| ObjectiveThis subject aims to investigate the types and distribution characteristics of traditional Chinese medicine syndrome of Gastroesophageal Reflux Disease(GERD)by systematic quantitative comprehensive statistical method and epidemiological investigation of clinical cases;In order to provide clinical basis for the combination of disease and syndrome of GERD.Methods(1)A single group rate meta-analysis was used in the literature study.Search literatures on TCM syndrome types of GERD,which were published in CNKI,WANFANG,VIP and CBM databases from the foundation of the database to December 31th,2021.Then,Metaanalysis was performed by using Stata 16.0 software.(2)Epidemiological investigation was used in the clinical analysis.A total of 392 GERD patients admitted to the gastroenterology outpatient department of Foshan Hospital of Traditional Chinese Medicine were collected.Data such as gender,age,onset time,course of disease,clinical symptoms and their degree,tongue and pulse pattern,gastroscopy results,and Hp infection were collected,and syndrome differentiation was performed according to the syndrome differentiation criteria.Symptoms of patients treated with traditional Chinese medicine were scored at first visit and each return visit.Microsoft Excel 16.41 was used to establish GERD TCM syndrome type database.After data collection,TCM syndrome type and related data of effective TCM treatment subjects and Western medicine treatment subjects were extracted,and SPSS Statistics 26.0 was used for statistical analysis.Results(1)literature study:19 articles including 3530 cases and 30 TCM syndrome types were reported.The results of Meta-analysis showed that the distribution frequency of heat stagnation in liver and stomach syndrome was 0.30[95%CI(0.26,0.35)],incoordination between liver and stomach syndrome was 0.26[95%CI(0.22,0.31)],gallbladder heat invading stomach syndrome was 0.21[95%CI(0.16,0.27)],dampness-heat of spleen and stomach syndrome was 0.19[95%CI(0.13,0.25)],Qi-phlegm stagnation syndrome was 0.16[95%CI(0.12,0.21)],deficiency of spleen and stomach syndrome was 0.13[95%CI(0.09,0.17)],phlegm-stasis obstruction syndrome was 0.13[95%CI(0.09,0.16)],deficiency of Qi and inversion syndrome was 0.12[95%CI(0.08,0.17)],spleen deficiency and dampness-heat syndrome was 0.10[95%CI(0.01,0.18)],deficiency of stomach yin syndrome was 0.07[95%CI(0.04,0.10)].(2)Epidemiological investigation:392 GERD patients,including 213 males and 179 females.The minimum age was 18 years old,the maximum 59 years old,and the mean age was(43.08±10.33)years old.The mean course of disease was(429.15±871.01)days;In spring(from February to April),the incidence was 29.85%.Main complaint was the main clinical symptom(main symptom),and the frequency of occurrence was reflux(157 times,40.05%),heartburn(147 times,37.50%),foreign body sensation in pharynx(36 times,9.18%),thorax and hypochondriac distension(33 times,8.42%),retrosternal pain(32 times,8.16%),belching(31 times,7.91%).The frequency of clinical symptoms were reflux(187 times,47.7%),heartburn(161 times,41.07%),belching(113 times,28.83%),and foreign body sensation(104 times,26.53%).Gastroscopy showed significantly more patients with non-erosive reflux than with erosive esophagitis and Barrett’s esophagus,bile reflux was confirmed in 18.89%of patients under endoscopy.Hp infection was present in 25%of patients who had undergone 13C or 14C breath tests.Among 392 GERD patients,28 did not use traditional Chinese medicine treatment,and 53 did not improve their symptoms after traditional Chinese medicine treatment.A total of 339 patients were included in TCM syndrome type statistics.There were 9 types of TCM syndrome in 339 cases.The frequency was as follows:liver and stomach disharmonious syndrome(43.36%),middle deficiency qi reverse syndrome(16.81%),liver depression and spleen deficiency syndrome(11.80%),spleen deficiency dampness-heat syndrome(11.80%),liver and stomach heat stagnation syndrome(7.67%),spleen deficiency and dampness-blocking syndrome(4.13%),qi stagnation and blood stasis syndrome(2.95%),cold and heat mixed syndrome(0.59%).The distribution of TCM syndromes and gender difference were statistically significant(χ~2=18.409,P=0.018<0.05).In terms of the influence of patient gender on the distribution of TCM syndromes,the proportion of male patients was higher than female patients in the syndrome of stagnation and heat of liver and stomach and the syndrome of disharmony between liver and stomach.The syndromes of liver depression and spleen deficiency and the reverse syndrome of middle-deficiency qi accounted for a high proportion of females.There was statistical significance between the distribution of TCM syndrome type and age group(χ~2=22.569,P=0.004<0.05).The distribution pattern of syndrome types in patients aged 30 was as follows:syndrome of disconcerting liver and stomach(17 cases)>syndrome of spleen deficiency and dampness-heat(8 cases)>syndrome of heat stagnation of liver and stomach(7 cases)>syndrome of deficiency qi and reverse of middle(2 cases)>syndrome of liver depression and spleen deficiency(1 case)>syndrome of spleen deficiency and dampness-blocking(1 case);The distribution pattern of syndrome types in patients aged 30-39 years old was as follows:liver and stomach disconcerting syndrome(34 cases)>spleen deficiency damp-heat syndrome(14 cases)>spleen deficiency dampheat syndrome(12 cases)>liver depression and spleen deficiency syndrome(9 cases)>liver and stomach heat stagnation syndrome(7 cases)>Qi stagnation and phlegm obstruction syndrome(5 cases)>spleen deficiency dampness-blockage syndrome(2 cases)>Qi stagnation and blood stasis syndrome(1 case);The distribution pattern of syndrome types in patients aged 40-49 years old was as follows:syndrome of disconcerting liver and stomach(46 cases)>syndrome of deficiency qi and reverse qi(18 cases)>syndrome of liver qi and spleen deficiency(12 cases)>syndrome of spleen deficiency dampness-heat(11 cases)>syndrome of liver and stomach heat stagnation(8 cases)>syndrome of qi stagnation and phlegm obstruction(3 cases)>syndrome of spleen deficiency and dampness-blocking(3 cases)>syndrome of qi stagnation and blood stasis(1 case);The distribution pattern of syndrome types in patients aged 50-59 years old was as follows:syndrome of disassociation between liver and stomach(50 cases)>syndrome of deficiency of qi and reverse qi(23 cases)>syndrome of spleen deficiency and dampnessheat(18 cases)>syndrome of spleen deficiency and dampness-heat(9 cases)>syndrome of spleen deficiency and dampness-heat blocking(8 cases)>syndrome of liver and stomach heat stagnation(4 cases)>syndrome of qi stagnation and phlegm blocking(2 cases)=syndrome of cold and heat confusion(2 cases)>syndrome of qi stagnation and blood stasis(1 case).The difference of TCM syndrome type distribution and body type was statistically significant(χ~2=41.611,P=0.000<0.01).Spleen deficiency damp-heat syndrome is more common in obese patients,and the proportion of emaciated patients in liver depression and spleen deficiency syndrome is higher than obese patients.In terms of the influence of season on the distribution of TCM syndrome types,the proportion of liver and stomach disharmony syndrome in spring and winter patients with gastroesophageal reflux disease was significantly higher than that in summer and autumn.Conclusion(1)There are 30 TCM syndrome types of GERD reported,and the syndrome of stagnation heat in liver and stomach has the highest distribution frequency.(2)The incidence of GERD is related to age,gender and season.The incidence of GERD increases with age,and the incidence of female is higher than that of male.The incidence of non-erosive reflux disease is higher than that of reflux esophagitis and Barrett’s esophagus.(3)In addition to the typical symptoms of GERD patients,regurgitation and heartburn,other atypical symptoms,such as foreign body sensation in the pharynx,fullness in the chest and flank,retrosternal pain and belching,can be the common initial symptoms.(4)The TCM syndrome types of the research objects that were effectively treated by innovative use of TCM were the statistical data sources.This topic found that the main TCM syndrome types of GERD were the syndrome of disharmony between liver and stomach,the syndrome of middle-deficiency qi inversion,the syndrome of liver-stagnation and spleen-deficiency,and the syndrome of dampness-heat of spleen.Except the syndrome of disharmony between liver and stomach,the other three TCM syndrome types were mainly spleen deficiency,which may be related to the cases from Lingnan region.(5)GERD syndrome type distribution was related to gender,age and body type. |
PDF Full Text Request