基于模糊认知图的慢性心力衰竭中医核心病机量化研究OA

Objective To address the problems of complex pathogenesis and difficult quantitative analysis of transmission rules of chronic heart failure(CHF)in traditional Chinese medicine(TCM),this paper introduced the fuzzy cognitive map(FCM)modeling method to construct a multi-level,quantifiable pathogenesis topological network,and systematically reveal the core pathogenesis,pattern classification differences and transmission rules of the CHF.Methods Taking the Chinese Medicine Diagnosis and Treatment Guidelines for Chronic Heart Failure(2022)as the data source,79 entity nodes(covering diseases,classifications,pathogenesis,and symptoms)were extracted through ontology modeling,and the FCM model was constructed by combining the expert panel scoring method with literature evidence.Gephi software was used for network visualization and multi-dimensional analysis.Results ①Quantitative analysis of the model showed that qi deficiency was the initial pathogenesis of CHF,and strongly correlated with blood stasis(weight=0.97,the same applied below),which constituted the core framework of"qi deficiency and blood stasis"in CHF.② Blood stasis had the highest betweenness centrality and was the key pivot connecting deficient and excessive pathogenesis.The strong correlation between blood stasis and phlegm revealed the characteristic of"concomitant phlegm and blood stasis"in the CHF pathogenesis.③Analysis of pattern classification differences demonstrated that heart failure with preserved ejection fraction(HFpEF)presented the pathogenesis characteristics of"qi deficiency(0.70)as the foundation and blood stasis(0.72)as the pivot",while heart failure with reduced ejection fraction(HFrEF)presented the characteristics of"hyperactivity of excessive symptoms of blood stasis(0.67)and water retention(0.56)".④Analysis of differences in New York Heart Association(NYHA)functional classification revealed the transmission chain of pathogenesis with disease progression:Grade Ⅰ was characterized by qi deficiency(0.64)as the root cause and blood stasis(0.73)as the manifestation;Grade Ⅱ showed aggravated qi deficiency(0.78)and blood stasis(0.77)with mild yin deficiency(0.28);Grade Ⅲ was a turning point,with qi deficiency(0.80)and blood stasis(0.81)reaching a peak and a sudden rise in water retention(0.35);and Grade Ⅳ was marked by excessive water retention(0.58)and prominent yang deficiency(0.30).Overall,the pathogenesis presented the transmission rule of"qi deficiency → blood stasis → fluid retention → yang deficiency".Conclusions By constructing an FCM-based topological network for TCM pathogenesis in CHF,this paper for the first time achieved systematic quantification and visual analysis of the multidimensional relationships of"classification-grading-syndrome element-syndrome-symptom",clarified the network pivot status of"qi deficiency and blood stasis"as the core pathogenesis of CHF,and revealed the pathogenesis differences and transmission rules of CHF across different classifications and grades.This method breaks through the limitations of traditional pathogenesis research in quantification and visualization,and provides a new analytical paradigm for TCM pathogenesis research.