Research Of Diabetic Osteoporosis TCM Syndrome Types

Objective:This paper is to observe and analyze TCM syndrome types of Diabetic Osteoporosis (DOP) in Chengdu, and to reveal its pathogenesis and syndrome distribution, so as to improve the clinical effects based on syndrome differentiation.Methods:A questionnaire of TCM syndromes of DOP was designed based on the following diagnostic criteria. The criteria of diabetes was formulated by World Health Organization (WHO) and the American Diabetes Association (ADA) Expert Committee in1999, criteria of osteoporosis was set by branch of osteoporosis and bone mineral salt disease, Chinese medical association in March2011, and the criteria of TCM syndromes were referenced both from China’s national standards of TCM syndrome terminology and chapters of diabetes metabolic bone disease associated syndrome in diabetes prevention and control guidelines with traditional Chinese medicine. Altogether,267DOP patients were enrolled. TCM syndrome type was determined by the investigators case by case. Results of syndrome differentiation were collected to carry out the frequency analysis. Data collected by four TCM diagnostic methods were analyzed by system variable cluster analysis and then compared with the TCM syndrome differentiation. Six TCM syndrome types of DOP were chosen, followed by a K-Means cluster analysis and a principal component analysis.Results:(1) General data analysis:Average age of the enrolled patients was69.3years old, with the peak onset between60and80(68.2%). The number of male patients was significantly lower than that of female with the ratio between male to female0.59:1, indicating high incidence of women. The body mass index (BMI) for most patients was normal with the average of20.67. The average diabetes duration was about10years. Up to55.8%cases had chronic complications of diabetes with57cases(21.4%) suffering from one complication with the most common one being diabetic peripheral neuropathy (41cases,15.4%)66cases(24.7%) suffering from two kinds of complications with the most common one being diabetic nephropathy and peripheral neuropathy (26cases,9.7%),11cases (4.1%) suffering from three kinds of complications, and15cases (5.6%) suffering from four kinds of complications. There were12%patients complicated with bone fracture, among which, the peak onset was between60to89years old. All the patients had high fasting blood sugar and high glycated haemoglobin and their blood calcium, magnesium, phosphorus, triglycerides, cholesterol, and uric acid were all on normal range. (2) Data analysis collected by the four TCM diagnostic methods:Soreness and weakness of waist and knees was the most frequent symptom, accounting for77.9%, followed by fatigue (70.0%), backache (58.4%), thin white tongue coating (49.4%), dizziness (46.1%), normal tongue (45.3%), and aversion to cold and favor of warm (41.6%). Symptoms with frequency between20%and40%were:frequent night urination, numbness of the limbs, thirst without much drink, deep thready pulse, insomnia and dreaminess, scanty tongue coating, eye dryness, cramps, pale dark tongue or dark purple tongue, hair loss or teeth shaking, stabbing pain of the waist and back, red tongue, unclear vision, stabbing pain of the limbs, tinnitus or deafness, exposure of sublingual veins, edema of lower extremity, constipation, irritability, and loss of appetite. Symptoms with frequency between10%and20%were:thready weak pulse, loose stools, dry mouth and desire to drink, puffy and tender tongue, thready and choppy pulse, wiry and slippery pulse, rapid thready pulse, palpitations, cold pain of waist and back, chest tightness, cold pain of limbs, bitter taste, thin and small tongue, night sweating, white and greasy tongue coating, swelling pain of waist and back, and spontaneous perspiration. Symptoms with frequency less than10%were:yellow and greasy tongue coating and floating pulse.Abnormal tongue body includes puffy and tender tongue (14.2%) and thin and small tongue (11.6%). About tongue color, slight red was the most frequent (45.3%), followed by pale and dark or dark and purple (29.6%), and red tongue (27.0%). About tongue coating, thin and white tongue coating (49.4%) was the most common, followed by scanty or peeled coating (30.7%), white and greasy tongue coating (10.5%), and yellow and greasy tongue coating (8.6%). Complex Pulse was most common, with floating pulse (4.5%) as the only single pulse condition. Heavy deep thready pulse (36.0%) was the most common, followed by thready weak pulse (19.9%), wiry and slippery pulse (13.5%), thin and choppy pulse (13.9%), and rapid thready pulse (13.1%).(3) TCM syndrome differentiation:The267DOP cases can be divided into ten types with the top six syndrome types (93.26%) being:dual deficiency of Yin and Yang with blood stasis blocking collaterals syndrome, liver kidney Yin deficiency with blood stasis blocking collaterals, Yin and Yang deficiency syndrome, liver kidney Yin deficiency syndrome, kidney Yang deficiency and kidney Yang deficiency with blood stasis blocking collaterals syndrome. The four less-common syndromes (6.74%) were liver and kidney Yin deficiency with phlegm and blood stasis blockage, liver and kidney Yin deficiency with phlegm dampness blockage syndrome, phlegm heat blocking syndrome, and blood stasis blocking collaterals.(4) System variable cluster analysis:゜lood stasis blocking collateralsSymptoms:stabbing pain of waist and back, numbness and stabbing pain of the limbs, pale and dark tongue or purple and dark tongue, exposure of sublingual veins, and thready and choppy pulse.②Phlegm damp trapping spleen and phlegm-damp-blood stasis blockage syndromeSymptoms:swelling pain of waist and back, dry mouth with desire to drink, palpitations, chest tightness, bitter mouth, constipation, red tongue, yellow greasy tongue coating, or wiry and slippery pulse, and white greasy tongue coating.③Liver and kidney Yin deficiency with liver yang hyperactivity syndrome Symptoms:fatigue, backache, thirst without much drink, unclear vision, tinnitus or deafness, dizziness, irritability, insomnia and dreaminess, eye dryness, cramps, night sweats, thin and small tongue, scanty or peeled tongue coating, floating pulse, rapid thready pulse.④Kidney Yang deficiency with spleen qi deficiency syndromeSymptoms:Soreness and weakness of waist and knees, cold pain of waist and back, hair loss or teeth shaking, aversion to cold and favor of warmth, loss of appetite, cold pain of limbs, spontaneous perspiration, edema of lower extremity, frequent night urination, loose stools, puffy and tender tongue, thin and white tongue coating, slight red tongue, thready weak pulse, or deep thready pulse.(5) Results of K-means clustering analysis and principal component analysis㎜iver and kidney Yin deficiency withliver yang hyperactivity syndrome Main symptoms:irritability, dizziness, insomnia and dreaminess, Soreness and weakness of waist and knees, waist and back sore, tinnitus or deafness, hair loss or teeth shaking, red tongue, and scanty or peeled tongue coating. Secondary symptoms: mental fatigue and lacking of strength, eye dryness, cramps, unclear vision, and thready weak pulse.②Liver and kidney Yin deficiency with liver yang hyperactivity and blood stasis blocking collaterals syndrome Main symptoms:aching, or soreness and weakness of waist and knees, insomnia and dreaminess, dizzy, scanty or peeled tongue coating, thin and white tongue coating. Secondary symptoms: mental fatigue and lacking of strength, eye dryness, numbness of the limbs, thirst without much drink, slight red tongue, and deep thready pulse.③Liver and kidney Yin deficiency with liver yang hyperactivity and blockage of phlegm dampness and blood stasis syndrome Main symptoms: Aching, soreness and weakness of waist and knees, dizziness, irritability, bitter taste, dry mouth and desire to drink, numbness of the limbs, palpitations, limbs stabbing pain, constipation, red tongue, pale dark tongue or dark purple tongue, and yellow greasy tongue coating. Secondary symptoms:fatigue, chest tightness, insomnia and dreaminess, loss of appetite, and wiry slippery pulse.④Kidney Yang deficiency syndrome Main symptoms: waist and back soreness, aversion to cold and favor to warmth, edema of lower extremity, puffy and tender tongue, thin and white tongue coating, and red tongue. Secondary symptoms:fatigue, frequent night urination, hair loss or teeth shaking, dizziness, and deep thready pulse.⑤kidney Yang deficiency with blood stasis blocking collaterals syndrome Main symptoms:waist and back soreness, numbness and stabbing pain of the limbs, frequent night urination, thin and white tongue coating, pale dark or dark purple tongue, sublingual veins exposure, and thin choppy pulse. Secondary symptoms:Aching, or soreness and weakness of waist and knees, and fatigue.⑥dual deficiency of Yin and Yang with blood stasis blocking collaterals syndrome. Main symptoms:aversion to cold and favors to warmth, irritability, dizziness, frequent night urination, stabbing pain or soreness of the waist and back, numbness of the limbs, fatigue, thin and white tongue coating, white and greasy tongue coating, pale dark tongue or dark purple tongue, and sublingual veins exposure. Secondary symptoms:Soreness and weakness or cold pain of waist and back, tinnitus or deafness, insomnia and dreaminess, thirst without much drink, loose stool, and thready weak pulse.Conclusion: (1) It’s feasible to combine TCM syndrome differentiation, cluster analysis and principal component analysis for the study of TCM syndrome type distribution of DOP. It may serve as a better guidance for clinical practice of Traditional Chinese medicine. Both doctor-conducted TCM syndrome differentiation and statistical analysis have advantages and disadvantages and they can supplement each other. The two differentiation methods showed substantial consistency in this study, indicating the credibility of this study. This study may set a good foundation for further study of DOP syndrome types, and may be helpful to improve the clinical curative effects.(2) Kidney deficiency may be the basic pathogenesis of this disease. Liver and kidney Yin deficiency may be an important disease mechanism, and liver dysfunction may be an important part leading to the disease. Dual deficiency of Yin and Yang may be the most common syndrome types seen in the terminal stage of the disease. Blood stasis may be the pathological products and aggravating factors throughout the disease. Damp phlegm and blood stasis can be seen in every stage of the disease, often leading to all sorts of symptoms, long-lasting atrophic debility of bones, and lots of other complications.