Problems And Countermeasures Of Syndrome Differentiation Of Thromboangiitis Obliterans

Purpose:Through a comprehensive cross-comparison of multiple authoritative literatures and academic literatures on syndrome differentiation and treatment of thromboangitis obliterans(TAO),this paper reveals the complex manifestation and basic causes of TAO syndrome differentiation anomia,and puts forward the basic methods and countermeasures of syndrome differentiation and regulation of TAO.Material and method:1.Collection of TAO’s authoritative literature on TCM syndrome differentiation issued by various competent departments,including 13 literature on syndrome differentiation compiled by State Administration of Traditional Chinese Medicine,China Association of Traditional Chinese Medicine,and textbooks such as TCM Surgery and Integrated Traditional and Western Surgery.2.Using CNKI,VIP and Wanfang database to search TCM Tao clinical syndrome differentiation and treatment literatures officially published in Chinese journals from 2000 to 2020.3.To compare the differences of Tao syndrome differentiation,symptoms,symptoms under the management of disease and symptoms under the management of syndrome differentiation,among authoritative literature on Tao syndrome differentiation,clinical literature on Tao syndrome differentiation and treatment,and between two kinds of literature,so as to fully reveal the problems,causes and ideas and methods of re-regulating the anomia of this disease.Results:1.Thirteen authoritative literatures including Tao syndrome differentiation criteria were sorted out and analyzed.The number of Tao syndrome differentiation in each literature varied from 4 to 6,and the syndromes under the guidance differed from each other,which could not reflect the relative stability and inheritance of the syndrome differentiation criteria;16 syndromes such as blood stasis were found,which seriously exceeded the actual bearing range of TAO syndrome differentiation diagnosis.Specifically,the following problems were found:(1)the problems among the 16 syndromes:the same syndromes with different names(blood stasis of blood vessels and blood stasis,blood stasis of veins;Heat toxin and vein heat toxin,etc.),the intersection of various syndromes(such as blood stasis and heat and dampness-heat toxicity),upper and lower syndromes(such as blood stasis and vein stasis and heat stasis,cold and coagulating syndromes;Kidney deficiency and Kidney Qi deficiency),degree difference syndrome(heat toxicity and heat toxicity)and other mixed coexistence,lack of the basic conditions of syndrome differentiation norms and standards.2.Problems with symptoms and symptoms in authoritative literature:In a different way to investigate the blood stasis syndrome,qi deficiency and cold syndrome two 3 card(cold and dampness,haemorrheological nature and Yin),found the card belongs to too many symptoms(23 local symptoms of blood stasis syndrome),serious beyond the normal range,contains the relationship between the symptoms(intermittent claudication contains a plodder),description,overlap(such as dark red or dark purple,though The skin can be purple red,cyanosis),pitcher syndrome symptoms(such as blood stasis in the affected limb numbness for cold and dampness and other characteristics)and other problems;The problems of the symptoms and the main symptoms:in the collation of the symptoms,it is found that there is conceptual overlap and inclusion between the symptoms and the main symptoms(such problems include resting pain,intermittent claudication and purple skin in the blood stasis syndrome).3.Forty-two literatures on clinical syndrome differentiation of Tao in academic circles were collated and analyzed.TCM syndrome differentiation counted 19 syndromes,including blood stasis,Yin and cold,dampness and heat pouring,heat toxicity,deficiency of both qi and blood,deficiency and cold,etc.The number of syndromes was too many,seriously beyond the actual syndrome differentiation range of Tao;There are syndromes with different names(stasis and blood stasis,dampness-heat and dampness-heat interflow,weakness of qi and blood and deficiency of qi and blood,cold and constipation between Yang deficiency and cold,etc.),syndromes with overlapping attributes(phlegm and dampness-heat obstruction and dampness-heat stasis and dampness-heat toxicity),syndromes with upper and lower levels(such as blood stasis and blood stasis of qi deficiency,blood stasis of qi stagnation and blood stasis,cold and constipation and blood stasis;Yin deficiency and heat poison hurt Yin),degree difference syndrome(heat poison and heat poison burning),single syndrome and compound syndrome(dampness-heat and dampness-heat poison)and so on.The Tao dialectical methods in academic circles can be roughly divided into four categories.The first category fully implements the Tao dialectical standards of authoritative literature on syndrome differentiation,but the authoritative literature referenced by various parties is not the same version,with great differences.The second kind is to make different changes on the basis of dialectical authoritative literature.The syndrome of cold coagulation and blood stasis identified by Ai Mingrui et al is the combination of the syndrome of cold coagulation and blood stasis in authoritative literature.The third kind is the doctor to start a new business,each go his own way,without the sign of reference standard,it is almost according to their own experience flexible dialectical syndrome.For example,Liu Ximin et al.differentiated the syndrome of Tao into the syndrome of blood stasis,the syndrome of Yang deficiency and cold coagulation,and the syndrome of phlegm dampness blocking collaterals.The fourth one is that TCM syndrome differentiation of TAO is in accordance with the stage of the disease course of Western medicine,but the reported results are inconsistent.4.Investigate the composition of symptoms and signs of TAO high frequency syndrome(frequency higher than 5)in academia:From the systemic symptoms,local symptoms,tongue signs and pulse symptoms,seven syndromic symptoms of Tao,including blood stasis syndrome,Yin cold syndrome,dampness-heat injection syndrome,heat toxicity syndrome,qi and blood deficiency syndrome,deficiency and cold syndrome and cold and dampness syndrome,were investigated.Each card has pointed out the symptoms(signs)there are too many,such as the local symptoms of blood stasis was more than 29),expression of local symptoms non-standard problems(such as heavy,struggling more colloquial),whisht into its certificate of symptoms(local symptoms of blood stasis syndrome have limb cold,limb chills,etc.,should be haemorrheological nature of composite)blood stasis,etc.5.Study on syndrome differentiation by stages:After reviewing the academic literature on syndromes according to stages,it is found that there are too many stages,too many derivative problems,too many problems in syndromes according to stages,and a lot of many-to-many problems in derivative problems and syndromes according to stages,etc.,and the idea of unifying this way of syndrome differentiation is proposed in the discussion and conclusion.Conclusion:1.There are great differences in TCM syndrome differentiation of thromboangiitis obliterans in various authoritative literatures,leading to no unified standard for TCM syndrome differentiation of TAO.We should focus on solving the problems of syndromes with the same syndromes with different names,syndromes with overlapping attributes,syndromes with different degrees and syndromes with different degrees.To solve the above problems,the breakthrough point is to manage the symptoms of the syndrome:keep some general symptoms,and remove the included symptoms(such as retaining intermittent claudication,delete heavy walking,difficulty,etc.);Combine or summarize the overlapping symptoms(such as dark red or purple skin,purple skin can be purple,cyanosis can be combined with clinical and expert consensus to delete),delete the symptoms of the other syndrome(such as blood stasis syndrome in the affected limb numb cold can be deleted as appropriate).2.It is difficult to solve the problem of disorder in syndrome differentiation in academic circles.The problem lies in that there is no unified standard for syndrome differentiation in TCM in authoritative literatures of thromboangiitis Obliterans,and in addition,clinical doctors change the syndrome name and symptoms at will,so the tendency of syndrome differentiation has not been inherited by academic circles.Emphasis was put on analyzing the differences in the tendency of syndrome differentiation between authoritative literatures and academic circles,supporting consistent syndrome differentiation(blood stasis syndrome,deficiency of qi and blood),adopting the viewpoints of academic circles(Yin cold,dampness and heat injection,deficiency and cold,etc.),and expunging the unadopted or rarely used syndromes(kidney deficiency,kidney qi weakness,heat toxicity injuring Yin,etc.).3.Eliminate the complicated and simplify the complicated,and focus on solving the contradictions between the symptoms and the symptoms of Tao:the contradictions between the academic syndrome and the symptoms of Tao,such as the excessive number of the academic syndrome and the symptoms of the symptoms,the inconsistency of correspondence(the symptoms mixed with other syndromes,etc.),the non-standard expression,overlap,etc.The core of these problems is that the symptoms of the disease are greatly expanded in various syndromes(for example,the pain expands into sore,swelling,and prickling pain of the toe,and the rest pain expands into persistent,stationary and intense pain at night,etc.).4.In academic circles,syndrome differentiation and syndromes should be carried out in stages,with desirable ideas,but there are various kinds of syndrome differentiation.In order to standardize the syndrome differentiation of TAO,we should focus on the differentiation of local symptoms and syndromes,corresponding to the clinical stages,combined with clinical practice,and focus on the specification of syndrome name,symptom title and composition,so as to solve the anastomosis problem between the stage and the syndromes of thromboangiitis obliterans,and provide a method for standardizing the syndrome differentiation of this disease and other surgical diseases.Specific countermeasures:Yin cold,deficiency cold should be the local ischemia period,blood stasis should be the nutritional disorder period,heat toxicity and dampness-heat should be the necrosis period,Qi and blood deficiency should be the recovery period.