The Study About TCM Syndrome Types Of Chronic Hepatitis C

Chronic viral hepatitis C (hereinafter referred to as chronic hepatitis C) is an infectious disease which is globally distributed and seriously harms the health of mankind. Its major clinical manifestations are lassitude, hypodynamia, anorexia, abdominal distention, hypochondriac pain and so on. Major locations of this disease are liver, spleen, and kidney. The course of the Pathological changes is characterized by the trend of qi stagnation, dampness, blood stasis, and asthenia of healthy energy. It belongs to diseases in TCM such as "epidemic toxin", "hypochondriac pain", "jaundice", "abdominal mass", "flatulent colic" and so forth. Ancient physicians mostly judged and diagnosed according to the theory of "damp-heat toxin", and combined treatment of TCM and western medicine is applied recently in our country in order to make reasonable and all-round syndrome differentiation for the pathogen tic condition and correct treatment, thus contributing to blocking further development of the disease and raising the patient's survival rate.Objective Through the observation and systematical analysis of symptoms and signs, laboratory indexes and B-US of patients with chronic hepatitis C, explore the principles and methods of the TCM syndrome differentiation, and formulate the preliminary criterion for the syndrome differentiation of the chronic hepatitis C.Methods Assemble 98 patients with chronic hepatitis C hospitalizing in Shenzhen Third People's Hospital from March to October in 2009, and complete the syndrome questionnaire according to the clinical symptoms and signs, tongue and pulse, laboratory examination indexes and B-US of the patients. Analyze the syndrome distribution of the disease and frequency of the information collected with the four diagnostic methods by SPPSS13.0 statistical software, and then conduct preliminary study of the correlation between certain laboratory examination indexes and the syndrome types.Results Study showed that the morbidity is gender-prone and age-prone to a certain extent. Among the 98 CHC patients surveyed, males, with average age of 39.53, account more than females obviously, which conform to epidemiological regular rules of this disease. Among the 85 screening symptoms and physical signs occurred, the top ten are roughly the same in terms of integration and frequency, but are different in the front and rear order, which indicated that integration is different from frequency in that integration reflects the seriousness of the symptom, while frequency reflects the times of the symptoms, and these are significant for the identification of the syndrome. There are mainly five types of tongue body, namely, carmoisine, carmoisine with signet on the fringe, rubrum, dark red and dark red with signet on the fringe, and tongue fur consists of yellowish greasy tongue, white and greasy tongue, thin and yellowish fur, thin and whitish fur and scanty fur. The tongue body combines with the tongue fur in 20 ways among which the reddened tongue appears most frequently, while the thin and whitish fur is the commonest in terms of the tongue fur. Pulse condition usually contain slippery pulse, frequent pulse, taut pulse, thin pulse and soggy pulse and so forth. Different laboratory indexes are partly correlated with syndrome types:slight increase of ALT and AST almost occurred in each syndrome type; the amount of TBIL is larger in stagnancy of warm-heat pathogen than in any other type; A, G, and A/G could be easily observed in stagnancy of warm-heat pathogen and Stagnation of Qi due to depression of the liver; and the comparison of A/G among stagnancy of warm-heat pathogen, Spleen deficiency and dampness stagnation liver-kidney deficiency carries statistical significance. These results indicated that the healthy energy was strong enough to counterbalance the disease despite the severe conditions. Of the twelve syndrome types occurred in this survey, the top six were stagnancy of warm-heat pathogen, Spleen deficiency and dampness stagnation, liver-kidney deficiency, stagnation of liver Qi and spleen deficiency, Stagnated Heat Syndrome in the Liver and Stomach and splenic asthenia and blood stasis. There are 28 cases with combined and accompanied syndromes among which the respectively accompanied stagnant blood (19 cases) and damp heat(12cases) occurred most frequently, and blood deficiency, liver stasis, splenic asthenia as well as deficiency of vital energy and so on also could be observed. Results of B-US in liver, the size of liver and the thickening of light spot in liver are of no statistical significance (P>0.05), but the part related to the condition of liver function have statistical significance. The length of the right lobe and the breadth of portal vein observed in the B-US of the liver make no obvious difference in terms of TCM syndrome type. There were only 5 cases in which the vascular lake lacked limpidity with high TCM symptoms scores including 2 scores and 3 scores, which meant that the vascular lake of the liver was lacking in limpidity and the patients' condition were rather serious with unfavorable prognosis. The amount of HCV RNA and anti-HCV makes no statistical significance among each syndrome type, but there were more HCV in type1, type2, type3, and type4 than in any other syndrome type. Amid the patients surveyed,80 were relatively satisfied with their physical condition, which accorded with the fact that clinical investigation always reflect mild symptoms. However, those with inconvenient daily lives accounted for 40%, which indicated that the patients had latent and inconspicuous physical signs, thus supplementing the deficiency during the interrogation of the patients. Fatigue, anorexia, irritability, worry of the disease being incurable or about the effects on family members and so on compose the representative signs, emotions and feelings of the chronic hepatopathy scale which is divided into 7 degrees from high to low, and the next survey Showed that degree4 around accounted for 92%, which fully indicated that patients were quite concerned about this disease.Conclusion Certain correlation does exist among the syndrome distribution of chronic hepatitis C, the information collected with the four diagnostic methods and some laboratory indexes. The study of the preliminarily-fixed criterion of syndrome differentiation based upon the statistical analysis of the correlation among four diagnoses'results, like except according to the type 5 chronic hepatitis Standard (Trial) formulated by the Medical Liver specialized Committee of the China Association of Traditional Chinese Medicine and Pharmacy, the syndrome differentiation of chronic hepatitis C also include damp-retention due to hypofunction of the spleen, hepatogastric heat retention, deficiency of both vital energy and yin, asthenia of pulmonosplenic qi, splenic asthenia, blood stasis as well as some states without syndrome to differentiate.Another,liver and stomach with the hot is a new syndrome in this course of discovertion, it is worthing to investage whether it is related with the region climate in south.some laboratory examination indexes and the syndrome types provides a better mode for clinical diagnosis. However, the research approach is yet to improve and shall be subject to further clinical validation.