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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
[1] Pei J, Sun LJ, Chen RX, Zhu T, Qian Y, Yuan D . The effect of electro-acupuncture on motor function recovery in patients with acute cerebral infarction: a randomly controlled trial[J]. J Tradit Chin Med, 2001,21(4):270-272
[2] Liu YZ, Yang JS, Zhang GR, Sun QL . Clinical study on acupuncture treatment of limb dyskinesia due to apoplexy[J]. Zhongguo Zhen Jiu, 1999,19(2):69-71
刘月芝, 杨甲三, 张国瑞, 孙启良 . 针刺治疗中风肢体运动功能障碍的临床研究[J]. 中国针灸, 1999,19(2):69-71
[3] Park J, White AR, James MA, Hemsley AG, Johnson P, Chambers J, Ernst E . Acupuncture for subacute stroke rehabilitation: a sham-controlled, subject- and assessor-blind, randomized trial[J]. Arch Intern Med, 2005,165(17):2026-2031
doi: 10.1001/archinte.165.17.2026
[4] Sze FK, Wong E, Or KK, Lau J, Woo J . Does acupuncture improve motor recovery after stroke? A meta-analysis of randomized controlled trials[J]. Stroke, 2002,33(11):2604-2619
doi: 10.1161/01.STR.0000035908.74261.C9
[5] Shiflett SC . Does acupuncture work for stroke rehabilitation: what do recent clinical trials really show?[J]. Top Stroke Rehabil, 2007,14(4):40-58
doi: 10.1310/tsr1404-40
[6] Liu ZD, Li HY, Song Y, Zhang BH, Guo JW, Cai YF, Huang Y, Pei J . Meta-analysis of the effects of acupuncture treatment on motor recovery for stroke patients[J]. Shanghai Zhen Jiu Za Zhi, 2008,27(11):38-42
刘志丹, 李海燕, 宋毅, 张博恒, 郭建文, 蔡业峰, 黄燕, 裴建 . 针灸治疗中风运动功能障碍随机对照临床研究文献系统评价[J]. 上海针灸杂志, 2008,27(11):38-42
[7] Duncan PW, Jorgensen HS, Wade DT . Outcome measures in acute stroke trials: a systematic review and some recommendations to improve practice[J]. Stroke, 2000,31(6):1429-1438
doi: 10.1161/01.STR.31.6.1429
[8] Bian ZX, Moher D, Li YP, Wu TX, Dagenais S, Cheng CW, Li J, Li TQ . Appropriately selecting and concisely reporting the outcome measures of randomized controlled trials of traditional Chinese medicine[J]. J Chin Integr Med, 2008,6(8):771-775
卞兆祥, Moher D, 李幼平, 吴泰相, agenais S, 郑颂华, 李静, 李廷谦 .恰当选择并清晰报告中医药临床研究的测量指标[J]. 中西医结合学报, 2008,6(8):771-775
[9] Lai SL . Key points about clinical effectiveness assess-ment of traditional Chinese medicine[J]. Guangzhou Zhong Yi Yao Da Xue Xue Bao, 2002,19(4):245-250
赖世隆 . 中医药临床疗效评价若干关键环节的思考[J]. 广州中医药大学学报, 2002,19(4):245-250
[10] You JS, Huang Y, Cai YF, Guo JW, Liang WX, Huang PX, Liu MC . Characteristics of traditional Chinese medicine syndromes in patients with acute ischemic stroke of yin or yang syndrome: a multicenter trial[J]. J Chin Integr Med, 2008,6(4):346-351
尤劲松, 黄燕, 蔡业峰, 郭建文, 梁伟雄, 黄培新, 刘茂才 . 缺血性中风急性期患者阴阳类证中医证候特点的多中心临床研究[J]. 中西医结合学报, 2008,6(4):346-351
[11] Group of Encephalopathy Emergency of State Admini-stration of Traditional Chinese Medicine. A draft for diagnosis and effect evaluation criteria of stroke[J]. Beijing Zhong Yi Yao Da Xue Xue Bao, 1996,19(1):56-57
国家中医药管理局脑病急症协作组. 中风病诊断与疗效评定标准(试行)[J]. 北京中医药大学学报, 1996,19(1):56-57
[12] Neurology Branch of Chinese Medical Association. Diagnosis of various cerebrovascular diseases[J]. Zhonghua Shen Jing Ke Za Zhi, 1996,29(6):379
中华医学会神经科学会. 各类脑血管疾病的诊断要点[J]. 中华神经科杂志, 1996,29(6):379
[13] Wang YY . Some advice about consummating the diagnosis system of traditional Chinese medicine[J]. Zhong Yi Za Zhi, 2004,45(10):729
王永炎 . 完善中医辨证方法体系的建议[J]. 中医杂志, 2004,45(10):729
[14] Gao Y . Some questions about constructing the clinical evaluation system of traditional Chinese medicine[J]. Zhongguo Zhong Yi Ji Chu Yi Xue Za Zhi, 2006,12(4):256-258
高颖 . 关于构建中医临床评价体系若干问题的思考[J]. 中国中医基础医学杂志, 2006,12(4):256-258
[15] Yang L, Huang Y, Cai YF, Du BX, Chen HX, Lu M, Huang PX . Analysis of syndrome distribution and evolution of 1 418 stroke cases with phlegm stagnation syndrome[J]. Liaoning Zhong Yi Za Zhi, 2004,31(6):460
杨利, 黄燕, 蔡业峰, 杜宝新, 陈红霞, 卢明, 黄培新 . 1 418例中风患者痰瘀证候分布和演变规律探析[J]. 辽宁中医杂志, 2004,31(6):460
[16] Wang SD, Si ZG, Huang YG, Du MH, Xie QF, Zhang XJ, Wang YX, Jia ZX, Liu ZX, Hu PL . Primary study on the syndrome of traditional Chinese medicine in stroke[J]. Zhongguo Zhong Yi Ji Zheng, 1995,4(2):85-88
王顺道, 司志国, 黄宜光, 杜梦华, 解庆凡, 张秀娟, 王一贤, 贾滋欣, 刘宗学, 胡沛林 . 中风病证候的初步研究[J]. 中国中医急症, 1995,4(2):85-88
[17] Huang Y, Guo JW, Zhang YT, Miu XL, Liu MC . Regulation evolution of the changes of traditional Chinese medicine syndrome in stroke[J]. Xin Zhong Yi, 2005,37(11):79-80
黄燕, 郭建文, 张燕婷, 缪晓路, 刘茂才 . 中风病证候动态演变规律研究[J]. 新中医, 2005,37(11):79-80
[18] Wang YY . Enhancing independence innovation ability to guide development of TCM[J]. Tianjin Zhong Yi Yao, 2006,23(3):177-181
王永炎 . 增强自主创新能力, 引领中医药事业发展[J]. 天津中医药, 2006,23(3):177-181
[19] Sun ZQ. Medical statistics[M]. Beijing: People's Medical Publishing House,2002 297-298
孙振球 . 医学统计学[M]. 北京: 人民卫生出版社,2002 297-298
[20] Chen G, Chen JW . Discriminant function for prediction and application of logistic regression analysis[J]. Shu Li Yi Yao Xue Za Zh, 2007,20(3):280-281
陈广, 陈景武 . Logistic回归分析的判别预测功能及其应用[J]. 数理医药学杂志, 2007,20(3):280-281
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