Initial Study Of Externalized TCM Differentiation Of Syndromes In The Cardiac Arrhythmia Due To Coronary Heart Disease

BACKGROUND:Cardiac arrhythmia due to coronary heart disease is an ordinary disease in clinicpractice. The incidence of this disease is ascending ride with the more rapid economic development and more aged society. Differentiation of syndromes is one of the TCM characteristics and essentialities. Presently, it's the best way for diagnostics of combination of Chinese medicine and Western medicine which integrate the modern medicine diagnosis with the TCM differentiation. However, it's not a easy way for the clinic diagnosis and treatment, education and laboratory research of TCM to communicate with the international, since the diagnosis and differentiation of TCM are not standardized. Therefore, it's necessary to carry on the study of the TCM diagnosis and differentiation criteria.OBJECTIVE:This study tries to discuss whether there is objective relationship between the TCMdifferentiation and the modern medicine diagnosis about Cardiac arrhythmia due to coronary heart disease or not, so it can provide feasibly externalized evidences for the study of the TCM differentiation, which can achieve a better balance between the macroscopical and microcosmic indexes of the TCM differentiation of syndrome. Finally, make out a new thinking way for establish the dynamic criteria of the TCM differentiation.METHODS:1. Literature ResearchThe thesis dissertate the pathogenesis of palpitations with chest discomfort (usually referring to ischemic heart disease and arrhythmias) comprehensively, through reviewing the ancient literatures and summarizing clinical experiences. Then it provide the theoretic basis for farther externalization of the TCM differentiation.2. Clinic Research80 patients in the first affiliated hospital of Guangzhou university of Traditional Chinese Medicine was chosen, who were diagnosed cardiac arrhythmia of CHD and palpitations with chest discomfort in TCM. According to related diagnosis criteria institute by the Chest Discomfort Emergency Collaboration Organization of the State Administration of TCM of People's Republic of China, we divided the 80 patients into 5 groups, which are group A (Heart-yang Deficiency group), group B (Qi and Ying Deficiency group), group C (Mental Disturbance due to phlegm-fire group), group D (heart-blood stagnation group) and group E (Qi and Blood Deficiency of Heart and Spleen). And there are at least two Associate Professors or Professors to diagnose the TCM differentiation of syndromes. Collect the general information and the history, record objective values of cholesterin, the coagulation of blood, blood uric acid, etc. Use SPSS 13.0 statistical analysis software packet to constitute database, process date management and analysis. In this statistics and analysis, oneway ANOVA for the TCM differentiation, Logistic regression for quantitative variable, and row multiply column table of chi square test for qualitative variable. The mean difference is significant at the 0.05 level.RESULTS:1. There are 80 cases of Cardiac arrhythmia due to coronary heart disease be adopted in the study. 45% of those cases are male and 55% of those cases are female;11.25% of those cases are differentiated to Heart-yang Deficiency 11.25% of those cases are differentiated to Heart-yang Deficiency, 25% of those cases are differentiated to Qi and Ying Deficiency, 15% to Mental Disturbance due to phlegm-fire, 25% to heart-blood stagnation and 23.75% to Qi and Blood Deficiency of Heart and Spleen.2. The SBP and PP of cases which are differentiated to Heart-yang Deficiency are the highest;those of other four differentiations are descended gradually. And the DBP of the all differentiations are not significantly different.3. The values of TC and LDL-C of Qi and Blood Deficiency of Heart and Spleen Syndrome are the highest and those of TG of Mental Disturbance due to phlegm-fire Syndrome heighten mostly.4. The values of PT and APTT of Heart-yang Deficiency Syndrome are highest, while those of Qi and Blood Deficiency of Heart and Spleen Syndrome are lowest;the values of FIB of Qi and Blood Deficiency of Heart and Spleen Syndrome are lowest, while the differences of those values among Heart-yang Deficiency Syndrome, Mental Disturbance due to phlegm-fire Syndrome and heart-blood stagnation Syndrome are significant.5. The values of AST and CK of Mental Disturbance due to phlegm-fire Syndrome are highest;the differences of the CK values between Qi and Blood Deficiency of Heart and Spleen Syndrome and Qi and Ying Deficiency Syndrome are significant;the values of CK-MB of Qi and Ying Deficiency Syndrome are highest.6. The level of the uric acid of Qi and Blood Deficiency of Heart and Spleen Syndrome is highest, while those of Qi and Ying Deficiency Syndrome and Mental Disturbance due to phlegm-fire Syndrome are lower.7. The results from Pearson relation analysis indicate that there are correlations between the 13 indicators which include TC, LDL-C, HDL-C and the TCM differentiations.8. The results of Logistic regression show that Heart-yang Deficiency Syndrome and Qi and Ying Deficiency Syndrome have positive correlations to the indicators which include TC, LDL-C, PT, APTT, FIB, CK-MB, age, the uric acid and HBP history. The dangerous factors related to Heart-yang Deficiency Syndrome are APTT, FIB, CK-MB, apoB. The indicators which are important to diagnose Qi and Ying Deficiency Syndrome are APTT, FIB, PP, while those that are important to diagnose Mental Disturbance due to phlegm-fire Syndrome are LDL-C, CK-MB, apoB and those that are important to diagnose heart-blood stagnation Syndrome are LDL-C, INR, FIB, CK-MB, apoB, PT, APTT.9. This Logistic regression equation is statistical significance:Heart-yang Deficiency Syndrome = -119.872 +1.110 X APTT+11.052 X FIB+ 0.002 X CK-MB-63.416 XapoBCONCLUSION:This study proceeds with Cardiac arrhythmia due to coronary heart disease. To announce the genuine connotation, we discuss the relationship between the TCM differentiation of syndromes and externalized indexes of clinic regular examines. Initial study show that It's not the index, which has significant difference in unitary objective index comparison, affect the diagnosis of the TCM differentiation of syndromes, the differentiation of single externalized index has no specificity for the diagnosis of the TCM differentiation of syndromes, and can not illuminate the tending to alter of the TCM differentiation of syndromes, all those prove the validity of the TCM Wholism. What it comes down to is that it has scientificity and practicality to research how to externalize the TCM differentiation of syndromes under the guide of the TCM concept of Wholism and it will provide theoretical basis for the further study.