Evaluation And Measurement Of Pathogenic Unit Of Stagnated Heat Based On Hemorrhagic Stroke

Objective:This study synthesizes various methods of differentiation of symptoms to establishs a novel TCM theory of pathogenic differentiation of symptoms based on pathogenic elements and pathogenic units according to Professor Zhou Zhong-ying's theory on pathogenesis determination.The objective is to build a standard and flexible method of differentiation of symptoms. This method can guide clinical practice better and improve quality of differentiation of symptoms. Professor Zhou Zhong-ying's theory on complex pathogenesis of stasis-heat can be explaned.To create and evaluate a scale measurement method for pathogenic unit(PU) of stasis-heat on hemorrhagic stroke.Methods:This research applied generalized dictionary model to analyze clinical case reports from National TCM physician-Zhou Zhong-ying to establish a novel TCM theory of pathogenic differentiation of symptoms based on pathogenic elements and pathogenic units with analysis of TCM theory. Using this system illuminates connotation on complex pathogenesis of stasis-heat. Based on this system, the study on an integrative mode of Chinese medicine syndrome differentiation and disease classification for hemorrhagic stroke was done. Step one:system of measurement and items possible on indictor of statis-heat was created by means of literature study and discussion of experts. Step two:the items of measurement scale were renewed,emended and perfected by experts'expericnce with clinical symptoms. Step three:the pathogenic unit is confirmed for patients of hemorrhagic stroke, at the same time, the parameters of validity and reliability of scale were checked. This research is a part of National Emphasis Foundation Research Development Plan(973 plan)—Study of Pathogenesis and foundation of molecule for stasis-heat in refractory of internal medicine.Results:A new system of based on pathogenic differentiation of symptoms based on pathogenic elements and pathogenic units was created by data mining. PU is an identical functional unit of pathogenesis. Clinical complicated symptoms can be regarded as linear combination of PU and indicators or items. PU of stasis-heat which is not split nonlinearly consists of PE of stasis and PE of heat. With method of experts'consultation, the dimension of scale on PU of stasis-heat for all diseases was found out, consisting of four facets of Xue-re,Xue-yu,Chu-xue and Shen-zhi. The scale includes 59 items,21 items belonging to Xue-re,15 items belonging to Xue-yu,17 items belonging to Chu-xue and 6 items belonging to Shen-zhi. The dimension of scale on PU of stasis-heat for hemorrhagic stroke was found out, consisting of three facets of Xue-re,Xue-yu, and Shen-zhi. The scale includes 32 items,19 items belonging to Xue-re,7 items belonging to Xue-yu and 6 items belonging to Shen-zhi. Cronbach's Alpha for all diseases is 0.924. Finally 25 of items were screened out, which have better reliability and significance of diagnosis based on experts' experience by clinical investigation. Multilevel structural equation mode 1 about 25 items was formed. Global goodness of fit statistics of multilevel SEM is good:Full Information ML Chi-Square=6402.47554(P<0.001),df=565, RMSEA=0.099816. This result shows model can be accepted on exterior index. Structural equation model shows association between latent variable of two order and one between. This reflects association between stasis-heat and facet (Xue-re,Xue-yu, and Shen-zhi)of scale. The result indicated Shen-zhi had more weight for stasis-heat than others, which reflects characteristic of acute hemorrhagic stroke. There are 25 manifest variables are statistical significance,which shows better fit statistics in internal assess. According to above study, the scale of PU of stasis-heat for hemorrhagic stroke were renewed and perfected. A quantitative method of measurement of stasis-heat for hemorrhagic stroke is built according to regression of factor score.Conclusion:All kinds of methods of differentiation of symptoms of TCM have distinct rule which pathogenic analysis is core. The PE and PU flexibly and simply disclose theory of pathogenic differentiation of symptoms. PE is an independent element of pathogenesis, and PU is an independent functional unit of pathogenesis. The latter is sub-unit of pathogenesis which can be demonstrated, low-dimension and inseparable element. The PU also is definite target of drug. One PU can be transformed another PU. Measurement and standardization based on PU can embody advantage and characteristic of pathogenesis determination. Stasis-heat is complex pathogenesis unit, which may be regarded as a PU. It consists nonlinearly of PE of stasis and heat. Based on this theory complex pathogenesis of stasis and heat can be explained and clarified. The method of expert's consultation based on Delphi is feasible to form original scale, which can focus on an issue to screen important items. However this method also indicates some disadvantage because of insufficiency of experts' experience. This research applied clinical investigation data to verify experts'experience. Based on a novel theory of pathogenesis determination, a specified scale of PU of stasis and heat for hemorrhagic stroke is created, which has good validity and reliability. This study had explored feasible method to measure PU in order to clinical experience of National TCM physician-Zhou Zhong-ying.