Syndrome Differentiation and Treatment Regularity in Traditional Chinese Medicine for Type 2 Diabetes: A Text Mining Analysis

Abstract

Objective: The goal of this study was to systematically summarize and categorize the syndrome differentiation, medication rules, and acupoint therapy in the domestic traditional Chinese medicine (TCM) literature on type 2 diabetes mellitus (T2DM), such that guidelines and new insights can be provided for future practitioners and researchers.

Methods: Taking randomized controlled trials (RCTs) on the treatment of T2DM in TCM as the research theme, we searched for full-text literature in three major clinical databases, including CNKI, Wan Fang, and VIP, published between 1990 and 2020. We then conducted frequency statistics, cluster analysis, association rules extraction, and topic modeling based on a corpus of medical academic words extracted from 3,654 research articles.

Results: The TCM syndrome types, subjective symptoms, objective indicators, Chinese herbal medicine, acupuncture points, and TCM prescriptions for T2DM were compiled based on invigorating the kidney and Qi, nourishing Yin, and strengthening the spleen. Most TCM syndrome differentiation for T2DM was identified as "Zhongxiao" (the lesion in the spleen and stomach) and "Xiaxiao" (the lesion in the kidney) deficiency syndromes, and most medications and acupoint therapies were focused on the "Spleen Channel" and "Kidney Channel." However, stagnation of liver Qi was mentioned less when compared with other syndromes, which did not have symptomatic medicines.

Conclusion: This study provides an in-depth perspective for the TCM syndrome differentiation, medication rules, and acupoint therapy for T2DM and provides practitioners and researchers with valuable information about the current status and frontier trends of TCM research on T2DM in terms of both diagnosis and treatment.

Keywords: Chinese herbal medicine; acupoint therapy; text mining; traditional Chinese medicine syndromes; type 2 diabetes mellitus.

Figure 1

Flowchart for the selection of RCTs.

Figure 2

Schematic diagram of stuttering word segmentation. Stuttering word segmentation technology roadmap, from word segmentation, removing stop words, loading custom dictionaries, keyword extraction, part-of-speech tagging to drawing keyword word cloud maps.

Figure 3

Graphic model for Latent Dirichlet allocation. K, total number of topics; β_k, topic, a distribution over the vocabulary; D, total number of documents; θ_d, per-document topic proportions; N, total number of words in a document (in fact, it should be N), Z _{d, n}, per-word topic assignment; W_{d, n}, observed word; α, 𝔶, Dirichlet parameters.

Figure 4

Frequency Distribution of Diabetes Symptoms. The frequency of TCM subjective symptoms in the diabetes literature. The abscissa represents the name of the subjective symptoms, and the ordinate shows the frequency of each symptom. The total number of subjective symptoms of TCM was 27,448, of which more than 2% are as follows: Obesity: 9,573 (34.8%); Polyphagia: 1,847 (6.7%); Polydipsia: 1,264 (4.6%); Polyuria: 1,160 (4.2%); Tiredness and fatigue: 1,160 (4.2%); Thirst and polyphagia: 1,010 (3.6%); Dysphoria in chest, palms, and soles: 621 (2.2%); Soreness and weakness of waist and knees: 579 (2.1%). The most frequent occurrence is “Obesity”, a common symptom of “spleen deficiency and dampness”.

Figure 5

Distribution of TCM Syndromes of Diabetes. The frequency of TCM syndromes in the diabetes literature. The abscissa represents the name of the syndrome; the ordinate shows the frequency of each name. The total number of TCM syndromes was 4,801, among which more than 2% are as follows: Syndrome of dampness stagnancy and spleen deficiency: 875 (18.2%); Yin and Yang deficiency syndrome: 502 (10.4%); Yin deficiency syndrome: 424 (8.8%); Liver-qi stagnation syndrome: 371 (7.7%); Liver and kidney Yin deficiency syndrome: 322 (6.7%); Spleen and kidney Yang deficiency: 239 (4.9%); Kidney Yin deficiency: 193 (4.0%); Stagnation of liver qi and spleen deficiency syndrome: 185 (3.8%); Stomach heat flaming syndrome: 170 (3.5%); Spleen deficiency syndrome: 163 (3.3%); Spleen and Kidney Deficiency Syndrome: 106 (2.2%). From the distribution of syndromes, it can be seen that the “spleen deficiency and dampness syndrome” appears most frequently, which may be related to diabetes the patient’s “polydipsia, polyphagia” is related, the spleen deficiency, and the movement and transformation are unfavorable, which leads to the body dampness, evil, and blood stasis group.

Figure 6

Distribution of TCM Prescribed Medicines for Diabetes. The frequency of TCM prescriptions in the diabetes literature. The abscissa represents the name of the TCM prescription; the ordinate shows the frequency of each prescription name. The total number of TCM prescriptions was 24,748, of which more than 2% are as follows: Pill of ingredients with Rehmannia: 1,420 (5.7%); Xiaoke Pills: 1,370 (5.5%); Deficiency of yiqin and blood unsmooth: 1,298 (5.2%); Jinlida Granules: 1,233 (4.9%); Qiqihuoxue Decoction: 983 (3.9%); Berberine: 779 (3.1%); Shenqi Jiangtang Granules: 529 (2.1%). The most frequently used ones are “pill of ingredients with Rehmannia”. The efficacy of the prescription is consistent with the above symptoms and syndromes.

Figure 7

TCM Acupuncture Points Names for Diabetes. The frequency of occurrence of acupuncture points in the diabetes literature. The abscissa represents the name of acupuncture points. The total number of acupuncture points was 12,458, of which more than 2% are the following: ST36: 973 (7.8%), SP36: 744 (5.9%), RN12: 567 (4.5%), BL20: 529 (4.2%), RN4: 522 (4.1%), ST25: 500 (4.0%), ST40: 487 (3.9%), BL23: 482 (3.8%), RN6: 347 (2.7%), LI11: 294 (2.3%), KI3: 293 (2.3%), SP9: 281 (2.2%), GB37: 259 (2.0%). The ordinate shows the frequency of appearance of each acupoint name; ST36 and SP36 are located on the Stomach Meridian of Foot-Yangming and Spleen Meridian of Foot-Taiyin. The abovementioned conforms to the TCM treatment principle.

Figure 8

A tree graph using an average join (between groups). Category 1 mainly treated the manifestations of spleen-kidney Yang deficiency syndrome, such as low spirit due to Qi deficiency, polyuria, BL23 and GB37; Category 2 was mainly Stagnation of liver qi and spleen deficiency syndrome; Category 3 was mainly liver and kidney Yin deficiency, such as dysphoria in chest, palms, and soles, thirst and drink, soreness and weakness of waist and knees, thirsty and drinking, Pill of ingredients with Rehmannia; Category 4 was mainly spleen deficiency, treatment with Astragalus membranaceus.