| BackgroudAt present,the prevalence of glucolipid metabolism disorder,such as diabetes,hyperlipidemia,nonalcoholic fatty liver diseases,hypertension,overweight,atherosclerotic cardio-cerebral vascular disorders,has increased continually.The existing single-disease treatment mode is unsatisfactory efficacy,resulting in low comprehensive control rate,which seriously threatens human health.Based on the above situation,from the holistic view of traditional Chinese medicine(TCM),my supervisor comprehensively understood and integrated the prevention and control of diabetes,hyperlipidemia,nonalcoholic fatty liver diseases,hypertension,overweight,atherosclerotic cardio-cerebral vascular disorders of glucolipid metabolism disorder,innovatively proposing the a new theory of Glucolipid Metabolic Disorders(GLMD),Dan-Zhuo,and enacted and issued the Specification of Diagnosis and Treatment of Glucolipid Metabolic Disorders(Dan-Zhuo)with Integrated Chinese and Western Medicine.The manifestations of GLMD arediverse,it can appear abnormal glucose and lipid metabolism,overweight non-alcoholic fatty liver disease,and even arteriosclerosis diseases,so that its syndromes are complicated and varied.Objective study of TCM syndromes is the focus and difficulty of TCM syndromes research,the introduction of the syndrome scale provides a new method to solve the problem of syndrome differentiation,in order to reduce the subjectivity and inconsistency in syndrome differentiation,which has practical significance for the construction of TCM syndrome objectification and standardization.Through the combination of literature and clinical research,this study revealed the distribution rules of TCM syndromes of GLMD,and formulates the syndrome scale of GLMD,so as to further standardize and improve the diagnosis and treatment of GLMD,and provide accurate,objective and scientific basis for the future clinical diagnosis and treatment and research of GLMD.ObjectiveBy combing the modern literatures related to GLMD,the distribution characteristics and main syndromes of were revealed.On this basis,the quantitative classification of syndromes was further developed,and an objective and scientific diagnosis scale of GLMD with high feasibility was developed to standardize the diagnosis of syndromes and provide a basis for clinical syndrome differentiation.Method1.Literature syndrome study: To search for TCM syndrome literature ofGLMD since the construction of China National Knowledge Infrastructure(CNKI)until to December 31,2018,Eligible literatures were screened by double inclusion/exclusion criteria.The frequency analysis method was used to statistically analyze the information of the four diagnoses in the final included literatures,which were analyzed of the distribution of main TCM symptoms,signs,tongue manifestation and pulse manifestation in patients with GLMD.2.Expert consultation: On the basis of literature research,combined with disease guideline/expert consensus,clinical data and teaching materials,the information of the four diagnostic methods involved in GLMD was further defined.Whereafter,Delphi method was used to screen out the four diagnostic information items and their corresponding syndrome dimensions.3.Clinical case collection and diagnostic scale formulation:According to the severity of the clinical feature,a quantifiable questionnaire of four diagnostic information of GLMD was established.After collecting TCM syndrome information of patients with GLMD through clinical investigation,the patients were identified from the dimension of 15 diseases nature/location.Using binary logistic regression analysis to screen four diagnostic information items under each syndrome dimension and calculated their weight values.The ROC curve was used to find the optimal diagnostic threshold for each syndrome scale.Finally,the score degree of each syndrome scale was graded by Quartile method,so as to complete the final TCM syndrome diagnosis scale.Result1.The distribution of four diagnostic information in the literatures:Among the 203 literatures,157 items related to the four diagnostic information of TCM patients with GLMD were included,which were complex and diverse.(1)The high frequency symptoms and signs of GLMD were tireness and weakness,dizziness,chest tightness,thirs and insomnia.(2)The main tongue color were red tongue,darkness tongue and pale tongue.(3)The main tongue shape were plump tongue and teeth-printed tongue.(4)The fur color were mainly white fur and yellow fur.(5)The fur character were mainly greasy fur,followed by thin fur and thick fur.(6)The first three pulse manifestation were thready pulse,stringy pulse and slippery puls in turn.2.The TCM syndrome of clinical cases: Regardless of single or combined diseases,the majority of excess syndromes of patients with GLMD were dampenss syndrome,phlegm syndrome and qi stagnation syndrome,whlie the majority of deficiency syndrome were Yin deficiency syndrome and qi deficiency syndrome,and the disease location were mainly in the kidney and live.3.Establishment of TCM syndrome diagnosis scale: There are 15 TCM syndrome scales.3.1 Qi stagnation syndrome: The scale contains 9 items,including dark lip,depression,sighing,chest tightness,chest pain,belching,abdominal distension,much flatus and stringy pulse.The scale of diagnostic threshold is2.1 points.A score of 2.10 to 2.70 is considered mild.A score of 2.70 to 5.70 is considered moderate.A score greater than or equal to 5.70 is considered severe.3.2 Dampenss syndrome: The scale contains 14 items,including tireness and weakness,obesity,facial edema,heavy sensation of head,anorexia,sticky and greasy in mouth,heavy sensation of limbs,much defecation,turbid urine,plump tongue,teeth-printed tongue,white fur,greasy fur and slippery pulse.The scale of diagnostic threshold is 2.45 points.A score of 2.45 to 3.50 is considered mild.A score of 3.50 to 5.90 is considered moderate.A score greater than or equal to 5.90 is considered severe.3.3 Phlegm syndrome: The scale contains 12 items,including obesity,dizziness,headache,heavy sensation of head,insomnia,much phlegm,chest tightness,chest pain,sticky and greasy in mouth,heavy sensation of limbs,greasy fur and slippery pulse.The scale of diagnostic threshold is 3.25 points.A score of 3.25 to 4.40 is considered mild.A score of 4.40 to 7.10 is considered moderate.A score greater than or equal to 7.10 is considered severe.3.4 Heat syndrome: The scale contains 12 items,including red complexion,dysphoria,irritability,increased eating with rapid hungering,bitter taste in mouth,halitosis,thirst,deep-colored urine,red tongue,dark red tongue,yellow fur and rapid pulse.The scale of diagnostic threshold is 3.75 points.A score of 3.75 to 4.60 is considered mild.A score of 4.60 to 7.20 isconsidered moderate.A score greater than or equal to 7.20 is considered severe.3.5 Syndrome of blood stasis: The scale contains 6 items,including dim complexion,dark lip,chest tightness,chest pain,numbness of limbs and dark red tongue.The scale of diagnostic threshold is 3.35 points.A score of 3.35 to4.00 is considered mild.A score of 4.00 to 6.90 is considered moderate.A score greater than or equal to 6.90 is considered severe.3.6 Syndrome of yang hyperactivity: The scale contains 5 items,including red complexion,dizziness,headache,dysphoria and irritability.The scale of diagnostic threshold is 3.45 points.A score of 3.45 to 5.00 is considered mild.A score of 5.00 to 9.70 is considered moderate.A score greater than or equal to 9.70 is considered severe.3.7 Syndrome of qi deficiency: The scale contains 15 items,including spiritlessness,tireness and weakness,obesity,spontaneous sweating,fear of cold,amnesia,panting,asthma,palpitation,tastelessness,much urine,frequent urination at night,pale tongue,teeth-printed tongue and thready pulse.The scale of diagnostic threshold is 3.45 points.A score of 3.45 to 4.50 is considered mild.A score of 4.50 to 8.00 is considered moderate.A score greater than or equal to 8.00 is considered severe.3.8 Syndrome of blood deficiency: The scale contains 9 items,including pale lips,dizziness,insomnia,blurred vision,dry and uncomfortable eye,palpitation,numbness of limbs,pale tongue and thready pulse.The scale ofdiagnostic threshold is 2.85 points.A score of 2.85 to 3.60 is considered mild.A score of 3.60 to 6.80 is considered moderate.A score greater than or equal to 6.80 is considered severe.3.9 Yang deficiency syndrome: The scale contains 14 items,includingpale white complexion,limbs edema,spontaneous sweating,fear of cold,much phlegm,palpitation,anorexia,soreness of loins,knee weakness,much defecation,much urine,frequent urination at night,plump tongue,teeth-printed tongue,white fur and deep pulse.The scale of diagnostic threshold is 2.95 points.A score of 2.95 to 4.10 is considered mild.A score of4.10 to 8.00 is considered moderate.A score greater than or equal to 8.00 is considered severe.3.10 Yin deficiency syndrome: The scale contains 12 items,including emaciation,night sweating,dizziness,insomnia,dreaminess,blurred vision,tinnitus,dysphoria,dry throat,knee weakness,constipation and less tongue.The scale of diagnostic threshold is 2.25 points.A score of 2.25 to 3.30 is considered mild.A score of 3.30 to 6.30 is considered moderate.A score greater than or equal to 6.30 is considered severe.3.11 Syndrome of disease location in heart: The scale contains 6 items,including pale white complexion,insomnia,dreaminess,palpitation,chest tightness and chest pain.The scale of diagnostic threshold is 5.95 points.A score of 5.95 to 6.70 is considered mild.A score of 6.70 to 10.80 is considered moderate.A score greater than or equal to 10.80 is considered severe.3.12 Syndrome of disease location in spleen: The scale contains 19 items,including tireness and weakness,dim complexion,pale lips,dark lip,obesity,facial edema,limbs edema,fear of cold,heavy sensation of head,panting,anorexia,tastelessness,sticky and greasy in mouth,belching,much flatus,heavy sensation of limbs,much defecation,loose stool and deep-colored urine.The scale of diagnostic threshold is 2.35 points.A score of 2.35 to 3.00 is considered mild.A score of 3.00 to 5.70 is considered moderate.A score greater than or equal to 5.70 is considered severe.3.13 Syndrome of disease location in liver: The scale contains 10 items,including dizziness,headache,dreaminess,blurred vision,tinnitus,dysphoria,irritability and bitter taste in mouth.The scale of diagnostic threshold is 3.35 points.A score of 3.35 to 4.20 is considered mild.A score of 4.20 to 6.50 is considered moderate.A score greater than or equal to 6.50 is considered severe.3.14 Syndrome of disease location in kidney: The scale contains 9 items,including amnesia,blurred vision,tinnitus,panting,low back pain,soreness of loins,knee weakness,turbid urine,and frequent urination at night.The scale of diagnostic threshold is 3.65 points.A score of 3.65 to 5.60 is considered mild.A score of 5.60 to 10.40 is considered moderate.A score greater than or equal to 10.40 is considered severe.3.15 Syndrome of disease location in stomach: The scale contains 10 items,including dim complexion,obesity,increased eating with rapidhungering,anorexia,sticky and greasy in mouth,acid regurgitation,belching,bitter taste in mouth,halitosis and abdominal distension.The scale of diagnostic threshold is 4.25 points.A score of 4.25 to 5.30 is considered mild.A score of 5.30 to 8.20 is considered moderate.A score greater than or equal to 8.20 is considered severe.Discussion1.The clinical manifestations of patients with GLMD are complex and diverse,which have the dysfunction of qi and fluid metabolism disorder leading to the production of dampness,phlegm,heat,blood stasis and other pathological products.The diseases location has involved a wide range of areas,including liver,spleen,kidney,heart,brain and other viscera.The syndromes of patients with GLMD in different disease states are similar and their syndrome distribution are characteristic of intermingled deficiency and excess: Dampness syndromes is the most syndromes in excess syndromes,and Yin deficiency syndromes is the most syndromes in deficiency syndromes.Above of them indicated that although there are many pathological states interlaced in patients with GLMD,different disorders of GLMD have the same pathogenic mechanism,which provides an evidence-based basis for the treatment of this disease..2.Through the document acquisition,expert consultation and clinical cases,using a variety of statistical methods,157 complex four diagnostic information items of GLMD were ultimately simplified into 15 syndromedimensions,including 71 items with diagnostic significance of syndromes.The diagnostic threshold value and the weight of corresponding items of each syndrome scale were determined,and the TCM syndrome diagnosis scale with characteristics of GLMD was finally developed,which has a strong comprehensive diagnostic ability. 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