| Objectives:For this topic,it uses clinical research to explore the symptoms and signs of patients with lumbar disc herniation,which includes the distribution and dynamic evolution pattern of TCM evidence elements and the correlation between common evidence elements of lumbar disc herniation and common symptoms and signs,so as to provide reference for the clinical identification of lumbar disc herniation.Methods:Clinical data of outpatients and inpatients with lumbar disc herniation from October 2019 to January 2021 at Jinjiang City Hospital of Traditional Chinese Medicine affiliated to Fujian University of Chinese Medicine were collected,and information on age,disease duration,symptoms and signs,evidence patterns and evidence elements of the study subjects were extracted after data normalization to establish a database,and statistics and analysis were performed.Results:1.General situation: Male patients accounted for 60.99%,female patients accounted for39.01%,age was concentrated in 30-50 years old,and patients with a longer disease duration of more than 3 months accounted for 58.78%.2.There were 17 triggers,and the common triggers were: sprain,exertion,weight bearing,cold,trauma,and slow onset of prolonged illness.3.There were 158 symptoms and signs(excluding tongue and pulse).The common symptoms and signs were: lumbago,lower limb pain,unfavorable lumbar movement,lower limb numbness,lower limb tenderness,unfavorable walking,lumbar tenderness,lumbar soreness,chilliness,poor sleep,and lumbar tightness.The common pain nature are: pulling pain,stabbing pain,fixed pain,soreness,cold pain,pain refusing to press,swelling pain,hidden pain;The common pain aggravating and relieving factors were: sharp pain when laboring,sharp pain when it is cold,alleviated during the day and aggravated at night,sharp pain when coughing and sneezing,alleviated pain when resting,sharp pain when doing activities,sharp pain in rainy days,alleviated pain when getting heated.4.There were 11 types of tongue colour,7 types of tongue shape and 9 types of tongue coating.The common tongue signs are: pale white tongue,red tongue,dull tongue,pale red tongue,dull red tongue,pale dull tongue,dull purple tongue,petechiae on the tongue,tooth marks on the tongue,fat tongue,white coating,thin coating,greasy coating,yellow coating and thick coating.5.There were 14 types of pulse,of which the common ones that occur were: stringent pulse,thin pulse,sunken pulse,astringent pulse,smooth pulse,tight pulse,counted pulse,weak pulse,and weak pulse.6.There were 120 types of evidence,of which 45(37.50%)were single evidence types and 75(62.50%)were compound evidence types.The common types of symptoms are: Qi stagnation and blood stasis,cold-damp paralysis,liver and kidney deficiency,blood stasis and damp-heat paralysis.7.There were 8 pathogenic evidence elements,of which the common ones occurring were: kidney,liver,meridian and spleen.8.There were 12 pathogenic elements,of which those included: blood stasis,dampness,cold,qi stagnation,yang deficiency,qi deficiency,wind,heat,phlegm,and yin deficiency.9.The frequency distribution of the pathological evidence elements liver,kidney and spleen differed between age groups,with the proportion of the pathological evidence elements liver and kidney gradually increasing with age;the proportion of the pathological evidence elements phlegm,qi deficiency and yang deficiency gradually increased with the prolongation of the disease duration,but there was no significant difference in the frequency distribution between the different disease duration groups.10.Correlation between common evidence and common symptoms and signs: the symptoms and signs that support the diagnosis of the evidence element "kidney" included weak waist,severe pain when laboring,numbness in the lower limbs,lumbago,inability to walk long distances,weak pulse and thin pulse.Symptoms supporting the diagnosis of "Liver" include lower limb limpness,fatigue,weak pulse and thin pulse;Signs that support the diagnosis of "meridians" included numbness in the lower limbs,severe pain when exposed to cold,dull red tongue and pale dull tongue;Signs that support the diagnosis of "spleen" included loose stools,muscle atrophy in the lower limbs,pale red tongue,teeth marks on the edge of the tongue,and thick coating;Signs that support the diagnosis of "blood stasis" included painful countenance,and stringiness of the pulse;And signs that support the diagnosis of the evidence element "dampness" included soreness and pain,sharp pain when exposed to cold,greasy moss,and tooth marks on the tongue;Signs that support the diagnosis of the evidence element "cold" included sharp pain when exposed to cold,soreness in the lower limbs,pain in the lower limbs,pale white tongue,white moss,and greasy moss.Symptoms that support the diagnosis of "qi stagnation" included tightness of the back,painful countenance,and a dull purple tongue.Symptoms supporting the diagnosis of "Yang deficiency",including soreness,lower limb limpness and weak pulse.Symptoms supporting the diagnosis of "Qi deficiency" included numbness in the waist,alleviated during the day and aggravated at night,and thin pulse;Symptoms and signs supporting the diagnosis of "Wind" included poor sleep and severe pain when exposed to cold;Symptoms and signs supporting the diagnosis of "Heat",included yellow urine,soreness and pain,and greasy moss;Symptoms and signs supporting the diagnosis of "Phlegm",included greasy moss;Symptoms and signs supporting the diagnosis of "Yin deficiency",included yellow urine,red tongue,little moss and weak pulse.Conclusion:1.The common pathogenic elements of lumbar disc herniation are kidney,liver,meridians and spleen,and the common pathogenic elements are blood stasis,dampness,cold,qi stagnation,yang deficiency,qi deficiency,wind,heat,phlegm,and yin deficiency.2.The 282 patients with lumbar disc herniation included in this study involved 120 types of evidence,with compound evidence accounting for 62.5% of the cases,and the types of evidence were more complicated and dominated by compound evidence.As the age of the patient increases,the proportion of the pathological elements kidney and liver increases gradually;As the duration of the disease increases,the proportion of the pathological elements kidney,phlegm,qi deficiency and yang deficiency increases gradually.The results of the frequency analysis and logistic regression analysis were basically consistent with the characteristics of the common evidence of lumbar intervertebral disc herniation,and the diagnostic support and strength of each common causative factor and symptom sign varied for different evidence elements. |
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