Study On TCM Syndromes And Related Influencing Factors In Children With Recurrent Abdominal Pain

Objective:To study the characteristics of TCM syndromes and the distribution rules of TCM syndromes of children's Recurrent Abdominal Pain(RAP),and to analyze the relationship between RAP and relevant factors such as case age,sex,course of disease,regional distribution,diet,disease incidence,growth and development,past history,allergy history,etc.Methods:122 cases of recurrent abdominal pain diagnosed as children were collected from January 2019 to January 2020 in the Pediatric Outpatient Department of the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine.Collect the case history and symptoms,fill in the clinical observation form of TCM syndromes,use 13C breath test to detect Hp infection,Excel and SPSS 23.0 statistical analysis data.Results:1.Clinical characteristics of RAP:122 cases were included in this study,with an average age of 7.96±2.94 years between 3 and 14 years old,with a male-female ratio of about 1.07:1.The course of the disease is mostly concentrated in 6 months to 3 years,abdominal pain has no obvious inducement,and the attack time is irregular or appears after meals.The frequency of abdominal pain attack in most cases is less than 60 times in 3 months,with an average of 1 pain attack in 0-1.5 days,which can be relieved within half an hour each time.Clinical manifestations are mainly periumbilical or epigastric dull pain,the pain is not severe,and it can show no or one or more accompanying symptoms.Most cases are accompanied by anorexia,with ruddy and normal complexion,few with leukoplakia,and the tongue coating and pulse condition are mostly red,white and greasy,and the pulse is heavy and thin.Most of the cases have no previous relevant medical history and allergy history.2.122 cases of RAP are distributed according to the pattern of traditional Chinese medicine syndromes:dampness blocking the middle energizer syndrome(42.63%)>spleen and stomach damp-heat syndrome(22.13%)>liver-stomach disharmony syndrome(20.49%)>stagnation of milk and food syndrome(5.73%)>spleen and stomach deficiency and cold syndrome(4.92%)>abdominal middle cold syndrome(2.46%)>stomach yin deficiency syndrome(1.64%).The test has statistical significance.3.Distribution of TCM syndrome types and general situation:The height classification among various syndrome types is correlated through statistical analysis.Regression analysis shows that the probability of high height cases as dampness blocking middle energizer syndrome is low.After examination,the distribution of syndrome types has no significant correlation with age,sex,duration of disease,urban and non-urban distribution,and has no correlation with the regularity of diet time,picky eating,amount of food intake,preference for meat,preference for sweets,or weight,previous relevant medical history and allergy history of the case.4.The distribution of TCM syndromes is related to the nature of pain:the most cases of colic are in the middle-cold syndrome of abdomen,the most cases of burning pain are in the damp-heat syndrome of spleen and stomach,the most cases of distending pain are in the disharmony of liver and stomach,the proportion of dull pain and distending pain are equivalent in the stagnation of milk and food syndrome,the most cases of dull pain are in the damp-resistance middle-jiao syndrome and the deficiency-cold syndrome of spleen and stomach,and the proportion of dull pain and burning pain are equivalent in the deficiency of stomach yin syndrome.Regression analysis also showed that the possibility of the burning pain type being spleen-stomach damp-heat syndrome is higher,the possibility of the distending pain type being liver-stomach disharmony syndrome is higher,and the possibility of the latent pain type being dampness blocking middle energizer syndrome is higher.5.The distribution of TCM syndrome types is correlated with pain relief methods:the proportion of self-relief cases in spleen-stomach deficiency-cold syndrome is equivalent to that after massage or hot compress,the proportion of self-relief cases in stomach-yin deficiency syndrome is equivalent to that of non-relief cases,and the most cases in other syndrome types are self-relief.In all cases of spontaneous remission,massage or hot compress,dampness blocking and middle jiao syndrome is the most common.6.The distribution of TCM syndromes is related to the accompanying symptoms:among the accompanying symptoms,nausea,vomiting,belching,abdominal distension,halitosis,anorexia and dry stool are distributed among various syndromes,affecting the distribution of TCM syndromes,of which belching,abdominal distension and halitosis are closely related to the distribution of TCM syndromes.According to regression analysis,the cases with halitosis are more likely to be classified as spleen-stomach damp-heat syndrome.Cases with belching but not halitosis are more likely to be classified as liver-stomach disharmony.Cases without abdominal distension are more likely to be classified as damp turbidity and middle obstruction.7.The distribution of TCM syndromes is related to the severity of the main symptoms:the proportion of middle and severe cases in stomach yin deficiency syndrome is equivalent,and the remaining syndromes are all middle cases.8.The distribution of TCM syndromes has no correlation with the presence or absence of inducement,pain duration,pain location and severity of secondary symptoms.9.Among 122 RAP cases,24 cases were Hp infection,with a positive rate of 19.67%.The age distribution was between 3 and 14 years old,with an average of 9.17±3.25 years old.The ratio of male to female was 1.4:1.After examination,Hp infection was statistically different from age,and had no statistical difference with gender,course of disease,regional distribution and severity of symptoms.10.The distribution of TCM syndromes of Hp positive cases from high to low is:dampness blocking middle energizer syndrome(41.67%)>spleen-stomach damp-heat syndrome(29.17%)>liver-stomach disharmony syndrome(25.00%)>spleen-stomach deficiency-cold syndrome(4.16%)>abdominal middle-cold syndrome(0%)=milk food stagnation syndrome(0%)=stomach yin deficiency syndrome(0%).After examination,there was no significant difference in the positive rate of Hp infection among different syndrome types.Conclusion:1.RAP in children is a chronic recurrent disease.The nature of pain is diversified,which can be relieved by itself but is easy to be repeated.The inducement is unknown and the regularity of onset time is not strong.The TCM syndrome type distribution is mostly damp-resistance and middle-jiao syndrome.Its distribution is related to the nature of pain,pain relief mode and severity of main symptoms.It is not related to Hp infection,age,sex,course of disease,region,diet,presence or absence of inducement,duration of pain,location of pain,growth and development,previous relevant medical history,allergy history and severity of secondary symptoms.2.This study suggests the syndrome characteristics of abdominal middle-cold syndrome,spleen-stomach damp-heat syndrome,liver-stomach disharmony syndrome,dampness blocking middle-jiao syndrome,milk-food stagnation syndrome,spleen-stomach deficiency-cold syndrome and stomach-yin deficiency syndrome.3.This study indicates the change rule of RAP syndrome and the evolution of heat syndrome:the syndrome of dampness blocking the middle energizer in the initial stage,the syndrome of stagnation of milk and food,the syndrome of damp-heat in spleen and stomach in the middle stage,and the syndrome of deficiency of stomach yin in the later stage.Evolution of cold syndrome:the middle-cold syndrome in abdomen starts at the beginning,and the deficiency of spleen and stomach is the main cold syndrome in the later period.4.Dampness blocking middle energizer syndrome is the most common among Hp positive children,followed by spleen and stomach damp heat syndrome,suggesting that it is related to Hp infection.Damp-heat can be generated due to the internal resistance of dampness and heat for a long time.Damp-heat blocking middle energizer syndrome can be the prophase state of spleen-stomach damp-heat syndrome,which may be the root of Hp susceptibility.