Characteristics Of Syndrome Elements Of Syndrome Drift Of Liver Depression And Spleen Deficiency In Chronic Hepatitis B

Objective:To study characteristics of syndrome elements of Syndrome drift in chronic hepatitis B (CHB) patients with Liver Depression and Spleen Deficiency, and to explore the regular patterns of syndromes drift.Methods:Syndrome drift was defined as emerging signs or symptoms inadequate for being recognized as another pattern of syndrome else. A total of 300 CHB patients were recruited in this study, all of those were Zheng classified as syndrome of Liver Depression and Spleen Deficiency and those liver biopsies showed both.necroinflammation gradings (G)< G3 and fibrosis stagings (S)< S3 in there livers. Symptoms of each patients were observed by the TCM four diagnostic methods and recorded. All patients were followed up weekly or biweekly for at least 3 months, follow-up was ended if when any new syndrome or sign emerged in the 3-month period. Syndrome and syndrome elements were documented at each visit. Syndrome elements including the location and the nature of disease were analysed by using a software of the TCM syndrome element program developed by Fujian University of TCM.Results:1. Syndrome drift is common in CHB with liver depression and spleen deficiency syndrome. Incidences of syndromes drift varied among syndrome of accumulated dampness-heat (90cases,57.7%), liver depression and qi stagnation syndrome (37cases,23.7%), liver-kidney yin vacuity syndrome (14cases,9.0%), pattern of static blood obstructing the network vessels (10cases,6.4%) and spleen-kidney yang deficiency syndrome (5cases,3.2%).2. Syndrome drifts are more likely to occurr in patients with G2 or S2 or higher HBV DNA.3. The common symptoms of patients with syndrome drift are bland taste in the mouth, stringlike pulse, belching, ruffian swelling after eating, fatigue and lack of strength, hypochondriac pain, emotional depression or anxiety, dereistic thinking, oppressive pain, abdominal swelling, dental impressions on the margins of the tongue, rib-side pain and distention, poor appetite,thin white tongue fur, bitterness in the mouth, rib-side distention, scant yellow urine, distending or scurrying pain, sigh, thirst, frequent loose stools, etc. (each covers more than 10% of total cases)4. Disease locations of CHB patients with liver depression and spleen deficiency are mainly liver, spleen, new-onset disease locations are gall bladder, stomach; when syndrome drift emerges, combination of disease location are mainly liver and stomach, spleen and stomach, liver and spleen or hepatobiliary disease.5. Disease nature of CHB patients with liver depression and spleen deficiency are:qi stagnation, wet; new-onset disease nature are blood stasis, yang deficiency, phlegm. When syndrome drift emerges, combination of disease location are mainly wet plus qi stagnation, wet plus phlegm, qi stagnation plus blood stasis.6. Syndrome location including liver, spleen appear both at baseline and during syndrome drifting; while stomach, exterior, midstage and gut are new-onset disease location when syndrome drift emerges. Syndrome elements such as wet, heat, qi stagnation, deficiency of Qi, deficiency of blood, sputum appear both at baseline and during syndrome drift emerging; heat, food accumulation, blood stasis, yang deficiency, rheum, water collecting are new-onset syndrome nature only when syndrome drift emerges.Conclusion:1. Syndrome drift is common in CHB liver depression and spleen deficiency syndrome.patients who have higher G,S, HBV DNA are more likely to emerge syndrome drift. Syndrome of accumulated dampness-heat, liver depression and qi stagnation syndrome are related syndromes of syndrome drift.2. Stomach, exterior, midstage and gut are new-onset disease location when syndrome drift emerges. Heat, food accumulation, blood stasis, yang deficiency, rheum, water collecting are new-onset syndrome nature when syndrome drift emerges. so, we should take care of those syndrome elements in the process of syndrome differienciation and treatment.3. Disease location including liver, stomach, spleen, gall bladder often mixed up when disease progress, so do the nature of disease including wet, qi stagnation, phlegm and blood stasis.so we should treat according to the subtle change and take Active antiviral therapy.