Preliminary Development Of Syndrome Differentiation Scale For TCM Syndrome Elements Of Insomnia

Objective Establish the syndrome differentiation scale of TCM syndrome elements of insomnia,so as to enhance the accuracy and objectivity of syndrome differentiation,and provide a certain theoretical basis for the diagnosis of insomnia.Methods 1.Literature investigation Through the investigation of the relevant literature on the syndrome characteristics of traditional Chinese medicine of insomnia and Chinese knowledge net and Wanfang since the founding of the people’s Republic of China.The main symptoms and syndrome diagnostic elements of insomnia were statistically analyzed.Summarize and draw up the diagnostic elements of TCM syndromes of insomnia and their related symptoms.2.Development of TCM Syndrome differentiation scale for Insomnia Start with the research on the elements of syndrome diagnosis of traditional Chinese medicine.Through the establishment of a research working group,the working group determines the content and structure of the scale.On the basis of literature research,reference to relevant books,combined with clinical experience to develop a preliminary item pool.Then carry on the expert questionnaire consultation,carry on the modification,supplement and deletion to the entry.To formulate a clinical questionnaire for the diagnosis of TCM syndromes of insomnia.Clinical research was carried out in the outpatient departments of major hospitals of Zhejiang University of traditional Chinese Medicine,and the general data and TCM syndromes of 150 patients with insomnia were investigated.The items were screened by Pearson correlation analysis,the diagnostic indexes were scored by logistic regression analysis,and the diagnostic threshold was determined by ROC curve.Preliminarily develop the syndrome differentiation scale of TCM syndrome elements of insomnia.Results(Ⅰ)Literature research1.In this literature study,there are 137 syndrome types,44 syndrome types are summarized by syndrome norms,and 20 syndrome elements are extracted.2.In the statistics of syndrome types,the frequency of heart-spleen deficiency syndrome(18.35%),heart-kidney disharmony syndrome(15.29%),phlegm-heat disturbing heart syndrome(14.23%),liver depression transforming fire syndrome(11.84%)and heart-gallbladder qi deficiency syndrome(11.57%)is relatively high,which is the main syndrome type of insomnia.3.From the distribution of syndrome elements in traditional Chinese medicine,there are 8 syndrome elements,which are heart,liver,spleen,kidney,gallbladder,stomach,lung,chest and diaphragm,and 12 syndrome elements,which are heat,qi deficiency,yin deficiency,blood deficiency,qi stagnation,phlegm,blood stasis,food accumulation,dampness,yang hyperactivity,yang deficiency and dryness.4.From the form of syndrome element combination,there are four kinds of syndrome element combination in the literature:single syndrome element combination(4.39%),two syndrome element combination(15.82%),three syndrome element combination(59.84%)and four syndrome element combination(19.95%),among which the three syndrome element combination is the most and the document combination is the least.(Ⅱ)Development of TCM Syndrome differentiation scale for Insomnial.From the perspective of the positive degree of experts,the positive coefficient of experts is 100%.2.Screening of syndromes and symptoms based on expert consultation and Pearson correlation analysis:Symptoms screened by food accumulation syndrome included stomachache,stomach distension,acid swallowing and greasy fur.Symptoms screened by phlegm syndrome included excessive phlegm,nausea,chest tightness and slippery pulse.Symptoms screened by heat syndrome included irritability,dry mouth,bitter mouth,constipation and yellow moss.Symptoms screened by yin deficiency syndrome included night sweats,hot flashes,five-heart fever,tinnitus,sore waist and knees,and less moss.The symptoms screened out in qi deficiency syndrome were fatigue,spontaneous sweating,shortness of breath and good shock.The symptoms screened in blood deficiency syndrome were palpitation,numbness of limbs,dizziness,dry eyes and pale tongue;the symptoms screened out in yang deficiency syndrome were fear of cold,cold limbs,frequent nocturnal urination and sinking pulse.The symptoms screened out in qi stagnation syndrome were good breath,good worry,hypochondriac distension and string pulse.The symptoms screened out in blood stasis syndrome were tingling,purple lips,purple tongue,blood stasis spots on the tongue and thickening of sublingual collaterals.3.According to the general data of clinical research,the average age of onset of insomnia was 45.29±13.96 years old,most of them were young people.The ratio of male to female was 0.6,most of them were female.The course of disease was mainly chronic insomnia.The PSQI score was moderate,and the sleep quality was common.4.From the correlation analysis between syndrome and syndrome,food syndrome is related to qi stagnation syndrome;phlegm syndrome is related to heat syndrome.Heat syndrome is related to phlegm syndrome and yin deficiency syndrome.Yin deficiency syndrome is related to heat syndrome and blood stasis syndrome.Qi deficiency syndrome is related to blood deficiency syndrome and yang deficiency syndrome.Blood deficiency syndrome is related to qi deficiency syndrome,qi stagnation syndrome and blood stasis syndrome.Qi stagnation syndrome is related to food accumulation syndrome and yang deficiency syndrome.Blood stasis syndrome is related to yang deficiency syndrome.5.From the correlation analysis between the main symptoms and syndromes,difficulty in falling asleep is related to qi deficiency syndrome.Dreaming is related to qi stagnation syndrome.Sleepless night is related-to heat syndrome.Early awakening is related to heat syndrome and yin deficiency syndrome.Easy to wake up is related to yin deficiency syndrome and yang deficiency syndrome.6.According to logistic regression and ROC curve,the score and diagnostic threshold of syndrome elements and symptom items of insomnia were determined.The results were as follows:①Food accumulation syndrome:diagnostic threshold was 8 points,stomachache 3 points,abdominal distension 2 points,acid swallowing 2 points,greasy fur 1 points.②Phlegm syndrome:the diagnostic threshold was 10 points,sputum 4 points,nausea 2 points,chest tightness 1 points,slippery pulse 3 points.③ Heat syndrome:the diagnostic threshold was 13 points,irritability 2 points,dry mouth 3 points,bitter mouth 2 points,constipation 2 points,yellow fur 4 points.④Yin deficiency syndrome:the diagnostic threshold was 13 points,night sweats 2 points,hot flashes 3 points,five upset fever 3 points,tinnitus 2 points,waist and knee soreness 1 points,less for 2 points.⑤Qi deficiency syndrome:the diagnostic threshold was 11 points,fatigue 2 points,spontaneous sweating 3 points,shortness of breath 3 points,good shock 3 points.⑥The diagnostic threshold of blood deficiency syndrome was 9 points,palpitation 3 points,limb numbness 1 points,dizziness 2 points,dry eyes 1 points,pale tongue 2 points.⑦Yang deficiency syndrome:the diagnostic threshold was 8 points,cold fear 2 points,limb cold 2 points,nocturnal urination frequency 1 point,pulse sinking 3 points.⑧Qi stagnation syndrome:the diagnostic threshold was 9 points,3 points for benevolence,3 points for sorrow,2 points for hypochondriac distension and 1 point for chord pulse.⑨Blood stasis syndrome:the diagnostic threshold was 20 points,tingling 4 points,lip blue 1 point,blue purple tongue 6 points,blood stasis spot tongue 3 points,sublingual collaterals thickening 6 points.Conclusion First,through literature research,expert consultation and clinical investigation,nine syndrome elements and related symptom entries of food accumulation,phlegm,heat,yin deficiency,qi deficiency,blood deficiency,yang deficiency,qi stagnation and blood stasis were determined.Second,from the analysis of the correlation between syndromes and syndromes,the relationship between syndromes is not isolated,but intertwined.Third,according to the results of logistic regression and ROC curve,it shows that this method has a high level of syndrome diagnosis,and this scale has good clinical practicability.And the content of the scale is simple,the item level is clear and clear,and the investigation is convenient and easy to implement.