| Objective:This study is to make a retrospective study of carotid atherosclerosis(CAS) TCM syndrome distribution law. Analysis on related indexes and influencing factors of CAS is to find more suitable TCM clincal therapeutic principle for CAS TCM syndrome. Clinical study of nourishing kidney and promoting blood circulation method purport to be about the exploration for TCM treatment.Method:This study was made with CAS clinical patient history as an investigation object,which were based on TCM syndrome using methods of epidemiology. These are attempts to give objective CAS law of TCM syndrome distribution and give evidence to CAS Syndrome standardization study. Syndrome distribution law study used retrospective method, investigated298cases of CAS patient, collected general clinical data, data of symtoms, and frequency of syndrome, use statistical comparative analysis, explore the CAS of syndrome distribution law and study correlation between related indexes and influencing factors. In the third section of nourishing kidney and promoting blood circulation method is to study etiology and pathogenesis of TCM, which motivate us to find very best therapeutic principle and herbs. Every treatment group and control group collected40cases each, cases were collected treatment group by outpatient and control group by the medical record review. All the data were analysed by descriptive analysis, mean number difference analysis, Mann-Whiteney U test, t-test, X--test, Logistic regression analysis using SPSS18.0statistical software package.Result:1. The frequency order of different TCM syndrome group was as follows, sputum stasis syndrome+qi stagnation and blood stasis syndrome+deficiency syndrome of both liver and kidney yin group117cases> sputum stasis syndrome+qi stagnation and blood stasis syndrome group85cases> qi stagnation and blood stasis syndrome+deficiency syndrome of both liver and kidney yin group47cases> sputum stasis syndrome+deficiency syndrome of both liver and kidney yin group30cases,etc.2. Sputum stasis syndrome group compared with other groups of carotid ultrasound. TCD,related index.using t-test show that left side plaque length. right side middle cerebral artery,right side anterior cerebral artery t-value was positive value (P<0.05or P<0.01)3. Qi stagnation and blood stasis syndrome group compared with other groups of carotid ultrasound, TCD,related index,using t-test show that apolipoproteinB, t-value was negative-value(P<0.05).4. Deficiency syndrome of both liver and kidney yin group compared with other groups of carotid ultrasound, TCD,related index,using t-test show that right side anterior cerebral artery, left side anterior cerebral artery, right and left side siphon degment of carotid artery, t-value was negative-value (P<0.05or P<0.01) and about the related index shows that systolic blood pressure and blood glucose t-value was positive-value(P<0.05).5. Sputum stasis syndrome+qi stagnation and blood stasis syndrome group compared with other groups of carotid ultrasound, TCD,related index,using t-test show that right and left side middle cerebral artery t-value was positive-value(P<0.05) and abut the related index shows that total cholesterol, very low density lipoprotein, apolipoproteinB t-value was negative-value (P<0.05).6. Sputum stasis syndrome+deficiency syndrome of both liver and kidney yin group compared with other groups of carotid ultrasound, TCD,related index,using t-test show that left side vertebral artery was positive-value(P<0.05) and about the related index shows that systolic blood pressure t-value was positive-value(P<0.05).7. Qi stagnation and blood stasis syndrome+deficiency syndrome of both liver and kidney yin group compared with other groups of carotid ultrasound, TCD,related index,using t-test show that right and left side anterior cerebral artery t-value was negative-value(P<0.05or P<0.01) and about the related index shows that age, systolic blood pressure t-value was positive-value(P<0.05).8. Sputum stasis syndrome+qi stagnation and blood stasis syndrome+deficiency syndrome of both liver and kidney yin group compared with other groups of carotid ultrasound, TCD,related index,using t-test show that left side vertebral artery was positive-value(P<0.05) and about the related index shows that age, systolic blood pressure t-value was positive-value(P<0.05).9. Four different TCM syndrome groups of carotid ultrasound used one-way Anova method to compared each other and show that among the four different types of syndrome groups plaque has no difference (P>0.05), also shows that compare between sputum stasis syndrome+qi stagnation and blood stasis syndrome group with sputum stasis syndrome+deficiency syndrome of both liver and kidney yin group t-value was negative-value(b> a;P<0.05).10. Sputum stasis syndrome of logistic regression analysis show that coronary atherosclersis P=0.000,OR=4.193, has positive correlation.11. Qi stagnation and blood stasis syndrome of logistic regression analysis show that lacunar cerebral infarction P=0.012,OR=0.383, has negative correlation.12. Deficiency syndrome of both liver and kidney yin of logistic regression analysis show that diabetes P=0.020,OR=1.881, hyperlipidemia P=0.046,OR=1.995, lacunar cerebral infarction P=0.006,OR=2.149, has positive correlation and also shows that coronary atherosclersis P=0.001,OR=0.362, has negative correlation.13. Sputum stasis syndrome+qi stagnation and blood stasis syndrome group of logistic regression analysis show that coronary atherosclersis P=0.002, OR=2.486, has positive correlation and also shows that lacunar cerebral infarction P=0.012,OR=0.480, has negative correlation.14. Sputum stasis syndrome+deficiency syndrome of both liver and kidney yin group of logistic regression analysis show that lacunar cerebral infarction P=0.023,OR=1.803, has positive correlation.15. Qi stagnation and blood stasis syndrome+deficiency syndrome of both liver and kidney yin group of logistic regression analysis show that hyperlipidemia P=0.009,OR=2.374,ageP=0.019,OR=1.033, has positive correlation.16. Sputum stasis syndrome+type of qi stagnation and blood stasis+deficiency syndrome of both liver and kidney yin group of logistic regression analysis show that all the variable factors are OR=1, it means that variable factor have no effect on CAS TCM syndrome group.17. The clinical effect of nourishing kidney and promoting blood circulation method on CAS patient show that treatment group of before and after treatment of plaque length and thickness t-value was positive-value(P<0.05). control group of before and after treatment of plaque length and thickness t-value was negative-value(P<0.05),showed statistical difference. Conclusion:1. Sputum stasis syndrome+qi stagnation and blood stasis syndrome+deficiency syndrome of both liver and kidney yin group117cases has the highest incidence of different TCM syndrome groups.2. Empirical syndrome’s like sputum stasis syndrome or qi stagnation and blood stasis syndrome are mostly have effect on CAS and cerebral arteriosclerosis.3. Deficiency syndrome’s like deficiency syndrome of both liver and kidney yin group are mostly have effect on age, hypertension, diabetes, hyperlipidemia.4. Among the four different TCM syndrome groups of plaque thickness has no difference each other. It is likely to think that plaque thickness is made of three syndrome factors which is participated by Sputum stasis syndrome, qi stagnation and blood stasis syndrome, deficiency syndrome of both liver and kidney yin group.5. Influencing factors of sputum stasis syndrome:Coronary atherosclersis.6. Influencing factors of qi stagnation and blood stasis syndrome:Lacunar cerebral infarction.7. Influencing factors of deficiency syndrome of both liver and kidney yin:Diabetes, Hyperlipidemia, Coronary atherosclersis, Lacunar cerebral infarction.8. Influencing factors of sputum stasis syndrome+qi stagnation and blood stasis syndrome:Coronary atherosclersis, Lacunar cerebral infarction.9. Influencing factors of sputum stasis syndrome+deficiency syndrome of both liver and kidney yin:Lacunar cerebral infarction.10. Influencing factors of qi stagnation and blood stasis syndrome+deficiency syndrome of both liver and kidney yin:Age, Hyperlipidemia.11. Nourishing kidney and promoting blood circulation method can reduce CAS plaque’s thickness.In this study, the main design of carotid atherosclerosis’s syndrome concluded to Sputum stasis syndrome,Qi stagnation and blood stasis syndrome and Deficiency syndrome of both liver and kidney yin group, which has therapeutic mode of strong pertinence.It is easier to find a proper herbs and therapeutic principle. It is very rare to see that TCM clinical syndrome shows only one single appearance.When you find to see only one syndrome appear and other syndrome not so obvious,that can be a syndrome differentiation first to be treated. But this can not be representing the whole idea of pathogenesis.In fact,one syndrome can not generalize all the CAS pathogenesis of TCM syndromes,just only compare to other syndromes,when one syndrome show prominent,then this syndrome differentiation is just a temporary medical differential mode of all the pathologic stages. Therefore,when doctors are in a TCM clinic practice,you have to use the proper TCM therapeutic mode to obtain the ideal effect. Generally, CAS gets larger as the increasing of age,which is long-term interference of metabolic disorder.According to TCM syndrome differentiation theory,sputum,blood stasis and deficiency syndromes are summarized as the core evolution law of CAS.These representative three syndromes of etiology and pathogenesis can make mutual transformation. Therefore, CAS syndromes mostly appears in the form of two or three syndromes together. In this research shows the most high requency of the three combination of Sputum stasis syndrome+Qi stagnation and blood stasis syndrome+Deficiency syndrome of both liver and kidney yin. Therefore,CAS is the result of sputum,blood stasis and deficiency syndromes’ interaction.The result of correlation between Sydromes and Influencing factors are made by Logistic retrospective analysis.which is made after analyzing the total frequency of all types of each syndrome combination.Therefore, Influencing factors can indicate a certain stage or composition of CAS syndrome.Also,in the help of inspection, auscultation-olfaction,interrogation and palpation method can strengthen accuracy of syndrome differentiation and treatment.It means that these Influencing factors can make the part of new form of syndrome differentiation method.In addition, some research reports shows that Sputum stasis syndrome of arteriosclerosis(AS) has much higher concentration of VLDL,LP than Deficiency syndrome of both liver and kidney yin. Sputum stasis syndrome of arteriosclerosis(AS) clearly related to hyperlipidemia,but this research shows that Deficiency syndrome of both liver and kidney yin has more influence on hyperlipidemia.This is because the results are analyzed by CAS distribution rules of manifestation.and this what makes more bigger influences on hyperlipidemia than to Sputum stasis syndrome of arteriosclerosis(AS).Therefore,I think that Sputum stasis syndrome and Deficiency syndrome of both liver and kidney yin all have influence on on hyperlipidemia.but after carotid plaque is formed. Deficiency syndrome of both liver and kidney yin has more correlated to lipid metabolism disorder than Sputum stasis syndrome.Self-made yishen huoxue decoction is made by blood stasis syndrome+ Deficiency syndrome of both liver and kidney yin combination.It is an effective treatment that can make reduce and stabilize Carotid plaque.Corresponding herbs to blood stasis syndrome are kudzu,tribulus,lumbricus, rhizomaligusticichuanxiong, salvia and corresponding herbs to Deficiency syndrome of both liver and kidney yin are radix polygoni multiflori preparata,ligustrum lucidum,wolfberry fruit. These herbs are not only have strong pertinence to each syndromes,and also modern medicine holds that these herbs have pharmacological action of lowering blood pressure,reducing blood lipid,hypoglycemic effect etc...Therefore this prescription has no contradiction between TCM thinking of syndrome differentiation and modern medicine. |
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