| Syndrome is evidence of external candidates of traditional Chinese medicine (TCM), which a certain stage of the disease process in the disease location, etiology, disease resistance, disease resistance potential and ability of the body such as the strength of the organic nature of the response to contact state, the performance can be observed for clinical symptoms and so on. Its information has the character of subjectivity, mistiness, invisibility, fuzzification, multilayer, uncertainty and so on. Affiliated with the symptoms of the syndrome to regulate syndrome, syndrome diagnostic criteria is the most commonly used method. However, the symptoms of syndrome belongs in the disease must be defined under the common syndrome in order to reflect the performance of research can overcome the arbitrariness of previous syndrome, is also conducive to determine clinical efficacy. Based on the thinking of evidence-based medicine (EBM), and under the framework of "disease and syndrome", for coronary heart disease with chronic heart failure as the starting point, use two methods of modern literature research and clinical cross-sectional epidemiological survey and combine with a variety of mathematical statistical methods to initial interpretation the characteristics and disciplines of common syndrome, syndrome elements and symptoms of coronary heart disease whit chronic heart failure, so that in order to establish a dialectical syndrome elements regulation as the core norms of coronary heart disease whit chronic heart failure syndrome, and provide a standardized and concise theoretical for clinical differentiationObjective:Through retrospective study of modern literature to analyze the common syndromes, symptoms of chronic heart failure, and split syndrome into syndrome elements in accordance with certain criteria. So that to preliminary investigate the distribution rule of common syndromes, syndrome elements and symptoms of chronic heart failure, and the relationship between syndromes/ syndrome elements with symptoms. All of these, use to provide reference to formulate a clinical information collection form, and lay the foundation for a further clinical multi-center, large sample epidemiological survey.Methods:Search the journals from China Academic Journal Full-text Database, Chinese Biomedical Literature Database and VIP Database of Chinese Journals, which the date from January 1994 to January 2008. Use NoteExpress2 software to establish a documentation database of chronic heart failure. Accord strictly to the inclusive and exclusive criterions to screen out qualified literatures. And then specify the name of its syndromes and symptoms. Sort data and enter them into EpiData3.1 software. Through SPSS16.0 statistical software, analyze them by using frequency, proportion, Logistic regression methods.Results:Through retrospective study of modern literature for past 15 years, there are 176 qualified literatures related to chronic heart failure reviewed, the conclusions as follow:1. The symptoms distribution of chronic heart failure:Specify the name of symptoms of chronic heart failure, and combine with experts discussions. The number reduces from pre-specified 269 to 145, and the total frequency is 4149 times. After investigate the symptoms which the frequency up 1.0% of total, which can find out that CHF major clinical symptoms are heart palpitation, shortness of breath, edema, fatigue, thready pulse, breathing difficulties, and pant, irregularly intermittent pulse, regularly intermittent pulse are also common.2. The syndromes distribution of chronic heart failure:There are 275 syndromes in modern literature. After removing repeated ones there are still 116 syndromes. Further more, specifying the name of symptoms, there are 43 syndromes. Syndromes diversity, which clearly shows the complexity of chronic heart failure itself, on the other hand also shows that there is no an uniformity criterions for their clinical syndrome. The study investigates both the frequency and constituent ratio of 43 syndromes, and the 7-8 bits stay the same. Therefore, the most common syndromes of CHF are heart-kidney yang deficiency syndrome, qi deficiency and blood stasis syndrome, heart yang deficiency syndrome, fluid retention syndrome, qi and yin deficiency syndrome, heart qi deficiency syndrome, yang deficiency and blood stasis syndrome. The more common syndromes are syndrome of water overflowing due to yang deficiency, syndrome of deficiency of both yin and yang, heart blood stasis syndrome, phlegm and blood stasis syndrome. Less common syndromes are syndrome of stagnant-heat invading collaterals, syndrome of insufficient kidney not accepting qi, syndrome of incoordination between gallbladder and stomach.3. The syndrome elements distribution of chronic heart failure:Syndrome elements occur 698 times and 34,939 cases in total 17,839 cases. The 6 bits of characteristic-syndrome elements stay the same, and the 3 bits of bit-syndrome elements stay the same. Therefore, the most common CHF syndrome elements are yang deficiency, qi deficiency, blood stasis, water retention, yin deficiency, phlegm; heart, kidney and lung.4. The distribution of chronic heart failure commonly syndromes/syndrome elements corresponding to its symptoms.Count frequency of the top 7 syndromes, the top 6 characteristic-syndrome elements and the top 3 bit-syndrome elements, and to understand its distribution. The symptom's frequency ranking in the top 10 (if the same frequency, extended to the same bottom) identified as common symptoms, the symptoms of high frequency can basically reflect the features of its corresponding syndromes, syndrome elements; by Binary Logistic Regression Analysis, the symptoms with more larger contribution can basically reflect the features of its corresponding syndrome elements.Objective:Base on the pre-survey, and then start a national multi-center clinical large sample cross-sectional epidemiological investigation. Use software to establish database of coronary heart disease with chronic heart failure. So that to preliminary investigate the distribution rule of common syndromes, syndrome elements and symptoms of chronic heart failure, and the relationship between syndromes/syndrome elements with symptoms. In order to provide reference and basis for the further development of distinguish coronary heart disease with chronic heart failure syndrome elements as the core elements of diagnostic criteria.Methods:Base on pre-literature study and the recommendations of clinical experts to formulate a clinical information collection form. After a discussion by experts and our team repeatedly revised, through the pre-investigation to estimate the consistency of clinical information collection form and perfect it, so that to formulate a determine one, and then start a clinical multi-center, large sample epidemiological survey. Use EpiData3.1 software to establish a database for clinical data. Through SPSS16.0 statistical software, analyze them by using frequency, proportion, logistic regression, unsupervised analysis (factor analysis, hierarchical cluster analysis)methods.Results: 1. Pilot investigation of coronary heart disease with chronic heart failure clinical cross-sectional surveyCoefficient correlation values of more than 83.33% of TCM symptoms exceeded 0.8. Values of more than 80% of TCM symptoms in other five hospitals exceeded 0.8(two-sided test, p<0.01),which show the coefficient correlation values about the most of symptoms in information collection form were qualified; some symptoms are lower than 0.8 in four hospitals or above, so modify them. Then optimize and adjust the problems of the form with its structure or content.2. The symptoms distribution of coronary heart disease chronic heart failure:There are 596 qualified cases in this clinical cross-sectional survey, and collect 170 symptoms. Among them there are 14 main symptoms,14 systemic symptoms,17 head and face symptoms.35 heart and flank symptoms,8stomach and abdominal symptoms,4 waist and limbs symptoms,7 restaurants and taste symptoms,3 sleep-related symptoms,7 soil-urine-related symptoms,43 tongue symptoms and 20 pulse symptoms(only the left hand pulse meter). High frequency of symptoms are fatigue (578/96.98%), shortness of breath (556/93.29%), spiritlessness (528/88.59%), breath difficult (467/78.36%), edema (331/55.54%), palpitations (451/75.67%), chest tightness (537/90.10%), and so on. The frequency of symptoms up 30% are less qi lazy words, chills, spontaneous sweating, hot flashes, dizziness, blurred vision, lips cyanosis, chest pain, cough, sputum, wheezing, reliance interest is not lying, abdominal distension, soreness and weakness of waist and knees, hands and feet are not warm, sleepy body weight, zhaojia bruising, poor appetite, tastelessness, dry mouth, insomnia, dreaming often, frequent urination at night, sublingual vein abnormalities, deep pulse, thready pulse, and weak pulse.3. The experience syndromes/syndrome elements distribution of coronary heart disease with chronic heart failure:Specifying the name of experience syndromes, there are 39 types, and the total frequency is 924 times. There are 9 types syndromes'frequency are up 3%: syndrome of deficiency of qi and blood stasis, syndrome of deficiency of both qi and yin, syndrome of intermingled phlegm and blood stasis, fluid retention syndrome, phlegm syndrome, syndrome of blood stasis, water retention and blood stasis syndrome, syndrome of water overflowing due to yang deficiency, syndrome of heart yang deficiency, which accounted for 76.84% of the total frequency. Among them the frequency of syndrome of deficiency of qi and blood stasis (174/18.83%) and syndrome of deficiency of both qi and yin (154/16.67%) are far more than other syndromes.Split syndrome into syndrome element. There are 16 characteristic-syndrome elements, and the total frequency is 1740 times. There are 9 bit-syndrome elements, and the total frequency is 1397 times. The top six sequences of characteristic-syndrome elements are:qi deficiency, blood stasis, yin deficiency, water retention, sputum, yang deficiency, which accounted for 95.46% of the total frequency. Among them the frequency of qi deficiency (497/28.56%) and blood stasis(448/25.75%) are far more than other characteristic-syndrome elements. The top four sequences of bit-syndrome elements are:heart, kidney, spleen, lung, which accounted for 89.26% of the total frequency. Among them the frequency of heart (578/41.37%) is far more than other bit-syndrome elements.4. The differences of experience syndromes/syndrome elements among the 14 hospitalsSpecifying the name of experience syndromes, CC hospital has 13 types, CZ hospital has 12 types, CD hospital has 15 types, DF hospital has 10 types, DZM hospital has 17 types, HZ hospital has 13 types, ZZ hospital has 10 types, WH hospital has 22 types, WX hospital has 14 types, XJ hospital has 15 types, YC hospital has 11 types, HN hospital has 12 types, ZR hospital has 19 types, and ZB hospital has 14 types. The top five sequences of syndromes come up to as much as 17 types among the hospitals. Syndrome of deficiency of qi and blood stasis, syndrome of deficiency of both qi and yin are the most commonly syndromes, but the other frequencies of syndromes are not the same. Syndrome elements have a higher degree reorganization among the hospitals, and concentrate in qi deficiency, blood stasis, yin deficiency, water retention, sputum, yang deficiency; heart, kidney, spleen and lung. The frequency syndrome elements are significantly higher than other types. Some hospitals also deem that there are some other syndrome elements related this disease, such as qi stagnation, wet, blood, cold, heat, wind, fire, hyperactivity of yang, sperm loss, drug; liver, stomach, gallbladder, collaterals, cerebral, and so on.5. The distribution of coronary heart disease with chronic heart failure commonly syndromes/syndrome elements corresponding to its symptoms.Count frequency of the top 7 syndromes, the top 6 characteristic-syndrome elements and the top 3 bit-syndrome elements, and to understand its distribution. The symptom's frequency ranking in the top 10 (if the same frequency, extended to the same bottom) identified as common symptoms, the symptoms of high frequency can basically reflect the features of its corresponding syndromes, syndrome elements; by Binary Logistic Regression Analysis, the symptoms with more larger contribution can basically reflect the features of its corresponding syndrome elements.6. TCM theory interpret the results of factor analysisFactor analysis method to extract 39 common factors, which reflects the main syndrome elements are qi deficiency, yin deficiency, blood stasis, yang deficiency, water retention, heart, kidney, spleen, lung.7. TCM theory interpret the results of hierarchical cluster analysisUsed two forms of 0,1,2,3 and 0,1, respectively, hierarchical cluster analysis method to cluster all the symptoms, which reflects the main syndrome elements are qi deficiency, yin deficiency, blood stasis, yang deficiency, water retention, heart, kidney, spleen, lung.Objective:Based on three perspectives of modern literature research, clinical cross-sectional epidemiological survey and findings of unsupervised data analysis methods, in order further to find distribution rule of common syndromes, syndrome elements of chronic heart failure with coronary heart disease, and the corresponding relationship between syndromes/syndrome elements with its symptoms.Methods:Frequency analysis, logistic regression analysis, unsupervised analysis (factor analysis, hierarchical cluster analysis).Results:The syndromes, syndrome elements results of modern literature research and clinical cross-sectional epidemiological investigation form frequency analysis, factor analysis, cluster analysis in a strong consistency. Especially, the distribution rule of syndrome elements consistent much more strangely. But the results of symptoms of its syndrome elements in the frequency analysis and logistic regression analysis are in the poor performance. Because three results of frequency analysis, logistic regression analysis, and frequency analysis compared with logistic regression analysis are not exactly the same. The same symptoms of its syndrome elements may be have some contact, which may reflect the core symptoms of its syndrome elements, and can be interpreted by TCM theory. But some symptoms are still can not fully explain the contact between it with its syndrome elements.1. On modern literature research, specifying the name, there are 145 symptoms,43 syndromes,23 syndrome elements. On clinical cross-sectional epidemiological research, there are 170 symptoms,39 syndromes,25syndrome elements. Factor analysis and hierarchical cluster analysis included 110symptoms, after anglicizing; there are 31 syndromes and 21 syndrome elements.2. The syndromes, syndrome elements of coronary heart disease with chronic heart failure, whose results of modern literature research and clinical cross-sectional epidemiological investigation form frequency analysis, factor analysis, cluster analysis in a strong consistency. Especially, the distribution rule of syndrome elements consistent much more strangely.3. The results of symptoms of its syndrome elements in the frequency analysis and logistic regression analysis are in the poor performance. Because three results of frequency analysis, logistic regression analysis, and frequency analysis compared with logistic regression analysis are not exactly the same.4. Through a comparative study of variety of statistical methods, the rustles as follow:4.1 The core and most commonly syndromes of coronary heart disease with chronic heart failure are syndrome of deficiency of qi and blood stasis, syndrome of heart yang deficiency, fluid retention syndrome, syndrome of deficiency of both qi and yin.4.2 The core and most commonly syndrome elements of coronary heart disease with chronic heart failure are yang deficiency, qi deficiency, blood stasis, water retention, yin deficiency, phlegm; heart, kidney and lung.4.3 The core and most commonly symptoms of coronary heart disease with chronic heart failure are heart palpitations, shortness of breath and difficulty breathing. The core symptoms of its syndrome elements:yang deficiency:lower extremity edema, tongue color white, tongue body fat; qi deficiency:spiritlessness, fatigue; blood stasis:dark red tongue, tongue with petechiae, cyanosis of lips; water retention:leg edema, moss color white, foam sputum; deficiency:night sweats, dry mouth; phlegm:cough, chest tightness; heart:heart palpitations, lower extremity edema; renal:oliguria.4.4 Using the factor analysis method, clustering analysis, the author discusses and confirmed that there are certain symptoms between data, namely, the inner link with "symptoms symptoms often combination" form, with the aid of the TCM theory can be interpreted. These "symptoms" popular "group" understanding for syndrome or syndrome factor.5. On the basis of modern literature research with a clinical multi-center, larger sample cross-sectional epidemiological survey, the results of which have certain representativenesses. All these can provide reference and basis for the further development of distinguish coronary heart disease with chronic heart failure syndrome elements as the core elements of diagnostic criteria.6. The sample size of this research is small; and there are other methods are not yet beginning. The work to compile statistics clinical physical and chemical indicators is continuing, and a lot of information need further explore, so the above result also need to further verification.
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