| Multiple System Atrophy (MSA) is a group of progressive degenerative disease of multiple sites of nervous system, and the cause of this disease is unknown. Its clinical symptom is complex. There are four type of main appearance of clinical symptom: vegetative nerve functional disturbance, Parkinson syndrome, defective coordination and functional lesion of pyramidal. MSA is insidious onset and slowly progress. The course of this disease is long. The patient's condition aggravates gradually and the prognosis is bad. The modern medicine does not know the cause and pathogenesis of MSA and has not effective way to treat it until now. The traditional Chinese medicine has appeared fine indication on the treatment of some of symptoms of MSA. However, at present, there is a few small sample or individual case report without systematic research of the cause and pathogenesis, characteristic of syndrome, determining the treatment based on differentiation of symptoms and signs.The purpose of this research is to provide view for the deep clinic research and to provide theory base for the effective determining the treatment based on differentiation of symptoms and signs. This research adopts cross section approach, and its study objects are the clinical sporadic patients. It bases on the diagnostic criteria which exists on the'consensus statement on the diagnosis of multiple system atrophy'published by Gilman et al in 1999. It collects overall 76 patients'information of different time. The information includes: four methods of examination of TCM, demography, history of present illness, history of past illness, family history, neurological check, function score of MSA, clinical typing. Basing on"the part of syndrome of clinical diagnostic and therapeutic terms of TCM"promulgated by State Technical Inspection Laboratory, we screened elementary syndrome, and established the corresponding diagnostic standard of syndrome. Through the data with four diagnostic methods of TCM, deciding the patient's type of syndrome one by one, and then taking some statistical methods to analyze all information comprehensively. And so we can comprehend the main symptoms, signs, and all kinds of syndrome'distribution condition of this disease. Base on this, we can refer the new recognition of the cause and pathogenesis of the disease, and can also provide reference and clue for further study. The main results are as follows:Walking unsteadily and dizzy are the main initial symptoms. The main symptoms and signs are as follows: walking unsteadily, bradyglossia, inarticulate speech, speech without enough QI, dizzy while standing up, constipation, debilitation of waist and leg, violet gloom labia, greasy fur, white fur, thinness fur, lubricate pulse, weak pulse, invirility. The different symptoms and signs between MSA-C,MSA-P are as follows: walking unsteadily, body of tongue trilling, bradykinesia, dull eyes, limbs contracture, the aggravation of dizzy after exertion, phlegm in the body, difficulty falling asleep. seeing objects vaguely, asthenia QI to speak, defecation acratia, difficult urination, the four symptoms are obvious with the patient's condition aggravating.With respect to the relatively short courses and milder condition of the 76 cases, the data here reflects the characteristic of syndromes distribution in the earlier period and metaphase. Five organs deficiency syndromes distribution: kidney deficiency is most common, up to 80.26%, with 61cases; then liver deficiency(34.21 % , 26cases);spleen deficiency and heart deficiency are comparatively less, with 18.42%(14cases) and 22.37%(17cases) respectively. There is no Lung deficiency in the 76 MSA cases. Kidney deficiency, liver deficiency, heart deficiency, spleen deficiency may manifest as themselves, or by other syndromes. Logistic regression analysis show that heart deficiency appears more easily in the female than in the male.Among the 76 cases of MSA: QI deficiency 52.63 % (40cases), Yang deficiency 11.84%(9csaes),Yin deficiency 13.16%(10cases),Blood deficiency 10.53%(8cases).In the early and intermediate stage, QI deficiency is most common, and Yin deficiency, Blood deficiency, Yang deficiency do not display obviously. There are also 25 patients without deficiency of QI, Blood, Yin, Yang in the 76 cases. Among the 25 patients, course of disease less than 3 years is up to 76%,and function scorce less than 40 is up to 92%. So it can say that there is not much obvious deficiency of QI, Blood, Yin, Yang in the early and intermediate stage. QI deficiency, Blood deficiency, Yang deficiency, Yin deficiency may manifest as themselves, and the rate of single deficiency of QI, Blood, Yin, Yang is more than by other syndromes. There is no case with deficiency of QI, Blood, Yin, Yang in our patients.In the sthenia syndromes, the rate of phlegm and dampness syndrome is the highest, up to 42.11%, with 32cases, then phlegm and dampness with heat syndrome; 39.47% (30cases), and then blood stasis syndrome, 32.89%(25cases); the depression of liver-QI syndrome and pathogenic fire derived from stagnation of liver-QI syndrome are comparatively less, with 6.58%(5cases) and 12.79%(12cases) respectively. All the sthenia syndromes distribute patients of our research. There are 8 patients without any deficiency of five organs deficiency and of QI, Blood, Yin, Yang. It hints that a few patients may have not obvious appearance of deficiency in the earlier period of onset. The analysis of dependability of syndrome show: the Yang deficiency correlates with pathogenic fire derived from stagnation of liver-QI syndrome and spleen deficiency and blood stasis syndrome; the Yang deficiency correlates with the depression of liver-QI syndrome significantly; liver deficiency correlates with pathogenic fire derived from stagnation of liver-QI syndrome; spleen deficiency correlates with phlegm and dampness syndrome and pathogenic fire derived from stagnation of liver-QI syndrome; phlegm and dampness syndrome correlates with phlegm and dampness with heat syndrome, blood stasis syndrome, depression of liver-QI syndrome and pathogenic fire derived from stagnation of liver-QI syndrome significantly; phlegm and dampness with heat syndrome correlates with blood stasis syndrome and pathogenic fire derived from stagnation of liver-QI syndrome significantly.Through the analysis of the results, the opinion can be referred that phlegm and muddy cause this disease. First, the count of the cases in the research with phlegm and dampness syndrome and phlegm and dampness with heat syndrome is 62, and it is the majority of all the cases. Second, the all kinds of clinical manifestation and the low disease incidence correspond with the characteristic of the phlegm and muddy. Third, the phlegm and muddy can damage liver and kidney, and the cases in the research are at the age which liver and kidney are deficiency and easily to be damaged. Fourth, in the cases of this study, the rate of female is less than male, which is consistent with the feature of the phlegm and muddy. It is yin pathogen, damages yang easily, and male bases on yang QI, so the male patients are more. The path mechanism of MSA exists in the four aspects. The phlegm and muddy in the middle energizer cause splenic sthenia syndrome; the phlegm and muddy harm the heart and its meridian; the phlegm and muddy invade the lung; the phlegm and muddy insult the liver, so the liver fail to maintain the normal flow of QI; the phlegm and muddy damage the kidney; with time going on, the stagnant blood has been formed.In a ward, the study indicates that in the five organs, MSA relates close to liver and kidney(as the core organ). In the initial period of this disease, QI is easily to be deficient, and the deficiency of Blood, Yin, Yang is not significant. In the development of this disease, the condition of asthenia and sthenia inclusion comes into being. It is first raised that the phlegm and muddy causes this disease. In the early time of the disease, pathogen should be eliminated first, then strengthen body resistance. In the later period, strengthening healthy QI and eliminating pathogens should be combined. And early treatment, to cut off the pathogenesis, dissipating phlegm and dehygrosis are also emphasized . |
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