Research On TCM's Syndrome Differentiation Of Arrhythmia

BackgroundArrhythmia is clinically common, with bradycardia with or without irregular heartbeat for the main characteristics. There are many types of arrhythmia, with different priorities. Differentiation is collected the signs and symptoms of material, through the analysis and synthesis, distinguish reason, nature, place and relationship between disease and evil, generalize and judge properties of TCM syndrome, is the basic characteristics of TCM essence, also its essence. But because of TCM diagnosis standard is not standard, each individual physicians are basically using clinical experience for treatment or single syndrome differentiation and treatment. The discriminate of standard is different, the subtype's multifarious and irregular, formulas choosing different. This makes clinical diagnosis and scientific of arrhythmia difficult and resistance, also limits the application of traditional Chinese medicine on arrhythmia. So, it is necessary to further promote the development of syndrome discrimination arrhythmia, especially the study of standardization, much still remains to be done.Research purposesThe dialectical typing study of current Chinese Medicine exists much shortage, such as there's still missing unity and objective criteria on the dialectical typing of current Chinese Medicine. No large sample, double-blind clinical study, macro and micro studies are separating, disease and evidence are separating. Therefore, on the basis of strengthening the disease and syndrome, macro and micro combination, this paper divided arrhythmia into fast arrhythmia and slow arrhythmia, conduct multi-center, large sample clinical trials. By clinical validation of objective indicators of arrhythmia, and combination of a variety of effective index, respectively establish diagnostic criteria of relative normative symptoms and diagnosis of syndromes for rapid arrhythmia and slow arrhythmia. Which can makes the diagnosis of symptoms and syndromes of traditional Chinese medicine to a certain extent union, the results of various clinical or experimental studies effective, improve efficiency of medical research, so to obtain best value for money ratio.Research methods1 literature researchThrough systematic review of arrhythmia form names, disease and syndrome, etiology, pulse condition, objective index, the Chinese type, syndrome discrimination and treatment aspects to do systematic review, summarize clinical experience, and try to understand characteristics, Chinese types of clinical experience of palpitation, in order to provide theoretical basis of Chinese discrimination of arrhythmia.2. Clinical researchWe totally studied 102 subjects were patients of En Dian Huai En Tang Traditional Chinese Medicine Clinic who were diagnosed as arrhythmia by the Department of Cardiology. Do strictly screening according with the inclusion and exclude criteria. Collecting large and many types of arrhythmia samples, record and quantitative diagnose symptoms of patients, inspect micro index before therapy of arrhythmia, put forward a set of more detailed classification standards. To classify arrhythmia into (1) fast arrhythmia, which was divided into:①the Xinqiyinxu, Xuemaiyuzu, Yuerhuare type②Xinpibuzum, Shitingzumai, Yuerhuare type③Xinqishuaiwei, Xuemaiyuzu, Yuerhuare type④Xinyinxuexu, Xuemaiyuzu, Yuerhuaer type⑤Xinqiyinxu, Feiyushengshui, Yuerhuare type. (2) slow arrhythmia was divided into:①the Xinpiqixu, Shixiatingxu, Xinmaishouzu type②Xinpiqixu, Xinmaishouzu, Xueliubuchang type③Xinpiqixu, Hanxianeisheng, Zuzhixinmai type④Xinshenyinyagnjuxu, Hanshiyuzu, Xinmaisezhi type⑤Xinpishenxu, Hantanyujie, Xinmaishouzu type. To do correlation analysis and multiple Logistic regression analysis of symptom, micro index and types of arrhythmia, to find micro index which affects symptom of arrhythmia and provides the basis for the dialectical therapy.Research results1. General situation:102, male,57 cases (55.9%), women 45 cases (44.1%). Patients are at the age of 38-85, average age 62.5±4.7years old. Incidence of arrhythmia of 61~70 year-old people was highest, accounted for 44.1%, followed by 51-60 year-old groups, accounts 36.3%.49 fast arrhythmia patients accounted for 48.0%, slow arrhythmia patients 53, accounted for 52.0%.2. Fast arrhythmia (1) According to single factor analysis, micro factors such as the blood pressure (systolic blood pressure and pulse pressure differential), lipids (TC and TG, LDL-C, HDL-C), level of serum myocardial zymogram (AST, LDH, CK, CK-MB), clotting level (PT, APTT, PIB, INR), level of serum uric acid and symptoms such as palpitations, chest tightness, chest pain, weakness, dizziness, quickness of breath, shortness of breath, panic, insomnia, moss greasy, strings pulse, smooth pulse, intermittent pulse, tart pulse and fast pulse etc. (2)Took Xinqiyinxu-Xuemaiyuzu-Yuerhuare type as reference to do multiple Logistic regression analysis. The results were:(1) 17 micro index such as the systolic blood pressure, TC, AST and LDH, CK, palpitations, chest pain, weakness, dizziness, shortness of breath, panic, insomnia, moss greasy, strings pulse, smooth pulse, intermittent pulse and fast pulse were independent influencing factors for Xinpibuzu-Shitingzumai-Yuerhuare type. (2) 18 micro index such as the systolic blood pressure, Moots-McKesson ratio, LDL-C, HDL-C, AST, CK, CK-MB, APTT, INR, uric acid, palpitations, chest pain, quickness of breath, insomnia, moss greasy, strings pulse, tart pulse and fast pulse were independent influencing factors for Xinqishuaiwei-Xuemaiyuzu-Yuerhuare type. (3) 15 micro index such as Moots-McKesson ratio, IG, LDH, CK, CK-MB, uric acid, palpitations, chest tightness, chest pain, quickness of breath, shortness of breath, panic, insomnia, moss greasy, strings pulse were independent influencing factors for Xinyinxuexu-Xuemaiyuzu-Yuerhuare type. (4) 11 micro index such as Moots-McKesson ratio, LDH, CK, APTT, PIB, uric acid, palpitations, dizziness, strings pulse, intermittent pulse and fast pulse were independent influencing factors for Xinqiyinxu-Feiyushengshui-Yuerhuare type.3. Slow arrhythmia (1) According to single factor analysis, micro factors such as the blood pressure (systolic blood pressure and pulse pressure differential), lipids (TC, apo-A), level of serum myocardial zymogram (AST, LDH, CK, CK-MB), clotting level (PT, APTT, PIB, INR), level of serum uric acid and symptoms such as palpitations, chest tightness, weakness, dizziness, quickness of breath, shortness of breath, panic, insomnia, strings pulse, smooth pulse, intermittent pulse, tart pulse and slow pulse etc. (2)Took Xinpiqixu-Shixiatingxu-Xinmaishouzu type as reference to do multiple Logistic regression analysis. The results were:(1) 10 micro index such as the apo-A, LDH, CK, CK-MB, APTT, PIB, level of serum uric acid, palpitations, weakness, panic were independent influencing factors for Xinpiqixu-Xinmaiyuzu-Xueliubuchang type. (2) 7 micro index such as CK-MB, PT, APTT, INR, dizziness, quickness of breath, insomnia were independent influencing factors for Xinpishenxu-Hanxianeisheng-Zuzhixinmai type. (3) 12 micro index such as systolic blood pressure, Moots-McKesson ratio, CK, CK-MB, PT, APTT, uric acid, quickness of breath, panic, insomnia, strings pulse and slow pulse were independent influencing factors for Xinshenyinyangjuxu-Hanshiyuzu-Xinmaisezhi type. (4) 8 micro index such as AST, LDH, APTT, palpitations, weakness, panic, smooth pulse and slow pulse were independent influencing factors for Xinpishenxu-Hantanyujie-Xinmaishouzu type.ConclusionThis subject mainly discusses Chinese medicine dialectical studies of arrhythmia, divide arrhythmia into fast and slow type, and each divide into five kinds of arrhythmia syndrome type. Preliminary conclusions are as follows:1. Five types of fast and slow arrhythmia patients with palpitations, chest tightness, chest pain, fatigue, dizziness, quickness of breath, shortness of breath, a sense of panic, insomnia, moss greasy, strings pulse, slippery pulse, rapid pulse, tart pulse and smooth pulse have different symptoms, the difference was statistically significant.2. ANOVA analysis showed that systolic blood pressure, pulse pressure, total cholesterol, TC, high density lipoprotein HDL-C, low density lipoprotein LDL-C, triglyceride TG, myocardial enzymes, prothrombintime PT, activated partial thromboplastin time APTT, Fibrin FIB and international normalized ratio INR, serum uric acid and other indicators in five kinds of fast arrhythmia syndrome types was statistically significant. Systolic blood pressure, pulse pressure, total cholesterol, TC, apolipoprotein apoA, myocardial enzymes, prothrombin time PT, activated partial thromboplastin time APTT, FIB and fibrin international normalized ratio INR, serum uric acid and other indicators in five kinds of slow arrhythmia syndrome types was statistically significant.3. multivariate Logistic regression analysis shows that, of all types of fast and slow arrhythmia syndromes, TCM symptoms and their individual micro-indicators vary individual.This fully shows that a single symptom or not enough of a micro-indicators of arrhythmia syndromes were determined, and this is consistent with the overall concept embodies the traditional Chinese medicine. Statistically significant integration of the various symptoms and micro indicators, may correct the arrhythmia, diagnostic and scientific proof.In summary, fast and slow arrhythmia syndromes are different to some extent by the above symptoms and microscopic indexes. In this study strengthen the disease and syndromes, based on the combination of macro and micro, from the perspective of the overall objective to study and the different arrhythmia diagnosis based on TCM. Through targeted micro-target individual symptoms and the establishment of a fairly standard TCM standards, and to treat the arrhythmia syndromes provide a specific target reference.