椎—基底动脉供血不足性眩晕的文献分析及临床证候研究
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摘要
“证”是对疾病某阶段机体整体反应状态所做的病理概括,包括了疾病过程中一定阶段的病位、病因、病性、病势及机体抗病能力的强弱等本质。“病”是对疾病全过程的特点与规律所做的概括。从病证结合入手更能从疾病的整个发展过程中正确把握证的本质。“证候要素”是组成证候的要素,基于证候要素的辨证方法通过对复杂证候的降维升阶,保持辨证的规范性,又给使用者以灵活性,是证候研究的重点方法。椎-基底动脉供血不足性眩晕(Vertebrobasilar Insufficient Vertigo, VBIV)是椎-基底动脉系统的缺血性脑血管病,属于临床常见病,多发病,其反复发作、缠绵难愈的特点给广大患者带来了极大痛苦,已成为临床干预的重要课题。本课题在病证结合的思想指导下,采用循证医学(Evidence-Based Medicine, EBM)的方法,从古代、现代文献研究及临床流行病学横断面调查等多个角度,结合多种统计方法,初步阐释VBIV常见表征、证候和证候要素的分布特点及规律,为建立VBIV辨证规范提供最基础的理论依据,从而对临床工作进行指导。
一、眩晕的古代文献研究
目的：对眩晕的古中医文献源流进行考证,并尝试从其中分离脑血管病性眩晕的认识,为现代病证结合模式下的VBIV辨证论治奠定基础。
方法：取《中华医典》光盘,从中以“眩”、“晕”、“旋运”、“头旋”等为关键词进行检索。通过整理相关古代文献,对眩晕相关病名、病因病机、治法及方药的演变进行总结,特别注意脑血管病相关眩晕和外因学说的的评价和认识。
结果：
1我国早期是以“眩”来代表运动幻觉,而“晕”后期取代了“眩”表示运动幻觉,“眩”变成了表示视物不清,黑朦的词语。“眩晕”病名在我国古代包括了运动幻觉、视物不清、昏沉、晕厥前兆,以及意识丧失的疾病在内。中医的“眩晕”等于西医的“头晕”。
2古代眩晕病机主要从外风、痰、火、虚演变向内风、痰、火、虚,瘀血病机出现较晚；脏腑涉及肝、脾、肾者居多,虚实夹杂,多种因素相兼致病者多,单一病因者较少。
3外感眩晕在古代地位较高,治疗中也多用疏散风邪之药物；内风病机出现之后外感眩晕地位逐渐降低,但其实只有清代明确提出了反对外风致眩的观点。
4古代医家已经对眩晕作为中风先兆的情况有一定的认识,认为其主要病机为肝风挟痰,气血亏虚,并提出了其治疗方案和诱因,其中也包含外感病因。
二、椎-基底动脉供血不足性眩晕的现代文献研究
目的：通过对现代文献中VBIV表征、证型、证素以及方剂和药物的统计分析,初步研究VBIV的中医证候分布规律以及辨证论治的特点。
方法：电子检索中文科技期刊全文数据库(VIP)、中国期刊全文数据库(CNKI);中国生物医学文献数据库(CBM),万方数据库。年限均为1994年1月-2010年12月。总结中医文献中VBIV的常见症状、证型、证素、证候、方剂和常用药物。
结果：
1表征统计：累积频率在50%以上的表征包括呕吐、恶心、失眠、耳鸣、肢体麻木、头痛、心悸、神疲乏力、头重如裹、腰膝酸软、视物旋转、胸闷、耳聋。高频舌质表征包括舌红、舌淡、舌有瘀点、舌有瘀斑、舌紫暗。舌苔以苔白腻、少苔、苔黄腻和苔白为高频表征。累积频率在50%以上的脉象有脉弦滑、脉弦细、脉滑、脉细弱、脉细涩、脉弦、脉涩。
2证型证素统计：文献中共初步统计出44种证型,实证16种,虚证11种,虚实夹杂证17种。44种证型中,累积百分比在50%以上的证型为痰浊、气血亏虚、气虚血瘀和瘀阻脑络,占总病例数的52.51%。VBIV的病位证素涉及肝、肾、心、脾、脑、络。以肾、络和脑为主。病性证素13个,其中实性病性证素7个,虚性病性证素6个,但患者数比接近2：1,实性证素为主。实性病性证素以痰、瘀血为主,虚性病理因素以气虚为主,其次为阴虚、血虚。
3方剂统计：累计频率超过50%的5方分别为半夏白术天麻汤、补阳还五汤、天麻钩藤饮、归脾汤、通窍活血汤。方剂类别上以祛痰、补益、理血剂为主。
4药物统计：VBIV的常用药物包括补益药：当归、黄芪、白术、甘草；活血化瘀药：川芎、丹参、红花；平肝熄风药：天麻；解表药：葛根；止咳化痰平喘药：半夏；利水渗湿药：茯苓；清热药：赤芍。
5结果显示大多素现代医家对VBIV的外感病因缺乏认识。
三、椎-基底动脉供血不足性眩晕急性发作期临床证候研究
目的：通过调查VBIV急性发作期的中医证候特征及规律,为本病急性发作期的辨证论治建立证候学基础。
方法：对392例VBIV急性发作期患者进行四诊信息采集,总结出VBIV急性发作期的常见症状体征、舌象、脉象。将主要表征转化为变量,采用聚类分析、因子分析方法对这些变量进行归类处理,总结VBIV急性发作期的常见证型。
结果：
1VBIV急性发作期的高频表征包括恶心、口干、神疲乏力、目不欲开、烦躁易怒、冷汗淋漓、唇色暗、口苦、健忘、项强、失眠、步履不正、肢体麻木、形体肥胖、心悸、呕吐、头重、畏寒、咽干、耳聋、便秘、懒言、腰膝酸软、胸脘痞闷、呕吐痰涎、渴欲饮热、语声低微、胸闷。高频舌质包括舌胖大、舌干、舌暗、舌淡、舌有齿痕和舌红高频舌苔包括苔腻、苔白、苔薄,高频脉象包括脉滑、脉弦、脉细。
2聚类分析归纳出的5个基本证型为：(1)痰浊上蒙证；(2)痰热内扰证；(3)气滞血瘀证；(4)脾肾阳虚,痰湿中阻证；(5)肝肾阴虚,风痰上扰证。
3因子分析归纳的5个基本证型为：(1)痰浊上蒙证；(2)肝肾阴虚证；(3)脾肾阳虚证；(4)痰热内扰证；(5)心脾两虚证。
4结果显示,VBIV急性发作期的病位在心、肝、脾、肾,虚证为主要为心脾两虚、肝肾阴虚和脾肾阳虚,而实邪有痰浊、痰热、风痰、瘀血,气滞,尤其以痰为多。聚类分析和因子分析的结果有较高的一致性。聚类分析的结果有2个虚实夹杂的证型,这与VBIV病机复杂,多为本虚标实的文献调查结果以及临床实际是相符的。
5聚类分析中出现了典型的外感风邪证候如舌淡红、脉浮、畏寒、肢体麻木等。提示我们平时考虑VBIV急性发作期病机时是否有所缺失。
结论：本研究通过对眩晕的古代文献研究,VBIV的现代文献研究,VBIV急性发作期表征、证型、证候要素的临床调查以及其间的横向及纵向比较研究,初步总结出VBIV急性发作期证候分布特点及规律,为以现代中医理论指导该病的临床治疗,尤其是急性期的临床治疗进行了初步的基础工作。但本研究样本量依然偏小,采用的统计分析方法有一定局限性,故以上结果尚待进一步验证。
Section1Review of Ancient TCM Literature about "Xuanyun"
Objective:To examine the origin and development of the disease "Xuanyun" in ancient TCM literature, and try to identify vertigo of vascular origin, so as to lay a foundation for the syndrome differentiation and treatment of vertebrobasilar insufficient vertigo under today's "syndrome-disease combination" mode.
Methods:"Xuan"," Yun","Xuanyun","Touxuan" was chosen as key words, and correlated documents in the Encyclopedia of Traditional Chinese Medicine Disc was inqueired. Development of the name, cause, pathogenesis, symptoms, syndromes and TCM treatments of "Xuanyun" in ancient China were studied, and more attention was paid to the description of probable vascular vertigo and the value of exopathy.
Results:
1"Xuanyun" TCM is equal to "dizziness", not "vertigo"
2The pathogeneses of "Xuanyun" in TCM were initially external wind, phlegm, fire and deficiency, and then changed into internal wind, phlegm, fire and deficiency. Blood stasis was not considered to be important for "Xuanyun" in early period. In TCM "Xuanyun" was related to liver, spleen and kidney, in which deficiency-excess complicated syndrome was most common, and it was mostly caused by multiple factors.
3Exogenous wind was considered an important cause of vertigo in ancient times, and Chinese herbs which could dispel wind were usually used in treatment of the disease, but after the theory of internal wind appeared, the use of these herbs became less. The theory of exogenous wind was only negated in the Qing Dynasty in TCM history.
4Doctors in ancient China had recognized that some kind of vertigo was a portent of stroke, the pathogeneses of which were liver-wind, phlegm and qi-blood asthenia. They also suggested the inducement of this included external wind.
Section2Review of Modern TCM Literature of Vertebrobasilar Insufficient Vertigo
Objective:By reviewing the syndrome, syndrome type, syndrome elements, formulae and herbs in modern TCM literature about vertebrobasilar insufficient vertigo, to do a prel iminary study of the characteristics of distribution of TCM syndromes and the law of syndrome differentiation and treatment in vertebrobasilar insufficient vertigo.
Methods:TCM journals publ ished between January1994and December2010from China Knowledge Resource Integrated Database (CNKI), Chinese Biomedical Literature Database (CBM), VIP Database of Chinese Journals, and Wanfang Database were inquired, and the common syndromes, syndrome types, syndrome elements, formulae and herbs in modern TCM literature about vertebrobasilar insufficient vertigo were studied.
Results:
1Analysis of syndromes:Symptoms and signs that had cumulative frequency above50%included vomiting, nausea, insomnia, tinnitus, numbness, headache, palpitation, fatigue, heavy-headedness, sore lumbus and knees, spinning sensation, chest tightness and hearing loss. Tongue presentations that had cumulative frequency above50%included red tongue, pale tongue, tongue with petechiae, tongue with ecchymosis, dark purple tongue, and tongue fur presentations had cumulative frequency above50%included white greasy fur, lack of fur, yellow and greasy fur and white fur. Pulse that had cumulative frequency above50%included wiry and slippery pulse, wiry and thin pulse, slippery pulse, thin and weak pulse, thin and unsmooth pulse, wiry pulse and unsmooth pulse.
2Analysis of syndrome type and syndrome elements:There were44syndrome types in all, including16excess syndrome types,11deficiency syndrome types and17deficiency-excess complicated syndrome types. Syndrome types that had cumulative frequency above50%included phlegm, qi and blood deficiency, qi deficiency with blood stasis, and blood stagnated in brain collaterals. The cumulative frequency of these syndrome types was52.51%.
The syndrome elements which described the organs related to vertebrobasi lar insufficient vertigo were liver, kidney, heart, spleen, brain and col laterals, main of which were the kidney, collaterals and brain. There were13syndrome elements described the characteristics of vertebrobasilar insufficient vertigo, seven excess and six deficiencies. The number of patients with excess syndrome elements was twice as much as that of those with deficiency syndrome elements. Main excess syndrome elements were phlegm and blood stasis, and main deficiency syndrome elements were qi deficiency, yin deficiency and blood deficiency.
3Analysis of formulae:Formulae that had cumulative frequency above50%included Banxia Baizhu Tianma Decoction, Buyang Huanwu Decoct ion, Tianma Gouteng Decoction, Guipi Decoct ion, Tongqiao Huoxue Decoction. Common formulae types were formulae that dispel phlegm, reinforce deficiency, and activate blood.
4Analysis of herbs:Chinese Angelica, Mongolian Milkvetch Root, Largehead Atractylodes Rhizome, Liquorice Root, Szechwan Lovage Rhizome, Dan-shen Root, Tall Gastrodia Rhizome, Lobed Kudzuvine Root, Ternate Pinellia, Indian Buead and Red Peony Root were most frequently used.
5The role of external wind in the acute stage of vertebrobasilar insufficient vertigo was not fully recognized by most doctors now.
Section3TCM Syndrome in the acute stage of vertebrobasilar insufficient vertigo
Objective:To investigate the TCM syndrome in the acute stage of vertebrobasilar insufficient vertigo, so as to set a syndrome foundation for the syndrome differentiation and treatment of this disease.
Methods:Information from the TCM four diagnostic methods of392patients was collected. High-frequency syndrome (including symptoms, signs, tongue and pulse) was analysed and variables was set. Cluster analysis and factor analysis were used to categorize these variables, so as to sum up the common syndrome types of vertebrobasilar insufficient vertigo.
Results:
1The syndromes with high frequency in the acute stage of vertebrobasilar insufficient vertigo were:dry mouth, fatigue, unwillingness to open eyes, irritability, cold sweat, dark purple lip, bitter taste in the mouth, forgetfulness, stiff neck, insomnia, disequilibrium, numbness, obesity, palpitations, vomiting, heavy head, fear of cold, dry pharynx, hearing loss, constipation, unwillingness to speak, sore lumbus and knees, stuffy and full sensation in the chest and abdomen, vomiting phlegm, thirsting for hot water, low voice and chest tightness. Tongue with high frequency proper of were fat tongue, dry tongue, dark tongue, pale tongue, tongue with indentation and red tongue, Tongue fur with high frequency were greasy fur, white fur and thin fur. Pulses with high frequency were slippery pulse, wiry pulse and thin pulse.
2Five main syndrome types in the acute stage of vertebrobasi lar insufficient vertigo extracted by the cluster analysis were:(1) phlegm syndrome,(2) phlegm-heat syndrome,(3) qi-stagnancy and blood stasis syndrome,(4) spleen-kidney yang deficiency together with retention of phlegmatic dampness syndrome,(5) liver-kidney yin deficiency together with wind phlegm disturbing syndrome.
3Five ma in syndrome types in the acute stage of vertebrobasi lar insufficient vert igo extracted by factor analysis were:(1) phlegm syndrome,(2) liver-kidney yin deficiency syndrome,(3) spleen-kidney yang deficiency syndrome,(4) phlegm-heat syndrome,(5) heart-spleen deficiency syndrome.
4The result showed the syndrome elements that described the organ related to vertebrobasi lar insufficient vertigo were heart, liver, spleen, and kidney.
The main deficiency syndrome elements were qi deficiency, blood deficiency, yin deficiency and yang deficiency, on the other hand, the main excess syndrome elements were phlegm, phlegm-heat, phlegm-wind, blood stasis and qi stagnation, of which phlegm was mostly seen. The result of the cluster analysis highly matched with that of the factor analysis. Two deficiency-excess complicated syndromes were found based on the result of cluster analysis. It matched with the result of literature review, which stated that vertebrobasilar insufficient vertigo had complicated pathogenesis.
5Based on the result of cluster analysis, there was a wind phlegm disturbing syndrome, in which syndromes such as pink tongue, floating pulse, chills and numbness presented the existence of exogenous wind-evil. It reminded us that we might have neglected some pathogens in the development of vertebrobasilar insufficient vertigo.
Conclusion:
The review of literature about vertebrobasilar insufficient vertigo and the clinical investigation of syndromes, syndrome types, and syndrome elements in acute stage of vertebrobasilar insufficient vertigo summarize the distribution characteristics and rules of syndrome in vertebrobasilar insufficient vertigo. A preliminary work for guiding the clinical treatment is finished. However, in this study, sample size is small, and the stat ist ical method has some limitations. A lot of information needs to be further explored, and the results above still need further verification.
一、眩晕的古代文献研究
目的：对眩晕的古中医文献源流进行考证,并尝试从其中分离脑血管病性眩晕的认识,为现代病证结合模式下的VBIV辨证论治奠定基础。
方法：取《中华医典》光盘,从中以“眩”、“晕”、“旋运”、“头旋”等为关键词进行检索。通过整理相关古代文献,对眩晕相关病名、病因病机、治法及方药的演变进行总结,特别注意脑血管病相关眩晕和外因学说的的评价和认识。
结果：
1我国早期是以“眩”来代表运动幻觉,而“晕”后期取代了“眩”表示运动幻觉,“眩”变成了表示视物不清,黑朦的词语。“眩晕”病名在我国古代包括了运动幻觉、视物不清、昏沉、晕厥前兆,以及意识丧失的疾病在内。中医的“眩晕”等于西医的“头晕”。
2古代眩晕病机主要从外风、痰、火、虚演变向内风、痰、火、虚,瘀血病机出现较晚；脏腑涉及肝、脾、肾者居多,虚实夹杂,多种因素相兼致病者多,单一病因者较少。
3外感眩晕在古代地位较高,治疗中也多用疏散风邪之药物；内风病机出现之后外感眩晕地位逐渐降低,但其实只有清代明确提出了反对外风致眩的观点。
4古代医家已经对眩晕作为中风先兆的情况有一定的认识,认为其主要病机为肝风挟痰,气血亏虚,并提出了其治疗方案和诱因,其中也包含外感病因。
二、椎-基底动脉供血不足性眩晕的现代文献研究
目的：通过对现代文献中VBIV表征、证型、证素以及方剂和药物的统计分析,初步研究VBIV的中医证候分布规律以及辨证论治的特点。
方法：电子检索中文科技期刊全文数据库(VIP)、中国期刊全文数据库(CNKI);中国生物医学文献数据库(CBM),万方数据库。年限均为1994年1月-2010年12月。总结中医文献中VBIV的常见症状、证型、证素、证候、方剂和常用药物。
结果：
1表征统计：累积频率在50%以上的表征包括呕吐、恶心、失眠、耳鸣、肢体麻木、头痛、心悸、神疲乏力、头重如裹、腰膝酸软、视物旋转、胸闷、耳聋。高频舌质表征包括舌红、舌淡、舌有瘀点、舌有瘀斑、舌紫暗。舌苔以苔白腻、少苔、苔黄腻和苔白为高频表征。累积频率在50%以上的脉象有脉弦滑、脉弦细、脉滑、脉细弱、脉细涩、脉弦、脉涩。
2证型证素统计：文献中共初步统计出44种证型,实证16种,虚证11种,虚实夹杂证17种。44种证型中,累积百分比在50%以上的证型为痰浊、气血亏虚、气虚血瘀和瘀阻脑络,占总病例数的52.51%。VBIV的病位证素涉及肝、肾、心、脾、脑、络。以肾、络和脑为主。病性证素13个,其中实性病性证素7个,虚性病性证素6个,但患者数比接近2：1,实性证素为主。实性病性证素以痰、瘀血为主,虚性病理因素以气虚为主,其次为阴虚、血虚。
3方剂统计：累计频率超过50%的5方分别为半夏白术天麻汤、补阳还五汤、天麻钩藤饮、归脾汤、通窍活血汤。方剂类别上以祛痰、补益、理血剂为主。
4药物统计：VBIV的常用药物包括补益药：当归、黄芪、白术、甘草；活血化瘀药：川芎、丹参、红花；平肝熄风药：天麻；解表药：葛根；止咳化痰平喘药：半夏；利水渗湿药：茯苓；清热药：赤芍。
5结果显示大多素现代医家对VBIV的外感病因缺乏认识。
三、椎-基底动脉供血不足性眩晕急性发作期临床证候研究
目的：通过调查VBIV急性发作期的中医证候特征及规律,为本病急性发作期的辨证论治建立证候学基础。
方法：对392例VBIV急性发作期患者进行四诊信息采集,总结出VBIV急性发作期的常见症状体征、舌象、脉象。将主要表征转化为变量,采用聚类分析、因子分析方法对这些变量进行归类处理,总结VBIV急性发作期的常见证型。
结果：
1VBIV急性发作期的高频表征包括恶心、口干、神疲乏力、目不欲开、烦躁易怒、冷汗淋漓、唇色暗、口苦、健忘、项强、失眠、步履不正、肢体麻木、形体肥胖、心悸、呕吐、头重、畏寒、咽干、耳聋、便秘、懒言、腰膝酸软、胸脘痞闷、呕吐痰涎、渴欲饮热、语声低微、胸闷。高频舌质包括舌胖大、舌干、舌暗、舌淡、舌有齿痕和舌红高频舌苔包括苔腻、苔白、苔薄,高频脉象包括脉滑、脉弦、脉细。
2聚类分析归纳出的5个基本证型为：(1)痰浊上蒙证；(2)痰热内扰证；(3)气滞血瘀证；(4)脾肾阳虚,痰湿中阻证；(5)肝肾阴虚,风痰上扰证。
3因子分析归纳的5个基本证型为：(1)痰浊上蒙证；(2)肝肾阴虚证；(3)脾肾阳虚证；(4)痰热内扰证；(5)心脾两虚证。
4结果显示,VBIV急性发作期的病位在心、肝、脾、肾,虚证为主要为心脾两虚、肝肾阴虚和脾肾阳虚,而实邪有痰浊、痰热、风痰、瘀血,气滞,尤其以痰为多。聚类分析和因子分析的结果有较高的一致性。聚类分析的结果有2个虚实夹杂的证型,这与VBIV病机复杂,多为本虚标实的文献调查结果以及临床实际是相符的。
5聚类分析中出现了典型的外感风邪证候如舌淡红、脉浮、畏寒、肢体麻木等。提示我们平时考虑VBIV急性发作期病机时是否有所缺失。
结论：本研究通过对眩晕的古代文献研究,VBIV的现代文献研究,VBIV急性发作期表征、证型、证候要素的临床调查以及其间的横向及纵向比较研究,初步总结出VBIV急性发作期证候分布特点及规律,为以现代中医理论指导该病的临床治疗,尤其是急性期的临床治疗进行了初步的基础工作。但本研究样本量依然偏小,采用的统计分析方法有一定局限性,故以上结果尚待进一步验证。
Section1Review of Ancient TCM Literature about "Xuanyun"
Objective:To examine the origin and development of the disease "Xuanyun" in ancient TCM literature, and try to identify vertigo of vascular origin, so as to lay a foundation for the syndrome differentiation and treatment of vertebrobasilar insufficient vertigo under today's "syndrome-disease combination" mode.
Methods:"Xuan"," Yun","Xuanyun","Touxuan" was chosen as key words, and correlated documents in the Encyclopedia of Traditional Chinese Medicine Disc was inqueired. Development of the name, cause, pathogenesis, symptoms, syndromes and TCM treatments of "Xuanyun" in ancient China were studied, and more attention was paid to the description of probable vascular vertigo and the value of exopathy.
Results:
1"Xuanyun" TCM is equal to "dizziness", not "vertigo"
2The pathogeneses of "Xuanyun" in TCM were initially external wind, phlegm, fire and deficiency, and then changed into internal wind, phlegm, fire and deficiency. Blood stasis was not considered to be important for "Xuanyun" in early period. In TCM "Xuanyun" was related to liver, spleen and kidney, in which deficiency-excess complicated syndrome was most common, and it was mostly caused by multiple factors.
3Exogenous wind was considered an important cause of vertigo in ancient times, and Chinese herbs which could dispel wind were usually used in treatment of the disease, but after the theory of internal wind appeared, the use of these herbs became less. The theory of exogenous wind was only negated in the Qing Dynasty in TCM history.
4Doctors in ancient China had recognized that some kind of vertigo was a portent of stroke, the pathogeneses of which were liver-wind, phlegm and qi-blood asthenia. They also suggested the inducement of this included external wind.
Section2Review of Modern TCM Literature of Vertebrobasilar Insufficient Vertigo
Objective:By reviewing the syndrome, syndrome type, syndrome elements, formulae and herbs in modern TCM literature about vertebrobasilar insufficient vertigo, to do a prel iminary study of the characteristics of distribution of TCM syndromes and the law of syndrome differentiation and treatment in vertebrobasilar insufficient vertigo.
Methods:TCM journals publ ished between January1994and December2010from China Knowledge Resource Integrated Database (CNKI), Chinese Biomedical Literature Database (CBM), VIP Database of Chinese Journals, and Wanfang Database were inquired, and the common syndromes, syndrome types, syndrome elements, formulae and herbs in modern TCM literature about vertebrobasilar insufficient vertigo were studied.
Results:
1Analysis of syndromes:Symptoms and signs that had cumulative frequency above50%included vomiting, nausea, insomnia, tinnitus, numbness, headache, palpitation, fatigue, heavy-headedness, sore lumbus and knees, spinning sensation, chest tightness and hearing loss. Tongue presentations that had cumulative frequency above50%included red tongue, pale tongue, tongue with petechiae, tongue with ecchymosis, dark purple tongue, and tongue fur presentations had cumulative frequency above50%included white greasy fur, lack of fur, yellow and greasy fur and white fur. Pulse that had cumulative frequency above50%included wiry and slippery pulse, wiry and thin pulse, slippery pulse, thin and weak pulse, thin and unsmooth pulse, wiry pulse and unsmooth pulse.
2Analysis of syndrome type and syndrome elements:There were44syndrome types in all, including16excess syndrome types,11deficiency syndrome types and17deficiency-excess complicated syndrome types. Syndrome types that had cumulative frequency above50%included phlegm, qi and blood deficiency, qi deficiency with blood stasis, and blood stagnated in brain collaterals. The cumulative frequency of these syndrome types was52.51%.
The syndrome elements which described the organs related to vertebrobasi lar insufficient vertigo were liver, kidney, heart, spleen, brain and col laterals, main of which were the kidney, collaterals and brain. There were13syndrome elements described the characteristics of vertebrobasilar insufficient vertigo, seven excess and six deficiencies. The number of patients with excess syndrome elements was twice as much as that of those with deficiency syndrome elements. Main excess syndrome elements were phlegm and blood stasis, and main deficiency syndrome elements were qi deficiency, yin deficiency and blood deficiency.
3Analysis of formulae:Formulae that had cumulative frequency above50%included Banxia Baizhu Tianma Decoction, Buyang Huanwu Decoct ion, Tianma Gouteng Decoction, Guipi Decoct ion, Tongqiao Huoxue Decoction. Common formulae types were formulae that dispel phlegm, reinforce deficiency, and activate blood.
4Analysis of herbs:Chinese Angelica, Mongolian Milkvetch Root, Largehead Atractylodes Rhizome, Liquorice Root, Szechwan Lovage Rhizome, Dan-shen Root, Tall Gastrodia Rhizome, Lobed Kudzuvine Root, Ternate Pinellia, Indian Buead and Red Peony Root were most frequently used.
5The role of external wind in the acute stage of vertebrobasilar insufficient vertigo was not fully recognized by most doctors now.
Section3TCM Syndrome in the acute stage of vertebrobasilar insufficient vertigo
Objective:To investigate the TCM syndrome in the acute stage of vertebrobasilar insufficient vertigo, so as to set a syndrome foundation for the syndrome differentiation and treatment of this disease.
Methods:Information from the TCM four diagnostic methods of392patients was collected. High-frequency syndrome (including symptoms, signs, tongue and pulse) was analysed and variables was set. Cluster analysis and factor analysis were used to categorize these variables, so as to sum up the common syndrome types of vertebrobasilar insufficient vertigo.
Results:
1The syndromes with high frequency in the acute stage of vertebrobasilar insufficient vertigo were:dry mouth, fatigue, unwillingness to open eyes, irritability, cold sweat, dark purple lip, bitter taste in the mouth, forgetfulness, stiff neck, insomnia, disequilibrium, numbness, obesity, palpitations, vomiting, heavy head, fear of cold, dry pharynx, hearing loss, constipation, unwillingness to speak, sore lumbus and knees, stuffy and full sensation in the chest and abdomen, vomiting phlegm, thirsting for hot water, low voice and chest tightness. Tongue with high frequency proper of were fat tongue, dry tongue, dark tongue, pale tongue, tongue with indentation and red tongue, Tongue fur with high frequency were greasy fur, white fur and thin fur. Pulses with high frequency were slippery pulse, wiry pulse and thin pulse.
2Five main syndrome types in the acute stage of vertebrobasi lar insufficient vertigo extracted by the cluster analysis were:(1) phlegm syndrome,(2) phlegm-heat syndrome,(3) qi-stagnancy and blood stasis syndrome,(4) spleen-kidney yang deficiency together with retention of phlegmatic dampness syndrome,(5) liver-kidney yin deficiency together with wind phlegm disturbing syndrome.
3Five ma in syndrome types in the acute stage of vertebrobasi lar insufficient vert igo extracted by factor analysis were:(1) phlegm syndrome,(2) liver-kidney yin deficiency syndrome,(3) spleen-kidney yang deficiency syndrome,(4) phlegm-heat syndrome,(5) heart-spleen deficiency syndrome.
4The result showed the syndrome elements that described the organ related to vertebrobasi lar insufficient vertigo were heart, liver, spleen, and kidney.
The main deficiency syndrome elements were qi deficiency, blood deficiency, yin deficiency and yang deficiency, on the other hand, the main excess syndrome elements were phlegm, phlegm-heat, phlegm-wind, blood stasis and qi stagnation, of which phlegm was mostly seen. The result of the cluster analysis highly matched with that of the factor analysis. Two deficiency-excess complicated syndromes were found based on the result of cluster analysis. It matched with the result of literature review, which stated that vertebrobasilar insufficient vertigo had complicated pathogenesis.
5Based on the result of cluster analysis, there was a wind phlegm disturbing syndrome, in which syndromes such as pink tongue, floating pulse, chills and numbness presented the existence of exogenous wind-evil. It reminded us that we might have neglected some pathogens in the development of vertebrobasilar insufficient vertigo.
Conclusion:
The review of literature about vertebrobasilar insufficient vertigo and the clinical investigation of syndromes, syndrome types, and syndrome elements in acute stage of vertebrobasilar insufficient vertigo summarize the distribution characteristics and rules of syndrome in vertebrobasilar insufficient vertigo. A preliminary work for guiding the clinical treatment is finished. However, in this study, sample size is small, and the stat ist ical method has some limitations. A lot of information needs to be further explored, and the results above still need further verification.
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