The Study Of The Key Symptoms Extraction And The Symptoms Survey Scale Development Of Dynamics-immobility-order-succession And Eight Therapies

ObjectiveWith the incidence of diabetes rising, the effect of traditional Chinese medicine in diabetes has great attention. But the variable symptoms and different diagnostic standards make the syndrome differentiation different. So the standartdization of syndrome differentiation of TCM is important. The characteristic of mathematical model is easy quantization, objectivity and accuracy, so it gets the extensive attention. The study uses Item Response Theory (IRT) and Structural Equation Model (SEM) to extract the key symptoms of the syndromes of diabetes, which proposed by dynamics-immobility-order-succession and eight therapies, to research the relation of symptoms and syndromes, to rsearch diabetic key pathogenesis, and to make the symptoms survey scale of diabetics in traditional chinese medicine.Methods1. By referencing<clinical terms of Traditional Chinese Medicine syndrome> and combining the usually symptoms of diabetes, making the scale of dynamics-immobility-order-succession and eight therapies.2. The investigation proceeds in the type2diabetes which was the patients of endocrinology department of Guangdong province hospital of TCM from Feb2012to Jan2013.3. Inputting the data by EpiData3.1, using CTT and IRT to screen the items, then making the final scale of dynamics-immobility-order-succession and eight therapies. Evaluating the reliability and validity of scale.4. Using the confirmatory factor analysis of SEM analyses the final items, to research and quantitate the relation of symptoms and syndromes.Result1. the number of sample is435. In the sample, the number of females is187, male is248, the pattern of deficiency kidney is84(19.3%), the pattern of deficiency qi and yin is299(68.7%), the pattern of constrained liver qi is178(40.9%),the pattern of hot blood is72(16.6%), the pattern of dry-heat clogging the lung and stomach is95(21.8%),the pattern of deficiency nourishment heart is40(9.2%), the pattern of damp heat collecting inside is253(58.2%), the pattern of congealed blood is187(43.0%).2. Screening the items by CTT and IRT. For the low Cronbach’s a and smooth TCC, the pattern of hot blood can not be quantitated. The items of others as follow.the pattern of deficiency kidney is consist of forgetfulness, tinnitus, soreness and weakness of waist and knees, frequent micturition,urine leaching;the pattern of deficiency qi and yin is consist of tired, hypodynamia of limbs, feeling heating,spontaneous sweating, night sweating,dizziness, palpitation, dryness in the mouth;the pattern of constrained liver qi is consist of depression, sigh,fullness and pain in the hypochondrium or lateral lower abdomen, being irritable;the pattern of dry-heat clogging the lung and stomach is consist of spontaneous sweating, bad breath, swelling and aching of gum, sticky phlegm, dry itchy nose and pharynx, gastric noisy, abdominal distension,gastral dull burn pain, nausea, belching;the pattern of deficiency nourishment heart is consist of palpitation, being easily scared; the pattern of damp heat collecting inside is consist of hiding fever, headache and heavy,abdominal distension, nausea, hunger without desire to eat, chest tightness, diarrhea,watery faeces;the pattern of congealed blood is consist of numb limbs,gores in the menses, limb pain.3. Analyzing the items by confirmatory factor analysis of SEM. The result is CFI=0.711TLI=0.669SRMR=0.075RMSEA=0.08690%C. I=(0.081,0.090). It confirms that the hypothetic model has a mediocre fit. The factors loading of the pattern of deficiency kidney are forgetfulness(0.499), tinnitus(0.410), soreness and weakness of waist and knees (0.766), frequent micturition(0.274),urine leaching(0.226), headache and heavy (0.210);The factors loading of the pattern of deficiency qi and yin are tired(0.789), hypodynamia of limbs(0.894), feeling heating(0.246), dizziness(0.430), dryness in the mouth(0.102);The factors loading of the pattern of constrained liver qi are depression(0.552), sigh(0.656),fullness and pain in the hypochondrium or lateral lower abdomen (0.415), being irritable(0.429), hunger without desire to eat (0.256), chest tightness (0.286);The factors loading of the pattern of dry-heat clogging the lung and stomach are bad breath(0.518), swelling and aching of gum(0.462), sticky phlegm(0.464), dry itchy nose and pharynx(0.575), gastric noisy(0.361), spontaneous sweating (0.527), gastral dull burn pain(0.214);The factors loading of the pattern of damp heat collecting inside are hiding fever(0.350), headache and heavy(0.277), dryness in the mouth (0.456).hunger without desire to eat(0.325), chest tightness(0.175), diarrhea (0.331),watery faeces (0.423); The factors loading of the pattern of congealed blood are numb limbs (1.000), limb pain (0.329). The pattern of hot blood and the pattern of deficiency nourishment heart don not make SEM analysis, for the small amount of items.4. Evaluating the reliability and validity of scale.Reliability:Cronbach’s a of the pattern of deficiency kidney is0.664, the pattern of deficiency qi and yin is0.720, the pattern of constrained liver qi is0.700,the pattern of dry-heat clogging the lung and stomach is0.752, the pattern of deficiency nourishment heart is0.682, the pattern of damp heat collecting inside is0.693,the pattern of congealed blood is0.726.Validity:forecasting accuracy of each patterns as follow:the pattern of deficiency kidney is86%, the pattern of deficiency qi and yin is69.9%,the pattern of constrained liver qi is78.9%, the pattern of dry-heat clogging the lung and stomach is81.8%, the pattern of deficiency nourishment heart is91.0%,the pattern of damp heat collecting inside is74.0%, the pattern of congealed blood is66.2%. the SEM result is CFI=0.711TLI=0.669SRMR=0.075RMSEA=0.08690%C.I=(0.081,0.090), which confirm the construct validity is mediocreConelusion1. By referencing<clinical terms of Traditional Chinese Medicine syndrome> and combining the usually symptoms of diabetes, making the scale of dynamics-immobility-order-succession and eight therapies. After screening the items using CTT and IRT, making the final scale. The reliability and validity of scale are good. 2. Using the confirmatory factor analysis of SEM analyses the final items, to research and quantitate the relation of symptoms and syndromes.3. Referencing the results of CTT, IRT and SEM, getting the key symptoms of the eight syndromes proposed by dynamics-immobility-order-succession and eight therapies.(1) The key symptoms of the pattern of deficiency kidney are soreness and weakness of waist and knees, forgetfulness, tinnitus, frequent micturition, pink tongue, thin and whitish tongue coating, deep or weak pulse.(2) The key symptoms of the pattern of deficiency qi and yin are hypodynamia of limbs, tired, dizziness, spontaneous sweating, and red tongue.(3) The key symptoms of the pattern of constrained liver qi are sigh, depression, fullness and pain in the hypochondrium or lateral lower abdomen, being irritable, tense pulse.(4) the key symptoms of the pattern of dry-heat clogging the lung and stomach are spontaneous sweating, dry itchy nose and pharynx, bad breath, swelling and aching of gum, sticky phlegm, gastric noisy, think and yellow tongue coating.(5) The key symptoms of the pattern of deficiency nourishment heart are palpitation, being easily scared.(6) The key symptoms of the pattern of damp heat collecting inside are hiding fever, dryness in the mouth, diarrhea, watery faeces, pink tongue, white or yellow and greasy tongue coating, slippery pulse.(7) the key symptoms of the pattern of congealed blood is consist of numb limbs, gores in the menses,limb pain, dinginess or litter darkness or dark red or litter dark red tongue, ecchymosis on tongue.4. From the results of SEM, we can recognize that the pattern of deficiency kidney is related to other patterns, the pattern of damp heat collecting inside also. The degree of correlation in the pattern of deficiency kidney with others is higher than the pattern of damp heat collecting inside with others. The degree of correlation in the pattern of deficiency kidney with the pattern of damp heat collecting inside is the highest. The correlation in the six syndromes point that the syndromes are not independent proposed by dynamics-immobility-order-succession and eight therapies. So when using the theory, we should own the whole concept, hold the key syndrome and key pathogenesis.