Research On TCM Syndrome Elements Of Endometriosis Based On Data Mining And Professor Zhao Ruihua's Research On Syndrome Differentiation

BackgroundEndometriosis is a common disease,frequently-occurring disease and intractable disease of females of child-bearing age.Its morbidity is 10-15%and it's increasing year by year.It has a wide range of lesions.It has the behavior of malignant tumor such as invasion,metastasis and recurrence.The sym,ptoms,such as dysmenorrhea,chronic pelvic pain,infertility,pelvic adhesions and cyst,seriously affect women's health and quality of life.Traditional Chinese medicine(TCM)has a significant effect on the treatment of endometriosis.However,there are many schools of TCM,with different academic ideas,especially in the syndrome differentiation and clinical medication,which brings difficulties to the understanding of the essential characteristics of this disease and the formation of the consensus of the industry.In terms of syndrome differentiation,there is no uniform standard for syndrome differentiation of endometriosis.Syndrome factor is the smallest unit in diagnosis of TCM.Accurate identification of syndrome factors is conducive to a deeper understanding of the essence of endometriosis and is helpful to the clinical syndrome differentiation and treatment.In terms of clinical treatment,there are a hundred schools of thought contending for the TCM syndrome differentiation of endometriosis,each with its own characteristics.To sum up the academic thought of famous TCM doctors in the treatment of endometriosis is helpful to improve the clinical efficacy and promote the inheritance and development of TCM culture.Prof.Zhao Ruihua has worked in TCM for more than 30 years,concentrating on the clinical and basic research of endometriosis,and has accumulated rich experience.Using data mining technology to analyze and summarize Prof.Zhao's clinical medical cases is of great help and value to academic succession.ObjectiveThis study preliminarily discusses the composition and distribution characteristics of syndrome factors of endometriosis,in order to provide a more objective basis for studying the distribution of syndrome factors and the standardization of syndrome differentiation.And to sum up professor Zhao Ruihua's ideas of syndrome differentiation on the treatment of endometriosis so as to inherit her academic ideology and promote it in clinical practice.MethodsResearch on Syndrome factors324 cases were selected from January 1st,2015 to December 31th,2017 in Guang'anmen Hospital of Chinese Academy of Chinese Medical Sciences(GAMH).The out-patient medical records were recorded into the clinical research data sharing system of G AMH.The related data was imported into the database of analysis mining platform of the clinical research data sharing system.Then,the source data was preprocessed by the human-machine combination mode.Descriptive statistics of general data were carried out by SPSS24.0 statistical analysis software,and the four-diagnostic information of TCM were carried out by cluster analysis and factor analysis.Study on the rule of syndrome and treatment370 cases were selected from the outpatient department of Prof.Zhao from January 1st,2015 to December 31th,2017 in Guang'anmen Hospital of Chinese Academy of Chinese Medical Sciences(GAMH).The out-patient medical records were recorded into the clinical research data sharing system of GAMH.The related data was imported into the database of analysis mining platform of the clinical research data sharing system.Then,the source data was preprocessed by the human-machine combination mode.Descriptive statistics of general data were carried out by SPSS24.0 statistical analysis software,and the four diagnostic information of TCM were carried out by cluster analysis and factor analysis.The information of herbal medicine was analyzed by the analysis mining platform of the clinical research data sharing system.Gephi0.9.2 software was used to conduct community analysis to explore the clinical experience of Prof.Zhao in the treatment of endometriosis.ResultsResearch on Syndrome factorsThe statistics of the frequency of four diagnosis information of the patients show that the common symptoms are mental fatigue and lack of strength(289),coldness of the body and limbs(261),lumbar soreness(230),premenstrual breast distending pain(229),irritability(215),menstrual clot(202)and so on.The common tongue manifestations include white coating(302),light red tongue(144),thin coating(138),dusky red tongue(99),slightly thick coating(86)and so on.The common pulse manifestations include wiry pulse(275),slippery pulse(157),thready pulse(146)and so on.After clustering analysis,all the symptoms are clustered into 25 categories,and the tongue manifestations are clustered into 6 categories.Because of the concentration of the pulse manifestations,it is not suitable for clustering analysis.A total of 17 syndrome factors are involved.Syndrome factors of disease location include uterus,spleen,liver,kidney,stomach,mind and gallbladder.The syndromes factors of disease resistance include Qi stagnation,blood stasis,Yang deficiency,dampness,Qi deficiency,heat,phlegm,blood deficiency,cold and Yin deficiency.After factor analysis,19 common factors were extracted from all symptoms.The tongue and pulse manifestations are not suitable for factor analysis.A total of 15 syndrome factors are involved.Syndrome factors of disease location include uterus,liver,spleen,stomach,kidney,mind and gallbladder.The syndromes factors of disease resistance include Qi stagnation,blood stasis,Qi deficiency,dampness,essence deficiency,heat,blood deficiency and Yang deficiency.Combined cluster analysis and factor analysis 14 common syndrome factors were extracted.Among them,there were 7 syndrome factors of disease location which include uterus,liver,spleen,kidney,stomach,mind,and gallbladder.There were 7 syndromes factors of disease resistance which include Qi stagnation,blood stasis,Yang deficiency,Qi deficiency,dampness,heat and blood deficiency.The syndrome factors in the two methods showed that the frequency of Qi stagnation,uterus,blood stasis,spleen,liver,Yang deficiency,Qi deficiency and dampness were the highest.Study on the rule of syndrome and treatmentThe 2041 times of 370 patients were divided into 4 groups.As the main treatment,a total of 736 visits were made to eliminate the cyst,a total of 309 visits were made to inhibit the recurrence,a total of 895 visits were made to promote pregnancy and a total of 101 visits were made to prevent miscarriage.For the treatment of eliminating the cyst,we often use Poria cocos,Endothelium Corneum Gigeriae Galli,bighead atractylodes rhizome,ginger,Codonopsis pilosula,Cassia twig,liquorice,semen coicis,Fructus Ziziphi Jujubae,Radix bupleuri,Radices paeoniae alba,Zedoary turmeric,Spina gleditsiae,Salvia Miltiorrhiza and so on.Drug categories mostly include the drugs for nourishing deficiency,invigorating blood circulation and eliminating stasis,dispelling internal cold,regulating Qi flow and transforming dampness.The four properties are mostly warm,mild,light cold and light warm.The five flavors are mostly sweet,spicy and bitter.Channel tropism mostly belong to spleen,stomach and liver meridians.The associations of the 736 prescriptions in the group were analyzed by community analysis.After sreening the relationship between the prescriptions with similarity of more than 0.5,they were finally classified into 3 categories(named categories 0,1,3).Category 0 accounted for 47.69%,mainly including Endothelium Corneum Gigeriae Galli,Poria cocos,Zedoary turmeric,Spina Gleditsiae,bighead atractylodes rhizome,Radix bupleuri,Salvia Miltiorrhiza and so on.Category 1 accounted for 2.17%,mainly including Cassia twig,Poria cocos,Radices paeoniae alba,Ligusticum wallichii,angelica,bighead atractylodes rhizome and so on.Category 3 accounted for 36.28%,mainly including Poria cocos,ginger,Codonopsis pilosula,bighead atractylodes rhizome,Fructus Ziziphi Jujubae,Fructus amomi,wrinkled giant hyssop and so on.For the treatment of inhibiting the recurrence,we often use Poria cocos,ginger,Endothelium Corneum Gigeriae Galli,bighead atractylodes rhizome,Codonopsis pilosula,Fructus Ziziphi Jujubae,Radix bupleuri,liquorice,Salvia Miltiorrhiza,Cassia twig,Zedoary turmeric,Radices paeoniae alba,Fructus amomi,Spina gleditsiae and so on.Drug categories mostly include the drugs for nourishing deficiency,invigorating blood circulation and eliminating stasis,regulating Qi flow,dispelling internal cold and transforming dampness.The four properties are mostly warm,mild,light cold and light warm.The five flavors are mostly sweet,spicy and bitter.Channel tropism mostly belong to spleen,stomach,liver and kidney meridians.The associations of the 309 prescriptions in the group were analyzed by community analysis.After sreening the relationship between the prescriptions with similarity of more than 0.5,they were finally classified into 3 categories(named categories 0,2,3).Category 0 accounted for 51.13%,mainly including Endothelium Corneum Gigeriae Galli,Poria cocos,bighead atractylodes rhizome,Zedoary turmeric,Salvia Miltiorrhiza,Radix bupleuri,Spina Gleditsiae and so on.Category 2 accounted for 36.25%,mainly including ginger,Poria cocos,Fructus Ziziphi Jujubae,Codonopsis pilosula,Fructus amomi,liquorice,Endothelium Comeum Gigeriae Galli,wrinkled giant hyssop and so on.Category 3 accounted for 2.91%,mainly including Radices paeoniae alba,Ligusticum wallichii,angelica,Cassia twig,ginger,Alisma orientalis,Polyporus umbellatus,Poria cocos and so on.For the treatment of promoting pregnancy,we often use Poria cocos,ginger,bighead atractylodes rhizome,Fructus Ziziphi Jujubae,Codonopsis pilosula,liquorice,Radix bupleuri,Cassia twig,Radices paeoniae alba,Fructus amomi,Endothelium Corneum Gigeriae Galli,Trigonella foenum-graecum,wrinkled giant hyssop,Fructus Lycii,Semen Cuscutae,Fructus ligustri lucidi,Radix dipsaci and so on.The main drug categorie is the drugs for nourishing deficiency,followed by the drugs for dispelling internal cold,invigorating blood circulation and eliminating stasis,regulating Qi flow,and transforming dampness.The four properties are mostly warm and mild.The five flavors are mostly sweet,spicy and bitter.Channel tropism mostly belong to spleen,stomach,kidney and liver meridians.The associations of the 895 prescriptions in the group were analyzed by community analysis.After sreening the relationship between the prescriptions with similarity of more than 0.5,they were finally classified into 3 categories(named categories 0,1,3).Category 0 accounted for 33.30%,mainly including Semen Cuscutae,Fructus Lycii,Poria cocos,Radix dipsaci,Fructus ligustri lucidi,liquorice,bighead atractylodes rhizome,Codonopsis pilosula and so on.Category 1 accounted for 51.28%,mainly including Poria cocos,bighead atractylodes rhizome,ginger,Codonopsis pilosula,Cassia twig,liquorice,Radix bupleuri and so on.Category 3 accounted for 3.24%,mainly including Cassia twig,Poria cocos,Ligusticum wallichii,Radices paeoniae alba,angelica,Alisma orientalis,Polyporus umbellatus,bighead atractylodes rhizome and so on.For the treatment of tocolysis,we often use Codonopsis pilosula,Poria cocos,Fructus Lycii,Semen Cuscutae,Fructus ligustri lucidi,bighead atractylodes rhizome,Fructus amomi,Radix dipsaci,ginger,Fructus Ziziphi Jujubae,liquorice,wrinkled giant hyssop,Morinda officinalis,lilium brownie,Fructus Tritici Levis,Radices paeoniae alba,Radix bupleuri,cassia twig and so on.Drug categorie is mainly for deficiency-nourishing drugs.The four properties are mostly?,warm and light warm.The five flavors are mostly sweet.Channel tropism mostly belong to spleen,kidney and stomach meridians.The associations of the 101 prescriptions in the group were analyzed by community analysis.After sreening the relationship between the prescriptions with similarity of more than 0.5,they were finally classified into 1 categories(named categories 0).Category 0 accounted for 82.18%,mainly including Poria cocos,Codonopsis pilosula,Fructus Lycii,Semen Cuscutae,Fructus ligustri lucidi,Radix dipsaci,bighead atractylodes rhizome,Fructus amomi and so on.ConclusionThere were 14 syndrome factors related to endometriosis.There were 7 syndrome factors of disease location,which include uterus,liver,spleen,kidney,stomach,mind and gallbladder.There were 7 syndromes factors of disease resistance,which include Qi stagnation,blood stasis,Yang deficiency,Qi deficiency,dampness,heat and blood deficiency.Among them,the frequency of Qi stagnation,uterus,blood stasis,spleen,liver,Yang deficiency,Qi deficiency and dampness were the highest,indicating that endometriosis and these syndrome factors have a close relationship.The treatment of Prof.Zhao was guided by the purpose of the patient's treatment.And she would carry out individualized treatment according to the characteristics of endometriosis.The groups of elimination of cyst and inhibition of recurrence were divided into three types:Qi stagnation and blood stasis syndrome was treated with Huoxue Xiaoyi Decoction,Qi deficiency and blood stasis and spleen and stomach weakness syndrome was treated with Liuhe Dingzhong Decoction,phlegm dampness stasis syndrome was treated with Wuling Powder and Danggui Shaoyao Powder.The group of pregnancy requirements was treated according to the stage of preovulation and postovulation.The preovulatory stage was divided into Qi stagnation and blood stasis syndrome,Qi deficiency and blood stasis syndrome,spleen and stomach weakness syndrome and phlegm dampness stasis syndrome which were treated with same formula as the above two groups.The postovulatory stage took invigorating the spleen and tonifying the kidney as the principle and treated by Shou Tai Pill and Decoction of Four Mild Drugs.The group of promotion of pregnancy and miscarriage prevention was treated by Shou Tai Pill and Decoction of Four Mild Drugs.