| Objective:Based on the International Classification of Primary Care,Third edition(ICPC-3),this study systematically analyzed the medical records of elderly patients with type 2 diabetes treated with traditional Chinese medicine(TCM),and explored the main reasons for diabetic patients to seek TCM treatment.At the same time,the relationship between common reasons for seeking medical treatment,diagnosis and medication was analyzed,and the medication experience of famous veteran TCM doctors for common reasons for seeking medical treatment of type 2 diabetes was explored,so as to provide reference for the treatment of type 2 diabetes by primary TCM general practitioners.Methods:This study was based on the medical records of diabetes treatment of famous TCM veterans in the "Tenth Five-Year Plan" National Science and Technology Research Program(2004BA721A01H10)and the key Research and Development Program project of Science and Technology Department of Jiangxi Province(20171ACG70011).The symptoms and diagnoses of the first chief symptoms of the medical cases were extracted by the method of regular expression and manual review.Symptoms and diagnoses were coded according to the ICPC-3.The data management and processing were carried out on the Access database platform.The regular expression table was established based on the results of the chief complaint segmentation,which corresponded to ICPC-3 code.The Chinese medicine prescriptions in the medical records were divided into words and standardized terms,and the correlation between the reasons for seeking medical treatment and the Chinese medicine was calculated.The degree of correlation was expressed by confidence and support.Word segmentation,association rule analysis and chi-square test were performed on SAS9.4 software platform.Results:A total of 386 cases were included in the study.The top 7 reasons for consultation accounted for 53.32%,which were excessive thirst(125),generalized weakness/fatigue(68),frequent urination/urgency(55),swelling and generalized edema(50),vertigo/dizziness(40),vision loss(33),and increased appetite(30).The main symptoms were endocrine/metabolic and nutritional system,general and non-specific symptoms,nervous system,urinary system and eye symptoms,respectively.According to the diagnostic classification results of ICPC-3,The top 10 diagnoses were type 2 diabetes mellitus(386),uncomplicated hypertension(87),chronic ischemic heart disease(37),stroke/cerebrovascular accident(31),chronic kidney disease(27),lipid disorders(19),heart failure(15),hypertension with complications(12),liver disease NOS(11),and cerebrovascular disease(9).The diagnosis of type 2 diabetes included21 diseases classified by ICD.The top 10 diagnoses were type 2 diabetes mellitus(332),diabetic nephropathy(34),diabetic retinopathy(28),diabetic autonomic disorder(17),diabetic foot disease(6),diabetic peripheral vascular disease(6),diabetic peripheral neuropathy(6),diabetic heart disease(5),and diabetic neuritis(4).The top 10 commonly used medicines for diabetes were Astragalus(167),Salvia miltiorrhiza(157),Poria coporia(130),yam(124),Radix rehmanniae radix(116),Gegen(116),Radix paeoniae rubra(113),Angelica sinensis(103),Lycium lycium(97)and Licorice(97).Medication characteristics for common reasons for consultation were as follows:(1)Puerariae radix,Trichosanthin,Ophiopogonis ophiopogonis and Astragalus membranaceus were related to excessive thirst.(2)For patients with generalized weakness/fatigue,the related herbs were Poria cocos,Ophiopoditis ophiopodiae,red Peony peony,Rhizoma alismatis,Ligusticum chuanxiong and Trichosanthin.(3)Trichopollen and anemarrhena asphodeloides were related to frequent urination/urgency.(4)Chinese herbs related to swelling and systemic edema were plantagina,peach seed,Rhizoma alismatis,Mony peel,rhubarb and Codonopsis ginseng.(5)For patients with vertigo/dizziness,Gastrodia,Pinellia pinellia and Achyranthes bidentata were related herbs;Characteristics of common diabetes concomitant diagnostic medications are as follows:(1)Chuanxiong Rhizoma was associated with uncomplicated hypertension;(2)The drugs related to chronic heart failure were Poria cocos,Atractylodes atractylodes,Pinellia pinellia,Codonopsis codonopsis and Zhuling.(3)Stroke/cerebrovascular accident related drugs were Lumbricus,Gastrodia,Silkworm,Uncaria uncaria,scorpion and Acorus tatarinowii;(4)TCM related to chronic kidney disease were Poria cocos,rhubarb,processed rehmannia,Rhizoma alismatis,Pinellia pinellia and Codonopsis radix.(5)Citrus peel related to lipid disorder;Conclusions:Based on ICPC-3,the classification of the reasons and diagnoses of elderly TCM diabetes patients can systematically and intuitively grasp the main reasons for diabetic patients to seek TCM treatment.The main reasons for seeking medical advice in the famous and old TCM cases collected in this study were divided into the endocrine,metabolic and nutritional systems which were mainly manifested as excessive thirst,increased appetite,frequent urination and weight loss,and mainly involved general and non-specific symptoms,nervous system,urinary system and eye symptoms.The classification of symptom as the reason for medical treatment by ICPC conforms to the characteristics of TCM based on symptom as the basis of diagnosis and treatment,and is also suitable for the further classification of medical records of special diseases treated by TCM.The results of correlation analysis between ICPC reasons and traditional Chinese medicine have certain reference significance for the diagnosis and treatment of diabetes in primary care.However,the diagnostic classification of diabetes based on ICPC-3 is relatively broad,and all kinds of complications of diabetes are unified as non-insulin-dependent diabetes,which is not good for the detailed analysis of the diagnosis and treatment experience of diabetes. |
PDF Full Text Request