| 1. ReviewVertigo in traditional Chinese madicine is named as xuanmao, touxuan, toufengxuan and xuanyun, etc. It is a sort of disease that its main symptoms involve in dizziness with dazzle, vertigo, unsteady standing and falling to the ground. It is often accompanied by tinnitus, weakness, nausea, and vomiting. The pathogenesis of vertigo is thought to be related to fire, phlegm, wind, deficiency of qi, blood, yin and yang in TCM.Early as Neijing time, there was abundant recordation of the pathogenesis of vertigo in the book. Zhang Zhongjing of Han Dynasty elaborated a lot about it in Shang han lun and Jin kui yao lue too. Later many practitioners supplemented constantly and gradually were divided into many schools, focusing on different causes including wind, phlegm, fire, asthenia or excess or mixture.According to the description in TCM books, the characters of vertigo related to phlegm are dizziness with dazzle, nausea, vomiting, much phlegm, a stuffy feeling in the chest and full feeling in stomach, headache and heavy body. The most contributed symptoms are rotating feeling, vomiting and full feeling in chest and stomach. The main treatment is removing phlegm, expelling wind and lowering adverse flow of qi to stop vomiting. The characters of vertigo related to fire are sudden and severe vertigo accompanied by bitter taste in the mouth, constipation and thirsty. The main treatment is clearing heat and lowering fire. The characters of vertigo related to liver wind are balance disturbance accompanied by tinnitus, pain and stuffy in both sides of midsectiono This kind of vertigo has a risk of coma probability. Asthenic syndrome includes deficiency of qi, blood, yin and yang. The main symptoms of qi or yang deficiency syndrome are vertigo attacking when standing, low voice, yellow face and slow weak pulse, etc. Yang deficiency syndrome will be manifested as aversion to cold in the back and preference for warmth in the head and face. It can be treated with drug tonifying qi and yang. The main symptoms in blood or yin deficiency are dysphoria with feverish sensation in the chest, palms and soles, night sweat, insomnia and slow weak pulse. Nourishing blood and yin is fit for blood asthenic syndrome. The manifestation of exogenous vertigo varies with the type of exogenous evil, often accompanied with headache, body aches, spontaneous sweating, fever, thirst or heaviness or other exterior syndrome. The symptoms of vertigo related to external injury have correlation to pathogeny.Among modern TCM scholars, most of them think this desease has the character of repeat outbreak. The pathogenesis is related to wind, fire, phlegm, block and asthenia.We searched 337 TCM articles (from 1994 to 2005) on CNKI net. The all articles involved thirty-five kinds of syndrom types. The statistical data indicated that the top ten syndromes were phlegm stagnation, qi and blood deficiency, flaming-up of liver yang, disturbing-up of wind and yang, yin-deficiency of liver and kidney, blood stagnation, deficiency yin leading to disturbing-up of yang, deficiency essence and energy in kidney, blood blocking in brain and asthenic qi leading to blood stagnation.There are still some questions to account for in standardization research about syndrome differentiation of vertigo. For example, many symptoms manifested in the syndrome having same name and the same symptom manifested in several different syndromes. It indicated different symptoms had different significance in syndrome differentiation. The comprehension to the same syndrome was variable, so it resulted in the different standard of differentiation.2. BackgroundVertigo is a common symptom. It may be involved in many diseases and often not easy to find out its real causes. Vertigo could be the indicator of serious diseases, especially in cerebralvascular diseases, sometimes leading to disability or even death. So it needs proper attention and treatment. However, the treatments of vertigo are insufficient and not perfect, remaining some problems. There are abundant experiences about treatment of vertigo in TCM. Meanwhile, there are some problems in the TCM researches about syndrome differentiation of vertigo, which poses great problems to the effective treatment of vertigo. For example, the standard of syndrome differentiation is not identical and the element of syndrome is too complicated to be mastered, etc. As far as the pathogenesis is concerned, it is considered that the vertigo syndrome is related to the wind, heat, phlegm and weakness, etc. in TCM. Yet the standard of this syndrome is not made. All that mentioned above become obstacle of study of vertigo. In order to complete the study of vertigo so as to improve the treatment of vertigo, we investigated the regular rule of distribution of TCM syndrome of vertigo from December 2004 to January 2006. The data was analyzed with cluster analysis, discriminatory analysis.3. Objects and methodsThere were one hundred and fifty-two patients who came from neurological department of Xiyuan hospital. The diagnosis criterion was according to theClinical Research of the New Medicine in TCM. The select criterion: 1)Typical symptoms: vertigo, dizziness or syncope. 2)Age from 18 to 85. The exclusion criterion:1)Accompanied by unconsciousness, aphasia and dementia , so as to cannot cooperate with investigation. 2)Severe psychiatric disorder. The syndrome differentiation criterion referred to the Diagnostics in TCM and the Disease Diagnosis and Curative Effect Criterion in TCM.After asking the patients some questions, we filled in the questionnaire. The questionnaire consists of vertigo feature, past medical history, accompanied symptoms, tongue and pulse condition, etc. The data was managed and analyzed with SPSS12. 0 software. 4. ResultsAmong the 152 patients who fit to the select criterion and exclusion criterion, 51 cases were male (33.6%) and 101 cases were female. The ratio of male and female was almost 1:2. The age of the patients was from 19 to 83 years old. There were 45 cases from 61 to 70 year-old, the percentage of these patients was most (29. 6%). There were 35 cases from 71 to 80 year-old , 31 cases from 51 to 60 year-old, 17 cases from 41 to 50 year-old and 16 cases from 31 to 40 year-old. There was only one less than 20 year-old or more than 80 year-old.The most accompanied disease was hypertension, its percentage was 44. 1% , and the second was Cerebral infarction. The proportion of dizziness was highest (50. 7%) and that of vertigo was 36. 2 percent. The most of cases had no aura before vertigo attacking . The proportion of suddenly attacking was higher than that of slowly appearing a little. Nearly 70% cases didn' t have incentive. The familiar incentives was the bad sentiment, fatigue and insomnia. The 49. 3% attacking was not relation to the position. The course of getting up or laying down often result in vertigo attack. There was no accompanied symptom among 30% cases. The familiar accompanied symptoms with vertigo included nausea and/or vomiting (38. 2%), palpitation (27%), sweat(15. 1%) and balance disturbance(22. 4%). The central neurone system function impaire was seldom. This is indicated that the rate of central vestibular vertigo was not very high.According to our investigation, more than 50 per patients had distractedness symptom. 40 to 50 per patients felt thirsty, tinnitus, poor memory and afraid of cold. 30 to 40 per cases had symptoms such as vomiting, unsteady walking, easy to tire and headche. 20 to 30 per cases had such symptoms as much dream, easy to awake, difficult to asleep, poor hearing, constipation, neck rigidity, afraid of heat, a stuffy feeling in the chest, short breath, little sleeping and palpitation. The symptoms in 10% to 20% patients involved in easyto be anxiety, depression, lower limb heaviness, sore waist, bitter taste in mouth, spontaneous perspiration, limb numbness, poor appetite, diminution of vision, eating little, eye pain, fullness in abdomen, timidity, easy to angry, singultation, eye dry and night sweat. 37.5% of the patients' tongue was pale red tongue and 46. 7% was thin and white fur. The familiar pulse conditions were taut pulse, thready pulse and deep pulse.According to traditional syndrome differentiation, the desease involved in several viscus, especially the heart, spleen, liver and kidney. According to the BaGang syndrome differentiation, the heat syndrome, cold and heat concomitance syndrome and asthenia sthenia concomitance syndrome were similar. According to the QiXueJinye syndrome differnetiation, the blocking qi syndrome, phlegm syndrome and deficiency qi syndrome were more than the others.The original variable was converted to 0 and 1 first, and then the index was analyzed with Quick cluster analysis. The cases were divided into three, four, five and six classes in turn. According to the clinical situation, three classes of the syndromes were typical in the TCM syndromes of vertigo. These syndromes were disturbing-up of the phlegm heat(48. 68%), both heart and spleen asthenic and yin and yang incongruous(41. 45%), yin-deficiency of liver and kidney leading to wind-phlegm stirring(9. 87%).With the discrimination analysis, we can make the discrimination functions of different syndromes. Comparing the coefficient of function, we got the critical symptoms in different TCM syndromes. Results:l)The critical symptoms of yin-deficiency of liver and kidney leading to wind-phlegm stirring were vertigo, hypomnesia, neck rigidity, distractedness, fat body, night sweat, nausea, vomiting and tinnitus. 2)The critical symptoms of disturbing-up of the phlegm heat were vertigo, thirsty and red tongue. 3) The critical symptoms of heart and spleen asthenic and yin and yang incongruous were dizziness, distractedness, afraid of cold, easy to tired, sleepless, aversion to heat, dreaming, headache and thirsty.Reclassifying the cases with the discrimination functions and comparing the original classes, there were 94. 1% cases to be differentiated correctly. After cross-validated, 81. 6% cases can be differentiated correctly.5. DiscussionsBy the clinical investigation, we have found out the characteristic of epidemiology and outbreak for vertigo. By the multivariate analysis in statistics, we got the distribution feature of the TCM syndrome on vertigo. The results were:phlegm-heat syndrome (48.68%), heart-spleen deficiency (41.15%), yin-deficiency of liver and kidney leading to wind-phlegm stirring (9.87%).The bases of the syndrome differentiation are not the same entirely in different times. In early ancient times, the doctors mainly prescribed medicine on the basis of symptoms and seldom based on the tongue and pulse condition. But in modern times, doctors emphasized the cross reference to symptoms, tongue and pulse condition. Sometimes the symptoms cannot match the tongue and pulse condition in clinic, even they are incompatible. Then we need decide to choose the symptoms or pulse condition. But the standard of choice is often different among doctors. Doctors commonly decide to choose which one based on their own clinical experiences. That results in the standard of syndrome differentiation is not uniform and short of impersonal evidence.The investigation showed the appearance rate of pale red tongue was 37. 5% and that of thin white fur was 46. 7%, both of them were higher than others. These patients' tongues were normal, but their symptoms existed objectively. As the feature of phlegm syndrome, the slippery pulse' s rate was 5. 9 percent. But the rate of phlegm heat syndrome was 48. 68 percent. Besides the objective factors, the difference to doctor' s experience was important reason that led the contradiction. Thus it decreased the significance of tongue and pulse condition in syndrome differentiation inevitably.The multivariate analysis is a statistic method that is used to research multifactor improblem. The TCM syndrome is the result of reciprocity of multifactor. It is the result of combining of symptom, tongue and pulse condition, and so on. So the multivariate analysis is often used to the research of TCM syndrome recently.With Quick cluster analysis, our investigation predigested the more than ten kinds of syndrome to three kinds, that were disturbing-up of the phlegm heat, both heart and spleen asthenic and yin and yang incongruous, yin-deficiency of liver and kidney leading to wind-phlegm stirring. With the discrimination analysis, we got 26 variable they had great significance in discriminating syndromes. And we got the discrimination functions, too. Comparing the coefficient of function, we got the critical symptoms in three different TCM syndromes. But there were some questions in our results. We need the further research to validate the results. For example, the fat body was commonly considered as the characteristic of the phlegm syndrome, but in the discrimination functions, the coefficient of it in the yin-deficiency of liver and kidney leading to wind-phlegm stirring syndrome was much higher than thatin two other syndromes. Additionally the cases we collected were not much enough, so the final results need be modified by further research.In one word, it is a question for discussion how to combine the modern statistic method with the experiences of TCM.
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