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Journal of Chinese Integrative Medicine ›› 2009, Vol. 7 ›› Issue (4): 334-341.doi: 10.3736/jcim20090407

Special Issue: Acupuncture & Moxibustion; Traditional Chinese Medicine

• Original Clinical Research • Previous Articles     Next Articles

Dynamic changes in traditional Chinese medicine syndromes in patients with ischemic stroke treated by acupuncture

Yi Songa,Jian Peia,Zhi-dan Liua,Hai-yan Lia,Ye-feng Caib,Jian-wen Guob,Yan Huanga   

  1. a Department of Acupuncture and Moxibustion, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
    b Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
  • Received:2008-10-16 Accepted:2009-02-10 Online:2009-04-20 Published:2009-04-15

Objective

To explore the dynamic state of traditional Chinese medicine (TCM) syndromes in acute ischemic stroke patients within 30 days of onset when treated with acupuncture, and to analyze the discrimination effects of the functions based on "decision trees" in identification of TCM syndromes of ischemic stroke.
Methods

A total of 264 cases with acute ischemic stroke regularly treated by acupuncture were included. Unified syndrome questionnaire was made by document retrieval and expert advice. The syndrome elements of the patients with acute ischemic stroke were surveyed on any day of three time periods (days 0-3, 4-10 and 11-30). The study was performed on multitime dynamic state results and correlated factors of basic TCM syndromes of the 264 patients. Bayes discriminant function of four syndromes of acute ischemic stroke on the basis of "decision trees" was used for computing the rate of miscarriage justice by original test and cross-validation, and the discrimination effects of "decision trees" were evaluated too.
Results

Wind, phlegm, fire-heat, qi deficiency, blood stasis, and hyperactivity of yang due to yin deficiency syndromes were found in the patients with acute ischemic stroke treated by acupuncture on the first 30 days of onset, and the incidence rates were 80.7%, 68.9%, 52.7%, 50.8%, 29.2% and 25.0% respectively. The mean scores and incidence rates of the six syndromes decreased gradually on three-time-point, especially of blood stasis syndrome. The main combined-syndromes were two-syndrome, three-syndrome and four-syndrome, and three-syndrome was the most frequently encountered type. Single syndrome was not found in the patients with acute ischemic stroke on the first three days of onset. Two-syndrome combination types were wind-phlegm, wind-heat, wind combined with qi deficiency or phlegm stagnation due to qi deficiency, phlegm-heat and blood stasis combined with hyperactivity of yang due to yin deficiency, and the incidence rates were 54.5%, 42.8%, 40.9%, 39.4%, 35.6% and 3.8% respectively. The mean scores of phlegm and qi deficiency in high-age patients were higher than those in low-age patients. The mean score and incidence rate of qi deficiency in female patients were higher than those in male patients. The mean score of phlegm in female patients was higher than that in male patients. To simplify the "decision trees" composed of 21 items, the group of Bayes discriminant function including eight most significant items out of the original 21 items was set up. The discrimination effect of the eight items including reddish face, constipation, yellow tongue fur, short breath, bright-white or gray complexion, tinnitus, feverish palms and soles and scanty tongue fur was similar to that of the 21 items, and there was no significant difference between the two functions.
Conclusion

Wind syndrome and phlegm syndrome are the major single syndromes occurring in acute ischemic stroke patients within 30 days of onset, and three-syndrome combination is the most frequent multiple syndrome type. After acupuncture treatment, some syndrome elements including wind, phlegm, fire-heat, qi deficiency, blood stasis, and hyperactivity of yang due to yin deficiency are gradually reduced, and combined syndrome type is gradually become simple. Eight syndrome element items including reddish face, constipation, yellow tongue fur, short breath, bright-white or gray complexion, tinnitus, feverish palms and soles and scanty tongue fur have important means in discriminating yin syndrome from yang syndrome and sthenia syndrome from asthenia syndrome.

Key words: Stroke, Acupuncture, Syndrome, Tendencies, Discriminant analysis

Table 1

Dynamic changes of mean scores of six syndromes in acute ischemic stroke"

Syndrome Score at different investigation time (x±s) F P
Days 0-3
(n=83)
Days 4-10
(n=86)
Days 11-30
(n=95)
Days 0-30
(n=264)
Wind 9.86±3.58 9.29±3.47 9.26±3.92 9.46±3.67 0.708 0.494
Phlegm 10.51±5.99 9.44±5.90 9.02±5.75 9.63±5.89 1.476 0.230
Fire-heat 6.86±4.51 6.76±4.36 6.28±4.23 6.62±4.35 0.444 0.642
Qi deficiency 7.83±5.06 7.05±4.95 6.85±5.34 7.22±5.12 0.884 0.414
Blood stasis 5.40±5.75 4.62±5.66 4.21±5.39 4.72±5.59 1.018 0.363
Hyperactivity of yang due to yin deficiency 4.80±3.48 4.74±3.70 4.44±3.70 4.65±3.63 0.250 0.779

Table 2

Dynamic changes of incidence probability for six syndromes in acute ischemic stroke"

Incidence at different investigation time [Cases (%)] Incidence of different investigation time [Cases (%)] χ2 P
Days 0-3
(n=83)
Days 4-10
(n=86)
Days 11-30
(n=95)
Days 0-30
(n=264)
Wind 71 (85.5) 70 (81.4) 72 (75.8) 213 (80.7) 2.745 0.253
Phlegm 62 (74.7) 57 (66.3) 63 (66.3) 182 (68.9) 1.875 0.392
Fire-heat 46 (55.4) 46 (53.5) 47 (49.5) 139 (52.7) 0.664 0.717
Qi deficiency 45 (54.2) 45 (52.3) 44 (46.3) 134 (50.8) 1.232 0.540
Blood stasis 31 (37.3) 22 (25.6) 24 (25.3) 77 (29.2) 3.926 0.140
Hyperactivity of yang due to yin deficiency 22 (26.5) 22 (25.6) 22 (23.2) 66 (25.0) 0.288 0.866

Table 3

Dynamic changes of syndrome combinations of six syndromes in acute ischemic stroke"

Syndrome combination Syndrome combination at different investigation time [Cases (%)] χ2 P
Days 0-3
(n=83)
Days 4-10
(n=86)
Days 11-30
(n=95)
Days 0-30
(n=264)
None syndrome 0 0 0 0
Single syndrome 0 6 (6.98) 10 (10.53) 16 (6.06) 8.809 0.012
Two-syndrome 18 (21.69) 18 (20.93) 25 (26.32) 61 (23.11) 0.874 0.646
Three-syndrome 31 (37.35) 33 (38.37) 34 (35.79) 98 (37.12) 2.948 0.229
Four-syndrome 22 (26.51) 24 (27.91) 20 (21.05) 66 (25.00) 5.800 0.055
Five-syndrome 12 (14.46) 5 (5.81) 6 (6.32) 23 (8.71) 5.039 0.080
Six-syndrome 0 0 0 0

Table 4

Frequencies of 21 syndrome elements in four main syndromes[Cases (%)]"

Syndrome element Frequency in yang syndrome Frequency in yin syndrome
Sthenia-fire
(n=71)
Asthenia-fire
(n =46)
Asthenia
(n =76)
Sthenia
(n=71)
X1 Red face 24 (34) 18 (39) 14 (18) 8 (11)
X2 Restlessness 23 (32) 13 (28) 14 (18) 14 (20)
X3 Dry stool 41 (58) 30 (65) 24 (32) 24 (34)
X4 Constipation 35 (49) 16 (35) 14 (18) 8 (11)
X5 Bitter taste 26 (37) 18 (39) 20 (26) 10 (14)
X6 Dry pharynx 16 (23) 19 (41) 17 (22) 4 (6)
X7 Red tongue 48 (68) 30 (65) 21 (28) 30 (42)
X8 Yellow tongue fur 41 (58) 19 (41) 9 (12) 21 (30)
X9 Taut and slippery pulse 23 (32) 11 (24) 13 (17) 10 (14)
X10 Lassitude and debilitation 33 (46) 17 (37) 53 (70) 24 (34)
X11 Angular salivation 20 (28) 11 (24) 31 (41) 8 (11)
X12 Hemianesthesia 16 (23) 9 (20) 22 (29) 19 (27)
X13 Short breath 3 (4) 1 (2) 16 (21) 0 (0)
X14 Bright-white or gray complexion 19 (27) 7 (15) 39 (51) 10 (14)
X15 Dim tongue 23 (32) 15 (33) 48 (63) 43 (61)
X16 Dizziness 23 (32) 22 (48) 26 (34) 20 (28)
X17 Tinnitus 2 (3) 17 (37) 11 (14) 10 (14)
X18 Feverish palms and soles 18 (25) 12 (26) 5 (7) 3 (4)
X19 Darkish red tongue 17 (24) 9 (20) 24 (32) 31 (44)
X20 Scanty tongue fur 11 (15) 18 (39) 8 (11) 8 (11)
X21 Small and frequent pulse or small and string pulse 15 (21) 21 (46) 15 (20) 16 (23)

Table 5

Miscarriage justice ratio of two discriminant functions[Cases (%)]"

Discriminant
function
Numbers of independent variable Miscarriage justice ratio (n =264)
Original test Cross validation
Before simplify 21 91 (34.5) 109 (41.3)
After simplify 8 105 (39.8) 114 (43.2)
χ2 1.590 0.194
P 0.207 0.660
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