Liver And Spleen Are Not Adjusted Syndrome Structure And Stratification Of Clinical Research,

This research aims to study on the hierarchical structure of the symdromes of Traditional Chinese Mmedicine (TCM),whose descriptions is not normalized, the level is inconsistent and the content is general. Under the symdromes theory guidance, take the syndrome of disharmony of liver and spleen (DLS syndrome) as an example, we proposed that the syndrome hierarchy delaminate by the diseased locations , disease nature , disease tendency , pathological factors , accompanied syndromes and signs , degree of seriousness of an illness. we make symdrome differentiation deeper, more detailed and normalized by the probing researches. Meanwhile, we bring the principle and methods to treat the syndrome. The main content of the thesis is as follows.Partâ… The study of the syndrome structure and syndrome hierarchy theory.We have a survey of the syndrome researches and propose the principles and methods of syndrome hierarchy research.The syndrome is the entire reflection of the human physiology pathological state, it has the feature of 'inner reality outside deficiency, developing by space-time, many dimensions interface'. In the syndrome standard perspective, it has worked out a national standard and "the guide rule of traditional Chinese Medicine new drug clinical research" and so on. Using modern science knowledge and technologies, some researchers have carried out the study of the essence of the syndrome , the study of the syndrome animal models, and the study of syndrome elements in the field of syndrome structure.Many scholars regard that syndrome has characteristic of multiple echelons, such as cause of a disease layer, disease location layer, disease nature layer, disease tendency layer, some researchers offered the thought of three layers of syndroms, namely the theoretical syndrome, the group syndrom and the specific syndrom. Prof Fang Yaozhong put forward the five steps of syndrome differentiation.Guided by syndrome theories, the hierarchical syndrome discrimination method is a three layers operating approach is stratifies, the first layer is disease location layer to distinguish the patient's internal organs, channel and subsidiary channel lacations and so on; The second layer is disease nature, to distinguish the attributes ,such as heat and cold, excess syndrome or deficiency one combined with the disease location; The third layer is disease tendency, pathological factors, accompanied syndromes and signs, and degree of seriousness of an illness. We raise that the syndrome unit is the smallest granularity in the Syndrome hierarchy differentiation , the syndrome unit is different from the syndrome element ,the syndrome element has more small granularity size ,and the general syndrome consists of one or more syndrome units . T he syndrome unit is more conform to the treatment methods and drugs.Taking DLS syndrome as an example, we study the syndrome hierarchy differiencation based on the summary of the connotation and epitaxy. Partâ…¡The study of the symptom structure characteristic of disharmony of liver and spleen syndrome1. The data and methodThe study is mainly based on the national standard and combining the diagnoses of TCM physicians. The clinical cases include: the outpatient data (378 cases with 665 examine times) that is observed by myself and my director), the outpatient data (522 examples with 1110 examine times scattering in 18 provinces and autonomous cities) that is observed by famous TCM veteran physicians and the ancient TCM cases (68 examples with 95 examine times).We use structured electronic medical record system to collect the clinical information in structured data, and establish the data warehouse platform , which integrates WEKA, BusinessObjects, Oracle Data Miner, SPSS, etc. to achieve the functionalites of on-line Analytical processing (OLAP), association rules, cluster analysis, differentiate analysis, complex network, and so on.We found that the common symptoms of the disharmony of liver and spleen syndrome is wiry or thready pules, white or yellow thin tongue coating, dark tongue, swallow tongue, poor sleep, poor appetite, abdominal distention, stomach pain, and so on. The sample clustering analysis (SPSS twe-step clustering) showed that the positioning and qualitative characteristics of the symptoms could be classified.2. Studying on the diagnostic criteria of syndrome of disharmony of liver and spleen based on support vector machinesSupport vector machines is the general best classification method of machine learning. We have determined the main symptoms to support the diagnosis of this syndrome, which are blue complexion, pain or distention in the hypochondrium, stomach oppression, fatigue, abdominal fullness, sallow complexion, abdominal pain, weak pulse, hematemesis, belching, gastric distention, stomach pain, bad appetite, restless, impatient irritability or depression, and greasy tongue coating wiry pulse, weak pulse and the small veins. These symptoms may play an important role in diagnostic criteria.Partâ…¢The study of the syndrome hierarchy differentiation methods of DLS syndromeBy analyzing the syndrome element features of DLS syndrome we sum up the syndrome characteristics of various levels, and then conduct the research on the syndrome hierarchy differentiation.1. Structural characteristics of DLS syndromeThe main accompanied syndromes are blood stasis, dampness, damp heat, phlegm, toxic heat, stasis toxic, fluid retention, disharmony of liver and stomach, liver Yin deficiency, kidney Yin deficiency, blood deficiency, kidney Qi deficiency, kidney-yin deficiency, deficiency and coldness of spleen and stomach, disharmony of Qi and blood, cold-heat complex, mental disturbance et al. Generated by the association rules method of Weka software, the results show that the merger of clinical syndromes are the main accompanied syndromes are fluid retention, Qi stagnation and blood stasis, liver Yin and kidney Yin deficiency, damp heat, toxic heat and blood stasis, Qi Yin, deficiency of Qi and blood and so on.2. Frame and method of syndrome hierarchy differentiation of DLS syndromeAccording to the theories of the syndrome hierarchical differentiation, weanalyzing the syndrome hierarchy of DLS syndrome, meanwhile we establish the data transformation methods for the syndrome hierarchy research.3. Syndrome hierarchy differentiation of DLS syndrome3.1 identify disease locationsIt's the first step to identify disease location of syndrome hierarchy differentiation .Besides liver and spleen, it often involves the stomach (27.58%), kidney (7.23%), heart (12.17%), lungs, intestines, gall bladder, and so on, as disease locations. More located in the Qi and easy to blood, up to the upper orificeson and dowm to the lower-JIAO, the uterus and DAI meridian, outward to Wei, lung, and skin. But it rarely involves pericardium and bladder.3.2 Identify disease natureThe disease nature mainly prefer to the cold and heat,defiency and excess .Described the nature clearly one of cold and heat or excess and deficiency at least 80.58% of the cases, the total consulting times of 79.57%.The cases with clearly stated cold and heat attribute is only 20.72% of the total cases, and 18.72% of the total consulting times. Heat syndrome was more than cold syndrome, which is about five times of the cold syndrome. It means that it is very common for Liver Qi Depression or stagnation of other pathological product to turn into fire. The cold-heat complex syndrome is also visible.Excess and deficiency syndrome occupied 80.48 percent of the cases, and 79.52 percent of the consulting times. Deficiency syndrome mingling with excess syndrome account for 395 cases (40.81%), and over 772 consulting times (41.28%). Deficiency syndromes have the different varieties of deficiency of Yin or Yang, deficiency of Qi or blood, Qi deficiency is most common, followed by Yin deficiency, blood deficiency andYang deficiency. Identify disease nature should combined with identifying disease locations.3.3 Identify pathological factors and accompanied syndromesRecords of tendency of disease are less. It is only 22.83 percent of the cases and 18.50 percent of the total consulting times. The main aspects are transformation of disease location, conversion of the disease nature and generating other pathogenic factor such as sputum, dampness, retention of food and so on.There are 19.32 percent of cases and 15.83 percent of consulting times records with accompanied syndromes. They are disharmony of stomach Qi, kidney deficiency, deficiency of heart Qi, Exogenous and blood stasis, etc. The kind of accompanied syndromes are closely related to the disease location.The main pathogenic factors of DLS syndrome are Qi stagnation, blood stasis, dampness, heat, fluid retention and the exogenous wind-evil.3.4 Differentiation of the degree and levels of syndromeOnly 3% of the total cases have the records of quantitative information of the syndrome, which only have semi-quantitative descriptions for spleen deficiency, blood stasis, dampness, damp heat and so on. However, quantitative information is retained entirely in the related prescriptions.This research explored a method of visual expression based on the effectiveness of Chinese herbs, ingredients and dosage in the prescriptions.According to ingredients, dosage ratio and proportion, the symptoms and herbs are different in the light of severe of the dampness syndrome and severe spleen deficiency syndromes. The results suggest that the ingredients or proportion in a prescription and dosage are different in the cases of different severity of the syndromes.4. Treatment of DLS syndromeThe general treatment approach of DLS syndrome is coordinating liver and spleen. The related core prescription is: Chaihu , Fuling , Baishu , danggui , baishao , gancao (prepared or unprepared) , Chenpi , Banxia , danshen , zhiqiao , dangshen , accompanied by the appropriate prescription modifications according to accompanied syndromes .We have a summary of the treatment of different accompanied syndromes and different disease of DLS syndrome.This thesis discussed the principles and methods of the syndrome hierarchical differentiation of DLS syndrome systematically ,enriched the theory of the syndrome differentiation of DLS syndrome,and also provided a hierarchical way, example and technological guidance. It is an exploratory research about the thinking way of syndrome differentiation. The database and the OLAP system of DLS syndrome cases have been established. We have explored the methods and principles, such as data mining technology, "syndrome -treatment" close connections, combined with clinical observation, "man-machine combination ", to conduct the syndrome research. It will be a methodology demonstrating case for other related syndrome researches.