Study On Prescriptions And Clinical Experience Of Professor Mao Dewen In Treating Non-alcoholic Fatty Liver Disease Based On Data Mining Technology

Objective: Based on data mining technology,this study studied the clinical cases of the professor Mao Dewen’s treatment of non-alcoholic fatty liver,carried out a statistical analysis of the drug prescriptions of the patients,and obtained the medication rules of the professor Mao in the treatment of non-alcoholic fatty liver,and summarized the clinical experience of famous doctors.Methods: A total of 220 cases of non-alcoholic fatty liver treated by Professor Mao Dewen were collected,and the collected medical records were standardized.Microsoft Office Excel 2019 was used to establish a total database to analyze the frequency distribution of main symptoms,treatment methods and components of traditional Chinese medicine in patients with non-alcoholic fatty liver disease under different TCM syndromes.Liver function(TBIL,ALT,AST,GGT),blood lipid(TG,TC)and controlled attenuation parameter(CAP)were evaluated in patients who regularly took TCM for 12 weeks or more.SPSS Modeler 18.0 was used to mine drug association rules for each syndrome type,and drug relationship network diagram was obtained.Core drug pairs were obtained by Apriori modeling.The Pearson algorithm in SPSS Statistics 26.0 systematic clustering method was used for systematic clustering analysis of high-frequency drugs under each syndrome type,representative prescriptions of each syndrome type were obtained,and the medication rule of Professor Mao in the treatment of non-alcoholic fatty liver was obtained.Results:(1)A total of 220 patients with non-alcoholic fatty liver disease were collected in this study,with the age range ranging from 78 years old to 21 years old.115 patients were aged 21-44 years old(about 52.27%),89 patients were aged 45-59 years old(about 40.45%),and 16 patients over 60 years old(about 7.28%).Among the 220 patients,161 were males,accounting for73.18% of the total number,and 59 were females,accounting for 26.82% of the total number,with a male to female ratio of 3.67:1.(2)After 12 weeks of TCM treatment,80% of the selected 96 patients had lower CAP,64% of TBIL,73% of ALT,64% of AST,61% of GGT,54%of TC,and 73% of TG.TBIL,ALT,AST,GGT,TC and TG were decreased(P<0.01),and CAP was also decreased(P<0.01).(3)Among the 220 cases of non-alcoholic fatty liver,the syndrome of dampness-heat accumulation with the highest frequency was 75 times,accounting for 34.09%,followed by the syndrome of phlegm turbidity and internal obstruction with 51 times,accounting for 23.18%,the syndrome of liver depression and spleen deficiency with 50 times,accounting for 22.73%,and the syndrome of phlegm-stasis interassociation with 44 times,accounting for 20.00%.(4)The prescription law of treating nonalcoholic fatty liver:In 220 cases of non-alcoholic fatty liver prescription,195 TCM were used,with a total frequency of 3177 times,among which 19 TCM with a frequency greater than 50 times were used,with a total frequency of 1375 times,accounting for43.28%,which was summarized as the professor Mao Dewen’s core drugs for the treatment of fatty liver.Besides asymptomatic symptoms,patients with non-alcoholic fatty liver syndrome of liver depression and spleen deficiency mainly suffered from hypochthymus.A total of 136 TCM flavors were used in treatment,among which the sweet,bitter,warm and spleen-restoring medicines were the most commonly used.The top 10 high-frequency medicines were Paeoniae paeoniae,bupleurum bupleurum,atractylosum,Tangerine peel,Danshen,Xiangfu,angelica sinensis,licorice,poria cocos and ligusticum Chuanensis.The commonly used core drug pairs obtained through modeling are: white peony with Codonopsis for nourishing blood and regulating menstruaries,Tangerine cortex with Fructus aurantii for regulating liver and Qi,white peony with Codonopsis for strengthening spleen and Qi,white peony with white Shu for regulating liver and spleen,Danshen with panax notoginseng for regulating collaterals and analgesia,angelica with white Peony for nourishing blood and softening liver,Bupleurum with angelica for regulating liver and blood.There are five treatment methods involved,and the frequency from high to low is soothing the liver and invigorating the spleen,soothing the liver and relieving depression,invigorating the spleen,soothing the liver and clearing the collages,and soothing the liver and dispersing the tangles.The treatment results suggest that soothing the liver and invigorating the spleen is the most frequent method.According to the pedigree diagram,five clusters were obtained,which were as follows: C1 white peony root,white Rhizoma atractylodes,codonopsis codonopsis,bupleurum bupleurum,Angica sinensis and poria cocos;C2 Ligusticum Chuanxiong;C3 Tangerine peel-Fructus aurantii-licorice;C4 Fu Shen-mint-Rhodiola Rosea-Bamboo Ru-roasted licorice-Danshen-Panax notoginseng-Rhizoma corydalis;C5Astragalus.C1 is the class formula of Xiaoyao SAN,which plays the role of soothing the liver and nourishing blood and regulating the spleen;C2 has the effect of promoting blood circulation and removing blood stasis;C3 has the effect of regulating qi and relieving pain;C1+C2+C3 is the class formula of Bupleurum Shugan SAN,which plays the role of soothing the liver and regulating qi,promoting blood circulation and relieving pain.C4 is the addition or reduction of Danshen decoction,which has the effect of promoting blood circulation,clearing collaterals and relieving pain.In addition to asymptomatic patients with phlegm-turbidity and internal obstruction syndrome of non-alcoholic fatty liver,the main symptoms were fatigue.A total of 124 TCM flavors were used for treatment,among which the most were sweet,warm and spleen-channelling drugs.The top 10high-frequency drugs were white rhizoma atractyloides,salvia miltiorrhiza,poria cocos,tangerine bark,pinellia pinellia,cassia seed,panax notoginseng,alismatis alismatis,licorice and rhodiola rosea.The commonly used core drug pair are: Poria Coix invigorates spleen and moistens dampness,Baizhu Coix invigorates qi and invigorates spleen,Poria Coix invigorates diarrhea and invigorates spleen and turbidness,Salvia miltiorrhiza and panax notoginseng to remove blood stasis and collars,Hawthorn with cassia seed to reduce turbidness and lipids,Baizhu with purgative diarrhea and heat to reduce turbidness,Tangerine peel with licorice to regulate qi and reduce phlegm.There are 5 kinds of treatment methods involved,and the frequency from high to low is strengthening spleen and turbidizing,resolving phlegm and dispersing accumulation,qi and resolving phlegm,resolving phlegm and reducing turbidizing,warming Yang and strengthening spleen.According to the pedigree diagram,five clusters were obtained,which were as follows: C1 Salvia miltiorrhiza-cassia seed-Hawthorn-Paeony-Trionychia sinensis;C2 Rhodiola-Calamus-malt;C3 Panax notoginseng-Rhizoma corydalis-mint-Bamboo Ru;C4 Tangerine peel-Licorice-Pinellia;C5 White fungus-Poria Coix-Alismatis alismatis-Astragalus.C1 has the effect of softening the liver and clearing collaterals;C2 has the effect of clearing phlegm,dampness and stomach,C4 is an important compatibility of Jianzhong Powder in "Taiping Huimin and Prescription Bureau",which has the function of eliminating phlegm and dispersing complications.among which C2+C4 is calamus phlegm decoction formula,has the effect of clearing phlegm and regulating qi;C3 has the function of clearing heat and eliminating boredom,removing blood stasis and relieving pain.C5 was prepared by addition or reduction of Poria Cocos Zexia Decoction,which had the effect of warming Yang and removing turbidity.Besides asymptomatic syndrome of dampness-heat accumulation of non-alcoholic fatty liver,patients with dry and bitter mouth were mainly treated with 141 traditional Chinese medicines,among which sweet and cold drugs were the most commonly used,and the top 10 frequently used medicines were salvia miltiorrhiza,panax notoginseng,Rhizoma corydalis,bupleurum,Rhodiola rosea,astragalus membranaceus,oyster,mint,coptis chinensis and bamboo ru.The core drugs commonly used are: sophora flavescens with Kunbu to clear heat and dry dampness,Danshen with Zedoary to promote blood circulation and remove blood stasis,Rhizoma corydalis with seaweed to clear heat and disperse dampness,Rhizoma corydalis with pinellia aurantii to dissipate dampness and dissipate dampness,Rhizoma Corydalis with Fructus aurantii to dissipate dampness and dissipate dampness,Rhizoma curcuma with Kunbu to dissipate phlegm and disperse phlegm,Shanci mushroom with white flower ophiotis to clear heat and detoxify,and Tangerine peel with Fu Shen to regulate qi and soothe the mind.There are 5kinds of treatment methods involved,and the frequency from high to low is clearing heat and dampness,clearing heat and dispersing tie,clearing heat and detoxifying,strengthening spleen and clearing heat,and removing dampness and yellow.According to the pedigree diagram,two clusters could be obtained,respectively: C1 poria cocos-seaweed-yellow essence-turtle beetle-oyster-Radix bupleurum-Radix astragalus-Rhizoma corydalis-angelica-Ligusticum Chuanxiong;C2 Coptis chinensis-Pinellia chinensis-Rhodiola Rosea-Tangerine peel-Licorice-White art-Danshen-Panax Notoginseng-cassia seed-Mint.C1 is a similar prescription of Jiedu Sanjie prescription in our hospital,which has the effect of clearing heat and detoxifying,promoting blood circulation and removing blood stasis.C2 is the composition of Huanglian Wendan Decoction,with the effect of clearing heat and dampness,and stomach gallbladder.The main symptom of patients with non-alcoholic fatty phlegm-stasis syndrome was hypocholic pain.A total of 112 drugs were used for treatment,among which the drugs belonging to bitter taste,warm taste and liver channel were the most.The top 10 high-frequency drugs were ligusticum ligusticum,angelica sinensis,peach kernel,bupleurum,notoginseng,Danshen,licorice,tangerine peel,poria cocos and astragalus membranaceus.The commonly used core drug pairs are: Chuanxiong with red peony root to disperse blood stasis and relieve pain,bupleurum with turtle jia to disperse liver and disperse Jie,Xianhecao with white flower snake tongue herb to clear heat and disperse jie,Chuanxiong with angelica to nourish blood and promote blood circulation,Salvia miltiorrhiza with Huangjing Chuanxiong with astragalus to promote Qi and collaterals,Rhizoma rhizoma with turtle jia to promote Qi and disperse jie,angelica with Rehmannia to clear heat and promote Jin.There are 7treatment methods involved,and the frequency from high to low is qi dispersing,activating blood circulation to remove blood stasis,activating blood circulation to relieve pain,activating blood circulation to regulate qi,removing blood circulation to relieve pain,dispelling wind and clearing collages,warming channels to relieve pain.According to the pedigree map,two clusters could be obtained,which were as follows: C1 Xianhecao-Ling-Shanci mushroom-Schistoderma lanceolata-Coix seed-Astragalus membranaceus-Bupleurum miltiorrhiza-yellow essence-Panax notoginseng-Xiangqi-oyster-Rhizoma corydalis-Poria cocos;C2Tangerine peel-Pinellia chinensis-Ligusticum Chuanxiong-Angelica-Licorice-peach kernel-Red flower-Red Peony root.C1 is the generic prescription of Ganxian Wan,which has the effect of removing phlegm and dampness,promoting blood circulation and removing blood stasis.C2 is the prescription of Xuefu Zhuyu Decoction,which has the effect of promoting blood circulation and removing blood stasis,Qi and relieving pain.Conclusion:(1)The professor Mao’s understanding of the etiology and pathogenesis of non-alcoholic fatty liver: the professor believes that the progression of non-alcoholic fatty liver is mainly due to the weakness of the spleen and stomach caused by the improper diet and living habits;the spleen transportation and loss of the spleen will hinder the dampness and produce phlegm and dampness;the dampness and dampness block the liver qi stagnation;the liver stagnation and heat will be generated after a long time;the dampness and heat fumigation and the disease will enter the collages,and then the blood stasis will be deficiency and the phlegm and blood stasis will be intermingled.In addition,the tutor believed that the regional climate in Guangxi was humid,and external dampness could also obstruct the spleen and stomach,resulting in dampness and heat intrude into the human body,or heat was caused by dampness and heat lingering for a long time.Therefore,although the non-alcoholic fatty liver was characterized by phlegm turbidity and internal obstruction and liver depression and spleen deficiency as the initial syndrome type,the syndrome of dampness-heat accumulation was more common,and finally gradually developed into the syndrome of phlegm-stasis interformation.(2)Professor Mao ’s prescription law for treating non-alcoholic fatty liver: The treatment of liver qi and spleen deficiency syndrome patients with the use of sweet,bitter,warm,spleen meridian drugs.With soothing the liver and invigorating the spleen as the main treatment method,the prescription of soothing the liver and invigorating the spleen,such as Paeony and Baizhu,was selected to dredge the liver and temper machine,and a small amount of activating blood drugs were used to dredge the zang Fu organs and meridians.Overall to regulate the Zang-fu Qi as a method,so that the liver and spleen regulation,disease healing.The core prescriptions for treating liver depression and spleen deficiency are Xiaoyao Powder,Bupleurum Shugan Powder and Danshen Decoction.The most common drugs used in treating patients with phlegm turbidity-obstructed syndrome are sweet,warm and spleen-channelling.Mainly to strengthen the spleen and turbid as the basic treatment,choose to strengthen the spleen and remove dampness,carry out turbid drugs to strengthen the spleen and turbid,with warm Yang drugs such as dry ginger,monkshood warm phlegm drink,make Cou rationale open,Qi is smooth,condensation is loose,to reach phlegm turbid.The core prescriptions for treating the syndrome of phlegm turbidity and internal obstruction are calamus phlegm-guiding decoction and poria cocos zexia decoction.In the treatment of dampness-heat syndrome,the most drugs were sweet,cold and liver meridian.With clearing heat and dampness,detoxifying and dispersing knot as the basic treatment,Coptidis,Hedyotis and other clearing heat and detoxifying drugs are often used.At the same time,the prescription of Huanglian Wendan Decoction is emphasized to clear heat and detoxifying liver and gallbladder.The core prescriptions for treating dampness-heat accumulation are Huanglian Wendan Decoction and Jiedu Sanjie prescription.In the treatment of phlegm-stasis interjunction syndrome,bitter,warm and liver channel drugs were used most.The main treatment is qi sanjie.Erchen Decoction and Xuefu Zhuyu decoction are often used to treat Qi and blood,and qi and blood regulating drugs are used to treat Qi and blood.The core prescriptions for treating the syndrome of phlegm-stasis interjunction are Huagan-fiber prescription and Xuefu Zhuyu decoction.