Distribution And Combination Of TCM Syndrome Elements Of Cholelithiasis And Its Correlation With Physical And Chemical Indexes

Objective: To study the distribution of TCM evidence elements of cholelithiasis,the pattern of mutual combination and the correlation between each evidence element and physical and chemical indexes,in order to seek the objective basis of TCM theory related to the diagnosis of this disease,and to apply the idea of individualized treatment to the development of cholelithiasis in practice for effective prevention and treatment.Methods: A prospective case epidemiological survey was conducted to collect a total of 151 patients with cholelithiasis who were admitted to the hospital between November 2021 and November 2022.We compiled the "Diagnostic Scale for Chinese Medicine Evidence in cholelithiasis" with single and compound elements as the starting point,and made the diagnosis of Chinese medicine evidence elements with reference to the "Evidence and Evidence Dialectics",summarized the distribution and combination of Chinese medicine evidence elements in cholelithiasis,and analyzed the correlation between Chinese medicine evidence elements and physical and chemical indicators.Results: 1.151 patients with cholelithiasis were included in this study,including 93 female patients and 58 male patients,P=0.004(<0.05),both of which were statistically different.Age was predominantly older than 70 years old,accounting for 35.1%.2.Patients with cholelithiasis were categorized into 7 pathogenic evidence elements,which were classified as original deficiency(qi deficiency,yin deficiency)and symptomatic reality(qi stagnation,dampness,phlegm,blood stasis,heat).Among them,the single pathological elements in descending order were dampness in 148 cases(98%),qi stagnation in 145 cases(96%),heat in 73 cases(48.3%),phlegm in 40 cases(26.5%),blood stasis in 70 cases(46.4%),yin deficiency in 29 cases(19.2%),and qi deficiency in 4 cases(2.6%);the compound pathological elements were triple pathological and The most common symptoms were triple and quadruple pathologies,followed by diphtheria,among which more than 5 cases were mainly the combination of qi stagnation + dampness + heat + blood stasis in 26 cases(17.22%),qi stagnation + dampness in 25 cases(16.56%),qi stagnation +dampness + blood stasis in 20 cases(13.25%),qi stagnation + dampness + heat in 15 cases(9.93%),qi stagnation + dampness + phlegm in 13 cases(8.61%).The analysis of the factors influencing the single evidence elements in TCM showed that the expression of serum ALT and AST was higher in the evidence elements of Qi stagnation,Dampness and Heat,and was positively correlated with the evidence element of Qi deficiency;the expression of serum TBIL was higher in the evidence elements of Heat,Blood stasis,Phlegm and Yin deficiency,serum TBIL was higher in heat,blood stasis,phlegm and yin deficiency evidence elements,and positively correlated with heat and yin deficiency evidence elements,with OR values comparing in descending order:yin deficiency and heat;serum TC was higher in wet,heat and yin deficiency evidence elements,and positively correlated with wet evidence elements;serum TG was positively correlated with heat evidence elements;serum GLU was positively correlated with phlegm evidence elements,and negatively correlated with blood stasis evidence elements.4.Analysis of factors influencing the composite evidence elements in TCM showed that qi stagnation+ The combination of Qi stagnation+ Dampness+ Phlegm turbidity was positively correlated with GLU and negatively correlated with ALP;the combination of Qi stagnation+Dampness+Blood stasis was negatively correlated with TC and GLU;the combination of Qi stagnation+Dampness+Blood stasis+He was positively correlated with ALP and GLDH.Conclusion:1.The clinical distribution of TCM evidence elements in cholelithiasis is regular,with solid evidence elements predominating,and dampness,qi stagnation and heat as its main evidence elements.2.The initial stage of cholelithiasis is dominated by solid evidence with significantly elevated liver function indexes,and along with the disease progression mostly develops into deficiency evidence,indicating that patients with cholelithiasis have worse liver function levels in deficiency evidence than in solid evidence.3.The lipid levels in patients with damp and hot evidence of cholelithiasis were higher than those in other evidence,suggesting that the abnormalities of lipid metabolism in patients with damp and hot evidence are more serious than those in other evidence,which may provide some basis for the identification of damp and hot evidence of cholelithiasis patients in Chinese medicine.4.Elevated blood glucose level can be one of the risk factors for the development of cholelithiasis,suggesting abnormal transmission of fluid and depletion of fluid and yin over time,which has certain guiding significance for the diagnosis of phlegm and yin deficiency evidence.