Study On Syndrome Elements, Syndrome Characteristics And Syndrome Evolution Law Of Coronary Heart Disease

Purpose:This research are the survey results about 1218 pieces of clinical expert questionnaire of coronary heart disease syndrome factors?syndrome features?syndrome pathology evolution rules on the six regions, recorded 3d structural correlation database, use various data mining and mathematical statistic methods such as frequency, cluster, decision tree, neural network and the probability transfer matrix etc.to analysis and clear the judgment standards of coronary heart disease syndrome factors, confirm that sentiment, deficient lung system qi, deficient spleen system qi, deficient heart system Yin and deficient kidney system Yin are mainly syndrome factors, clarify their functions during all phases of coronary artery disease and corresponding syndrome relationships with different syndromes, Clear syndrome characteristics of coronary heart disease in each period, also the internal evolution rules among syndromes of the development in each phase.Material and method:Use the TCM and western medicine guides and advices about coronary heart disease for diagnostic criteria, based on large literature studies and experts advices, the theory of modern psychological measurement, decision-making with structural ways and the scale study methods to develop the clinical expert questionnaire of coronary heart disease syndrome factors?syndrome features?syndrome pathology evolution rules. Use three rounds Delphi method to modify, add, delete and adjust the content of the questionnaire repeatedly, in order to ensure the items and contents of questionnaire response clinical symptoms and signs of coronary heart disease accurately, and then after the questionnaire the reliability and validity evaluation were excellent, the large sample of clinical experts investigation will begin in many centers.The questionnaire will send to six regions, they are the Northeast (Shenyang), North of China (Beijing), Northwest (Lanzhou, Xining) , Southeast (Guangzhou), Southwest (Chongqing), South of China (Shanghai), and a total of 41 hospital clinical doctors to be surveyed. At last, we collected 1218 qualified questionnaires. Use the computer equipment to establish the Access questionnaire database, input qualified questionnaire and second check, then build the clinical expert questionnaire 3d structural correlation database of coronary heart disease syndrome factors?syndrome features?syndrome pathology evolution rules eventually. Basing on SAS statistical analysis software, we analyse the data using frequency, decision-making tree, the nerve network, structure, probability transfer matrix and so on.Results:1.Main coronary heart disease syndrome factors in the four stages of frequency results:Yang heart syndrome factor in four phases (early onset period,paroxysm period,remission period,recovery period)frequency distribution as follows: 61%,90%,71%,41%;Phlegm retention for:78%,96%,76%,61%;Blood stasis:58%,83%,66%,51%.Gradually increased frequency in early and paroxysm period,and general equilibrium decline in remission and recovery period,show the changes the development trend from vigorous to failure.2. Relationships of major coronary heart disease syndromes and syndrome factors by statistic results show: The syndromes frequency distribution of sentiment, deficient lung system qi, deficient spleen system qi, deficient heart system Yin and deficient kidney system Yin syndrome factors are among 3.14% -100% in each stage. Conversely, each stage Syndrome frequency distribution in syndrome factors of sentiment, deficient lung system qi, deficient spleen system qi, deficient heart system Yin and deficient kidney system Yin are among 5.14% -78.82%.3. The decision tree results show:The judgment rules of Coronary heart syndrome main factors of Yang heart?phlegm retention?blood stasis in the four stages of coronary heart disease,neural network training,the forecast effect is consistent with that,whether training sets or set of evaluation?test sets accuracy reached 58%-94% between.4. With cluster method to analyse the database, we summarize the syndromes features of four periods and twelve types, they are the early onset period consisted of Qi open-minded syndrome and Qi and Yin deficiency syndrome; paroxysm period contained Qi stagnation and phlegm obstruction syndrome, Yang malaise heart syndrome, Cold coagulation heart vessel syndrome and Blood stasis Yang syndrome; remission period consisted of Liver and spleen no coordination syndrome, yang deficiency of heart and kidney syndrome and cardiopulmonary Qi deficiency syndrome; recovery period have Heart Qi deficiency syndrome, Yang deficiency and Qi stagnation syndrome and Qi and Yin deficiency syndrome.5. Transition probability matrix derived evolution of the syndrome is5.1 Early onset period?paroxysm period:Qi open-minded syndrome(64.9%)?Yang malaise heart syndrome; Qi open-minded syndrome(21.96%)?Qi stagnation and phlegm obstruction syndrome;Qi and Yin deficiency syndrome(41.34%)?Yang malaise heart syndrome;Qi and Yin deficiency syndrome(21.02%)?Qi stagnation and phlegm obstruction syndrome;Qi and Yin deficiency syndrome(20.32%)?Cold coagulation heart vessel syndrome;Qi and Yin deficiency syndrome(17.32%)?Blood stasis Yang syndrome?So, the law of early onset period to paroxysm period is that all syndromes are easy to permit the development of Yang malaise heart syndrome and Qi stagnation and phlegm obstruction Syndrome.5.2paroxysm period?remission period:Yang malaise heart syndrome(55.64%)?cardiopulmonary Qi deficiency syndrome;Yang malaise heart syndrome(34.87%)?Liver and spleen no coordination syndrome;Qi stagnation and phlegm obstruction Syndrome(42.76%)?cardiopulmonary Qi deficiency syndrome;Qi stagnation and phlegm obstruction Syndrome(30.92%)?yang deficiency of heart and kidney syndrome;Qi stagnation and phlegm obstruction Syndrome(26.32%)?Liver and spleen no coordination syndrome;Blood stasis Yang syndrome(66.67%)?cardiopulmonary Qi deficiency syndrome;Blood stasis Yang syndrome(19.35%)?yang deficiency of heart and kidney syndrome;Blood stasis Yang syndrome (13.98%)?Liver and spleen no coordination syndrome;Cold coagulation heart vessel syndrome(91.43%)?cardiopulmonary Qi deficiency syndrome?The law of paroxysm period to remission period is that all syndromes are easy to development of cardiopulmonary Qi deficiency syndrome;Yang malaise heart syndrome is easy to development of Liver and spleen no coordination syndrome,Qi stagnation and phlegm obstruction Syndrome is easy to development of yang deficiency of heart and kidney syndrome.5.3remission period?recovery period:cardiopulmonary Qi deficiency syndrome(61.72%)?Qi and Yin deficiency syndrome;cardiopulmonary Qi deficiency syndrome(22.72%)?Yang deficiency and Qi stagnation syndrome;cardiopulmonary Qi deficiency syndrome(15.56%)?Heart Qi deficiency syndrome;Liver and spleen no coordination syndrome(72.08%)?Yang deficiency and Qi stagnation syndrome;Liver and spleen no coordination syndrome(19.8%)?Qi and Yin deficiency syndrome;yang deficiency of heart and kidney syndrome 46.97%)?Yang deficiency and Qi stagnation syndrome;yang deficiency of heart and kidney syndrome(28.03%)?Qi and Yin deficiency syndrome;yang deficiency of heart and kidney syndrome(25%)?Heart Qi deficiency syndrome;The law of remission period to recovery period is that all syndromes are easy to development of cardiopulmonary Qi deficiency syndrome is easy to development of Qi and Yin deficiency syndrome,Liver and spleen no coordination syndrome and yang deficiency of heart and kidney syndrome is easy to development of Yang deficiency and Qi stagnation syndrome.Conclusion:1. Syndrome factorsThe analysis results of Frequency distribution show that the main coronary heart syndrome factors including sentiment, deficient lung system qi, deficient spleen system qi, deficient heart system Yin and deficient kidney system Yin, and gradually increased in early and paroxysm period, general equilibrium decline in remission and recovery period. The decision trees play an important role in order research on importance of variables, combinations with syndrome factors and syndrome corresponding. That can tell the influence between different syndrome variables and syndrome factors clearly, also which syndrome factors affect in the process of coronary artery disease. It plays a guiding part in clinical diagnosis and treatment. Neural network can judge for predictions of syndrome factors model that guarantee the feasibility of experiments, while ensuring extrapolating of regulation.2. Symptoms distributionAll variables in the questionnaire for coronary heart disease by statistical methods of frequency distribution, drawing their histograms about different stages with all items,analyzing the dynamic changing mechanism of each variable in different stages dialectically with theory of TCM. The results show that the majority of variables concentrate from early to paroxysm period with illness aggravating, but gradually decrease from remission to recovery period with light tendency. The change is according with the clinical manifestations of coronary heart disease that provides theoretical basis and data support for inducting syndromes features and evolution regulation.3 syndrome featuresWith cluster method to analyse the database, we summarize the syndromes features of four periods:?early onset period: Qi open-minded syndrome, Qi and Yin deficiency syndrome.?paroxysm period: Qi stagnation and phlegm obstruction syndrome, Yang malaise heart syndrome, Cold coagulation heart vessel syndrome and Blood stasis Yang syndrome.?remission period: Liver and spleen no coordination syndrome, yang deficiency of heart and kidney syndrome and cardiopulmonary Qi deficiency syndrome.?recovery period: Heart Qi deficiency syndrome, Yang deficiency and Qi stagnation syndrome and Qi and Yin deficiency syndrome. That enriches the content of coronary heart disease syndromes.4 Qi(Yang) difficiency and sentiment factorsQi (Yang) difficiency and sentiment factors run through the whole coronary lesions, which is high proportion of the frequency distribution in each stage, among that sentiment factor reach over 95%.Also each stage consists of syndromes major in Qi(Yang) difficiency and sentiment factors during the development of coronary heart disease,such as Qi open-minded syndrome and Qi and Yin deficiency syndrome in early onset period, Qi stagnation and phlegm obstruction syndrome and Yang malaise heart syndrome of paroxysm period , Liver and spleen no coordination syndrome and cardiopulmonary Qi deficiency syndrome in remission period and Yang deficiency and Qi stagnation syndrome and Qi and Yin deficiency syndrome of recovery period.That indicated both Qi(Yang) difficiency and sentiment factors are primary factors in coronary artery disease,so pays attention to the self regulationg and protect self Qi(Yang) can reduce the disease come out.5 spleen and stomach symptomsThere are mang digest symptoms of different degrees in each syndrome of different stages, such as abdominal fullness and distention, gastral cavity flatulence, retching, nausea and vomiting, inappetence, hiccups or belch etc. Heart and spleen are linked together with meridians, whose relationship is mother and son, connected with ZongQi, so spleen and stomach's wrong can lead to heart disease also caused by it. They are reached on the principles of the name called "stomach heartache" (?Neijing?) and deficiency treatment of Chest pain with "ginseng soup" (?Jinkuiyaolue?)by ancients.6 syndrome evolution rules6.1 analyze them according to constituent ratio of every stage's syndromes Constituent ratio of each stage syndromes from high to low in order are:?early onset period: Qi open-minded syndrome, Qi and Yin deficiency syndrome.?paroxysm period: Qi stagnation and phlegm obstruction syndrome, Yang malaise heart syndrome, Cold coagulation heart vessel syndrome and Blood stasis Yang syndrome.?remission period: Liver and spleen no coordination syndrome, yang deficiency of heart and kidney syndrome and cardiopulmonary Qi deficiency syndrome.?recovery period: Heart Qi deficiency syndrome, Yang deficiency and Qi stagnation syndrome and Qi and Yin deficiency syndrome. That enriches the content of coronary heart disease syndromes. 6.2 analyze used by transition probability matrix?rules of development from early to paroxysm period: a. Qi and Yin deficiency syndrome to Yang malaise heart syndrome,Qi stagnation and phlegm obstruction syndrome and Cold coagulation heart vessel syndrome.B.Qi open-minded syndrome to Yang malaise heart syndrome and Qi stagnation and phlegm obstruction syndrome.?rules of development from paroxysm to remission period: all syndromes develop to cardiopulmonary Qi deficiency syndrome easily, Yang malaise heart syndrome goes to Liver and spleen no coordination syndrome,also Qi stagnation and phlegm obstruction syndrome easily develops to Liver and spleen no coordination syndrome and yang deficiency of heart and kidney syndrome both.?rules of development from remission to recovery period: all syndromes develop to Yang Qi and Yin deficiency syndrome and deficiency and Qi stagnation syndrome easily, yang deficiency of heart and kidney syndrome goes to Heart Qi deficiency syndrome.7 characteristics of TCMAccording to the frequency distribution and development regularity we found: coronary heart disease is the center of heart, involving in lung, spleen, liver and kidney as the lesions mode of five zang-organs related, whose various kinds of syndrome factors'performance of cold, phlegm, qi, blood stasis, deficiency etc. that cross reciprocal and interact as both cause and effect on the human body, manifestate dysfunction of viscera. Therefore, we should not depart from heart, ends with heart and ignore it meanwhile in clinical treatment of TCM.