Research On The Etiology And Pathogenesis Of Epilepsy In Traditional Chinese Medicine Based On Ancient Books

ObjectiveThe occurrence and development of epilepsy have different characteristics of etiology and pathogenesis.The understanding of epilepsy in traditional Chinese medicine is early,and the understanding of etiology and pathogenesis is also gradually deepening.This study systematically combs the ancient literature,analyzes the understanding of the etiology and pathogenesis of epilepsy in traditional Chinese medicine,and standardizes the terminology,in order to provide help for the standardized diagnosis and treatment of epilepsy.MethodsBased on the ancient books,this paper studies the selection of dynasties from the Spring and Autumn Period and the Warring States Period to the Republic of China,and uses the method of philology and computer technology to search,screen,extract and label the ancient books related to epilepsy in traditional Chinese medicine.On this basis,the disease name of epilepsy in traditional Chinese medicine and the understanding of etiology and pathogenesis of doctors in past dynasties are sorted out,and the standardization of etiology and pathogenesis terminology is studied.(1)Data source:① Ancient books of traditional Chinese medicine related to epilepsy recorded in the databases of "Chinese Medical Code"(CD fifth edition)and " Chinese Medical Archives"(http://www.gydc.ac.cn:81/#).②Literatures related to epilepsy mentioned in China National Knowledge Infrastructure(CNKI)database.③"ZY/T001.1-1994 Criteria of diagnosis and therapeutic effect of diseases and syndromes in traditional Chinese medicine ","GB/T 16751.1-2023 Clinic terminology of traditional Chinese medical diagnosis and treatment—Part 1:Diseases","GB/T 10112-2019 Terminology work—Principles and methods","GB/T 15237.1-2000 Terminology work--Vocabulary--Part 1:Theory and Application","GB/T 20348-2006 Basic theory nomenclature of traditional Chinese medicine"," Internal Medicine of Traditional Chinese Medicin","Basic Theory of Traditional Chinese Medicine ","Etiology and Pathogenesis of Traditional Chinese Medicine " and " Terminology of Traditional Chinese Medicine","Common Terminology Dictionary of Traditional Chinese Medicine ","Dictionary of Traditional Chinese Medicine:Basic Theory Volume"," Standardization of Terminology of Traditional Chinese Medicine " and other standards,guidelines,national planning textbooks and other reference books.(2)Literature search:①Enter the search " epilepsy " in the ancient database of"Chinese Medical Code" and " Chinese Medical Archives ",and select " text " as the search scope.Search the dissertation database in CNKI,the search method is " theme",the keyword is set to " epilepsy ",and the time range is selected from the establishment date of the database to October 2022.The ancient books involved are obtained into electronic data or paper books,and the relevant monographs are searched by bibliography method.For the ancient books without a monograph,the etiology and pathogenesis are searched one by one in the medical records and medical records,or the identification of related diseases.Finally,650 ancient books related to epilepsy were obtained.②Website CNKI set the retrieval method as " theme",and the keywords were set as "epilepsy "+" etiology and pathogenesis " or "epilepsy "+"terminology " or " etiology and pathogenesis " +" terminology ".The time range is from the establishment date of the database to October 2022.Read the standards,guidelines,national planning textbooks and other reference books to find the description of the etiology,pathogenesis and terminology of epilepsy in the data.(3)Literature screening:①There is a relatively complete discussion on the theory of epilepsy or the etiology and pathogenesis of epilepsy in the bibliography.②Only one article was retained for the same doctor’s theory or repeated publication of the same research content.Exclusion criteria:①The etiology and pathogenesis of epilepsy are unknown or irrelevant.②Retelling previous views or summarizing previous views without new meaning.③Animal experimental study.④Clinical research based on western medicine treatment.(4)Date extraction:① Establish Excel tables to extract and input the external characteristics of traditional Chinese medicine ancient books.The input information includes the same and different names of ancient books,the year of completion,the author(including the dynasty,the way of writing),etc.②Extract the content of the ancient books,each category is saved in the form of word documents.It is divided into 9 categories:the origin of disease name,etiology and pathogenesis,syndrome differentiation,treatment principle and method,prescription and medicine,acupuncture and moxibustion external treatment,medical case and medical speech,prevention and care,other miscellaneous records.(5)Date annotation:The content of ancient literatures is divided into 11 semantic types,including "disease name","symptom","etiology","pathogenesis","disease location","disease nature","therapeutic principle and treatment","prescription","Chinese medicine","acupoint"and"crowd".Take the"artificial+machine"mode for labeling.Firstly,33%of all texts are selected,and the text is manually labeled with the help of the open source text tool Doccano.It was used as a training set and a test set,divided according to the way of 7.5:2.5.Then,the Bert-BiLSTM-CRF model was used to train the named entity recognition task,and fine-tuned on the basis of the SikuBERT pre-training model.Finally,the accuracy,recall rate and harmonic mean on the verification set reached 0.701,0.762 and 0.73,respectively.The trained model was applied to the subsequent automatic annotation of 67%data,and the automatic annotation results were manually corrected and modified.Results(1)By combing and researching the names of epilepsy,a total of 32 names of epilepsy in traditional Chinese medicine were obtained.There are "Xian","epilepsy","peak epilepsy","convulsive epilepsy","snake epilepsy","wind epilepsy","dietary epilepsy","Yang epilepsy","Yin epilepsy","six livestock epilepsy","horse epilepsy","cow epilepsy","sheep epilepsy","pig epilepsy","dog epilepsy","chicken epilepsy","five viscera epilepsy"," liver epilepsy","heart epilepsy","spleen epilepsy","lung epilepsy","kidney epilepsy","diaphragm epilepsy"," intestinal epilepsy","five epilepsy"," five viscerv five livestock epilepsy","wu epilepsy","dark epilepsy","dark wind","fetal epilepsy","heat epilepsy","dementia epilepsy ".(2)Through manual labeling and automatic labeling,there were 226 causes and 186 pathogenesis of remaining epilepsy.The causes were divided into two categories:congenital factors and acquired factors.The acquired factors were divided into four categories:exogenous causes,internal injury causes,pathological product causes and other causes.The pathogenesis is divided into two categories:basic pathogenesis and system pathogenesis.The system pathogenesis is divided into three categories:viscera pathogenesis,meridian pathogenesis and endogenous five evil pathogenesis.According to the respective classification of etiology and pathogenesis,the original texts of ancient books are arranged in chronological order.(3)Based on the " GB/T 10112-2019 Terminology Working Principles and Methods"," GB/T 15237.1-2000 Terminology Working Vocabulary Part 1:Theory and Application"," Research on the Standardization of Terminology of Traditional Chinese Medicine","GB/T 20348-2006 Basic Theory Terminology of Traditional Chinese Medicine","Basic Theory of Traditional Chinese Medicine","Etiology and Pathogenesis of Traditional Chinese Medicine" and " Noun of Traditional Chinese Medicine","Dictionary of Common Terminologies of Traditional Chinese Medicine","Dictionary of Traditional Chinese Medicine:Basic Theory " are used as references.The etiology and pathogenesis of epilepsy were sorted out and the terminology standardization was studied.Standardization of etiology and pathogenesis nouns:① Sorting out the annotation results of ancient books,screening and deleting duplicate entries,entries that do not meet clinical research or entries that are not required for this study.②Because the ancient language expression is different,and the disease is developing and changing,complex and diverse,the etiology and pathogenesis often appear in the form of multiple nouns,or phrases,short sentences,etc.,and the compound nouns are not convenient for the standardization of terms.Therefore,these compound etiology and pathogenesis are properly decomposed,which is conducive to grasping the core words for analysis.③The relationship between different references of the same concept is synonymous.The reference in the synonymous relationship is called synonym,and the synonyms are merged.④The synonyms are classified according to the grade,and the entries under the same grade are more similar.This ranking is conducive to knowledge combing and convenient to find nouns.To determine the terminology and hierarchical relationship of etiology and pathogenesis of epilepsy in traditional Chinese medicine:According to the basic theory of traditional Chinese medicine and the relationship between etiology and pathogenesis,the terminology of etiology and pathogenesis of epilepsy were classified,hierarchical and coded according to the needs of clinical diagnosis and treatment,referring to standards,guidelines,national planning textbooks and other reference books.The etiological terms of this disease are divided into two categories:congenital factor terms and acquired factor terms.The acquired factor terms are further divided into four categories:exogenous etiological terms,internal injury etiological terms,pathological product etiological terms and other etiological terms.The pathogenesis terminology is divided into two categories:basic pathogenesis terminology and systematic pathogenesis terminology.The basic pathogenesis terminology is divided into three categories:the term of the rise and fall of pathogenic factors,the term of the imbalance of yin and yang,and the term of the disorder of qi,blood and body fluid.The systematic pathogenesis terminology is divided into three categories:the term of viscera pathogenesis,the term of meridian pathogenesis and the term of endogenous five evil pathogenesis.Referring to " GB/T 15657-1995 Classification and Code of Traditional Chinese Medicine Syndromes ",the terms of etiology and pathogenesis were classified into large categories according to the academic ontology of traditional Chinese medicine and its category affiliation,and then classified into several categories,subcategories and subcategories,until the term name,so as to establish the category relationship of each etiology and pathogenesis term." A " represents the identifier of the etiology terminology," B " represents the identifier of the pathogenesis terminology,"." represents the classification level,and then the serial number is added to encode the specific term entry.The terminologies on both sides of"." are the upper and lower relations.The terminologies between the two "." are parallel relations.The term with "." at the end of the code represents a term class.(4)Clear concept connotation:Finally,16 etiological terminology of epilepsy were obtained,there are " insufficient endowment","fetal toxin","wind pathogen"," cold pathogen ","summer pathogen"," dampness pathogen","dryness pathogen fire(heat)pathogen ","joy","anger","panic","improper diet","overwork ","phlegm","blood stasis ","mistreatment ".And 26 pathogenesis terminology of epilepsy were obtained,there are "deficiency","excess","intermingled deficiency and excess","yang excess and yin deficiency","yin excess and yang deficiency ","qi deficiency"," qi stagnation","qi inverse","blood deficiency","blood stasis ","phlegm accumulation","qi and blood deficiency","qi stagnation and blood stasis","blood following qi inverse","heat disturbing the mind"," wind heat disturbing the mind","phlegm obscuring the mind ","phlegm fire disturbing the mind","spleen deficiency generating phlegm","asthenia renal edema","renal fire","earth failing to control water","visceral qi imbalance","meridian qi stagnation","liver yang transforming wind","accumulated pathogenic factors transforming into fire ".A total of 42 terminology need to clarify the concept connotation,mainly based on " GB/T 20348-2006 Basic Theory Terminology of Traditional Chinese Medicine " and are defined with reference to textbooks,dictionaries,etc.Among them,23 terms are defined by this standard,and 8 terms are defined from " Noun of Traditional Chinese Medicine " and " Dictionary of Common Terminology of Traditional Chinese Medicine ".The remaining 11 terms or reference books are not specified,or the author has not fully adopted them,they are summarized and defined by reading ancient books and literature.(5)The etiology and pathogenesis corpus in ancient books and the preferred terms of etiology and pathogenesis after standardization were statistically analyzed,and the relationship between these etiology and pathogenesis terms was sorted out to obtain a relationship diagram.Conclusion(1)The name of epilepsy and the description of its symptoms were first seen in the " fifty-two disease prescriptions ",which laid the foundation for later generations to understand the disease.Sui and Tang Dynasties,the classification of epilepsy further,there are named according to symptoms,there are named according to etiology,disease,disease location.During the Song,Jin and Yuan Dynasties,the understanding of epilepsy was increasingly rich,and the theoretical system was increasingly mature.In the Ming and Qing Dynasties,the understanding of epilepsy was further developed,and the identification of epilepsy,mania and syncope was clearly put forward.(2)Systematically combing the ancient literature of traditional Chinese medicine,32 names of epilepsy were finally obtained.Combined with manual labeling and automatic labeling,226 causes and 186 pathogenesis of epilepsy were obtained.Then,established the etiology and pathogenesis corpus of ancient books of epilepsy.By screening repeated nouns,decomposing compound nouns,merging synonyms and other methods,these nouns were standardized,and finally 16 terms of epilepsy etiology and 26 terms of pathogenesis were obtained.(3)In the process of sorting out and researching,it is found that the causes of epilepsy in traditional Chinese medicine include congenital endowment deficiency,fetal toxicity,exogenous six evils,seven emotions and internal injuries,improper diet,excessive labor,phlegm,blood stasis,and mistreatment.Among them,fetal toxicity,wind,panic,phlegm and blood stasis are common.The pathogenesis of epilepsy includes deficiency,excess,intermingled deficiency and excess,yang excess and yin deficiency,yin excess and yang deficiency,and so on.Qi and blood deficiency or stagnation are common.The dysfunction of viscera,mainly heart,spleen,liver and kidney.It can be seen that the treatment of this disease focuses on extinguishing wind,relieving convulsion,resolving phlegm,and dredging stasis.Prevention should pay attention to the regulation of heart,spleen,liver and kidney,and maintenance during pregnancy.It provides ideas for the follow-up academic research of epilepsy in traditional Chinese medicine,and also provides reference for the clinical diagnosis and treatment of epilepsy in contemporary traditional Chinese medicine.