| Purpose:By combing the results of Clinical expert questionnaire on elements, characteristics and pathogenesis evolution rules of syndrome of coronary heart disease combined with heart failure, we accurately and completely screened the effective information of coronary heart disease combined with heart failure syndrome to form three-dimensional-structure relational database of clinical expert questionnaire on pathogenesis and syndrome characteristics of coronary heart disease combined with heart failure with the method of combining TCM disease and symptom. Through data mining techniques and statistical methods, we analyzed the database, determined the judgment standard and the syndrome characteristics of coronary heart disease combined with heart failure syndrome and detected their evolution rules of syndrome and pathogenesis.Materials and methods: This study adopted clinical epidemiology flow cross-sectional investigation method by distributing questionnaire survey conducted on clinical doctors.First, questionnaire was compiled from the ancient and modern literature that were able to express the study on the content items accurately, combined with the experience of clinical specialists.By three rounds of expert consultation using Delphi questionnaire, "syndrome of coronary heart disease factors and evolution law of pathogenesis of syndrome and syndrome questionnaire of clinical experts" was eventually formed. Survey of clinicians in relevant professional. The reliability and validity of questionnaire was determined through early pilot 300 questionnaires and network questionnaire input system with China Academy of Traditional Chinese Medicine, Shangzhitong(Beijing) limited development of clinical research survey of information technology systems were adopted. The filling out of coronary heart disease and heart failure syndromes is realized by adopting the network of online questionnaires.a total of 1504 copies of qualified expert questionnaire were collected and syndrome database with oronary heart disease and heart failure TCM Syndrome elements, characteristics and evolution were created through clinical investigation on medicine physician working in 51 hospitals in North China, Northeast, East, South, Southwest, Northwest.By the probability of statistical analysis on database’s frequency, clustering and the transferring of probability of metastasis, syndrome characteristics and evolution of the syndrome were determined.Results:1. Four stages of coronary heart disease and congestive heart failure(CHF former stage, pre-clinical stage, clinical stage, end stage) showed symptoms of frequency distribution:In patients with Yang and quality physical body and blood stasis based;Chest pain minded, mostly characterized by early, middle and late, such as chest pain, smothering or choking, severe chest and back pain, gray face and cold limbs;Arrhythmias is usually happened at heart, accompanied with heart emptiness, irritability, palpitation, insomnia, anxiety Chuti, end-stage heart palpitations, cold hands and feet and limbs;The most typical features of early respiratory symptoms as fatigue, shortness of breath, dry cough without phlegm,The clinical manifestations of the stage include unable to lie, hold sitting position, midnight arousal, and breathlessness,final phase is often accompanied by more severe coughing at night,and sputum is less dense but more in volume accompanied by cyanosis and sweating,coughed more frequently and pink foamed sputum;Water metabolism disorder characterized mainly for early failure are:Lower extremity edema with dry mouth,susceptible to illness, an increase in urination frequency, especially at night.As the disease progresses, edema caused by parts spread to face, eyelids and the whole body, accompanied by less urination or even none,large visible sweat can be observed;The usual complexion is pale and bleak, with purple lips and dots,a feeling of blocking in the throat which is itchy, and also accompanied by neck veins tympanitesing and they are full when right ribs are to be pressed,chest are blocked and full abdomen and a lack of appetite can be observed. Patients prefer light food and a swelling pain, like throbbed by needles, can be felt.A symptom of a lack of appetite and vomiting are to be found in the last stage of illness;The symptom of the whole body includes feelings of tedious, afraid of cold, insomnia; the mid-stage symptom includes chill, unease, sleep less soundly and frightfelt,and fatigue; late-stage, drowsiness,absent-minded,and purple in color of skin and nails.Statistical results of the frequency of tongue and pulse show that int the first stage of heart failure patients, tongues are in a more flaccid state, and pre-clinical stage can see tongue with visible pale white color, big fat shaped, scalloped, greasy and slippery coat with white and yellow color.Clinical stage can see visible tongue color of dark purple, tongues with greasy, slippery, gray or yellow coat. Most patients with end-stage sublingual vein tortuosity bruising, petechiae tongue, little or no coat coat. Patients in the early stage are often featured with heavy pulse veins, and visible progression, knot pulse and pulse generation can be observed along the development of the illness.2. The decision tree shows that criteria for factors of heart failure syndrome prior to the coronary heart disease and heart failure are: vital energy stagnation in the chest and abdomen without any manifestation from the appearance,chest distends;weak vital energy:palpitation and fatigue;weak spleen:fatigue and preferring of light diet, diluted constipation.Criteria for symptom prior to the clinical stage:vital energy stagnation, swollen pain in the chest and ribs, depressed and full feeling in the chest; blood stasis:dark tongue color and ecchymosis, sharp pain in the ribs;phlegm blocked in the throat:swollen tongue, with print of teeth, greasy coated tongue, slippery pulse,suffocated pain in the chest;weak vital energy:fatigue and palpitation;weak spleen: fatigue and liken of light diet, diluted constipation;weak yang energy in the heart:cold limbs, palpitation;weak yang energy in spleen:light diet, cold limbs,diluted constipation;weak vital energy in the liver blood circulation:dull pain in the ribs, light in lips color, pale complexion.Criteria for clinical factors:condensation of coldness in the human body:slippery coated tongue, dark in the color and gray in the tongue, slow pulse, cold pain in the chest and blue faces;phlegm blocked in the throat:swollen tongue with teeth trace; be short of breath,even suffocated to the degree of awake at night, edema in the lower body, greasy coated tongue.3.The analysis of nervous system holds that:in the stage of coronary heart disease and heart failure, the nervous modes, except weak lunges and heart vital energy that can not produce nervous system, has a wrong judgmental rate less than 1% in predication; therefore attest to the satisfactory result. In the early stage of clinical stage, except weak lunges vital energy that can not produce nervous system,has a wrong judgmental rate less than 1% in predication; therefore attest to the satisfactory result. In the stage of clinical stage, except weak lunges vital energy that can not produce nervous system,has a wrong judgmental rate less than 1% in predication; therefore attest to the satisfactory result. In the last stage, except weak lunges vital energy that can not produce nervous system,has a wrong judgmental rate less than 1% in predication; therefore attest to the satisfactory result and to the judgmental ability of the decision tree.4. Cluster analysis shows that: Prior to the coronary artery disease and heart failure stage, heart failure symptoms can be clustered into two groups: the first group of symptom clusters are as follows: palpitations, abdominal fullness conscious, without fullness showing in the appearance, fatigue, difficulty in falling asleep, empty feeling in the heart; the second group showed symptom clusters: palpitations, shortness of breath after exertion.Pre-clinical stages of coronary artery disease and heart failure can be clustered into five groups symptom clusters: symptoms of the first group are shortness of breath with a stuffy chest to the degree of night arousal, breathlessness, unease within various organs; the second group showed symptom clusters to: shortness of breath; third group of symptoms group were as follows: pain, heart palpitations, threatening inflation, consciously abdominal fullness,no obvious sign of fullness, fatigue; fourth group showed symptom clusters: eyelid edema, facial swelling, leg edema, chest boredom blues as full; the fifth group symptom clusters as follows: cold hands and feet, swollen lower body, palpitation and fatigue.Coronary artery disease and heart failure clinical stage can be clustered into four groups symptom groups: the first group showed symptom clusters: fatigue, shortness of breath with a stuffy chest, even the middle of the night awakenings, breathlessness; the second group showed symptom clusters to: facial swelling, eyelid edema, limb muscle stays liquid water table, chest tingling, flank ache, acupuncture; the third group showed symptom clusters: sour in the waist and lower body, facial swelling, big full abdominal to a degree of water sounding when shake a vessel; a fourth group symptom clusters as follows: chills, body fluid stayed on the surface of limbs flank ache like pressing a needle within.End-stage coronary artery disease and heart failure symptoms can be clustered into two groups: the first group of symptom clusters as follows: systemic edema, coma, sweating heavily and densely, cough, sputum, coughing frequently, phlegm with pink color; the second group showed symptom clusters: systemic edema, palpitations, shortness of breath with stuffy chest, even arise during the midnight.5. The transition probability matrix results: heart failure stage(stage A) is divided into the heart energy deficiency syndrome and weak converse. results can be seen from the probability transition matrix, heart and deficiency of both liver and spleen do not transfer easily converted to 35.32% and yang syndrome certificates 27.38%; vital energy does not transfer easily converted to the liver and spleen and energy deficiency syndrome 45.78%, 18.31% respectively.Pre-clinical phase(phase B) is divided into energy deficiency, liver and spleen not compatible, dampness and blocked yang. Survey results can be seen from the transfer matrix,energy deficiency syndrome ca be easily converted for lack energy were 38.76% and accumulated fluid in kidney 29.46%; incompatible in the liver and spleen, can be easily translate into lack of energy deficiency syndrome, 65.81% and resistance network 17.09%; spleen does not transfer easily for the case of qi deficiency syndrome, lacking of energy and kidney water pan 66.76% 19.27%; dampness syndrome angry easily converted into kidney water pan qi deficiency syndrome were 45.95% and 29.73%; yang being held back and lack of energy were converted to 58.23% and kidney fluid 18.99%.Clinical stage(stage C) were divided into the weak qi, the block of body network, kidney and cold fluid network syndrome. Results can be seen from the transfer probability matrix, lack of qi deficiency syndrome were easily converted to water vapor heart syndrome and asthma 72.61% 27.39% off yang; he block of body network can be easily converted to breathe off the yang 65.32% and heart syndrome 34.68%; kidney and cold fluid network syndrome can be easily converted to breathe off the yang 67.01% and heart syndrome 32.99%; cold fluid network syndrome can be easily converted to breath 60% off yang and fluid network syndrome 40%.Conclusion:1 Design of the questionnaireliterature from pass and present China has been Combed to select the accurate items that can best express the content of the research. Combined with the clinic docotor’s medical experience, Questionnaires on Elements of Coronary Heart Disease Syndrome, Development for Clinic Experts were made after the 3 rounds of consultation to experts using Delphi’s methods. The questionnaire is believed to be reliable and effective, which in turn could represents the content of research accurately.2 Elements of SyndromesIt is concluded,referring to the statistics of the frequency of the coronary heart disease and heart failure, that the nature of the patients are mostly weak in yang energy, blood stasis.The early stage of heart failure mainly involves the weak and stagnation of heart, lung, spleen. Pre-clinical stage’s syndrome mainly involves the heart, liver, spleen, showing qi stagnation, blood stasis, phlegm, heart deficiency, Spleen Qi, Yang heart, spleen yang deficiency, liver blood deficiency. In the clinical stage, yang and blood stasis mainly involving the heart, kidney, showing phlegm, heart deficiency, heart yang, deficiency. End-stage mainly manifests cold condensation of heart, spleen, kidney, showing phlegm, heart yang, spleen yang deficiency, deficiency.3 Syndrome FeaturesUsing statistical clustering method for coronary heart disease and heart failure expert questionnaire,analysis on the database for statistical, four stages are summarized: pre-stage heart failure, including heart and spleen deficiency, vital energy rushing against the card; pre-clinical phase includes vital energy deficiency, liver and spleen incompatible, certificate dampness; clinical stage includes lack of energy deficiency syndrome,energy circulates blockage, weak kidney, cold diet preference; end stage manifests asthma with weak yang energy, shuiqilingxin heart syndrome.4 Syndrome Evolution PrinciplesCoronary heart disease and heart failure has a total of four stages with 13 syndromes: the principle of evolution is all the syndrome are easily transformed into the liver and spleen incompatible syndrome from the heart failure stage to the pre-clinical stage,during which the two are easily transformed to qi deficiency and humid qi blockage symdrome, respectively. During the clinical stage to the end stage of evolution is a lack of qi deficiency syndrome were easily converted to shuiqilingxin heart syndrome,and body circulation obstruction, kidney syndrome and cold syndrome are easily converted to the lack of yang syndrome. |
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