Methodology And Macroscopic Diagnostic Research On Criteria Of Coronary Heart Disease With Intermingled Phlegm And Blood Stasis Syndrome

The proportion of blood stasis and phlegm wet(turbidity)in coronary heart disease(CHD)gradually increased,coronary heart disease with intermingled phlegm and blood stasis syndrome is a very common syndrome,but there is no current diagnostic criteria for clinical follow rencently.This study combined with the Delphi method and analytic hierarchy process(AHP)and principal component analysis(PCA)and comprehensive evaluation method,comprehensive evaluation model was constructed,based on the periodical,expert consultation,to research the macro diagnostic criteria on coronary heart disease of phlegm-damp syndrome,coronary heart disease with intermingled phlegm and blood stasis syndrome,coronary heart disease with intermingled phlegm and blood stasis syndrome which transformed other syndromes and the relationship between the related syndromes of physical and chemical indicators.Part1 Coronary Heart Disease Syndrome Distribution Regularity of Methodology Research based on Literature Research ObjectBy statistical frequency of different syndrome type or element,summarize the syndrome elements distribution characteristic and evolution trend,through nearly 40 years coronary syndromes distribution of literature research,so as to the distribution of clinical coronary heart disease(CHD)and provides some references for the development trend.MethodsThrough the establishment of literature inclusion and exclusion criteria,extract on coronary syndromes or syndrome element distribution regularity study of traditional Chinese medicine of related literature.Respectively using frequency statistics and arithmetic average method and principal component analysis combined with the comprehensive evaluation function,to analysis of coronary heart disease in TCM syndrome element weights in the literature,to compare their differences.Results1.Based on the number of statistics and arithmetic average method,found that the sequence on excessive syndrome of TCM of coronary heart disease,syndrome of blood stasis(37.65%),syndrome of phlegm-damp(turbidity)(26.66%),and syndrome of Qi stagnation(16.70%)make up a large part.In coronary heart disease deficiency syndrome of TCM syndrome factor,syndrome of deficiency of vital energy(40.67%),syndrome of Yin deficiency(24.26%)make up a large part.In coronary heart disease in TCM syndrome of blood stasis(22.32%),syndrome of Qi deficiency(16.56%),syndrome of phlegm-damp(turbidity)(15.81%).The blood stasis,qi deficiency and phlegm-damp(turbidity)as the main syndrome factors in coronary heart disease of TCM syndrome.2.Based on principal component analysis(PCA)combined with the comprehensive evaluation function,through the establishment of a comprehensive evaluation model,the weight sequence in coronary heart disease in TCM syndrome factor as follow,phlegm-damp(turbidity)(0.134),syndrome of deficiency of vital energy(0.130),syndrome of cold stagnation(0.115),syndrome of blood stasis(0.113),syndrome of Yang deficiency(0.109),syndrome of blood deficiency(0.108),syndrome of Yin deficiency(0.106),fire syndrome(0.094),syndrome of qi stagnation(0.091).ConclusionThrough the evaluation methodology reflected different syndrome factor in coronary heart disease syndromes importance from another aspect,analysis results are closer to the actual situation,to explain the essence of syndrome distribution regularity of coronary heart disease.Part2 Standardization Research on Clinical Characterization Terminology of Coronary Heart Disease with Intermingled Phlegm and Blood Stasis Syndrome ObjectIn order to regulate terms and specification of coronary heart disease with intermingled phlegm and blood stasis syndrome,the clinical manifestations of terms in order to make a clear definition of the connotation of symptoms,make the description more objective,by current standards and literature review,the connotation of study on the existing clinical characterization of coronary heart disease,to normalize the clinical symptoms of important specification,in order to make unified consistent recognition of clinical manifestations.Methods 1.To clear coronary heart disease with intermingled phlegm and blood stasis syndrome by definition related content by collecting relevant standards,guidelines which isreleased today.2.To extract relevant coronary heart disease with intermingled phlegm and blood stasis syndrome by frequency of four items derive literature,to comb high frequency items of deeper meaning from the origin and evolution 3.Designed the coronary heart disease with intermingled phlegm and blood stasis syndrome by four diagnostic information of experts questionnaire,according to the result of literature research,through two rounds of Delphi expert consultation,determine the weight of clinical manifestations of items of coronary heart disease with intermingled phlegm and blood stasis syndrome Results1.Through literature review,extract the coronary heart disease with intermingled phlegm and blood stasis syndrome by four diagnostic information,including clinical symptoms 37 items,tongue manifestation 13 items,pulse condition 11 items,combing the historical principle and evolution,gives the connotation of the clear definition.2.Filtrated coronary heart disease with intermingled phlegm and blood stasis syndrome by clinical characterization of 12 items by Delphi method preliminary.The chest stuffy and pain,moss greasy tongue,tongue dark purple,purple tongue with spotted ecchymosis,pulse string,sublingual veins purple and lip purplish,heaviness of limbs,fat body,sticky mouth,those cover 80% of the weights in the clinical characterization items of coronary heart disease with intermingled phlegm and blood stasis syndrome,which has great significance.ConclusionStandardization on phlegm and blood stasis related terminology that is beneficial to the clinical characterization of coronary heart disease with intermingled phlegm and blood stasis syndrome to specification.To understand the existing semantic environment,and to dig deeper into the connotation of its clinical manifestations,to guide the clinical syndrome differentiation which has great significance and value.Based on the Delphi phlegm and blood stasis and coronary heart disease and the clinical characterization of item selection,to established coronary heart disease with intermingled phlegm and blood stasis syndrome diagnosis index is of great significance.Part3 Diagnostic Criteria and Methodology Research on Coronary Heart Disease with Intermingled Phlegm and Blood Stasis Syndrome and Its Transformed Syndrome ObjectTo study macroscopic syndrome differentiation of TCM diagnosis of syndrome of phlegm-damp(turbidity)and intermingled phlegm and blood stasis syndrome of coronary heart disease,to describe clinical manifestations of coronary heart disease with intermingled phlegm and blood stasis syndrome,to make a systematic knowledge on its transformed syndrome and provide the basis of the differentiation,to improve the clinical identification coronary heart disease with intermingled phlegm and blood stasis syndrome Methods1.Based on the modern literature research,coronary heart disease,phlegm dampness syndromes by statistical literature related to clinical manifestations of word frequency,diagnosis of coronary heart disease,phlegm dampness syndromes entries2.Build hierarchy model of phlegm-damp syndrome of coronary heart disease,to research the clinical characterization of weight distribution of phlegm-damp syndrome of coronary heart disease,through the expert questionnaire,combined with the published the diagnostic criteria of blood stasis syndrome of coronary heart disease,to construct the macro diagnostic criteria of coronary heart disease with intermingled phlegm and blood stasis syndrome.3.To study of coronary heart disease,phlegm-damp syndrome physical and chemical index and the weight on transformation syndrome of coronary heart disease with intermingled phlegm and blood stasis syndrome,which is based on Delphi questionnaires by using principal component analysis(pca)combined with the comprehensive evaluation function.Results1.Through the literature word frequency statistics,selected 26 indicators of clinical characterization of phlegm-damp syndrome of coronary heart disease,make sure 10 items that considered the expert opinion.2.The weight sequence of phlegm-damp syndrome of coronary heart disease as follows: tongue manifestation(0.529),clinical symptoms(0.295),pulse manifestation(0.176).The weight sequence of tongue manifestation of phlegm-damp syndrome of coronary heart disease as follows: moss greasy(0.497),white and smooth fur(0.269),fat tongue have teeth marks(0.233).The weight sequence of tongue manifestation of phlegm-damp syndrome of coronary heart disease as follows: chest stuffy and pain(0.222),heaviness of limbs(0.120),sticky mouth(0.112),fat body(0.108),abdomen distention and fullness(0.091),complexion grey cloud(0.082),sticky bowels(0.076),sleepiness(0.075),anorexia(0.072),nausea(0.055).The weight sequence of pulse manifestation of phlegm-damp syndrome of coronary heart disease as follows:slippery pulse(0.517),soggy pulse(0.303),loose and slow pulse(0.179).3.To set macro diagnostic criteria phlegm-damp syndrome and pintermingled phlegm and blood stasis syndromes of coronary heart disease.Conclusions1.The result of weight sequence of phlegm-damp syndrome of coronary heart disease,those clinical characterization such as moss greasy,white and smooth fur,fat tongue have teeth marks,slippery pulse,chest stuffy and pain,loose and slow pulse,heaviness of limbs,sticky mouth take the 80% proportion,which have the important reference basis in diagnosis.2.It has certain clinical significance to research macroscopical diagnostic criteria of intermingled phlegm and blood stasis and phlegm-damp syndromes of coronary heart disease,based on the analytic hierarchy process(ahp)by consulting has certain clinical experience of experts,who filled the questionnaire survey on the spot.Part4 The Research on Weight of Index of Physical and Chemical Phlegm-damp Syndrome of Coronary Heart Disease Based on Principal Component Analysis PurposeTo study the relationship between pathogenesis physical and chemical examination results of the phlegm-damp syndrome of coronary heart disease,and its importance for diagnosis phlegm-damp syndrome of coronary heart disease.MethodsConstruction questionnaire of physical and chemical indicators of phlegm-damp syndrome of coronary heart disease,using the method of filled the questionnaire survey on the spot,to confirm the weight of physical and chemical indexes of phlegm-damp syndrome of coronary heart disease by using evaluation function combined with the main analysis method which based on the result of expert questionnaire result.ResultsThe weight sequence of physical and chemical indexes of phlegm-damp syndrome of coronary heart disease as follows: ultrasonic cardiogram(0.188),blood sugar(0.142),inflammation factors(0.118),CRP(0.108),blood lipids(0.103),HCY(0.090),lipoprotein(0.076),uric acid(0.015).ConclusionUltrasonic cardiogram,blood sugar,inflammation factors,CRP,blood lipids take the 80% proportion,which have the important reference basis in diagnosis of phlegm-damp syndrome of coronary heart disease.Part5 Macroscopic and Microscopic Diagnostic Indicators of Weight Research on Coronary Heart Disease with intermingled phlegm and blood stasis Transforming syndromes ObjectTo study the indicated diagnostic weight of the syndrome diagnosis index of coronary heart disease with intermingled phlegm and blood stasis syndrome by using of the principal component analysis method,in order to follow the study of the diagnostic criteria of pcoronary heart disease with intermingled phlegm and blood stasis syndrome.MethodsConstruction macroscopic and microscopic Indicators questionnaire of coronary heart disease with intermingled phlegm and blood stasis transforming syndromes,using the method of filled the questionnaire survey on the spot,to confirm the weight of physical and chemical indexes of phlegm-damp syndrome of coronary heart disease by using evaluation function combined with the main analysis method which based on the result of expert questionnaire result.Results1.Blocking Collaterals syndrome of indicated diagnostic weight order: palpitation,unsmooth pulse,recurrent of chest pain and falling unhealed,plaque instability,enhanced inflammatory activity,numbness of limbs,irritability,chest tightness,pulse string,plaque formation.2.Fire syndrome of indicated diagnostic weight order: plaque formation,plaque instability,enhanced inflammatory activity,heartache like burning,irritability,rapid pulse,bitter taste,yellow tongue fur,red tongue,dry throat,yellow urine,constipation.3.Generating toxic syndrome of indicated diagnostic weight order order: sore throat,aphtha,severe bitter taste,dangerous situation,sublingual collaterals purplish red or reddish purple,old tongue,peeling off tongue coating,middle and severe angina pectoris,unsmooth pulse,plaque formation,plaque instability,green or purple tongue,enhanced inflammatory activity,intermittent pulse.Conclusion1.The indicated diagnostic weight of coronary heart disease with intermingled phlegm and blood stasis syndrome changed into blocking collaterals syndrome have important reference value on palpitation,unsmooth pulse,episodes of chest pain and falling unhealed.2.The indicated diagnostic weight of coronary heart disease with intermingled phlegm and blood stasis syndrome changed into fire syndrome have important reference value on heartache like burning,irritability,rapid pulse,bitter taste,yellow tongue fur,red tongue.3.The indicated diagnostic weight of coronary heart disease with intermingled phlegm and blood stasis syndrome changed into generating toxic syndrome have important reference value on sore throat,aphtha,severe bitter taste,dangerous situation,sublingual collaterals purplish red or reddish purple,old tongue,peeling off tongue coating,middle and severe angina pectoris,unsmooth pulse.4.Plaque and inflammatory activity in the three syndromes have a large weight,which have important reference value in the clinical syndrome differentiation.