Explore The Medication Rules Of Chinese Medicine Of Professor Huang Wenzheng For The Treatment Of Chronic Kidney Disease Based On Data Mining
Mar 13, 2022
Contact: Audrey Hu Whatsapp/hp: 0086 13880143964 Email: audrey.hu@wecistanche.com
Shao-Ning Dong, Yao-Guang Wang, Bing Xu, Liang Jin, Cui-Han Wang
Abstract:
In recent years, chronic kidney disease (CKD) received increased attention due to its high prevalence and adverse effects. Current treatment options for CKD are limited. Many patients seek alternative therapies, such as traditional Chinese medicine (TCM). TCM has been used widely in the treatment CKDfor many years. The purpose of this study is to explore the medication rules of Professor Huang Wenzheng's treatment of CKD with Chinese medicine based on data mining. The structured case database was built for 131 patients with CKD treated by Prof. Huang. The complex network analysis was applied to analyze the medication principle of Chinese medicines. The study found the backbone network and three-level network of the Chinese medicines for the treatment of CKD by homogeneous network analysis. The 5 top commonly used herbs were Dan Shen (Radix Sahiae Miltiorrhizae), Fu Ling(Poria). Huang Qin(Radix Scutellariae), Sheng Di Huang(Radix Rehmgnmige Recent), and Sha Ren (Fructus Amomi Villosi), respectively.
Keywords: Chronic kidney disease, Huang Wenzheng, Clinical practice, Complex network
1. Background
Chronic kidney disease(CKD) is a kind of kidney damage where the glomerular filtration rate(GFR)has been below the RSV 60ml (min 1.73 m)for at least 3 months. The renal damage is diagnosed by either pathological abnormalities, or kidney damage experimental indexes (such as blood, urine, or abdominal images)[1]. CKD refers to multiple diseases including chronic glomerulonephritis, IgA nephropathy, and diabetic nephropathy. A recent national survey has demonstrated that the prevalence of CKD reached 10.8% in China [2]. CKD has received increased attention due to its high prevalence, adverse effects, and tremendous medical cost [3]. Current treatment options for chronic kidney disease are limited. Many patients seek alternative therapies such as traditional Chinese medicine(TCM). TCM has widely been used in the treatment of various diseases in China for thousands of years. TCM in the treatment of CKD can improve the clinical symptoms, reduce hematuria and proteinuria, alleviate western pharmaceuticals adverse reactions, increase renal protection, and improve the life quality of the patients, so as to improve the clinical curative effect of CKD. Research has revealed TCM could improve renal function through influencing glomerular filtration rate 4.5]retrospective analysis of clinical data and the data mining method.
2. Materials and Methods
2.1 Data Source
Collecting and collating medical records for CKD came from Professor. Huang Wenzheng in the TCM Nephropathy Clinic of First Affiliated Hospital of Tianjin University of TCM from Oct 20.2003 to Jan 13, 2015. These records involved 131 cases and 1909 clinic visits, including CG without kidney biopsy; IgA nephropathy and diabetic nephropathy with a kidney biopsy, as well as chronic renal failure progressed from the disease above with non-dialysis-requiring renal failure.
2.2 Diagnostic criteria
2.2.1 Western medicine diagnostic criteria
①In accordance with the diagnostic criteria for CKD in Kidney Disease Outcome Quality Initiative (K/DOQl) issued by National Kidney Foundation (NKF) in 2002. CKD refers to the disease of kidney damage or GFR less than 60ml/ （min·1.73m²）lasting for at least 3 months. Kidney damage refers to the renal pathological abnormalities, or renal damage experimental indexes (such as blood, urine, or imaging abnormalities) [1,2].
② In accordance with the diagnostic criteria for Chronic nephritis in the standard developed by the Kidney Disease Group of Chinese Journal of Internal Medicine editorial committee in Taiping, Anhui conference in Jun 1922[6].
③In accordance with the diagnostic criteria for IgA nephropathy in Guide on Clinical Diagnosis and Treatment: Clinical Practice Guidelines· Nephrology Volume [7] and Nephrology [8] issued by Kidney Disease Group of Chinese Medicine Association in 2012.
④ In accordance with the diagnostic criteria for diabetic nephropathy in Guide on Clinical Diagnosis and Treatment: Clinical Practice Guidelines， Nephrology Volume [7] issued by Kidney Disease Group of Chinese Medicine Association in 2012 and clinical diagnostic criteria for diabetic nephropathy in WHO [9].
⑤In accordance with the diagnostic criteria for chronic renal failure in the standard developed by the Kidney Disease Group of Chinese Journal of Internal Medicine editorial committee in Taiping, Anhui conference in June 1992 [8].
2.2.2 TCM Syndrome Diagnostic Criteria
Should the original medical records contain Professor Huang Wenzheng's notes, the original medical records shall prevail.
2.3 Medical Record Screening
2.3.1 Inclusion Criteria
The disease meets the diagnostic criteria of the 4 diseases stated above. The clinical data are complete and reliable. The patients have been treated with TCM decoction only, not taking other Chinese medicine. The patient hasn't been taken dialysis.
2.3.2 Exclusion Criteria
Patients with severe infection; Myocardial infarction or heart failure; Hepatic insufficiency; Malignant hypertension and severe cerebrovascular disease; Diabetic ketoacidosis; Patients with malignancy and other emergent or severe illness; Patients who have received renal replacement; Lack of clinical data.
2.4. Research Methods
Establish a structured electronic medical record database with the help of"Information Sharing System of Medical Treatment and Clinical Research in TCM"(The sharing system for short).Log on to the database by using the PL/SQL Development software, use SQL statements to query the database, and save the query results. Use the Liquorice software to conduct homogeneous and heterogeneous network analyses by applying the complex network method, and extracting 3 levels of prescription networks from the database.
3. Result
3.1 Analysis of prescription
3.1.1 Prescription for CG
The level 1 sub-network of the prescription for CG represented the initial part of Professor Huang's prescription in clinical practice (Figure 1A), in which Huang Qi(Radix Astragali seu Hedsari)and Mai Dong(Radix Ophiopogomis) can nourish yin and benefit qi, Shan Yao(Rhizoma Dioscoreae), Fu Ling (Poria), and Sha Ren(Fructus Amomi Villosi) can invigorate spleen for eliminating dampness, Bai Mao Gen (Rhizoma Imperatae) can cool blood to stop bleeding. In the level 2 sub-network of the prescription, Bian Dou Yi(Semen Dolichoris Album), He Ye (Folium Nelumbinis), Si Gua Luo(Retinervus Luffae Fructus), and Liu Yi San consisted a commonly administrated herbal medicine prescription for summer-heat cold. The group of Dan Dou Chi(Semen Sojae Preparatum), Sang Ye(Folium Mori), She Gan (Rhizoma Belamcandae), and Ku Xing Ren(Semen Armeniacae Amarum) as well consisted of a widely used herbal medicine prescription for wind-heat cough (Figure 1B). Moreover, the sub-network in the third level illustrated the paired herbs that Professor Huang used frequently for CG (Figure 1C). Combined with Wu Wei Zi (Fructus Schisandrae Chinensis), Wu Mei (Fructus Mume) can encourage the production of body fluid to quench thirst and nourish vin to stimulate the heart. The combination of Di Long(Lumbricus)and Hong Hua (Flos Carthami) can activate blood and dredge collaterals. Dong Kui Zi(Fructus Mahal) with Wang Bu Liu Xing (Semen Vaccariae)can relieve stranguria by diuresis. Additionally, Bai Wei(Radix Cwanchi Atrati ), Yu Zhu (Rhizoma Polvgonati Odorat), and Cong Bai(Bulbus Alii Fistulosi)can treat wind-heat cold associated with yin deficiency. Jiao Bin Lang (Semen Areca), Ji Nei Jin(Endothelium Corneum Gigeriae Galli), Yu Jin(Radix Curcumae), Fo Shou (Fructus Citri Sarcadactylis), and Mai Ya(Fructus Hordei Germinatus)can treat gastrectasia and anorexia attributed to food accumulation and qi stagnation. Gua Lou(Fructus Trichosanthis), Xie Bai(Bulbus Alli Macrostemonis)、Jiang Xiang(Lignum Dalbergiae Odoriferae), Yan Hu Suo (Rhizoma Corydalis), San Qi (Radix Notoginseng), Hu Bo(Succimum), and Gui Ban (Carapax Testudinis)can treat chest distress, angina, and palpitations.
