TCM Syndromes Of Cerebral Small Vessel Disease-related White Matter Lesions And Preliminary Intervention Study Of Huoluo Yi Nao Recipe

White matter lesions(WMLs)is a common manifestation of brain imaging in the elderly,and it is also one of the common imaging characteristics.of cerebral small vessel disease(CSVD).Its etiology is related to myelinoclasis and the damage of neuraxon caused by chronic cerebral hypoperfusion.Its clinical manifestations are varied,including dizziness,cognitive impairment,gait disorder,urination disorder,depressive state and so on.At present,modern medicine is still lack of clear treatment for the disease,mainly by controlling blood pressure,blood lipids,high homocysteine and other risk factors to delay the progress of white WMLs associated with CSVD.In the aspect of traditional chinese medicine(TCM),it is generally believed that WMLs has the syndrome characteristics of 'a mixture of deficiency and excess'.The location of the disease was mainly concentrated in the kidney and brain.Traditional Chinese medicine is effective in the treatment of white WMLs associated with CSVD,which can significantly alleviate the clinical symptoms.Objective:(1)To study the syndrome characteristics of WMLs associated with CSVD by using TCM syndrome score scale.(2)According to the TCM syndrome characteristics,Huoluo Yinao prescription is selected to treat the disease.Evaluating TCM syndrome score scale and western scale to prove the clinical efficacy.Methods:(1)We collected 91 patient with WMLs associated with CSVD in the Dongfang Hospital of Beijing University of Traditional Chinese Medicine.To summarize the TCM syndrome characteristics of WMLs associated with CSVD,We designed TCM syndrome score scale(TCM symptom score scale and TCM syndrome element scale)and observed the syndrome elements and location elements of the disease.(2)We screened a total of 20 patients with WMLs associated with CSVD.All the patients were evaluated by TCM syndrome score scale,MMSE,MoCA,BBS,TMT and SPPB scale before and after the intervention to evaluate the curative effect of Huoluo Yinao prescription.Results:(1)In 91 patients with WMLs associated with CSVD,there were more females than males,and the average age was 64.03±7.80.There was significant difference in age among different grades of WMH(P<0.05).The clinical characteristics of 91 patients with WMLs associated with CSVD were analyzed,the results showed that forgetfulness,dizziness,slow walking,unsteady walking and decreased control of urination were the main clinical symptoms.The first of the symptoms is forgetfulness,and its number is 77 and its proportion is 84.6%.The Second symptom is dizziness,the number and proportion of which are 72 and 79.1%.The third symptom is slow walking,and its number is 69 and proportion is 75.8%.Unsteady walking is fourth symptom,the number and proportion of which are 68 and 74.7%.Head heaviness is fifth symptom,and its number is 59 and proportion is 64.8%.Decreased control of urination is sixth symptom,the number and proportion of which are 51 and 56.0%.The correlation between different grades of WMH and main symptoms was analyzed.The results showed that forgetfulness,dizziness,slow walking and decreased control of urination were positively correlated with WMH grades(P<0.05),while unsteady walking or head heaviness were not significantly correlated with WMH grades(P>0.05).The cognitive,balance and gait functions of different grade of WMH were compared and analyzed.The results showed that the scores of MMSE,MoCA,Berg,TMT and SPPB decreased gradually with the aggravation of WMH grades,and the difference among different grades were statistically significant(P<0.05).The cognitive function,balance function,gait function and fall risk of 91 patients with WMLs associated with CSVD were evaluated,and the WMH grades of different functions were compared and analyzed.The results showed that there were significant differences in cognitive function,balance function,gait function and fall risk among different grades of WMH patients.There was a positive correlation between the impairment of these functions and WMH grades.In the 91 cases,the percentage rates for 8 syndrome factors are as follows:Marrow Sea deficiency 90.1%,Phlegm Turbid 58.2%,Blood deficiency 42.9%,Qi deficiency 23.1%,Stagnation of blood 20.9%,Yang deficiency 9.9%,Yin deficiency 13.2%,Wind Phlegm 5.5%.In the 91 cases,the percentage rates for 5 disease location elements are as follows:brain 91.2%,kidney 80.2%,spleen 36.3%,heart 35.2%;liver 25.3%.The proportion of inclusion of kidney and brain is 71.4%.The proportion of three-syndrome-factor inclusion is 51.6%.The proportion of two-syndrome-factor inclusion is 41.8%,and the proportion of inclusion of Phlegm Turbid,Marrow Sea deficiency and Blood deficiency is 22.0%.The proportion of inclusion of Phlegm Turbid,Marrow Sea deficiency is 54.9%.The TCM syndrome factors of 91 patients with WMLs associated with CSVD were analyzed by cluster analysis,when they were grouped into two groups,Phlegm Turbid,Marrow Sea deficiency and Stagnation of blood were grouped into one group,and other syndromes were clustered into one group.In the 91 cases,the number of deficiency syndrome are 25,the number of patient with deficiency syndrome and excess syndrome at the same is 65,and the number of excess syndrome is 1.The correlation analysis between TCM syndrome factors and symptoms showed that Phlegm Turbid was positively correlated with dizziness and carebaria(P<0.05),and Marrow Sea deficiency was positively correlated with slow walking and forgetfulness(P<0.05).There was no obvious correlation between other syndrome factors and symptoms of WMLs associated with CSVD(P>0.05).(2)20 patients with WMLs associated with CSVD were evaluated by TCM syndrome score scale and western scale before and after the treatment.We analyzed the score of the same patient before and after intervention.The results showed that after intervention,the TCM symptom score scale raises significantly,while the scores of MoCA,BBS and SPPB were higher than those before intervention.(P<0.05,with statistical significance).Conclusion:WMLs associated with CSVD can cause impairment of cognitive function,balance function and gait function.The main symptoms of it are forgetfulness,dizziness,slow walking and unsteady walking.The disease is mainly deficiency syndrome or a mixture of deficiency and excess.Its major syndrome factors are Marrow Sea deficiency and Phlegm Turbid,the main lesions are in the kidney and brain.Huoluo Yinao prescription can effectively alleviate the main symptoms of WMLs associated with CSVD.