Distribution rule of traditional Chinese medicine patterns in 4, 734 schizophrenia patients: a multicenter study

TANG Qisheng; SUN Wenjun; ZHANG Yijie; MA Liang; WANG Di; ZHENG Junran; CAI Guangchao; XU Hongmei; XUE Yun; WANG Zhiqiang; WANG Xuehao; YAN Aiguo; HUANG Shijing; ZHANG Binbin

doi:10.3969/j.issn.1006-2157.2023.10.014

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Distribution rule of traditional Chinese medicine patterns in 4, 734 schizophrenia patients: a multicenter study

Clinical Studies | 更新时间：2023-11-06

- Distribution rule of traditional Chinese medicine patterns in 4, 734 schizophrenia patients: a multicenter study
- Journal of Beijing University of Traditional Chinese Medicine Vol. 46, Issue 10, Pages: 1422-1430(2023)
- 作者机构：
  
  1.北京中医药大学第三附属医院　北京　100029
  2.北京市朝阳区第三医院
  3.首都医科大学附属北京安定医院
  4.北京回龙观医院
  5.北京市大兴区心康医院
  6.北京市昌平区中西医结合医院
  7.北京市石景山区精神卫生保健所
  8.清华大学垂杨柳医院
  9.北京市延庆区精神病医院
  10.北京市平谷区精神病医院
  11.中国中医科学院广安门医院
  12.北京中医药大学东直门医院
- 作者简介：
  
  Prof. SUN Wenjun, Ph.D., Chief Physician, Doctoral Supervisor. The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51, Xiaoguan Street, Outside Andingmen, Chaoyang District, Beijing 100029. E-mail: doctorsunwenjun@126.com
- 基金信息：
  
  Beijing Natural Science Foundation(7222274);Capital Funds for Health Development and Research(2022－2－7035)
- DOI：10.3969/j.issn.1006-2157.2023.10.014
  CLC： R277.7
- Received：30 May 2023，
  
  Online First：10 July 2023，
  
  Published：30 October 2023
- 稿件说明：
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TANG Qisheng, SUN Wenjun, ZHANG Yijie, et al. Distribution rule of traditional Chinese medicine patterns in 4, 734 schizophrenia patients: a multicenter study[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(10): 1422-1430.
DOI：

TANG Qisheng, SUN Wenjun, ZHANG Yijie, et al. Distribution rule of traditional Chinese medicine patterns in 4, 734 schizophrenia patients: a multicenter study[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(10): 1422-1430. DOI： 10.3969/j.issn.1006-2157.2023.10.014.

摘要

目的

采取大样本、多中心的横断面研究方法，探讨精神分裂症患者的中医证候分布规律。

方法

2020年5月—2021年4月，在北京市12个分中心(北京中医药大学第三附属医院、北京市朝阳区第三医院、首都医科大学附属北京安定医院、北京回龙观医院、北京市大兴区心康医院、北京市昌平区中西医结合医院、北京市石景山区精神卫生保健所、清华大学垂杨柳医院、北京市延庆区精神病医院、北京市平谷区精神病医院、中国中医科学院广安门医院、北京中医药大学东直门医院)招募精神分裂症患者。共纳入精神分裂症患者4 734例，男性2 529例，女性2 205例，平均年龄50.81岁。通过中医证候学量表、阳性和阴性精神症状评定量表、四诊资料，评价患者精神状态并记录症状，填写《精神分裂症中医证候观察表》。构建症状关系网络图，从中提取证候靶位及证候要素。然后将证候靶位和证候要素应证组合，形成基础证。分别通过关联规则、贝叶斯网络、聚类分析对基础证进行证候提取，最后汇总3种方法得出的证候类型，结合中医理论和专家组意见，同类合并，提取共同的证候。

结果

运用关联规则构建了162项症状之间的关系网络图，提取了16个基础证。关联规则提取了痰火扰神、心肝火旺、气滞血瘀、阴虚火旺、肾虚肝郁、痰蒙神窍、脾肾阳虚、心脾两虚、痰气郁结9个证候，聚类分析提取了心肝火旺、痰火伤阴、气滞血瘀、阴亏血少、脾肾阳虚、痰湿内阻、心脾两虚、肾气亏虚、胆气亏虚9个证候，贝叶斯网络提取了痰火扰神、心肝火旺、阴虚火旺、气滞血瘀、瘀热互结、肾虚肝郁、痰蒙神窍、脾肾两虚、心脾两虚、心肾不交和肝肾亏虚11个证候。经过汇总，提取了3种方法重合的痰火扰神、心肝火旺、气滞血瘀、阴虚火旺、痰蒙神窍、心脾两虚、脾肾阳虚和肾虚肝郁8个证候类型。精神分裂症的临床症状包括阴性症状(2 893例，占61.11%)和阳性症状(1 841例，占38.89%)，前者属中医学“癫证”范畴，证候为脾肾阳虚(22.94%)、痰蒙神窍(17.79%)、心脾两虚(13.98%)、肾虚肝郁(6.40%)；后者属中医学“狂证”范畴，证候为痰火扰神(12.63%)、气滞血瘀(11.03%)、阴虚火旺(10.25%)、心肝火旺(4.99%)。

结论

本研究探索了精神分裂症的中医证候规律，总结了常见的8个证候类型，为中医药论治精神分裂症提供了辨证基础。

Abstract

Objective

We aimed to find the distribution rule of traditional Chinese medicine(TCM) patterns of schizophrenia patients from the result of a large-sample

multicenter

cross-sectional study.

Methods

From May 2020 to April 2021

we recruited schizophrenic patients in the following 12 sub-centers in Beijing: The Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine

The Third Hospital of Chaoyang District

Beijing Anding Hospital of Capital Medical University

Beijing Huilongguan Hospital

Daxing Xinkang Hospital

Changping Hospital of Integrated Chinese and Western Medicine

Shijingshan Mental Health Care Institute

Chuiyangliu Hospital of Tsinghua University

Yanqing District Psychiatric Hospital

Pinggu District Psychiatric Hospital

Guang'anmen Hospital of China Academy of Chinese Medical Sciences

and Dongzhimen Hospital of Beijing University of Chinese Medicine. In total

734 schizophrenic patients(2

529 men and 2

205 women with an average age of 50.81 years) were included

and their mental symptoms were evaluated using the TCM Pattern Scale

Positive and Negative Syndrome Scale

and the four diagnostic method (inspection

listening and smelling

inquiry

and palpation and pulse taking). After finishing the Schizophrenic TCM Pattern Observation Form

the distribution of the patients′ TCM patterns was analyzed through the following steps: (Ⅰ) building a network diagram of all symptoms to extract the pattern locations and elements using association rules; (Ⅱ) combining the pattern locations with the pattern elements to form basic pattern

using the method of association rules

and Bayesian network

cluster analysis; and (Ⅲ) summarizing the patterns according to TCM theories and TCM expert consensus

and selecting the same patterns as the patterns of schizophrenia.

Results

Association rules were used to construct a relationship network diagram of 162 symptoms

and 16 basic TCM pattern were extracted. Among them

(Ⅰ) association rules extracted nine TCM patterns(phlegm-fire disturbing mind

hyperactivity of heart-liver fire

stagnation of qi and blood stasis

hyperactivity of fire due to yin deficiency

kidney deficiency and liver depression

spirit confused by phlegm

yang deficiency of the spleen and kidney

deficiency of both the heart and spleen

and phlegm-qi stagnation with binding); (Ⅱ) cluster analysis extracted nine patterns(hyperactivity of heart-liver fire

phlegm fire burning yin

stagnation of qi and blood stasis

yin deficiency and blood insufficiency

yang deficiency of the spleen and kidney

stagnation of phlegm-dampness

deficiency of both the heart and spleen

deficiency of kidney qi

and deficiency of bile qi); and (Ⅲ) the Bayesian network extracted 11 patterns(phlegm-fire disturbing mind

hyperactivity of heart-liver fire

hyperactivity of fire due to yin deficiency

stagnation of qi and blood stasis

intermingled phlegm and heat

kidney deficiency and liver depression

spirit confused by phlegm

deficiency of both the spleen and kidney

deficiency of both the heart and spleen

disharmony between the heart and kidney

and liver-kidney deficiency). Finally

eight common patterns were summarized

including phlegm-fire disturbing mind

hyperactivity of heart-liver fire

stagnation of qi and blood stasis

hyperactivity of fire due to yin deficiency

spirit confused by phlegm

deficiency of both the heart and spleen

yang deficiency of the spleen and kidney

and kidney deficiency and liver depression.The clinical features of schizophrenic patients included negative symptoms(2

893 cases

61.11%) and positive symptoms(1

841 cases

38.89%). The former belongs to the TCM "epilepsy syndrome" category

and the patterns of yang deficiency of the spleen and kidney(22.94%)

spirit confused by phlegm(17.79%)

deficiency of both the heart and spleen(13.98%)

and kidney deficiency and liver depression(6.40%) are involved. The latter belongs to the TCM "manic psychosis syndrome" category

and the patterns of phlegm-fire disturbing mind(12.63%)

stagnation of qi and blood stasis(11.03%)

hyperactivity of fire due to yin deficiency(10.25%)

and hyperactivity of heart-liver fire(4.99%) are involved.

Conclusion

This study may provide a reliable basis for forming plans for TCM diagnosis and treatment of schizophrenia

which can be guided by the 8 TCM patterns from 4.734 patients.

关键词

Keywords

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