Analysis Of Incunabula And The Clinical Experience Of Professor Gan Zuwang In Treating Chronic Laryngeal Based On Data Mining

ObjectiveIn the study,the ancient medical record database of chronic laryngeal and the medical record database of Professor Gan Zuwang’s treatment were built based on the knowledge externalization and intelligent processing system of traditional Chinese medicine.Through data mining surfaced a summary of the medication rule of ancient physicians and Professor Gan Zuwang’s prescriptions.The summary serves as a guide for both clinical practice and research.MethodsResearch platform:Developed and maintained by the big data team of Guangdong Hospital of Traditional Chinese Medicine,the TCM knowledge externalization and intelligent processing system offers access to more than 1100 such ancient medical books as Chinese Medical Canon,and provides such functions as document retrieval,provision extraction,classification and annotation.Based on ontology knowledge base and modeling of deep learning inference,the automatic construction framework of traditional Chinese medicine knowledge in otolaryngology specialty was established.With recurrent neural network and knowledge clustering of automatically extracted TCM information from research data and identified knowledge units,the knowledge map was automatically constructed,and the tacit knowledge points were transformed into visual block relations.Ancient Book Research:With a query of 40 textbooks and monographs on otolaryngology came the identification of the terms of chronic laryngeal as search words in the TCM knowledge externalization and intelligent processing system.The preliminarily retrieved provisions in the ancient books were extracted according to the inclusion and exclusion criteria,thus building a database of chronic laryngeal in ancient books for data-mining and analysis.Clinical research:Collected and organized were the books written by Professor Gan as well as his students,TCM cases published in periodicals,and medical cases documented and hand-copied by Professor Li Yunying.Among these materials,a total of 91 medical cases of chronic laryngeal were recorded.On the research platform,the database of Professor Gan’s medical record was built for data-mining and analysis.ResultsAncient literature research:903 prescriptions and 160 related drugs for chronic laryngeal were collected.The result of the medication rule analysis is as follows:1.Frequency analysis of medication:The top 20 drugs are rehmannia glutinosa,ginseng,ginger,licorice,bitter almonds,honey,angelica sinensis,platycodon grandiflorum,cinnamon,radix opogonis,rhizoma coptidis,scutellaria baicalin,ephedra,aconite,poria,paraffin,Terminalia chebula,jujube,pinellia ternata,and mint.2.Core drugs:according to the word cloud map,the core drugs are Rehmannia glutinosa,Ginseng,Licorice,Angelica sinensis,Ephedra,Radix Ophiopogonis Radix,diwaricate saposhnikovia root,Radix Paeoniae Paeoniae,etc.3.The commonly used drugs of the main efficacy are:qi-tonifying drugs,wind-cold-dispersing drugs,heat-clearing and phlegm-reducing drugs,qi regulating drugs,yin-tonifying drugs,wind-heat dispersing drugs,drugs for relieving cough and asthma,and etc.4.Drug property analysis:The four qi properties are mild(22.5%),warm(21.9%),flat(18.1%),cold(15.9%)and slightly cold(11.3%);The five flavor properties are sweet(34.6%),pungent(25.1%)and bitter(21.7%).The channel tropism are lung(24.5%),spleen(16.7%),heart(14.3%)and stomach(13.1%).5.8 core combinations of herbs were mined with the knowledge map analysis.With the knowledge map and clinical prescriptions are mined couplet medicines of balloonflower root and liquorice,of prepared rhizome of rehmannia and chinese angelica root,of chinese ephedra and divaricate saposhnikovia root,of dwarf lilyturf root and white mulberry leaf,of perilla and tatarian aster root and rhizome,of bitter apricot seed and white mulberry bark.6.Analysis of historical prescriptions:the prescriptions in the Song,Jin and Yuan Dynasties were licorice,prepared rhizome of rehmannia,cinnamon,ginseng,chinese ephedra,ginseng,chuanxiong,diwaricate saposhnikovia root,mainly to tonify qi and ease-up the voice,to clear lung and disperse blood stasis,to detoxify.The prescriptions in the Ming Dynasty were prepared rhizome of rehmannia,chuanxiong rhizome,liquorice,ginseng,chinese angelica root,dwarf lilyturf root,divaricate saposhnikovia root to tonify qi and ease-up the voice,regulating middle energizer,clear lung and dissolve phlegm,and detoxify.The prescriptions in the Qing Dynasty and the period of the Republic of China corresponded with tonifying qi and easing up the voice,invigorating yin and moisturizing throat,and clearing lung and dissolving phlegm.Clinical Research:91 prescriptions of Professor Gan and 135 related drugs for chronic laryngeal were collected.The result of the medication rule analysis is as follows:1.Frequency analysis of drugs used:the top 20 drugs were:concretio silicea bambusae,radix platycodon grandiflorum,angelica sinensis,licorice,red peony root,triplex root,zedoary,peach kernel,cicada slough,poria cocos,honeysuckle,centella asiatica,belamcanda chinecsis,radix scrophulariae,kelp,chinese yam,radix pseudostellariae,algae,rhizoma atractylodis macrocephalae.2.Analysis of four qi of TCM:the top four in frequency are plain,cold,warm and slightly cold;The top 3 of the frequency ratio of five flavours in TCM are sweet,bitter and spicy.3.The main meridians of TCM are lung,liver,spleen,heart,stomach and kidney.4.The efficacy of the drugs used by Professor Gan mainly included drugs for promoting blood circulation and removing blood stasis,tonic drugs,antipyretics drugs,relieving superficy drugs and qi-regulating drugs,and drugs for its complexed syndrome.5.With such comprehensive analysis as the cluster analysis,frequent item set,association rule are mined the couplet medicines of curcuma zedoary and rhizoma sparganii,peach kernel and herba lycopi,poria cocos and rhizoma atractylodis macrocephalae,radix rehmanniae recen and radix scrophulariae,platycodon grandiflorum and folium eriobotryae,tabasheer and fritillaria cirrhosa,honeysuckle and blackberry lily,agastache rugosus and eupatorium,cicada slough and folium mori,red peony root and rhizoma phragmitis.6.8 prescriptions were mined according to the knowledge map of drug clustering.Based on "testing syndrome by prescription",Professor Gan’s treatment was inferred to correspond with wind-heat syndrome,phlegm-heat syndrome,phlegm-blood stasis syndrome,wind-phlegm syndrome,spleen-qi deficiency syndrome,lung-kidney yin deficiency syndrome,and phlegm-heat stagnation syndrome.ConclusionThe prescriptions of ancient physicians were in accordance with supporting healthy energy,eliminating pathogenic factors and seeking both temporary and permanent solutions.The key of treating the deficient is to make up for the deficiency,to take care of qi and yin in particular.The key of treating the actual with such syndromes as wind cold,phlegm-heat,gas stagnation,phlegm,blood stasis and toxin is to prescribe medicine of expelling wind and cold,removing heat-phlegm,regulating qi,eliminating phlegm,invigorating blood stasis,detoxificating and eliminating pathogens.The treatment of rectifying qi in particular corrsponeded with flexing qi and clearing orifices.In the Song,Jin and Yuan Dynasties,the prescriptions of invigorating the lung,nourishing yin and larynx,sweating,drying wetness corresponded with such syndromes as deficiency of lung qi,deficiency of yin,cold by exopathogen and damp middle energizer.In the Ming Dynasty,the key treatment was invigorating qi,easing the voice and regulating the functions of the stomach and the spleen.Such treatments as clearing liver,tonifying heart,promoting blood circulation and removing blood stasis increased for the stagnation of liver meridian,deficiency of heart qi and blood,and blood stasis.During the Ming and Qing Dynasties,the key treatment was invigorating qi,nourishing yin and throat,clearing lung and resolving phlegm.The understanding and medicating of promoting blood circulation and resolving phlegm were further developed in the period,but the key prescriptions remained resolving phlegm.Professor Gan Zuwang studied ancient treatment and made bold attempts to innovate.He founded the theory of "intermediary syndrome",put forward the "five diagnoses and ten principles" of otolaryngology differentiation and treatment,so as to improve and develop TCM in voice medicine.In the treatment of chronic laryngeal,the exterior-syndrome-solving treatment corresponding with the exterior-pathogen-trapped exterior syndrome is given in the first place.The accurate grasp of the pathogenesis of qi stagnation,blood stasis,phlegm coagulation and heat toxin is required in clinical practice.From the overall perspective,it is essential to review the five internal organs,especially the liver and spleen,prescribe with the syndrome,offer both treatment and nourishment,use medicine flexibly,and medicate effectively.Treating stubborn blood stasis was to disperse blood stasis and ease the voice with Fanggan’s Danqing Sanjia Powder.Such guiding prescriptions in laryngology as platycodon grandiflorum and belamcanda chinensis were often given in clinical practice.