| ObjectiveTo discuss the characters of syndrome elements of Chronic Renal Failure (CRF) from bothliterature research and clinical investigation,We analyzed the magazines about CRF at first tocomprehend the distribution of general syndrome elements, syndromes and symptoms,then setdown questionnaire of symptoms based on its Symptoms and expert consultation.The purposeof the section of clinical investigation is to apply the evaluated questionnaire to investigate thegeneral symptoms in clinical,then set up database and used various mathematics methods todiscuss the combination rule of symptoms and distill syndrome elements which is the least unitof syndrome combined by symptoms,It can find out the characters of syndrome elements ofCRF and provide epidemic foundation to the upbuild of syndrome elements differentiationsystem. meanwhile, We also have analyzed.Methods1 Search the published magazines related to CRF in medicine part of Chinese JournalFull-text Database and analyse its general symptoms,syndromes and syndromeelements.Summarize the distribution rule of symptoms,syndromes and syndrome elements2 Standardize the name of general symptoms of CRF and uniform the different name ofthe same symptom.3 Establish the questionnaire of clinical symptoms of CRF and the handbook ofquestionnaire based on the standardization of symptom and symptom graduation andconsultation on experts.4 Taking informal investigation to evaluate the quality of questionnaire so as to amendand consummate the questionnaire and the handbook of questionnaire.5 Investigate general symptoms of CRF about 601 cases in 6 different clinicalcenters. Making strictly quality control to ensure an authentic and integrate outcome.6 An Epidata database will be set up based on the questionnaire.Put the data in it andcheck the data,then transform Epidata database into SPSS database.7 Applying information technologies,guided by Chinese medicine theories and based onthe analysis of data,we want to discuss the combination rule of symptoms and distill thegeneral syndrome elements of CRF and provide credible foundation to the upbuild ofsyndrome elements differentiation system.Results1 Through the analysis of modern literature of Chinese medicine of CRF from 1994 to2004,We found that there are about 172 Chinese medicine symptoms appeared in the literature and the total frequence is 2885. The symptoms of frequence more than 100 are weakness 182,soreness and weakness of waist and knees 141,anorexia 132,edema 115,nausea 100, Thefrequency of each symptom is 6.31%,4.89%,4.58%,3.99%,3.47%. The symptoms whichfrequence is more than 50 are vomiting 98,oliguria 95,vertigo 84,abdominal distension 82,fear of cold 77,loose stool 76,coldness in hands and feet 70,dry mouth 67,shortness of breath57,spiritlessness 54,deep-colored urine 50. After dispart tongue manifestation into three typeof tongue color,tongue shape and condition and tongue fur, We found that pale tongue,redtongue and pink tongue have more frequence in tongue color, plump tongue,teeth-printedtongue and ecchymosis on tongue have more frequence in tongue shape and condition, greasyfur,white fur and yellow fur have more frequence in tongue fur. There are 18 types of pulsemanifestation appeared in the literature. The former five pulse manifestation in frequence arethready pulse,deep pulse,rapid pulse,weak pulse and stringy pulse. There are 148 types ofsyndromes appeared in the literature after standardized all the syndromes. The syndromeswhich frequence is more than 10 are syndrome of deficiency of spleen and kidney yang 61,syndrome of deficiency of liver and kidney yin 53,syndrome of deficiency of both qi and yin35,syndrome of deficiency of both yin and yang 30,syndrome of deficiency of stomach andkidney qi 28,syndrome of dampness-heat 18,dampness retention syndrome 17,syndrome ofdeficiency of spleen and kidney of both qi and yin 16,syndrome of blood stasis 15 andsyndrome of stagnation of fluid-dampness 13. The frequency of each syndrome is 12.3%,10.7%,7.1%,6.1%,5.7%,3.6%,3.4%,,3.2%,3% and 2.6%. Through the analysis ofsyndrome elements We found the former three syndrome unites of location of disease infrequence are kidney,spleen and liver. The frequency of which is 16.74%,12.43% and 5.35%.the former three syndrome unites of nature of disease and pathological mechanism in frequenceare damp,yin deficiency and yang deficiency. The frequency of which is 13.13%,12.64% and10.83%. From the analysis of typic symptoms of general syndromes and syndrome elements, Wefound that the first ten symptoms among all the symptoms are matched to Chinese medicinetheory. When looked into the combination conditions of syndrome elements of disease nature inthe magazines, We found that yin deficiency+yang deficiency,yin deficiency+qi deficiencyand dampness+heat are more in the mode of the two combination of syndrome elements anddampness+yin deficiency+heat and dampness+qi deficiency+heat are more in the mode ofthe three combination of syndrome elements.2 Based on the analysis of modern literatuers of Chinese medicine of CRF,thestandardization of symptom,the standardization of symptom graduation and consultation onexpert,We made out the questionnaire of clinical symptoms of CRF and the handbook ofquestionnaire. After informal investigation for the evaluation of the quality of the questionnaire,Questionnaire is used to collect clinical symptoms of CRF about 601 cases. We set up symptom database for the research of general syndrome unites by many mathematics methods.3 Through the descriptive analysis of the 601 cases,We found there is about 42.3%â…¢period cases of CRF and its number is the most in all cases. 297 cases are male and 304 casesare female. The percentage of male and female is 49.4% and 50.6%.In nationality, The Hannationality is the most, The number is 578,about 96.2%.In age,The oldest is 65 and theyoungest is 18.Mean age is 49.84.In marriage status,The most is in double harness with livespouse.The number of which is 528,about 87.9%.In occupation structure,The most is retiree,workman and peasant. The number of each is 124,117 and 115 and the percentage is 22.0%,19.5% and 19.1%. There are 206 cases about 34.3% whose study experience is junior highschool. People of senior high school experience take second place and its number is 196,about32.6%.Only 107 people about 17.8% have college (junior college) experience.When analysisthe primary affection, We found the former five diseases are chronic glomerulonephritis (259,43.1%),hypertensive nephropathy (99, 16.5%),diabetic nephropathy (93, 15.5%),chronicpyelonephritis (42, 7.0%) and drug-induced renal impairment (42, 7.0%). The frequency ofcommon symptoms in former 20 are (1) weakness, (2) soreness and weakness of waist andknees, (3) fear of cold, (4) spiritlessness, (5) frequent urination at night, (6) dry pharynx,(7) dry mouth, (8) dry skin, (9) morbid forgetfulness, (10) anorexia, (11) insomnia, (12)dreaming often, (13) heavy body, (14) dysphoria, (15) vertigo, (16) thirst with desire to drink,(17)palpitation, (18) deep-colored urine, (19)nausea, (20) lumbago. Most of the cases werediagnosed as consumptive disease,(chronic) obstruction and rejection,edema and lumbago.The most of syndrome differentiation in experience is syndrome of deficiency of both yin andyang and stagnation of fluid-dampness,Next three syndromes are syndrome of deficiency ofspleen qi and kidney qi,syndrome of deficiency of both qi and yin and syndrome of deficiencyof spleen yang and kidney yang. From the analysis of syndrome elements in the experiencedsyndrome differentiation, We can find the more syndrome elements of disease nature arepathogenic water (dampness),yang deficiency,qi deficiency and yin deficiency.In thesyndrome elements of disease location, elements of kidney,spleen and liver are more.Whenlooked into the combination conditions of syndrome elements,yang deficiency + pathogenicwater (dampness) is the most in the two combination of syndrome elements of disease nature.yin deficiency + yang deficiency + pathogenic water (dampness) is the most in the threecombination of syndrome elements of disease nature.The most of the combination of syndromeelements of disease location is spleen and kidney. Every elements of disease nature have moreoombination with kidney. Compared with the results of literature analysis, The frequency ofweakness and soreness and weakness of waist and knees is also the most in the literature.Thereare seven same symptoms in the first twenty symptoms.They are anorexia,nausea,dizziness,fear of cold,dry mouth,spiritlessness and deep-colored urine. Syndrome of yang deficiency of spleen and kidney,syndrome of deficiency of both qi and yin and syndrome of qi deficiency ofspleen and kidney are more in both epidemic research and literature analysis.Syndromeelements of disease nature of dampness,yin deficiency,yang deficiency and qi deficiency andsyndrome elements of disease location of kidney, spleen and liver are also more in theliterature. But there is more difference in the combination of syndrome elements,In theliterature, Some syndrome elements has more combination with heat,Whereas it is little in theepidemic research.Perhaps it has some relation with the autumn and winter epidemic researchseason.Through the analysis of data, We also found there are some differences in commonconditions among different stages,different zones and different primary diseases.4 The result of clustering analysis pointed out that the syndrome elements of CRFinclude yang deficiency,qi deficiency,yin deficiency,dampness (pathogenic water),reversedflow ofqi,blood stasis and heat (fire), etc.5 Through the factor analysis, We supposed that the syndrome elements of CRF includeyang deficiency,qi deficiency,yin deficiency,dampness (pathogenic water),reversed flowof qi,blood stasis,wind,dryness and heat (fire), etc.6 Based on Exproratory Factor Analys and Chinese medicine theory, We optimized theoutcome of Factor Analys.Then applied with Ctructural equation model (Confirmatory FactorAnalys) to check if the optimized 13 factors fit data. The outcome show the fit of model iswell.The 13 factors reflected the character of the data by and large. So We can presume that thesyndrome elements of CRF include qi deficiency,reversed flow of qi,yin deficiency,yangdeficiency,pathogenic water (dampness) and blood stasis. We also discussed the relationshipbetween factors from outcome and it accord to Chinese medicine theory in the main.7 The result of latent class analysis pointed out that the syndrome elements of CRFinclude qi deficiency,yang deficiency,yin deficiency,pathogenic water,dampness,qistagnation,reversed flow of qi,blood stasis,etc.With the development of latent class analysismethod,It will must bring breakthrough to the research of syndrome of Chinese medicine.8 When applied the method of complex system entropy cluster to the symptoms ofCRF, We can suppose that one syndrome element can has many styles and different syndromeelements can have a lot of same symptoms from the outcome and we can also fred out that thesyndrome elements of CRF include yang deficiency,qi deficiency,yin deficiency,reversedflow of qi,pathogenic water,dampness,blood stasis,qi stagnation and dryness, etc.9 Through the comparison of the outcomes of different analysis methods such asclustering analysis, factor analysis, ctructural equation model,latent class analysis and complexsystem entropy cluster on clinical data of CRF, We found there are some common among theoutcomes.These symptom clusters represent the syndrome elements of CRF. So we can supposethat the main syndrome elements of CRF are qi deficiency,yang deficiency,yin deficiency, pathogenic water (dampness),qi stagnation,reversed flow of qi,blood stasis, etc.10 Method of logistic regression analysis was applied between disease symptoms andsyndromes or syndrome elements in syndrome differentiation made by clinical physicianexperience.Some outcomes have coherence with Chinese medicine theory, such as the analysisof syndrome of deficiency of both yin and yang and stagnation of fluid-dampness and theanalysis of syndrome of yang deficiency of spleen and kidney. Due to the limitation of sampleamount and some other reasons,the result is not very perfect.Conclusions1 There is some relationships between the symptoms of CRF, the symptoms can bedivided into many sorts,these sorts are similar to the syndrome or syndrome elements.Perhapsthe syndrome is formed in the summary of the laws of symptoms in clinical practices2 Through the analysis of literatures and the research of clinical,We can suppose thecommon syndrome elements of disease nature of CRF include qi deficiency,yang deficiency,yin deficiency,dampness,pathogenic water,qi stagnation,blood stasis,dryness and heat,etc.Itcan be divided into two groups of deficiency of genuine qi and excessiveness of the evil.syndrome elements of disease location of CRF mainly include kidney,spleen,liver,heart andstomach.3 Syndrome elements have many styles formed by the combination of its differentsymptoms,The combining laws between different syndrome elements are being discussed nextstep.4 There is intercross between symptoms of different syndrome elements.Differentsyndrome elements may have same symptoms. The diagnosis and discrimination of syndromeelements must depend on its special symptoms5 Syndrome or syndrome elements is a complex system, Many questions of it neededdiscussed with the development of many kinds of methods.
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