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Evidence-Based Complementary and Alternative Medicine
Volume 2018, Article ID 8305892, 11 pages

A Real-World Evidence Study for Distribution of Traditional Chinese Medicine Syndrome and Its Elements on Respiratory Disease

Fei Xu (1,2), Wengqiang Cui (3), Qing Kong (1,2), Zihui Tang (1,2) and Jingcheng Dong (1,2)

1 Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, China
2 Institutes of Integrative Medicine, Fudan University, Shanghai, China
3 Department of Integrative Medicine and Neurobiology, State Key Laboratory of Medical Neurobiology, Institute of Acupuncture Research, School of Basic Medical Science, Fudan University, Shanghai, China

Abstract

Background. This study aimed to investigate the distribution and characteristics of traditional Chinese medicine (TCM) syndrome and its elements on respiratory diseases (RDs) based on real-world data (RWD). Methods. A real-world study was performed to explore the relationships among TCM syndrome and RDs based on electronic medical information. A total of 26,074 medical records with complete data were available for data analysis. Factor analyses were used to reduce dimensions of TCM syndrome elements and detect common factors. Additionally, cluster analyses were employed to assess combinations of TCM syndrome elements. Finally, association rule analyses were performed to investigate the structures of TCM syndrome elements to estimate the patterns of TCM syndrome. Results. A total of 27 TCM syndromes were extracted from RWD in this work. There were four TCM syndromes with >5.0% frequency based on the distribution frequency. The top five pathogenesis TCM syndrome elements were Tan, Huo, Feng, Qi_Xu, and Han. Factor analysis, cluster analysis, and association rule analysis demonstrated that Tan, Huo, Feng, Qi_Xu, Shen, and Fei were the core TCM syndrome elements. Conclusion. Four common Shi TCM syndromes on RDs were identified: Tan_Re_Yong_Fei, Tan_Zhuo_Zu_Fei, Feng_Re_Fan_Fei, and Feng_Han_Xi_Fei; two core common Xu TCM syndromes (Fei_Shen_Qi_Xu and Fei_Yin_Xu) and two core common Mix TCM syndromes (Fei_Pi_Qi_Xu-Tan_Shi_Yun_Fei and Fei_Shen_Qi_Xu-Tan_Yu_Zu_Fei) were also determined. The core TCM syndrome elements of Tan, Huo, Feng, Qi_Xu, Shen, and Fei were identified in this work.

Free full text:
https://www.hindawi.com/journals/ecam/2018/8305892/

Excerpts:

"Traditional Chinese medicine (TCM) has progressively gained wider attention worldwide due to its specific theory and long historical clinical practice [1]. Throughout the world, TCM is increasingly being used for individuals by 10-20% annually [2]. TCM has obvious advantages of extending strength through the invigoration of the body and clearing the root of disease with fewer side effects and multi-target effects [3]. TCM has popularly been used to manage many diseases, such as inflammatory diseases, cancer, and respiratory disease [4–8].

"In clinical practice, TCM practitioners form diagnoses and prepare prescriptions mainly on the basis of the pattern of the manifestation of symptoms that vary between each individual, which is known as TCM syndrome (also called “ZHENG”) [9]. TCM syndrome is a specific set of symptom or a pattern of symptoms presenting the body’s internal and external condition at a certain stage [9]. Generally, it describes the patterns of bodily disharmony according to eight principles. In addition, it also differentiates syndromes according to another system: qi, blood, body-fluid differentiation, and zangfu (organ). TCM syndrome has successfully guided disease research and the prescribing of herbal formulas. Moreover, TCM syndrome, in conjunction with modern medicine diagnosis, is fundamental for diagnosis and treatments in China. Syndrome elements that are gained from four-step validation contribute to syndrome patterns. The syndrome elements are used for explaining TCM syndrome patterns and for reflecting the innate pathologic factors [10]."

"Generally, in China, TCM treatment for RDs [respiratory diseases] has a long history, and numerous basic and clinical studies have assured that TCM has curative effects [13, 14]."

"In this study, the two most frequent RDs were COPD (32.05%) and lung infection (27.81%).Our findings indicated that four common syndromes in decreasing order of frequency were Tan_Re_Yong_Fei, Tan_Zhuo_Zu_Fei, Feng_Re_Fan_Fei, and Feng_Han_Xi_Fei. Frequency analyses showed the four Shi TCM syndromes with >5.0% frequency. In the Shi TCM syndrome group, factor analyses also indicated the four common syndromes for RDS. Cluster analyses and association rule analyses presented the combinations among Tan, Huo, Feng, Han, and Fei, suggesting that the four TCM syndromes were the common ones for RDs. Similarly, in the Xu TCM syndrome group, Fei_Shen_Qi_Xu and Fei_Yin_Xu were two core common TCM syndromes, and among the Mix TCM syndromes, Fei_Pi_Qi_Xu-Tan_Shi_Yun_Fei was the most common. Additionally, frequency analyses, factor analyses, cluster analyses, and association rule analyses for TCM syndrome elements demonstrated that the predominant elements in the pathogenesis of RD were Tan, Huo, Feng, and Qi_Xu. The main disease location is Fei and Shen.

"Currently, a standard TCM syndrome differentiation of some RDs has not yet been established, such as COPD. In general, the standard TCM syndrome differentiation was just primarily established from the literature analysis and expert counseling, and there is limited evidence for clinical application. In this study, data collected from 26,074medical case records reflected the clinical common syndromes of RDs, which provided powerful evidence for a standard TCM syndrome differentiation. In TCM, syndrome pattern is the principle for treatment, and more attention should then be paid to the accuracy of syndrome classification. In this study, the abovementioned eight syndrome patterns may provide a guideline for differentiation and treatment for RDs.

"Syndrome elements are the smallest unit of syndrome patterns explaining complexity and flexibility of TCM syndrome differentiation and reflecting the innate pathologic factors [10]. The real-world study demonstrated that lungs were more easily attacked by Tan, Huo, and Feng. Pathogenic Feng (wind) is the leading pathological cause of all diseases. When the defense system is weak and the protective Qi loses its ability to protect the body from foreign pathogens, which are often attached with other morbidity factors, such foreign pathogens invade the human body [21]. Phlegm syndrome appears in almost all RDs. For instance, frequency of phlegm in COPD is almost 60% [22]. The pathogenic factors may disrupt the function of lungs, block Qi, and blood circulation, influence the function of organs, and cause numerous negative changes in the body. Thus, phlegm is the pathological product of the disturbance of body fluid in the transportation and stagnation of body fluids [23]. Moreover, phlegm syndrome is almost always accompanied by other syndromes, such as phlegm-damp, phlegm-heat and phlegm-stasis syndromes [12, 24]. Consistent with the previous findings, these syndrome elements, Tan (damp), Huo (heat), Feng (stasis.) and Shui_Ting, appeared frequently in RDs in the present study.

"Although Shi syndromes had the highest distribution frequency, Xu syndromes appear throughout the whole course of disease. Deficiency in origin mainly included lung and Qi deficiency; as the disease continued to advance, Yin and Pi deficiency appeared. In a long course, Shen was involved and insufficiently presented. If it brought about Yin deficiency of Shen, it was not nourishing Gan wood and finally led to Gan and Shen deficiency and prosperity of fire [25]. When the syndrome was accurately differentiated and distinguished, the primary and secondary symptoms were taken into account. For example, a clinical investigation of 2,500 adult asthma cases identified the common ZHENG with primary and secondary symptoms [24]. Interestingly, these phenomena were in accordance with the analysis results of syndromes and elements frequency distribution."

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Comment: recall that the World Health Organization has decided to include Chinese medicine diagnoses in its new International Classification of Diseases codes:
https://respectfulinsolence.com/2018/10/04/the-world-health-organization-embracing-traditional-chinese-medicine-pseudoscience-in-icd-11/