| Research on clinical characteristics and evolutive trend of acute stroke with syndrome of qi deficency and blood stasis based on retrospection on medical caseObjective:By retrospectively analysis clinical features of stroke with qi deficency and blood stasis as originating state, to explore the clinical connotation of yang (qi) deficiency cause wind, and summarize clinical evidence that the previous identify qideficency and blood stasis according to the clinical features that come from the case analysis,besides, observe the evolution of qi deficency and blood stasis at different points in the acute stage of stroke by case review, to analysis the evolution trend of qi deficency and blood stasis in the acute stage of stroke.Methods.-Collect 1049 cases of hospitalized patients with stroke within 3 days,85 casese were diagnosed qi deficency and blood stasis.using a unified scale investigate n"stroke medical records information form", collect onset 1-3d,5-7d, 10-14d three point information which mainly includes basic information about the patient, predisposing factors, onset form of Chinese medical information, medical history, personal history, family history, diagnosis, prescriptions and other information. Build a database of stroke medical case, firstly, carry on a descriptive statistical study on the stroke informations; then compare qi deficency and blood stasis with non qi deficency and blood stasis in order to search for clinical characteristics of qi deficency and blood stasis; at last, retrospective study the appearing rules and evolution trend of qi deficency and blood stasis in different years and different points.Results:l.There are 85 casese of stroke with qi deficency and blood stasis, accounting for 8.10%over the same period of the total hospitalized stroke patients, ranking fourth among all TCM syndromes of stroke,;the average age was 66.76 ± 10.393 years,60-70 years and 70-80 years old are two peaks of incidence, there was no significant difference (P> 0.05) in age compared with non qi deficency and blood stasis; patients with qi deficency and blood stasis mainly occurs in the fall and winter seasons,especially in winter, there was no significant difference (P> 0.05) in season compared with non qi deficency and blood stasis; fatigue is the most common factor in patients with qi deficency and blood stasis that there is a clear predisposing factors, there was no significant difference (P> 0.05) compared with non qi deficency and blood stasis; the most common past history of patients with qi deficency and blood stasis are hypertension, stroke, coronary heart disease, accounting for respectively 56.47%,51.76%,32.94%, the percentage of qi deficency and blood stasis group that exists previous history of stroke, coronary heart disease, history of atrial fibrillation are higher than non qi deficency and blood stasis group (P<0.05).2. According to frequency of occurrence in descending order, the common clinical symptoms of patients with qi deficency and blood stasis are fatigue or burnout or asthenic breathing (57.65%), dizziness (48.24%), dry stool (32.94%), choking water cough (25.88%), palpitations (25.88%), inalienable limb pain (24.71%), chest distress (24.71%), stool unsolved in a few days (23.53%), insomnia (20.00%). headache (20.00%). cough (16.47%), gait disturbance (16.47%), anorexia (14.12%). dry mouth (11.76%), nausea or vomiting (10.59%), frequent urination (10.59%), urinary incontinence (10.59%), suffocation (10.59%); in the fatigue or burnout or asthenic breathing, dry stool, inalienable limb pain, chest distress, pale complexion, suffocation, limbs not warm, short breath, residual urine endless or poor, loose stools, foot swelling, stool sticky uncomfortable symptoms are higher than non qi deficency and blood stasis (P<0.05). From the view of tongue, the frequency of occurrence of pink tongue, dark tongue, big fat tongue, tongue with scalloped edges, white moss, thin moss in qi deficency and blood stasis group are higher than non qi deficency and blood stasis group (P<0.05); from the view of pulse, the frequency of occurrence of relaxed pulse, deep pulse, thready pulse, weak pulse, astringent pulse, knotted and regularly intermittent pulse in qi deficency and blood stasis group are higher than non qi deficency and blood stasis group (P<0.05).3. The incidence of stroke with qi deficency and blood stasis show a raising trend in four periods of 90 years ago,1990±1994,1995±1999,2000 after, the highest period of incidence is 2000 after (13.68%). The incidence age shows a gradual increasing trend, especially compared with the overall.4. The incidence frequency of stroke with qi deficency and blood stasis in the time of 1-3d,5-7d,10-14d are respectively 8.10%,14.68%,24.69%, the percentage of qi deficency and blood stasis gradually increases as the development of stroke. Among the 85 patients with qi deficency and blood stasis, there are 60 cases maintain the original type in the time of 5-7d, while there are 50 cases maintain the original type in the time of 10-14d;,those strokes with heart spirit cofused by p hie gm,phlegm-heat and blood stasis,stirring wind due to yin deficiency as originating syndromes are more likely to evolve into qi deficency and blood stasis, the evolution rate are respectively 28.57%,23.53%,16.67%.5.The basic treatment principle of qi deficency and blood stasis is supplementing qi and activating blood circulation, the basic prescription is Buyanghuanwu decoction that is composed of red peony root, angelica, astragalus, earthworm, peach kernel, safflower. At the same time,increase and reduce traditional Chinese medicine according to the clinical symptoms.Conclusions:1.Stroke with qi deficency and blood stasis as the initial syndrome has the following clinical features:pale complexion, fatigue or burnout or asthenic breathing, chest distress, suffocation, short breath, inalienable limb pain, foot swelling,limbs not warm, residual urine endless or poor, loose stools, stool sticky; performance of tongue is pink tongue, dark tongue, big fat tongue, tongue with scalloped edges, white moss, thin moss; performance of pulse is relaxed pulse, deep pulse, thready pulse, weak pulse, astringent pulse, knotted and regularly intermittent pulse, past history of stroke,coronary heart disease and atrial fibrillation is related with qi deficency and blood stasis. The clinical manifestations above can be used as clinical evidence to identify qi deficency and blood stasis.2. Within 14 days of the incidence of stroke, the proportion of qi deficency and blood stasis is becoming bigger and bigger, this phenomenon is consistent with the previous studies that qi deficency and blood stasis is more common in the recovery stage of stroke; qi deficency and blood stasis has about 60% maintain unchanged within 14 days of the incidence of stroke, half of the other 40% evolved into wind and phlegm and blood stasis obstruction syndrome.3. Stroke is caused by reversed flow of qi, yang hyperactivity cause wind, wind and phlegm and blood stasis obstruction has become a recognized stroke disease pathogenesis, yang (qi) deficiency cause wind, qi deficency and blood stasis leading to stroke should be payed more attention, the treatment principle of acute stroke with qi deficency and blood stasis is Yiqihuoxue. |
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