The Set Up Of The Vertebroarterial Type Of Cervical Spondylopathy Inventory And The Evaluation Of Clinical Curative Effect

With the evolvement of diseases, chronic diseases, degenerative diseases and senile diseases have become the main danger to human health. But clinical study showed that Lab examination is very difficult to reflect the real curative effects of these diseases. For example, symptoms of spinal retroversion are difficult to be explained by radiological examinations properly. Lab examination can' t reflect the developments of rheumatoid arthritis exactly. More and more researchers realized the limits of classic curative effect evaluation standard in multifactor diseases and began to look for a new standard to measure subjective feelings and the abilities to accomplish ordinary life. The new standard belongs to consequence index, which is at another level—integrity level.In Wilson' s view, to evaluate final results, consequence indexes can be divided into five levels: biological and physiological variables, symptom status, functional status, and general health perceptions, overall quality of life. The former two levels are classic consequence indexes in western medicine evaluation, which focus on cells, organs and relatively independent systems of human body. The latter three levels, which enjoy more and more attention among people, are based on the consequence indexes about activities of daily life scale (ADLS) and quality of life (QOL), focusing on individuals. It is very necessary and effective to use consequence indexes at integrity level in evaluating curative effect for tumor and rheumatoid arthritis (RA) treatment.Since 1980, indexes of integrity level are used to evaluate the therapy' s curative effects on vertigo comprehensively abroad. A typicaland representative example is Jacobson' s Dizziness Handicap inventory (DHI). DHI is used to evaluate the therapy of vestibular dysfunctions by some researchers abroad, for its reliability and validity, and good relevance to severity. But at home, only dizziness and function of cervical spondylopathy inventory includes some contents at integrity level, such as assistances needed in daily life, work condition. These items are too simple to reflect the damage of vestibule function.Methods:1. Rationale of the inventory:Chinese medicine recognizes the disease from the viewpoint of integrity, and sum up the medical theory during long-time clinical experience. Traditional evaluation in Chinese medicine and the integral evaluation in modern western medicine are different theoretically.In western medicine, integrity means collection and complex compound, constituting of separate parts;but in Chinese medicine, integrity means undividable and congenital, with two main aspects—Ying and Yang. Every substance is from internal of integrity. Some scholars describe the two opinions as "collective entity" and "congenital entity" . Differences in the perspective lead to different meanings of indexes at integrity level directly. Concept of integrity at the functional level in western medicine involves physical function, mental function, social function, role function, and so on. And the standard of effective evaluation is based on every segment (function). Chinese medical conception of integrity is based on syndrome. "Internal congenital Qi differentiation occurs during the activities of Qi, and Qi turns into Ying and Yang" . So this evaluation is on one dimension— imbalance of Ying and Yang. Domestic scholars analyze the difference of oriental and western meanings of integrity from philosophical standpoint, and bring up a new scientific integrity conception. This concept absorbs great progress in western medicine about combination and affirms the existence of objects and its great significance, when emphasizing the character of "congenital integrity" . Therefore, Chinese medical integrity has its advantage, and implies that oriental and western medicine can be complementary to each other.2. Specificity of the inventorySyndrome indexes of Chinese medicine are based on four diagnostic methods: inspection, auscultation and olfaction, inquiry and pulse-taking and palpation. Contents of inquiry, the same as QOL scale, are about patient' s subjective feelings. Studies in recent 20 years showed that these feeling indexes can be measured objectively by scales. Doctors can get information of the other three aspects by inspecting, listening, which is base on clinic experience. To replace the feeling and experience of doctors, some scholars try to measure tongue and pulse by color-digital process and recognition system, but the others confirm that no great progress is made in the researches about modernization of Chinese medical diagnosis. The technique of diagnosis by doctors' feeling and experience is still particular advantage of TCM. Including inspection, human' s feeling goes its special way. Progresses still lack in the field such as self-adjust and self-study in comprehensive system. Above all, modern machine can' t replace the feeling of human body.3. Discussions on methodology of the inventoryMethodology of the inventory is based on macro-indexes in effect evaluation turns matured. At present, methodology of Chinese medical evaluation is still at the beginning for TCM' s particularity. This is the main content of our study.In our opinion, it is more practicable combining qualitative indexes with quantified indexes. In inquiry, use the well known items of other measurements. Take tongue inspection and pulse feeling as qualitative indexes, which is more objective than the others. According to the frequency and reaction of main items, we screen out useful indexes.4. Significance of the inventoryIn current literature, fact is that the main techniques are based on western medicine indexes in oriental and western treatments. In the hospital of TCM, the therapy is combing disease with syndrome, but the curative effect evaluation standard is completely from western medicine. This status bring dangers in two aspects: 1. the curative effect standard can' t reflect the true validity of traditional Chinese medicine. 2. By using the western standards, more and more young Chinese physicians will belittle the practicability and specificity of TCM. Therefore it is keypoint to establish a new evaluating standard for TCM.It has been found that method of clinical studies play great role in developing alternative medicine (including oriental medicine). Recently, some syndrome indexes are involved in the clinical studies of NIHNCCAM (National institutes of health of national center for complementary and alternative medicine).In our study, cervical spondilysis of veterboarterial type inventory indicates.the feasibility to form a new inventory based on the syndrome differentiation. It provides scientific evidences for screening out objective and systematic indexes for C therapy of TCM.Result:To identify the specificity of syndrome indexes, we tried prospective study in three groups: cervical spondilysis of veterboarterial type, cervical spondilysis of nerve-root type, and healthy old persons as control. We tried to find out whether Yang deficiency syndrome is the only special syndrome of cervical spondilysis of veterboarterial type, or the character of cervical spondylisis, or the common syndrome of senile disease.According to diagnostic standard of TCM, we classify the syndrome indexes and select the items of inventory. The sensitivity and specificity are different between diagnostic indexes and curative effect evaluating indexes, principallyTherefore, two parts are involved in our Chinese syndrome indexes. One is Chinese curative effect evaluating inventory with good reliability and validity, the other is relative symptoms inventory of TCM with not very good reliability.From February. 2005 to April. 2006, 220 subjects are involved in our formal study, among which 192 subjects have been studied for 3 weeks after treatment. Another study was taken on 28 subjects 24hrs later by different researcher after the first observation.Conclusion:On the basis of studies at home or abroad, we tried to form a cervical spondylisis inventory of veterboarterial type. The scale of cervicalspondylisis of veterboarterial type, involving functional status, mental function, and medical syndrome, has been formed through collecting 220 subjects of cervical spondylisis of veterboarterial type. The validity and sensitivity of this scale has been proved to be perfect by mental measurement.At the same time, we have discussed the methodology of evaluating inventory of TCM. In our opinion, quantitative indexes and qualitative indexes should be combined in the inventory, and screen out quantitative indexes to form the curative effect scale of TCM according to the principle of scale' s methodology. There are still some disadvantages in our inventory for cervical spondilysis of veterboarterial type, such as correlation rate, reaction rate, the dimensions of syndromes and the specificity of some indexes. It may be improved later in the further clinical studies.