Correlation Between The Grades Of Chronic Venous Insuffficiency And TCM Syndrome Types

Objective: Through literature retrieval and collation,the common TCM syndrome types of lower limb chronic venous insufficiency(CVI)were summarized,and the relationship between classification and TCM syndrome types was discussed in combination with the syndrome types of clinical cases and the distribution characteristics of CEAP classification,providing certain scientific basis and reference in the clinical treatment of CVI based on syndrome differentiation.Methods:(1)Through the development of scientific and rigorous retrieval methods,the modern literature published at home and abroad in the past 30 years based on the treatment of CVI by traditional Chinese medicine or integrated traditional Chinese and western medicine was retrieved.According to the inclusion and exclusion criteria of the literature,the literature database was established after three screening.The statistical methods of frequency analysis,factor analysis,principal component analysis and cluster analysis were used to analyze the syndrome types of traditional Chinese medicine and related traditional Chinese medicine included in the literature,The TCM syndrome differentiation and distribution of CVI and the common TCM syndrome types of CVI in the literature are summarized.(2)Screening 160 cases of CVI hospitalized in the Department of Wound Repair and Peripheral Vasculature of the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from September 2020 toNovember 2022,classifying and grading them according to the criteria of TCM syndrome differentiation and CEAP classification,and using SPSS27.0statistical software for statistical analysis to explore the correlation between CVI classification and TCM syndrome types.Results:(1)114 articles were included,including 6852 cases of CVI,and the information in the cases was collected.The results showed that 49 symptoms,73 oral Chinese medicines and 15 effective syndrome types were collected.The quality of the included documents was evaluated.The improved Jadad scale was used to evaluate the documentary evidence,with an average score of 1.4824.The documentary evidence was graded according to the traditional medical evidence grading standard of Professor Liu Jianping of the evidence-based medicine center of Beijing University of Traditional Chinese Medicine,and the results showed that there were 0 grade I documents(0%),83 grade II documents(72.81%),1 grade III documents(0.88%),and 30 grade IV documents(26.32%).(2)The 49 symptoms sorted out in the CVI literature were analyzed by principal component analysis.The first five principal components were extracted according to the results of the statistical information table,and the centroid clustering method was used to cluster.These symptoms were mainly divided into five groups.Finally,the common syndrome types of CVI were:Qi deficiency and blood stasis syndrome,damp-heat down-injection syndrome,blood stasis vein syndrome,blood heat stasis syndrome,spleen deficiency and dampness syndrome.The first six principal components were extracted from 73 traditional Chinese medicines according to the results of the statistical information table,and the centroid clustering method was used to cluster them.These symptoms were mainly divided into six groups.Although they were not completely consistent with the common TCM syndrome types sorted out,from the perspective of drug efficacy,they basically conformed to the corresponding treatment principles of various TCM syndrome types of CVI.(3)160 cases meeting the inclusion criteria were divided into 95 cases of qi deficiency and blood stasis syndrome,20 cases of blood heat stasis syndrome,10 cases of spleen deficiency and dampness excess syndrome,and35 cases of damp-heat stasis syndrome according to the criteria of TCM syndrome differentiation;According to CEAP classification criteria,48 cases were classified as C2,21 cases as C3,40 cases as C4,2 cases as C5,and 49 cases as C6;After Chi-square test,there was a significant correlation between TCM syndrome types and CEAP grading(P<0.05).C2~C6 grades can be seen in the syndrome of qi deficiency and blood stasis.C2,C3 and C4 have obvious advantages.There is no difference between C2 and C4 grades(P>0.05),and there is significant difference between C3 and C2 and C4grades(P<0.05).C2,C4 and C6 can be seen in the blood heat stasis syndrome,mainly C2.There is a significant difference between C2 and C4 and C6grades(P<0.05).C3,C4 and C6 can be seen in damp-heat stasis syndrome,mainly C6.There is a significant difference between C6 and C3 and C4grades(P<0.05).The distribution of Qi deficiency and blood stasis syndrome can be seen in all grades C2 to C6.In grades C2,C3 and C4,Qi deficiency and blood stasis syndrome is the main syndrome.The difference between Qi deficiency and blood stasis syndrome and other syndrome types is significant(P<0.05).Conclusions:(1)The most frequent TCM syndrome types in modern literature research in the past 30 years are: Qi deficiency and blood stasis syndrome,damp-heat down-injection syndrome,blood stasis and vein obstruction syndrome,blood heat stasis syndrome,spleen deficiency and dampness excess syndrome,which are consistent with the distribution of cases in this clinical study;(2)There is a significant correlation between CEAP classification of chronic venous insufficiency of lower limbs and TCM syndrome types.Qi deficiency and blood stasis is the basic pathogenesis of CVI,and also the basic syndrome type.Qi deficiency and blood stasis syndrome can be seen at all levels of clinical classification,mainly at C2 and C4 levels,mainly manifested as varicose veins of lower limbs,and/or changes in skin and subcutaneous tissue;The blood heat stasis syndrome is mainly C2 grade,mainly manifested as redness,swelling,heat and pain in the local superficial veins of the lower limbs;The damp-heat stasis syndrome is mainly of C6 grade,which is mainly manifested by the change of local active ulcer of lower limbs.