A study on the pattern of medication used by famous Chinese gynecologists in the treatment of dysmenorrhea based on the data mining method

Wen-Ming Cao ,Li-Li Yu ,Kui-Mei Zhang ,Shu-Ling Zhang*

1Changle County People's Hospital,Weifang 262400,China.2Pingan Hospital,Longhua District,Shenzhen 518109,China.

Abstract Objective:To explore the pattern of medication used in the treatment of dysmenorrhea by famous Chinese gynecologists based on the data mining method.Method:The electronic search of the Chinese journal full-text database CNKI,WIP database,Wanfang database,and biomedical database was used to download the experience awareness of famous Chinese gynecologists on the literature of dysmenorrhea treatment,including the self-experience introduction of Chinese gynecologists and the experience summary of students.Conduct a manual search to extract relevant literature on dysmenorrhea treatment.An Excel sheet was used to create a statistical summary table from which all data collected were classified into dysmenorrhea,TCM diagnosis,Western medicine diagnosis,TCM evidence differentiation,and high-frequency pharmacological gender classification.Statistical methods were used to perform frequency statistics for all syndromes,formulations and herbal medicines and to apply association rules to mine potential connections between two diseases,syndromes,prescriptions and herbal medicines to summarize the pharmacological patterns of TCM gynecology treatment of dysmenorrhea.The method was used to provide evidence for differentiation and drug ideas and to improve the efficacy of the clinical treatment of dysmenorrhea.Results:Among the 50 gynecologists in The Experience of Famous Chinese Gynecologists,153 journal articles and 22 monographs that met the requirements were collected,and the total number of prescriptions finally collected was 715.A total of 294 medical cases were included,and the high-risk age group for the onset of dysmenorrhea was concentrated between 27–36 years old.The types of dysmenorrhea can be categorized into eight types,and the number of occurrences in descending order:Qi stagnation and blood stasis,cold clotting and blood stasis,kidney deficiency and blood stasis,heat burning and blood stasis,Qi and blood deficiency,damp-heat stasis,Qi deficiency and blood stasis,and liver and kidney deficiency.Famous TCM gynecologists used 296 kinds of herbs for treating dysmenorrhea,with a total drug frequency of 8020 times,of which the total frequency of the top 100 herbs was 7355 times,accounting for 91.71% of the total frequency.Conclusion:(1) Famous Chinese gynecologists treat dysmenorrhea with the guiding principle of "if it does not pass,it hurts;if it does not glory,it hurts".Blood stasis is the main type of dysmenorrhea,and the method of activating blood stasis is the main treatment for dysmenorrhea.(2) Dysmenorrhea is mainly caused by real evidence,among which primary dysmenorrhea can be caused by real evidence,deficiency evidence and mixed evidence of deficiency and real,and the prescriptions used are mainly sutra prescriptions;secondary dysmenorrhea is mainly caused by real evidence and mixed evidence of deficiency and real,and the prescriptions used are mainly empirical prescriptions and are often used together with drugs to disperse nodules.(3) Commonly used herbal medicines for treating dysmenorrhea include Danggui,Baishao,Chuanxiong,Xiangfu,Yanhusuo,Chishao,Gancao and Wulingzhi.Common classic formulas include Siwu Tang,Wenjing Tang,Shixiao San,Shaofuzhuyu Tang,Sini San,Jinlingzi San,and Xiaoyao San.Typical experienced formulas:Neiyi 1 Fang,Neiyi 2 Fang,Neiyi 3 Fang,Jiaweimojie Tang,Bailiansanjie Tang,Neiyizhitong Tang,Huoxuequyuhuazheng Tang,etc.

Keywords:data mining;Chinese medicine;famous gynecologists;dysmenorrhea

Introduction

Dysmenorrhea refers to a condition in which women are menstruating,and the occurrence of dysmenorrhea seriously affects women's quality of life.Western medicine classifies dysmenorrhea into primary dysmenorrhea and secondary dysmenorrhea [1–2].Primary dysmenorrhea,also known as functional dysmenorrhea,refers to dysmenorrhea without organic lesions in the female reproductive organs and is mostly seen in young women.This pain usually relieves or disappears after marriage or childbirth.Secondary dysmenorrhea refers to dysmenorrhea with organic lesions,such as endometriosis and uterine adenomyosis.Endometriosis is endometrial tissue (glandular and/or mesenchymal) that has a growth function,which grows outside the endometrium and myometrium of the uterine cavity,causing recurrent cyclic bleeding,resulting in cyclic bleeding and secondary or progressive dysmenorrhea.

TCM is an empirical discipline and a clinically applied discipline.In addition to mastering basic theoretical knowledge,TCM scholars need to continuously summarize and improve their knowledge next time.

Data mining is the process of extracting implicit and application-worthy information from large,incomplete,fuzzy,and random data and is one of the hot topics of research in today's society[3].Western medicine has applied data mining to the diagnosis and prognosis of diseases and the study of the etiology of multifactorial diseases.Within the field of Chinese medicine,data mining is widely used for specific diseases,treatment methods,medical cases and experience studies of famous and old Chinese doctors,and association rules are one of the most commonly used methods.The treatment experience of famous veteran TCM practitioners exists mostly in the form of tacit knowledge,and the academic heritage of TCM has a large amount of content that can only be understood but not communicated,which can be made explicit by applying data mining technology.

This study focuses on the study of the rules of medication used in the treatment of dysmenorrhea by famous TCM gynecologists based on a data mining method,which is reported as follows.

Material and Methods

Data screening

A literature search was conducted in four databases in turn,and the search results were imported into Noteexpress 3.0 software to first check for duplicate literature and remove duplicates.The titles or abstracts of the literature were reread to remove literature that was not relevant to the treatment of dysmenorrhea;literature about dysmenorrhea was downloaded from the four databases.By reading the full text,eligible literature was selected according to the inclusion and exclusion criteria.The literature included the self-experience of famous gynecologists,summaries of disciples' experience,and literature on clinical observation of famous gynecologists' experience with prescriptions.The monographs of 50 gynecologists were searched manually using school library resources and online electronic resources.Experience and medical records related to dysmenorrhea were identified through the catalog,and eligible content was selected based on inclusion and exclusion criteria.The time period ends in October 2021.

Methods

The names of 50 famous Chinese gynecologists were categorized,and the type,title,monograph name,Chinese medicine diagnosis,Western medicine diagnosis,Chinese medicine evidence type,prescription name,specific Chinese medicine and the number of visits,duration of illness,and age in the medical cases were recorded in the Excel sheet in order to meet the requirements.To exclude the influence of artificially increasing the medication of a certain type of evidence and to ensure the accuracy of identification,only the information of the first three visits will be entered for medical cases with more than three visits.If the medical case information of the same patient appeared in different data,only one entry was made.In this study,the TCM diagnoses were all dysmenorrhea,but the Western medical diagnoses were primary dysmenorrhea,secondary dysmenorrhea,adenomyosis,and endometriosis.If the Western medical names are too detailed,it is not conducive to discovering the pattern of medication for each type of dysmenorrhea.In view of this,we extracted the Western medical diagnosis according to the original symptoms,gynecological examination and auxiliary tests and then unified the types of dysmenorrhea according to the Western medical diagnosis.Both primary dysmenorrhea and membranous dysmenorrhea are considered primary dysmenorrhea.Adenomyosis,uterine adenomyoma,endometriosis,endometriosis combined with adenomyosis,uterine.Endometritis and cervical stenosis with organic lesions are unified as secondary dysmenorrhea.However,the type of dysmenorrhea was not clearly stated in some literature,and no relevant examination was performed,so it was impossible to determine the type of dysmenorrhea,and to ensure the accuracy and authenticity of the data,we recorded it as dysmenorrhea uniformly.

Results

Results of the literature search of included medical practitioners

A total of 1780 studies related to dysmenorrhea by famous gynecologists were retrieved,and 475 studies were obtained by removing duplicate studies and removing irrelevant literature after reading the titles and abstracts of the literature,reading the full text,and finally obtaining 153 studies that met the requirements according to the inclusion and exclusion criteria developed in this study.There were 22 monographs that met the requirements by hand search.The final total number of prescriptions collected was 715.

Distribution of patients' age and duration of illness in medical cases

A total of 294 medical cases were included,and the analysis of the age and duration of illness of the patients in the included medical cases revealed that the onset of dysmenorrhea was mainly in women of childbearing age.The high-risk age group for the onset of dysmenorrhea was concentrated between 27–36 years old,while the duration of illness varied,with the majority of patients having a duration of more than 1 year.

Statistics on the dysmenorrhea types

There were 715 prescriptions in this study,187 prescriptions for primary dysmenorrhea and 262 prescriptions for secondary dysmenorrhea,which were collectively referred to as dysmenorrhea when the type of dysmenorrhea could not be specified in some literature,for a total of 266 corresponding prescriptions (Table 1).

Table 1 Distribution of types of dysmenorrhea

Statistical results of dysmenorrhea evidence patterns in the included literature

Primary dysmenorrhea and secondary dysmenorrhea have many similarities in TCM evidence patterns.The 715 prescriptions collected corresponding to dysmenorrhea had eight types of evidence types:Qi stagnation and blood stasis evidence,cold clotting and blood stasis evidence,kidney deficiency and blood stasis evidence,heat burning and blood stasis evidence,Qi and blood deficiency evidence,damp-heat stasis evidence,Qi deficiency and blood stasis evidence,and liver and kidney deficiency evidence,as shown in Table 2.

Statistical results of commonly used prescriptions

Famous TCM gynecologists used 296 kinds of herbs for treating dysmenorrhea,with a total drug frequency of 8020 times,of which the total frequency of the top 100 herbs was 7355 times,accounting for 91.71% of the total frequency.Commonly used herbal medicines for treating dysmenorrhea include Danggui,Baishao,Chuanxiong,Xiangfu,Yanhusuo,Chishao,Gancao,and Wulingzhi.Common classic formulas include Siwu Tang,Wenjing Tang,Shixiao San,Shaofuzhuyu Tang,Sini San,Jinlingzi San,and Xiaoyao San.Typical experienced formulas:Neiyi 1 Fang,Neiyi 2 Fang,Neiyi 3 Fang,Jiaweimojie Tang,Bailiansanjie Tang,Neiyizhitong Tang,Huoxuequyuhuazheng Tang,etc.

Statistical results of the efficacy of the top 100 Chinese herbal medicines

The total frequency of use of the top 100 herbal medicines was 7355,accounting for 91.71% of the frequency of use of all herbal medicines,so it can be considered that the top 100 herbal medicines in terms of frequency are commonly used for treating dysmenorrhea.The types of drugs commonly used in the treatment of dysmenorrhea were blood activators,blood tonics and qi regulators.The frequency and type of drugs used are shown in Table 3.

Similarities and differences in the identification of primary and secondary dysmenorrhea

To further explore the similarities and differences in the treatment of primary dysmenorrhea and secondary dysmenorrhea,we extracted 187 prescriptions for primary dysmenorrhea and 262 prescriptions for secondary dysmenorrhea for comparison.The results of the study revealed that both primary dysmenorrhea and secondary dysmenorrhea were based on the evidence of Qi stagnation and blood stasis.In secondary dysmenorrhea,the evidence of actual and deficiency-actual mixed evidence was predominant,and the evidence of kidney deficiency and blood stasis and heat burning blood stasis accounted for a certain proportion of secondary dysmenorrhea.In primary dysmenorrhea,there were deficiency,actual and mixed deficiency and actual evidence,and cold stagnation and blood stasis evidence and kidney deficiency and blood stasis evidence accounted for a higher proportion in primary dysmenorrhea.See Table 4 for details.

Characteristics of selected prescriptions for primary dysmenorrhea and secondary dysmenorrhea

We analyzed the prescriptions for primary dysmenorrhea and secondary dysmenorrhea and found that the prescriptions of famous gynecologists for the treatment of primary dysmenorrhea mainly included Jiaweimoyao Tang,Wenjing Tang,Siwu Tang,Shaofuzhuyu Tang,Bazhen Tang,Gexiazhuyu Tang,Sini San and Tiaogan San.The main prescriptions for treating secondary dysmenorrhea are Neiyi 3 fang,Jiaweimoyaotang,Guizhifulingwan,Neiyi 1 fang,Neiyi 2 fang,Bailiansanjietang,Neiyizhitongtang,Huoxuequyuhuazhengtang,etc.It can be seen that famous gynecologists use mostly sutra prescriptions for the treatment of primary dysmenorrhea and empirical prescriptions for the treatment of secondary dysmenorrhea.See Table 5.

Table 2 Distribution table of dysmenorrhea syndrome type

Table 3 Frequency and type statistics of the top 100 Chinese medicines

Table 4 Comparison of disease-evidence similarities and differences

Table 5 Comparison of disease-square similarities and differences

Discussions

According to famous veteran gynecologists,the basic pathogenesis of primary dysmenorrhea is "pain if it does not pass,pain if it does not glory" [4].The bookJing Yue Quan Shutold us:"abdominal pain during menstruation,the evidence has deficiency and reality.Solid or because of cold stagnation,or because of blood stagnation,or because of gas stagnation,or because of heat stagnation;deficiency,there is because of blood deficiency,there is because of gas deficiency" [5].The causative factors of "blockage" include qi stagnation,cold-heat,phlegm condensation and other real evil;"nonglorification"can be due to qi and blood deficiency,kidney qi is not full,etc.,resulting in the uterus not being moistened.

Leading Chinese gynecologists agree that "internal obstruction of blood stasis" is the core pathogenesis of secondary dysmenorrhea.Some doctors [6] consider "dampness and heat stasis" as the basic pathogenesis and believe that stasis of blood in the body for a long time can affect the flow of qi,blood and fluid,resulting in stagnation of qi and blood,stagnation of water and dampness,and prolonged stagnation of heat.Blood stasis,Qi stagnation,and Damp-Heat are mutually agglutinated in the lower jiao,and during the menstrual period,blood stagnation gathers in the ramus,which aggravates the stagnation and causes pain if it does not pass,which is called dysmenorrhea.

Clinically,the treatment of primary dysmenorrhea is based on the identification of evidence,with diarrhea for real and tonic for deficiency.Because primary dysmenorrhea does not have organic lesions,it is mainly related to the fullness of the sea of blood during menstruation,overflowing in the uterus and rapid changes of qi and blood,so medicine is mainly used in the week before and during menstruation to treat the cause of the disease,using treatment methods such as warming the menstruation and dispersing cold,draining the liver and qi,clearing heat and removing dampness,benefiting qi and nourishing blood,and tonifying the liver and kidneys so that the qi and blood of the flush are full and fluent,and then there is no painful menstruation.Secondary dysmenorrhea is treated on the basis of evidence-based treatment,with emphasis on staged treatment.The degree of stagnation of blood stasis blocking the cellular vasculature and collaterals is progressively increasing,and the lack of smooth drainage of menstrual blood becomes more obvious,so dysmenorrhea is progressively increasing [7].According to the principle of "treating the symptoms in an urgent manner and treating the root cause in a slow manner",the main purpose of menstruation is to promote the flow of qi and blood,resolve blood stasis and relieve pain.Due to the blockage of stasis,the new blood cannot return to menstruation and overflow,which may be accompanied by heavy menstruation and leakage in the collapse,so the treatment should be"generalizing the cause,activating the blood and removing stasis".In the nonmenstrual period,the treatment method is based on the identification of the causes of blood stasis and obstruction and the addition of drugs to resolve stasis and disperse nodules to achieve the goal of treating both the symptoms and the root cause.For those who have been suffering from a deficiency for a long period of time,an appropriate amount of deficiency tonics can be used.

As famous veteran TCM practitioners have deep theoretical knowledge,profound knowledge,unique academic ideas and rich clinical experience,summarizing the experience of famous veteran TCM practitioners and exploring the laws of medication are effective ways to learn TCM,inherit TCM and improve the efficacy of TCM.Due to the limitations of geography,time,energy and financial resources,most of us are not able to visit famous TCM doctors to follow the consultation and study,but with the convenience brought by modern information technology,we can consult the monographs and literature related to famous old TCM doctors,summarize the experience,inspire thinking,and learn from all so that the experience of famous old TCM doctors can be passed on and carried forward for the benefit of more patients.

In this study,we mainly reviewed the literature and monographs related to the treatment of dysmenorrhea by 50 famous TCM gynecologists inThe Experience of Famous TCM Gynecologistsand applied frequency analysis and association rules to the types of dysmenorrhea,evidence,prescriptions and herbs involved in the study to determine the potential connection between disease,evidence,prescription and medicine,which can not only inherit the experience of famous TCM gynecologists in treating dysmenorrhea but also guide TCM scholars to not only pass on the experience of famous TCM gynecologists in the treatment of dysmenorrhea but also guide TCM scholars in the precise grasp and application of identification,prescriptions and herbal medicines and improve the clinical efficacy of TCM in treating dysmenorrhea.

In this study,there were 715 prescriptions,and the Western medical diagnosis was extracted according to the dysmenorrhea treated by the prescriptions.A total of 187 prescriptions for primary dysmenorrhea and 262 prescriptions for secondary dysmenorrhea were found,and some of the literature could not specify the type of dysmenorrhea,so they were collectively referred to as "dysmenorrhea",totaling 266 prescriptions.

Primary dysmenorrhea and secondary dysmenorrhea have many similarities in TCM evidence patterns.The 715 prescriptions collected corresponding to dysmenorrhea had eight types of evidence:Qi stagnation and blood stasis evidence,cold clotting and blood stasis evidence,kidney deficiency and blood stasis evidence,heat burning and blood stasis evidence,Qi and blood deficiency evidence,damp-heat stasis evidence,Qi deficiency and blood stasis evidence,and liver and kidney deficiency evidence.

Famous TCM gynecologists used 296 kinds of herbs for treating dysmenorrhea,with a total drug frequency of 8020 times,of which the total frequency of the top 100 herbs was 7355 times,accounting for 91.71% of the total frequency.Commonly used herbal medicines for treating dysmenorrhea include Danggui,Baishao,Chuanxiong,Xiangfu,Yanhusuo,Chishao,Gancao,and Wulingzhi.Common classic formulas include Siwu Tang,Wenjing Tang,Shixiao San,Shaofuzhuyu Tang,Sini San,Jinlingzi San,and Xiaoyao San.Typical experienced formulas:Neiyi 1 Fang,Neiyi 2 Fang,Neiyi 3 Fang,Jiaweimojie Tang,Bailiansanjie Tang,Neiyizhitong Tang,Huoxuequyuhuazheng Tang,etc.

We analyzed the prescriptions for primary dysmenorrhea and secondary dysmenorrhea and found that the prescriptions of famous gynecologists for the treatment of primary dysmenorrhea mainly include Jiaweimoyao Tang,Wenjing Tang,Siwu Tang,Shaofuzhuyu Tang,Bazhen Tang,Gexiazhuyu Tang,Sini San,Tiaogan San,etc.The main prescriptions for treating secondary dysmenorrhea are:Neiyi 3 Fang,Jiaweimoyao Tang,Guizhifuling Wan,Neiyi 1 Fang,Neiyi 2 Fang,Bailiansanjie Tang,Neiyizhitong Tang,Huoxuequyuhuazheng Tang,etc.It can be seen that famous gynecologists use mostly sutra prescriptions for the treatment of primary dysmenorrhea and empirical prescriptions for the treatment of secondary dysmenorrhea.We extracted 187 prescriptions for primary dysmenorrhea and 262 prescriptions for secondary dysmenorrhea for comparison.The results of the study revealed that both primary dysmenorrhea and secondary dysmenorrhea were based on the evidence of Qi stagnation and blood stasis.In secondary dysmenorrhea,the evidence of actual and deficiency-actual mixed evidence was predominant,and the evidence of kidney deficiency and blood stasis and heat burning blood stasis accounted for a certain proportion of secondary dysmenorrhea.In primary dysmenorrhea,there were deficiency,actual and mixed deficiency and actual evidence,and cold stagnation and blood stasis evidence and kidney deficiency and blood stasis evidence accounted for a higher proportion in primary dysmenorrhea.