Development Of TCM Syndrome And Diagnosis Scale For Decreased Ovarian Reserve Function

Purpose:Syndrome differentiation and treatment is the key and difficult point of TCM diagnosis and treatment.The development of TCM syndrome waiting and diagnosis scale is conducive to the standardization and standardized development of syndrome differentiation and treatment.To develop the TCM syndrome diagnosis scale of hypoovarian reserve function to provide a relatively standard and objective scale for the diagnosis of hypoovarian reserve function.Method:1.(1)Research on TCM syndrome of decreased ovarian reserve function from CNKI,Wipp.com,Wanfang data,Chinese Traditional Chinese Medicine Literature and Journal Retrieval Database,Chinese biomedical literature Database and self-built database was searched until March 2022,and a total of 240 clinical research literatures on TCM syndrome distribution containing DOR were selected.To summarize the TCM diagnosis criteria of ovarian reserve dysfunction,including standard sources,syndrome types,four diagnosis information,etc.(2)By reading the included literature,we screened out the literature containing the etiology and pathogenesis of the decreased ovarian reserve function of famous traditional Chinese medicine practitioners or summarized the syndrome types,searched the "Huiya e-book" database of our school and consulted the paper collection of our school library,and collected a total of 3 books and the syndrome differentiation experience of 28 famous traditional Chinese medicine practitioners.(3)After reading the included literature,a total of 54 medical documents containing symptoms of decreased ovarian reserve were screened out,and 46 DOR cases with complete information of four diagnoses were added from the tutor’s clinic,a total of 100 medical records were summarized for symptoms,signs and tongue and pulse information.(4)Refer to "Diagnostics of Traditional Chinese Medicine" and appropriately combine clinical practice to conduct standardized processing of the four diagnosis information extracted from literature syndrome diagnosis,syndrome differentiation experience of famous doctors and clinical medical cases,and establish DOR TCM syndrome database to form a syndrome entry pool.In addition,the frequency statistics of syndromes and symptoms were analyzed,cluster analysis and factor analysis were carried out for high frequency symptoms,and the items of syndromes were preliminarily screened.2.(1)According to the information items of the main syndrome types and symptoms of ovarian reserve loss obtained from previous studies,the Expert Questionnaire of TCM Syndrome Diagnosis Scale for ovarian Reserve Loss was developed.There were two rounds of the expert questionnaire,and the first round(30 participants)mainly determined the main syndrome types and symptoms of DOR.The second round(30 experts)was to determine the importance of the main syndromes and symptoms.The opinions and suggestions of two rounds of expert questionnaires were analyzed and summarized to form the initial DOR syndrome patients questionnaire.(2)20 patients with DOR were pre-investigated and revised to form an official version of the patient questionnaire.(3)A total of 365 questionnaires were distributed in 6 hospitals in Jiangxi Province,Guangdong Province,Tianjin City and Yunnan Province for clinical investigation.(4)Discrete trend method,differentiation analysis method,correlation coefficient method and Kronbach coefficient method were used to conduct statistical analysis on the questionnaires of patients,and the syndrome items were screened by expert consultation method.(5)Fisher discriminant method was used for item weighting,ROC curve was used to determine the optimal threshold value,DOR TCM syndrome diagnosis model was initially constructed,and item scoring was performed by proportional expansion.The four clinical diagnosis information of 362 patients was substituted into each syndrome type diagnostic scale,and the diagnostic results of the scale were compared with those of clinicians to verify the performance of the scale.Results:1.(1)The frequency analysis results of this study showed that the main syndrome types of DOR were kidney deficiency and liver depression syndrome,kidney deficiency syndrome,kidney deficiency and blood stasis syndrome,liver and kidney Yin deficiency syndrome,kidney Yin deficiency syndrome,spleen and kidney Yang deficiency syndrome.(2)Cluster analysis results showed that three-layer cluster: spleen-kidney Yang deficiency syndrome,Yin deficiency syndrome,kidney deficiency and liver stagnation and blood stasis syndrome were the main syndrome types of DOR;five-layer cluster: Yin deficiency syndrome,spleen-kidney Yang deficiency syndrome,kidney qi deficiency syndrome,kidney deficiency and blood stasis syndrome,liver depression syndrome were the main syndrome types of DOR.(3)Factor analysis results showed that Yin deficiency syndrome,kidney deficiency syndrome and Yang deficiency syndrome were the main syndrome types of DOR.(4)The main symptoms of DOR were divided into menstruation and reproductive conditions.The main symptoms of menstruation were low menstrual volume(75.12%),late menstrual period(55.40%)and amenorrhea(37.79%),and the main symptoms of reproductive conditions were infertility(57.98%).(5)The symptoms of DOR syndrome included waist pain and knee weakness(59.39%),dizziness(57.04%),tinnitus(54.23%),insomnia(45.54%),hypolibido(36.62%),irritability and irritability(34.74%),fatigue(31.92%),hot flash and sweat(30.99%),and thin white moss(31.46%).Red tongue(30.75%),thin pulse(67.84%),dull pulse(54.46%),chord pulse(37.32%).2.(1)The statistical analysis of the results of the first round of expert questionnaire concluded that the main syndrome type of DOR was deficiency of kidney qi;(1)Syndrome of kidney Yin deficiency(syndrome of liver and kidney Yin deficiency,syndrome of heart and kidney failure);Syndrome of Yin deficiency and blood dryness;(3)Kidney Yang deficiency syndrome(spleen kidney Yang deficiency syndrome);(4)Concurrent syndrome(concurrent syndrome of liver depression,concurrent syndrome of blood stasis),that is,the above main symptoms can be concurrent clips.The results of the second round of expert questionnaire showed that the average recognition degree of 30 experts for the above DOR main syndrome types was 88.1%,the lowest recognition degree was 70%(2),and the highest recognition degree was 100%(3).(2)The results of the second round of expert questionnaire showed that the main syndrome types of DOR in order of importance were kidney qi deficiency syndrome(4.63),kidney Yin deficiency syndrome(4.63),liver and kidney Yin deficiency syndrome(4.47),kidney deficiency and liver depression syndrome(4.47),kidney Yang deficiency syndrome(4.33),combined liver depression syndrome(4.23),kidney deficiency and blood stasis syndrome(4.1),and heart-kidney disharmony syndrome(4.07)),spleen and kidney Yang deficiency syndrome(4.07),Yin deficiency and blood dryness syndrome(3.9),combined blood stasis syndrome(3.83).The full score ratio of deficiency of kidney qi,deficiency of kidney Yin,deficiency of kidney and liver,deficiency of liver and kidney and deficiency of kidney and Yang were 70%,66.67%,56.67%,53.33% and 53.33%,respectively.It is suggested to increase the syndrome of insufficient kidney essence.3.(1)The distribution frequency of TCM syndrome types in 362 patients with DOR ranked from high to low as complicated with liver depression(74.31%),complicated with blood stasis(64.92%),kidney Yin deficiency(including 15.75% syndrome of liver and kidney Yin deficiency and 9.12% syndrome of blood dryness.34.53%),syndrome of kidney qi deficiency(22.38%),syndrome of kidney Yang deficiency(including 14.09%of spleen and kidney Yang deficiency,accounting for 21.55% in total),syndrome of combined spleen deficiency(20.17%),syndrome of kidney and essence deficiency(10.77%),and syndrome of heart and kidney failure(10.50%).(2)The top 20 of the four diagnosis information of 362 patients with DOR were dark redness(86.46%),lumbago and knee pain(84.25%),fatigue(83.15%),insomnia and dreams(81.77%),irritability(80.66%),blood clots(80.11%),lower abdominal pain(72.1%)during menstruation.Delayed menstruation(3.59%),low menstruation(3.38)%),hypolibido(3.02%),hair loss or alopecia(70.99%),depression/sighing(70.44%),forgetfulness(70.17%),dizziness,tinnitus(70.17%),breast/thoracolepigastric pain(66.85%),palpitation(55.8%),dry stools(52.21%),loose stool(51.66%)),irregular menstruation(49.72%),full stomach(49.45%),and vaginal dryness(49.45%).4.Entry screening results:(1)Syndrome of kidney qi deficiency:amenorrhea,delayed menstruation,early menstruation,fatigue,dizziness,tinnitus,lumbar acid and knee tenderness or pain,frequency of urination,loss of libido,heavy pulse and weak pulse.It is suggested to add words and dilute them.(2)Syndrome of insufficient kidney essence: small menstrual volume,amenorrhea,delayed menstruation,forgetfulness,sparse or alopecia hair,dizziness,tinnitus,sore waist and knee,weak or painful tongue,thin pulse.It is recommended to add light tongue and white moss.(3)Kidney Yin deficiency syndrome: less menstruation,amenorrhea,delayed menstruation,lumbar acid and knee tenderness or pain,dizziness and tinnitus,five upset heat,hot flushes and sweat,night sweats,two zygomatic flushing,less tongue moss,thin pulse,pulse number.Tongue red is recommended.(4)Liver and kidney Yin deficiency syndrome:less menstruation,early menstruation,dizziness,tinnitus,astringent eyes,dry mouth and throat,five upset heat,hot hot sweat,insomnia and dreams,waist acid knee soft or pain,vaginal dryness,facial melasma or dark spots,red tongue,less tongue coating,thin pulse.(5)Yin deficiency and blood dryness syndrome: less menstruation,amenorrhea,delayed menstruation,dizziness,tinnitus,dry mouth and throat,five upset heat,insomnia and dreams,hot hot sweating,vaginal dryness,dry skin or itching,astringent eyes,dry stool,zygomatic flushing,less tongue coating,thin tongue,thin pulse.(6)the heart and kidney do not meet the syndrome: dizziness tinnitus,palpitation,insomnia dream,waist acid knee soft or pain,dry mouth and throat,five upset heat,hot hot sweat,night sweat,red tongue,less tongue coating.It is recommended to add palpitation,pulse thinness and pulse number.(7)of kidney Yang deficiency syndrome: menstrual quantity is little,menstruation delay,exhausted god to sleep soundly,chills,waist even have diarrhoea,abdominal pain,loss of libido,pee qing long,night to urinate,taken down clear quantity,complexion ? white,facial swelling,tongue body fat,whitish,pale tongue,slide,vein.(8)of spleen kidney Yang deficiency syndrome: menstruation delay,fatigue,lumbar acid knee soft god or pain,loss of appetite,stomach bilges full,taken down clear quantity,night to urinate,even diarrhea,loose stools,complexion ?white,facial swelling,tongue body fat,whitish,pale tongue,sliding,pulse heavy,late of arteries and veins,arteries and veins.It is recommended to add cold pain in the waist and abdomen and tooth marks on the tongue.(9)Syndrome of liver depression: less menstruation,irregular menstruation,insomnia and dreams,irritability and irritability,mood depression/sighing,breast/thorax and hypochondriac distension pain,lower abdominal distension pain,dry mouth and bitter mouth,dark red tongue,thin yellow moss,thin pulse and string pulse.(10)Syndrome with blood stasis: small amount of menstruation,amenorrhea,delayed menstruation,pain in the lower abdomen during menstruation,dark red menstruation,blood clots in menstruation,dry mouth and no desire to drink,tingling pain in the waist and abdomen,peechia in the tongue,torpid and astringent veins under the tongue,dark complexion or swarthy,dark lips,dark tongue and pale tongue are suggested.5.The score of TCM syndrome diagnosis and breakdown scale of DOR is summarized as follows(more than 20 points can diagnose the syndrome type):(1)Kidney qi deficiency syndrome: dizziness and tinnitus 8 points,lumbar acid and knee weakness 7 points,fatigue 9 points,urination frequency 6 points,weak tongue 1 point,and heavy pulse 1 point.(2)Kidney essence deficiency syndrome: amenorrhea/menarche late to 7 points,loss of libido 2 points,forgetfulness 5 points,hair thinning or hair loss 6 points,dizziness,tinnitus/deafness 2 points,lumbago and knee weakness or pain 4 points,thin tongue 7 points,thin pulse 2 points.(3)Kidney Yin deficiency syndrome: waist and knee sore or pain 8 points,dizziness and tinnitus 7 points,five upset hot 9 points,hot flush 15 points,night sweats 12 points,two zygomatic flush 15 points,tongue less than 5 points,pulse fine 13 points.(4)Syndrome of liver and kidney Yin deficiency: waist and knee tenderness or pain 10 points,dizziness(dizziness)tinnitus 7 points,astringent eyes 16 points,dry mouth and throat 4 points,facial melasma or dark spots 10 points,pulse fine 6points.(5)Yin deficiency and blood dryness syndrome: dry mouth 3 points,five upset heat 2 points,insomnia 2 points,vaginal dryness 2 points,dry skin or itching 12 points,eyes 5 points,dry stool 2 points,two zygomatic flushing 1 point,less tongue coating 1 point,thin tongue 3points,thin pulse 1 point.(6)The heart and kidney do not meet the syndrome: waist and knee pain or pain 5 points,dizziness and tinnitus3 points,palpitation 12 points,palpitation 4 points,five upset heat7 points,less tongue moss 3 points,pulse fine 3 points,pulse number3 points.(7)Kidney Yang deficiency syndrome: decreased libido 7 points,fear of cold 7 points,waist and abdomen cold pain 7 points,clear urination 5 points,night frequency 5 points,lower clearance 1 point,facial ? white 5 points,facial puffiness 3 points,white slimy fur 6points,pulse sinking 2 points.(8)Spleen-kidney Yang deficiency syndrome: fear of cold 8 points,lumbar acid and knee weakness or pain3 points,abdominal cold pain 13 points,more than 5 points,five points diarrhea 3 points,facial expression ? white 4 points,facial puffiness9 points,weak tongue 3 points,tooth marks on the tongue side 6 points,and white and slippery fur 2 points.(9)Combined with liver depression syndrome: dry mouth/bitter mouth 7 points,insomnia and dreams 3 points,irritability 11 points,emotional depression/good sighing 6 points,breast/chest and hypochondriac pain 8 points,lower abdominal pain 2points,thin yellow fur 5 points,pulse string 3 points.(10)Combined blood stasis syndrome: lower abdominal pain 5 points,dark red menstruation 6 points,blood clots between menstruation 10 points,dry mouth 4 points,dark purple lips 3 points,petechiae in the tongue 3 points,tortuosity of sublinguals 3 points.6.Performance test results of DOR TCM syndrome diagnosis scale: Kappa value of renal qi deficiency syndrome in DOR TCM syndrome diagnosis scale was less than 0.4,indicating poor performance test results;The Kappa values of kidney essence deficiency syndrome,kidney Yin deficiency syndrome,liver and kidney Yin deficiency syndrome,Yin deficiency syndrome and blood dryness syndrome,spleen and kidney Yang deficiency syndrome,and blood stasis syndrome were between 0.4-0.75,indicating that the consistency of performance test results was moderate.The Kappa value of heart-kidney disjunction syndrome,kidney-yang deficiency syndrome and liver-depression syndrome was greater than 0.75,indicating good consistency of performance test.To sum up,the accuracy of diagnosis results of DOR syndrome scale is reasonable,and it has certain practicability.Conclusion:1.In this study,the distribution law of TCM syndrome of DOR was summarized from multiple angles and in an all-round way by combining previous literature research,book research,clinical medical cases and later multi-center clinical reality through various statistical analysis methods such as frequency statistics,factor analysis and cluster analysis.2.By referring to relevant scale design requirements at home and abroad,this study constructs DOR TCM syndrome database by consulting a large number of relevant data.After two rounds of expert consultation and one round of patient survey,entries are reasonably screened by combining various statistical methods,ensuring the comprehensiveness and rigor of the structure of DOR TCM syndrome diagnosis scale.3.This study innovatively explored the development of a diagnostic scale for all major syndrome types of the disease at one time.The disease syndrome types were diverse,including 10 major syndrome and concurrent syndrome of DOR,and the classification of syndrome types was detailed.Because the basic pathogenesis of this disease is mainly kidney deficiency,its TCM syndromes are more similar,which increases the difficulty of diagnosis and discrimination.At the same time,the proportion of syndromes collected by questionnaires was uncertain,and the number of syndromes was difficult to be evenly distributed.Therefore,the quality of diagnostic scales for some syndromes is relatively low.However,this study also analyzed the representative items of each syndrome type to a certain extent,providing a reference for clinical and scientific research.