Study On Syndrome Factors, Syndrome Characteristics And Pathogenesis Of TCM Syndromes Of Coronary Heart Disease With Diabetes Mellitus

Purpose： To research TCM syndrome factors syndrome characteristics and pathogenesischanges of coronary heart disease complicated with diabetes mellitus.Material and method：Based on Clinical manifestations of coronary heart diseasecomplicated with diabetes mellitus. Refering to the ancient and modern literature. Using themethod of Philology. Through three rounds of Delphi methods, we consult opinions andsuggestions of experts and statistics experts, to evaluate questionnaire, screening, correction,determine the questionnaire structure and content. Through questionnaire survey system, wedistribute the questionnaire to1504clinical doctors of51hospitals in six regions, to make asurvey of the questionnaire. By using frequency analysis, clustering analysis and probabilitytransfer matrix method to make statistical analysis.Results：1.The results of302questionnaires distributed in six region show that the questionnaire’sCronbach’s αcoefficient is0.9876, multiple-factor analysis show: the cumulative explainedvariance respectively are88.2%、88.2%、88.9%.2.Symptom frequency distribution of the three stages of coronary heart disease complicatedwith diabetes mellitus indicate：In terms of physical distribution，most are yin deficiency,phlegm-dampness, dampness-heat and qi deficiency. It is common for dull pain of chest. Ateach stages of palpitation, we can see the symptom of epigastric fullness, severe palpitationand sleepless,and feeling of oppression over the chest. The degree of thirst change from thexerostomia, thirst, thirst with desire to drink to thirst without desire to drink. The degree ofdiet change from more food to less food. In all different stages of the disease, we can seefrequent urination,gradually emaciation, aggravated edema, parahidrosis, itching of eyes,dry eyes and aggravated auditory abnormality. We can also obviously see dry skin symptomand acroparesthesia, and also will become more and more serious. With the development ofdisease, the systemic symptom will get more and more serious. Frequency statistics of the tongue and pulse indicate: in the early stage, the tongue color ismostly pink, light-white and red; the tongue shape is mostly moderate, teeth marked, plumpand thin; the sublingual venae is mostly red color; the tongue coating is mostly moderate, thin,dry, moist and scanty；the coating color is mostly white and yellow; In the stage of coronaryheart disease complicated with diabetes mellitus, the tongue color is mostly red, deep red,dark, pink, and light-white; the tongue shape is mostly teeth marked, plump,thin，ecchymotic and prickly; the color of sublingual venae is mostly deep red, the shape ofsublingual venae is wide and circuitous,also emerging some tiny collaterals or branch aroundsublingual-threads; the nature of tongue coating is dry, greasy,thick,moist and thin, or withscanty coating or without coating；the coating color is mostly yellow and light yellow; Inchronic complications period, the tongue color is mostly dark, purple, red and deep red；thetongue shape is mostly ecchymotic， fissured，mirror-liked, teeth marked and thin; thesublingual venae is cyanotic and seriously circuitous, and it distributed all over the tonguebase; the nature of tongue coating is dry, greasy, thick, rootless,or with scanty coating orwithout coating；the coating color is mostly yellow, gray and black. In all stages of thedisease,the state of tongue is amyotrophic and soft. In the stage of coronary heart diseasecomplicated with diabetes mellitus, we can also see trembling tongue. During the stage ofchronic complications,we will see the performance of trembling and spirality.In the earlystage of coronary heart disease complicated with diabetes mellitus, there will be thin, rapid,sunken and wiry pulse; In the stage of coronary heart disease complicated with diabetesmellitus, there are mostly slippery, weak,tight and unsmooth pulse; During the stage ofchronic complications, we can see thin, sunken, unsmooth, wiry, weak, knotted andintermittent pulse.3.decision tree results, coronary heart disease and diabetes early syndrome factor criteria: QiStagnation:"with hiccups or belch","with CO expansion";"blood stasis tongue color: dark","lip ecchymoses","lip dark purple","purple tongue"; heat evil:"the tongue color red","tongue mass dryness","under the context of deep red tongue","bitter","facial redness".Coronary heart disease complicated with diabetic period syndrome factor criteria: QiStagnation:"hypochondriac pain","with hiccups or belch","pulse","heart" fullness "; bloodstasis: tongue ecchymosis," visible "skin petechia","with cyanosis","sublingual vein trunk micro rough or tortuosity, around the small collaterals or branch","sublingual venationskeleton branches emerge on both sides, group product into"; phlegm:"tongue tooth marks","slippery pulse","tongue embryo quality tired","pulse","overweight","tongue thick," with"dizzy"; heat evil:"fur quality dry","tongue Jiang color","tongue prick (red, white or black)","tongue color","the pulse number","lip rouge"; spleen:"with" weak ", with loss of appetite","thin stool"; deficiency of kidney yin:"tinnitus as cicada","apprehensiveness uneasy","pulse","hot night sweats","pulse","flushing". Coronary heart disease with chroniccomplications of diabetes period syndrome factor criteria: Qi Stagnation:"rough pulse","withhiccups or belch","coerce bilges","hypochondriac pain"; blood stasis:"purple tongue","tongue ecchymosis","with cyanosis","tongue color dark":"with phlegm; pan evil","tonguethick","pleural edema","tongue state shortening","abdominal edema","tongue tooth marks","tongue sliding","quality of greasy tongue"; heat evil:"purple tongue","fur quality dry","tongue prick (the red, white or black)","tongue color","tongue Jiang color"; spleen:"with"weak ", with loss of appetite","thin stool"; Yin deficiency:"apprehensiveness uneasy","withthirst","hot night sweats","tinnitus as a cicada","night sweating","with low back pain".4.neural network results: diabetes early except phlegm, spleen qi deficiency, yin deficiency oftraining set to predict the effect on coronary heart disease, prediction neural network to qistagnation, blood stasis, phlegm, Qi deficiency and syndrome factor is better, the validationset, evaluation set, the vast majority of forecast accuracy rate reached75%above, whichproves the good effect of decision tree. Neural network prediction of heat evil results. Incoronary heart disease patients with diabetes, chronic complications during the predictionperiod of stagnation of Qi and blood stasis, neural network, phlegm, heat evil, spleendeficiency, kidney yin deficiency and syndrome factor is better, both the training set andvalidation set, evaluation set, the prediction accuracy reached80%(chronic complications85%) above, thus verify the decision tree to good effect.5. Clustering analysis indicate that the early stage of coronary heart disease complicated withdiabetes mellitus can clustering for three groups of symptoms:The first group showed: dullpain of chest, epigastric hollowness, feeling of oppression over the chest, dry skin,sleeplessness and dreamy, pink or red tongue, thin and rapid pulse. The second group showed:epigastric hollowness, tastelessness, dreamy, amnesia, dyscoimesis, tired, abdominal distention, teeth marked and plump tongue, sunken pulse; The third group showed:Dyspnea,unsmooth breathing and chest ache, epigastric fullness, abdominal distention,overweight, dizziness, anorexia and sken pulse.The stage of coronary heart disease complicated with diabetes mellitus can clustering forthree groups of symptoms: The first group showed: dull pain of chest, severe palpitation andsleepless, sleeplessness and dreamy, dry eye, frequent urination, emaciation, with thirsty,palpation, sweat, tired, red tongue and sunken thin pulse. The second group showed:Dyspnea,unsmooth breathing and chest ache, rapid digestion of food and polyorexia,dyscoimesis, severe palpitation and sleepless, abdominal distention,with singultus and belch,bitter taste of mouth, sticky and greasy in mouth,red tongue,yellow and greasy coating; Thethird group showed: Dyspnea,unsmooth breathing and chest ache, like to eat greasy food, fat,abdominal distention,with palpation, singultus and belch, the color of sublingual venae ismostly cyanotic, the shape of sublingual venae is wide and circuitous,also emerging sometiny collaterals or branch around sublingual venae; plump tongue with teeth mark, greasytongue coating, sunken pulse, slippery pulse or wiry pulse.During the stage of chronic complications can clustering for two groups of symptoms: Thefirst group showed: emaciation, dyspnea, unsmooth breathing and chest ache, severepalpitation and sleepless, along with tinnitus, insomnia with restlessness, dry eyes, lumbago,acroagnosis, acroparesthesia and numbness of limbs, dark tongue, ecchymotic tongue, withscanty coating or without coating, thin pulse; The second group showed: Dyspnea, unsmoothbreathing and chest ache, severe palpitation and sleepless, acroagnosis, along with diminishedsexual desire,nausea,palpitation, tiredness, sweating, edema below the waist, can not besupine, ecchymotic tongue, sunken or unsmooth pulse.6.The rule of pathogenesis evolutions concluded by transition probability matrix:From theearly stage of coronary heart disease complicated with diabetes mellitus to the stage ofcoronary heart disease complicated with diabetes,the rule is that all syndrome types are easilytransform to Qi and Yin deficiency syndrome; From the stage of coronary heart diseasecomplicated with diabetes mellitus to the stage of chronic complications, the rule is that bothQi and Yin deficiency syndrome and phlegm-heat syndrome are usually change into yinasthenia and blood stasis(kidney),while the Phlegm and Blood Stasis Syndrome convert into yang asthenia and blood stasis (kidney).Conclusion：1.Questionnaire:the statistical analysis results of the questionnaire show: the Internalconsistency is wonderful, the reliability and content are excellent and the structure is clear.It has a good structure validity.2.Symptoms distribution: Through analysis of frequency distribution, we found that yindeficiency and spleen Qi deficiency run through all stages of the disease. The early stage ofcoronary heart disease complicated with diabetes mellitus are mainly related to heart, liverand spleen, also internal heat due to yin deficiency and qi-blood deficiency are mostimportant factors. The stage of coronary heart disease complicated with diabetes mellitusmainly involves heart, liver, spleen and stomach, taken heat, phlegm turbidity and bloodstasis as pathological factors, along with consumption of qi and yin. The stage of chroniccomplications mainly involves heart, spleen and kidney, along with decline of qi and blood,deficiency of both Yin and Yang,blood stasis. The symptom changes conform to the rule ofpathogenetic condition evolution, which will contribute to the further research.3.Syndrome factors:Syndrome factors of symptom frequency distribution analysis showedthat coronary heart disease and diabetes, the main syndrome elements of blood stasis, phlegm,qi stagnation, heat evil, spleen qi deficiency, yin deficiency, and frequency distribution fromcoronary heart disease and diabetes, diabetes, chronic complications during the early period ofincreased. Decision tree statistical methods of syndrome factors in order of importance, candetermine the different stages of prime elements syndrome symptoms change, to theimportant guidance for clinical diagnosis and treatment of play. The statistical method ofneural network can judge the prediction of syndrome factors model, guarantee the feasibilityand regularity of extrapolation of experimental.4. Characteristics of syndrome: Using clustering statistics method to analyse thequestionnaire database,we conclude eight symptom of the three stages of coronary heartdisease complicated with diabetes mellitus.The earlier stage of coronary heart diseasecomplicated with diabetes mellitus: yin-deficiency and fire-hyperactivitysyndrome, deficiency of heart and spleen syndrome, syndrome of qi and phlegm stagnation; The stage of coronary heart disease complicated with diabetes mellitus: Qi-Yin deficiencysyndrome, syndrome of phlegm-heat, Phlegm and Blood Stasis Syndrome; The stage ofchronic complications: yin asthenia and blood stasis(kidney), yang asthenia and bloodstasis(kidney).5.The regulation of pathogenesis and syndrome evolution: In the earlier stage of coronaryheart disease complicated with diabetes mellitus, the characteristic of pathogenesis is yin andblood deficiency, stagnation of qi due to depression of the liver,spleen-qi deficiency, thepathological products are asthenia fire and phlegm. In the earlier stage of coronary heartdisease complicated with diabetes mellitus, the characteristic of pathogenesis is deficiency ofboth qi and yin, the pathological products are phlegm, Pathogenic heat and blood stasis. Inthe stage of chronic complications, the characteristic of pathogenesis is asthenia of both yinand yang, phlegm and blood stasis invading collaterals. Transition probability matrixconclude that from the early stage of coronary heart disease complicated with diabetesmellitus to the stage of coronary heart disease complicated with diabetes,the rule is thatall syndrome types are easily transform to Qi and Yin deficiency syndrome; From the stage ofcoronary heart disease complicated with diabetes mellitus to the stage of chroniccomplications, the rule is that both Qi and Yin deficiency syndrome and phlegm-heatsyndrome are usually change into yin asthenia and blood stasis(kidney),while the Phlegm andBlood Stasis Syndrome convert into yang asthenia and blood stasis(kidney).