| BackgroundThe current trend for TCM academic development tends to become slow,which is shown in two aspects:on the one hand,the practice of TCM international exchange turns to be difficult;on the other hand,the internal development of TCM industry is hindered by the conventional framework characterized by "individual-oriented" or "group-oriented" Consequently,the results from the relevant research and clinical practice are hardly integrated.This situation attributes to many reasons.First,when comparing the development patterns of TCM and contemporary natural science,the author thinks one of the reasons is the insufficient interpretation of TCM with contemporary scientific language as well as the lack of commonly acceptable technical terms, nomenclature and criterion.The theory of the discipline and clinical practice has not yet formed a united system which is able to self-develop.TCM stresses on clinical efficacy and deems it as the essence of its theories and value. Therefore,does it have a clear view on its diagnostic theories(including disease differentiation,syndrome differentiation and symptom differentiation)? Is there a unanimous standard for TCM disease differentiation,syndrome differentiation and symptom differentiation? What is the content in detail? After a primary research,the author found all the above issues are under exploration and controversy among experts who have given multiple explanations about the meaning and relation of disease differentiation,syndrome differentiation etc,and many individual theories and hypothesis have been established by the experts.Although TCM diagnosis has been studied at the theoretical level,research focused on the practice level has been seldom touched.The experience of clinical practice has shown the TCM therapy for lumbar disc herniation has advantage over the current western medicine.However,it also corresponding reflects that the scarcity of standardization and consistence still prevail in the TCM diagnosis.Besides, there are many valuable clinical theories and experiences accumulated since ages waiting for further data mining and analysis.Concerning the aspect of TCM syndrome classification,discrepancy between its theory and clinical application also exists to certain extent.Based on the TCM diagnosis for lumbar disc herniation,this study aims to explore the relationship of TCM disease differentiation,syndrome differentiation and symptom differentiation and their functional identity in clinical practice in order to reconstruct the theoretical model for TCM diagnosis and intervention(not only for syndrome differentiation).It hopes to gain experience in setting up new explanation for TCM theories in the view of modern natural science and provide reference for the standardization of the whole discipline.ObjectiveThe main purpose is to reconstruct and initially testify the theoretical model for the TCM diagnosis for lumbar disc herniation.The secondary purpose is to establish a series of application tools for content analysis and methods for data analysis based on TCM knowledge.DesignThere are two stages in the study.At stage one,the theoretical model is studied on the basis of content analysis of literature research;at stage two,the model is tested by a survey study.Stage oneResearch method and procedure(1) Object for literature research:the TCM literature about lumbar disc herniation is extensively collected,including the medical records by ancient TCM doctors,modern professional publication,diagnostic criteria set up by academic organizations,books by eminent TCM doctors,medical journals and clinical case records.(2) Literature sampling:the collected literature is categorized,labeled and sampled.(3) The analytic unit is identified.(4) The tools for content analysis are framed.The scale for nuclear category about knowledge on disease differentiation,syndrome differentiation is set up and its consistency is evaluated.(5) Content analysis for TCM diagnosis and intervention,including qualitative and quantitive analysis.(6) Relevant explanation and comparison,establishment of the theoretical model. The main results(1) General condition:Totally 199 pieces of TCM literature are evolved in the study,in which 100 are about theoretical study,the other 99 are about clinical practice;7(3.5%) are modern comprehensive records,10(5.05%) are works by eminent doctors,122(62.6%) are journal papers,22(11.05%) are ancient literature,38(19.09%) are clinical case records.(2) Diagnostic rules for ancient literature:the 22 pieces of ancient literature are all theoretical,in which low back pain is the main symptom.The TCM intervention strategy is comprehensive therapy.6(27.2%) are about diseases differentiation treatment,12(54.6%) are about syndrome differentiation treatment,4(18.2%) are about integration of disease differentiation and syndrome differentiation.There are two conditions for disease differentiation: the first one focuses on "backache" as the central etiologic and pathologic factor(4 pieces) which mainly attributes to the coldness-damping(including blood-heat,dampness-heat and wind-heat) and liver and kidney deficiency and blood stasis,the second one focuses on the general feature of the disease development which characterized by wind-heat and wind toxin or blood disturbance by wind-heat at the initial stage,by qi and blood disharmony at the middle stage,and by vitality deficiency(mainly qi and blood deficiency) at the chronic stage which mainly treated by gastric medicine.Concerning the mode of syndrome differentiation,single methods featured by the eight principles,Zang-fu and etiology are common.In short,it is characterized by qi obstruction and blood stais and wind-coldness at the initial stage,and by vitality deficiency at the chronic stage which is mainly the deficiency of liver and kidney.(3) The diagnostic rules for modern literature:there are 177 pieces of modern literature evolved in the study.The main clinical manifestation includes low back pain and backache and paralytic disease which lacks aggregative tendency.The methods of clinical intervention can be classified by local treatment,comprehensive treatment and integration of the two.In local treatment(67 pieces),the main treatment method is enema(56 pieces,83.58%) and the diagnostic basis is low back pain.The intervention strategies include pass by the active and travel qi -relieve pain,in which 13 pieces(6.9%) are about local syndrome differentiation.In comprehensive diagnosis(206 pieces),36 are about disease differentiation,in which the common etiologic and pathogenic factors are "qi obstruction and blood stasis","wind-coldness-dampness obstruction","clodness condensate meridian" and "qi and blood deficiency" etc.The homogeneity of disease differentiation(12 pieces) is characterized by evil pathogen at the onset stage,insufficient vitality at the relief stage,or insufficient vitality plus evil stasis between the above two stage.There are 71 pieces of syndrome differentiation treatment in comprehensive therapy,which are mainly about diagnosis for Zang-fu,qi and blood and etiology integration.The most frequent syndromes are:coldness dampness,liver and kidney deficiency,blood stasis,qi deficiency and blood stasis,qi obstruction,sputum-stasis,wind-clodness, dampness-heat,deficiency of spleen kidney,etc.(4) The comparison of ancient and modern diagnosis:The ancient therapy mainly stressed on comprehensive treatment,which the modern therapy stressed on local treatment.The ancient diagnosis and treatment are centered by the symptom "low back pain" whose strategies mainly include "juan paralysis and relieve pain",but this trait has been weakened in modern diagnosis.Concerning syndrome differentiation, the ancient literature is dominated by wind-coldness(16%) but only four(1.3%) are found in modern literature which is featured by coldness-damping(25.6%). There are few records about blood stasis and liver depression and spleen deficiency in ancient literature(7%),but more have been found in modern literature(12.3%).The ancient literature also stresses on the integration of disease differentiation and syndrome differentiation which is based on disease classification of stages and phrases to make further diagnosis(7/10); and the modern literature has more content in the integration of disease and syndrome differentiation,which includes the records about TCM syndrome differentiation and western medicine integration as well as pharmacology and the modification by syndromes based on disease differentiation therapy occupying a large portion in the study.Stage twoResearch method and procedure(1) cross-sectional study on lumbar disc herniation patients:the study objects are patients diagnosed with lumbar disc herniation in three hospitals including Guangdong Provincial Hospital of TCM.There are five researchers in the study.The research instrument is the clinical case report form(CRF) developed by a strict process.The study period is from March 2008 to Februay 2009.(2) case-control retrospective study:the clinical records for lumbar disc herniation patients are searched manually and from the hospital information management system,including those hospitalized in the orthopedic department.There are 38 cases are accessed and the data are collected by the clinical case report form.(3) Data analysis:the study objective and content are determined by professional requirement,the methods includes descriptive analysis,uni-factor analysis,cluster analysis,and data mining methods such as rough set analysis,association rules and cluster analysis etc. The main results(1) general materials:71 valid CRFs are collected,in which one is excluded due to the diagnosis,therefore,there are 70 valid cases in the study, including 43 cases(61.4%) at the active stage,27 cases(38.6%) at the relief stage.(2) Major TCM symptoms and diseases:â‘ Descriptive statistics:among the patients at the active stage,the symptoms include backache(34 cases), lower limb ma pain(33 cases),lower limb radiology pain(35 cases) whose frequencies are approximately equal,and they usually appears simultaneously. Among the patients at the relief stage,the commonly seen symptoms includes waist activity limitation(12 cases),intermittent claudication(10 cases) and lower limb flaccidity soft-inability(11 cases).The diseases which the researcher have diagnosed according to the nation diagnostic standard include "low back pain"(44 cases,most frequent),backache(14 cases),and paralytic disease(13 cases) etc.The modern local therapy as well as disease and syndrome differentiation can receive evident support from lumbar spine' s CT/MRI.â‘¡Rough set analysis on main symptoms at different stages:the filtered attributes which have great contribution to the diagnosis includes 14 items, i.e.backache,lower limb' s radiology pain,intermittent claudication,muscle paralysis,lower limb numb,etc.19 rules for diagnostic classification at active stage are created,and 11 are created for relief stage.The result shows that three symptoms are important for stage classifications,i.e. appearance of hemafecia which is dominant,increased bowel frequency and acute onset which are of help for diagnosis.(3) The analysis of syndrome differentiation factors and key etiologic mechanism:â‘ Cluster analysis in multiple statistics:combined with professional knowledge,the result of cluster analysis for all selected symptoms indicates the existence of the following syndromes including:"sthenic syndrome","pain in office set", "coldness-damping",and "dampness-heat","yang deficiency","qi and blood deficiency" and "liver and kidney deficiency" etc.The cluster analysis for tongue and pulse symptoms implies syndromes such as "heat or dampness-heat","qi unbalance or qi stasis","qi deficiency","yang deficiency or qi and blood deficiency" etc.The cluster results about clinical historical features imply "chronic onset" and "initial onset" as two categories.â‘¡Cluster analysis in data mining:the result from data mining is similar to that from multiple statistics.â‘¢Association rules" the analysis based on the algorithm of association rules mainly focused on the tongue and pulse symptom indexes,which indicates the existence of the syndromes such as "blood stasis","yang deficiency or blood deficiency","liver and kidney deficiency","dampness-heat","damp coldness" and "wing-coldness".It can be found that one index owns different associations with other various indexes.(4) Rules for clinical classification:the cluster analysis for the 70 cases indicates classifications including:"obstruction of coldness and heat","qi deficiency and blood stasis", "wind-coldness-dampness obstruction","qi and blood deficiency","yang deficiency of kidney","liver and kidney deficiency" etc.And the differences in clinical stage,general condition of the patient and accompanied symptoms such as diarrhea and bowel hyperkinesias are also important factors to the classification.In general,there is no apparent tendency of aggregation in cluster analysis(especially with the inter-group linking method),and the results are only for reference.Conclusion(1) TCM diagnosis is not only made by disease differentiation,but also on many models and methods.And hence the systematic evaluation based on content analysis is able to realize the initial reconstruction of the theoretical model for TCM diagnosis and intervention of lumbar disc herniation. That is,to clarify the diagnostic approach respectively focusing on disease differentiation,syndrome differentiation and symptom differentiation in which the merits of TCM thinking can be effectively applied to analyze the relationship of relevant factors such as cause and effect,major and minor syndromes,and early or later so as to systematically and thoroughly master the main problems of the disease and set up the strategy for interventions. (2) The survey and data analysis of the study helps to identify some significant factors for establishing an initial theoretical model for the TCM diagnosis and intervention of ulcerative colitis,as well as some methods for data analysis under the theoretical framework of TCM.(3) Introduction and application of the analytic methods:The analytic methods such as content analysis and multiple analysis should be applied based on TCM knowledge so that fine and valid outcome can be expected.
|
PDF Full Text Request