| Purpose：Explore methods of structural equation modeling (SEM) and TCM syndromeresearch linking theory; explore the feasibility of the framework of the SEMStudy in the Syndrome analysis; with the help of IBM SPSS AMOS20.0, SEM practicaloperation platform, verify and reveal coronary heart disease syndromecharacteristics, syndrome elements, and pathogenesis evolution; demonstrate thestructural equation model is reasonable, quantitative and effective TCM syndromeresearch method, both in theory and practical application.Material and method：On the basis of three-dimensional structure relationaldatabase of coronary heart disease syndrome elements, syndrome characteristicsand syndrome pathogenesis evolution questionnaire by clinical experts,distinguish data information in four stages of early, ictal, remission andrecovery; structurally transform and process database to meet Amos requirementby perl language and IF statement.Explore data mining in three-dimensional structure relational database ofcoronary heart disease syndrome elements, syndrome characteristics and syndromepathogenesis evolution questionnaire by clinical experts with the help ofstructural equation modeling. Based on the former research of early exploratoryfactor analysis (EFA), launch model verification and modification of measuredmodel, to found coronary heart disease syndromes characteristic model; launchthe second-order CFA model to analyze relationship of TCM syndromecharacteristics and syndrome elements, and extract the effective syndromeelements; launch latent variable path analysis (PA-LV) to explore causalconnection of pathogenesis development between different coronary heart diseasestages, and explicit the evolution principle of coronary heart diseasepathogenesis.Results：1. Measurement model test results show that twelve syndrome feature model in four phases of coronary heart disease syndromes has a good model fit. In earlystage, the qi stagnation in chest syndrome model is made up of chest oppression,chest pain, dysphoria, not warm hands, back pain, abdominal swelling,hypochondriac pain and sigh, with connection between sigh and hypochondriac pain,chest oppression and sigh. Deficiency of both qi and yin syndrome model is madeup of breath shortness, palpitation, chest dull pain, back pain, dizziness,fatigue and dysphoria, with connection between breath shortness and palpitation,palpitation and fatigue, chest dull pain and fatigue. In ictal stage, Qistagnation and phlegm blockage syndrome model is made up of chest oppression,dizziness, dysphoria, not warm hands, back pain, abdominal swelling, inappetence, nausea, sigh, hypochondriac pain and dyspnea, with connection betweennot warm hands and in appetence, in appetence and abdominal swelling, sigh andhypochondriac pain. Deficiency in heart yang syndrome model is made up of chestoppression, dysphoria, chest pain, back pain, dyspnea, not warm hands, inappetence, abdominal swelling and nausea, with connection between chestoppression and chest pain, not warm hands and in appetence, in appetence andabdominal swelling. Coagulated cold in heart syndrome model is made up of chessoppression, dyspnea, back and shoulder pain, back pain, not warm hands, dysphoria,waist knee edema, in appetence and nausea, with connection between not warm handsand in appetence. Blood stasis and yang lacking syndrome is made up of palpitation,chess oppression, back and shoulder pain, back pain, dyspnea, cold sweat, notwarm hands, waist and knee soreness, lower limb edema, dizziness, fatigue andthirsty, with connection between back-shoulder pain and back pain, back-shoulderpain and dyspnea, dyspnea and lower limb edema, waist and knee soreness andthirsty, palpitation and fatigue, back-shoulder pain and fatigue.In remission stage, disharmony of liver and spleen syndrome model is made upof hypochondriac pain, abdominal swellings, in appetence, sigh, hiccough, chestoppression, chest pain, back pain, dysphoria, and dizziness, with connectionbetween hypochondriac pain and sigh, in appetence and dysphoria, hypochondriacpain and chest pain, chest oppression and chest pain, dysphoria and dizziness. Yang deficiency of heart and kidney syndrome model is made up of chest oppression,chest pain, back pain, hiccough, fatigue, waist and knee soreness, not warm hands,cold, sweat, lower limb edema, dizziness and dyspnea, with connection betweenchest oppression and chest pain and hiccough, hiccough and fatigue and sweat,cold and not warm hands, cold and dyspnea, dizziness and hiccough. Qi deficiencyof heart and lung syndrome model is made up of palpitation, hiccough, fatigue,chest oppression, dyspnea, and back pain, with connection between dyspnea andchest oppression and back pain, fatigue and dyspnea, fatigue and back pain,palpitation and back pain. In recovery stage, deficiency of heart qi syndromemodel is made up of palpitation, hiccough, fatigue, chest oppression, chest dullpain, insomnia, dizziness, dysphoria, sweat, and edema, with connection betweendizziness and dysphoria, edema and chest oppression, hiccough and fatigue,palpitation and hiccough. Yang deficiency and qi stagnation syndrome model ismade up of chest oppression, chest dull pain, back pain, not warm hands, cold,dysphoria, hypochondriac pain, sigh, waist and knee soreness, dyspnea, edema,and abdominal swellings, with connection between cold and sigh, hypochondriacpain and sigh, cold and dyspnea, cold and edema, abdominal swellings and waistand knee soreness, hypochondriac pain and dyspnea, sigh and dyspnea, dyspneaand edema. Deficiency of both qi and yin syndrome model is made up of chestoppression, chest dull pain, back dull pain, palpitation, fatigue, sweating,dysphoria, dry cough, retching, thirst, waist soreness, and lower limb edema,with connection between chest dull pain and back dull pain, chest oppressionand palpitation and fatigue, chest oppression and dysphoria, palpitation anddysphoria, fatigue and dysphoria, dysphoria and lower limb edema.2. The results of syndrome elements second-order CFA model reveal: In ictal stage,Qi stagnation and phlegm blockage syndrome contains syndrome elements of Qistagnation {not warm hands, sigh, hypochondriac pain, dysphoria}, phlegm{dizziness, dyspnea, chest oppression, back pain}, spleen qi deficiency{abdominal swellings, in appetence, nausea}, with loading1.027,0.958,1.033.Coagulated cold in heart syndrome contains syndrome elements of heart yang deficiency {chest oppression, dyspnea, not warm hands, dysphoria}, spleen yangdeficiency {in appetence, nausea}, cold pathogen {back pain, back-shoulder pain,waist and knee edema}, with loading1.023,0.982,0.889. Blood stasis and yanglacking syndrome contains syndrome elements of blood stasis {back-shoulder pain,back pain, cyanosis}, heart yang deficiency {dyspnea, cold sweating, not warmhands, chest oppression}, heart qi deficiency {dizziness, palpitation, fatigue},kidney qi deficiency {waist and knee soreness, lower limb edema, thirst}, withloading0.608,1.033,0.888,0.828. In remission stage, qi deficiency of heartand lung syndrome contains syndrome elements of heart qi deficiency {palpitation,fatigue, chest oppression, back pain}, lung qi deficiency {hiccough, dyspnea},with loading0.985and0.897. In recovery stage, deficiency of both qi and yinsyndrome contains syndrome elements of deficiency of heart qisyndrome{palpitation, fatigue, sweat, chest oppression, chest dull pain, backdull pain, dysphoria}, heart yin deficiency{retching, dry cough}, kidney yindeficiency{thirst, waist soreness, lower limb edema}, with loading0.194,0.499and1.869.3．The results of PA-LV model indicates pathogenesis evolution rules as follows:Earlyâ†'Ictal: qi stagnation in chest syndrome will turn into blood stasis andyang lacking syndrome, Qi stagnation and phlegm blockage syndrome, coagulatedcold in heart syndrome, deficiency in heart yang syndrome with loading0.67,0.69,0.00and0.45. Deficiency of both qi and yin syndrome will turn into bloodstasis and yang lacking syndrome, Qi stagnation and phlegm blockage syndrome,Coagulated cold in heart syndrome, Deficiency in heart yang syndrome with loading0.25,0.46,0.17and0.40. Ictalâ†'Remission: Blood stasis and yang lackingsyndrome will turn into yang deficiency of heart and kidney syndrome, qideficiency of heart and lung syndrome, disharmony of liver and spleen syndromewith loading1.00,0.80and0.69. Qi stagnation and phlegm blockage syndromewill turn into yang deficiency of heart and kidney syndrome, qi deficiency ofheart and lung syndrome, disharmony of liver and spleen syndrome with loading0.80,0.38and0.87. Coagulated cold in heart syndrome will turn into yang deficiency of heart and kidney syndrome, qi deficiency of heart and lung syndrome,disharmony of liver and spleen syndrome with loading0.92,0.43and0.92.Deficiency in heart yang syndrome will turn into yang deficiency of heart andkidney syndrome, qi deficiency of heart and lung syndrome, disharmony of liverand spleen syndrome with loading0.89,0.38and0.90. Remissionâ†'Recovery: yangdeficiency of heart and kidney syndrome will turn into deficiency of both qiand yin syndrome, deficiency of heart qi syndrome, yang deficiency and qistagnation syndrome with loading0.23,0.78and0.81, qi deficiency of heartand lung syndrome will turn into deficiency of both qi and yin syndrome,deficiency of heart qi syndrome, yang deficiency and qi stagnation syndrome withloading0.16,0.88and0.72, disharmony of liver and spleen syndrome will turninto deficiency of both qi and yin syndrome, deficiency of heart qi syndrome,yang deficiency and qi stagnation syndrome with loading0.27,0.67and0.81.As a result, heart yang deficiency will cause cold pathogen, phlegm, qi staginess,blood staginess. Therefore, heart yang deficiency is the base of coronary heartdisease, and cold pathogen, phlegm, qi staginess, blood staginess are the mainsyndrome elements.Conclusion：1. Structural equation model is the effective method for syndrome analysis.Syndromes within the real outside virtual, dynamic space-time,multi-dimensional interface characteristics and structural equation model bothshow the influence of systematic principle. The introduction of the SEM methodmade it a reasonable, effective and quantifiable syndrome research tool.2. Measurement model based on the EFA factor structure can reveal syndromecharacteristics comprehensiveness. The measurement model results show that thetwelve syndrome models from four stages that the EFA (cluster analysis) exploredare reasonable, and can effectively verify coronary heart syndromescharacteristics. Measurement model based on theoretical assumption and EFAfactor analysis is more effective and comprehensive than pure EFA analysis. 3. The second-order CFA model is an effective method to extract the syndromeelements. Factor loadings greater than0.75with a high degree of co linearityis recognized as syndrome elementary, with syndrome as latent variables. TheCFA models effectively extract the12syndrome elements and reflect the thinkingprocess of the syndromes of dimensionality reduction degree elevation.4. Latent variable path analysis model is to explore innovative approaches tothe evolution of the pathogenesis. Compared to other methods, PA-LV model canclearly identify affect the strength force of the various stages of coronaryheart disease, whether the effect is obvious, the direct or the indirect pathway,and how will the prognosis transformed, which is an innovative research method.5. The Wenyang beneficial heart treatment is the effective treatment method forcoronary heart yang deficiency. Combined the Wenyang qi and heart nutrition,blood circulation and vessel unblock and spirit releases together, on the basisof cardiac phenomenological theory, the treatment will overall grasp coronaryheart lesions and effective for both treating and healing. |
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