| ObjectsThe distribution characteristics of syndrome elements and syndromes of Amyotrpnic Lateral Sclerosis(ALS)were preliminarily explored to provide a basis for the establishment of a standardized TCM syndrome differentiation system for Amyotrpnic Sclerosis.Methods1.After literature research and expert consultation,the ALS TCM syndrome information collection table was developed by referring to the terms of Clinical Diagnosis and Treatment of Traditional Chinese Medicine and the Terms of Common Symptoms of Traditional Chinese Medicine.2.A total of 87 cases with ALS were collected from Xiyuan Hospital of Chinese Academy of Chinese Medicine,Dongfang Hospital of Beijing University of Chinese Medicine,No.1 Middle School Hospital of Baoding,The Third Hospital of Peking University,China-Japan Friendship Hospital and Peking Union Medical College Hospital.3.Excel software was used to establish database and SPSS22.0 statistical software was used for statistical analysis of data.Descriptive statistical methods were used to calculate frequency and frequency,including general information of patients,first symptoms and information of four diagnoses of TCM.Cluster analysis was used to analyze the information of the four diagnoses of TCM,and four clusters were formed.Principal component analysis was used to extract the primary and secondary symptoms of each cluster.By referring to syndrome differentiation of syndrome elements and combining expert opinions and clinical experience,the table of relationship between disease syndromes and disease location and syndrome elements was obtained.The correlation analysis method was used to analyze the correlation of all syndromes,extract the combination of evidence-based elements,and refer to the "National Standard of the People's Republic of China-Syndrome Part of TCM Clinical Diagnosis and Treatment Terms",etc.,to judge and classify all types of TCM syndromes.Correlation analysis method was used to analyze the correlation between each syndrome type and influencing factors.Results1.87 patients with ALS were more male than female,with a male to female ratio of about 2:1 and 59 males,accounting for 67.8%.There were 28 females,accounting for 32.2%,and the difference was not statistically significant.The minimum age was 36 years old,the maximum age was 82 years old,and the average age was 52±10.72 years old.The average age of the disease was 52±10.68 years for males and 52±11.21 years for females.The majority of patients were 51-60 years old and 41-50 years old,accounting for 35.6%and 25.3%,respectively,with a total of 60.9%.In terms of personal history,29 long-term smokers,accounting for 33.3%;There were 12 long-term drinkers,accounting for 13.8%.A total of 9 persons,accounting for 10.3%,had definite exposure to toxic substances.In terms of past history,40(46.0%)had been diagnosed with shoulder joint disease.A total of 37 patients(42.5%)had been diagnosed with cervical spine diseases.A total of 20 patients,accounting for 26.4%,had been diagnosed with lumbar disease.The number of patients with hypertension was 14,accounting for 16.1%.There were 12 patients with hyperlipidemia,accounting for 13.8%.There were 4 patients(4.6%)with diabetes mellitus.As for the course of disease,the longest course was 51 months and the shortest was 6 months,with an average of 20.4±4.5 months.There were 49 patients with course of disease less than 25 months,accounting for 56.3%,with short and medium course of disease more common.In terms of treatment,44(50.6%)had taken or are now taking riluzole;50 people,accounting for 57.5%,had taken or have taken Traditional Chinese medicine;Forty-three(49.4%)had received acupuncture treatment or have received acupuncture treatment.As for the first symptom,27 patients(31.1%)had unilateral upper limb weakness.Unilateral and bilateral leg weakness were followed by 15 and 13,accounting for 17.2%and 14.9%,respectively.There were 23 cases(26.4%)with neck or back weakness,indistinctness of speech,cough in drinking water and difficulty in swallowing.According to the first symptoms,36 patients,accounting for 41.4%,were found to have upper limbs.There were 28 patients with lower limb onset,accounting for 32.1%.There were 23 cases of bulbar medulla(bulbar),accounting for 26.4%.2.Extract the syndrome element combination with the highest correlation in each cluster.Cluster 1:"qi deficiency"-"spleen","wet"-"spleen";Cluster 2:"qi deficiency"-"spleen","Qi stagnation"-"liver";Cluster 3:"qi deficiency"-"spleen","qi deficiency"-"lung";Fourth cluster:"Yang deficiency"-"spleen","Yang deficiency"-"kidney".3.Referring to the "National Standard of the People's Republic of China-TCM Clinical Diagnosis and Treatment Terms syndrome Part" and combining expert opinions and clinical experience,the extracted syndromes are summarized into four types of TCM syndromes:spleen deficiency dampness accumulation type,liver and spleen stagnation heat type,spleen and lung qi deficiency type and spleen and kidney Yang deficiency type.According to the primary and secondary symptoms obtained by principal component analysis,the primary and secondary symptoms of each syndrome type are as follows:Spleen deficiency dampness accumulation type:the main symptoms are limb weakness,muscle flaccid,mental fatigue,head and body heavy,muscle stiffness,less qi and lazy words,loose stools;Second disease for muscle beating,eating less na stay,thick moss,moss white,heavy pulse.Liver and spleen depression-type:the main symptoms are limb weakness,depression,abdominal distension,phlegm yellow and sticky,dry stool,short yellow urine,moss yellow,pulse string.The second symptom is lack of clear speech,muscle beating,red tongue,moss greasy,pulse slippery.Spleen and lung qi deficiency:the main symptoms are limb weakness,muscle weakness,less qi and lazy speaking,shortness of breath,low voice,eating less sodium,stool sugar thin,spontaneous sweating,sputum white clear thin;Secondary symptoms are slow action,fatigue,speech,pale tongue,white moss white.Spleen-kidney Yang deficiency type:the main symptoms are limb weakness,muscle weakness,cold feet,stool tangxi,night urine frequency,waist and knee soft,wugeng diarrhea,tongue fat;The secondary symptoms are emaciated body,asthenia pulse,slow movement,fatigue,difficulty in swallowing,and moss slipping.4.There were 31 cases(35.6%)of spleen deficiency dampness accumulation type;A total of 22 patients(25.3%)were found to have deficiency of lung and kidney Yang.Twenty patients(23.0%)with spleen and lung qi deficiency were found.There were 14 patients with spleen deficiency and liver depression,accounting for 16.1%.5.Among the male patients,there were 18 cases(20.7%)with spleen deficiency and 19 cases(21.8%)with spleen and kidney Yang deficiency,which accounted for the highest proportion.Among the female patients,there were 13 cases of spleen-deficiency and dampness type,accounting for 14.9%,with the highest proportion.The distribution of each syndrome type in gender was not statistically significant(P>0.05).6.There were significant differences in age distribution of each syndrome type(P<0.05),31-40 years old,41-50 years old and 51-60 years old were the most in patients with spleen deficiency and dampness type.Spleen-kidney Yang deficiency was most common in patients aged 61-70 years and>70 years.There was a negative correlation between age and spleen deficiency dampness accumulation type(P<0.05).Age was positively correlated with spleen-kidney Yang deficiency(P<0.05).7.There were significant differences in the distribution of the course of each syndrome(P<0.05),and the patients with spleen deficiency and dampness accumulation at<12 months and 13-24 months were the most.The most patients were of spleen-kidney Yang deficiency at 25-36 months.>36 months spleen and lung qi deficiency was the most.The course of disease was negatively correlated with the dampness accumulation type of spleen deficiency(P<0.05).The course of disease was positively correlated with spleen-kidney Yang deficiency(P<0.05).8.In patients with upper limb onset,the occurrence frequency of spleen-kidney Yang deficiency was higher than that of other onset sites(P<0.05);In patients with medulla oblongata,the occurrence frequency of spleen-deficiency and liver-depression type was higher than that of other initial sites(P<0.05).9.The occurrence frequency of spleen-kidney Yang deficiency was higher in patients with segmental 17-24 than in patients with segmental 17-24(P<0.05).The frequency of spleen-deficiency and dampness accumulation was higher in patients with 41-48 segments than in patients with other segments(P<0.05).The dampness accumulation type of spleen deficiency was positively correlated with the functional score(P<0.05).10.According to chi-square test,the occurrence frequency of spleen-deficiency dampness accumulation type and spleen-kidney Yang deficiency type in patients with slow progression was higher than that of patients with rapid progression(P<0.01,P<0.01);The frequency of patients with rapid progression was higher than that of patients with slow progression(P<0.01,P<0.01).11.The first stage was positively correlated with the spleen deficiency dampness accumulation type(P<0.01);Stage 2 was positively correlated with spleen-lung qi deficiency and spleen-kidney Yang deficiency(P<0.05 and P<0.05).Stage 4 was positively correlated with spleen-kidney Yang deficiency(P<0.01).Conclusions1.In this study,87 patients with ALS can be classified into 4 types:spleen deficiency dampness accumulation type,spleen deficiency liver depression type,spleen and lung qi deficiency type,and spleen and kidney Yang deficiency type.Among them,the number of patients with spleen deficiency and dampness accumulation type was the largest,which was characterized by light age,short course of disease,mild degree of disease,slow progression of disease,and less loss of functional areas.The younger the patient,the more frequently this type appears.Secondly,spleen-kidney Yang deficiency type:the patient is older,the course of disease is 2-3 years,most of the upper limbs start,the degree of disease is severe,the progress of disease is slow,and the functional areas lose the most.The older the patient,the more frequently the type appears.2.In clinical syndrome differentiation,the patient's age,course of disease,onset site,degree of disease,rate of progression and loss of functional areas should be taken into account.In the treatment,we should first grasp the spleen deficiency,and when the disease is relatively mild in the initial stage,we should emphasize dampness and strengthen the spleen second.In the later stage of the disease,when the disease is more severe,tonify the Yang of the spleen and kidney. |
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