| Object:We have explored the characteristics of TCM syndrome elements of hyperlipidemia,the correlation between syndrome elements and clinical biochemical indexes,the correlation between syndrome elements and medication of TCM,and have explored a unified and convenient method of TCM syndrome differentiation of hyperlipidemia from theory,diagnosis and treatment aspects to achieve the regularity,objectivity and standardization of treatment,so as to provide reference for clinical diagnosis and treatment of hyperlipidemia with TCM.Method:（1）Literature research.（1）Theoretical research.By means of literature investigation,comparative study and conceptual analysis,the ancient and modern literatures on hyperlipidemia and TCM syndrome elements were sorted out,and the research viewpoints in the field of hyperlipidemia TCM and TCM syndrome elements were summarized through induction,deduction,Abstract generalization,analysis and synthesis.（2）Data mining.Sort out all the articles concerning clinical research of hyperlipidemia from three online databases,which are CNKI,WANFANG DATA and CQVIP.On the one hand,the TCM syndrome type is extracted from the selected literature,and the TCM syndrome name is standardized.Extract traditional Chinese syndrome elements of hyperlipidemia based on articles concerning syndromes elements.On the other hand,Extracting Chinese herbs from the literature,and standardize their name,four Qi,five flavors,meridians tropism and efficacy of Chinese herbs.Establish a database of traditional Chinese syndrome elements of hyperlipidemia and Chinese herbs.The data were statistically analyzed with SAS 9.4statistical software and association rules.The statistics of disease location elements,disease nature elements,Chinese herbs and frequency of use were statistically analyzed.The association rules were used to analyze the relationship between syndrome type,disease location elements,disease nature elements and Chinese medicine,and the compatibility of Chinese medicine.The relationship between them was visualized by cytoscape.（2）Clinical research.Clinical data were collected from 209 patients with primary hyperlipidemia,clinical information as listed:general condition,symptoms gathered by four diagnostic methods,and clinical biological indicators of TC、TG、LDL-C、HDL-C、PT、APTT and so on.Using the"Traditional Chinese Medicine Intelligent（Assisted）Diagnosis and Treatment System Version 10.0"software to analyze the four diagnostic information of patients in Chinese medicine,extract TCM syndrome elements（disease location elements,disease nature elements）,and establish clinical syndrome elements and biochemical indicators of clinical hyperlipidemia database.Data were analyzed by SAS 9.4 statistical software on the relationship between disease location elements,disease nature elements and gender,age and clinical biochemical parameters.Logistic regression analysis was used for the count data.P<0.05 was considered statistically significant.Results:（1）Literature research.（1）Theoretical research.Most of the etiology and pathogenesis of hyperlipidemia in traditional Chinese medicine think that diet is improper,excessive leisure and less work,emotional internal injury,phlegm turbidity,blood stasis,visceral disorders.Few studies on syndrome elements and hyperlipidemia have shown that spleen,liver and kidney are the common symptoms of disease location.There are deficiency and excess of pathogenic factors,phlegm,blood stasis and qi stagnation are common in solid pathogenic factors,and deficiency of Qi and Yin are common in deficiency pathogenic factors.（2）Data mining.120 articles in accordance with standard of research were selected,and 14 normalized TCM syndrome types were established.7 disease locations elements were extracted:spleen,kidney,liver,meridian,gallbladder,stomach and heart spirit（brain）.The spleen,kidney and liver accounted for 88.55%.12 main disease natures elements were extracted:phlegm,blood stasis,yin deficiency,qi deficiency,dampness,qi stagnation,yang deficiency,fire（heat）,essence（marrow）deficiency,blood deficiency,toxin and yang hyperactivity.The natures of Chinese herbs frequently used to treat hyperlipidemia are mostly“warm,normal,slightly cold,cold and slightly warm”.The flavors of them are mainly“sweet,bitter and pungent",and the meridian entry are mainly"liver,spleen,stomach,lung,heart and kidney.”The top 10 frequently used herbs were Hawthorn（Shanzha）,Salvia mil（Danshen）,Rhizoma Alisma（Zexie）,Polygonum multiflorum（Heshouwu）,Pinellia（Banxia）,white atractylodes（Baizhu）,Cassia（Juemingzi）,Tangerine（Chenpi）and Rhubarb（Dahuang）.The groups of Chinese herbs used in high frequency are tonifying deficiency,promoting blood circulation to remove blood stasis,facilitating urination and diffusing dampness,promoting digestion,clearing heat,regulating qi and eliminating phlegm.The results of correlation between affected locations and use of Chinese herbs are stated as followings:There are significant correlations between syndrome elements of affected spleen and use of Chinese herbs including Rhizoma Alisma（Zexie）,Fuling,Salvia mil（Danshen）and Hawthorn（Shanzha）.There are significant correlations between syndrome elements of affected kidney and use of Chinese herbs such as Polygonum multiflorum（Heshouwu）and Rhizoma Alisma（Zexie）.There are significant correlations between syndrome elements of affected liver and use of Chinese herbs containing Polygonum multiflorum（Heshouwu）and Cassia（Juemingzi）.The results of correlation between use of Chinese herbs and top-frequency natures of disease and are stated as followings:There are significant correlations between syndrome elements of phlegm and use of Chinese herbs such as Hawthorn（Shanzha）,Rhizoma Alisma（Zexie）,Pinellia（Banxia）,Salvia mil（Danshen）,Fuling.There are significant correlations between syndrome elements of blood-stasis and use of Chinese herbs such as Hawthorn（Shanzha）and Salvia mil（Danshen）.There are significant correlations between syndrome elements of dampness and use of Chinese herbs such as Hawthorn（Shanzha）,Fuling and Rhizoma Alisma（Zexie）.There are significant correlations between syndrome elements of yin-deficiency and use of Chinese herbs such as Polygonum multiflorum（Heshouwu）,Wolfberry（Gouqizi）,Hawthorn（Shanzha）and Rhizoma Alisma（Zexie）.There are significant correlations between syndrome elements of qi stagnation and use of Chinese herbs such as Bupleurum（Chaihu）,Hawthorn（Shanzha）,Chalk（Baishao）and Salvia mil（Danshen）.There are significant correlations between syndrome elements of yang-deficiency and use of Chinese herbs such as Aconite（Fuzi）,Magnolia（Houpo）,White atractylodes（Baizhu）,Atractylodes（Cangzhu）,Dried ginger（Ganjiang）and Epimedium（Yinyanghuo）.There are significant correlations between syndrome elements of fire（heat）and use of Chinese herbs such as Cassia（Juemingzi）,Rhubarb（Dahuang）,Hawthorn（Shanzha）,Bupleurum（Chaihu）,Salvia mil（Danshen）and Capillaris（Yinchen）.Chinese medicine compatibility tips are commonly used in three combinations,combination one:Pinellia（Banxia）,Tangerine（Chenpi）,White atractylodes（Baizhu）;combination two:Hawthorn（Shanzha）,Rhubarb（Dahuang）,Salvia mil（Danshen）,Cassia（Juemingzi）,Polygonum multiflorum（Heshouwu）,Rhizoma Alisma（Zexie）;combination three:Wolfberry（Gouqizi）,Cornus officinalis（Shanzhuyu）,Chinese yam（Shanyao）and Prepared rehmannia glutinosa（Shudihuang）.（2）Clinical research.Among the 209 hyperlipidemia patients who met the study criteria,95（45.45%）were male and 114（54.55%）were female.By analyzing information gathered from four traditional diagnostic methods with the 10th version of intelligent（auxiliary）system of traditional Chinese diagnosis and treatment,12 disease location elements are extracted,which are liver,heart,diaphragm,stomach,lung,spleen,kidney,meridian,sinew and bone,bladder,heart spirit（brain）and large intestine.18 disease nature elements are also extracted,including phlegm,yin deficiency,dampness,yang hyperactivity,blood stasis,heat,blood deficiency,qi deficiency,qi stagnation,dryness,yang deficiency,fluid deficiency,adverse qi flow,water retention,stirring wind,insecurity,stirring blood and blood heat.The analysis found that:There was a significant difference between the disease syndrome elements（such as disease location element spleen,disease location element liver,disease location element heart,disease nature element qi deficiency,disease nature element qi stagnation）and gender（P<0.05）.The probability of the disease location element spleen,liver,heart and disease nature element qi deficiency and qi stagnation of female patients in hyperlipidemia is greater than that of men.There was significant difference between the spleen of disease-location syndrome element and TG,LDL-C,HDL-C,PT,ALT,TC,HGB,TBIL and ALP（P<0.05）.The spleen of disease-location syndrome element was negatively correlated with TG,LDL-C,HDL-C,PT,ALT and HDL-C,while the spleen of disease-location syndrome element was positively correlated with TC,HGB,TBIL and ALP.The lower the levels of TG,LDL-C,HDL-C,PT and ALT,the higher the levels of TC,HGB,Tbil and ALP,the greater the possibility of spleen syndrome element.There was a significant difference between the disease location element heart and PT,APTT and ALT（P<0.05）.The disease location element heart was negatively correlated with PT.The disease location element heart was positively correlated with APTT and ALT.The lower the APTT,the higher the ALT level,the more likely the disease location element heart is.There was a significant difference between qi deficiency of the disease nature element and TC and LDL-C（P<0.05）.The qi deficiency of the disease nature element is negatively correlated with TC.The qi deficiency of the disease nature element is positively correlated with LDL-C.The lower the TC level,the higher the LDL-C level,and the greater the possibility of qi deficiency of the disease nature element.There was a significant difference（P<0.05）between disease nature element phlegm and APTT.There was a negative correlation between disease nature element phlegm and APTT.The higher the level of APTT,the smaller the possibility of disease nature element phlegm and the higher the possibility of non-disease nature element phlegm.There was a significant difference between disease nature element Yang hyperactivity,Yin deficiency,fire（heat）and GLU（P<0.05）.There was a negative correlation between disease nature element Yang hyperactivity and GLU,and there was a positive correlation between disease nature element Yin deficiency and fire（heat）and Glu.The higher the level of Glu,the lower the possibility of disease nature element Yang hyperactivity,the greater the possibility of disease nature element Yin deficiency or fire（heat）.There was a significant difference between disease nature element dampness and APTT（P<0.05）.There was a negative correlation between disease nature element dampness and APTT,and a positive correlation between disease nature element dampness.The shorter the APTT time,the higher the possibility of disease nature element dampness.There was a significant difference between disease nature element dryness and RBC（P<0.05）.There was a positive correlation between disease nature element dryness and RBC.The higher the level of RBC,the greater the possibility of disease nature element dryness.Conclusion:（1）Distribution regularity of TCM syndrome elements in hyperlipidemia was obtained through clinical analysis and literature analysis.The study indicates that hyperlipidemia is commonly located in spleen,liver and kidney.the disease nature elements of hyperlipidemia can be both deficiency and excess.It is common to see the types that are either excess with phlegm,blood stasis,dampness and qi stagnation,or deficiency of qi and yin.（2）To find out the traditional Chinese medicines associated with various common syndromes of hyperlipidemia,and to find out the combination law of medicinal drugs in hyperlipidemia.The treatment of hyperlipidemia is centered on the liver,spleen and kidney,sputum,phlegm,dampness,qi stagnation and evil,balance qi and blood yin and yang,and regulate the viscera.（3）There is a correlation between the TCM syndrome elements of hyperlipidemia and the commonly used biochemical indicators in clinical practice to provide meaningful tips for TCM clinical syndrome differentiation.If TC is positively correlated with the spleen of the disease location syndrome element,the increase in TC level indicates an increased likelihood of the disease in the spleen.（4）TCM syndromes elements not only have the connotation of TCM syndrome differentiation,but also objectively regulate dialectical methods.TCM syndromes have a certain correlation with modern clinical biochemical indicators,and can guide the clinical use of TCM.Therefore,it is feasible to use syndrome differentiation for the diagnosis and treatment of hyperlipidemia.Clinical application value. |
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