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Journal of Chinese Integrative Medicine ›› 2010, Vol. 8 ›› Issue (4): 332-340.doi: 10.3736/jcim20100406

Special Issue: Traditional Chinese Medicine

• Original Clinical Research • Previous Articles     Next Articles

Syndrome characteristics of traditional Chinese medicine: summary of a clinical survey in 767 patients with gastric cancer

 Da-zhi Suna, Long Liub, Jian-peng Jiaoa, Pin-kang Weia, Lin-di Jiangc,Ling Xud   

  1. a Department of Traditional Chinese Medicine, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
    b School of Traditional Chinese Medicine, Second Military Medical University, Shanghai 200433, China
    c Department of Epidemiology, Zhongshan Hospital, Fudan Uniersity, Shanghai 200032, China
    d Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
  • Received:2009-08-28 Accepted:2010-02-10 Online:2010-04-20 Published:2010-04-15
  • Contact: Ling Xu E-mail:xulq67@yahoo.com.cn

Objective

The present study is a summary of syndrome types of gastric cancer in order of priority based on clinical practical situations, routine clinical syndrome differentiation and a large-sample clinical survey in 767 patients with gastric cancer.
Methods

Based on the six-type classification of gastric cancer in a previous study, a bedside syndrome differentiation diagnosis was made simultaneously by two attending doctors of traditional Chinese medicine ( TCM) to avoid possible diagnostic bias. A clinical differentiation survey form designed under the direction of epidemiologists was filled out by patients with gastric cancer in multiple centers, and the results were digitally valued and statistically analyzed.
Results

The symptoms and signs in each syndrome type of gastric cancer were ranked in order of priority as follows: distended pain, stringy pulse, eructation, mood-related pain, susceptibility to anger, acid regurgitation, hiccup, fullness sensation or distension after eating just a little, dizziness, thin pulse, abdominal enlargement, obstruction sensation after eating, moving pain, and uneven pulse in disharmony between liver and stomach; dark red tongue with little fur or a smooth surface, burning pain, rapid pulse, associated burning heat in anus, dry mouth, fissured tongue, thin pulse, tidal fever in the afternoon, nausea and vomiting, and night sweating in impairment of yin due to stomach heat; slender tongue fur, obstruction after eating, slow pulse, moderate pulse, rapid and irregular pulse, normal mood, abdominal pain, diarrhea, cold extremities, lower-extremity edema, cold intolerance, pale complexion, dizziness, emaciation, hiccup, silence, nausea, uneven pulse, acid regurgitation, fullness sensation or distension after eating just a little, vomiting, and constipation in deficiency-cold in spleen and stomach; uneven pulse, stabbing pain, tortuous sublingual vein, blue or purplish tongue, fixed pain, tarry stool or dark red stool, vomiting of dark red fluid, pale complexion, dry mouth without desire to drink, stringy pulse, white tongue fur, nausea, thin tongue fur, colic pain, hiccup, dizziness, acid regurgitation, bitter taste in mouth, slow pulse, rapid and irregular pulse, thin pulse, and pain relief by pressing in interior retention of toxin stagnation; slippery pulse, greasy and thick tongue fur, dry mouth without desire to drink, vomiting of bilious fluid, nausea, bitter taste in mouth, fullness sensation or distension after eating just a little, colic pain, and hiccup in stagnation of phlegm-dampness; abdominal pain relief by pressing, map-like tongue, thin pulse, weakness, yellowish complexion, dizziness, spontaneous sweating, fissured tongue, epigastric discomfort, night sweating, emaciation, cold intolerance, constipation, nausea, and dry tongue in deficiency of both qi and blood.
Conclusion

The summarized syndrome types of gastric cancer from this study are consistent with the clinical situations and would prove to be more referential for TCM syndrome differentiation diagnosis and treatment of gastric cancer.

Key words: Gastric cancer, Syndrome, Traditional Chinese medicine

"

Symptoms and signs Cases (%) Frequency of each syndrome type (%) χ2 P
A B C D E F
Distended pain 84 (28.6) 63.1 3.6 15.5 6 6 6 254.95 0.001
Vague pain 141 (48.0) 24.8 9.2 25.5 14.9 12.1 13.5
Stabbing pain 28 (9.5) 0 3.6 7.1 78.6 0 10.7
Dull pain 11 (3.7) 27.3 9.1 9.1 27.3 9.1 18.2
Colic pain 16 (5.4) 25 6.3 0 25 25 18.8
Burning pain 14 (4.8) 28.6 57.1 14.3 0 0 0
Hunger pain 92 (31.3) 26.1 9.8 16.3 26.1 12 9.8 13.07 0.22
Postprandial pain 52 (17.7) 46.2 9.6 21.2 13.5 3.9 5.8
Diet-related pain 150 (50.7) 34 8.7 18.7 16 9.3 13.3
Localized pain 244 (83.0) 25.8 11.1 19.3 22.1 10.7 11.1
Moving pain 50 (17.0) 72 0 14 2 2 10 44.71 0.001
Flank pain 32 (10.9) 65.6 3.1 15.6 9.4 0 6.3 262.6 0.001
Relieved at day and worsened at night 31 (10.5) 32.3 6.5 32.3 12.9 3.2 12.9
Worsened at day and relieved at night 38 (12.9) 21.1 15.8 29 15.8 10.5 7.9
Pain not related to time 225 (76.5) 36 8.4 14.7 20 9.8 11.1 14.3 0.16
Pain relief by pressing 207 (70.4) 29.9 11.3 20.6 12.3 10.8 15.2
Pain can not be relived by pressing 87 (29.6) 43.7 4.6 12.6 33.3 4.6 1.2 45.97 0.001
Mood-related pain 62 (21.0) 51.6 6.5 21 16.1 0 4.8 18.51 0.002
Pain not related to mood 232 (79.0) 28.9 9.9 17.7 19.4 11.6 12.5
Fullness sensation 346 (45.0) 37.9 8.1 29.9 11.3 11.6 11.3 53.23 0.001
Constipation 136 (17.7) 32.4 11 12.5 20.6 8.8 14.7 39.97 0.001
Diarrhea 62 (8.1) 16.1 1.6 56.5 4.8 4.8 16.1 25.59 0.001
Intestinal obstruction 43 (5.6) 23.3 7 37.2 11.6 14 7 2.98 0.703
Associated with anal burning sensation 4 (0.5) 25 50 0 25 0 0 12.99 0.023
Normal stool color 664 (86.4) 32.2 7.7 36.6 6.8 8.6 8.1 143.67 0.001
Clay colored stool 3 (0.4) 0 0 33.3 33.3 0 33.3
Tarry stool or dark red stool 102 (13.3) 18.6 3.92 7.8 43.1 7.8 18.6
Normal consistency 524 (68.1) 32.6 7.4 33 9.4 9 8.6 59.07 0.001
Dry stool or loose stool 26 (3.4) 26.9 0 42.3 15.4 7.7 7.7
Loose stool 96 (12.5) 16.7 3.1 52.1 11.5 4.2 12.5
Dry stool and difficulty in defecation 120 (15.6) 31.7 10.8 13.3 21.7 10 12.5
Diarrhea with indigested food 3 (0.4) 33.3 0 66.7 0 0 0
Stool at several-day intervals 180 (23.4) 27.2 8.3 27.8 13.3 10 13.3
Stool daily or 1 555 (72.2) 31.7 7 34.1 11.4 8.1 7.8
2 times every other day
Stool three to five times daily 31 (4.0) 22.6 3.2 38.7 9.7 6.5 19.4 16.08 0.377
Stool above five times daily 3 (0.4) 33.3 0 33.3 0 0 33.3
Morning or night diarrhea 40 (5.2) 15 2.5 67.5 0 2.5 12.5 27.1 0.001
Appetite as usual 521 (67.8) 31.1 5 36.9 11.9 7.5 7.7
Appetite less than usual 238 (31.0) 28.6 11.8 24.4 10.5 10.5 14.3 32.52 0.001
Appetite better than usual 10 (1.3) 30 10 20 30 10 0
Preference for heat and warm 424 (55.1) 32.6 5.7 33.5 10.4 9 9
Preference for cool 36 (4.7) 19.4 16.7 13.9 33.3 11.1 5.6 45.97 0.001
No special finding 309 (40.2) 28.5 8.1 34 11 7.4 11
Obstruction after eating 49 (6.4) 12.2 2 67.4 6.1 6.1 6.1 28.99 0.001
Nausea 165 (21.5) 27.9 9.7 17 17 14.6 13.9 36.54 0.001
Vomiting 89 (11.6) 25.8 13.5 13.5 18 12.4 16.9 28.36 0.001
Morning eating and evening vomiting 5 (5.6) 40 20 0 40 0 0 16.43 0.354
Evening eating and morning vomiting 1 (1.1) 100 0 0 0 0 0
Vomiting after eating 19 (21.4) 26.3 0 31.6 10.5 15.8 15.8
Vomiting not related to time 64 (71.9) 23.4 17.2 9.4 18.8 12.5 18.8
Vomit what eat 52 (58.4) 30.8 13.5 15.4 15.4 7.7 17.3 25.25 0.047
Vomiting of mucus and water 17 (19.1) 35.3 17.6 11.8 0 23.5 11.8
Vomiting of dark red fluid 16 (18.0) 6.3 0 12.5 43.8 12.5 25
Vomiting of bilious fluid 4 (4.5) 0 50 0 25 25 0
Acid regurgitation 267 (34.7) 43.5 10.5 18.4 7.9 7.5 12.4 64.33 0.001
Hiccup 393 (51.1) 40.5 5.9 27.7 8.9 6.4 10.7 45.91 0.001
Eructation 181 (23.5) 42.5 5 29.3 10.5 5.5 7.2 18.3 0.003
Normal mood 574 (74.6) 25.1 7.7 38.9 9.8 8.5 10.1 68.14 0.001
Reticent 102 (13.3) 34.3 4.9 19.6 22.6 8.8 9.8
Susceptibility to anger 93 (12.1) 58.1 6.5 9.7 11.8 7.5 6.5
Symptoms and signs Frequency of each syndrome type (%) χ2 P
Cases (%) A B C D E F
Epigastric discomfort 408 (53.1) 31.9 8.1 26 12.3 8.8 13 24.57 0.001
Spontaneous sweating 104 (13.5) 23.1 6.7 34.6 9.6 5.8 20.2 17.64 0.003
Night sweating 137 (17.8) 25.6 14.6 21.2 16.1 7.3 15.3 29.58 0.001
Tidal fever in the afternon 40 (5.2) 20 17.5 27.5 10 5 20 13.56 0.019
Cold intolerant 194 (25.2) 20.1 5.2 49 5.7 5.7 14.4 47.75 0.001
Dry mouth 287 (37.3) 26.1 15 25.8 10.8 11.5 10.8 54.63 0.001
Desire to drink 213 (74.2) 27.2 17.8 31 7.5 6.1 10.3 42.87 0.001
Not desire to drink 74 (25.8) 23 5.4 12.2 20.3 27 12.2
Bitter taste in mouth 218 (28.4) 33.5 11.5 21.6 7.3 12.8 13.3 36.74 0.001
Dizziness 258 (33.6) 23.6 8.9 37.6 8.1 5.8 15.9 33.35 0.001
Weakness 458 (76.9) 26.2 8.1 34.7 10 7 14 36.72 0.001
Emaciation 400 (52.0) 27.3 8 29.5 13.5 9.3 12.5 16.19 0.006
Abdomen enlargement 37 (4.8) 13.5 13.5 43.2 5.4 10.8 13.5 9.29 0.098
Lower extremity edema 25 (3.3) 12 8 52 16 12 0 9.07 0.107
Cold extremities 101 (13.1) 21.8 6.9 53.5 45.5 2 10.9 28.44 0.001
Normal complexion 429 (55.8) 39.4 7.5 33.3 7.9 7.7 4.2
Pale complexion 134 (17.4) 12.7 6 48.5 6 8.2 18.7
Dark complexion 91 (11.8) 27.5 7.7 19.8 31.9 9.9 3.3 147.2 0.001
Yellowish complexion 115 (15.0) 19.1 7 22.6 16.5 10.4 24.4
Good sleep 377 (49.0) 32.1 6.6 35.8 10.1 9.8 5.6 23.46 0.009
Moderate sleep 226 (29.4) 26.1 6.6 30.1 13.7 8.9 14.6
Poor sleep 166 (21.6) 31.9 9 29.5 12.7 4.8 12.1
Full tongue 715 (93.0) 31.5 7.4 32.6 11.3 8.7 8.5
Dry tongue 54 (7.0) 14.8 3.7 35.2 16.7 5.6 24.1 20.04 0.001
Fissured tongue 45 (5.9) 13.3 22.2 26.7 8.9 8.9 20 25.91 0.001
Tooth-marked tongue 61 (7.9) 24.6 3.3 42.6 11.5 13.1 4.9 7.287 0.2
Pink tongue 403 (52.4) 38.2 3.5 33 5.7 11.2 8.4
Red tongue 149 (19.4) 26.9 14.8 40.3 2.7 4.7 10.7
Whitish tongue 82 (10.7) 15.9 1.2 47.6 3.7 7.3 24.4
Bluish and purplish tongue 111 (14.4) 22.5 0.9 15.3 52.3 6.3 2.7 426.71 0.001
Dark red tongue 24 (3.1) 4.2 70.8 12.5 8.3 0 4.2
Whitish tongue fur 563 (73.2) 31.8 3.2 33.4 13.3 10 8.4 61.48 0.001
Yellowish tongue fur 20 (2.6) 15 5 70 5 5 0 13.44 0.02
Grayish black tongue fur 2 (0.26) 100 0 0 0 0 0 4.61 0.466
Thin tongue fur 437 (56.8) 35.2 3.7 32.5 14 3.7 11 59.19 0.001
Thick tongue fur 106 (13.8) 21.7 2.8 21.7 14.2 33 6.6 100.26 0.001
Moist tongue fur 135 (17.6) 36.3 2.2 38.5 9.6 3.7 9.6 14.11 0.015
Dry tongue fur 29 (3.8) 24.1 20.7 20.7 17.2 6.9 10.3 10.32 0.067
Smooth tongue fur 32 (4.2) 9.4 9.4 62.5 6.3 9.4 3.1 16.387 0.006
Old fur 7 (0.9) 57.1 0 28.6 0 0 14.3 3.8 0.578
Slender tongue 20 (2.6) 15 5 70 5 5 0 13.44 0.02
Greasy tongue fur 215 (28.0) 25.6 2.3 33 9.3 24.7 5.1 112.19 0.001
Tongue without fur 37 (4.8) 2.7 59.5 18.9 2.7 0 16.2 168.26 0.001
Map-like tongue 7 (0.9) 14.3 28.6 14.3 0 0 42.9 15.38 0.009
Normal sublingual vein 624 (81.1) 31.3 7.9 38.6 4.5 7.9 9.9
Tortuous sublingual vein 145 (18.9) 26.2 4.1 7.6 42.8 11 8.3 186.6 0.001
Stringy pulse 326 (42.4) 54.9 5.8 12.9 17.8 4 4.6 228.59 0.001
Slippery pulse 132 (17.2) 31.1 8.3 13.6 4.6 34.9 7.6 156.97 0.001
Thin pulse 338 (44.0) 19.8 11.8 39.1 6.2 5.9 17.2 103.18 0.001
Deep pulse 410 (53.3) 26.6 5.6 33.4 13.4 9.5 11.5 13.47 0.019
Rapid pulse 47 (6.1) 12.8 42.6 25.5 4.3 2.1 12.8 98.72 0.001
Slow pulse 24 (3.1) 12.5 0 66.7 12.5 0 8.3 15.18 0.01
Moderate pulse 94 (12.2) 19.2 3.2 60.6 5.3 3.2 8.5 39.45 0.001
Uneven pulse 58 (7.5) 1.7 0 15.5 81 1.7 0 293.75 0.001
Rapid and irregular pulse 0 - - - - - - -
Slow irregular pulse 1 (0.1) 0 0 100 0 0 0 2.052 0.842
Intermittent pulse 2 (0.3) 0 0 0 0 0 100 18.81 0.002

"

Group Variable Odds ratio (95% confidence interval) P value
A Distended pain 6.10 (3.51, 10.57) 0.00
Moving pain 0.14 (0.07, 0.27) 0.00
Mood-related pain 2.59 (1.46, 4.59) 0.00
Fullness sensation or fullness feeling after eating just a little 1.93 (1.42, 2.64) 0.00
Obstruction after eating 0.30 (0.13, 0.72) 0.00
Acid regurgitation 2.52 (1.84, 3.48) 0.00
Hiccup 2.77 (2.00, 3.84) 0.00
Eructation 2.05 (1.45, 2.90) 0.00
Susceptibility to anger 2.59 (1.46, 4.59) 0.00
Dizziness 0.61 (0.43, 0.86) 0.00
Abdomen enlargement 0.35 (0.13, 0.90) 0.02
Stringy pulse 8.77 (6.13, 12.56) 0.00
Thin pulse 0.39 (0.28, 0.55) 0.00
Uneven pulse 0.04 (0.00, 0.26) 0.00
B Burning pain 18.32 (5.76, 58.22) 0.00
Associated anal burning sensation 13.43 (1.86, 97.27) 0.00
Vomiting 2.42 (1.25, 4.70) 0.00
Night sweating 2.02 (1.63, 5.23) 0.00
Tidal fever in the afternoon 3.01 (1.27, 7.16) 0.01
Dry mouth 6.90 (3.57, 13.33) 0.00
Dark red tongue 45.18 (17.67, 115.53) 0.00
Fissured tongue 4.31 (2.01, 9.26) 0.00
Slippery and scanty tongue fur 31.07 (14.77, 65.33) 0.00
Thin pulse 3.72 (2.02, 6.86) 0.00
Rapid pulse 14.54 (7.44, 28.43) 0.00
C Pain 0.31 (0.22, 0.44) 0.00
Fullness sensation or fullness feeling after eating 0.33 (0.24, 0.46) 0.00
Constipation 0.24 (0.14, 0.41) 0.00
Diarrhea 2.93 (1.73, 4.96) 0.00
Obstruction sensation after eating 4.72 (2.54, 8.75) 0.00
Nausea 0.35 (0.22, 0.54) 0.00
Vomiting 0.27 (0.14, 0.75) 0.00
Acid regurgitation 0.33 (0.23, 0.47) 0.00
Hiccup 0.63 (0.46, 0.85) 0.00
Normal mood 3.64 (2.37, 5.58) 0.00
Reticent 0.46 (0.27, 0.77) 0.002
Cold intolerant 2.55 (1.83, 3.58) 0.00
Dizziness 1.38 (1.01, 1.90) 0.04
Emaciation 0.73 (0.54, 0.99) 0.04
Low extremity edema 2.29 (1.03, 5.09) 0.04
Cold extremities 2.73 (1.78, 4.17) 0.00
Pale complexion 2.26 (1.54, 3.30) 0.00
Slender tongue fur 5.01 (1.90, 13.20) 0.00
Slow pulse 4.31 (1.82, 10.22) 0.00
Moderate pulse 3.79 (2.43, 5.92) 0.00
Rapid pulse 3.79 (2.43, 5.92) 0.00
Uneven pulse 0.35 (0.17, 0.73) 0.00
D Pain 2.91 (1.85, 4.58) 0.00
Stabbing pain 25.89 (9.78, 68.53) 0.00
Colic pain 1.48 (0.46, 4.79) 0.51
Localized pain 13.93 (1.88, 103.19) 0.00
Pain relief by pressing 0.27 (0.15, 0.50) 0.00
Tarry stool or dark red stool 10.21 (6.23, 16.72) 0.00
Nausea 1.89 (1.10, 2.90) 0.02
Vomiting of dark red fluid 5.53 (1.65, 8.54) 0.00
Acid regurgitation 0.54 (0.32, 0.89) 0.02
Hiccup 0.57 (0.36, 0.89) 0.01
Dry mouth without desire to drink 3.03 (1.41, 6.48) 0.00
Bitter taste in mouth 0.51 (0.29, 0.90) 0.02
Dizziness 0.57 (0.34, 0.95) 0.03
Dim complexion 4.73 (2.83, 7.91) 0.00
Bluish and purplish tongue 21.41 (12.80, 35.82) 0.00
Group Variable Odds ratio (95% confidence interval) P value
Whitish tongue fur 1.96 (0.10, 3.49) 0.02
Thin tongue fur 1.70 (1.06, 2.70) 0.03
Tortuous sublingual vein 23.44 (13.93, 39.42) 0.00
Stringy pulse 2.78 (1.76, 4.40) 0.00
Thin pulse 0.35 (0.21, 0.58) 0.00
Moderate pulse 0.39 (0.15, 0.99) 0.04
Rapid pulse 0.39 (0.15, 0.99) 0.04
Uneven pulse 66.38 (32.14, 137.09) 0.00
E Colic pain 1.48 (0.46, 4.79) 0.50
Fullness sensation or fullness feeling after eating 1.95 (1.16, 3.28) 0.00
Nausea 2.34 (1.37, 4.00) 0.00
Vomiting of bilious fluid 2.50 (0.23, 26.4) 0.02
Hiccup 0.57 (0.34, 0.96) 0.03
Dry mouth without desire to drink 5.49 (2.57, 11.73) 0.00
Bitter taste in mouth 2.05 (1.22, 3.44) 0.00
Thick tongue fur 10.40 (6.03, 17.96) 0.00
Greasy tongue fur 14.78 (7.71, 28.33) 0.00
Slippery pulse 17.40 (9.74, 31.08) 0.00
F Abdominal pain relieved by pressing 14.61 (1.96, 108.88) 0.00
Constipation 1.85 (1.07, 3.21) 0.03
Nausea 1.76 (1.04, 2.97) 0.03
Epigastric discomfort 2.42 (1.43, 4.09) 0.00
Night sweating 1.98 (1.15, 3.40) 0.01
Spontaneous sweating 2.92 (1.68, 5.09) 0.00
Cold intolerant 1.94 (1.18, 3.20) 0.01
Dizziness 2.74 (1.68, 4.45) 0.00
Weakness 4.89 (2.47, 9.68) 0.00
Emaciation 2.05 (1.23, 3.42) 0.00
Sallow complexion 4.25 (2.53, 7.16) 0.00
Dry tongue 0.29 (0.15, 0.58) 0.00
Fissured tongue 2.53 (1.17, 5.49) 0.01
Map-like tongue 7.30 (1.60, 33.27) 0.00
Thin pulse 5.37 (3.03, 9.54) 0.00
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