| BACKGROUNDIt is hard to cognize the syndromes and pathogenesis of acute hemorrhagic stroke for its changefully transformation. In 1987, 1990 and 1994, State Administration of Traditional Chinese Medicine promulgated diagnoses and treatment norm many times so that standardization can direct and promote clinical and scientific research of stroke. However lots of researches illuminated syndrome combination shape of hemorrhage stroke is complex. For example above 3 symptoms belong to each series of times exist at the same time are particularly obvious in the acute stage. Uncertainty and nonstandard in the type of syndromes seriously block the development of modernized differentiation of syndromes study.OBJECTIVETo demonstrate scientificity and universality of differentiation of syndromes in classification of syndromes of yang and yin of hemorrhagic stroke acute stage, we initially work out a terse, manipulable and well-judged standard.METHODS1 The theoretic researchWe summarize clinical experience, rather entirely take cognizance of hemorrhagic stroke commonness pathogenesis, syndromes characteristic of yang syndrome and yin syndrome, through having systems reviewed the factors and pathogenesis discussion of hemorrhagic stroke in modern times. Thus foundation is provided for constituted the marker of differentiation of yang syndromeand yin syndrome.2 The clinical researchTwelve units of hospital cooperated including Guang Dong province TCM Hospital with responsibility for "shi wu" tackle key problem "The acute stage of stroke colligation treatment project research" .gathered 411 cases in all according to the standard of including and excluding norm strictly. Investigated objects are separated in five groups in term of five time points, such as 1st day, 3rd day, 7th day, 14th day and 21st day. Doctors of TCM attending physician or attending physician upwards research personnel collects the information of syndrome on the basis of inspection, listening and smelling, asking, pulse-taking. They accomplish differentitation of syndromes separately with independence according to the standard for differentiation of syndromes of yang syndrome and yin syndrome, diagnosis standard of stroke syndrome, traditional Chinese medicine diagnosis standard of stroke, assessing standard of curative effect. And they also fill the case report form table according to the facts.We use Epidata2.la software packet to constitute database, use SPSS11.0 statistical analysis software packet to process data management and analysis after the end of investigate and study the cases. Adopting the method of description frequence and comparison compositor, we fixed authority weight in order to confirm stable quantity numerical value of syndrome marker. Function in mathematics type of syndrome judgment is instituted by the method of discriminant analysis and clustering analysis.RESULTS1. There are 411 cases of hemorrhagic stroke be adopted in the study.2. 82.7% of hemorrhage stroke patient of 411 cases at onset of illness are yang syndrome .The proportion of yang syndrome in the whole acute stage is keeping on 55. 4%~83. 8% all along.3. Six markers stand out after having fixed differentiation of syndromes marker authority weight of yang syndrome of hemorrhage stroke. They are reddened tongue proper (0.9588) , yellow fur (0.9059) , reddish complexion with fever (0.7647) .rapid pulse (0.7324) , bitter taste and dryness in mouth and throat (0.7294) , irritability and restlessness (0.7000) . Six markers stand out of marker authority weight value of yin syndrome. Theyare quietly on bed without irritability (0.9176) , white fur (0.8767) , dim and pale complexion or lips (0.8630) , pale tongue proper (0.8356) , slow and loose pulse or deep and thready pulse (0. 7945) , no bitter taste and dryness in mouth and throat (0.6712) .4. Hemorrhagic stroke yang syndrome on the basis of association endow authority weight is quantitied. Liminal value of diagnosis is 44. 05~75. Light degree is 47~57. Mid degree is 58~73. Heavy degree is bigger than 74. Result of yin syndrome is 17. 6-—41. 6. Light degree is 18—26. Mid degree is 27—32. Heavy degree is bigger than 33.5. Through discriminate analysis, we filtrate the differentiation of syndromes marker of yang syndrome and yin syndrome. They are reddish complexion with fever, dim and pale complexion or lips, irritability and restlessness, bitter taste and dryness in mouth and throat, no bitter taste and dryness in mouth and throat, reddened tongue proper, pale tongue proper, white fur, slow and loose pulse or deep and thready pulse. Reddened tongue proper is the most contributed to the diagnosis of yang syndrome (48. 459). Pale tongue proper is the most contributed to the diagnosis of yin syndrome(50.442) .6. After five steps filter of Logistic Regression analysis, the markers of four diagnostic methods in diagnostic cast of yang syndrome are reserved, yellow fur, pale tongue proper, no bitter taste and dryness in mouth and throat> quietly on bed without irritability, dim and pale complexion. The OR numerical value of yellow fur among them is bigger than 1.Logistic Regression Equation:9.n9+0377tail-1.765she2-1.220kou2-l.l24fan2-1221mian2* = 1 , ^9.179+0.377te?l-1.765s*tf2-1.220kou2-1.124/fl/i2-1.22Lww?27. When hemorrhagic stroke comes on, in order the chief syndromes manifestation are hyperactivity of liver-yang and upward disturbance due to wind-fire syndrome (27. 5%) , upward disturbance of seven orifices due to wind-fire syndrome (22.9%) , meridians blockage due to wind-phlegm and blood stasis syndrome (15.8) .inner blockage of seven orifices due to phlegm-heat syndrome (13.1 % ) , phlegm-heat and fu-organs in excess condition and upward disturbance due to wind-phlegm syndrome (11.4%). Wind stirring due to yin deficiency syndrome (0.7%) and blood stasis due toqi deficiency syndrome (1.5%) appeared terribly few. Transformation of syndromes manifestation after the acute stage are meridians blockage due to wind-phlegm and blood stasis syndrome (28.9%) , wind stirring due to yin deficiency syndrome (25.7%) , blood stasis due to qi deficiency syndrome (25. 4) , phlegm-heat and fu-organs in excess condition and upward disturbance due to wind-phlegm syndrome (10. 5%) . The occurrence rate of meridians blockage due to wind-phlegm and blood stasis syndrome keeps on higher level than others all the time, and ascends gradually (15.8%~ 28.9%) . CONCLUSION1. Causes and pathogenesis in The rule of etiological factors and pathogenesis to the acute stage of hemorrhagic stroke:2. Habitual Yang abundance usually become yang syndrome due to wind, which is fire, phlegm, blood stagnation gather together in brain and block mental activity and seven orifices because of yin deficiency in liver and kidney, liver-yang, liver-wind, liver-fire accompanied with phlegm and blood stagnation disturbing brain mind. Habitual yin abundance usually develops yin syndrome totally due to deficiency in qi/yang that causes wind, phlegm and blood stagnation gathering together to block brain and seven orifices. In the beginning of disease yin syndrome is mainly. Winds, fire, phlegm, Fu-organ in excess condition are superficial and acute. In the course of diseases phlegm and blood stagnation are fundamental pathological factors. After acute stage yin syndrome is familiar mainly representing deficiency in origin for example "yin deficiency in liver and kidney" or"deficiency in qi/yang" .3. To initially work out quantitative standard of differentiation of syndromes of yang syndrome and yin syndrome, it will offer evidences for standard and measuring study of the disease and syndromes in the acute stage.4. Simultaneous deficiency and excess condition, cold-heat syndrome is usually mixed with syndrome changing, but yang syndrome is mainly in total performance.5. In the type of syndrome of "Professional Standard" , "hyperactivity of liver-yang and upward disturbance due to wind-fire syndrome" ,"phlegm-heat and fu-organs in excess condition and upward disturbance due... |
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