| OBJECTIVEAt present,the research on the clinical symptoms of essential hypertension (E.H.) still lack of an overall,multi-dimension,unified diagnostic standard in Chinese Medicine.The traditional ways of categorization is mainly based on the clinical experience of experts.Nevertheless,it still lack of an objective and regularized standard.This research is based on the concept of evidence-based medicine(EBM),directing at subjects with primary E.H.discovered from physical examination,selected from northern,middle,and southern part of China respectively.In this research,we utilize multi-centered,mass-sampling method combined with modern Epidemic Diseases' Questionnaire and Cluster's Analysis probing into the categorization of hypertensive symptoms and the regularity of distribution.MATERIAL AND MATHODIn reference to the classification in《Zhong Yi Liang Hua Zhen Duan》written by Xu Di Hua,combined with the questionnaire designed according to the clinical actual situation and database in FileMaker software.Since August 2007 until April 2008,research had been conducted in several places such as BeiJing China-Japan Friendships Hospital,ShanDong Province LiaoCheng City RenMin Hospital,FuJian Province FuZhou City ShengEr RenMin Hospital Medical Checkup Centre and BeiJing ChangPing district,HePingLi Community Medical Service Centre.A total of 477 cases are collected including the patients' general detail,the information from four clinical diagnosis methods of Chinese Medicine(SiZhen),and the biochemistry examination data.The above information are then keyed into the database program.Information from SiZhen are inputted into SPSS 16.0 software,scattered data had been undergone the process of merging and compacting.Lastly,two phases of duster's analysis are carried out subsequently.RESULT1.General Distribution:1) Location:ShanDong Province has the highest incidence(67.09%),followed by FuJian Province(20.75%),and the least BeiJing(12.16%).2) Blood Pressure classification:88.7%of patients belong to first and second stages of hypertension,(Stage 1:43.4%,Stage 2:45.3%respectively),Stage 3 patients constitute the least which is 11.3%.3) Gender proportion:Male higher than female with 2.9 to 1 ratio.4) Age:40-60 years old contributes the most with the statistic of 51.16% followed by＜40 years old,24.74%and 60-79 years old,24.1%.5) History:90.6%are first diagnosed;the other 9.4%are once diagnosed as hypertension yet did not take it seriously or receive any treatment.6) BMI:Overweight patients make up to 73.4%,normal BMI patients,25.8%, underweight patients,0.4%.7) Biochemistry Examination:Patients with abnormal level of blood cholesterol constitute 60.3%of total.Patients with abnormal blood sugar level forming up to 16.76%of total..2.Symptom Distribution PatternResearch shows that 51.2%of patients present no significance chief complaint, patients suffers from troubling symptoms in daily life constitute 48.64%.The major sign and symptoms of hypertension are mainly presented as symptoms from liver,kidney and heart system and the deficiency of yin and qi,excessive yang,or the blockage of phlegm.1) Symptoms from liver system:dizziness(36.3%),Irritable(34%),headache (25.2%).2) Symptoms from kidney system:tinnitus(26.8%),soreness and weakness of lower back and knee(28.1%),frequent micturition(9.2%),xerophthalmia (20.5%)3) Symptoms from heart system:insomnia(28.3%),amnesia(32.1%)and constriction in chest(23.1%),chest pain(9.2%),palpitation(22.9%),shortness of breath(21.2%)4) Symptoms of deficiency of qi:fatigue(11.7%)5) Symptoms of deficiency of yin:xerostomia and thirst(26.6%),constipation (6.7%).6) Symptoms of excessive yang:reddish face and ears(27.0%),bitter taste in mouth(31.0%)7) Symptoms of phlegm retention:sticky and greasy in mouth(8.8%)3.Tongue Characteristic Distribution Pattern54.5%of the patients' tongue characteristic presented as pink tongue which belongs to normal tongue.Abnormal tongue characteristic mainly presented as reddened tongue(28.9%),purplish tongue with ecchymosis(16.6%),pale tongue is the least(9.4%);tongue coating mainly presented as greasy fur(41%)with yellow color(59.3%),thin fur 31.9%,white fur and scanty fur are 11.74%and 4.2%respectively.In Pulse qualities,wiry pulse(58.7%)appear with the highest percentage,wiry and slippery pulse 27.9%,wiry and thready pulse 14.3%,wiry and rapid pulse 19.9%,slippery pulse 16.6%,unsmooth pulse 14.9%,feeble pulse 17%.4.Two-Step Cluster's Analysis ResultTwo-step cluster analysis are done from 3 to 7 clusters.The 7 clusters result is the most appropriate which are Deficiency of qi in heart and kidney, Hyperactivity of liver-yang,Deficiency of yin and yang,phlegm-dampness, Impeded blood circulation due to blood stasis.The symptoms presenting the higher percentage in every cluster are more significant in TCM theory. Hyperactivity of liver-yang(24.1%) and phlegm-dampness(27.1%) presenting the higher percentage,Deficiency of qi in heart and kidney(10.1%),Deficiency of yin and yang in kidney(8.4%),and Impeded blood circulation due to blood stasis(9.0%) presenting in the lower percentage.5.Distribution Pattern of the Two-Step Cluster's Analysis Result1) Blood pressure classification:Deficiency of qi in heart and kidney,Hyperactivity of liver-yang,Blood stasis ratio exhibit rising trend parallel with the level of blood pressure; Deficiency of yin and yang and phlegm-dampness ratio decrease along with the Blood pressure rising.2) Gender:Female Deficiency of yin and yang in kidney presenting the higher ratio compare with male,the other type of syndromes male has higher ratio.3) Location:Southern area's Hyperactivity of liver-yang,phlegm-dampness and Blood stasis presenting a higher ratiothan northern area.Northern area,Deficiency of qi in heart and kidney and Deficiency of yin and yang in kidney presenting a higher ratiothan Southern areas.4) Age:Incidence of Deficiency of qi in heart and kidney,Deficiency of yin and yang and Blood stasis present ascending trend along with ages. Hyperactivity of liver-yang and Phlegm-dampness which belongs to excess syndrome mainly concentrate at the age group＜40 and 40～60 years old, present descending trend along with ages.5) BMI:In BMI normal groups,Deficiency of yin and yang,Phlegm-dampness, Blood stasis with the proportion higher than BMI abnormal groups.In BMI abnormal groups,Deficiency of qi in heart and kidney,Hyperactivity of liver-yangwith the proportion higher than BMI normal groups.6) Blood cholesterol:In Blood cholesterol abnormal groups,Hyperactivity of liver-yang, Phlegm-dampness have a higher percentage.Blood cholesterol abnormal groups like Hyperactivity of liver-yang,Blood stasis are slightly higher than Blood cholesterol normal groups.7) Blood sugar:In Blood sugar abnormal groups Deficiency of qi in heart and kidney presenting higher ratio than Blood sugar normal groups,due to the sample of the Blood sugar abnormal groups are too little,only 4%,there are no clinical meanings.CONCLUSIONTwo-Step Cluster Analysis result come out with 6 catagories,which are Deficiency of qi in heart and kidney,Deficiency ofyin and yang,Hyperactivity of liver-yang,Phlegm-dampness,Blood stasis and Unable to classify groups. The Hyperactivity of liver-yang and Phlegm-dampness have higher incidence of complication(51.2%),means that restraining hyperactivity of yang,dissipating dampness and reducing phlegm are important in clinical.Compare the 4 differentiations of syndroms which currently in effect with Two-Step Cluster Analysis result,there are not only Deficiency of yin and yang, Hyperactivity of liver-yang,Phlegm-dampness three types,but including the Deficiency of qi in heart and kidney and Blood stasis.This research shows that the clinical presentations of the E.H.patients are complex along with numerous complications and paradoxical symptoms,hence,the result of comparison between Cluster Analysis with differentiations of syndroms from specialist only have 30%of similarity,further investigation and larger sampling approach are required to identify whether it is due to the stability of the cluster or the uncovered reasons of the sampling group. |
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