Study On TCM Syndrome Differentiation System Of IgA Nephropathy Based On "Image Thinking"

ObjectiveThe purpose of this study is to explore the TGM syndrome differentiation system of IgA nephropathy based on the "image thinking",and establish the TCM four-diagnosis system of IgA nephropathy,in order to guide the TCM treatment of such patients,give targeted and effective TCM intervention measures,and provide the basis for TCM clinical work.MethodsA total of 55 patients with primary IgA nephropathy who were hospitalized in nephrology or treated in the outpatient department of Guangdong Hospital of Traditional Chinese Medicine from December 1,2019 to December 1,2020 were collected.General information of patients,clinical test indicators and other data were collected.By referring to ancient books and combining with modern doctors,the TCM syndrome differentiation method of IgA was summarized and analyzed,and the information collection table of TCM four diagnoses of IgA nephropathy based on "image thinking" was established to collect TCM syndrome information of patients.Then,the method of "image-element-syndrome pattrenphenotype " was used to analyze the disease nature and location syndrome elements of IgA nephropathy patients,and the disease nature and location syndrome elements were compared under the TCM diagnosis of patients in hospital and outpatient treatment,so as to explore the comprehensiveness of TCM syndrome differentiation system based on "image-thinking" on IgA nephropathy syndrome differentiation.Finally,patients with IgA nephropathy’s nature of disease and location of disease were organically integrated,and the syndrome type of traditional Chinese medicine was obtained.Results1.The common conscious symptoms of patients with IgA nephropathy were fatigue(50.91%),dry mouth(43.64%),bitter mouth(32.73%),easy sweating(30.91%),drinking too much water(30.91%),and dreaming too much(30.91%).The common symptoms identify by others were:fine pulse(67.27%),pulse string(65.50%),faint tongue(60.00%),yellow moss(43.60%),abdominal tenderness(40.00%),bright red eyelid(38.18%),heavy pulse(34.55%),pale eyelid(30.91%).2.The disease sites of IgA nephropathy were:kidney(52.73%)>spleen(49.09%)>liver(30.91%)>heart(14.55%)>skin(12.73%).Based on the score threshold of 20,spleen,liver,heart,skin,and mind were less than 20 points in IgA nephropathy,while kidney was more than 20 points,there was no statistically significant difference between the scores of kidney syndrome elements and those of spleen,liver,heart and skin(P>0.05).The spleen,liver,heart and skin with the score of disease location and syndrome element<20 were compared respectively(P>0.05),and there was no statistical significance.According to the distribution statistics of disease location syndrome in patients with IgA nephropathy,the score of kidney(23.86± 10.63)and frequency were the highest,followed by spleen(18.79±4.59),liver(18.12±5.54),heart(18.25±2.76)and skin(19.00±6.66).The results showed that kidney was the most important site of IgA nephropathy,followed by spleen,liver,heart and skin.3.In this study,14 patients with IgA nephropathy had no disease location.11 had single disease locations,16 had double disease locations,9 had three disease locations,3 had four disease locations,and 2 had five disease locations or more.4.The syndrome elements of IgA nephropathy were as follows:deficiency syndrome:Yin deficiency(58.18%)>Qi deficiency(56.36%)>Blood deficiency(49.09%)>Yang deficiency(36.36%),excess syndromes:dampness(47.27%)>heat(36.36%)>phlegm(32.73%)>Water and Dampness Retention(18.18%)>blood heat(12.73%)>Yang hyperactivity(10.91%)>Qi stagnation(9.10%).20 was taken as the integral threshold,among IgAN patients with disease syndromes<20 points,there were heat,dampness,Yang hyperactivity,phlegm,blood heat,Qi stagnation,and Water and Dampness Retention,in the pairwise comparison between them,there were no statistically significant differences between each other syndromes(P>0.05).The patients with scores>20 were blood deficiency,Yin deficiency,Qi deficiency and Yang deficiency.BIood deficiency,Yin deficiency,Qi deficiency,Yang deficiency compared with Water and Dampness Retention,the difference was significant(P<0.01).There was statistical difference between Yang deficiency and dampness,phlegm(P<0.05).Yang deficiency(28.24±10.64)had the highest score,followed by Yin deficiency(25.22±11.87),Qi deficiency(22.68±8.94),and blood deficiency(21.74±6.17).It can be seen that the main syndromes in IgaN patients are deficiency syndrome,with Qi deficiency,blood deficiency,Yang deficiency and Yin deficiency as the main diseases,followed by dampness,heat,Yang hyperactivity,phlegm,blood heat,Qi stagnation and Water and Dampness Retention.5.In this study,the eyelid color of 55 IgA nephropathy patients was half white and half red in 1 case,represented insufficient blood flow and stagnation in the body,pale eyelid in 17 cases,representing insufficiency of blood flow in the body,red eyelid in 16 cases,indicating normal blood transfusion,21 cases of bright red eyelid,representing blood fluid in the case of stagnation.It can be seen that patients with IgA nephropathy have abnormal body fluid metabolism.6.The main syndromes of IgA nephropathy based on "image thinking" were phlegm and dampness syndrome,a total of 11 cases,followed by deficiency of kidney Yin and Yang(8 cases),deficiency of spleen Yang and qi(7 cases),Water and Dampness Retention(6 cases),and hyperactivity of fire due to yin deficiency(6 cases).The TCM diagnosis of the patients at the initial diagnosis and treatment mainly included spleen and kidney qi deficiency,retention of damp-heat and blood stasis(26 cases),spleen and kidney qi deficiency and blood stasis(11 cases),both qi and Yin deficiency,retention of damp-heat and blood stasis(8 cases),spleen and kidney qi deficiency and water dampness-heat stasis(6 cases).The disease location and syndrome elements of IgA nephropathy based on "image thinking" were compared with those at the initial diagnosis and treatment,there was a significant difference between liver and heart disease position syndrome elements under image thinking and at the initial diagnosis and treatment(P<0.01),There was statistical significance in the comparison of skin disease site elements with those in at the initial diagnosis and treatment(P<0.05).At the same time,the frequency of spleen and kidney in at the initial diagnosis and treatment was more than that of image-thinking syndrome differentiation,with significant difference(P<0.01).Blood deficiency,Yang deficiency,phlegm,blood heat,water dampness-heat stasis,and abnormal body fluid metabolism under the syndrome differentiation of image thinking were significantly different from those under the diagnosis of traditional Chinese medicine in hospital and outpatient department(P<0.01),while the syndrome elements of Yang hyperactivity under the syndrome differentiation of image thinking were statistically significant compared with those at the initial diagnosis and treatment(P<0.05).However,there were four identical syndromes in TCM diagnosis under the syndrome differentiation of image thinking and that at the initial diagnosis and treatment,which were Qi deficiency,Yin deficiency,dampness and fever syndrome elements respectively.Pairwise comparison of the four syndromes showed significant difference(P<0.01),it can be seen that TCM syndrome differentiation based on "image thinking" can identify more disease sites-and disease syndrome elements.Conclusion1,Based on the "image thinking" method of TCM syndrome differentiation,this study enriched the disease location and syndrome elements of patients with IgA nephropathy,thus expanding the information of TCM syndrome differentiation and classification of IgA nephropathy.2.Using the "image thinking" method of TCM syndrome differentiation,we preliminarily constructed the TCM syndrome differentiation system of IgA nephropathy,which has a certain promoting effect on the further standardization of TCM diagnosis and treatment of IgA nephropathy.