Study On TCM Syndrome Classification Diagnosis Scale And TCM Syndrome Characteristics Of Parkinson 's Disease

ObjectiveBy a comprehensivearticleanalysis, the study extracted the main symptoms,syndrome elements and syndrome of patients with Parkinson’s Disease. And we prepared Syndrome Diagnostic Scale by using mathematical model. Validity and reliability are evaluated in the perspective study.This study established basis of developing syndromes-subtyping scales in patients with Parkinson’s Disease for clinical syndromes differentiating and therapeutic assessment. According to the data of clinical research, we studied on characteristics of of Parkinson diseasesyndromes, which provided the basis for the intervention of traditional Chinese medicine.Method1.With the method of retrospective survey, we retrieved published study on Parkinson’s disease syndromes of modern articlein CNKI between 1978 to January 2015, using manual and computer retrieval methods.The subject headings were:Parkinson’s disease,fibrillation and syndromes, syndrome elements or symptoms.We included 53 qualified articles according to inclusion and exclusion criteria for each articleafter reading the content and abstract of papers. We used SPSS 16.0 to descript frequency of PD’syndromes, symptoms and syndrome elements in accord with requirements of the documents and analyzed distribution features of the PD’s TCM syndrome,symptoms,syndrome elements.2.2.We designed a" Chinese medicine syndrome questionnaire for Parkinson’s Disease ",the questionnaire mainly included general information, medical history, clinical manifestations, diagnosis conclusion and. the TCM syndrome of Parkinson’s disease. We collected clinical data, screened the symptom items by cluster analysis, drew the corresponding relations and then analyzed syndrome elements, draw common syndrome typesand the relationship of syndrome-symptoms of PD, using the regression, and finally determine the scale threshold by ROC curve, and finally re-used of small samples to verify the validity of the scale.3.We screened 295 patients with PD according to the above questionnaire, analyzed the overall distribution of PD’syndromes, syndrome elements, symptoms, through the analysis on the PD syndromes according to patients’age, gender distribution, region, occupation, cultural degree and Hoya classification.Result1. According to the records of 53 articles,in addition to the four primary symptoms of Parkinson’s disease, the main frequency of other symptoms are forgetfulness, limb detained convulsion, dry mouth, lack of power, expression, insomnia, salivate, upset, indifference, pain, constipation, spontaneous perspiration, gait instability,night sweats, frequency of urine, etc. The more common texture of tongueare pink, dark, pale tongue, sublingual vein stasis, dry, ecchymosis, the tip of the tongue is red and sublingual bruising, ect, greasy moss, thin yellow moss, less moss; Pulse condition:the more frequency, string pulse, sink of arteries and veins, weak pulse, astringent pulse. The location syndromes elements are:liver, kidney, brain, channels and collaterals, spleen, heart, bones and muscles;The nature syndrome elements: endogenous wind, Yin deficiency, qi deficiency, blood deficiency, phlegm, blood stasis, hot,wet, Yang deficiency, and qi stagnation, cold. More frequency of syndrome are Yin deficiency of liver and kidney, deficiency of qi and blood, deficiency of qi and Yin, deficiency of kidney and marrow, dynamic liver-wind, kidney Yang deficiency, phlegm and blood stasis resistance collaterals, Yin deficiency and yang strong, much sputum due to spleen deficiency, deficiency of Yin and Yang, qi and blood stasis.2.With articles’ research results and expert advice, we designed 1 "Parkinson disease Chinese medicine syndrome questionnaire", with which 387 patients of Parkinson’s disease were screened, and 295 included.They were 44 to 88 years old, the average age was 68.78 ± 9.53 years old; 199 cases were male and 96 were female; Classification according to the level of education:including illiteracy for 5 cases, accounting for 1.69% of the total. Primary school 13 cases, accounting for 4.4%; Junior high school 54 cases, accounting for 18.3%.5819.66% of high school, college and above 165 cases, accounting for 55.93%; According to the geographical points, east China group conclude 24 people, accounting for 8.14%; North China group conclude 239 people, accounting for 81.01%; Huazhong group conclude 11 people, accounting for 3.73%; The group conclude 7 people, accounting for 2.37%; The northeast group conclude 14 people, accounting for 4.75%; For professional aspect:there were 44 workers, accounting for 14.9%,41 teachers,13.5%; 26 farmers,8.6%; 69 Cadre,22.8%; there were 90 Staff,29.8%; Other 25,8.3%; according to the modified H-Y:there were 47 cases (15.9%)in level 1;there were 46 cases(15.6%)in level 1.5,43 cases (14.6%)in level 2,46 cases (15.6%)in level 2.5;68 cases (23.1%)in level 3,38 cases (12.9%)in grade 4,7cases (2.4%) in grade 5.Also we designed a PD syndrome scale which contained 8 syndrome types:Yin deficiency of liver and kidney, deficiency of qi and blood deficiency of kidney and marrow, dynamic liver-wind, blood stasis resistance collaterals, inside heat and yang strong, much sputum inside the body, spleen yang deficiency. And 8 CM typing syndrome diagnostic scales of PD were established. The total score of every syndrome is 50, diagnostic threshold score is 20.Diagnostic performance of the scale is that the sensitivity of the scale is between80.4% and 91.8%, the specificity of the scale is between 57.5% and 85.8%, Youden index between 49.2% and 76.3%. Clinical validation by the small sample was applied, the result showed that the sensitivity of the scale was between 60% and 92.8%, the specificity of the scale was between 75% and 94%, Youden index between 75% and 94%, accuracy rate was between 63.3% and 98%.3.PD common TCM syndromes distribution results show that nature syndrome elements are endogenous wind, yin deficiency, Qi deficiency, blood deficiency, reduced marrow, Yang Kang, heat, phlegm and stasis, location elements are brain, liver and kidney, heart, spleen and so on. Parkinson syndrome showed a higher rate are endogenous liver wind (64.4%), deficiency of kidney and marrow by 35.6%), yin deficiency of liver and kidney(37.6%) deficiency of qi and blood (21%), phlegm (15.9%). The chi square test for TCM syndromes in sex (PearsonX2=13.173, P=0.068), regional (PearsonX2=32.671, P=0.248), age (PearsonX2= 11.969, P=0.996), the degree of culture (PearsonX2=13.437, P=0.991), professional (PearsonX2=20.976, P=0.971) distribution showed no difference.There was statistically difference (PearsonX2=119.416, P=0.000< 0.001) for the TCM syndromes distribution of Parkinson disease in the Hoya classification. Correlation analysis for the TCM syndromes and Hoya classificationshowed that:liver and kidney yin deficiency (partial correlation coefficient R=0.141, P=0.015), qi and blood deficiency (R=0.152, P=0.009), deficiency kidney and marrow (R=0.118, P=0.043), heat and yang hyperactivity (R= 0.0.178, P=0.002), phlegm (R=0.306, P=0.000), spleen yang deficiency (R=0.203, P=0.000) were positively correlated with Hoya grade. As the disease progresses, patients with liver and kidney deficiency, qi and blood deficiency, deficiency of kidney marrow, hyperactivity of Yang and heat, phlegm, spleen yang deficiency is severer; while there is no significant correlation betweenwind,congestion of collaterals and severity of illness.In Hoya grade 1-1.5 group,asthenia in TCM Syndromes originof Parkinson’s Diseasewere mainly deficiency of both qi and blood, yin deficiency of liver and kidney.deficiency kidney and marrow, and asthenia in superficialitywas dynamic liver wind. There was no significance between them, but there was significance between the three and between the intrinsic phlegm, spleen yang deficiency, blood stasis obstructing collaterals and internal heat and hyperactivity of Yang. In Hoya grade 2 group and asthenia in TCM Syndromes originof Parkinson’s Disease were mainly deficiency of both qi and blood, yin deficiency of liver and kidney,deficiency kidney and marrow,deficiency of both qi and blood is most prominent, and asthenia in superficialitywas dynamic liver wind and intrinsic phlegm, and phlegm connotation is more obvious. In Hoya grade2.5 group,asthenia in TCM Syndromes originof Parkinson’s Disease were mainly deficiency of both qi and blood, yin deficiency of liver and kidney,deficiency kidney and marrow, and asthenia in superficialitywas dynamic liver wind.In Hoya grade 3 groups, the TCM Syndromes of the deficiency syndromes were more obvious, yin deficiency of liver and kidney was most prominent, asthenia in superficialitywas dynamic liver wind and intrinsic phlegm, and phlegm connotation is more obvious.In Hoya classification group 4, asthenia in TCM Syndromes originof Parkinson’s Disease were mainly deficiency of both qi and blood, yin deficiency of liver and kidney,deficiency kidney and marrow, spleen yang deficiency; asthenia in superficialitywas dynamic liver wind.In Hoya grade 5, asthenia in TCM Syndromes originof Parkinson’s Disease was more obvious, and liver wind stirring inside, accumulation of phlegm and silt blocking collaterals, heat hyperactivity of Yang also increased significantly, so that there was no statistical difference.between different TCM syndromes no statistical difference.The survey also found that the incidence of PD increased with age, theeducation degree, the higher the education degree, the higher the incidence of PD, the Universitycultureaccounted for more than 65%.Conclution1. By CNKI article retrieval, in accord with 53 articles, there were 1730 cases in Parkinson’s disease syndromes and syndrome elements. the frequency scan results showed that, the main location elements:liver, kidney, vein, spleen, heart, brain; The main nature elements are endogenous wind, Yin deficiency, qi deficiency, blood deficiency, Yang deficiency, marrow reduce, phlegm, yang up, internal heat and blood stasis; there are 13 main syndromes:Yin deficiency of liver and kidney, deficiency of qi and blood,deficiency of qi and Yin,deficiency of kidney and marrow, dynamic liver-wind, kidney Yang deficiency, phlegm and blood stasis resistance collaterals, Yin deficiency and yang strong, much sputum due to spleen deficiency, deficiency of Yin and Yang, qi and blood stasis.Through the article search, search distribution regularity of PD TCM syndromes, symptoms and the syndrome elements, make positive role for the research of TCM syndrome type and specification and provides the reference for TCM diagnosis scale.2.With articles’research results and expert advice, we designed a PD syndrome scale which contains 8 syndrome types:they were Yin deficiency of liver and kidney, deficiency of qi and blood deficiency of kidney and marrow,dynamic liver-wind, blood stasis resistance collaterals, inside heat and yang strong, much sputum inside the body, spleen yang deficiency. And 8 CM typing syndrome diagnostic scales of PD were established. The total score of every scale is 50, diagnostic threshold score is 20. Clinical validation by the small sample was applied, the result showed that the sensitivity of the scale was between 60% and 92.8%, the specificity of the scale was between 75% and 94%, Youden index between 75% ～ 94%, accuracy rate was between 63.3% and 98%.3.preliminary study of 295 patients with Parkinson’s disease characteristics of TCM syndrome distribution showed that show that there are eight syndrome types:Yin deficiency of liver and kidney, deficiency of qi and blood deficiency of kidney and marrow,dynamic liver-wind, blood stasis resistance collaterals, inside heat and yang strong, much sputum inside the body, spleen yang deficiency. there are 6 location elements:brain, liver and kidney, heart, spleen and so on. There are 10 nature syndrome elements:endogenous wind, yin deficiency, Qi deficiency, blood deficiency, reduced marrow, Yang Kang, heat, phlegm and stasis.The chi square test of TCM syndromes in sex, regional, age, the degree of culture, professional distribution showed that there was no difference.Yin deficiency of liver and kidney,liver wind moving inside and deficiency of kidney and marrowdeficiency of qi and blood, phlegm turbidity implication, spleen Yang deficiency,heat hyperactivity of Yang, were positively associated with hoya degree, namely as the illness progresses,the more and more serious they were. There was no business with silt blocking collaterals,dynamic liver wind and Hoya.During the course of Parkinson’s disease,yin deficiency of liver and kidney,liver wind moving inside and deficiency of kidney and marrowand deficiency of qi and blood Played important role all the way, the highest proportion, prompt with its played important roles in the pathogenic process, along with the illness aggravating,their degree also grown; Based on virtual, Parkinson’s disease in the hoya grading at various stages, and each has outstanding, in the hoya grade 2 groups, deficiency qi and blood was more significant; In the hoya grade 2.5,3 groups, liver and kidney Yin deficiency is the most prominent; In the hoya class 4, liver and kidney Yin deficiency, spleen Yang deficiency is more important. In Parkinson’s disease, asthenia in superficialitywas dynamic liver wind, and phlegm turbidity implication in Parkinson’s disease hoya class 2,2.5,3 groups was especially big, reveals phlegm turbidity play an important role in in the medium-term pathogenesis of Parkinson’s disease. As the illness progress, degree of heat hyperactivity of Yang,spleen Yang deficiency, blood stasis collaterals empirical increasingly occupy important position in the disease, until the hoya grade 5, there was no significant difference between the syndromes.Study PD’s characteristics and distribution regularity of TCM syndrome element and syndromes, provide evidence for TCM intervention.