| Section1Review of Ancient TCM Literature about "Xuanyun"Objective:To examine the origin and development of the disease "Xuanyun" in ancient TCM literature, and try to identify vertigo of vascular origin, so as to lay a foundation for the syndrome differentiation and treatment of vertebrobasilar insufficient vertigo under today’s "syndrome-disease combination" mode.Methods:"Xuan"," Yun","Xuanyun","Touxuan" was chosen as key words, and correlated documents in the Encyclopedia of Traditional Chinese Medicine Disc was inqueired. Development of the name, cause, pathogenesis, symptoms, syndromes and TCM treatments of "Xuanyun" in ancient China were studied, and more attention was paid to the description of probable vascular vertigo and the value of exopathy.Results:1"Xuanyun"TCM is equal to "dizziness", not "vertigo"2The pathogeneses of "Xuanyun" in TCM were initially external wind, phlegm, fire and deficiency, and then changed into internal wind, phlegm, fire and deficiency. Blood stasis was not considered to be important for "Xuanyun" in early period. In TCM "Xuanyun" was related to liver, spleen and kidney, in which deficiency-excess complicated syndrome was most common, and it was mostly caused by multiple factors.3Exogenous wind was considered an important cause of vertigo in ancient times, and Chinese herbs which could dispel wind were usually used in treatment of the disease, but after the theory of internal wind appeared, the use of these herbs became less. The theory of exogenous wind was only negated in the Qing Dynasty in TCM history.4Doctors in ancient China had recognized that some kind of vertigo was a portent of stroke, the pathogeneses of which were liver-wind, phlegm and qi-blood asthenia. They also suggested the inducement of this included external wind.Section2Review of Modern TCM Literature of Vertebrobasilar Insufficient VertigoObjective:By reviewing the syndrome, syndrome type, syndrome elements, formulae and herbs in modern TCM literature about vertebrobasilar insufficient vertigo, to do a prel iminary study of the characteristics of distribution of TCM syndromes and the law of syndrome differentiation and treatment in vertebrobasilar insufficient vertigo. Methods:TCM journals publ ished between January1994and December2010from China Knowledge Resource Integrated Database (CNKI), Chinese Biomedical Literature Database (CBM), VIP Database of Chinese Journals, and Wanfang Database were inquired, and the common syndromes, syndrome types, syndrome elements, formulae and herbs in modern TCM literature about vertebrobasilar insufficient vertigo were studied.Results:1Analysis of syndromes:Symptoms and signs that had cumulative frequency above50%included vomiting, nausea, insomnia, tinnitus, numbness, headache, palpitation, fatigue, heavy-headedness, sore lumbus and knees, spinning sensation, chest tightness and hearing loss. Tongue presentations that had cumulative frequency above50%included red tongue, pale tongue, tongue with petechiae, tongue with ecchymosis, dark purple tongue, and tongue fur presentations had cumulative frequency above50%included white greasy fur, lack of fur, yellow and greasy fur and white fur. Pulse that had cumulative frequency above50%included wiry and slippery pulse, wiry and thin pulse, slippery pulse, thin and weak pulse, thin and unsmooth pulse, wiry pulse and unsmooth pulse.2Analysis of syndrome type and syndrome elements:There were44syndrome types in all, including16excess syndrome types,11deficiency syndrome types and17deficiency-excess complicated syndrome types. Syndrome types that had cumulative frequency above50%included phlegm, qi and blood deficiency, qi deficiency with blood stasis, and blood stagnated in brain collaterals. The cumulative frequency of these syndrome types was52.51%.The syndrome elements which described the organs related to vertebrobasi lar insufficient vertigo were liver, kidney, heart, spleen, brain and col laterals, main of which were the kidney, collaterals and brain. There were13syndrome elements described the characteristics of vertebrobasilar insufficient vertigo, seven excess and six deficiencies. The number of patients with excess syndrome elements was twice as much as that of those with deficiency syndrome elements. Main excess syndrome elements were phlegm and blood stasis, and main deficiency syndrome elements were qi deficiency, yin deficiency and blood deficiency.3Analysis of formulae:Formulae that had cumulative frequency above50%included Banxia Baizhu Tianma Decoction, Buyang Huanwu Decoct ion, Tianma Gouteng Decoction, Guipi Decoct ion, Tongqiao Huoxue Decoction. Common formulae types were formulae that dispel phlegm, reinforce deficiency, and activate blood.4Analysis of herbs:Chinese Angelica, Mongolian Milkvetch Root, Largehead Atractylodes Rhizome, Liquorice Root, Szechwan Lovage Rhizome, Dan-shen Root, Tall Gastrodia Rhizome, Lobed Kudzuvine Root, Ternate Pinellia, Indian Buead and Red Peony Root were most frequently used.5The role of external wind in the acute stage of vertebrobasilar insufficient vertigo was not fully recognized by most doctors now.Section3TCM Syndrome in the acute stage of vertebrobasilar insufficient vertigoObjective:To investigate the TCM syndrome in the acute stage of vertebrobasilar insufficient vertigo, so as to set a syndrome foundation for the syndrome differentiation and treatment of this disease.Methods:Information from the TCM four diagnostic methods of392patients was collected. High-frequency syndrome (including symptoms, signs, tongue and pulse) was analysed and variables was set. Cluster analysis and factor analysis were used to categorize these variables, so as to sum up the common syndrome types of vertebrobasilar insufficient vertigo.Results:1The syndromes with high frequency in the acute stage of vertebrobasilar insufficient vertigo were:dry mouth, fatigue, unwillingness to open eyes, irritability, cold sweat, dark purple lip, bitter taste in the mouth, forgetfulness, stiff neck, insomnia, disequilibrium, numbness, obesity, palpitations, vomiting, heavy head, fear of cold, dry pharynx, hearing loss, constipation, unwillingness to speak, sore lumbus and knees, stuffy and full sensation in the chest and abdomen, vomiting phlegm, thirsting for hot water, low voice and chest tightness. Tongue with high frequency proper of were fat tongue, dry tongue, dark tongue, pale tongue, tongue with indentation and red tongue, Tongue fur with high frequency were greasy fur, white fur and thin fur. Pulses with high frequency were slippery pulse, wiry pulse and thin pulse.2Five main syndrome types in the acute stage of vertebrobasi lar insufficient vertigo extracted by the cluster analysis were:(1) phlegm syndrome,(2) phlegm-heat syndrome,(3) qi-stagnancy and blood stasis syndrome,(4) spleen-kidney yang deficiency together with retention of phlegmatic dampness syndrome,(5) liver-kidney yin deficiency together with wind phlegm disturbing syndrome.3Five ma in syndrome types in the acute stage of vertebrobasi lar insufficient vert igo extracted by factor analysis were:(1) phlegm syndrome,(2) liver-kidney yin deficiency syndrome,(3) spleen-kidney yang deficiency syndrome,(4) phlegm-heat syndrome,(5) heart-spleen deficiency syndrome.4The result showed the syndrome elements that described the organ related to vertebrobasi lar insufficient vertigo were heart, liver, spleen, and kidney. The main deficiency syndrome elements were qi deficiency, blood deficiency, yin deficiency and yang deficiency, on the other hand, the main excess syndrome elements were phlegm, phlegm-heat, phlegm-wind, blood stasis and qi stagnation, of which phlegm was mostly seen. The result of the cluster analysis highly matched with that of the factor analysis. Two deficiency-excess complicated syndromes were found based on the result of cluster analysis. It matched with the result of literature review, which stated that vertebrobasilar insufficient vertigo had complicated pathogenesis.5Based on the result of cluster analysis, there was a wind phlegm disturbing syndrome, in which syndromes such as pink tongue, floating pulse, chills and numbness presented the existence of exogenous wind-evil. It reminded us that we might have neglected some pathogens in the development of vertebrobasilar insufficient vertigo.Conclusion:The review of literature about vertebrobasilar insufficient vertigo and the clinical investigation of syndromes, syndrome types, and syndrome elements in acute stage of vertebrobasilar insufficient vertigo summarize the distribution characteristics and rules of syndrome in vertebrobasilar insufficient vertigo. A preliminary work for guiding the clinical treatment is finished. However, in this study, sample size is small, and the stat ist ical method has some limitations. A lot of information needs to be further explored, and the results above still need further verification. |
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