Clinical Research On Syndrome Factors Of Traditional Chinese Medicine Of Congestive Heart Failure

Specialty: Cardiology of Traditional Chinese MedicineAuthor: Liang Yun-yuTutor: Professor Zou XuBackgroundChronic heart failure (CHF) is definitely defined to a series of clinical synthesize, whose syndromes in traditional Chinese Medicine(TCM) and the syndrome-types marked diversity. Most of the research of syndromes in TCM emphasis is on the syndrome-types, but lacks to the analysis of syndromes in TCM or the summary of regulation. Professor Deng Tie-tao proposed the academic theoretic of "Interconnections between Five Viscera" and "Interconnections between Heart and Spleen", which achieved the great therapeutic effect in patients with CHF. Therefore, this research tries to scoop out internal characteristic of the CHF in a great deal of clinical information, and to investigate the main clinical characteristics of syndrome factors of TCM under different circumstance of the position and the function of CHF, to reveal the preliminary conclusion of "Interconnections between Five Viscera" and "Interconnections between Heart and Spleen", to help the doctors to make cure decision in categorical identification.ObjectiveTo investigate the main clinical characteristics of syndromes in TCM in patients with CHF, and focus on the position and the function of pathologic factors that related to "Heart" and "Spleen" under different period in CHF.MethodsThis research according to diagnosis standard and bring-into standard, 217 patients with CHF included hospitalization and outpatient were involved during in August, 2006～March, 2007. A questionnaire was inquired to investigate the characteristics of syndromes of TCM. To Set up the database about the information of TCM categorical identification. To withdraw each syndrome factor and make the statistic analysis by the way of index sign description, Principal components analysis and cluster analysis.Result1. The disease character factorsAdopting Principal components analysis, the first 18 factors Cumulative percentage is 68.422%, can reflect truely to original variables. The loss of appetite, pale, lazy speech have bigger capacity at the first factor; tongue-coating white, pale tongue have bigger capacity at the second factor; vein be circuit and purple under tongue, enlarged tongue, white phlegm, polyuria at night have bigger capacity at the third factor; cough with phlegm, pulse Xuan, pulse slippery, greasy fur on tongue have bigger capacity at the fourth factor; fatness has bigger capacity at the fifth factor; edema, oliguria have bigger capacity at the sixth factor; shortness of breath has bigger capacity at the seventh factor; emaciation has bigger capacity at the eighth factor; asthma, wipe pulse have bigger capacity at the ninth factor; turning around difficultly has bigger capacity at the tenth factor; insomnia has bigger capacity at the 11th factor; greasy fur on tongue has bigger capacity at the 12th factor; fatigue has bigger capacity at the 13th factor; vein expose on the neck, dark tongue quality have bigger capacity at the 14th factor; dizzy, palpitation has bigger capacity at the 15th factor; the chest stuffy has bigger capacity at the 16th factor; insomnia has bigger capacity at the l?th factor up; abdominal distension has bigger capacity at the 18th factor.29 symptoms above mentioned are divided 2 types. One type includes the particular symptoms in CHF, the other type are the symptoms that help to categorical identification. Under cluster analysis, the first type symptoms as follows: asthma, edema and fatigue belong to a cluster; palpitation, blue vein revelation belong to the other cluster, the second type symptoms as follows: shortness of breath, chest stuffy, loss of appetite, dizzy, insomnia belong to 1st cluster; lazy to talk, emaciation, oliguria, the abdominal distension, turning around difficultly, wipe pulse belong to 2nd cluster; cough with phlegm, white phlegm belong to 3rd cluster; pale, vein be circuit and purple under tongue, enlarged tongue, fatness, polyuria at night belong to 4th cluster; pulse slippery, greasy fur on tongue, the tongue-coating white, pale tongue, dark tongue quality belong to 5th cluster.2. The disease location factorsAdopted cluster analysis, 217cases is divided into 4 types in TCM categorical identification. The type with syndrome of deficiency of QI and phlegm syndrome are related with heart, lung and spleen. The type with syndrome of deficiency of YANG is related with kidney. The type with syndrome of deficiency of QI and YIN is related with heart and liver. Anyway, among the different disease character factors, the relationship between heart and spleen are always close.3. The regulation of the syndrome factorsIn regard to disease character factors,"asthma, fatigue and loss of appetite" are the main symptoms in CHF, which have the most weight through different classes of heart function. Syndrome of deficiency of YIN has the bigger weight in the heart function classⅡ. Phlegm syndrome express obviously the heart function classⅢ. The stagnation of blood present to increase trend at the heart function all levels.In regard to disease location factors, the five internal organs is related, and the symptoms belonging to heart and spleen has bigger weihgt at different heart function levels. The symptom of lung are suffered more in the heart function classⅡ; The symptom of spleen are suffered more in the heart function classⅢandⅣ. With the disease developing, express deficiency of heart and kidney.Conclusion1. The disease character factors in CHF are phlegm syndrome and stagnation of blood as sthenic syndrome; deficiency of QI, deficiency of YIN and deficiency of YANG as deficiency syndrome.2. The type with syndrome of deficiency of QI and phlegm syndrome are related with heart, lung and spleen. The type with syndrome of deficiency of YANG is related with heart, spleen and kidney. The type with syndrome of deficiency of QI and YIN is related with heart, spleen and liver.3. CHF syndromes in TCM begin with deficiency of Heart-qi or deficiency of heart-QI-YIN, companied with the stagnation of blood, change slowly from yin to yang, from heart to kidney, from deficiency excess, then develop into deficiency of Heart-yang and Heart-qi, deficiency of both Heart-yang and kidney-yang, even deficiency of Heart-yin and Heart-yang, etc. 4. According to academic theory of Processor Deng Tie-tao, and the result in this research, it is indicated that the syndromes in TCM of CHF is corresponded to theoretic of "Interconnections between Five Viscera" and "Interconnections between phlegm syndrome and stagnation of blood". So these theories can provide the evidences for clinical categorical identification5. For adopting the multivariate statistical analysis in the database of CHF four diagnosis informations, it showed that the multivariate statistical analysis can be used as one of the important methods in the research on syndromes in TCM.