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Journal of Chinese Integrative Medicine ›› 2009, Vol. 7 ›› Issue (12): 1139-1144.doi: 10.3736/jcim20091209

• Original Clinical Research • Previous Articles     Next Articles

Clinical study of syndrome differentiation standards for chronic skin ulcer of lower limbs

Ya-jie Wang , Ha-fa Que   

  1. Institute of Chinese Traditional Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
  • Received:2009-09-16 Accepted:2009-10-30 Online:2009-12-20 Published:2009-12-15
  • Contact: Ha-fa Que E-mail:huafaque@126.com

Objective

To establish evidence and standards for syndrome differentiation of patients with chronic skin ulcer of lower limbs, which can be used to supervise and further improve the clinical treatment. The evidence and standards would also lay a foundation for the integrative evaluation system of clinical effects.
Methods

This is a prospective study of clinical case collection and analysis. The syndrome factors of chronic skin ulcer of lower limbs were collected from clinical cases, and then the essential factors of syndromes were chosen to make cluster analysis and principal component analysis. After syndrome classification, specialist consultation was performed. Forecasting syndrome models were established on the basis of the statistical analysis and the specialist consultation.
Results

The syndrome factors in 338 cases of chronic skin ulcer of lower limbs were clustered into four syndrome categories including deficiency of both qi and blood, spleen deficiency with dampness encumbrance, qi deficiency with blood stasis and blood stagnation with dampness-heat. The deficiency of both qi and blood, and qi deficiency with blood stasis were merged into qi deficiency with blood stasis by expert revision. The primary and secondary symptoms were identified by principal component analysis and average ranking determined by experts. The qi deficiency with blood stasis, spleen deficiency with dampness encumbrance, and blood stagnation with dampness-heat could reflect the clinical syndrome characteristics in patients with chronic skin ulcer of lower limbs.
Conclusion

Chronic skin ulcer of lower limbs can be differentiated in three syndrome types, and differentiation of local symptoms of the ulcer is very important in syndrome differentiation of chronic skin ulcer of lower limbs.

Key words: Skin ulcer, Lower extremity, Syndrome differentiation classification, Clinical study

Table 1

Literature distribution frequency of major syndrome factors in chronic skin ulcer of lower limbs"

Syndrome factor Frequency Syndrome factor Frequency
Pain疼痛 49.23% Tenuity of pus质地稀薄 18.46%
Foul-smelling pus脓水臭秽难闻 47.69% Dark purple ulcer疮面紫暗 18.46%
Swelling skin疮周皮肤漫肿 46.92% Dripping clear pur滋水淋漓 17.69%
Greyish white ulcer疮面灰白(苍白) 45.38% Hyperpigmentation周围皮肤色素沉着 17.69%
Flaccidity of tendons and vessels筋脉横解 44.62% Dark red skin around the ulcer疮周皮肤暗红 16.15%
Subsiding sore疮口下陷 43.85% Light red/light whitish ulcer疮面色淡红(淡白) 15.38%
Cyanosis of skin周围皮肤紫黑 39.23% Anorexia纳呆 14.62%
Dripping pur脓水淋漓 36.92% Thick fur上附脓苔 13.08%
Dull black skin疮周皮肤暗黑 36.15% White greasy fur苔白腻 13.08%
Red and swelling of the skin红肿 33.85% Bloody pus分泌物脓血水 12.31%
Red skin around the ulcer疮周皮肤焮红 33.85% Stale granulation肉芽不鲜 12.31%
High swelling of ulcer edge边缘高突如缸口 32.31% Slippery pulse脉滑数 11.54%
Swollen limb患肢肿胀 31.54% Swollen granuloma肉芽(肿胀)高突 10.77%
Itch and pain痒痛 29.23% Necrosis of fascia上覆坏死筋膜 10.77%
Yellow greasy fur苔黄腻 27.69% Bloated limb患肢浮肿 10.77%
Damp ulcer疮周湿疮 24.62% Thin whitish fur苔薄白 10.77%
Darkish red ulcer疮面暗红(色暗) 23.08% Rapid pulse脉数 10.77%
Pale tongue舌质淡 22.31% Spreading yellow pur黄水浸淫 10.00%
Spreading and putrid ulcer疮口浸淫腐溃 21.54% Slough腐肉不脱 10.00%
Rough and thick skin周围皮肤板滞木硬 20.77% Hot skin皮肤灼热 10.00%
Red tongue舌质红 20.00% Loose stool大便溏薄 10.00%
Itchy skin周围皮肤瘙痒 19.23% Deep and thready pulse脉沉细 10.00%
Greyish black pus分泌物绿色(灰黑) 18.46%

Table 2

Syndrome category results from cluster analysis, principal component analysis and expert cosulting"

Deficiency of both qi and blood Spleen deficiency with dampness encumbrance
Syndrome factor Load Weight Syndrome factor Load Weight
Few pus渗出量少 0.804 4.40 Anorexia纳呆 0.901 5.86
White fur苔白 0.798 4.25 Swollen granuloma肉芽肿胀高突 0.882 3.29
Thin fur苔薄 0.796 6.25 Distention pain胀痛 0.850 5.20
Thready pulse脉细 0.728 6.60 Slippery pulse脉滑 0.847 6.80
Light red/light whitish granuloma肉芽淡红(淡白) 0.689 2.60 Dripping clear pur滋水淋漓 0.837 3.43
Debilitation乏力懒言 0.666 4.20 Loose stool大便溏薄 0.813 5.00
Sticky pus脓水质黏 0.654 7.00 Abdominal distention腹胀 0.763 7.50
New epithelium around the ulcer疮周新生上皮 0.505 11.00 Light yellowish pus脓水淡黄 0.756 4.43
Tenuity of pus脓水稀薄 0.722 3.57
White greasy fur苔白腻 0.705 7.86
Qi deficiency with blood stasis Blood stagnation with dampness-heat
Syndrome factor Load Weight Syndrome factor Load Weight
Rough and thick skin疮周皮肤板滞木硬 0.780 4.29 Heat pain热痛 0.889 3.40
Subsiding sore疮口下陷(形如缸口) 0.718 3.33 Dry mouth口干渴 0.880 11.00
Dark purple granuloma肉芽紫暗 0.690 4.29 Warm skin and slight fever肤温微热 0.862 7.80
Greyish black pus分泌物绿黑 0.686 8.25 Rapid pulse脉数 0.849 10.33
Greyish white granuloma肉芽灰白(苍白) 0.683 2.89 Yellow greasy fur苔黄腻 0.838 6.00
High swelling of ulcer edge疮周起白色厚边 0.622 6.22 Dripping pur脓水浸淫 0.835 3.11
Dull black skin疮周暗黑 0.607 5.43 Dry stool大便干结 0.814 12.86
Stabbing pain刺痛 0.593 7.60 Foul-smelling pus脓水臭秽难闻 0.797 2.75
Swollen lower limb下肢暮肿朝消 0.589 6.14 Dark red tongue舌暗红 0.765 9.00
Clear and profuse urine小便清长 0.568 7.67 Turbid yellow urine小便黄浊 0.714 10.50
Pale tongue舌淡胖 0.543 8.75 Itch and pain痒痛 0.663 8.71
Rough and thick skin疮周皮肤粗糙增厚 0.535 7.56 Thick fur上覆脓苔 0.623 8.50
Purple tongue舌紫暗 0.500 9.00 Itchy skin疮周皮肤瘙痒 0.619 10.14
Dark red skin around the ulcer疮周暗红 0.593 9.17
Swelling skin疮周漫肿 0.546 11.67
Damp ulcer疮周湿疮 0.536 10.33
Darkish red ulcer肉芽色暗(暗红) 0.520 16.60

Table 3

Syndrome model of spleen deficiency with dampness encumbrance for chronic skin ulcer of lower limbs"

Syndrome factor Load Weight
Swollen granuloma肉芽肿胀高突 0.882 3.29
Dripping clear pur滋水淋漓 0.837 3.43
Tenuity of pus脓水稀薄 0.722 3.57
Light yellowish pus脓水淡黄 0.756 4.43
Distention pain胀痛 0.850 5.20
Sallow complexion面色萎黄 4.80
Loose stool大便溏薄 0.813 5.00
Anorexia纳呆 0.901 5.86
Lassitude肢体倦怠 6.40
Abdominal distention腹胀 0.763 7.50
Slippery pulse脉滑 0.847 6.80
White greasy fur苔白腻 0.705 7.86

Table 4

Syndrome model of qi deficiency with blood stasis for chronic skin ulcer of lower limbs"

Syndrome factor Load Weight
Greyish white ulcer肉芽灰白(苍白) 0.683 2.89
Subsiding sore疮口下陷(形如缸口) 0.718 3.33
Rough and thick skin疮周皮肤板滞木硬 0.780 4.29
Dark purple ulcer肉芽紫暗 0.690 4.29
Dull black skin疮周暗黑 0.607 5.43
High swelling of ulcer edge疮周起白色厚边 0.622 6.22
Stabbing pain疮周皮肤粗糙增厚 0.593 7.60
Debilitation刺痛 0.666 4.20
Swollen lower limb下肢暮肿朝消 0.589 6.14
Dizziness头晕眼花 6.25
Thin whitish fur苔薄白 0.798 4.25
Thready pulse脉细 0.728 6.60
Taut pulse脉弦 6.60
Pale and bulgy tongue舌淡胖 0.543 8.75
Purple tongue舌紫暗 0.500 9.00

Table 5

Syndrome model of blood stagnation with dampness-heat for chronic skin ulcer of lower limbs"

Syndrome factor Load Weight
Foul-smelling pus脓水臭秽难闻 0.797 2.75
Dripping pur脓水浸淫 0.835 3.11
Thermalgia热痛 0.889 3.40
Warm skin and slight fever肤温微热 0.862 7.80
Thick fur上覆脓苔 0.623 8.50
Itch and pain痒痛 0.663 8.71
Dark red skin around the ulcer疮周暗红 0.593 9.17
Itchy skin疮周皮肤瘙痒 0.619 10.14
Damp ulcer疮周湿疮 0.536 10.33
Swelling skin疮周漫肿 0.546 11.67
Darkish red ulcer肉芽色暗(暗红) 0.520 16.60
Turbid yellow urine小便黄浊 0.714 10.50
Dry mouth口干渴 0.880 11.00
Dry stool大便干结 0.814 12.86
Yellow greasy fur苔黄腻 0.838 6.00
Dark red tongue舌暗红 0.765 9.00
Rapid pulse脉数 0.849 10.33
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