Syndrome Classification Based on Manifold Ranking for Viral Hepatitis

Treatment determination based on syndrome differentiation is the key of Chinese medicine. A feasible way of improving the clinical therapy effectiveness is needed to correctly differentiate the syndrome classifications based on the clinical manifestations. In this paper, a novel data mining method based on manifold ranking （MR） is proposed to explore the relation between syndromes and symptoms for viral hepatitis. Since MR could take the symptom data with expert differentiation and the symptom data without expert differentiation into the task of syndrome classification, the clinical information used for modeling the syndrome features is greatly enlarged so as to improve the precise of syndrome classification. In addition, the proposed method of syndrome classification could also avoid two disadvantages in previous methods： linear relation of the clinical data and mutually exclusive symptoms among different syndromes. And it could help exploit the latent relation between syndromes and symptoms more effectively. Better performance of syndrome classification is able to be achieved according to the experimental results and the clinical experts.

Study of 160 breast cancer patients with distant metastasis after operation by way of TCM syndromes classification

Objective: To discuss the relationship between the postoperative breast cancer with distant metastasis and the TCM syndromes classification. Methods: 160 postoperative 5-year breast cancer patients from 1995 to 2000 were tracked, summed up and analysized TCM syndromes as stagnation of hepatic qi, deficiency of spleen and pathogenic phlegm reten- tion, blood stasis and toxin stagnation, deficiencies of both blood and qi. Results: (1) For blood stasis and toxin stagnation TCM syndrome, the metastatic rate raised to 45% during 5 years. However, the metastatic rates of other three TCM syn- dromes are 15%, 17.5% and 22.5% respectively. The general distant metastasis rate was 27.5% (P<0.01). (2) Lymph node metastasis, tumor size, Her-2 and its receptor have no obvious relation with TCM syndromes classification (P>0.05). Conclu- sion: (1) TCM syndrome classification has close relation with breast cancer distant metastasis. Distant metastasis have close relationship with blood stasis and toxin stagnation syndrome. (2) Lymph node metastasis, tumor size, Her-2 and its receptor have no obvious relation with TCM syndromes classification, which suggested that metastatic ability has been programmed in the early stage of carcinoma initiation. (3) Significantly enlightening for predict the prognosis under the guide of TCM syn- drome classification and take right therapeutic strategy: attack pathogen and activate blood circulation against cancer.

Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve reflect carpal tunnel syndrome severity?

Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately reflects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 patients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Significant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.29 between mild and more severe（moderate and severe） carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% specificity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% specificity. These results suggest that the inlet-to-outlet ratio reflected the severity of carpal tunnel syndrome.

The Comparative Study on Two Models of Syndrome Differentiation of the Hand, Foot and Mouth Disease: An Investigation Analysis of the Signs and Symptoms on 2325 Cases

Objective To realize the characteristics of "zheng" differentiation-treatment for hand, foot and mouth disease(HFMD), a new methodology of syndrome differentiation for different stages of HFMD has been explored. Methods Total of 2 325 cases with HFMD were recorded by distributing them into exterior syndrome stage, interior syndrome stage, severe syndrome stage and recovered syndrome stage, respectively, and the main symptoms and subsidiary symptoms of different stages of HFMD have been observed. The major and minor pathogenesis of HFMD in different stages were obtained, and compared with the "2010 Guideline for the Diagnosis and Treatment of HFMD". Results It was found that the major pathogenesis of exterior stage was defined as "the invation of the wenevil to the defender of the body with the collaterals got involved ", and the minor as "qi deficiency"; in interior stage, "the fury of Gan-Yang" was the main pathogenesis, and "qi in chaos and qi deficiency" was the minor; in severe syndrome stage, "the damage of heart, liver and lung" was the main pathogenesis, and "qi in chaos" was the minor; and the pathogenesis of recovered stage was "qi-yin deficiency". Compared with the "2010 Guideline for the Diagnosis and Treatment of HFMD", it showed that "the obstruction of the fei-pi qi by the mixture of shi-re evil" and "the mixture of shi-re" in vivo was quite difficult to be explained in completely different context in the general situation; in the severe stage, the TCM clinical characteristics of syndrome differentiation might lose; in the early acute severe cases, the phenomenon that xin-yang and fei-qi almost ran out was difficult to be observed, then, the line between the severe and the acute severe became vague.Conclusions The theory of syndrome differentiation by stages of HFMD was reasonable in the actual situation of clinical description on HFMD which was expected to be further tested and widely applied in the "zheng" differentiation-treatment of HFMD in the future.

Nervous function and manifestations of mental psychology in patients with post-stroke depression of different syndrome types of traditional Chinese medicine

BACKGROUND： Poly-criteria pathogenesis of patients with stroke causes diversity of syndrome types of traditional Chinese medicine （TCM）; meanwhile, complexity and diversity of pathological mechanism also play a key role in determining severity so as to induce effects on nervous function and manifestation of mental psychology in patients with post-stroke depression （PSD）. OBJECTIVE： To analyze the syndrome types of TCM with nervous function and manifestations of mental psychology in PSD patients so as to provide evidence for the treatment based on the syndrome differentiation. DESIGN： Contrast observation. SETTING： Departments of Neurology and Traditional Chinese Medicine, General Hospital of Fuxin Mining Industry Group. PARTICIPANTS： A total of 469 outpatients or inpatients with stroke were selected from the Department of Neurology, General Hospital of Fuxin Mining Industry Group from April 2002 to July 2005. All subjects met the diagnostic criteria of stroke established by the Fourth National Cerebrovascular Disease Academic Meeting in 1995 and were finally diagnosed with CT and MRI. Totally, 177 PSD patients were involved in the final analysis and provided the confirmed consent. There were 121 males and 56 females aged from 46 to 79 years. METHODS： （1） All the enrolled subjects were diagnosed for syndrome differentiation by senior TCM physicians within 1 week before discharge based on Diagnostics of Traditional Chinese Medicine, which was classified into 5 types, including sputum-stasis stagnation syndrome, qi stagnation and blood stasis, kidney-essence deficiency, deficiency of the spleen and stomach and phlegm-fire disturbing the heart. In addition, they were also assessed by neurologic deficit scale （NDS; 45 points in total; the higher the scores were, the severer the deficit was）, Fugl-Meyer assessment, （FMA; 100 points in total, including 66 points of upper limbs and 34 points of lower limbs; the higher the scores were, the stronger the motor function was）, modified Barthel index [BI; 100 points in total; the higher the scores were, the better the activity of daily life （ADL） was], symptom checklist-90 （SCL-90; including total scores, positive scores, mean and average scores of positive items）, Hamilton depression rating scale （HAMD） and Hamilton anxiety rating scale （HAMA, the higher the scores were, the severer the degree was）. （2） Patients were divided into one symptom type, two symptom types and ≥ 3 symptom types; meanwhile, they were also divided into deficiency symptom, excess symptom and deficiency-excess symptom. Scores among various groups were compared simultaneously. MAIN OUTCOME MEASURES： Comparison of nervous function and mental psychology of PSD patients with various symptoms. RESULTS： （1） Differences of various symptoms： Among 177 patients, there were 43 subjects in the types of sputum-stasis stagnation, 64 in qi stagnation and blood stasis, 21 in kidney-essence deficiency, 33 in deficiency of the spleen and stomach, and 16 in phlegm-fire disturbing the heart. In the comparison of the scores of nervous function and psychological tests among different syndrome types, the scores of most motor functions of upper and lower limbs, total scores of FMA and ADL in PSD patients of sputum-stasis stagnation, qi stagnation and blood stasis, kidney-essence deficiency were obviously lower than those of the total samples and PSD patients of deficiency of the spleen and stomach and phlegm-fire disturbing the heart, whereas the total scores of NDS, HAMD, HAMA, SCL-90 and SCL-90 positive items, average number of SCL-90 positive items and average score of SCL-90 positive items in the former three groups were all obviously higher than those in the latter three groups （P 〈 0.05 - 0.01）. （2） Different number of syndrome types： In the comparison of the scores of nervous function and psychological tests among the PSD patients with different number of syndrome types, the scores of most motor functions of upper and lower limbs, total scores of FMA and ADL in PSD patients with one or two syndrome types were obviously higher than those of the total samples and the PSD patients with three or more syndrome types, whereas the total scores of NDS, HAMD, HAMA, SCL-90 and SCL-90 positive items, average number of SCL-90 positive items and average score of SCL-90 positive items were all obviously lower in the former two than in the latter two （P 〈 0.05 - 0.01）. （3） There were no obvious differences in the scores of most items of nervous function and psychological tests among the PSD patients of deficiency syndrome, excess syndrome and the deficiency-excess syndrome （P 〉 0.05）. CONCLUSION： The damages of nervous function and mental psychology are more serious in PSD patients with the syndrome types of sputum-stasis stagnation, qi stagnation and blood stasis, kidney-essence deficiency, as well as those with several （three or more） syndrome types, and the conditions may be improved by the treatment based on TCM syndrome differentiation.

A data-driven method for syndrome type identification and classification in traditional Chinese medicine

The efficacy of traditional Chinese medicine （TCM） treatments for Western medicine （WM） diseases relies heavily on the proper classification of patients into TCM syndrome types. The authors developed a data-driven method for solving the classification problem, where syndrome types were identified and quantified based on statistical patterns detected in unlabeled symptom survey data. The new method is a generalization of latent class analysis （LCA）, which has been widely applied in WM research to solve a similar problem, i.e., to identify subtypes of a patient population in the absence of a gold standard. A well-known weakness of LCA is that it makes an unrealistically strong independence assumption. The authors relaxed the assumption by first detecting symptom co-occurrence patterns from survey data and used those statistical patterns instead of the symptoms as features for LCA. This new method consists of six steps： data collection, symptom co-occurrence pattern discovery, statistical pattern interpretation, syndrome identification, syndrome type identification and syndrome type classification. A software package called Lantern has been developed to support the application of the method. The method was illustrated using a data set on vascular mild cognitive impairment.

Treatment of 33 Cases of Nerve Tinnitus by Acupuncture on Syndrome Differentiation

Summary： Thirty-three cases of nerve tinnitus were treated mainly by needling acupoints Baihui（GV 20）, Tinggong（SI 19）, Tinghui（GB 2）, Yifeng（TE 17） and Zhongzhu（TE 3）. In the presence of kidney deficiency, Shenshu（BL 23） and Mingmen（GV 4） were added; in the presence of liver-gallbladder fire preponderance, Taichong（LR 3） and Qiuxu（GB 40） were added; in the presence of exogenous wind heat, Waiguan（TE 5） and Hegu（LI 4） were added. After 6-course treatments, 6 cases were cured, 22 cases improved and 2 cases failed, with the total effective rate of 93.9%.

Clinical Observation on Treatment of Post-operative Gastrointestinal Syndrome with Combined Acupuncture and Herbs

Objective： To observe the therapeutic effect of treating postoperative gastrointestinal syndrome with combined needles and herbs. Method： Altogether 117 in-patients were randomly allocated into the treatment group of 86 cases and control group of 31 cases. Point injection was mainly adopted in the treatment group plus Chinese herbal decoction, while Western medicine was adopted in the control group. And then the therapeutic effect of the two groups was compared. Result： The total effective rate of the treatment group and control group were 96.5% and 80.6% respectively, and the treatment course of the treatment group was significantly shorter than the control group （P 〈 0.01）. Conclusion： Combined needles and herbs have excellent effect in treating postoperative gastrointestinal syndrome and were superior to Western medicine.

Clinical Study of Tuina on Tension-type Headache with Syndrome Differentiation

The 6 point behavioral rating scale and Stead＇s grading method of diagnostic scale were applied to evaluate objectively the therapeutic effects of Tuina on 150 patients with tension-type headache in the experimental and controlled groups in this study. The results indicated that abdominal Tuina method of invigorating blood circulation and regulating qi had better effect than the routine Tuina method in treating tension-type headache. Meantime, it is considered that eliminating the immoderate defensive response caused by the process of headache-muscular contraction headache is the academic basis of the marked effect.

Features analysis on Traditional Chinese Medicine syndromes in patients with diabetic peripheral neuropathy

OBJECTIVE:To study the features of the distribution and differentiation ofTraditional Chinese Medicine(TCM)syndromes in patients with diabetic peripheral neuropathy(DPN).METHODS:We collected clinical data on illness course,age,fasting blood glucose,saccharogenic hemoglobin,TCM syndromes,tongue,and pulse of238 DPN patients.Differentiated main syndromes(Yin deficiency and exuberant heat,invasion of spleen by damp-heat,deficiency of both Qi and Yins,and deficiency of both Yin and Yang)and accompanying syndromes(blood stasis and phlegm-dampness)of diabetes were also recorded.The features of DPN syndromes were then analyzed.RESULTS:Among the four main syndromes of diabetes,deficiency of both Yin and Yang was the most common in the 238 DPN patients,of which89%-96%had blood stasis.CONCLUSION:The method of differentiating syndromes of diabetes can be applied to DPN patients.Deficiency of both Yin and Yang,often accompanied by blood stasis,is commonly seen.

Acupuncture Treatment of Irritable Bowel Syndrome Based on Differentiation of Symptoms and Signs

According to differentiation of traditional Chinese medicine, Irritable Bowel Syndrome was classified into two types, disharmony of the liver and spleen and deficiency of the heart and spleen, which were treated with acupuncture respectivdy. As a result, of 31 cases, 25 cases had marked effectiveness, 5 cases had effectiveness and 1 case had ineffectiveness.

Analysis of the Diagnostic Consistency of Chinese Medicine Specialists in Cardiovascular Disease Cases and Syndrome Identification Based on the Relevant Feature for Each Label Learning Method

Objective：To analyze the diagnostic consistency of Chinese medicine（CM） specialists in patients with cardiovascular disease and to study syndrome classification and identification based on the multi-label learning method.Methods：Using self-developed CM clinical scales to collect cases,inquiry information,complexity,tongue manifestation and pulse manifestation were assessed.The number of cases collected was 2,218.Firstly,each case was differentiated by two CM specialists according to the same diagnostic criteria.The consistency of the diagnosis based on Cohen’s Kappa coefficient was analyzed.Secondly,take the same diagnosis syndromes of two specialists as the results of the cases.According to injury information in the CM scale ＂yes＂ or ＂no＂ was assigned ＂1＂ or ＂0＂,and according to the syndrome type in each case ＂yes＂ or ＂no＂ was assigned ＂1＂ or ＂0＂.CM information data on cardiovascular disease cases were established.We studied CM syndrome classification and identification based on the relevant feature for each label（REAL） leaming method,and the diagnostic rate of the syndrome was studied using the REAL method when the number of features selected was 5,10,15,20,30,50,70,and 100,respectively.Results：The syndromes with good diagnostic consistency were Heart（Xin）-qi deficiency,Heart-yang deficiency,Heart-yin deficiency,phlegm,stagnation of blood and stagnation of qi.Syndromes with poor diagnostic consistency were heartblood deficiency and blood deficiency of Heart and Liver（Gan）.The highest diagnostic rates using the REAL method were Heart-yang deficiency followed by Heart-qi deficiency.A different number of features,such as 5,10,15,20,30,40,50,70,and 100,respectively,were selected and the diagnostic accuracy based on five features showed the highest diagnostic accuracy.The top five features which had a strong correlation with the syndromes were in accordance with the CM theory.Conclnsions：CM syndrome differentiation is strongly subjective and it is difficult to obtain good diagnostic consistency.The REAL method fully considers the relationship between syndrome types and injury symptoms,and is suitable for the establishment of models for CM syndrome classification and identification.This method can probably provide the prerequisite for objectivity and standardization of CM differentiation.

Treatment of 102 Cases of Tourette＇s Syndrome with Acupuncture plus Herbal Medicine

102 cases of Tourette＇s syndrome were divided into three types of the liver and kidney yin deficiency, phlegm and damp blockage and spleen and stomach deficiency. Acupuncture, auricular-plaster therapy, cupping therapy and herbal medicine were combined to treat this syndrome. As a result, 30 cases were satisfactorily effective, 61 cases were improved and 11 cases were ineffective with a total effective rate of 98.2% and no side effects were noticed during treatment.

Clinical Observation on 48 Cases of Peripheral Facial Paralysis Treated by Acupoint-penetrating Acupuncture

In the treatment of 48 cases of peripheral facial paralysis by puncturing Yangbai （GB 14） toward Yuyao （Ex-HN 4）, Dicang （ST 4） toward Jiache （ST 6）, Xiaguan （ST 7） toward Jiache （ST 6）, Sibai （ST 2） toward Quanliao （SI 18）, Baihui （GV 20） toward Taiyang （Ex-HN 5）, Yintang （Ex-HN 3） toward Shangen （Ex HN ）, Cuanzhu （BL 2） toward Jingming （BL 1）, and Hegu （LI 4） toward Laogong （PC 8） on the sick side, with other acupoints added in accordance with the symptoms, the results showed cure in 39 cases, remarkable effect in 7 cases, failure in 2 cases, and the curative rate in 81.2% and the effective rate in 95.8%.

Observation on Therapeutic Effect in Acupuncture Treatment of Soft Tissue Injuries by Differentiation of Deficient and Excessive Patterns

Objective： To compare the therapeutic effects between the needling method by identification of deficient and excessive patterns and the needling method by routine meridian differentiation in the treatment of soft tissue injuries. Methods. 380 cases of the patients with soft tissue injuries were randomly divided into pattern identification group （200 cases, with the needling method by identification of deficient and excessive patterns） and meridian identification group （180 cases, with the needling method by routine meridian differentiation）, to observe and compare the therapeutic effects in the two groups. Results： The curative effect was 86% in the pattern identification group and 31.11% in the meridian identification group, with a significant difference （P〈 0.01）. In comparison with the total average treatment times in the cured and improved cases, the pattern identification group was 8.8 days and the meridian identification group was 15.6 days, with a remarkable significant difference （P〈 0.01）. The pattern identification group was better than the meridian identification group. Conclusion： In the treatment of soft tissue injuries, the needling method by identification of deficient and excessive patterns was better than the needling method by routine meridian differentiation.

Treatment of 43 Cases of Enuresis by Acupuncture

By classification with syndrome differentiation into the three patterns of deficient cold in the lower energizer, qi deficiency in the spleen and lung and damp heat in the Liver Meridian, 43 cases of enuresis were treated by puncturing Baihui (GV 20), Guanyuan (CV 4) and Shanyinjiao (SP 6). After two courses of the treatment, the results showed cure in 28 cases, improvement in 13 cases and failure in 2 cases. Key Words Enuresis - Acupuncture Therapy - Syndrome Differ Classification Translator: HUANG Guo-qi

Clinical Study on Treatment of Depression with Combined Acupuncture & Medicine

Purpose To observe and compare the curative effects of combined acupuncture and medicine with simple herbal medicine on treatment of depression.Method Altogether 63 cases were enrolled according to the determination of internationally accepted self-evaluation depression scales (SDS), among tehm 33 cases were treated with combination of acupuncture and herbal medicine (acupuncture-medicine group) and the other 30 cases were in treated with herbal medicine alone (herbal medicine group)Results The total effective rate of acupuncture-medicine group was 90.9% and that of herbal group was 80.0%. And there was significant statistics difference between the curative effects of two groups (P<0.05) without obvious adverse reaction.Conclusion Combination of acupuncture and medicine has better effect in treating depression than herbal medicine group. Key Words Depression - Acupuncture Medication Combined - Syndrome Differ Classification Author: XU Hong (1967-), femake, attending physicianTranslator: HAN Chou-ping

Clinical Observation of 40 Cases of Acne Treated by Acupuncture plus Herbal Drugs

Acne is divided into the patterns of wind and heat in the lung meridian and accumulation of dampness and heat. Forty cases of acne were treated by acupuncture plus herbal drugs (acupuncture and drug group, A) and 30 cases were treated by simple acupuncture as the control group (acupuncture group, B). The results showed basic cure in 31 cases, remarkable effect in 5 cases, effect in 3 cases, failure in 1 case and the total effective rate of 97.5% in Group A, and basic cure in 16 cases, remarkable effect in 6 cases, effect in 3 cases, failure in 5 cases and the total effective rate of 83. 3% in Group B. There was no significant difference (P>0.05) in the therapeutic effect and there was a significant difference (P<0.01) in the curative rate in the two groups. The therapeutic effect was obviously better in Group A than in Group B. Key Words Acne - Acupuncture Therapy - Drug Therapy (TCD) - Syndrome Differ Classification Author: CAI An-he (1971-), male, residentTranslator: Huang Guo-qi

Treatment of Depression by Acupuncture in 36 Cases

Thirty-six cases of depression were mainly treated by needling Shenmen (HT 7), Sanyinjao (SP 6) and Zusanli (ST 36). In the case of liver-qi atagnation, Taichong (LR 3) and Hegu (LI 4) were added; in the case of phlegm-dampness accumulation, Fenglong (ST 40) and Yinlingquan (SP 9) were added; in the case of deficiency of both heart and spleen, Xinshu (BL 15) and Pishu (BL 20) were added. Fifteen cases were cured, 7 cases markedly improved, 8 cases improved and 6 cases failed. Key Words Depression - Acupuncture-Moxibustion - Syndrome Differ Classification Author: YE Guo-chuan (1960-), male, attending physicianTranslator: XIAO Yuan-chun

Treatment of 92 Cases of Allergic Rhinitis by Combination of Acupuncture and Medicine

Objective： To investigate the therapeutic effect of combination ot acupuncture and medicine in treating allergic rhinitis. Methods： Acupuncture, moxibustion, nasal inhalation and oral administration of Chinese materia medica were used as a composite treatment for different constitutions. The relations of the patient＇s age, syndrome type and course of disease to the therapeutic effect were investigated. Results： Among the treated 92 cases, marked effectiveness occurred in 68, effectiveness in 16 and ineffectiveness in 8, with a total effective rate of 91.3%. The therapeutic effect was not good in the patients who belonged to dry heat in lung meridian type and had the course of disease for more than 20 years. Conclusion： A combination of acupuncture and medicine has an exact therapeutic effect on allergic rhinitis.