Study On The Law Of TCM Syndrome Differentiation Of Visceral Manifestation In Esophageal Cancer

Objective:Esophageal cancer is one of the most common malignant tumors of digestive system in China,but there is still a lack of standardized and unified system of syndrome differentiation in clinical practice.Syndrome differentiation and treatment is an important characteristic and essence of TCM.Accurate syndrome differentiation guides the thinking of dispatching prescription and is the key and premise of TCM clinical efficacy.This paper intends to apply the Visceral Manifestation syndrome differentiation system created by Professor Wu to the diagnosis and treatment of esophageal cancer,and explore its rule of differentiation and treatment.Methods:The first part is to summarize the following contents by literature research:(1)Chinese medicine literature:Chinese medicine name of esophageal cancer,etiology and pathogenesis,classification and treatment,clinical and basic research,disease and physical correlation research;(2)Western medicine literature:advances in diagnosis and pathological typing,epidemiological research and risk factors,genetic research,mechanism and treatment frontier.The second part is retrospective study:clinical data of 1023 patients with esophageal cancer were collected and divided into 5 groups according to treatment stages(group 1:newly diagnosed group;Group 2:surgery group;Group 3:chemotherapy group;Group 4:radiotherapy group;Group 5:symptomatic treatment group);Patients were further stratified according to TNM stage,and each group was divided into 4 groups(group A:Stage Ⅰ group;Group B:Stage Ⅱ group;Group C:Phase Ⅲ group;Group D:Stage Ⅳ);The patients in group 1 were tentatively divided into 3 subgroups according to pathological type(group a:squamous cell carcinoma group;Group β:adenocarcinoma group;Group y:other cancer group).The symptoms and signs of the cases were identified by location and characteristic,and then frequency distribution statistics,correlation analysis,cluster analysis and principal component analysis were performed.The distribution and combination rule of symptoms,location,pathologic features and site-combined pathologic features of esophageal cancer were analyzed after intervention of different disease stages,pathological types and treatment methods.The "Diagnosis information table of esophageal cancer symptoms" was preliminarily constructed,and the basic syndromes and pathologic features of esophageal cancer were summarized.The third part is the application exploration of clinical differentiation and treatment:based on the above research basis,the theory of syndrome differentiation and syndrome differentiation of esophageal cancer was applied to clinical differentiation and syndrome differentiation of esophageal cancer,and the characteristic connotation of "combination of disease and syndrome","detection of symptoms and syndrome differentiation","principle and flexibility" were explored to further guide clinical prescription use.The fourth part is discussion:combined with the research results,the name of esophageal cancer,the location of Tibetan symptoms and the characteristics of Tibetan symptoms are discussed and analyzed,so as to further standardize the TCM syndrome differentiation of esophageal cancer and provide a more adequate basis for clinical treatment.Results:(1)Group 1 had 166 symptoms,group 2 had 163 symptoms,group 3 had 122 symptoms,group 4 had 137 symptoms,and group 5 had 179 symptoms.Group 1 included spleen,liver,stomach,esophagus and kidney,and 14 diseases including phlegm,blood stasis,Qi stagnation,Qi deficiency and Yin deficiency.Group 2 included 9 lesions including spleen,liver,stomach,esophagus and lung,and 16 lesions including phlegm,blood stasis,Yin deficiency,Qi deficiency and blood deficiency.Group 3 included spleen,stomach,liver,esophagus and kidney,and 12 diseases including phlegm,Qi stagnation,Qi deficiency,blood stasis and Yin deficiency.Group 4 included stomach,spleen,liver,lung and kidney,and 15 diseases including phlegm,blood stasis,Yin deficiency,Qi deficiency and Qi stagnation.Group 5 included 9 disease sites including liver,spleen,kidney,esophagus and heart,and 13 diseases including phlegm,Qi stagnation,blood deficiency,stasis and Qi deficiency.(2)Cluster of symptoms:group 1 was clustered into 15 categories,group 2 into 17 categories,group 3 into 15 categories,group 4 into 18 categories,group 5 into 16 categories;Cluster of disease sites:group 1 clustered into 5 categories,group 2 clustered into 3 categories,group 3 clustered into 3 categories,group 4 clustered into 3 categories,group 5 clustered into 3 categories;Pathological clustering:group 1 was grouped into 4 categories,group 2 into 4 categories,group 3 into 4 categories,group 4 into 3 categories,and group 5 into 3 categories.Cluster of disease sites combined with disease:group 1 was clustered into 5 categories,group 2 into 4 categories,group 3 into 5 categories,group 4 into 5 categories,and group 5 into 8 categories.(3)Principal component analysis:The cumulative variance contribution rate of group 1 was 73.916%,and the load coefficient was above 0.3,and there were 13 principal components in total.In group 2,the contribution rate of cumulative variance was 74.894%,and the load coefficient was above 0.3.In group 3,the contribution rate of cumulative variance was 83.257%,and the load coefficient was above 0.3.There were 16 main components in total.In group 4,the contribution rate of cumulative variance was 77.433%,and the load coefficient was above 0.3.There were 20 main components in total.The cumulative variance contribution rate of group 5 was 79.555%,and the load coefficient was above 0.3,and there were 17 main components in total.(4)Based on the symptom distribution of 1023 patients with esophageal cancer and the clinical syndrome differentiation experience of the tutor,183 esophageal cancer symptoms and tongue and pulse manifestations were screened out to standardize the disease location and pathologies,and the "standard diagnosis information table of esophageal cancer syndromes" with "pathologies and pathologies" as the core was constructed.(5)"Insufficiency of the spleen with stagnation of phlegm and blood stasis" is the basic certificate for esophageal cancer,and consult relevant syndrome differentiation standard,combined with the tutor’s clinical experience in the diagnosis of esophageal cancer,esophageal cancer is worked out the spleen,liver,kidney,heart,lung disease characteristics of syndrome and phlegm,blood stasis,and Qi stagnation,Qi deficiency,blood deficiency,Yin deficiency and Yang deficiency,heat(fire),jing kui,wet,dyspepsia,water stop disease characteristics.Conclusion:(1)The literature research results indicate that esophageal cancer mainly belongs to the category of "choking diaphragm",which always belongs to positive deficiency and evil solid.The incidence is closely related to the spleen,liver and kidney.Phlegm,blood stasis and Qi stagnation are important pathological factors in the occurrence and development of this disease,and emotional factors have an important influence on its incidence and outcome.(2)Retrospective study showed that the basic disease of esophageal cancer was located in the spleen,the basic disease was phlegm,blood stasis and Qi stagnation,and the basic syndrome was " Insufficiency of the spleen with stagnation of phlegm and blood stasis ";Phase and disease for liver,kidney,phase and disease for Qi deficiency,Yin deficiency,Yang deficiency and so on.The results of location clustering and pathogenicity clustering reflect the intrinsic correlation between location and pathogenicity,and reveal the pathogenesis of esophageal cancer to some extent.The result of location and pathologic clustering reflects the internal relation and combination rule between location and pathologic of esophageal cancer.(3)The theoretical system of syndrome differentiation of Tibetan signs and symptoms emphasizes the location and nature of disease,following the syndrome differentiation principle of " syndrome differentiation,detection of symptoms,combination of principle and flexibility,combination of disease and syndrome".The syndrome differentiation of esophageal cancer under the guidance of the theory of syndrome differentiation of Tibetan signs and symptoms takes the combination of disease and syndrome as the basis of diagnosis,and the combination of disease and syndrome as the key point.