Preliminary Methodology Exploration of TCM Syndrome Regulation Laws Research Based on TCM Constitution Clinical Medical School, Hubei University of Traditional Chinese Medicine Xiang Nan
Zheng Hou Syndromes Syndrome differentiation WFCMS Zheng is the essential feature of a disease at a particular time and space during its occurrence and development. Hou is the condition, phenomena and information flow of a disease at a particular time and space during its occurrence and development. Zhenghou or syndrome is a unity of essence and phenomena. The internal syndrome is reflected through the external manifestation. Syndrome differentiation is a process of understanding internal essence through analyzing external manifestations.
The status of syndromes in TCM WFCMS Syndrome is the core of the basic theory of TCM Syndrome is closely related to the treatment of syndrome differentiation of TCM Grasping syndrome is the key of clinical diagnosis The research of syndrome s essence is the breakthrough point of TCM academic development
TCM informatics WFCMS Fundamental research of the informatics of TCM This refers to the standardization and normalization of the information and technique of TCM, including the research of its terminology, classification, codes, measuring unit and so on. Key Words of Basic Theory of TCM Clinic Terminology of Traditional Chinese Medical Diagnosis and Treatment Basic Words of Traditional Chinese Medicine and Pharmacy Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine National Central Product Classification and Codes: Chinese Medicine Fundamental Norms of Information Construction in Hospitals of TCM
TCM informatics WFCMS Applied Research of TCM Informatics -TCM expert system -TCM clinical date base system of -information management system of hospitals of TCM
TCM informatics WFCMS Literature Research of TCM Informatics research into literature indexing and retrieval techniques research into scientific and technical information retrieval system of TCM research into digitizing technique of historical documents
Frame of TCM syndrome informatics system Informatics of TCM Syndrome TCM Syndrome TCM Informatics Normalizati on of the information of TCM syndrome WFCMS (top level) (middle level) Research of distribution laws of TCM syndrome Research of evolution laws of TCM syndrome Research of regulation laws of TCM syndrome (basic level)
Key research points of TCM syndrome informatics Syndrome is the core Standardization is the basis Information technology is the tool Clinical trial is the support
Standardization Research of Syndrome Information
Concept It refers to the establishment of information naming and defining principles and methods in pursuit of unification in concept. WFCMS Determine attributive classification and coding of information, that is to formulate classification principles and coding methods of disparate attributes (such as medical attribute and semantic attribute) according to different needs so as to accomplish the classification and coding of syndrome information and realize the unification of information transmission and sharing. The normalization of information flow is to normalize every link of syndrome information flow so as to realize the unification of dynamic process control.
Research Course of 30 Years WFCMS Formulation phase of National Standard(1990-2003) Classification and Codes of TCM Diseases and ZHENG National Central Product Classification and Codes: Chinese Medicine Formulation phase of strategic research and planning(2003-2006) Strategic Research of TCM Standardization Construction Plan of TCM Standardization Research phase of standard classification of TCM technology (2007-2010) Chart of system of TCM technology standard Strategic research of TCM standardization
Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine
Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine is the national standard compiled by State Administration of TCM, which was issued on 25th July 1995 and implemented on 1st January 1996
Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine is guided by TCM theory, referring to the principle and methods of the book International Statistical Classification of Diseases, regarding diseases and syndromes as two separate systems, adopts classifications of three levels, with diseases governing syndromes, and uses combined coding of six letters and digits, covering 624 disease names and 1624 syndrome names.
1.Classification and coding of TCM clinical diagnosis TCM clinical diagnosis requires the identification of syndromes after the identification of the name of disease to guide the clinical treatment. Therefore, disease and syndrome are the two inseparable and significant parts in TCM diagnosis. As a result, this standard stipulates for classification and coding of TCM diseases and syndromes respectively.
2.the diagnosis mode and structure of TCM diseases and syndromes The National Standard stipulates in the form of law for the first time that the TCM diagnosis mode of diseases and syndromes should be conducted as follows. TCM diagnosis of diseases =TCM disease name + TCM syndrome TCM Diagnosis of Diseases and Syndromes TCM Disease Name TCM Syndrome department specialty disease name differentiation attribute syndrome system system subcategory reclassified subcategory Sketch-map of TCM disease diagnosis structure
3. Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine WFCMS The national standard Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine prescribes the classification and codes of diseases and syndromes of TCM. It applies to the following areas such as health statistics, TCM treatment, TCM medical record management, TCM clinical treatment quality evaluation, scientific research, teaching, publication, international academic exchange and so on.
(1)Classification and coding of names of diseases 1)Principle of classification TCM disease names are classified in accordance with its clinical department and specialized department system. Categories of clinical department Categories of clinical department include the following eight departments: medical department, surgical department, department of gynecology, department of pediatrics, ophthalmology, E.N.T.department, department of dentistry and stomatology, and orthopedics. Category of Specialized Department system It is based on the special attribute of the disease names in Specialized Department system Subcategory of Specialized Department system It is based on the secondary special attribute of the disease names in Specialized Department system
2)Classification and coding of disease name Names of diseases should be classified and coded with both the 26 English letters (the initial letter of Pinyin) and Arabic figures. The coding pattern should be as follows: ending number of disease name serial number of disease name subcategory number of special department system category of department identification number of disease name
3)Examples for the classification and coding of TCM disease name name of disease code -------------------------------------------------------------- internal diseases BN pulmonary system diseases cough exogenous cough cough with internal injury consumptive lung disease cardiovacular disease palpitation palpitation with fear 怔仲病 BNF BNF010 BNF011 BNF012 BNF020 BNX BNX010 BNX011 BNX012
(2)Classification and coding of syndromes 1)Classification principle of syndromes It is classified into categories and subcategories according to the attribute of each category, which is based on TCM clinical syndrome differentiation system. categories of syndromes It falls into six major categories including disease cause, yin-yang-qiblood-body fluid-sputum, zang-fu organs-meridians and collaterals, six meridians and Wei-Qi-Ying-Xue. There is also a category which contains other syndromes whose attribute is indefinite. Subcategory of syndromes This is based on the first content attribute of the syndrome The third-class category of syndromes This is based on the second content attribute of the syndrome.
2)Coding for the classification of syndromes In this standard, the coding for classification of syndromes adopts the combined Pinyin letters and Arabic figures, which is as follows: ending number of syndrome serial number of syndrome reclassified subcategory of syndrome subcategory of syndrome category of syndrome identification number of syndrome
3)Examples for the classification and coding of syndromes WFCMS names codes ------------------------------------------------ etiological factor wind factor pathogenic wind ZB ZBF ZBF000 excess of pathogenic wind ZBF001 pathogenic wind attacking collaterals ZBF020 pathogenic wind impairing lung ZBF040 toxic heat caused by pathogenic wind ZBF060
Since 1995,our nation has held over 20 study classes promoting the application of national standard of TCM. More than 2000 units and over 3000 people have participated in this program. The national standard of the book Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine has been issued over 5000 and this promotion activity has made great achievements. 2000 所 1995.12 3000 人 5000 册
The national standard Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine has been extensively implemented in the TCM organizations of 31 provinces and WFCMScities in China.
istribution of fields of application: WFCMS TCM industry, scientific research, industry management Literature management research and development of new medicine, Scientific research TCD Research and development of new medicine hospital management, standard formulation and literature management. Hospital management Standard formulation
The supporting program of the 11th Five-Year Plan Research of TCM Technology Classification Standard
Units of association Beijing University of Chinese Medicine Hubei Provincial Hospital of TCM Guangdong Provincial Hospital of TCM Guang anmen Hospital, China Academy of Chinese Medicine Science Yangtze University Institute of Acupuncture and Moxibustion, China Academy of Chinese Medicine Science Hubei University of Chinese Medicine
Technical Route Specific research on distribution status and basic standard catalog of TCM disease and syndrome diagnosis Research of standard classification and basic standard catalog of acupuncture, massage and osteopathy technique Specific study of standard classification and basic standard catalog of clinical Chinese medicine technology Specific study of standard classification and basic standard catalog of TCM nursing technology Specific study of standard classification and basic standard catalog of TCM rehabilitation, prevention and health care technology Specific study of standard classification and basic standard catalog of TCM information and literature technology Specific study of standard classification and basic standard catalog of TCM equipments and other technologies Specific study of standard classification and basic standard catalog of other TCM characteristic treatments Classification principles and normal research of TCM technology standard system 中医技术标准体系表编制研究 Specific study of standardization status and developing tendency of Chinese Medicine Diagram of TCM technology standard system Strategic research of TCM Standardization
Formulation basis of TCM standard system diagram Basic theory of TCM, Clinical Chinese medicine, orthopedics, acupuncture, massage, rehabilitation, prevention and health care, TCM nursing, clinical Chinese medicine, TCM informationization, TCM historical literature, TCM equipments, adequate techniques, education management, scientific research management category(15) List of standard(15) statistics of standard (15)
Formulation ground for diagrams of TCM standard system Laws and regulations documents of Standard Documents of Industry Previous research WFCMS Standardization Law of the People s Republic of China Regulations of the People s Republic of China Traditional Chinese Medicine Principles and requirements for preparing diagrams of standard system, Classification and Codes of Diseases and ZHEGN of Traditional Chinese Medicine, Criteria of Diagnosis and Therapeutic Effect o f Diseases and Syndromes in Traditional TCM, Guidelines for Diagnosis and Treatment of Common Internal Diseases Statistics and Survey System of National Health in 2007,Disciplinary classification of Education Bureau of China, Management Method of TCM Medical Institutions (trial) Basic System Frame and Classification Norm of TCM Standard
structural diagram of TCM standard system Statistics of TCM standard Diagram of TCM standard system list of TCM standard Specification for formulation
中医药标准体系 基础标准类技术标准类管理标准类工作标准类 标准制修订通则类 共性技术类 共性管理类 行政工作类 名词术语类 中医技术类 中医管理类 医疗工作类 信息分类与代码类 中药技术类 中药管理类 药事工作类 计量单位类 中医医史 文献技术类 教育管理类 教学工作类 图标 模型类 信息技术类 科研管理类 科研工作类 语言翻译类 装备技术类 中医医史 文献管理类 其它工作标准类 其它基础标准类 环境与能源技术类 信息管理类 其它技术标准类 WFCMS 装备管理类 国际合作交流管理类 环境与能源管理类 其它管理标准类
250 200 150 100 50 0 WFCMS 7 8 基础标准 技术标准 管理标准 9 51 33 26 78 122 156 57 211 132 二级类目三级类目四级类目五级类目 category: First level:4 Second level:30 Third level:110 Fourth level:356 Fifth level:400 total:900
Achievements Structural innovation of TCM standard system An organic relation, or standard community has been established among different TCM standards with the consideration of industry management, characteristics of TCM academic and TCM development. Innovation of classification and coding of TCM standard The classification principle and coding method in this research has realized the structuring and codification of TCM standard system. Promoting the play of TCM standard system effectiveness Organized and scientific diagram of TCM standard system provides an overall blueprint for the construction and internal relations of TCM standard.
Research of Syndrome Distribution Laws
ConceptWFCMS Syndrome distribution is a concept derived from TCM clinical epidemiology. It refers to the sequence of syndromes appeared in frequency from TCM clinical diagnosis, or clinical syndrome distribution. The study of distribution law is to classify the data from clinical trial, analyze the causes and summarize its conditions and characteristics of distribution law.
Specific Study I WFCMS Research into TCM disease diagnosis distribution of discharged patients in 1994 from 88 TCM hospitals in China
Source of Data This material comes from the investigation of quality management of disease type from TCM hospitals in China in 1994. The investigation, based on the overall investigation of national health service in 1993 issued by National Health Service, employs multivariable analysis technique by taking social economy, culture, education, health care, demographic structure into consideration and taking county (city or urban area) as basic unit to make stratified sampling. Finally, 88 TMC hospitals were chosen as valid samples, among which are 7 provincial hospitals, 21 municipal hospitals,60 county hospitals. This study takes the TCM clinical data and relevant information on the first page of the case records of the discharged patients in 1994 in 88 TCM hospitals to establish database, as the original material.
统计单位分级分层示意图 有效调查中医院 88 家 126574 份 省及省以上级 地 ( 市 ) 级 县 ( 市 ) 级 7 家 34894 份 21 家 32273 份 60 家 61732 份 大城市 中城市 小城市 县城 2 家 4478 份 9 家 12725 份 8 家 13739 份 2 家 1331 份 第二层 第三层 第四层 第五层 15 家 17215 份 22 家 23650 份 19 家 16819 份 4 家 1723 份
Analysis of treatment methods WFCMS 69.85% 30.15% 中医及中西医结合 88414 例 西医 总病例数 38160 例 126574 例 There are 126,574 discharged cases in 1994 from 88 TCM hospitals. They are classified according to the different treatment methods. 88,414 patients were administered the treatment of TCM and combination of TCM and Western Medicine, which accounts for 69.85% of the total number; 38,160 patients of Western Medicine, accounting for 30.15%
ntegrity Analysis of TCM Clinical Diagnosis The written standard of TCM medical record issued by State Bureau of Traditional Chinese Medicine states that TCM medical record should be completed with TCM disease and syndrome diagnosis and Western Medicine disease diagnosis. The objects of this study are cases with complete TCM diagnosis and the combined diagnosis of TCM and Western Medicine Integrity Analysis of TCM Clinical Diagnosis category number of cases % Cases with complete diagnosis 78,605 88.91 Cases with incomplete diagnosis 9,809 11.09 -- in total 88,414 100.00
57.40% 前 100 位病 证诊断其他 Among 78605 cases, 5908 cases are administered TCM syndrome treatment and among the first 100 diagnoses, there are 45121 cases, accounting for 57.40% of the total number of cases. the proportion of the first 100 disease and syndrome diagnoses in the total cases
前二十位中医病 证诊断构成 WFCMS 2500 2000 1500 1000 500 0 骨折病类 气滞血瘀证 2345 2.98% 肛肠病类 湿热下注证 2338 2.97% 中风病 风痰阻络证 1743 2.22% 胁痛病 肝胆湿热证 1227 1.56% 伤筋病类 气滞血瘀证 1205 1.53% 肛漏病 湿热下注证 1022 1.30% 感冒病 风热袭表证 998 1.27% 胸痹心痛病心血瘀阻证 946 1.20% 咳嗽病 风热犯肺证 939 1.19% 风湿痹病 风寒湿痹证 875 1.11% 喘病 痰湿蕴肺证 871 1.11% 肺炎喘嗽病风热犯肺证 837 1.06% 热淋病 湿热下注证 836 1.06% 咳嗽病 痰热壅肺证 820 1.04% 胃脘痛病 肝胃气滞证 710 0.90% 头部内伤病瘀阻脑络证 706 0.90% 中风病 气虚血瘀证 699 0.89% 眩晕病 痰浊上蒙证 683 0.87% 中风病 阴虚风动证 680 0.87% 眩晕病 气血亏虚证 634 0.81% 外感热病类湿热蕴结证 593 0.75%
4.00% 4.10% 11.89% 44.67% 13.72% 6.90% 33.20% 17.43% 17.19% 17.91% 29.00% 风痰阻络证 1743 气虚血瘀证 699 阴虚风动证 680 肝阳暴亢证 464 痰火闭窍证 160 痰热腑实证 156 风热犯肺证 939 例 痰湿蕴肺证 486 例 肺阴亏虚证 195 例 痰热壅肺证 820 例 风寒袭肺证 388 例 中风病 在前 100 位中医病 证诊断中的证候构成 咳嗽病 在前 100 位中医病 证诊断中的证候构成
Distribution of TCM Disease Diagnosis WFCMS According to the statistics of 78605 cases, 475 disease names are obtained, accounting for 76% of the total 625 disease names listed by National Standard. It indicates that the disease names of National Standard can satisfy the present demands of TCM clinical disease diagnosis. The distribution of TCM disease names of discharged patients from 88 TCM hospitals in 1994 can be obtained based on the number of cases with the same disease and its proportion list in the sample. For the sake of analysis, TCM disease names of the first 100 cases are analyzed in the following table.
诊前断二构十位中医病名 5000 4000 3000 成 WFCMS 2000 1000 0 中风病 4822 6.13% 咳嗽病 3558 4.53% 肛肠病类 3279 4.17% 眩晕病 3264 4.15% 伤筋病类 3239 4.12% 骨折病类 2487 3.16% 胃脘痛病 2364 3.01% 胁痛病 2271 2.89% 喘病 2216 2.82% 胸痹心痛病 2163 2.75% 心悸病 1973 2.51% 肺炎喘嗽病 1931 2.46% 感冒病 1872 2.38% 风湿痹病 1669 2.12% 热淋病 1244 1.58% 腹痛病 1219 1.55% 头部内伤病 1175 1.49% 水肿病 1166 1.48% 肛漏病 1139 1.45% 泄泻病 1108 1.41%
前 100 位中医病名诊断顺位分段病例构成 分段数 病例数 占总病例数 % 前 10 29,663 37.74* 前 20 44,159 56.18 前 30 53,288 67.79 前 40 59,318 75.46 前 50 63,298 80.50* 前 60 66,031 84.00 前 70 68,093 86.63 前 80 69,676 88.64 前 90 70,951 90.26 前 100 72,035 91.64*
Distribution of TCM Syndromes Diagnosis 1027 syndrome names were obtained from the statistics of 78605 cases,accounting for 63.24% of the total 1624 syndrome names listed by National Standard, which indicates that the syndrome names summarized by National Standard can satisfy the needs of clinical syndrome differentiation diagnosis. The distribution of TCM syndromes of discharged patients from 88 TCM hospitals in 1994 can be obtained based on the number of cases with the same syndrome and its sequence list. For the sake of analysis, TCM syndrome diagnoses of the first 100 are analyzed in the following table.
the construction of TCM syndrome diagnoses of the first 20 cases WFCMS 8000 6000 4000 2000 0 气滞血瘀证 7265 9.24% 湿热下注证 5037 6.41% 风热犯肺证 2982 3.79% 痰热壅肺证 2066 2.63% 肝胆湿热证 1844 2.35% 风痰阻络证 1769 2.25% 风热袭表证 1570 2.00% 痰湿蕴肺证 1500 1.91% 肝肾阴虚证 1498 1.91% 心血瘀阻证 1386 1.76% 血瘀证 1160 1.48% 气血亏虚证 1114 1.42% 脾胃虚寒证 1048 1.33% 瘀阻脑络证 1020 1.30% 风寒湿痹证 1014 1.29% 湿热蕴结证 1013 1.29% 湿 热证类 973 1.24% 气虚血瘀证 789 1.00% 心脾两虚证 747 0.95% 湿热内蕴证 739 0.94%
The structure of TCM syndrome differentiation system 0.04% 0.56% 0.63% 35.34% 六经证类 30 例 0.04% 28.15% 卫气营血证类 444 例 0.56% 其他证类 495 例 0.63% 脏腑经络证类 22125 例 28.15% 35.28% 阴阳气血津液痰证类 27729 例 35.28% 病因证类 27782 例 35.34%
前 10 位证候属性分类病例构成 ( 国标 共有 56 个证候属性分类, 前 10 位病例数为 69523, 占 88.44%) 14000 12000 10000 8000 6000 气证类 12238 15.57% 风证类 11975 15.23% 肝证类 9933 12.64% 湿证类 9825 12.50% 痰证类 7727 9.83% 血证类 5292 6.73% 脾证类 4459 5.67% 心证类 3316 4.22% 肺证类 2809 3.57% 热证类 1949 2.48% 4000 2000 0
85.10% 气 血证类 14.90% 气 阴证类气 痰证类气 湿证类气 火证类气 热证类气 阳证类气 毒证类 气证类中以气 血证类为主占 85.10% 50.20% WFCMS The analysis of subcategories in the three syndrome categories of Qi, Wind and Dampness is showed in the following charts. 风 热证类 湿 热证类 49.80% 风 寒证类风 痰证类风 湿证类风 火证类风 毒证类风 燥证类 96.64% 3.36% 湿 卫分证类湿 毒证类湿 痰证类湿 火证类 风证类中以风 热证最多占 50 20% 湿证类中以湿 热证类为主占 96 64%
78605 cases are classified according to their clinical departments and TCM clinical disease and syndrome diagnosis of each department is distributed as follows. 8.30% WFCMS Study of TCM Diseases and ZHENG Diagnosis Distribution in Different Clinical Departments 11.93% 54.17% 内科 42581 外科 9376 儿科 6526 骨伤科 7156 肛肠科 3904 妇科 2604 皮肤科 484 眼科 2331 耳鼻喉科 1258 针灸科 1555 其他科 830 Distribution of different clinical cases
临床各科前三位中医病 证, 病名, 证候名分布 病 证 病名 证候名 内科 * 1 中风病 风痰阻络证 1 中风病 1 风热犯肺证 2 感冒病 风热袭表证 2 咳嗽病 2 风痰阻络证 3 胸痹心痛病心血瘀阻证 3 眩晕病 3 痰湿蕴肺证 外科 1 肛肠病类湿热下注证 1 肠痈病 1 湿热下注证 2 头部内伤病瘀阻脑络证 2 肛肠病类 2 气滞血瘀证 3 胁痛病肝胆湿热证 3 伤筋病类 3 瘀阻脑络证 WFCMS 肛肠科 1 肛肠病类 湿热下注证 1 肛肠病类 1 湿热下注证 2 肛漏病 湿热下注证 2 肛漏病 2 气滞血瘀证 3 肛肠病类 气滞血瘀证 3 肛裂病 3 血热肠燥证 皮肤科 1 蛇串疮病 肝经郁热证 1 蛇串疮病 1 肝经郁热证 2 湿疮病 湿热浸淫证 2 湿疮病 2 湿热浸淫证 3 白庀病 风热血燥证 3 皮肤病类 3 湿 热证类
妇科 1 症 * 瘕病 血瘀证 1 症 * 瘕病 1 血瘀证 2 带下病类 湿热下注证 2 崩漏病 2 肾气不足证 3 崩漏病 气不摄血证 3 胎动不安病 3 气不摄血证 儿科 1 肺炎喘嗽病风热犯肺证 1 肺炎喘嗽病 1 风热犯肺证 2 小儿咳嗽病风热犯肺证 2 小儿咳嗽病 2 痰热壅肺证 3 肺炎喘嗽病痰热壅肺证 3 小儿泄泻病 3 湿 热证类 眼科 * 1 圆翳内障病肝肾阴虚证 1 圆翳内障病 1 肝肾阴虚证 2 绿风内障病风火攻目证 2 暴盲病 2 气滞血瘀证 3 聚星障病 肝经风热证 3 绿风内障病 3 肝经风热证 耳鼻喉科 1 乳蛾病 肺肾阴虚证 1 乳蛾病 1 气滞血瘀证 2 乳蛾病 风热外侵证 2 鼻衄病 2 胃火炽盛证 3 慢喉音病 气滞血瘀证 3 鼻渊病 3 风热外侵证 骨伤科 1 骨折病类 气滞血瘀证 1 骨折病类 1 气滞血瘀证 2 伤筋病类 气滞血瘀证 2 伤筋病类 2 血瘀证 3 伤筋病类 血瘀证 3 腰痛病 3 肝肾不足证 针灸科 1 哮病 肺气亏虚证 1 中风病 1 肺气亏虚证 2 中风病 风痰阻络证 2 哮病 2 风痰阻络证 3 中风病 气虚血瘀证 3 伤筋病类 3 气虚血瘀证
Study of TCM diseases and syndromes diagnosis distribution in hospitals of different levels The 88 sampled TCM hospitals are classified into provincial, municipal and county levels. Discharged patients in 1994 from TCM hospitals of the same level falls into a group, and TCM diseases and syndromes diagnosis distribution is studied in hospitals of disparate levels. Its distribution and structure is as follows. the distribution statistics of discharged cases in hospitals of different levels total number 78,605 level umber of hospitals cases % provincial 7 25,455 32.38 Municipal 21 21,073 26.81 county 60 32,077 40.81
There are 5908 TCM disease and syndrome diagnoses in the sampling materials and they are classified and analyzed according to hospitals of different levels. Therefore, the number of TCM disease and syndrome diagnoses from hospitals of different levels is showed in the following chart. WFCMS statistics of TCM disease and syndrome diagnoses from hospitals of different levels total number of diseases and syndromes 5,908 level of hospitals number of diseases and syndromes % provincial 3,598 60.09 municipal 1,883 31.87 county 2,942 49.80
不同级别医院前三位中医病 证, 病名, 证候名分布 病 证病名证候名 省级 1 骨折病类气滞血瘀证 1 中风病 1 气滞血瘀证 2 中风病风痰阻络证 2 骨折病类 2 湿热下注证 3 肛肠病类湿热下注证 3 肛肠病类 3 痰热壅肺证地级 1 肛肠病类湿热下注证 1 伤筋病类 1 湿热下注证 2 骨折病类气滞血瘀证 2 肛肠病类 2 气滞血瘀证 3 伤筋病类气滞血瘀证 3 眩晕病 3 风热犯肺证县级 1 肺炎喘嗽病风热犯肺证 1 咳嗽病 1 气滞血瘀证 2 中风病风痰阻络证 2 中风病 2 风热犯肺证 3 感冒病风热袭表证 3 眩晕病 3 湿热下注证
Research of TCM diseases and syndromes distribution in hospitals of different areas The sampled 88 TCM hospitals are divided into five districts including north China (north & northeast of China), east China, middle-south China, northwest part of China, southwest part of China. All the discharged patients from TCM hospitals of one district in 1994 are brought under a group and then TCM clinical diagnosis distribution is studied in these five districts. 14.11% 17.50% statistics of cases distribution in hospitals of different districts 8.52% 34.74% 25.14% WFCMS 北方区 22 所 13755 华东区 23 所 19758 中南区 21 所 27306 西北区 12 所 6696 西南区 10 所 11090
不同地区前三位中医病 证, 病名, 证候名分布 病 证 病名 证候名 北方 1 中风病 风痰阻络证 1 中风病 1 湿热下注证 2 肛肠病类 湿热下注证 2 胸痹心痛病 2 风痰阻络证 3 中风病 阴虚风动证 3 眩晕病 3 痰热壅肺证 华东 1 肛肠病类 湿热下注证 1 伤筋病类 1 气滞血瘀证 2 伤筋病类 气滞血瘀证 2 中风病 2 湿热下注证 3 骨折病类 气滞血瘀证 3 咳嗽病 3 风热犯肺证 中南 1 骨折病类 气滞血瘀证 1 骨折病类 1 气滞血瘀证 2 感冒病 风热袭表证 2 咳嗽病 2 湿热下注证 3 伤筋病类 气滞血瘀证 3 眩晕病 3 风热犯肺证 西北 1 肺炎喘嗽病风热犯肺证 1 肺炎喘嗽病 1 风热犯肺证 2 骨折病类 气滞血瘀证 2 咳嗽病 2 气滞血瘀证 3 肛肠病类 湿热下注证 3 感冒病 3 湿热下注证 西南 1 肛肠病类 湿热下注证 1 肛肠病类 1 湿热下注证 2 肛漏病 湿热下注证 2 伤筋病类 2 气滞血瘀证 3 伤筋病类 气滞血瘀证 3 咳嗽病 3 风热犯肺证
Specific Study II Comparative analysis of the current situation of TCM clinical diagnosis of discharged patients from 10 TCM hospitals in 1994 and 1996 in China
Source of data The objects of specific sample survey are 10 TCM hospitals representative in hospitals of the same level in the whole country. They are of certain scale, with complete disease types, have conducted application activities of TCM academic standard promotion, and employ a unified TCM medical record information management system through computers. Among the samples, there are six provincial hospitals, three municipal ones and one of county level. A database is constructed and classified by using the TCM clinical diagnoses (the sample selecting rule follows the previous one) and related information on the first page of the medical records of discharged patients in 1994 and 1996, which is used as data for dynamic comparison. statistics of data classification from specific sample survey unit (case) name the group of 94 (%) the group of 96(%) TCM and combination of TCM and Western Medicine treatment 49,650 (100.00) 40,020 (100.00) Diagnoses matching this study 33,543 ( 67.56) 34,417 ( 86.00)
Analysis of data TCM disease and syndrome names are obtained from statistics and analysis of the two groups respectively in 1994 and 1996 from 10 hospitals. WFCMS Statistics of TCM disease and syndrome diagnoses in 1994 and 1996 unit: number category the group of 1994 the group of 1996 national standard TCM disease names 391 466 625 TCM syndrome names 797 1103 1624 TCM disease and syndrome diagnoses names 4485 6431 --
94 年组前 20 位中医病 证诊断与其在 96 年相应构成对照分析 94 年 ( 总数 33,543 例 ) 96 年 ( 总数 34,417 例 ) 中医病 证名称 顺位例数占小计 % 总数 % 顺位例数占小计 % 总数 % 骨折病类气滞血瘀证 1 1,892 23.21 5.64 1 2,136 38.64 6.21 肛肠病类湿热下注证 2 1,074 13.17 3.20 3 575 10.40 1.67 腰痛病 气滞血瘀证 3 491 6.02 1.46 45 92 1.66 0.27 伤筋病类气滞血瘀证 4 450 5.52 1.34 17 202 3.65 0.59 肛肠病类湿 热证类 5 396 4.86 1.18 13 206 3.73 0.76 中风病 肝肾阴虚, 风阳上扰证 6 392 4.81 1.17 6 304 5.50 0.88 中风病风痰阻络证 7 300 3.68 0.89 7 280 5.07 0.81 中风病气虚血瘀证 8 284 3.48 0.85 15 217 3.93 0.63 咳嗽病痰热壅肺证 9 276 3.39 0.82 33 120 2.17 0.35 泄泻病湿 热证类 10 254 3.12 0.76 211 25 0.45 0.07 中风病肝肾阴虚证 11 248 3.04 0.74 12 262 4.74 0.76 感冒病风 热证类 12 248 3.04 0.74 93 57 1.03 0.17 积聚病正虚瘀结证 13 242 2.97 0.72 437 11 0.20 0.03 肺炎喘嗽病痰热闭肺 14 240 2.94 0.72 48 88 1.59 0.26 眩晕病肝阳上亢证 15 237 2.91 0.71 5 329 5.95 0.96. 小 计 8,152 100.00 24.30 5,528 100.00 16.06
94 年组前 20 位中医病名诊断与其在 96 年的构成对照分析 94 年 ( 总数 33,543 例 ) 96 年 ( 总数 34,417 例 ) 中医病名 TCD 顺位例数占小计 % 总数 % 顺位例数占小计 % 总数 % 中风病 BNG080 1 2,220 11.35 6.62 2 2,296 12.82 6.67 骨折病类 BGG000 2 2,069 10.58 6.17 1 2,663 14.87 7.74 肛肠病类 BWG000 3 1,871 9.56 5.58 4 1,280 7.15 3.72 咳嗽病 BNF010 4 1,335 6.82 3.98 7 681 3.80 1.98 腰痛病 BNS150 5 1,180 6.03 3.52 23 2,345 13.10 1.19 眩晕病 BNG070 6 1,144 5.85 3.41 3 1,449 8.09 4.21 肺炎喘嗽病 BEZ020 7 910 4.65 2.71 33 276 1.54 0.80 伤筋病类 BGS000 8 875 4.47 2.61 20 454 2.54 1.32 胸痹心痛病 BNX020 9 857 4.38 2.55 8 677 3.78 1.97 风湿痹病 BNV070 10 808 4.13 2.41 6 724 4.04 2.10 心悸病 BNX010 11 781 3.99 2.33 5 1,032 5.76 3.00 胁痛病 BNG010 12 746 3.81 2.22 10 648 3.62 1.88 水肿病 BNS010 13 726 3.71 2.16 1 583 3.26 1.69 感冒病 BNW010 14 644 3.29 1.92 22 411 2.30 1.19 胃脘痛病 BNP010 15 643 3.29 1.92 19 479 2.68 1.39 小计 : 19,565 100.0 58.33 17,904 100.0 52.02
Comparative analysis of TCM syndrome diagnosis of the first 20 cases in 1994 and 1996 94 年 ( 总数 33,543 例 ) 96 年 ( 总数 34,417 例 ) 证候名称 TCD 顺位例数占小计 % 总数 % 顺位例数占小计 % 总数 % 气滞血瘀证 ZYVXK0 1 4,411 27.89 13.15 1 4,674 29.33 13.58 湿热下注证 ZBMRD0 2 1,764 11.15 5.26 3 1,145 7.18 3.33 湿热证类 ZBMR00 3 1,349 8.53 4.02 2 1,639 10.28 4.76 湿热内蕴证 ZBMR20 4 834 5.27 2.49 6 901 5.65 2.62 肝肾阴虚证 ZZGS40 5 773 4.89 2.30 9 647 4.06 1.88 风热证类 ZBFR00 6 736 4.65 2.19 5 904 5.67 2.63 气阴两虚证 ZYVY30 7 694 4.39 2.07 4 940 5.90 2.73 痰热壅肺证 ZYTR90 8 622 3.93 1.85 13 436 2.74 1.27 血瘀证 ZYX120 9 467 2.95 1.39 28 227 1.42 0.66 肝肾不足证 ZZGS10 10 459 2.90 1.37 8 661 4.15 1.92 气虚血瘀证 ZYVXM0 11 444 2.81 1.32 11 538 3.38 1.56 心血瘀阻证 ZZXX30 12 440 2.78 1.31 21 305 1.91 0.89 风热犯肺证 ZBFR50 13 426 2.69 1.27 27 234 1.47 0.68 肝肾阴虚, 风阳上扰证 ZZGS41 14 418 2.64 1.25 17 321 2.01 0.93 肝阳上亢证 ZZGA30 15 403 2.55 1.20 10 553 3.47 1.61 气血两虚证 ZYVX30 16 341 2.16 1.02 15 376 2.36 1.09 小计 15,817 100.00 47.15 15,937 100.00 46.31
Examples for dynamic evolution of TCM disease names in 1994 and 1996 disease year sequence cases % 94 6 1144 3.41 Vertiginous { 96 3 1449 4.21 Palpitation { 94 11 781 2.33 96 5 1032 3.00
Study of developing laws of syndromes WFCMS Developing laws of syndromes studies the dynamic developing route and laws of majors syndromes during the occurrence and development of diseases according to distribution laws of TCM disease and syndrome diagnoses under study and the category and structure of the major syndromes.
Study of regulation laws of syndromes WFCMS The study, based on studies of syndrome distribution and developing laws, is an enhancement of dynamic developing laws of TCM syndromes with the main objective of disclosing relevant factors and conditions which influence syndrome development. The study of regulation laws of syndromes is the key technology of realizing dynamic evaluation of TCM clinical efficacy.
Review of TCM Therapeutic Evaluation Methodology Therapeutic evaluation of traditional syndromes Doctors' observation, auscultation and olfaction, interrogation, pulse taking and patients' oral response, further observation after treatment evaluation:recovered, improved, effective and ineffective
Review of TCM Therapeutic Evaluation Methodology Semiquantitative method The book Guiding Principles for Clinical Study of New Chinese Medicine has made semiquantitative classification to syndromes. For example: fullness in abdomen, occasional or after meal 0.5h (+),after meal 1h (++),over 6h every day(+++),whole day(++++)
Review of TCM Therapeutic Evaluation Methodology WFCMS evidence-based medicine RCT clinical trial Western medicine gold standard
Review of TCM Therapeutic Evaluation Methodology Study of clinical evaluation in the real world Integrated system of TCM clinical scientific and research information
Our thinking WFCMS Measure scale for health is the most effective instrument to depict diseases.
Fitness
Fitness WFCMS TCM fitness Fitness is expounded from the perspective of relative stability of constitution. It is explained by using the theory of relative balance of Yin and Yang. It is expounded from the perspective of Qi activity ascending and descending, circulation of Qi and blood. It is explained from the angle of holism, the harmonious unity of internal and external circumstances. Constitution identification provides a route and key technology for health evaluation.
Theory of constitution WFCMS Constitution refers to the relatively stable characteristics of physical makeup, physiological function and mental activities inherited or acquired in one s lifetime.
Theory of constitution Components Physical makeup Physiological function Mental activities
Classifications Theory of constitution Good health Neutral type Qi asthenia type Qi stagnation type constitution Yin deficiency type Blood stasis type Yang deficiency type Damp and hot type Phlegm and damp type
Normal curve o f syndromes WFCMS It shows the formation, development, transformation and ending of every syndrome and the original value includes the information reflected by constitution type. TCM constitution identification is one of the fundamental elements of drawing normal cure of syndromes.
Exploration into methodology normal curve fitting procedure Curve fitting is to choose adequate curve type to fit observed data and use corresponding curve equation to analyze the relationships of two variables. The correlation is synthesized and identified from the goodness of fit of measured curve and normal curve. The accurate drawing of normal curve directly influence the outcome.
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