Ischemic Stroke Toast Etiology Of Parting With Tcm Dialectical Type Of Correlation Studies

Stroke, one of the health-threatening principle diseases, is the main reason of death and mutilation around the world, in which Cerebral Infarction (CI) is the most frequently. Stroke has shot up to the first death, and be the first killer in the latest publication in the cause of death in line. And the state and the patients who are in the economic burden of stroke are already eroding. As everyone known, stroke is a disease with high incidence rate, high case fatality rate, high rate of deformity and high recurrence rate. It is an important task to know how and what to do in de acute stage cure and secondary prevention. More and more research suggests that CI is syndrome with multiple causes, but not a single disease. On this premise, American scholar Adams and his partners advanced classical TOAST classification, which is the base of aetiological classification of CI. And clinical of the relevant research related to the most. But, the most clinical research based on classical TOAST classification show that the unknown cause type make up the largest proportion. And it flings down a real challenge to a more pertinent clinical treatment. Also, there is a poor consistency between the different researchers. Korean scholar made a NEW-TOAST aetiological classification in 2007. It makes up for a lots deficiencies of the old TOAST classification. The consistency between different researchers increased, and the proportion of unknown cause type decreased. The NEW-TOAST classification with its strong operability has been deemed to a better classification of ischemic stroke in clinical treatment. But, there is no study report about the reliability, the validity and other clinical researches based on NEW-TOAST classification. There is still large room to research. Our study, by statistic the ischemic stroke patients in NEW-TOAST classification and the syndrome differentiation and tying of traditional-Chinese medicine (TCM) to observe three contents. First, to investigate whether a correlation between NEW-TOAST classification and the syndrome differentiation and tying of TCM. Analysis the different types of syndrome in TCM from the pathogeny deck, to provide evidence for the standardization of differentiation of symptoms and signs for classification of syndrome of CI in traditional-Chinese medicine. Accordingly, the clinical determination of treatment and secondary prevention based on differentiation of symptoms and signs can be better guaranteed. Second, to investigate the proportion of different NEW-TOAST classification, and find out the point of the new classification. Then, to provide a basis for the clinical diagnoses and treatment. Third, by correlation studies, to investigate the connection between the NEW-TOAST classification or types of syndrome in TCM and area of infarction, accordingly to widen our mind on clinical diagnoses and treatment.Method:According to《standards for stroke differentiation in internal medicine emergency case in Beijing Regional Common Diseases Diagnosing》(2007, by China Academy of Chinese Medicine Sciences) and《Treating Practice and standards》revised by C. M. A (Chinese medical association) in its fourth national CVD(Cardiovascular Disease) academic conference, we divided 167 cases of patients with CI into:with NEW-TOAST classification:Atherothrombosis (AT), Cardioembolism (CE), Small Artery Disease (SAD), Stroke of Other Determined Etiology (SOD) and Stroke of Undetermined Etiology (SUD); with types of syndrome in TCM:liver and yang hyperactivity,up stirring of Wind-Fire, Qi-Deficiency and Blood-Stasis,Choroids Paralysis and Block, Phlegm-Heat and Fu-organ Constipation,Up Stirring of Wind Phlegm, Deficiency of Vital Energy and Blood Stasis, and stirring of wind due to deficiency of YIN. We use carotid ultrasonographic, head CTA,MRA,DSA to identify the degree of vascular lesion, use head CT,MRT to identify cerebral infarction lesion and the area of infarction, use heart ultrasonographic and Holter to identify the heart disease, use infraclavicula and legs ultrasonographic to identify peripheral vascular lesion. All data is inputted into computer, managed andprocessed by SPSS. X2-test (numeration data), Two-sided test(Size of test a=0.05) is applied.Result:1.167 cases of patients with CI, the comparison of NEW-TOAST classification from big to small:Atherothrombosis (AT)> Small Artery Disease (SAD)> Stroke of Undetermined Etiology (SUD)>Cardioembolism(CE)>Stroke of Other Determined Etiology (SOD).2.167 cases of patients with CI, the comparison of Chinese medicine certificate type from big to small:Wind-Phlegm and Blood-Stasis,Choroids Paralysis and Block> Phlegm-Heat and Fu-organ Constipation,Up Stirring of Wind Phlegm> Deficiency of Vital Energy and Blood Stasis> stirring of wind due to deficiency of YIN> liver and yang hyperactivity,up stirring of Wind-Fire.3.167 cases of patients with CI, the comparison among NEW-TOAST classification and Chinese medicine certificate type has not statistics sense distinctly (P>0.05).4. The comparison between NEW-TOAST classification of ischemic stroke and area of infarction has statistics sense distinctly, P<0.05(0.017).5. The comparison between different patterns of CI syndrome in traditional Chinese medicine and area of infarction has statistics sense distinctly, P<0.05(0.031). Conclusion:1. Among the NEW-TOAST classification of ischemic stroke, Atherothrombosis (AT) has the largest proportion.2. Among the different patterns of ischemic stroke syndrome in traditional Chinese medicine, Wind-Phlegm and Blood-Stasis,Choroids Paralysis and Block has the largest proportion.3. The NEW-TOAST classification and Chinese medicine certificate type has not statistics difference. May be because the number of sample is limited, the Chinese medicine certificate type use multiple type and the examine is not enough effect. But we can see, the Chinese medicine certificate type of Atherothrombosis (AT) is mainly based on Wind-Phlegm and Blood-Stasis,Choroids Paralysis and Block, and the Chinese medicine certificate type of Cardioembolism(CE) is mainly based on Deficiency of Vital Energy and Blood Stasis.4. The comparison between different area of infarction in ischemic stroke, the NEW-TOAST classification has statistics sense distinctly, the anterior circulation infarct is mainly based on Atherothrombosis (AT). And the posterior circulation infarct is mainly based on Small Artery Disease (SAD).5. The comparison between different area of infarction in ischemic stroke, the Chinese medicine certificate type has statistics sense distinctly, the anterior circulation infarct is mainly based on Wind-Phlegm and Blood-Stasis,Choroids Paralysis and Block. And the posterior circulation infarct is mainly based on Phlegm-Heat and Fu-organ Constipation,Up Stirring of Wind Phlegm.