| ObjectiveThis thesis is to explore quantitative relationship of five viscera, according to the researches on studying CM (Chinese medicine) symptoms of acute exacerbations of Chronic Obstruct Pulmonary Disease (COPD) and Chronic Heart Failure respectively by the methods of clinical epidemiology and non-linear principal component analysis, structural equation model, etc.MethodsThe data collecting was acuired from cross-sectional survey. In accordance with the program's requirements, the clinical research team of 973 Project, Inheritance and innovation Research of the doctrine of the correlation of five viscera, used clinical epidemiological methods to collect the research cases from inpatients and outpatients in Guangdong Provincial Hospital of Chinese Medicine and then completed epidemiological questionnaire of clinical syndroms of CM. The cases included 266 cases of the acute exacerbations of COPD and 373 cases of that of Chronic Heart Failure respectively. Using softwares of Epidata and StatTrans to establish two regular databases of five visceral symptoms about two diseases, all the data were analyzed by SPSS15.0, SAS9.1 and AMOS7. 0 on the relevant statistic models. Non-linear principal component analysis was used to extract 5 principal components respectively, on the two databases with SAS9. 1, which represented aggregative indicators of respective viscera CM symptoms. Based on the 5 principal components, structure equation modeling was used with SAS9.1 to explore their quantitative relationship of five viscera. By means of SPSS15. 0, spearman correlation analysis and stepwise multiple linear regression were used to study relations between each aggregative indicator and other four viscera CM symptoms. Path graphs were made by AMOS7.0. ResultsDuring the clinical research of the acute exacerbations of COPD , there were 266 effective cases collected. Most cases(95.5%) were diagnosed Lung Distension through differentiation of syndromes in CM. Descriptive analysis shows that the quantity of effective CM symptoms set in advance in lung was 42, in liver was 11, in spleen was 28, in kidney was 22, and in heart was 16. From the results of final non-linear principal component analysis, each component could explain more than 90% information of raw data, named as Fei, Gan, Pi, Shen and Xin. Structural equation modeling analysis suggests that a positive correlation could be showed between spleen and lung, lung and kidney, spleen and kidney, heart and spleen, and heart and lung, however, a negative correlation between heart and kidney. On the other hand, lung, spleen, kidney and heart contacted closely with each other. Involving two viscera, it is closely related beween lung and kidney, next heart and lung, spleen and lung, heart and spleen and spleen and kidney. Involving three viscera, it is closely between heart and lung and kidney, next between spleen and lung and kidney, next is the heart and spleen and lung. Involving four viscera, it is closely related between heart and spleen and lung and kidney. Judging from the total effect, a positive correlation can be showed between spleen and lung, liver and kidney, liver and lung, liver and spleen, spleen and kidney. These results were in line with part of the theory of Five Elements Theory, such as earth (spleen) generates metal (lung), fire (heart) generates earth (spleen), metal (lung) generates water (kidney) and water (kidney) restricts fire (heart). Selecting data from Fei, pi and shen which were more complete relatively and carrying on correlation and regression method to analyze the relationship between their principle components and the other four viscera symptoms, the results suggested that lung was closely related with spleen, kidney and heart symptoms, the pathogenesis mainly reflected malfunctions of spleen, deficiency of kidney qi, deficiency of heart blood. Spleen was closely related with lung, kidney, heart and liver symptoms, the pathogenesis mainly reflected disturbance of water metabolism, deficiency of heart blood and stagnancy of liver qi. Kidney was closely related with other four viscera symptoms, the pathogenesis mainly reflected dysfunction of the viscera and imbalance between yin and yang.During the research of Chronic heart failure ,373 effective cases were collected. Descriptive statistics analysis showed that the quantity of effective CM symptoms set in advance in lung was 34, in liver was 23, in spleen was 42, in kidney was 25 and in heart was 15. From the results of final non-linear principal component analysis, each component could explain more than 95% information of raw data, named as Fei, Gan, Pi, Shen and Xin. Structural equation modeling analysis suggested that a positive correlation could be showed beween spleen and lung, heart and spleen, kindey and liver and liver and spleen, however, a negative correlation beween spleen and kindey. However, the indirect effect among five viscera was weak. Judging from the total effect, Liver had a positive effect on the spleen. These results were in line with part of the theory of Five Elements Theory, such as earth (spleen) generates metal (lung), fire (heart) generates earth (spleen), water (kindey) generates wood (liver), earth (spleen) restricts water (kindey). Correlation and regression analysis showed that the heart was closely related to lung, spleen and kindey symptoms, the pathogenesis mainly reflected deficiency of lung and heart, malfunctions of spleen, internal retention of water and disorder by phlegm and heat. The lung was related to spleen, liver, kindey and heart symptoms, the pathogenesis mainly reflected obstruction of heart by phlegm stagnancy, abnormal consciousness, deficiency of qi of both lung and spleen, deficiency of liver yin and blood and deficiency of kidney yang. The spleen was related to all other four viscera symptoms, the pathogenesis mainly reflected deficiency of blood of both heart and spleen, obstruction of lung by phlegm, deficiency of liver yin and blood, disorder by phlegm and heat and deficiency of yang of both spleen and kidney. The kindey was related to lung spleen and liver symptoms, the pathogenesis mainly reflected deficiency of qi of both lung and kidney, deficiency of spleen qi and deficiency of yin of both liver and kidney. The liver was related to all other four viscera symptoms, the pathogenesis mainly reflected obstruction of lung by phlegm, deficiency of blood of both heart and liver, abnormal consciousness, edema due to spleen yang deficiency and deficiency of kidney-essence.ConclusionStructural equation modeling is a powerful analytical method. Using the structural equation modeling and non-linear principal component analysis, it is of methodological significance to explore the doctrine of the correlation of five viscera. This thesis comprehensively analyzes CM symptoms of two diseases respectively, acute exacerbations of COPD and Chronic Heart Failure. The conclusion of the former suggests that the lung is revelent to spleen, kindey and heart, especially the two modes of three viscera of intercorrelation are heart and lung and kidney, spleen and lung and kidney. Those are in line with the theory of Chinese medicine. Meanwhile, positive correlation is showed between spleen and kindey, spleen and heart, lung and liver and liver and kindey, however, negative correlation is showed between heart and kindey. The results can up to part of the theories of the Five Elements Theory, such as earth generates metal, fire generates earth, water generates wood and water restricts fire. The conclusion of the latter suggests that the heart is revelent to spleen, meanwhile, positive correlation is showed between spleen and lung, kindey and liver, liver and spleen, negative correlation is showed between spleen and kindey. The results can can up to part of the theories of the Five Elements Theory, such as fire generates earth, earth generates metal, water generates wood and wood restricts water. Different diseases, different stages of diseases, the syndrome reflects the characteristics of multi-organ-related. The more serious condition, the more organs involve, the more complex combination syndrom.Come to a general conclusion, any two viscera are mutual effected and promoted each other. The dysfunction of one viscera can affect the other fours. From clinical researches of one or more major diseases, it is very important and practical and significant to systematically explore the connotation of of the correlation of five viscera in order to guide clinical diagnosis and treatment of modern complicated illnesses. |
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