| Ischemic diseases of lower limbs include arteriosclerosis obliteration of lower limbs, thrombosis obliteration vasculitis of lower limbs and ac ute arterial embolism in diabetic feet, three of which belong to toe gang rene in Chinese medicine. As for clinical symptoms, they all have the thr ee-phase manifestations: the phase of nutritional disturbance, the phase of local ischemia and the phase of necrosis. Ever since a long time ago, people have accumulated copious experience on treating ischemic diseases of lower limbs, and have summarized many effective therapeutic methods. T his study combines modern scientific research methodology with mathematic al statistics methodology, and use clinical epidemiology/DEM method, math ematical statistics, weight calculation and cluster analysis to research the quantization of peri-operative Chinese medicine syndromes as well as the diagnosing standards, providing diagnosing evidence for determination of treatment based on pathogenesis obtained through differentiation of s ymptoms and signs in Chinese medicine in ischemic diseases of lower limbs, filling and perfecting theory basement of ischemic diseases of lower lim bs, and scientific, useful, and clinically easy-operative four methods of examination standards for Chinese medicine differentiation of symptoms a nd signs in ischemic diseases of lower limbs.By formulating retrospective clinical observation table, we collected 86 cases who have undergone operation in ischemic diseases of lower limbs and complied with the choosing standards; all the indicators of patients were input into the computer as variables, and SPSS database was establ ished by using SPSS 13.0 software. We did frequencies analysis of all the symptoms, tongue and pulse, and deleted those variables that had very low frequencies among the syndromes. Furthermore, we did cluster analysis to the symptoms, tongue and pulse of all the patients, and according to cluster center, all the indicators were divided into 4-6 kinds. Then we ana lyzed the main components of every kind, determined the major, minor and combining symptoms, summarized the representative symptoms, and induced the pattern of syndrome. In reference to therapeutic terminology of syndro me in Chinese medicine edited by Chinese medicine diagnosis research inst itution in Hunan Chinese medicine college and standard of diagnosis and curative effect of syndrome in Chinese medicine published by national Chinese medicine drug administration, and combining our practical observation, we specified the categorizing basement of Chinese medicine differentiati on of symptoms and signs; besides, we concluded the relatively scientific pattern of syndrome of ischemic diseases of lower limbs, based on the condition of the differentiation of symptoms and signs of cases collected in accordance with the formulation, accompanying conditions of every pattern of syndrome, and the relationship between distribution of pattern of syndrome and post-operational course.1. Collection of clinical symptoms and results of statistical analysis.1.1 There are 26 variables for symptoms of collected patients with ischemic diseases of lower limbs, among which dizziness, shortness of breath, fatigue, dry mouth, bitter mouth, anorexia, dry skin, muscle atrophy, and lip cyanosis often appear, with probability over 30%, while dry stools, swelling, limb numbness, tinnitus, reddish c omplexion, abdominal distension, soreness of waist and knee appear with lower frequency, with the probability below 15%.1.2 Tongue properties of patients who have done operation in ischem ic diseases of lower limbs mainly include pink, purple and dark red, with appearing probability 48.84%. 26.74%, and 32.56% respectively; coated tongue mainly include black, white and dark yellow, with appearing probability 61.63%, 50%, and 26.74% respectively; tongue pr operty pale, tongue body fat and coated tongue lack of saliva and smooth often have very low probability. Pulse tracings mainly show s mall pulse, wiry pulse, and slippery pulse, with appearing probabil ity 41.86%, 36.05%, and 24.42% respectively, while infrequent pulse, weak pulse, slow-irregular pulse and abrupt pulse have relatively low probability, below 11%.1.3 Analysis of major components by means of differentiation of sym ptoms and signs: major symptoms related to the first communal fact or include dizziness, syncope, shortness of breath, fatigue; major symptoms related to the second communal factor include plenty of sp utum, coated tongue white and slippery pulse; major symptoms relate d to the third communal factor include pale of face and lips, fatig ue, tongue property pale, coated tongue white, small pulse; major s ymptoms related to the fourth communal factor include fever, reddish complexion, dry stools, tongue property red, coated tongue yellow, frequent pulse; major symptoms related to the fifth communal factor include soreness of waist and knee, fatigue, shortness of breath, tongue property white, coated tongue white, weak pulse; major symp toms related to the sixth communal factor include numbness of limbs and trunk, tongue property purple and black, coated tongue dark ye llow, and wiry pulse.1.4 By means of K-means cluster analysis, combining the symptoms, tongue properties and pulse properties, and in accordance with thera peutic terminology of syndrome in Chinese medicine and standard of diagnosis and curative effect of syndrome in Chinese medicine, we can categorize five patters of syndrome: the pattern of deficiency of both QI and blood, the pattern of blood stagnancy due to deficiency of QI, the pattern of damp invasion of lower energizer, the partern of deficient cold, and the pattern of yin asthenia and toxic hot.2. Based on the patterns of syndrome in this study, analyze the colle cted cases in clinic.2.1 Overall conditions of differentiation of symptoms and signs: am ong the 86 cases in clinic who have taken operation in the ischemic diseases of lower limbs, 29 are divided into the pattern of defici ency of both QI and blood, accounting for 33.7%, 25 are divided into the pattern of blood stagnancy due to deficiency of QI, accounting for 29.1%, 12 are divided into the pattern of damp invasion of lower energizer, accounting for 14.0%, 16 are divided into the pattern of deficient cold, accounting for18.6%, and 4 are divided into the pattern of yin asthenia and toxic hot, accounting for 4.7%.2.2 Overlapping and accompanying conditions of every pattern of syndrome: seen form clinical differentiation of symptoms and signs, the pathogenetic conditions are relatively complicated in patients who have taken operation in ischemic diseases of lower limbs. Among the patients, 19 cases have the simple pattern deficiency of both QI and blood, 18 cases have the simple pattern of blood stagnancy due to deficiency of QI, 8 cases have the simple pattern of damp invasion of lower energizer, 4 cases have the simple pattern of deficient cold, and 1 case has the simple pattern of yin asthenia and toxic hot. 26 cases have combining patterns of syndrome, among whom 7 cases have deficiency of both QI and blood accompanied with blood stagnancy due to deficiency of QI, which is the most common type in combining patterns, 4 cases have blood stagnancy due to deficiency of QI accompanied with damp invasion of lower energizer, 8 cases have deficiency of both QI and blood accompanied with deficient cold, and 2 cases have deficiency of both QI and blood accompanied with yin asthenia and toxic hot.2.3 The relationship between distribution of pattern of syndrome and course of disease after operation in ischemic diseases of lower limbs: the patterns of blood stagnancy due to deficiency of QI, damp invasion of lower energizer and yin asthenia and toxic hot are closely related to the course of disease (P＜0.01); as the disease develops, the above three patterns gradually reduce; the pattern of deficiency of both QI and blood and the pattern of deficient cold often appear ten days after the operation.Conclusion:In the opinion of Chinese medicine, changing principles of "evil factor" and "healthy energy" in peri-operative period, are that if the evil factor is flourishing before operation, the healthy energy is also flourishing; if the evil factor is got rid of after operation, the healthy energy is also deficient. As a result, after the operation, the overall treatment principles are mainly concentrating on strengthening the healthy factor, assisted by getting rid of the evil factor. Under the guide of integrated concept, with the core of determination of treatment based on pathogenesis obtained through differentiation of symptoms and signs, Chinese medicine emphasizes analyzing pathogenetic conditions of diseases completely, globally and systemically, resolving the symptoms, and targeting on treating the essence of diseases. For patients who have taken operation in ischemic diseased of lower limbs, they have deficient healthy energy, due to loss of QI and blood, caused by severe disease, long-tern disease and operation; they often have the pattern of deficiency of both QI and blood and the pattern of deficient cold, because loss of QI and injury of yin cause the damage of spleen and stomach, which in turn, causes the dysfunction of transporting and digesting food, resulting in lack of starting material for making QI and blood, and disturbance of distribution of fluid; patients are often seen the pattern of blood stagnancy due to deficiency of QI, because deficient QI and powerlessness causes the dysfunction of blood circulation after the operation; in addition, patients are also seen the patterns of damp invasion of lower energizer, blood stagnancy due to deficiency of QI and yin asthenia and toxic hot, because the toxic heat has accumulated in the body for a long time, and it can not be expelled in a short period after the operation.According to the mentioned above, we conclude the clinical therapeutic method for patients who have undergone the operation in ischemic diseases of lower limbs, which mainly focuses on nourishing QI and blood, warming yang and eliminating cold, activating blood circulation to dissipate blood stasis, and clearing away heat evil and promoting diuresis, assisted by removing blood stasis, eliminating stagnation and detoxication, in order to strengthening the healthy energy and getting rid of the evil factor. |
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