Initial Set Up And Evaluate Acute Ischemic Stroke "Yin And Yang Type Syndromes" Clinical Dialectical Thinking Mode

BackgroundStroke serious harm to human health,and ischemic stroke as the main types of stroke,it is the high incidence and high mortality,high morbidity worldwide to become great danger to be tackled by a disease.The results show that in the past Chinese medicine can be significantly reduced in patients with acute stroke mortality and morbidity,and it' s unique advantages in the international community have gradually produced a certain impact.But because of complex etiology and pathogenesis of stroke,it' s clinical type views rather inconsistent,and lack of unified standards-Syndrome.Therefore,to explore the rule of dialectical of stroke,and their standardization and standardized research on the treatment and research of stroke become very realistic significance.ObjectiveTo summury the academic thinking of "yin and yang" of treating stroke by my tutor,professor Liu Maocai.Initial set up acute ischemic stroke "yin and yang type Syndromes " clinical dialectical thinking mode to make it more in line with actual clinical ischemic stroke.And evaluate it in a large sample and multi-center cross-sectional survey.Methods1 Part of this clinical study completed in two phases,the first phase of cross-sectional survey research is the early research of the norms Syndrome, the purpose of the research is to preliminary set up the four consultation acquisition table of acute ischemic stroke syndromes.Six Syndromes of quantitative criteria of "Eighth-Five" key project as the gold standard,and verify the rate and consistency of the two standard Syndromes.And provide the basis for further clinical study of norm Syndromes.The second phase is the expansion of cross-sectional samples of investigations and studies, according to previous norms Syndrome 1,252 cases of statistical analysis on the results,in view of experience with experts in the draft or that there is a discrepancy is not in line with the part again literature research and expert advice.Merger,added,deleted the content of Four consultation acquisition table of the "Standardize differentiation of ischemic stroke(draft)",and preparation of the four consultation acquisition table of the " Standardize differentiation of ischemic stroke ",and initial set up and evaluate the acute ischemic stroke "yin and yang type Syndromes" clinical dialectical thinking mode.2 The first phase,the acute phase of ischemic stroke patients with 1,252 cases in accordance with "yin and yang type Syndromes" clinical dialectical thinking mode Syndrome,all data have taken Access document preservation,the survey forms can be achieved in the computer,software development when given in the query,and "Eighth-Five" key project scale stroke syndrome diagnosis percentile of the survey given in the table entries,and the completion of data collection can be directly for various syndromes diagnosis,and can be graded according to level of inquiries,if we can enquiries≧ 7 cases of Wind (≧ 7 can be diagnosed).We classified "yin deficiency and yang excess Syndrome" and "fiery-type Syndrome" into yang-type Syndrome category.The cases who have yin deficiency and yang excess Syndrome are classified in yang-deficiency Syndrome,those without yin deficiency and yang excess Syndrome but have fiery-type Syndrome are classified in yang-positive Syndrome. Those without such Syndromes are classified in yin-type Syndrome.The cases which have Qi-deficiency Syndrome are classified in yin-deficiency Syndrome category,and those without Qi-deficiency Syndrome are classified in yin-positive Syndrome category.Comparing the difference of the two dialectical standards,Calculation of the two standards of diagnostic rate and Kappa values.3 The second phase,we use the forward-looking and cross-sectional survey methods,and use the acquisition Table of stroke combined by disease and syndromes for four diagnostic information collection.We establish the acute phase of ischemic stroke database of 4,077 cases of acute ischemic stroke patients with stroke disease syndromes.To the medical profession thinking as the guide,we initial establish and evaluate the acute stroke "yin and yang type Syndromes" clinical dialectical thinking mode.Result1 In the early part of norms Syndrome study,1252 cases of all patients with acute stroke patients according to "Yin and Yang type Syndromes" clinical dialectical thinking mode of standards Syndrome(deficiency of Yang Syndrome, positive of Yang Syndrome,deficiency of Yin Syndrome,positive of Yin Syndrome).Six Syndromes of the " Eighth-Five science and technology research" quantitative criteria for the certification of gold standard,analyzed the results of cluster analysis indicate that the yang-type Syndrome diagnosis rate is 85.5%,yin-type Syndrome diagnosis rate is 91.5%.Suggesting that the dialectical method has a high rate of agreement,the clinical issues raised by "yin and yang type Syndromes" clinical dialectical thinking mode have higher standards of accuracy.Through the "Eighth-Five scale" norms that assignment after the diagnosis of Deficiency Yang Syndrome patients(30.5%)was significantly higher than that under the four diagnostic information collection platform acquisition norms after the results(19.1%);on the contrary,through The former diagnosis of "Positive Yang Syndrome" patients(15.4%)was significantly lower than the latter(24.8%),but the two combined diagnosis after diagnosis as "Yang-type Syndrome" of patients,both before and after the results were obtained 45.9% and 43.9%,which is basically the same.The diagnosis of "Yin-type Syndrome" before and after the results of the two methods comparison(52.7%and 56.1%) are basically the same.Note further consultation based on the four platforms collected information collection norms Syndrome is the result of considerable accuracy.2 Certification of the first phase of exploration:the overall rate higher compared with the four diagnostic indicators of expertise and the 3 signs of this study(fiery Syndrome,yin-deficency Syndrome and Qi-deficency Syndrome), but some indicators such as red tongue,yellow tongue in fiery Syndrome are not consistent,they have higher weight meet the diagnosis of expertise,but rapid pulse has lower weight in fiery Syndrome,some indicators such as tongue skew,soft physical can not contraction,partial body numb,thirsty like to drink hot water etc have litter or no relationship with the fiery Syndrome. Analyze the reasons,some indicators such as tongue skew,soft physical can not contraction,partial body numb are all indicators dialectical for diseases, so they have higher frequency in four Diagnostic indicators and therefore will affect the statistical results.The emergence of some indicators such as thirsty like to drink hot water can he interpreted as the syndromes of the stroke are more complex,composite Syndrome more common than single syndrome, some indicators of fiery Syndrome have lower weight than other Syndromes. Qi-deficency Syndrome,sputum Syndrome and blood stasis Syndrome are more common than fiery Syndrome in clinical,but according to the "yin and yang type Syndromes" clinical dialectical thinking mode those who have fiery Syndrome are classified as yang-type Syndrome.3 The second phase of exploration permits analysis:The results of this study showed that,according to "Yin and Yang type Synddromes" clinical dialectical thinking mode differentiation Syndrome in general is feasible. Compared with the experience of experts and the four diagnostic indicators of the three "yin and yang type Syndromes" clinical dialectical thinking mode signs(The first-class road sign is fiery Syndrome,and the second-class road signs are yin-deficiency Syndrome and Qi-deficency Syndrome),they have a better rate.But there are still some problems:such as top ten four diagnostic indicators of "Yin deficiency Syndrome"(the second-class road signs)are red tongue,Dry stool,upset irritability,red looking,dry and red lips,dry throat,rapid pulse,meridian below the tongue Tortuous and cyanosis,soft and acid waist and knee,Yellow and Chise urine.Most indicators of the yin-deficiency Syndrome overlap the fiery Syndrome.The indicators specific reflect the yin-deficency Syndrome are not too much.The rates were lower compared with the four diagnostic indicators of expertise(Fever looking, virtual trouble can not sleep,night sweats,vertigo,tinnitus,red tongue, moss less).The reasons of this conclusion may be included in the survey of acute ischemic stroke patients with the existence of bias:If the patients included in this study generally less severe diseases,patients of Yin-type Syndrome account for the overwhelming majority,Yang-deficiency Syndrome samples collected in this study is not enough,etc.ConclusionDifferential treatment is a major characteristic of Chinese medicine diagnosis and treatment.The efficacy of Chinese medicine can not do without the correct and standard differential treatment,Therefore,standardized,and standardization is the key link of the development and modernization of traditional Chinese medicine.The topic is under the guidance of the theory of the Chinese medcicine through literature review,evaluation,expert advice etc.We use the "Stroke Disease Diagnostic Criteria certification" of the "Eighth-Five " key project as a blueprint for the qualitative and quantitative analysis of the study.And initial set up the acute Ischemic stroke "yin and yang type Syndromes" clinical dialectical thinking mode to make it more in line with actual clinical ischemic stroke,and a large sample multi-center, cross-sectional survey Syndromes its evaluation.The results show that:the Institute of acute ischemic stroke identified "yin and yang type Syndromes" clinical dialectical thinking mode by three to four nodes Differentiation Syndrome is feasible,with higher clinical relevance.At the same time,the conclusion of the study for the future to further improve acute ischemic stroke treatment programmes,it also for acute ischemic stroke clinical efficacy of Chinese medicine evaluation index system to interfere with the foundation.