Gao Zhong-ying academic thought and experience and use of Bufei Decoction treatment of common diseases of the respiratory system drug law
|School||Beijing University of Traditional Chinese Medicine|
|Course||Chinese medical science|
|Keywords||Lung-tonifying decoction Professor Gao Zhongying Entropy clustering of complex systems Data mining|
Lung-tonifying decoction has been documented in a number of literatures as a kind of representative prescription to reinforce lungs. It was originally used for over-strained cough, organ deficiency, hot fever, spontaneous sweating and asthma due to excessive phlegm. In textbooks on Chinese internal medicine, lung-tonifying decoction has been used for asthma patients with lung Qi deficiency, but relative reports were rarely seen in literatures published in recent years, and clinically many patients with long-term cough cannot be effectively alleviated. By the application of lung-tonifying decoction, Professor Gao Zhongying has achieved excellent therapeutic effect, accumulated a wealth of clinical experiences, and formed a lot of unique academic thinking. However, high-tech means has riot been adopted for a systematic and comprehensive summary. Under the guidance of Professor Gao Zhongying, we will apply the data-mining techniques of modern medical informatics in this study to arrange Professor Gao’s academic thoughts and clinical experiences. "Access" will be used as a data platform, and Professor Gao’s outpatient prescription would be entered into the database in accordance with standard case-writing requirements. The database is small-scale and only occupies a tiny space, so it’s quite convenient to use it. We can draw out medical cases and search for information at any time under any conditions (such as time, name, disease name, etc.). In the long run, it can help us get research materials and summarize the medical cases in practical work. Therefore, with practical applicability, it can be widely used for sorting out daily medical cases, laying a favorable foundation for arranging Professor Gao’s academic thoughts.Eminent TCM doctors are rich in clinical experiences characterized by the individualization of diagnostic thinking and differential treatment methods, especially the unique dialectical thinking and effective treatment. Professor Gao can "use fewer herbs and less dose to achieve better effect", which is a famous feature of his treatment. By adopting data mining techniques, we have made an analysis on medical record information about typical prescription-syndromes to find the relationship between eminent doctors’ high-frequency prescription, symptoms and syndromes, and to search for the association rules of syndrome - symptom, symptom - medication and syndrome - medication. It has urgent practical significance to make an exploration on the clinical treatment thinking and medication rules.Objective: To make an exploratory research on the rules of prescription compatibility by data mining techniques, and to summarize Professor Gao’s medication experiences for treating common chronic respiratory diseases and his clinical compatibility rules by accumulating, collecting and classifying the medical records and cases of Professor Gao’s treatmentMethod: We collected 389 medical records of Professor Gao Zhongying treating common chronic respiratory diseases, and built a structural template of medical cases based on the Access 2007 platform for collecting Professor Gao’s clinical diagnosis and treatment information. Patients’ information was entered into the database in accordance with national standard format for writing medical cases. We made a detailed record of patients’ medical cases and entered the clinical data of 389 medical records into Epidata database platform for entropy clustering to form Professor Gao Zhongying’s database of medical records. In this study, Epidata 3.1 database platform ,entropy clustering and other methods were used to study three main aspects of mining implicit in the database behind the prescription drug laws, the first level is the single herb, mainly achieved through the frequency of law; second level is the analysis of drugs, mainly through mutual information, association rules, etc., to explore the treatment of chronic respiratory disease common drugs on the initial reveal the prescription drug laws; last level is through a complex system entropy clustering, cluster analysis, multiple combination between the analysis of drug law. These three levels of reflection, and complement each other, revealing Professor Gao Zhongying common prescription drug laws.Results: We have made an analysis on the rules of "Lung-tonifying decoction" drugs’ association and dose changes: In this study, 0.15 is adopted as minimum support, and the minimum confidence is greater than 0.7. Through frequency statistics, we conclude that 28 drugs are mostly frequently used by Professor Gao Zhongying to treat common chronic respiratory diseases with a frequency of over 30 times, and through a modified method of mutual information, we have found 47 commonly-used couplet drugs with association coefficients of above 0.05 and modified mutual information value of above 0.1. By applying the entropy clustering method of complex systems, we get 34 core combinations of drugs, among which there are 9 important combinations listed as follows: Cocklebur, Magnolia, Vinegar Bupleurum, Schisandra; Pinellia, Fritillary, Coltsfoot Flower, Blackberry Lily; Coltsfoot Flower, Blackberry Lily, Perilla Seed, Lepidium Seed; Blackberry Lily, Perilla Seed, Lepidium Seed, Aster; Cocklebur, Ephedra , Magnolia; Vinegar Bupleurum, Radix Sileris, Ebony; Arisaema Cum Bile, Trichosanthes, Skullcap; Rehmannia, Astragalus, Schisandra; Rehmannia, Radix Pseudostellariae, Schisandra. Conclusion: Professor Gao Zhongying creates the "five-organ reinforcing method" with the viewpoint of treating lung diseases by lung-tonifying decoction, and coincidently the drugs with highest statistical frequency such as radix pseudostellariae, astragalus, rehmannia, schisandra, aster and morus alba are all important components of lung-tonifying decoction (the lung-tonifying decoction is originally composed of morus alba, rehmanniae, ginseng, aster, astragalus and schisandra). This also confirms that the statistics & theory of clinical data is consistent with the practical application. Most drugs used with a frequency of over 30 times are effective in relieving cough and asthma according to textbooks. For instance, lepidium seed is a representative drug for removing heat from lung and relieving asthma, and it is an essential component in treating common chronic respiratory diseases; Trichosanthes is representative for removing heat-phlegm, and pinellia for eliminating dampness and phlegm, so both of them are required drugs in the treatment of common chronic respiratory diseases, which inevitably involve cough and sputum.In the application of couplet drugs, the compatibility of cocklebur and magnolia has the highest modified value of mutual information, i.e., 0.20823, and it is an effective combination in the treatment of allergic rhinitis. Psoralen and the Gorgon (the modified value of mutual information is 0.1568) are usually combined by Professor Gao Zhongying to treat common chronic respiratory diseases, especially deficiency syndromes. Ephedra can be used for freeing lung and relieving asthma, and almonds are commonly used for relieving cough and asthma, so their compatibility is a classic combination for the treatment of cough syndromes. According to statistics, the modified value of mutual information for the combination of these two drugs is 0.1384, which is consistent with clinical practice.Among major drug combinations, the group of cocklebur, magnolia, vinegar Bupleurum and schisandra is the core combination for the treatment of allergic rhinitis; and the group of pinellia, fritillary, coltsfoot flower and blackberry lily is the core combination for treating cough syndromes. The doses of perilla seed, lepidium seed, blackberry lily or coltsfoot flower or aster can be changeable in their compatibility depending on the severity of cough and phlegm syndromes. Astragalus, rehmannia, heterophylla and schisandra are all important components of lung-tonifying decoction, so their compatibility is quite identified among core combinations. In addition, cocklebur, ephedra, magnolia can be added to decoction for treating allergic rhinitis, and the group of vinegar Bupleurum, radix sileris and ebony is a combination of anti-allergy drug. The arisaema cum bile, skullcap and trichosanthes are all essential traditional Chinese medicines for treating heat-phlegm diseases.We have applied data mining techniques to study eminent TCM doctors’ experiences, and the outcome is in line with clinical practices. It has great importance for the summary of eminent TCM doctors’ experiences.