Exploring The Evidence And Medicine Analysis Of Chinese Medicine For Acute9 Cerebral Infarction Based On Complex Network Approach Infarction

BackgroundCerebrovascular accidents rank first among fatal or disabling diseases in adults,and acute cerebral infarction is the most common type of stroke,accounting for about 67%of all stroke patients.Its high morbidity,disability and mortality rates place a heavy burden on families and society.Currently,the latest guidelines for the treatment of acute cerebral infarction in Western medicine recommend the use of therapies such as thrombolysis,anticoagulation,antiplatelet aggregation,intracranial pressure lowering,fiber lowering,and stent placement.In recent years,research on TCM in acute cerebral infarction has grown year by year,especially in the literature of randomized controlled trials,indicating that TCM has achieved certain efficacy in the treatment of acute cerebral infarction.In the clinical practice of TCM,the use of medication by TCM practitioners based on experience is widespread,and is most common among senior and famous TCM practitioners who have been practicing for many years.However,there is a wide variety of TCM compound prescriptions for the treatment of acute cerebral infarction,each with its own advantages and disadvantages;and the inconsistent results of therapeutic efficacy studies of TCM compound prescriptions in literature studies and real-world studies make it difficult for clinicians to make a choice when screening the use of medications.Therefore,it is necessary to compare the efficacy of herbal compound prescriptions for acute cerebral infarction in literature studies and real-world studies.Objectives1.Primary objective:To explore the diagnosis and treatment ideas of Chinese medicine for acute cerebral infarction and prescription medication pattern by using complex network method(scale-free network model).2.Secondary objective:To construct a study on the difference analysis of the diagnosis and treatment of the total population of acute cerebral infarction and the middle school and recurrence population based on the medical database.Contents1.Exploratory study on the core prescription medication pattern of acute cerebral infarction literature data using complex network methodBased on the randomized controlled trials and clinical cases in the literature,we established and explored their effective experiences on the treatment of acute cerebral infarction,and discovered the drug prescriptions in the core position by providing the networked drug dispensing diagram,drugs with different degrees of association frequency and corresponding topological values.Based on the existing expert cases,we collected and organized the prescriptions of the three national medical masters and the brain disease experts of the Brain Disease Branch of the Chinese Association of Traditional Chinese Medicine,standardized the drug names and then used the methods of statistical analysis of system integration and complex networks to analyze the frequency of prescriptions,drug properties and core prescriptions of the medical cases.We also used complex network methods to explore the core drug and prescription usage patterns of randomized controlled trials and encephalopathy expert cases in the literature data of TCM for acute cerebral infarction.2.Exploratory study of Chinese medicine for acute cerebral infarction based on real-world data using complex networksTo analyze the characteristics and key nodes of the complex network based on real-world acute cerebral infarction diagnosis and treatment data.Through data cleaning of acute cerebral infarction patients’ diagnosis and treatment data in the HIS system of tertiary hospitals,a core network diagram of "disease-evidence-medicine"was constructed to reveal the relationship between core symptoms,core evidence and core medicine,and to explore the implicit heterogeneous relationship between three different sub-networks,so as to analyze the characteristics of the complex network based on real-world acute cerebral infarction diagnosis and treatment data.The core network is divided into the following two parts:on the one hand,the core symptoms,the core evidence and the core drugs are related to each other.On the one hand,the complex network approach is used to discover the core network of "disease-evidence-medicine"of the real-world acute cerebral infarction population.On the other hand,we analyze the similarities and differences between the recurrence and non-recurrence of acute cerebral infarction treated by TCM through the complex network approach,and explore the real-world core medication use in the total acute cerebral infarction population and in different outcome situations.MethodsPart I:Using the complex network method to mine the randomized controlled trials of acute cerebral infarction and the similarities and differences in the core prescriptions and medications of randomized controlled trials of different evidence types,to summarize and sort out the evidence,treatment methods,drug frequency,categories,and nature and flavor attribution analysis of the treatment of acute cerebral infarction by national medical masters and stroke experts,to analyze the development trend of the complex network method in the field of acute cerebral infarction,and to explore the commonalities and characteristics of Chinese medicine in the treatment of acute cerebral infarction.The second part is based on the complex network analysis method.Part II:Based on the complex network analysis method,the BA scale-free network model is used to study the core complex network analysis of "disease-evidence-medicine"in the total population of real-world acute cerebral infarction patients and the middle school and recurrence population.Results1.Results from the complex network literatureThe analysis of the literature data consisted of two parts,which were the search of the Chinese and English databases for Chinese herbal compound prescriptions from randomized controlled trials of Chinese medicine for the treatment of acute cerebral infarction and the Chinese databases for prescriptions of clinically validated cases by encephalopathologists for the treatment of acute cerebral infarction,respectively,to compare and analyze the effective core drug combinations in the research literature database.We searched all the literature on Chinese medicine for acute cerebral infarction in four major Chinese databases and three major English databases,and imported 170581 relevant entries into the literature management software NoteExpress(V3.5.0.9054),and finally screened 628 randomized controlled trials.628 randomized controlled trials applied a total of 284 flavors of Chinese medicine,and the results involved 21 classes of drugs,such as antiphlogistic drugs,heat-clearing drugs,deficiency-supplementing drugs,qi-regulating drugs,tranquilizers,and phlegm-transforming drugs,etc.The high-frequency drugs obtained from the high-frequency analysis of the literature,such as Chuanxiong,Honghua,Tao Ren,Dan Shen,Niubizi,and Chicken Blood Vine,were mainly used to activate blood circulation and resolve blood stasis,and also to quench wind and stop spasm,dry dampness and cool blood,and tonify qi and activate blood;deficiency-supplementing drugs were second.There were 183 studies related to the symptoms,among which Qi deficiency and blood stasis were in the first place,followed by phlegm-stasis obstruction,wind-phlegm obstruction,phlegm-heat and internal organs solidity,and wind-phlegm stasis obstruction.Among the commonly used drug pairings,Chuanxiong had the highest frequency of pairings with Angelica sinensis,Safflower,Astragalus,and Dilong,followed by Angelica sinensis with the second highest frequency of pairings with Safflower,Astragalus,and Dilong,respectively.In the case of angular drug pairing,Chuanxiong and Di Long had the highest frequency of drug pairing,followed by Astragalus,Angelica and Safflower,respectively.The complex network topology values were analyzed in terms of node degree,proximity centrality,reconciliation centrality,mediation centrality,clustering coefficients,feature vector centrality and frequency of drug use,and eight herbs,including Chuanxiong,Di Long,Angelica,Safflower,Radix Paeoniae,Astragalus,Salvia and Peach kernel,were more important in Chinese medicine for acute cerebral infarction.We searched the Chinese databases for expert cases of acute cerebral infarction treated by three national medical masters and Chinese encephalopathologists from the Chinese Association of Encephalopathy,and imported 716 related records into NoteExpresss(V3.5.0.9054),and finally screened out 70 Chinese articles.138 soup and proprietary Chinese medicines were found in the 70 expert cases,and the total number of applied Chinese medicines was 311.The results involved 19 categories of drugs,such as antiphlogistic drugs,heat-clearing drugs,deficiency-supplementing drugs,qi-regulating drugs,tranquilizing drugs,phlegm-transforming drugs,etc.The 70 related articles involved a total of 96 clinical cases of evidence,and according to the Chinese medical classification,qi deficiency and blood stasis evidence and phlegm-heat and internal organs evidence ranked first.In terms of drug pairs and horn drug pairings,Chuanxiong had the highest frequency of pairings,followed by Di Long.The complex network topology values were analyzed in terms of node degree,proximity centrality,reconciliation centrality,mediation centrality,clustering coefficients,feature vector centrality and frequency of drug use,and the Chinese herbal medicines such as Di Long,Dan Shen,Chuan Xi ong,Red Peony,Tian Ma,Shi Calamus,Tao Ren,Safflower,Hooked Vine,Angelica sinensis,Stiffness,Poria,Hooked Vine and Biliary South Star were more important in the treatment of acute cerebral infarction by Chinese medicine.2.Real-world research findingsFor 5791 patients with acute cerebral infarction from three tertiary hospitals,the core drugs for the total population of acute cerebral infarction,the middle school population of acute cerebral infarction and the recurrent population were analyzed.The core drugs for the total population of acute cerebral infarction were Poria,Semen,Atractylodes,Radix Angelicae Sinensis,Pericarpium Citri Reticulatae,Rhizoma Chuanxiong,Radix Paeoniae Alba,Radix Astragali,Rhizoma Tenuiflora,and Salviae Miltiorrhizae,and the core TCM disease diagnoses were stroke,dizziness,thirst and chest paralysis.The core TCM evidence types were wind-phlegm obstruction evidence and qi deficiency and blood stasis evidence.The core drugs for patients with acute cerebral infarction in junior high school were Poria,Semen,Chuanxiong,Tianma,Atractylodes,Chen Pi,Peach kernel,Red Flower,and White Peony.The core drugs for acute cerebral infarction recurrence hospitalized for 2-3 times are Poria,Semen,Atractylodes,Angelica,Chen Pi,Chuanxiong,Bai Shao,Astragalus,Tian Ma and Salvia.The core drugs for patients hospitalized for 4-5 times for recurrence of acute cerebral infarction are Fu Ling,Atractylodes Macrocephalae,Rhizoma Atractylodes,Radix Angelicae Sinensis,Radix Angelicae Sinensis,Radix Angelicae Sinensis,Radix Astragali and Radix Paeoniae Alba.Patients with acute cerebral infarction recurrence hospitalized for 6-10 times,the core drugs are Fu Ling,Atractylodes Macrocephalae,Radix et Rhizoma Polygonati,Rhizoma Tenuifolia,Pericarpium Citri Reticulatae,Radix Angelicae Sinensis,Radix Angelicae Sinensis,Radix Astragali,Radix Paeoniae Alba.In patients with acute cerebral infarction who have been hospitalized for more than 10 times,the core drugs are Chen Pi,Fu Ling,Atractylodes Macrocephalae,Danshen,Angelicae Sinensis,Astragalus,Radix Paeoniae Alba,Rhizoma Chuanxiong,Radix Puerariae Sinensis and Radix Codonopsis.Acute cerebral infarction evidence society 1,2,4"evidence-treatment"is the most closely related,society 1(tonic qi and clear heat to remove blood stasis society),society 2(benefit qi and return yang to dispel wind and phlegm society)society 4(dispel wind and phlegm to activate blood to remove blood stasis society),the diagnosis data flow between evidence and treatment is relatively balanced from two before and after stroke treatment The overall situation of the" evidence-medication-evidence"(change of evidence)"evolution correspondence shows that each type of evidence is mostly transformed to wind-phlegm blocking association A and qi deficiency-blood stasis association D after treatment.Conclusion1.The core pathogenesis of acute cerebral infarction disease is deficiency of the root cause and the symptoms of the symptoms,and the mixture of deficiency and reality.The pathological nature is"wind,fire,phlegm,dampness,stasis and deficiency".When acute cerebral infarction occurs in junior high school,Yin deficiency and Yang hyperactivity,wind and Yang changes are the main causes,along with Qi and blood deficiency,so that phlegm and blood stasis block the meridians;when acute cerebral infarction recurs,liver,kidney and spleen deficiency,phlegm and blood stasis stagnate in the meridians and are difficult to be resolved,blocking the Qi mechanism,containing poison and generating heat and fire,"wind,fire,phlegm,stasis and deficiency,are both the cause and pathology.Wind,fire,phlegm,stasis and deficiency are both the cause of the disease and the pathology,and are mutually causal,making the disease more complex and variable.2.Acute cerebral infarction should be treated with a balance of deficiency and reality.In junior high school,the main treatment is to tonify Qi,invigorate Blood,and open the ligaments,and the prescriptions are based on the formula of invigorating Blood and resolving blood stasis,the formula of resolving phlegm and opening the ligaments,the formula of calming the liver and quenching the wind,and the formula of clearing heat and resolving phlegm and opening the orifices;after the recurrence of the disease,attention should be paid to tonifying deficiency and invigorating Blood,and treating phlegm and stasis together,and the prescriptions are based on the formula of benefiting Qi and invigorating Blood,the formula of nourishing the liver and kidney;and the formula of benefiting Qi and fixing the deficiency.The Chinese medicines used according to the results of the diagnosis were Danhong injection,safflower yellow pigment injection,Ginkgo biloba leaf preparation,Panax ginseng preparation,Shuxuetong injection,Longblood Tongluo capsule,Tongxinluo capsule and Brainheart capsule.3.In this study,we explored the law of "disease-evidence-medication"through the method of complex network,screened the core medications for the total population of acute cerebral infarction,the middle school population of acute cerebral infarction and the recurrent population of acute cerebral infarction,and initially clarified the network of evidence,treatment and medication for acute cerebral infarction,which provided a methodological reference for clinical understanding of disease characteristics.The method of complex network drug mining is practical and feasible,and can provide ideas for drug research of complex and difficult-to-treat diseases.