The Syndromes And Subtypes Of Premenstrual Dysphoric Disorder:Theoretical Exploration And Cross-sectional Epidemiological Investigation

Background:Premenstrual Dysphoric Disorder(PMDD)is a severe form of Premenstrual Syndrome(PMS).How to divide and diagnose the clinical subtypes of Premenstrual Dysphoric Disorder(PMDD)has been the focal point in the international medical science.Under the establishment of modern medical disease diagnosis,how do the traditional Chinese medicine(TCM)syndromes reflect the characteristics of the disease?What’s the relationship of the syndrome and clinical subtype?They are hotspots of the combination research on disease and syndrome.The syndromes and clinical subtypes of PMDD,which have been rarely reported,is an important scientific issue worth exploring in depth.Objective:On the basis of the deep research by my tutor and his team,they found that Liver-qi invasion and Liver-qi depression syndromes are the main syndromes of PMS.We try to prove that PMDD Liver-qi invasion and Liver-qi depression syndromes are the main syndromes of TCM and the main clinical subtypes of modern medicine through the theoretical discussion and cross-sectional epidemiological investigation,.It will provide new knowledge of TCM syndromes differentiation for the PMDD international medical frontier research.And it will provide the new ideas on TCM syndromes and modern medical subtypes for the combination research on disease and syndrome.This research is of theoretical reference value and practical guidance significance and will improve the clinical diagnosis and treatment level of PMDD.Methods:The methods used for theoretical exploration are concept definition,bibliometric methods and logical argumentation.Specifically,to the related concept should reveal the connotation and limit the extension;search the domestic and foreign relevant representative literatures,sort out the research progress,and analyze the evidence of TCM syndrome and clinical subtypes of PMDD;propose the new understanding of TCM syndrome and clinical subtypes according to induction and deductive logic,put forward the new hypothesis of TCM syndrome and modern medical clinical subtype of PMDD.In the positive exploration,the cross-sectional epidemiological investigation has been used,DSM-IV as the diagnostic criteria,record by PMDD clinical epidemiological survey and DRSP in Shandong University of Traditional Chinese Medicine,Forever Technology Group Co.,Ltd.,Bohui Textile mills,the first secondary school of Changqing,Fuqun supermarkets.The frequency analysis,statistical methods Spearman correlation analysis,Binary Logistic regression and factor analysis have been used by statistical software IBM SPSS Statistics 22.0.The scientific hypothesis and hypothesis testing are used to combine the theoretical exploration and positive exploration.Propose the scientific hypothesis from the new understanding of theoretical exploration,and get evidence from positive exploration to make theoretical proof to test the evidence and scientific hypothesis.Finally obtain the new theoretical understanding with theoretical basis,and scientific evidence.Result:1.The theoretical exploration:the subjects and methods of theoretical research and the syndrome and subtype of diseases(1)The subjects and methods of theoretical researchBy combing the theory and related concepts could clear that the definition,object and method of theoretical research.The differentiation of TCM syndromes and clinical subtypes are the important concepts and propositions,important object of theoretical research.The syndromes and subtypes especially the TCM syndrome differentiation and clinical subtype of disease is an important theoretical issue,which has been seldom discussed.So it is an important theoretical prerequisite and problem that worth exploring.This research based on those understanding to made the following discussion and results.(2)Positive exploration:syndromes of TCM and subtypes of disease①Research methods of syndrome concepts and constitutionThe concept of syndrome has five kinds of Cognition:syndrome is the abbreviated form of syndrome or pattern;syndrome as same as pattern;syndrome as same as pathogenesis;syndrome include syndrome and pattern;syndrome is the diagnosis conclusion,including the position,etiology and character course even the development trends of the disease.Cluster analysis has been used for the research methods of syndrome constitution,such as principal component analysis,factor analysis,discriminate analysis and Logistic regression analysis.②The basic meaning and division method of clinical subtypesDisease subtypes,which refer to the different categories under the disease,the mutual exclusion between the subtypes,together can completely describe a diagnosis of phenomenology.Subtypes can be divided as course subtypes,clinical subtypes,pathogenesis subtypes,genes subtypes,clinical subtypes,pathological subtypes,etc...Clinical subtypes are subtypes of a disease classification,mainly for the diagnosis of a class of diseases based on clinical manifestations of subtypes.Subtypes can be classified according to the literature analysis,bioinformatics analysis techniques,epidemiological survey,and collective wisdom of experts,mathematical statistics and other research methods.③The differentiation of TCM syndrome under the diseaseAfter determining the specific disease,TCM syndrome should first reflect the characteristics of the disease,then have the characteristics of mutual identification.④Relationship between syndrome and subtypeThere are many similarities between syndromes and clinical subtypes:first,they are the classification of the disease;second,they are composed of certain relationship groups of symptoms;third,the clinical subtypes/syndromes can be transformed between each other;fourth,the purpose of the classification is to better identify the disease,improve clinical efficacy.The main difference between the two is that the division of TCM syndromes is mainly based on the theory of TCM pathogenesis,and there are some subjective ones.The classification of clinical subtypes is diverse and mostly based on scientific and objective classification.(3)Syndrome and Clinical Subtype of PMS/PMDD①Syndromes and syndromes of PMS/PMDDThere are 89 literatures have been found through cross-database retrieval,the distribution of year is inverted U-shaped trend,mostly at 2010;Shandong University of Traditional Chinese Medicine and Guangzhou University of Traditional Chinese Medicine contribute maximum number of literatures,moreover the proportion of the university is much higher than the hospital;more than half of the literatures were supported by the state-level fund.Finally 33 RCT literatures have been adopted by the revised JADAD,14 literatures score 4 and more points,and syndromes mainly as Liver-qi invasion and Liver-qi depression syndrome.②Clinical subtypes of PMS/PMDDUsing the MEDLINE database,the keywords were searched for 6 articles,mainly based on clinical symptoms through the scale,classification to emotional type,body type and mixed type.③ The syndrome Liver-qi invasion and Liver-qi depression of PMDD and the existing clinical subtype comparisonThe syndrome of TCM differentiation more based on TCM pathogenesis theory in domestic,combined with clinical experience.They thought the liver is the main pathogenesis of the disease;the main syndromes are Liver-qi invasion and Liver-qi depression.The methods on the classification of PMDD subtype international are the epidemiological survey,Delphi method;symptomatic rating scale as the research tools use DRSP mostly.2.Positive exploration:the cross-sectional epidemiological investigation(1)A total of 3958 cases of childbearing age women,age between 18-45 years old,were investigated.380 cases of PMDD patients were diagnosed.The prevalence rate of the surveyed was 9.6%.(2)The most frequent syndrome is Liver-qi invasion(43.4%),then Liver-qi depression(42.1%),followed by Liver-qi stagnation with deficiency of the spleen syndrome(26.3%),pathogenic fire derived from Liver-qi stagnation syndrome(15.2%).Liver-qi stagnation and blood stasis syndrome(15.3%).Liver-qi stagnation(14.2%)and kidney deficiency syndrome(14.2%)are less and appear non-dominated card;the vast majority of syndromes associated with the liver,liver leakage is the most important PMDD pathogenesis.(3)PMDD symptoms can be divided into emotional symptoms,physical symptoms and social function categories.Emotional symptoms are 7 in total,the frequency of mild mood symptoms,followed by moderate,rarely severe,and to upset,irritability and emotional depression mainly feel hopelessness and fear less likely.No social function symptoms appear severe,decreased learning ability accounted for most of the symptoms of social dysfunction;decreased ability homemaker is the least.Physical symptoms total of 32 severe appears the maximum frequency is soreness and weakness of waist and knees,dreams,insomnia;moderate frequency of occurrence up to abdominal bulge,small abdominal distension pain,fatigue;most mild frequency of occurrence of fatigue,shantaixi,abdominal distension.The overall frequency of the most frequent fatigue,abdominal distension,abdominal pain,shan taixi,abdominal pain.(4)Emotional symptoms,irritability and upset a certain correlation with emotional depression,anxiety,depression,hopeless,fear not relevant.Emotional depression and anxiety,depression,hopeless was a significant positive correlation with the upset,fear there is some correlation.Irritability and decreased learning ability,chest fullness,chest pain showed a significant positive correlation with the upset,fatigue,dreams,dry mouth and throat,mouth pain,breast tenderness,Shan Taixi,abdominal pain,soreness and weakness of waist and knees have some relevance.Emotional depression and depression,breast tenderness,hopeless,anxiety,decreased ability to work,homemaker capacity decreased,decreased learning ability,Mukuang black halo,edema,stretching,fullness in head was a significant positive correlation.Anddizziness,upset,fear,chest tightness,Shan Taixi have some relevance.(5)Binary Logistic regression analysis showed irritability,chest fullness,dreams,loose stools,insomnia,abdominal distension,breast tenderness,chest,are statistically significant danger signs of Liver-qi invasion.Emotional depression,anxiety,head halo,fatigue,dark purple menstrual flow,abdominal pain,breast tenderness,are statistically significant danger signs of Liver-qi depression.(6)Through factor analysis extracted two common factors,common factor 1:emotional depression,anxiety,feeling of hopelessness,fatigue,chest tightness,Shan Taixi,decreased ability to work,learning ability.Common factor 2:irritability,dreams,stretching,fullness in head,dry mouth and throat,chest fullness,chest pain.Combined with professional knowledge,common factors land Liver-qi depression syndrome are similar.Common factors2 and symptoms of Liver-qi invasion are similar.(7)The Liver-qi invasion and Liver-qi depression patients’ score on DRSP has tested by independent samples T-test.It is no significant on functional impairment and physical subscales.On the depression subscale,Liver-qi depression and Liver-qi invasion difference is significant,and Liver-qi depression higher than Liver-qi invasion.On the irritability subscale,the Liver-qi invasion and Liver-qi depression difference is significant,and Liver-qi invasion higher than Liver-qi depression.3.The combination of theoretical exploration and positive exploration(1)The conclusion of theoretical research suggests that TCM syndromes of PMDD should meet the characteristics of diagnostic criteria;syndrome classification should have the characteristics of mutual identification.(2)The epidemiological investigation gives evidence that the Liver-qi invasion and Liver-qi depression syndrome of PMDD meet the criteria above.(3)Through the argumentation and evaluation in the combination of theoretical exploration and positive exploration,which the Liver-qi invasion and Liver-qi depression syndrome of PMDD meet given standard,are expected to be the clinical subtypes which can be recognized by the Chinese medicine and modern medicine.Conclusion:1.Syndrome combination refers to the combination of modern medical diseases and syndromes of traditional Chinese medicine.The logical relationship between disease and syndromes is that disease is a superior concept,and syndrome is the underlying concept.Therefore,the diagnosis of modern medical diseases under the premise(under the conditions)TCM syndrome differentiation and its type,first of all should meet the characteristics of disease diagnosis,and have the characteristics of mutual identification between the syndromes.This should be to determine the diagnosis of modern medical diseases under the premise of Chinese medicine syndrome differentiation and its classification is scientific and credible evaluation criteria.2.Disease subtypes,is the modern medicine on the different types of disease awareness and division.The disease is divided into different subtypes,can make people understand the type of disease more clearly,more clear diagnosis,treatment more effective.3.Disease diagnosis,TCM syndrome and modern medical subtypes,especially between the clinical sub-types,there is a certain cross-coincidence,in-depth exploration of the relationship between the syndrome is a combination of Western medicine recognized an important way.4.PMS/PMDD TCM syndrome and clinical subtypes,are based on the clinical symptoms of the division,after the division of the disease more understanding,more importantly,the diagnosis and treatment of the disease have a more clear goal.TCM syndromes can be recognized by modern medicine,become a modern medical recognition subtype,Chinese medicine can really go to the international,to the medicine outside the big peer.5.Liver syndrome,liver qi and yang are the main syndromes of PMDD,which are characterized by the diagnostic criteria of PMDD disease,and have the characteristics of mutual identification.The main evidence of this assertion is:(1)Logical relationship with the concept of disease and syndromes(2).Conform to PMDD diagnostic criteria(3)By symptomatic unconditional logistic regression and factor analysis,it can be inferred that the Liver-qi invasion syndrome and the Liver-qi depression syndrome are two groups of relatively independent symptom groups.Liver-qi invasion to impatient for its clinical characteristics,often accompanied by more dreams,head swelling,eyes astringent,dry mouth and throat,Xiong Xie fullness,Xiong Xie pain and other symptoms;Liver-qi depression to emotional depression for its clinical features,often accompanied by anxiety,feeling hopeless,fatigue,chest tightness,good too much interest,decreased ability to work,learning ability and other symptoms.5.4 Liver-qi depression and Liver-qi invasion syndrome of PMDD in patients with DRSP depression,impatient irritability subscale significant difference,verify the correctness of the two syndromes.6.In the face of the international medicine cutting-edge attention problem that how to distinguish and confirm the clinical subtypes of PMDD.In order to solve this problem,the classification which Liver-qi depression and Liver-qi invasion syndrome of PMDD provide a new perspective and approach,this remains to be studied in the future.7.The principles of the combination of theoretical exploration and positive exploration:firstly,theoretical guidance,put forward the the new scientific hypothesis;secondly,according to the scientific hypothesis to test evidence,choose to support or refute the theory or hypothesis;thirdly,scientific hypothesis to obtain the test evidence,need more multivariate follow-up verification;fourthly,variable validation of the scientific hypothesis could have far-reaching impact.There are some limitations in this study,including the symptoms involved in the study may not be clinically repeated,the research method to be improved and the size of the population did not fully meet our expectations.