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Journal of Chinese Integrative Medicine ›› 2011, Vol. 9 ›› Issue (4): 374-381.doi: 10.3736/jcim20110405

• Original Clinical Research • Previous Articles     Next Articles

Biochemical characteristics of traditional Chinese medicine syndromes and their elements in patients with hepatitis B cirrhosis

Ji-li Yuan1, Hua Zhang1, Lei Wang2, Yan Lin1, Xin-cai Hu1, Qin Zhang2, Ping Liu1,3()   

  1. 1. Institute of Liver Diseases, Shuguang Hospital, Key Laboratory of Liver and Kidney Diseases of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
    2. Department of Liver Diseases, Shanghai Public Health Center, Shanghai 201508, China
    3. E-Institute of Traditional Chinese Internal Medicine, Shanghai Municipal Education Commission, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
  • Received:2010-11-25 Accepted:2011-01-10 Online:2011-04-20 Published:2011-04-15
  • Contact: Liu Ping E-mail:liuliver@vip.sina.com

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Objective: To investigate the characteristics of traditional Chinese medicine (TCM) syndromes and their elements in patients with posthepatitic cirrhosis by analyzing the relationships between signs and symptoms and biochemical parameters.
Methods: A total of 440 patients with hepatitis B cirrhosis treated in Shanghai Public Health Center and Shuguang Hospital, Longhua Hospital and Central Hospital of Putuo District Affiliated to Shanghai University of Traditional Chinese Medicine during January 2002 to January 2006 were enrolled in this study. Signs and symptoms and biochemical information of patients were collected by using a self-designed questionnaire regarding the four examinations of TCM. Signs and symptoms were firstly analyzed to find the frequency of occurrence. Then, the patients were divided into two groups according to non-existent or existent sign and symptom and the correlations between the signs and symptoms which occurred most frequently and their biochemical parameters were analyzed.
Results: Sixteen symptoms which occurred most frequently were fatigue, colored urine, liver palms, opaque complexion, string-like pulse, weakness at waist and knees, dry month and bitter taste in the mouth, profuse dreaminess and poor sleepiness, heaviness of limbs, abdominal distention, yellow eyes, fine pulse, impetuosity and susceptibility to rage, splenomegaly, poor appetite, and distension and fullness in the chest and hypochondrium. A previous study on syndrome differentiation of 900 patients with posthepatitic cirrhosis showed 4 syndrome patterns: internal accumulation of dampness-heat, liver-kidney yin deficiency, internal accumulation of blood stasis-heat, and liver depression and spleen deficiency. Further analysis showed that internal accumulation of dampness-heat syndrome was characterized by obvious hepatic inflammation, poor synthesis function and more asctites. Liver-kidney yin deficiency syndrome was characterized by low-level hepatic inflammation, poor synthesis function and more ascites. Internal accumulation of blood stasis-heat syndrome was characterized by low-level hepatic inflammation, poorer synthesis function, ascites and splenomegalia, and liver depression and spleen deficiency syndrome was characterized by slight hepatic inflammation, synthesis function injury, decreased internal portal vein diameter and less ascites.
Conclusion: Different syndrome patterns have different pathological features, showing the complexity and polymorphism of syndrome construction.

Key words: posthepatitis cirrhosis, syndrome, pathological conditions, signs and symptoms, biological parameters, clinical trial

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Table 2

Relationships between main signs and symptoms and experimental parameters of 440 patients with posthepatitic cirrhosis (x±s)"

Sign or
symptom		 Cr
(μmol/L)		 BUN
(mmol/L)		 TAG
(mmol/L)		 TC
(mmol/L)		 ALT
(IU/L)		 AST
(IU/L)		 GGT
(IU/L)		 ALP
(IU/L)		 ChE
(kU/L)		 TBil
(μmol/L)		 ALB
(g/L)		 G
(g/L)		 ApoA
(g/L)		 PT
(s)		 AFP
(ng/mL)		 Portal vein
(mm)		 Spleen
(mm)		 Ascites
Fatigue
No 72±15 4.7±1.6 1.4±0.6 4.3±1.5 72±74 71±55 88±72 172±116 5.6±3.0 43±67 35.1±7.9 34.2±6.1 0.98±0.38 16.2±3.1 37.4±88.6 13.2±1.8 48.7±11.1 0.85±0.90
Yes 79±27 5.1±3.2 1.3±0.7 4.0±1.3 77±72 89±76 82±75 187±130 5.2±3.3 55±58 34.4±8.0 35.9±7.4 0.89±0.36 17.1±4.0 56.6±93.2 12.6±1.8 48.7±13.3 0.93±1.07
Z –1.875 –0.770 –2.094 –1.047 –1.539 –2.176 –0.926 –1.376 –1.246 –1.945 –0.894 –1.945 –2.019 –1.571 –3.295 –2.708 –0.147 –0.237
P 0.061 0.441 0.036 0.295 0.124 0.030 0.355 0.169 0.213 0.052 0.371 0.052 0.044 0.116 0.001 0.007 0.883 0.813
Yellow urine
No 76±27 5.2±2.0 1.5±0.7 4.5±1.5 73±113 66±68 71±65 149±80 5.6±2.8 30±58 38.3±7.4 34.1±7.1 1.03±0.35 14.9±2.3 32.0±53.6 12.9±1.7 45.7±12.1 0.57±0.82
Yes 78±24 5.0±3.2 1.3±0.7 3.9±1.3 97±121 109±133 93±100 203±171 5.1±3.4 66±76 33.3±7.7 36.1±7.2 0.86±0.36 17.5±4.0 60.0±101.5 12.7±1.9 49.7±13.0 1.03±1.07
Z –1.020 –2.081 –3.505 –3.975 –3.410 –5.484 –2.281 –3.406 –1.948 –8.327 –6.208 –2.791 –4.111 –6.752 –2.816 –1.133 –2.691 –3.887
P 0.308 0.037 0.000 0.000 0.001 0.000 0.023 0.001 0.051 0.000 0.000 0.005 0.000 0.000 0.005 0.257 0.007 0.000
Liver palms
No 77±24 5.0±1.8 1.4±0.7 4.3±1.5 88±119 87±93 83±84 213±241 6.1±4.8 52±67 36.0±7.5 34.7±7.8 0.96±0.38 16.0±3.4 55.1±101.0 13.0±1.4 48.5±12.9 0.68±1.01
Yes 77±25 5.1±3.2 1.3±0.7 4.0±1.3 92±120 102±129 89±96 182±111 5.0±2.5 59±76 34.0±8.1 35.9±7.0 0.89±0.35 17.1±3.9 52.2±89.8 12.7±2.0 48.8±12.9 1.00±1.03
Z –0.138 –1.053 –1.980 –2.121 –0.043 –1.359 –0.441 –0.542 –2.774 –2.087 –2.564 –1.879 –1.711 –2.771 –0.290 –1.839 –0.704 –3.151
P 0.891 0.292 0.048 0.034 0.966 0.174 0.659 0.588 0.006 0.037 0.010 0.060 0.087 0.006 0.772 0.066 0.481 0.002
Opaque complexion
No 77±22 5.1±4.1 1.5±1.0 4.2±1.4 144±164 146±184 112±117 237±172 5.8±3.2 67±83 35.1±7.7 36.1±7.5 0.90±0.33 17.6±4.5 67.1±113.0 12.7±2.0 46.4±12.9 0.73±1.09
Yes 78±26 5.0±2.1 1.3±0.5 4.0±1.3 70±89 79±78 78±80 171±144 5.1±3.3 53±69 35.3±8.1 35.4±7.1 0.91±0.38 16.6±3.5 47.4±82.8 12.7±1.8 49.7±12.8 0.99±1.00
Z –0.224 –1.230 –2.424 –1.275 –6.172 –5.741 –3.804 –6.014 –2.252 –1.982 –1.219 –0.909 –0.602 –1.742 –1.928 –0.457 –2.336 –3.167
P 0.822 0.219 0.015 0.202 0.000 0.000 0.000 0.000 0.024 0.047 0.223 0.363 0.547 0.082 0.054 0.648 0.019 0.002
Stringlike pulse
No 78±29 5.1±2.1 1.3±0.7 3.9±1.1 80±118 87±98 78±78 179±117 5.0±2.7 50±66 35.0±8.1 36.1±8.2 0.93±0.38 16.4±3.2 35.7±72.0 12.7±1.8 49.0±12.0 1.07±0.99
Yes 77±23 5.0±3.3 1.4±0.7 4.1±1.4 96±120 103±131 92±99 195±169 5.4±3.5 60±76 34.3±7.9 35.4±6.8 0.89±0.35 17.1±4.1 61.0±99.7 12.8±1.9 48.7±13.3 0.84±1.05
Z –0.242 –0.880 –2.743 –1.472 –2.098 –1.875 –2.123 –1.346 –1.302 –1.693 –1.064 –0.349 –0.721 –1.207 –2.799 –0.038 –0.360 –2.662
P 0.809 0.379 0.006 0.141 0.036 0.061 0.034 0.178 0.193 0.090 0.287 0.727 0.471 0.228 0.005 0.969 0.719 0.008
Weak at waist and knees
No 76±20 4.9±1.8 1.4±0.6 4.4±1.4 89±110 93±102 83±84 212±210 5.7±2.7 61±88 35.5±8.0 35.5±6.7 0.92±0.36 16.4±3.7 45.2±77.1 12.9±1.8 48.0±12.8 0.60±0.96
Yes 78±27 5.1±3.4 1.3±0.7 3.9±1.3 91±125 100±131 90±98 178±116 5.1±3.5 55±64 34.0±7.9 35.6±7.5 0.90±0.36 17.7±3.9 57.0±99.6 12.6±1.8 49.1±13.0 1.08±1.04
Z –0.158 –0.381 –2.810 –2.976 –0.178 –1.077 –0.850 –2.424 –3.135 –0.280 –1.796 –0.208 –0.883 –1.872 –0.149 –1.105 –0.639 –5.147
P 0.875 0.703 0.005 0.003 0.859 0.281 0.395 0.015 0.002 0.780 0.072 0.835 0.377 0.061 0.882 0.269 0.523 0.000
Dry month and bitter taste in the mouth
No 78±26 5.2±4.1 1.3±0.6 4.2±1.5 110±149 127±172 98±105 230±214 5.3±2.7 64±79 33.9±8.4 36.4±7.9 0.85±0.37 17.3±4.1 63.5±109.0 12.8±1.8 49.1±13.8 0.76±1.05
Yes 77±24 4.9±2.0 1.3±0.7 4.0±1.3 80±98 82±76 82±86 167±104 5.2±3.8 53±70 34.9±7.7 35.1±6.8 0.94±0.35 16.6±3.6 47.0±81.8 12.7±1.7 48.5±12.3 1.00±1.02
Z –0.329 –0.481 –0.394 –0.825 –2.115 –3.081 –1.514 –4.538 –0.997 –2.129 –1.554 –1.508 –2.536 –2.190 –2.003 –0.613 –1.176 –2.891
P 0.742 0.630 0.693 0.410 0.034 0.002 0.130 0.000 0.319 0.033 0.120 0.131 0.011 0.029 0.045 0.540 0.240 0.004
Profuse dreaminess and poor sleepiness
No 80±24 4.9±2.2 1.4±0.7 4.2±1.4 98±123 105±122 99±111 203±167 5.4±2.7 58±65 34.9±7.5 35.1±6.5 0.76±1.07 16.6±3.9 56.5±81.7 12.9±1.7 49.0±11.8 0.76±1.07
Yes 76±26 5.1±3.3 1.3±0.7 4.0±1.3 86±118 93±121 81±79 181±147 5.2±3.6 57±78 34.3±8.3 35.9±7.6 1.02±1.01 17.0±3.8 50.7±98.9 12.9±1.8 48.5±13.6 1.02±1.01
Z –1.594 –0.162 –1.401 –1.213 –1.785 –0.473 –1.440 –2.726 –1.354 –0.500 –1.034 –0.984 –1.773 –1.159 –2.972 –0.007 –0.372 –3.259
P 0.111
 0.871
 0.161
 0.225
 0.074
 0.636
 0.150 0.006 0.176 0.617 0.301 0.325 0.076 0.246 0.003 0.994 0.710 0.001
Heaviness of limbs
No 73±19 5.0±1.8 1.3±0.6 4.3±1.3 77±92 82±85 83±85 171±153 5.4±3.9 45±64 36.1±7.5 34.6±6.5 0.99±0.35 15.7±3.0 40.5±76.1 12.8±1.9 47.5±12.7 0.89±0.94
Yes 81±29 5.1±3.6 1.3±0.7 3.9±1.3 103±139 112±145 92±100 206±156 5.2±2.6 68±79 33.1±8.1 36.4±7.7 0.83±0.36 17.8±4.2 63.9±104.0 12.7±1.8 49.8±13.0 0.94±1.12
Z –3.330 –0.884 –0.793 –3.035 –3.370 –4.373 –1.989 –4.616 –0.400 –4.032 –4.362 –2.962 –4.934 –5.766 –3.909 –0.799 –2.086 –0.351
P 0.001 0.377 0.428 0.002 0.001 0.000 0.047 0.000 0.689 0.000 0.000 0.003 0.000 0.000 0.000 0.424 0.037 0.726
Abdominal distention
No 75±18 4.8±1.7 1.4±0.6 4.4±1.3 79±33 82±67 83±70 178±96 5.5±3.8 54±76 36.2±8.0 35.0±6.8 0.94±0.37 16.2±3.3 43.2±72.7 12.8±1.9 47.5±13.1 0.67±0.84
Yes 80±30 5.3±3.8 1.2±0.7 3.8±1.3 70±63 83±65 76±60 177±107 5.0±2.6 60±71 33.0±7.6 36.1±7.6 0.87±0.35 17.5±4.2 62.3±108.0 12.7±1.7 50.0±12.6 1.16±1.15
Z –1.300 –0.651 –3.203 –5.101 –0.138 –1.432 –0.816 –0.723 –1.542 –1.400 –4.285 –1.611 –2.185 –3.435 –0.540 –0.658 –1.714 –4.336
P 0.194 0.515 0.001 0.000 0.890 0.152 0.414 0.470 0.123 0.161 0.000 0.107 0.029 0.001 0.589 0.511 0.087 0.000
Yellow eyes
No 73±20 4.9±1.7 1.4±0.6 4.4±1.3 76±102 72±82 76±67 170±157 5.9±3.8 29±42 38.1±7.6 34.7±7.2 1.02±0.36 15.0±2.3 34.1±62.8 12.8±1.6 46.4±11.0 0.65±0.86
Yes 81±28 5.2±3.8 1.3±0.8 3.7±1.3 106±134 124±147 99±112 209±151 4.7±2.4 85±87 30.9±6.5 36.5±7.1 0.79±0.33 18.7±4.2 71.9±112.0 12.7±2.0 51.1±14.2 1.19±1.12
Z –3.009 –1.097 –3.074 –6.195 –4.105 –7.769 –2.018 –3.963 –4.818 –12.900 –9.828 –3.133 –6.760 –10.53 –4.274 –0.557 –4.477 –5.012
P 0.003 0.273 0.002 0.000 0.000 0.000 0.044 0.000 0.000 0.000 0.000 0.002 0.000 0.000 0.000 0.578 0.000 0.000
Thin pulse
No 78±23 5.0±3.4 1.4±0.8 4.1±1.4 109±134 113±144 98±101 217±178 5.5±3.9 69±83 34.0±8.0 35.5±6.9 0.86±0.36 17.3±4.2 64.5±100.0 12.7±2.0 48.8±13.7 0.86±1.08
Yes 76±27 5.1±2.2 1.2±0.5 4.1±1.3 68±95 78±80 74±81 155±112 5.0±2.3 42±56 35.2±7.9 35.6±7.6 0.96±0.36 16.2±3.2 38.4±79.8 12.7±1.7 48.6±11.8 0.99±0.97
Z –0.925 –1.289 –1.813 –0.151 –4.965 –4.116 –4.067 –6.334 –0.541 –4.715 –1.748 –0.570 –2.882 –2.200 –4.973 –0.131 –0.332 –2.221
P 0.355 0.197 0.070 0.880 0.041 0.000 0.000 0.000 0.589 0.000 0.080 0.568 0.004 0.028 0.000 0.896 0.740 0.026
Impetuosity and susceptibility to rage
No 78±24 5.1±3.2 1.4±0.7 4.1±1.5 100±129 106±110 89±90 207±146 5.5±2.8 67±88 34.1±8.0 35.3±6.7 0.87±0.38 17.1±4.1 59.3±104.4 12.8±1.9 48.5±13.5 0.75±0.99
Yes 77±26 4.9±2.0 1.3±0.7 4.0±1.2 78±105 88±134 86±97 167±164 5.0±3.8 44±46 35.1±7.8 36.0±7.8 0.95±0.33 16.5±3.5 44.5±73.7 12.7±1.7 49.0±12.0 1.14±1.05
Z –0.025 –0.291 –2.558 –0.659 –2.465 –2.406 –0.755 –4.925 –2.443 –3.565 –1.656 –0.579 –2.470 –1.406 –2.147 –0.333 0.000 –4.177
P 0.980 0.771 0.011 0.510 0.014 0.016 0.450 0.000 0.015 0.000 0.098 0.563 0.016 0.160 0.032 0.739 1.000 0.000
Splenomegaly
No 76±17 5.0±3.3 1.4±0.7 4.3±1.4 102±119 111±144 98±106 221±175 5.9±3.8 63±86 35.3±7.6 36.2±7.2 0.89±0.36 16.9±4.0 61.2±101.0 12.7±1.9 45.8±13.3 0.61±0.97
Yes 79±33 5.1±2.5 1.2±0.7 3.7±1.2 74±119 80±76 73±69 146±107 4.5±2.1 48±60 33.4±8.3 34.7±7.2 0.92±0.37 16.8±3.6 41.1±77.5 12.8±1.7 53.3±10.8 1.35±0.97
Z –1.031 –0.238 –5.863 –4.588 –4.214 –2.614 –3.617 –8.052 –4.984 –0.644 –2.739 –2.189 –0.707 –0.255 –4.553 –1.774 –5.502 –8.363
P 0.302 0.812 0.000 0.000 0.000 0.009 0.000 0.000 0.000 0.520 0.006 0.029 0.480 0.799 0.000 0.076 0.000 0.000
Poor appetite
No 75±19 5.0±1.7 1.3±0.6 4.2±1.3 74±82 79±73 81±84 177±154 5.3±3.7 45±54 35.8±8.1 35.2±7.2 0.94±0.36 16.1±3.2 35.9±54.0 12.9±1.9 48.9±11.9 0.84±0.97
Yes 81±31 5.2±4.1 1.3±0.8 3.8±1.4 114±155 124±164 97±105 207±155 5.2±2.7 75±91 32.8±7.4 36.2±7.2 0.85±0.36 17.9±4.4 77.2±125.0 12.6±1.8 48.4±14.2 1.03±1.12
Z –1.610 –1.798 –1.389 –3.866 –3.191 –4.767 –2.174 –2.944 –0.109 –4.013 –4.003 –2.003 –2.253 –4.240 –3.428 –2.008 –0.375 –1.478
P 0.107 0.072 0.165 0.000 0.001 0.000 0.030 0.003 0.913 0.000 0.000 0.045 0.024 0.000 0.001 0.045 0.708 0.139
Hypochondriac pain
No 78±27 5.0±2.1 1.3±0.6 4.1±1.4 81±105 92±117 87±95 185±166 5.0±3.3 57±77 34.7±8.1 35.2±7.1 0.94±0.35 16.7±3.8 52.4±96.4 12.9±1.8 48.5±13.4 1.01±1.04
Yes 76±18 5.1±5.0 1.5±1.0 4.0±1.3 124±159 121±134 91±86 205±107 6.2±3.0 58±99 33.7±7.5 36.9±7.4 0.78±0.37 17.4±4.0 54.7±77.0 12.2±1.9 49.5±10.9 0.58±0.95
Z –0.032 –1.523 –1.995 –0.388 –2.691 –3.258 –1.717 –2.730 –3.652 –1.665 –1.115 –2.176 –4.076 –2.036 –1.521 –3.091 –0.577 –3.992
P 0.975 0.128 0.046 0.698 0.007 0.001 0.086 0.006 0.000 0.096 0.265 0.030 0.000 0.042 0.128 0.002 0.564 0.000
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