Epidemiological Investigation Of TCM Syndromes On EISH In Hong Kong Region And Pathogenesis Discussion

BackgroundIsolated Systolic Hypertension in the Elderly(EISH) is one of the frequent cardiovascular diseases,found mostly in people over 60 years old,with high morbidity and mortality rate.It was reported by the out-patients departments that even thought 80%of the patients knew they had the disease but only 28%of the known cases were under control.Also many problems exist in the treatment.Bian Zheng Lun Zhi(determination of treatment based on pathogenesis obtained through differentiation of synptoms and signs,BZLZ) is the peculiarity and quintessence of Traditional Chinese Medicine(TCM).Zheng Hou(Syndrome) is the premise and foundation of BZLZ.Also it is the bridge and juncture correlating TCM theory with clinical diagnosis and treatment.Syndrome research is key piont and focal point of TCM modernization.Pahtogenesis elucidates the happenese, development and change of disease.It is the essence of Syndrome.So syndrome-pathogenesis is the breakthrough of TCM theory research,also the foundation of clinic.Pathogenesis investigation is premise of TCM from theory deduction changing to clinical evidence which based on syndrome research.Although many studies had been done on pathogenesis of EISH,and it got some progress,but there was still no breakthrough.Clinical Epidemiology and Evidence-based Medicine are the most receiced scientific methodology in nowadays medical world to do clinical research.The principle and methods of Epidemiology provide clinical evidence for syndromeathogenesis. So based on literature research,expert consultant and case review, following clinical epidemiological principle,combining Disease with Syndrome,we can undertake large sample clinical study and analyze and evaluat the clinical data to observe different clinical manifestation of syndrome of EISH.ObjectivesTo understand the syndrome distribution of EISH in Hong Kong region as there was still no report on the epidemiological investigation of TCM syndromes on EISH for Hong Kong region.To gain more insight in the inter-relationship among the syndrome,pathogenesis and the mechanism of disease of EISH so that we can apply the results clinically.Method1.Investigative objects were EISH patients who were residents in Hong Kong region and above 60years old.2.Diagnosis criteria:Diagnostic criteria of EISH and the ranking criteria were based on Prevention and Treatment Guide of Hypertension of China 2005.TCM syndromes were conferred on Clinical Research Guide Principle of Chinese New Materia Medica in Treating Hypertension 2002 and literature analysis.Five main syndromes which were Gan Yang Shang Kang(hyperactivity of liver-YANG,GYSK), Gan Shen Yin Xu(hepatic and renal yin deficiency,GSYX),Yin Xu Yang Kang (asthenic yin causing predominant yang,YXYK),Tan Shi Yong Sheng(phlegmatic hygrosis obstruct and excessive,TSYS) and Yin Yang Liang Xu(deficiency of both yin and yang,YYLX) were identified.Body mass index(BMI) was used to measure the obesity.Obesity diagnostic criteria refers to Over Weight and Obesity Diagnostic Criteria of Asian Adult.3.Sampling method:Using group sampling to collect EISH patients from Hong Kong area.4.Quality control:Included investigator training,investigate process and analytic process review.5.Epidemiological investigation:Face-to-face interview was used to carry out the investigation.The questionnaire includes basic information,hypertension history, family medical history,lifestyle,medical treatment,TCM symptoms,et al.6.Medical examination:Blood pressure was measured by the method recommended by Prevention and Treatment on Hypertension Guide.Body height, body weight and abdomen circumference were measured using the international unified methods.7.Statistical method:Used Epidata 2.1 software to set up database.Two persons used two computers to input the data,then converted to the SPSS database after checking.SPSS 13.0 software was used to do the statistical analysis.Applied Descriptive Statistics is used to analyze basic information.Chi-square test was used to do the comparison of constituent ratio and single factor analysis.Binary Logistic Regression is used to do the Multi-Factors analysis. Result1.General epidemiologic feature302 EISH patients were investigated.165 cases were male,137 cases were female.The age range was 60-98 years old.There were 108(35.8%) of 60-69 years old;138(45.7%) of 70-79 years old and 56(18.5%) were older than 80 years.The onset of the disease main in the age range of 70-79.There were no difference between male and female(x~2=0.36,P=0.982).The number of obesity patients was 72,about 23.8%.Disease course from 1 to 35 years.11(3.6%) of them with course shorter than 1 year,88(29.1%) of them with course range from 1-5 years,69(22.8%) of them with course range from 6-9 years,82(27.2%) with course range from 10-14 years,24(7.9%) with course range from 15-19 years,and 28(9.3%) with course longer than 20 years. Among the patients,the percentages of 1,2,3 degree blood pressure were 68.2%, 24.2%and 76%respectively.The most frequent complications were diabetes(17.2%), cerebral infarction(11.6%),coronary heart disease(9.3%).In the family medical diseases inquiry,19.2%of the samples with the family members who had hypertension.In the lifestyle inquiry,17.2%patients often had high salt diet,7.3% patients often drunk wine excessively,21.7%patients had been or have being smoking.The patients who often drink chinese double-stewed soup were 21.9%,who often drunk herb tea were 7.3%.In the treatment aspect,the treatment rates of 1,2,3 degree blood pressure were 71.8%,84.9%and 91.3%respectively.And the difference between different degree blood pressure was significant(x~2=8.172,P=0.017).2.Epidemiologic feature of TCM syndrome in Hong Kong regionIn this investigation,according to the frequency,the sequence of main syndromes were YXYK(30.1%),YYLX(16.9%),GSYX(16.2%),GYSK(12.3%), TSYS(12.3%).Other syndromes its ratio was less than ten percent were Qi Xu(2%), Xue Yu(1.7%),Tan Re Nei Yun(1.7%),Qi Yin Liang Xu(1.3%) and Yang Xu(1%).3.Syndrome distribution among the influential factorsAnalyzing the relationship between age,disease course with syndrome,we found that different age layer and disease course manifested different main syndromes. In the age group of 60-80 years old,major syndromes were GSYX and YYLX,and no difference between the male and the female groups(x~2=5.212,P=0.391).There were difference between different degree of blood pressure:Grade-1 mainly with YXYK(30.1%);grade-2 mainly with GYSK(20.5%) and grade-3 with YXYK(34.8%).As the blood pressure grade rises,YXYK syndrome was increased as well.There was no significant difference between disease course and syndrome,but it appeared that GSYX and YYLX had the greatest proportion for those with courses longer than 20 years.There was no co-relation between the onset of different complications(coronary heart disease or metabolic disease) and the syndromes(x~2= 9.08,P=0.106;X~2=8.184,P=0.146).For those who had high-salt diet,they had less GSYX syndrome.For those excessive wine drinkers,the difference between different syndrome was also significant(x~2=22.01,P=0.015).Frequent wine drinkers with more YXYK(45.5%).Those who took double-stewed soup frequently were less with GSYS and GYSK.Physical exercise was insignificant in the syndrome(x~2= 15.893,P=0.103),same as whether taking high blood pressure medicine(x~2= 10.082,P=0.073).4.The Logistic Regression analysis on the relationship among the syndromesFrom a multi-factor analysis perspective,GSYX co-relates with age(70-79 years old),obesity,coronary heart disease and Chinese herbal tea.YXYK co-relates with body-shape,excessive wine drinking and consuming medicine.TSYS co-relates with excessive wine drinking,double-stewed soup and coronary heart disease.GYSK co-relates with double-stewed soup.YYLX co-relates with grade-2 hypertension, metabolic disease,high-salt diet and Chinese herbal tea.Conclusion1.The major syndrome for EISH in Hong Kong region are YXYK(30.1%), YYLX(16.9%),GSYX(16.2%),GYSK(12.3%),TSYS(12.3%).2.3%with SY. Comparing with those under 60 years old ISH cases,the difference is significant: more EISH with GSYS and YYLX,less GYSK than ISH.For those under 60 years old ISH,their major syndromes are:GYSK and YXYK(total 61.5%). 2.By analyzing the age group,those from 60-80 years old are less with TSYS, but more with GSYX and YYLX.Different blood pressure degree also demonstrated different syndromes:Degree-1 mainly with YSYK,Degree-2 mainly with GYSK, and Degree-3 mainly with YXYK.From the disease course perspective,those with＞20 years are mainly with GSYX and YYLX and least with TSYS/GYSK.There is a significant decrease in YXYK and significant increase in YYLX with disease course longer than 14 years.From the life style perspective,those with high-salt diet have less on the GSYX than those without high-salt diet.Frequent wine drinkers are more on YXYK.Those who never took double-stewed soup are mainly have GYSK.3.From multi-factors analysis,the major factors that contributes to GSYX are: age(70-79 years old),obesity,coronary heart disease and Chinese herbal tea.From the regression analysis:those at 70-79 years old,or obese tend to be more GSYX. YXYK co-relates with body-shape,excessive wine drinking and consuming medicine. TSYS co-relates with excessive wine drinking,double-stewed soup and coronary heart disease.GYSK co-relates with double-stewed soup.YYLX co-relates with grade-2 hypertension,metabolic disease,high-salt diet and Chinese herbal tea. However,those who just occasionally take high-salt diet or double-stewed soup tend to be moreYYLX,which do not match with our daily clinical observation.Generally speaking,the derived formula for YXYK,YYLX and GSYX are more meaningful and match with the clinical observation,but still incomplete.YXYK and YYLX have a better match with clinical observation,but the matching is less for TSYS.4.The mechanism of the EISH relates with the Liver,but the root cause is in the Kidney.