| ObjectiveBy investigating the relationships between syndrome evaluation and individual symptom improvement of heat constipation patients, using three different evaluation methods, to find out the foundation of quantitative method for evaluating the degree of the symptoms. Further verified the important degree of heat constipation’s symptoms to TCM syndrome, make use of a clinical big sample review study.To obtain a quantitative method for evaluating the degree of the symptoms belongs to the familiar desease’s TCM syndromes, we had recognized the symptom constitutes of the heat constipation syndrome, understood the important degree of symptoms to the syndrome, and classified the major symptom and minor importance symptom by Delphi method and the patients inspects.MethodPart one, the importance of symptoms were further verified, by means of the large sample of clinical data. While we scored the symptoms with different methods, and studied the curative effect whether change, in order to make clear the principle of the symptom classify quantization score. Part two, we checked and read clinical search medical literatures concerning TCM syndrome type, symptom constitutes and symptoms of function constipation from CNKI and CQCIP(from 1989 to 2009), obtained all symptoms of heat constipation, and regard them as picking of the experts and patients investigation. According to Delphi’s investigation questionnaire design and organization principle, we carried on the expert investigation aimed at the symptom’s primary, specificity, importance to syndrome, clinical incidence, and seriousness description. When the experts researched a meeting of mind, the investigation was stopped. Then, we made an analysis based on the data, while 100 heat constipation patients were investigated about the feeling of themselves on the symptoms’effect. We also analyzed the result of the investigation. Consulted two results of analysis , we established the symptoms composition of heat constipation, identified seriousness description, abstracted the major symptoms and minor symptoms.Result1.The result of part one1.1Frequency of symptoms and other statistics of clinical trial data showed that 8 symptoms’importance to syndrome , such as dry stool and etc, was similar to the result of the experts and patients investigate.1.2 Under the different rating methods, we compared the test group with the control group on the curative effect of TCM syndrome. Under method two, the test group has difference with the control group on total effectiveness, P<0.05.Under the original method , the test group is different with the control group on effectiveness and Remarkable curative and heal effectiveness, P<0.05.1.3 Under the different rating methods, we analyzed the correlation of the decrement between the total score and the score of the important symptoms. The correlation between the decrement of the important symptoms and the symdrome effect in original method is the most big. The correlation coefficient of the test group and the control group is 0.962 and 0.956.1.4 Abdominal distention ,s effect scored by method three were different to others between test group and control group, P<0.0001.2. The result of part two2.1 In literatures study , 38 symptoms were concluded. The symptoms which were similar were Compressed and combined. The symptoms whose incidence below 30% were not chosen. At last, 14 symptoms were chosen to be Optional items of investigate, they were dry stool, defecation frequency decrease, defecation difficulty, defecation prolonged, abdominal distention,abdominal pain,dry mouth,halitosis,red complexion, fever, dysphoria, Short red urine ,insomnia, anorexia, red tongue, yellow or yellow dry fur and rapid slippery pulse.2.2 Delphi method expert investigate had been organized two times. The views of the experts were consistent in two investigate. The Positive degree of the experts were 95.03% and 100% in two investigate. After the first investigate, anorexia, red complexion, fever, dysphoria and insomnia were deleted.2.3 In the investigate of the heat constipation aimed at the symptom’s primary and specificity, dry stool, defecation frequency decrease, defecation difficulty, defecation prolonged, yellow or yellow dry fur were primary symptoms; dry stool, defecation frequency decrease, defecation difficulty, defecation prolonged were specificity to disease, while dry stool, defecation difficulty, defecation prolonged, dry mouth,halitosis, red tongue and yellow or yellow dry fur were specificity to TCM syndrome.2.4 In the investigation aimed at the symptom’s importance to syndrome, all symptoms were important and they all play roles to diagnose of heat constipation syndrome. The symptoms ordered by importance from the most important to the least important, were dry stool, defecation frequency decrease, defecation difficulty, defecation prolonged, yellow or yellow dry fur, abdominal distention, red tongue, dry mouth,rapid slippery pulse, halitosis, Short red urine , abdominal pain, dysphoria.2.5 Some symptoms’severity of heat constipation were described into 3 degree.2.6 The result of the investigate of the patients about the feeling of themselves on the symptoms’effect was similar to the one of the expert investigate. They also thought the symptoms, such as dry stool, defecation frequency decrease, defecation difficulty, defecation prolonged, abdominal distention , were important to themselves . They thought the face acne and anal fissure were important, too. Other symptoms were not important. Short red urine, insomnia, fever, red complexion were the least important symptoms, especially.2.7 Comprehensive analyzed the results of experts and patients’investigates , we recognized the symptom constitutes of the heat constipation syndrome, made clear that the major and minor symptoms. 1.Trough the study of the Frequency of symptoms and other statistics in clinical big sample data, the result is similar to the result of the experts and patients investigates.2.When the severity degree is not changed, the individual symptom evaluation will not be affected, for its evaluate Standard.3.The symptom is scored by 2 degree, the individual symptom evaluation will reduce, for some evaluation is obliterated. So, the symptom which has high incidence and high severity degree, should be score by more degree as possible, in order to reflect all effects.4. Advice from the experts, by means of Clinical experience, theoretical knowledge and research results , to the symptom constitutes of the heat constipation syndrome is very accurate and reliable. Delphi method is a feasible method to obtain the advice from experts, it is a effective way to make the TCM syndrome reach to Standardization.5. Take into account the patient’s own feelings on the influence degree of symptoms is characteristic of this study, which can make up experts’advice lacked of emotional, and make the result of the study reflect the patient-centered thinking.6. In accordance with the importance to syndrome quantify the symptoms, and score the important symptoms by more degree, the effects is a stable, which is a convenient and reliable graded and quantitative method. Conclusion... |
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