Study On The Characteristics And Combination Of TCM Syndromes In Acute Decompensated Phase Of Chronic Heart Failure

Objective:To explore the characteristics and combination rules of traditional Chinese medicine(TCM)syndromes in the acute decompensated period of chronic heart failure,and to elucidate the pathogenesis of this disease by TCM,so as to provide theoretical basis for clinical syndrome differentiation and treatment of heart failure.Methods:This study randomly observed a total of 120 inpatients and outpatients according to the diagnostic criteria and inclusion criteria from December 2018 to December 2019 in Changzhou wujin hospital of TCM.The established acquisition scale of TCM syndromes in the acute decompensated period of chronic heart failure was used by two senior doctor of traditional Chinese medicine experts to collect four diagnostic information in the acute decompensated period and to identify the objective syndrome through direct observation.The types and information database of TCM syndromes of patients with acute decompensated chronic heart failure were constructed and the key elements of each syndrome were extracted.The main statistical methods included descriptive analysis,frequency analysis,validity test analysis,factor analysis,principal component analysis and normalization analysis.Results:1.There were 120 patients with heart failure(60 males and 60 females)and the maximum and minimum age was 92 years old and 42 years old each,with an average age of 70.66 years old.The mean age was 68.92 years for males and 72.40 years for females.Patients aged 70-79 years account for the largest proportion,accounting for 38.30%of the total cases which was followed by patients aged>80 years old,accounting for 21.70%of the total cases.2.Among all the clinical types of heart failure,patients with systolic heart failure account for the most,accounting for 91%and the diastolic heart failure and indeterminate disease were less common,accounting for 5%and 3.3%,respectively.3.Among all the patients with heart failure,coronary heart disease and hypertensive heart disease were the majority,accounting for 50%and 23.3%,respectively.The distribution of other disease groups was average,and the proportion of congenital heart disease was the least,accounting for only 2.5%.4.Arrhythmia was the most common complication in heart failure patients(37.5%),followed by respiratory tract infection(16.7%).Patients with electrolyte disturbance account for 5.0%.The proportion of venous thrombosis and pulmonary embolism in lower extremities is extremely small,less than 3.0%in total.5.The main symptoms of heart failure with a frequency of more than 40%are fatigue,asthma,decreased intake,chest tightness,dark tongue,weak breath,white tongue coating,insomnia,light tongue coating,greasy tongue coating,edema,cough sputum,palpitations,fine pulse,dark lip color,dry mouth.6.Combination rules of heart failure syndromes:single syndromes(10.0%),dual syndromes(15.0%),triple syndromes(45.8%),four syndromes(26.7%),five syndromes(1.7%),and six syndromes(0.8%).Single syndrome:Qi deficiency(33.3%),Yin deficiency(25.0%),Yang deficiency(16.7%),blood stasis,phlegm turbidity and excessive fluid all accounted for 8.3%.Two syndromes:Qi deficiency+Yin deficiency(27.8%),Qi deficiency+blood stasis(22.2%),Qi deficiency+phlegm turbidity(16.7%),Qi deficiency+Yang deficiency(11.1%).Qi deficiency+excessive fluid,Yang deficiency+blood stasis,Yang deficiency+phlegm turbidity,Yang deficiency+excessive fluid accounted for 5.6%,the other two syndromes were much less.Three syndromes:Qi deficiency+blood stasis+excessive fluid(34.5%),Qi deficiency+Yin deficiency+blood stasis(20.0%),Qi deficiency+Yin deficiency+excessive fluid(3.6%),Yang deficiency+blood stasis+water decoction(3.6%).Four syndromes:qi deficiency+Yang deficiency+blood stasis+excessive fluid(21.9%),Qi deficiency+Yin deficiency+blood stasis+excessive fluid(18.8%),Qi deficiency+Yang deficiency+blood stasis+phlegm turbidity(15.6%),Yang deficiency+Yin deficiency+blood stasis+phlegm turbidity(12.5%),Qi deficiency+Yin deficiency+blood stasis+phlegm turbidity(9.4%),Qi deficiency+blood stasis+excessive fluid+phlegm turbidity(6.3%).The combination of five elements and six elements is much less.7.In cardiac ?-? level,the weight distribution of asthma,languid and food reducing is almost unanimous.The three diseases are(Yang)Qi deficiency,Qi deficiency and Yang Qi deficiency.The weight of dizziness and insomnia which belong to Yin deficiency in heart function grade ? is much larger.In cardiac function grade ?,cough with phlegm,occupied the main weight,lip color dark and greasy tongue coating belongs to Yang deficiency or blood stasis.In cardiac function grade ? the weight of edema and less urinate is much bigger,which belongs to Yang deficiency and excessive fluid.Conclusions:1.The disease elements locations of heart failure are mainly in heart,lung,spleen,liver and kidney.The deficiency syndrome elements are mainly Qi deficiency,Yang deficiency and Yin deficiency,while the positive syndrome elements are mainly blood stasis,phlegm turbidity and excessive fluid.2.The study on the syndrome elements combination rules of 120 patients with heart failure shows that:(1)there are six compound modes that are the combination of single syndrome element,two syndrome elements,three syndrome elements,four syndrome elements,five syndrome elements and six syndrome elements,among which the combination of three syndrome elements is the most common,followed by the combination of four syndrome elements and two syndrome elements.(2)Qi deficiency is the most common single syndrome element;Qi deficiency+blood stasis is most common in the combination of two syndrome elements followed by Qi deficiency+phlegm turbidity.Qi deficiency+Yin deficiency+blood stasis+excessive fluid is the most common of the three syndromes combination,followed by Qi deficiency+Yin deficiency+blood stasis,Qi deficiency+Yin deficiency+excessive fluid and Yang deficiency+blood stasis+excessive fluid;The combination of Qi deficiency+Yang deficiency+blood stasis+excessive fluid was the most common of the four syndromes combination,followed by Qi deficiency+Yin deficiency+blood stasis+excessive fluid.The combination of five elements and six elements is relatively rare.3.Qi deficiency generally first appeared during the syndrome evolution of heart failure,followed by Qi and Yin deficiency syndromes which may be accompanied by blood stasis as the illness aggravating.If it comes to the acute decompensated period and the cardiac function level is ?-?,the TCM syndromes will develop into heart kidney Yang deficiency,Yin and Yang both deficiency,Xin Yang Qi deficiency,excessive fluid deficiency,phlegm retention resistance lung syndrome,etc.4.Multivariate statistical method is one of the important methods to study the syndrome of heart failure.