The Diagnosis And Treatment Of Coronary Heart Disease By Professor Li Ping

Background:Coronary artery disease(CAD)is a cardiovascular disease in which insufficient blood is supplied to the heart because of plaque buildup in the coronary arteries,or arterial spasm,leading to myocardial ischemia.The corresponding Traditional Chinese Medicine(TCM)diagnosis for CAD is "chest obstruction with pain," which describes angina pectoris.TCM has advantages in treating CAD which merit further research,such as symptom alleviation,prevention of MACE,post-surgery care,restenosis prevention,control of cardiac risk factors,and supplying alternatives for cases contraindicated to modern medicine.Objective:This is a retrospective study of Professor Ping Li's CAD outpatient case records accumulated over the course of 5 years.Using data mining,case studies,and supervisor interviewing,Professor Ping Li's diagnostic and treatment approach for CAD was analyzed.The resulting trends and patterns gleaned from this study will hopefully contribute to the development and spread of TCM means to treat CAD.Method:Outpatient records of Professor Ping Li's cases dated from September 2012 to September 2017 were retrieved.Data was then inputted into Microsoft Office Excel 2007 and subsequently data mined.Using frequency analysis and association rules,patterns and trends were observed between TCM medication and symptoms.Afterwards,case studies were performed to outline common syndromes of CAD and suggest base formulas for each.With the combined results gathered from the aforementioned research methods,an interview and discussion was held with Professor Ping Li to analyze,confirm,and gain insight on these results.Results:(1)Out of 3580 case reports,a total of 319 patients' files were accepted into the study,totaling 814 reports.Among these patients,43.26%were male,while 56.74%were female.The mean age was 61.04 years old.(2)Including medicines that underwent different processing methods separately,a total of 344 different Chinese medicines were used in these case records.The most commonly individually used Chinese medicines were processed bitter orange,turmeric root,hoelen,grassleaf sweetflag rhizome,sun-dried tangerine peel,coptis rhizome,bamboo shavings,Chinese knotweed vine,ginger-processed pinellia,Szechuan lovage rhizome,red sage root,kudzu root,notoginseng root,ophiopogon tuber,Chinese cucumber,lumbricus,rhodiola,bupleurum root,safflower,and processed white atractylodes rhizome.Using frequency analysis,132 common TCM medicine groups were confirmed,all involving combinations of grassleaf sweetflag rhizome,turmeric root,processed bitter orange,sun-dried tangerine peel,hoelen,bamboo shavings,coptis rhizome,ginger-processed pinellia,and Chinese knotweed vine.Among these groupings,35 were pairs,54 were trios,37 were quadruplets,and 6 were quintuplets.Grassleaf sweetflag rhizome and turmeric root was the most common pairing,with a total of 287 tallied appearances.(3)Using association rules analysis,the relation between medicines were further studied.Support was set to 200,while confidence was set to 0.9,resulting in 496 rules.Among them,67 rules had a confidence of 0.99 or above.The most prominent was "grassleaf sweetflag rhizome,turmeric root?processed bitter orange",with a support value of 239 and confidence of 1.0.(4)Results of frequency analysis indicate that the most common symptoms which appeared over 100 times were chest stuffiness,poor sleep,palpitations,angina pectoris,shortness of breath,dry mouth,and dizziness.There were not many cases of symptom exacerbation,but amongst them chest stuffiness at 20 recorded times was most frequent;afterwards in order of frequency were palpitations,shortness of breath,and angina pectoris.Among records of no symptom change,poor sleep was found most prevalent by a large margin of 122 times,followed by agitation,chest stuffiness,increased irritability,and palpitations.The most frequently alleviated symptoms were chest stuffiness,palpitations,angina pectoris,and poor sleep,all of which were recorded to have occurred over 100 times.Symptoms that most frequently disappeared were angina pectoris,chest stuffiness,palpitations,and shortness of breath.(5)The most common tongue manifestations which appeared over 100 times were dark tongue,white coating,red tongue,greasy coating,yellow coating,engorged tongue,thick coating,fissured tongue,thin coating,darkened sublingual veins,pale tongue,andswollen sublingual veins.The most frequently occurring pulse types were slippery pulse,deep pulse,wiry pulse,rapid pulse,thready pulse,moderate pulse,irregularly intermittent pulse,regularly intermittent pulse,stagnant pulse,and deep-sited pulse.(6)Using association rules analysis,the relation between medicine groups and symptoms plus tongue/pulse were confirmed.Support was set to 70,while confidence was set to 0.3.There were 787 rules generated for "medicine groups?symptoms",in which the prevalence of symptoms were ranked as "chest stuffiness>poor sleep>palpitations".4662 "medicine groups?tongue/pulse" rules were generated;among them "slippery pulse" and "red tongue" had the highest correlation.Other results included "dark tongue","engorged tongue","white coating","yellow coating,","thick coating","greasy coating","red tongue,yellow coating,","red tongue,greasy coating","red tongue,slippery pulse","dark tongue,slippery pulse","white coating,slippery pulse",and“greasy coating,slippery pulse".(7)The most common syndromes of CAD were phlegm-stasis,phlegm-heat,and qi stagnation with blood stasis,all appearing 100 or more times.(8)The results of frequency analysis indicate that the most commonly relevant case histories in relation to CAD were hypertension,hyperlipidemia,coronary stenting,diabetes mellitus,cerebral infarction,cervical spondylosis,thyroid nodules,atrial fibrillation,chronic gastritis,and fatty liver.(9)Association rules for "medicine groups?related history" all resulted in hypertension as consequent;support was set to 70,and confidence to 0.3.The most highly correlated rule was "grassleaf sweetflag rhizome,turmeric root?hypertension" with a support of 122 and confidence of 0.4281.(10)By performing case studies for select records,a general outline of common CAD clinical syndromes and their corresponding base formulas was generated:XiangShaLiuJunZi decoction for spleen deficiency,SanRen decoction or GuaLouXieBaiBanXia decoction for phlegm and dampness,HuangLianWenDan decoction for phlegm-heat,ChaiHuShuGan powder for liver-qi stagnation,TaoHongSiWu decoction for qi stagnation and blood stasis,TianWangBuXin pill for heart yin deficiency,LingGuiZhuGan decoction for heart yang deficiency,LiuWeiDiHuang pill for liver-kidney deficiency.(11)Subsequent interview showed that research results coincided with Professor Ping Li's clinical experience and medical opinion.Professor Ping Li's diagnostic guideline for CAD is"identify as chronic or acute,deficiency or excess;differentiate between qi and blood;identify phlegm,heat,dampness,and cold;locate at zang or fu organs,meridians or collaterals;consider gender,age,and comorbidities".Conclusion:Professor Ping Li's most commonly used Chinese medicines for CAD are grassleaf sweetflag rhizome,turmeric root,processed bitter orange,sun-dried tangerine peel,hoelen,bamboo shavings,coptis rhizome,ginger-processed pinellia,and Chinese knotweed vine.Amongst them,acrid and bitter taste are most prevalent;most channel into the heart,spleen,stomach,and lung meridians;herbs to remove dampness and phlegm makeup the majority,with qi boosting herbs also being prevalent.Research results determined that most CAD syndromes fall under phlegm,dampness,heat,qi stagnation,blood stasis,and deficiency;thus,most commonly used Chinese medicines for CAD remove phlegm and dampness,cool heat,circulate qi and blood,and boost deficiencies."The heart controls blood,vessels,and spirit" together with "regulating the spleen to treat the heart",are the two main academic viewpoints guiding TCM treatment of CAD.According to Professor Ping Li,disease diagnosis,syndrome differentiation,and constitution differentiation should all be utilized together.The order of diagnosis should be chronic versus acute,deficiency versus excess;qi versus blood;phlegm,heat,dampness,or cold;zang versus fu organs,meridians versus collaterals;then finally gender,age,and comorbidities should be considered.Principle of treatment should be excess dispellation if urgent,deficiency boosting if stable.Using data mining,case studies,and supervisor interviewing,a quantitative and qualitative analysis of Professor Ping Li's CAD treatment expertise was performed successfully.