| Objective:To investigate the distribution of TCM syndrome elements and related factors in patients with temporomandibular disorder(Temporomandibular disorders,TMD).Methods:A clinical questionnaire survey was conducted on TMD patients in the Department of Rehabilitation Department of Dongzhimen Hospital of Beijing University of traditional Chinese Medicine from April 2022 to October 2022.The general information,Pain Numerical Rating Scale(Numeric Rating Scale,NRS),Generalized Anxiety Scale-7(GAD-7),Patient Health Questionnaire items-9(PHQ-9),Collection Table of Traditional Chinese Medicine(TCM)Syndrome elements of Temporomandibular Disorder were collected.The results were inputted into Excel 2019,and the weight of syndrome factor was calculated by simplified measurement method,and the weight value of syndrome factor≥14 was taken as effective factor.SPSS 25.0 and SPSS Modeler 18.0 were used for descriptive statistical analysis and correlation test.Continuous variables were expressed by mean ±standard deviation(x±s),continuous data between the two groups were expressed by t-test,and continuous data between multiple groups were analyzed by analysis of variance.The classified variables were expressed by frequency and percentage,and the chi-square test was used for comparison between groups.Nonparametric rank sum test was used to compare the rank data between groups.All tests were bilateral,P<0.05 was considered statistically significant.The correlation between clinical symptoms of TMD was analyzed,association rules of valid syndrome elements were analyzed by SPSS Modeler 18.0,cluster analysis was carried out by SPSS 25.0,and syndrome rules of TMD were summarized based on systematic clustering method-association rules-syndrome element syndrome differentiation.Results:1.General data:Among 117 patients with temporomandibular disorder,41 were male,accounting for 35.0%,and 76 females,accounting for 65.0%.The ratio of male to female was 1:1.9.In terms of the age of onset,most of the patients with temporomandibular disorder occurred in the youth group of 18-29 years old,71 cases,accounting for 60.7%,33 cases,28.2%,12 cases,10.2%,over 50 years old,1 case,0.9%.The course of the disease ranges from 3 days to 20 years,of which 75 cases are less than 1 year,accounting for 64.1%;35 cases are 1-5 years,accounting for 29.9%;and 7 cases are more than 5 years,accounting for 6.0%.There were 69 first-time patients,accounting for 59.0%,and 48 non-first-time TMD patients,accounting for 41.0%.Among the TMD patients,85.47%of the patients were accompanied with pain,x ± s was 4.19 ± 2.23,and 81 cases with limitation of mouth opening accounted for 69.23%,and the x±s of mouth opening was 32.32± 3.80mm.2.Results of syndrome element distribution:According to the simplified weight measurement method in syndrome factor differentiation,there were 4 effective syndrome elements:liver,surface,heart and uterus,and 12 disease syndrome elements:qi stagnation,cold,qi deficiency,blood deficiency,dampness,blood stasis,yang deficiency,yin deficiency,heat,phlegm,closure,yang hyperactivity.3.Syndrome combination rule:based on the systematic clustering method-association rules-syndrome element differentiation,it is concluded that the common TCM syndrome types of TMD are liver depression and qi stagnation syndrome,qi stagnation and blood stasis syndrome and surface cold syndrome.4.Results of correlation analysis:among different genders,there were 17 males(41.5%)and 41 females(53.9%)in patients without anxiety,21 males(51.2%)and 32 females(42.1%)in mild anxiety patients,and 2 males(4.9%)and 3 females(3.9%)in moderate anxiety patients.Among the patients with severe anxiety,1 was male,accounting for 2.4%,and there was no female with severe anxiety.The incidence of mild depression was 30.3%in female patients and 12.2%in male patients.Chi-square test showed that the incidence of mild depression in female patients was higher than that in male patients,and the difference was statistically significant(P=0.029).The correlation between NRS score and depression:the average PHQ-9 score of severe NRS patients was 3.38 ± 2.68,that of moderate NRS patients was 2.50 ± 2.43,that of mild NRS patients was 1.27 ± 1.49,and that of pain-free patients was 2.06 ± 2.30.There was significant difference among the four groups by analysis of variance(P<0.01).According to the PHQ-9 grade,the incidence of mild depression in severe NRS patients was 37.5%,29.0%in moderate cases,4.6%in mild cases and 17.7%in patients without pain.The incidence of mild depression was statistically significant among the four groups(P<0.05).By Fisher exact probability test,the incidence of mild depression was statistically significant among the four groups.The correlation between NRS score and anxiety:the average GAD-7 score of severe NRS patients was 6.44± 3.52,that of moderate patients was 4.21 ± 2.91,that of mild patients was 3.18 ± 2.13,and that of pain-free patients was 3.94 ± 2.14.By analysis of variance,there was significant difference among the four groups(P<0.05).According to the GAD-7 grade,the incidence of mild anxiety in severe NRS patients was 75%.The incidence of mild anxiety in moderate patients was 38.7%.The incidence of mild anxiety in mild patients was 36.4%,and that in patients without pain was 59.2%.By Fisher exact probability test,the incidence of mild anxiety was statistically significant among the four groups(P<0.05).The incidence of mouth opening limitation was 80.4%in patients with sleeping molars and 59.0%in patients without sleeping molars.Chi-square test showed that there was significant difference between the two groups(P<0.01).Conclusion:1.The incidence of temporomandibular disorder in women is higher than that in men,and the onset age of the patients is mainly between 20 and 40 years old,mainly in young and middle age.2.Patients with temporomandibular disorder with pain are related to the incidence of anxiety and depression:anxiety and depression are more likely to occur in patients with pain.3.In patients with temporomandibular disorder of different genders,the incidence of depression in females was higher than that in males.4.Sleep molars may be related to the incidence of limited mouth opening in patients with TMD.5.The main syndrome element of temporomandibular disorder is liver,which is related to uterus,surface and mind.There are 12 syndrome elements of disease,including 8 syndrome elements of solid disease:qi stagnation,cold,dampness,blood stasis,heat,phlegm,closure,hyperactivity of yang,deficiency of qi,blood deficiency,yang deficiency and yin deficiency.6.The common TCM syndromes in patients with temporomandibular disorder are liver depression and qi stagnation syndrome,qi stagnation and blood stasis syndrome and surface cold syndrome. |
