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Objective To explore the distribution characteristics and regularity of traditional Chinese medical (TCM) syndromes in patients with sepsis in Department of Emergency of our hospital by enalyzed their clinical data and TCM four clinical diagnostic information so as to provide the basis for TCM standardized diagnosis and treatment of sepsis. Methods From July 2016 to October 2017, 135 patients with sepsis were admitted to the Department of Emergency and Department of Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Zhejiang Chinese Medical University, 110 cases in sepsis group, 25 cases in sepsis shock group. An unified questionnaire was developed to collect the patients' general data, infection site and TCM four clinical diagnostic information (TCM syndromes, tongue coating, pulse signs, etc.) for dialectical typing on the day of admission with definite diagnosis, the relevant laboratory examinations were completed within 24 hours after the confirmative diagnosis was made, and the quick sequential organ failure assessment (qSOFA) and SOFA scores were calculated. Results In 135 cases of sepsis, pulmonary infection (51.9%) was the main one, followed by abdominal infection (25.9%). The distribution of TCM syndromes: the toxic heat syndrome was the main syndrome in sepsis group (61.8%) and acute deficiency syndrome was the main syndrome in sepsis shock group (68.0%), the difference between the two groups being statistically significant (P < 0.001). There were no statistical significant differences in comparisons of infection related indicators between sepsis and septic shock groups, different TCM syndromes of sepsis (all P > 0.05), such as white blood cell count (WBC), percentage and absolute value of neutrophils, C-reactive protein (CRP), procalcitonin (PCT). the lactic acid in patients of the acute deficiency syndrome was significantly higher than those in patients of the toxic heat syndrome, the stoppage of the qi of the bowels syndrome and blood stasis syndrome [mmol/L: 2.8 (1.5, 4.2) vs. 1.3 (1.0, 1.8), 1.6 (1.3, 3.8), 1.6 (1.2, 2.9), P < 0.001], and in septic shock group was significantly higher than that in the sepsis group [mmol/L: 4.0 (2.7, 5.7) vs. 1.4 (1.1, 1.9), P = 0.000]. The rate of qSOFA ≥ 2 score was 25.5% (28/110) in sepsis group, and 80.0% (20/25) in sepsis shock group, the difference being statistically significant (P < 0.001); while the rate of qSOFA ≥ 2 score was 69.4% (25/36) in patients of acute deficiency syndrome, 42.1% (8/19) in patients of the stoppage of the qi of the bowels syndrome, 19.1% (13/68) in patients of toxic heat syndrome and 16.7% (2/12) in patients of blood stasis syndrome, the differences also being statistically significant (all P < 0.001). The scores of SOFA in septic shock group [7.0 (5.0, 10.0)] and acute deficiency syndrome group [6.0 (4.0, 9.0)] were significantly higher compared with those in sepsis group [3.0 (2.0, 4.0)] and other syndrome types patients [toxic heat syndrome 3.0 (2.0, 4.0), the stoppage of the qi of the bowels syndrome 4.0 (2.0, 6.0) and blood stasis syndrome 4.5 (3.0, 5.0)], the differences being statistically significant (all P < 0.001). Conclusions The distribution of TCM syndromes of sepsis is related to the severity degree of sepsis, in TCM dialectical typing of sepsis, from toxic heat syndrome developing into the stoppage of the qi of the bowels syndrome, and from blood stasis syndrome to acute deficiency syndrome, the SOFA score and lactic acid level were gradually increased as the disease condition was continuously aggravating, so the SOFA score and lactic acid could be used as the reference indicators for the severity degree of sepsis; in septic patients with different TCM syndromes, the rates of qSOFA ≥ 2 were different, and the qSOFA score combined with patient's TCM syndrome can enhance the early diagnosis of sepsis.
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This study mainly explored the pulse parameters in children with RRTI with different TCM syndromes,aiming at providing therapeutic indexes and objective basis for its diagnosis and treatment.Three hundred and forty-eight cases of RRTI were divided into five groups,including the group of qi deficiency in the lung (or Fei Qi Xu,FQX),the group of invasion of the lung by wind-heat (or Feng Re Fan Fei,FRFF),the group of invasion of lung by wind-cold (or Feng Han Fan Fei,FHFF),the group of obstruction of phlegm-damp in the lung (or Tan Shi Zu Fei,TSZF) and the group of obstruction of phlegm-heat in the lung (or Tan Re Yong Fei,TRYF).65 children of good health were involved in the control group.Z-BOX pulsemeter apparatus was applied to the paraticipants for analyzing their pulse parameters.As a result,it was found that values of h1,h3,h4,h5,t and h4/h1 of RRTI children decreased,compared with the children of good health (P ＜ 0.01);while h1,h3,h4 and h5 of children in FQX group declined (P ＜ 0.01);and the values of h4,h5,t,w,h3/h1,h4/h1 and h5/h1 of children in FRFF group went down (P ＜ 0.01);while the values of h1,h3,h4,h5,t,w,h3/h1 and h4/h1 of TRYF group fell (P ＜ 0.01);and those of h5,t and h5/h1 of children in FHFF group decreased (P ＜ 0.01).Compared with FQX group,h1 value of FRFF group increased (P ＜ 0.01),while the values of w,h3/h1,hs/h1 and w/t of FRFF group declined (P ＜ 0.01);and the h1 value of TSZF group boosted (P ＜ 0.01),while the value of w and h3/h1 of TRYF group decreased (P ＜ 0.01);and the h5/h1 value of FHFF group fell (P ＜ 0.01).In comparison with FRFF group,the values of t,w and h5/h1 of TSZF group went up (P ＜ 0.01),while the values of h1 and h3 of TRYF group declined (P ＜ 0.01).In comparison with TSZF group,the values of h3,h4,t and w of TRYF group went down (P ＜ 0.01),and the t value of FHFF group decreased (P ＜ 0.01).In conclusion,the pulse parameters of RRTI children can be recognized as objective indicators for TCM syndrome differentiations.
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Objective To explore the relationship between traditional Chinese medicine(TCM) syndrome types of diabetic nephropathy(DN) patients and inflammatory factors, thus to supply evidence for syndrome differentiation, clinical treatment, illness evaluation and prognosis of DN patients. Methods The study was carried out in 120 cases of DN patients, and the patients were differentiated into TCM syndromes according to the clinical manifestations. Blood and urine samples were detected with enzyme-linked immunosorbent assay (ELISA). The correlation of syndrome types with blood and urine tumour necrosis factor-like weak inducer of apoptosis (TWEAK), interleukin-1β(IL-1β) and IL-10 was analyzed, and the detection results were compared to 30 healthy volunteers. Results (1) Compared with the healthy control, abnormal blood and urine TWEAK content and abnormal blood IL-1β were shown in DN patients at the stages of non-albuminuria, small-amount albuminuria, large-amount albuminuria, and renal insufficiency(P<0.05); blood IL-10 content was increased in DN patients without albuminuria(P<0.05).(2) DN patients with yin-deficiency and dryness-heat had higher blood and urine TWEAK contents than DN patients with other syndrome types (P<0.05). The blood TWEAK content was in decreasing sequence in the syndrome types of yin-deficiency and dryness-heat, Qi-yin deficiency, spleen-kidney Qi deficiency, yin-yang deficiency; the urine TWEAK content was in decreasing sequence in the syndrome types of yin-deficiency and dryness-heat, Qi-yin deficiency, spleen-kidney Qi deficiency, yin-yang deficiency(P<0.05). DN patients with damp-heat syndrome had the highest blood IL-1βcontent (P < 0.05), and yin-deficiency and dryness-heat had the lowest IL-1β content (P < 0.05). DN patients with yin-deficiency and dryness-heat had higher blood IL-10 content (P<0.05), and the blood IL-10 content was in decreasing sequence in the syndrome types of yin-deficiency and dryness-heat, Qi-yin deficiency, spleen-kidney Qi deficiency, yin-yang deficiency. Conclusion TCM syndrome types of DN patients are correlated with TWEAK, IL-1β and IL-10, and the results will supply evidence for syndrome differentiation, clinical treatment, illness evaluation and prognosis of DN patients .
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Objective An analysis was carried out for the reports of traditional Chinese medical syndrome patterns of psoriatic arthritis (PsA) patients in related reports issued in the recent 35 years, thus to explore the characteristics of syndrome patterns of PsA patients and to supply evidence for the syndrome classification. Methods Electronic retrieval was performed in the reports of PsA syndrome analysis issued in the Chinese medical journals from the year of 1979 to 2013. Traditional Chinese medical syndrome information of PsA patients was extracted from the reports, and then was standardized and classified. SPSS 17.0 software was applied for the analysis of occurrence frequency of syndromes, syndrome elements, tongue and pulse states. Results A total of 84 reports were obtained, and 26 reports met the inclusion criteria. In the 26 included reports, 10 kinds of tongue texture, 15 kinds of tongue fur and 22 kinds of pulse states were present. After the standardization of the syndromes, a total of 39 syndrome patterns were obtained. After combination of the similar syndromes, 14 syndromes were included into the analysis. In the 14 included syndrome patterns, the leading 5 patterns were wind-damp heat arthralgia, wind-heat with blood dryness, excessive heat toxin, wind-cold damp arthralgia, and liver-kidney deficiency. Fourteen syndrome elements were extracted from the syndromes, and 9 were included into the analysis after combination of the similar syndrome elements. The top syndrome elements were heat, phlegm-dampness, wind, dryness, deficiency, and blood stasis. Conclusion The syndrome patterns of PsA patients are various, and the syndrome elements of cold, heat, phlegm-dampness, wind, dryness, and blood stasis play an important role in the pathogenesis of PsA.
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Objective To investigate the biological characteristics of primary osteoporosis syndrome types from the perspective of mitochondrial DNA ( mtDNA) , thus to reveal the nature of osteoporosis and its traditional Chinese medical syndrome types. Methods A total of 210 osteoporosis women patients meeting the diagnostic criteria, inclusion criteria and exclusion criteria were collected from July of 2011 to October of 2013. The osteoporosis patients were differentiated into the syndrome types of yin deficiency of liver and kidney ( N=67) , yang deficiency of spleen and kidney ( N=70) and qi stagnation and blood stasis ( N=73) . And a total of 69 age-matched post-menopause non-osteoporosis patients were chosen as the control group, which were classified into the syndrome of harmony of Qi and blood. The peripheral blood was sampled for detecting mtDNA copy number with fluorescent quantitatitation PCR and for examining 8-hydroxy-2’-deoxyguanosine ( 8-OHdG) content by enzyme-linked immunosorbent assay (ELISA) . Statistical methods was used to analyze the correlation of bone mineral density (BMD) with mtDNA copy number and 8-OHdG content in different groups. Results The difference of mtDNA copy number was significant between the osteoporosis patients and non-osteoporosis patients (P<0.05), and was also significant among the three syndrome types of osteoporosis patients (P<0.05) . And 8-OHdG content showed the same features between the osteoporosis patients and non-osteoporosis patients (P<0.05) and among the three syndrome types of osteoporosis patients (P<0.05) . The correlation analysis results showed that mtDNA copy number was positively correlated with BMD, while 8-OHdG was negatively correlated with BMD in each group. Conclusion The mtDNA copy number and 8-OHdG content are correlated with the syndrome types of primary osteoporosis patients, and close correlation is shown between spleen-kidney yang deficiency and 8-OHdG, and between liver-kidney yin deficiency and mtDNA copy number.
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Objective To investigate the distribution of traditional Chinese medical syndrome patterns of dengue fever, thus to standardize its clinical diagnosis and treatment and to enhance its therapeutic effect. Methods A prospective clinical trial was carried out in 210 dengue fever patients who were admitted from July to October of 2014. The clinical data of four physical examinations were collected and analyzed for the analysis of the distribution of syndrome patterns. Results ( 1) The traditional Chinese medical syndromes of 210 dengue fever patients were characterized by fever and aversion to cold, heaviness of limbs, poor appetite, headache and heaviness of head, abdominal fullness and discomfort, yellowish urine, yellowish and greasy fur, sluggish pulse. ( 2) The syndrome patterns of dengue fever were classified into blockage of damp-heat, disease involving both defensive phase and qi phase, heat attacking qi phase, heat attacking blood phase, toxicity invading pericardium, and sudden loss of yang-qi. The incidence of six patterns was in decreasing sequencing. ( 2) The results of laboratory examination showed that the decrease of white blood cell ( WBC) , neutrophil percentage and platelet count was obvious, and the haematocrit ( PLT) became disordered. The results of recheck showed taht the increase of calcitonin and C-reactive protein were not obvious, and the damage of vital organs was less. Conclusion Dengue fever can be classified into the damp-heat pestilence in traditional Chinese medical field. The syndrome patterns of dengue fever are dominated by blockage of damp-heat, and disease involving both defensive phase and qi phase, and correspondingly, the therapeutic methods should be focused on clearing heat, resolving dampness, and strengthening spleen.
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Objective To explore the regularity of the distribution of traditional Chinese medical syndrome elements in early renal injury patients with type 2 diabetes mellitus ( T2DM) . Methods A total of 200 patients with T2DM early renal injury were enrolled into the study. Syndrome element differentiation was carried out for the analysis of the distribution of syndrome location and syndrome nature. Results ( 1) Kidney had the highest scores of syndrome location , and then came the spleen, and meridians and collaterals . The syndrome location scores of kidney, spleen, meridians and collaterals differed from those of liver, heart, lung, and stomach ( P<0.01) . ( 2) In excess syndrome elements, the percentage of syndrome elements of phlegm, blood stasis, dampness was in decreasing sequence. In deficiency syndrome elements, the percentage of syndrome elements of yin deficiency, qi deficiency, and yang deficiency was in decreasing sequence. ( 3) For the distribution of syndrome elements, kidney yin deficiency had the highest scores, next came spleen qi deficiency, and finally came blood stasis of meridians and collaterals. Conclusion In T2DM early renal injury patients, kidney, spleen, meridians and collaterals are the main affected location; yin deficiency, qi deficiency, and yang deficiency are the predominant deficiency syndrome elements, and phlegm, blood stasis, dampness are the predominant excess syndrome elements. Kidney yin deficiency, spleen qi deficiency , and blood stasis of meridians and collaterals are the commonly-seen syndrome patterns in T2DM patients with early renal injury.
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Objective To explore the correlation of modern medical examination indexes with the traditional Chinese medical syndrome types of reflux esophagitis ( RE) , thus to supply evidence for the standardization of syndrome differentiation. Methods Seventy-six RE patients who met the inclusion criteria were enrolled into the study. And then we investigated the correlation of traditional Chinese medical syndrome types with endoscopicmucosal performance grading, plasma Ghrelin content, esophageal mucosal substance P ( SP) and vasoactive intestinal peptide (VIP) . Results (1) Syndrome patterns of RE showed certain correlation with the endoscopic mucosal performance (P<0.01) . Endoscopic mucosal performance grade 0-Ⅲ corresponded to the syndromes of gallbladder heat attaching stomach, liver-stomach disharmony/phlegm-qi blocking middle energizer, hepatogastric stagnant heat, middle energizer deficiency with reversed flow of qi, respectively. ( 2) The plasma Ghrelin content of RE patients with syndrome of phlegm-qi blocking middle energizer was lower than that of the patients with other syndrome patterns, and the difference was significant compared with the syndromes of hepatogastric sta gnant heat, liver-stomach disharmony, and gallbladder heat attaching stomach ( P<0.05 or P<0.01) . ( 3 ) The expression level of SP in the esophageal mucosa was the highest in the syndrome of hepatogastric stagnant heat, and was the lowest in the syndrome of phlegm-qi blocking middle energizer; expression level of VIP in the esophageal mucosa was the highest in the syndrome of middle energizer deficiency with reversed flow of qi, and was the lowest in the syndrome of hepatogastric stagnant heat ( P<0.05 or P<0.01) . Conclusion Traditional Chinese medical syndrome types of RE have correlation with endoscopic mucosal performance and immunohistochemical detection results for gastrointestinal hormones, which will be beneficial to the estimation of the development and severity of RE.
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Objective To investigate the differential gene expression in chronic hepatitis B (CHB) patients with typical syndromes of traditional Chinese medicine ( TCM) syndromes, and to explore the relationship between TCM syndromes and gene expression. Methods Peripheral blood samples were collected from CHB patients and healthy volunteers before treatment. After total RNA of leukocytes was isolated, the gene expression profiles were detected by microarray. The expression levels of partial genes were tested by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR) . Results Microarray analysis results showed that there were significant differences of gene expression between CHB patients and healthy volunteers, and among CHB patients with the syndrome of liver-qi stagnation and spleen deficiency, syndrome of damp-heat accumulation, and syndrome of liver-kidney yin deficiency. The results of gene ontology ( GO) and signal pathway analysis between the healthy control and CHB patients with various syndromes showed that the specially-regulated genes of CHB patients with liver-qi stagnation and spleen deficiency were mainly related to cytokinetic process, those in patients with dampness-heat accumulation were mainly related to the positive regulation of lipid storage, and those of patients with liver-kidney yin deficiency were mainly related to the activities of nitric oxide synthase regulator. The real time RT-PCR for partial genes presented the similar results with those of gene microarray. Conclusion There are specific expression profiles of differential genes and significant differential genes in CHB patients with the syndrome of liver-qi stagnation and spleen deficiency, syndrome of damp-heat accumulation, and syndrome of liver-kidney yin deficiency, which may be the molecular foundation for the classification of TCM syndromes of CHB patients.
