A Preliminary Epidemiological Study And Discussion On Traditional Chinese Medicine Syndromes Of Chronic Fatigue Syndrome

Objective: Chronic fatigue syndrome (CFS) are a group of sustained or recurrent fatigue, accompanied by a variety of neurological, psychiatric symptoms, but no organic and mental diseases characterized syndrome. At present, the specific treatment of CFS was lacked. However, it was reported that Chinese medicine treatment of the disease had obtained good effect. TCM syndrome of CFS differentiated on the basis of many physicians experience and confused, so that it impacted evaluation of Chinese medicine treatment of CFS. Our purpose was to discuss the multivariate statistical analysis of TCM syndrome types feasibility and evidence-based features of CFS. Therefore, based on Chinese medicine theory and the symptoms of quantitative research methods, clinical symptoms of epidemiological investigations about CFS were collected, combining disease and syndrome differentiation and mathematical statistical methods of CFS symptoms were used. Methods: This study was a cross-sectional questionnaire survey There were some patients with CFS who came from department of traditional Chinese medicine of Affiliated Hospital of Luzhou Medical College, Chinese medicine hospital of Luzhou and department of traditional Chinese medicine of Hejiang people's hospital from May 2004 to May 2008. CFS was diagnosed according to CDC (1994) CFS diagnostic criteria. The contents of investigation included patients general situation, clinical symptoms, signs, such as tongue and pulse tracings. Based on books of Chinese medicine and clinical practice, the CFS were divided into four syndromes including type of deficiency of both the heart and spleen, stagnation of liver-QI with deficiency of the spleen, hepatic and renal yin deficiency, and damp-retention due to hypofunction of the spleen. The questionnaire was in triplicate. After completing a questionnaire, three experts in Chinese medicine diagnosed the syndromes for every patient with CFS independently. Then the agreed were involved in this study. At last 441 cases of four patients with CFS had included this study. Then we tried to establish the TCM model of chronic fatigue syndrome by setting up the database of 441 patients with CFS and using descriptive statistical analysis, cluster analysis, factor analysis and other multivariate statistical analysis in spss13.0. Results: 1.Patients with CFS were mostly in adults, and the proportion of 31-55 years old accounted for 67.8 percent. Prevalence in city was higher than in rural areas, and women were more than men. mental accounted for 78 percent in occupational distribution of population, significantly higher than manual workers. One of the teachers, civil servants, commercial staff, and students were high crowd attendance. 2.According to the 441 cases of CFS, patients with symptoms characteristic of CFS could be divided into 3 categories of TCM syndrome, including type of deficiency of both the heart and spleen(n=114); stagnation of liver-QI with deficiecy of the spleen(n=162); and hepatic and renal yin deficiency(n=165). 3.Three Chinese medicine symptom's relevance demonstrated that stagnation of liver-QI with deficiecy of the spleen was being related to hepatic and renal yin deficiency(regression coefficient=0.017), but deficiency of both the heart and spleen has the inverse correlation with hepatic and renal yin deficiency(regression coefficient=-0.382) and stagnation of liver-QI with deficiecy of the spleen(regression coefficient=-0.108). 4.According to the critical theory of factor analysis(regression coefficient≧ 0.4), we obtained TCM syndrome differentiation of the main points. The main points of hepatic and renal yin deficiency included burning sensation of five centres, low-grade fever or hectic fever, frequent urination at night, loosening of tooth and alopecie, nocturia, hypaphrodisia, lumbodynia, hyperhidrosis, morbid forgetfulness, edema of lower extremity, dark complexion and pulsus parvus. Stagnation of liver-QI with deficiecy of the spleen was involved in sighing, deprementia, restlessness and tantrum, throat pain, sentiment, chest complaint or abdominal pain, tongue cyanosis, face pale, pharyngeal swelling, moss yellow or greasy, and so on. That of deficiency of both the heart and spleen included decreased food appetite, capacity for food reduces, dizziness, abdominal distention or loose stool, muscle or joint pain, chest distress or cardiopalmus, and face pale or chlorsis. At last, carried on the back substitution examination according to the multi-dimensional statistical analysis model to 441 CFS cases, the correct judgment rate was 85.49%. Conclusion: 1.The crowd attendance of CFS in the city was higher than in rural areas in seeing a doctor community, mental workers were more than manual , and the young and the middle aged was the main community. 2.The main TCM syndromes of CFS included in insomnia, lumbodynia, abdominal distention, decreased food appetite, many dreams accompany waking up easily, dizziness, mental depression, capacity for food reduces, forgetfulness, face pale and wiry pulse. Then thease symptoms revealed the pathogenesis of CFS was possible as a result of "deficiency of organ dysfunction". CFS was close to heart, liver, spleen and kidney, and the deficiency of four organs was the mainly pathological mechanism. The TCM syndrome included type of deficiency of both the heart and spleen, stagnation of liver-QI with deficiecy of the spleen, and hepatic and renal yin deficiency. The main points of hepatic and renal yin deficiency included burning sensation of five centres, low-grade fever or hectic fever, frequent urination at night, loosening of tooth and alopecie, nocturia, hypaphrodisia, lumbodynia, hyperhidrosis, morbid forgetfulness, edema of lower extremity, dark complexion and pulsus parvus. Stagnation of liver-QI with deficiecy of the spleen was involved in sighing, deprementia, restlessness and tantrum, throat pain, sentiment, chest complaint or abdominal pain, tongue cyanosis, face pale, pharyngeal swelling, moss yellow or greasy, and so on. That of deficiency of both the heart and spleen included decreased food appetite, capacity for food reduces, dizziness, abdominal distention or loose stool, muscle or joint pain, chest distress or cardiopalmus, and face pale or chlorsis. 3. The method which the clinical epidemiology and the multi-dimensional statistical analysis were unified to carry on syndrome differentiation to some kind of vigorous sickness could overcome the randomness based on personal experience, which had good application value in studing on TCM syndromes. 4. The development of evidence-based medicine could provide to new direction of the study in traditional Chinese medicine diagnostics.