Wen | Doctor LuEdit | XihefollowWith the activity of the construction industry and the development of the transportation industry,Severe trauma has become one of the main causes of human death, with a mortality rate of approximately 10%.Relevant studies show that about 27% of patients with severe trauma have Pulmonary contusion

Wen | Doctor Lu

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With the activity of the construction industry and the development of the transportation industry,Severe trauma has become one of the main causes of human death, with a mortality rate of approximately 10%.

Relevant studies show that about 27% of patients with severe trauma have Pulmonary contusion. If the lung condition of patients with mild Pulmonary contusion worsens further, they are likely to develop into acute respiratory distress syndrome (ARDS), and often need to establish artificial airway and mechanical ventilation treatment.

Patients with Pulmonary contusion have unique Pathophysiology characteristics, combined with severe trauma and complicated conditions,Affected by various factors and inflammatory reactions, ICU hospitalization time is often prolonged and the mortality rate increases.

For mild patients, timely control of changes in their condition, accurate differentiation of symptoms, and containment of their transition to severe illness are the key to successful treatment.

Syndrome differentiation and treatment "is the core of the theoretical system of traditional Chinese medicine,There are many TCM syndrome differentiation methods for severe trauma, such as Eight principles, Weiqiyingxue, Sanjiao, etc.

Most doctors adopt the methods of "disease classification" and "syndrome differentiation", which leads to personalized syndrome differentiation plans. In addition, most severe trauma patients have many factors that affect syndrome differentiation, and the results cannot be unified, which brings confusion to clinical research.

Therefore, there is an urgent need to establish a new dialectical system to solve the current difficulties.

The essence of pathological changes is syndrome elements, and the core of syndrome differentiation is syndrome elements.

Identifying syndrome elements based on symptoms can not only avoid the subjective influence of physicians, but also improve the accuracy of syndrome differentiation.

Therefore,The Establishment of the System of "Differentiation of Syndrome Elements"To overcome the shortcomings of existing syndrome differentiation methods, reflect the essential characteristics of syndrome differentiation, and have the effect of using simplicity to overcome complexity, more objectively, accurately, and scientifically reflect the nature of the disease, thereby reflecting the true characteristics of the condition, improving the accuracy of clinical syndrome differentiation and treatment, and achieving therapeutic effects.

Through the extraction and analysis of TCM syndrome elements of patients with severe trauma combined with mild Pulmonary contusion, this paper discusses the characteristics of TCM syndrome elements, so that clinical doctors can timely control the changes of patients' conditions and provide reference for TCM syndrome differentiation of this disease. The current report is as follows.

Case selection: The diagnostic criteria of Western medicine comply with the diagnostic criteria for severe trauma specified in the "Procedures and Standards for In-hospital Treatment of Severe Trauma".

There is no clear diagnostic criteria for Pulmonary contusion,And clinical manifestations include cough, chest tightness, chest pain, and even difficulty breathing. Combined with chest auscultation, signs such as wet rales or decreased respiratory sounds can be heard.

For the main manifestations on CT, the imaging physician with the title of attending physician or above should calculate the area of Pulmonary contusion, and the area of Pulmonary contusion should be calculated for those with mild symptoms< 20%.

Inclusion criteria:It meets the diagnostic criteria of severe trauma with mild Pulmonary contusion: the medical records are complete and can provide the syndromes needed for syndrome element extraction.

Exclusion criteria: patients with incomplete medical records, patients with moderate to severe Pulmonary contusion or those who need mechanical ventilation, and patients with other organ injuries.

Source of cases: A total of 132 patients with severe trauma combined with mild Pulmonary contusion diagnosed by Shandong Wendeng Orthopedic Hospital from January 2018 to December 2020 were collected, and 112 patients met the inclusion criteria.

Research method: After confirming the general situation of the patient and the required evidence elements, fill them in an Excel spreadsheet and analyze the frequency and frequency.

Using SPSS22 software, exclude syndrome elements with a frequency of less than 3%, and use systematic clustering method to analyze the clustering of syndrome elements.

Result: Among the 112 enrolled patients with gender and age, there were 73 males (65.18%) and 39 females (34.82%), with a male to female ratio of 1.87:1. The age distribution was as follows: 22 patients aged 20-40, 38 patients aged 41-60, and 41 patients aged 61-80; 11 cases aged 80.

Injury factors: Among the 112 enrolled patients, there were 71 car accident injuries, 16 high-altitude falling injuries, 15 mechanical injuries, 4 heavy object injuries, 4 crush injuries, and 2 other injuries.

Distribution of syndrome elements: A total of 112 enrolled patients summarized 26 types of syndrome elements, including 9 disease location syndrome elements and 17 disease nature syndrome elements. The most frequently occurring disease location syndrome element was lung,The frequency of appearance is lower in the chest diaphragm, surface, liver, gallbladder, spleen, stomach, kidney, and large intestine.

Pathogenic Syndrome ElementsThe frequency of blood stasis is highestNext are phlegm, qi stagnation, yin deficiency, qi deficiency, wind, cold, dampness, blood deficiency, yang deficiency, yin deficiency, and jin deficiency. The frequency of blood movement, toxicity, blood cold, dryness, and blood heat is relatively low.

Cluster analysis of syndrome elements: Using SPSS 22 software and nearest neighbor element clustering method, excluding disease type syndrome elements and disease location syndrome elements with frequency less than 3, cluster analysis of 26 syndrome elements was conducted using nearest neighbor element method.

The combination pattern of syndrome elements is: the disease location syndrome elements, liver and gallbladder, and the disease nature syndrome elements, blood deficiency, and dampness accumulation are one type of syndrome, and the combination syndrome types can be liver blood deficiency and dampness accumulation under the jiao.

The disease location and syndrome element table, along with the disease nature and syndrome element wind and cold accumulation, can be combined into the syndrome types of exterior cold syndrome and exterior deficiency syndrome.

The syndrome elements of spleen and stomach, as well as the syndrome elements of spleen and stomach deficiency, yin deficiency, and yang deficiency, are classified into one category. The syndrome types can be combined as spleen and stomach yin deficiency and spleen and stomach yang deficiency. The syndrome elements of lung, chest and diaphragm, as well as the syndrome elements of blood stasis, are classified into one category, and the syndrome types can be combined as follows:Pulmonary blood stasis syndrome or upper jiao blood stasis syndrome.

When the scale approaches 5, the pathogenic syndrome elements of qi stagnation, qi deficiency, phlegm, yin, and blood stasis are grouped together with the disease location syndrome elements of lung and chest diaphragm, and can be combined into lung qi deficiency syndrome, suspended yin, lung qi stasis syndrome, and phlegm turbidity obstructing lung syndrome. When the scale is 25, each item is grouped into one category.

Trauma is one of the ancient medical topics, and with the development of the economy and society, the incidence rate has not decreased but increased.

In China, the number of deaths due to severe trauma is over 200000 every year, and the economic loss is as high as 6% of the gross domestic product.

With the improvement of people's quality of life and changes in transportation methods, there are many areas of injury caused by trauma, making treatment difficult.

Modern research shows that Systemic inflammatory response syndrome (SIRS) caused by severe trauma is the main cause of multiple organ dysfunction (MODS).

However, the lung is the most vulnerable target organ in this process, especially when combined with Chest injury or Pulmonary contusion, it is very easy to lead to further development of the disease into acute respiratory distress syndrome (ARDS), increase the number of days in ICU and the incidence of complications, and if not treated in time, the case fatality rate can be as high as 14%~40%.

There is no name of Pulmonary contusion in Traditional Chinese medicine. According to the clinical manifestations of Pulmonary contusion,Chest tightness, cough, chest pain, etc. can be categorized as coughing, chest pain, etc,As stated in "Su Wen Ke Lun", "The appearance of lung cough is characterized by coughing and wheezing with sound, and even spitting blood.

For the dialectical treatment of Pulmonary contusion, there are different opinions. For example, Lu Yue and others believe that the TCM disease of lung injury is caused by heat, toxin, and warm pathogen. It first attacks the lung, and the heat pathogen turns into toxic pathogen over time. Phlegm and blood stasis are pathological products.

Chang Tzi-chin and others believed that,Toxic pathogens are the main cause of lung injury, and it is advocated to use the method of clearing the internal organs and relieving heat to prevent sepsis related lung injury.

These studies are all about the understanding of Pulmonary contusion from different perspectives. Although they are helpful for clinical application, patients with severe trauma have complex conditions, different syndromes, and are affected by subjective factors of the doctors. The results of syndrome differentiation are lack of accuracy, standardization and repeatability.

This also brings difficulties for clinical practitioners to differentiate and evaluate the progression of patients' diseases.

The establishment of a new system of "syndrome element differentiation" integrates the essential contents of the eight principles, viscera, and six meridian differentiation, and proposesThe Law of thought of TCM syndrome differentiation is to identify syndrome elements and form syndrome names according to syndrome.

Revealed the universal laws, essence, and characteristics of syndrome differentiation, and found the key to simplifying complex and flexible syndrome differentiation methods, which is more in line with the actual clinical syndrome differentiation and is easy to master and operate.

It enables doctors to distinguish and deal with various clinical syndromes more flexibly, overcomes the shortcomings of the past mixing of ancient and modern methods, imprecise concepts, incomplete content, and even contradictory and confusing, fully reflects the scientificity of Traditional Chinese medicine, and is a new system of syndrome differentiation with great significance for the development of traditional Chinese medicine.

Therefore, from the perspective of syndrome elements, the author analyzes the characteristics of disease location and disease distribution of patients with severe trauma combined with mild Pulmonary contusion, in order to extract the characteristics of syndrome differentiation and classification of the disease and guide clinical diagnosis and treatment.

Based on the above background, this study combed 112 patients with severe trauma and mild Pulmonary contusion, and found that the distribution and combination of syndrome elements were as follows:This disease involves 9 elements of disease location and syndrome, namely lung, chest diaphragm, surface, liver, gallbladder, spleen, stomach, kidney, and large intestine.

The frequency of occurrence is highest in the lungs and chest diaphragm, followed by the surface, with less involvement in the kidneys and large intestine.

There are four types of combinations: lung, surface, lung+chest diaphragm, spleen+stomach,The main location of this disease is in the lungs and chest diaphragm, so the proportion of lung and chest diaphragm in the disease location syndrome elements is extremely high.

The Huangdi Neijing says that "the lung governs the exterior, and the qi governs the respiration", and the Spleen and Stomach Theory says that "the spleen and stomach are the source of qi and blood biochemistry". The spleen governs transportation and circulation, and governs blood circulation. Pulmonary disease lasts for a long time, and the function of transportation and circulation of children, mothers, and middle energizers is damaged. Therefore, the exterior, spleen, and stomach can also be involved in the disease location and syndrome elements.

The kidney is the innate foundation, the organ of water and fire, the root of qi, the lung is injured, and prolonged illness affects the kidney. The hand Taiyin lung meridian and the hand Yangming large intestine meridian are external and internal,The lung qi dominates the promotion of depression, while the lung qi is deficient and unable to promote the conduction of dross in the large intestine.

Therefore, the kidney and large intestine can be seen in the disease location syndrome elements, but the lower frequency of the two in this disease may be due to the small sample size included, the condition is in the primary stage, and has not reached the stage of prolonged illness, kidney or large intestine transmission.

There are 17 pathogenic syndrome elements, including blood stasis, phlegm, qi stagnation, yin, qi deficiency, wind, cold, dampness, blood deficiency, yang deficiency, yin deficiency, jin deficiency, blood circulation, toxin, blood cold, dryness, and blood heat.

The frequency of blood stasis, phlegm, and qi stagnation is high, followed by yin, qi deficiency, wind, cold, dampness, blood deficiency, yang deficiency, and yin deficiency. The combination of disease related syndrome elements is mainly a single syndrome element, with blood stasis having the highest frequency, followed by a combination of two syndrome elements. Blood stasis+qi stagnation is the most common, and no combination of three or more disease related syndrome elements is found.

It can be seen that in the early stages of this disease, empirical evidence is more common,The main pathogenic syndrome elements are blood stasis, phlegm, and qi stagnation, which are consistent with the main pathogenesis of lung injury proposed by modern research.

This study obtained 12 syndrome types through cluster analysis: lung blood stasis syndrome or upper jiao blood stasis syndrome, lung qi deficiency syndrome, suspended drink, lung qi stagnation, phlegm turbidity obstructing lung syndrome, liver blood deficiency, dampness accumulation lower jiao syndrome, superficial cold syndrome, superficial deficiency syndrome, spleen stomach yin deficiency, spleen stomach yang deficiency syndrome.

The most common syndrome types are: pulmonary blood stasis or upper energizer stasis.

Therefore, lung blood stasis syndrome is the most common, followed by lung qi stagnation syndromeDisease location and syndrome element lung, disease nature and syndrome element blood stasis and qi stagnation play an important role in the onset and development of severe trauma with mild Pulmonary contusion, and are the core pathogenesis of this disease.

Follow up on the development of the condition,Patients may exhibit symptoms of lung qi deficiency and superficial symptoms, such as aversion to cold, fever, spontaneous sweating, and strong neck.

As the theory of traditional Chinese medicine suggests, the lungs regulate the body's surface defense function by regulating the skin and fur. The exhalation and exhalation of the lungs can effectively activate the body's functions of "warming and dividing the flesh, nourishing the skin, and regulating the opening and closing of the body".

Qi is the commander of blood and blood is the mother of Qi. Prolonged lung blood stasis and qi stagnation can lead to deficiency of lung qi and liver blood, and weakened "Rongwei" function, thus exhibiting symptoms of superficial symptoms.

The spleen is responsible for the circulation and circulation of blood, and for the long-term development of lung diseases. As a result, the function of the middle energizer is impaired, resulting in symptoms such as spleen and stomach yin deficiency, spleen and stomach yang deficiency, and dampness accumulation in the lower energizer.

Anyway,Although the symptoms and pathogenesis of patients with severe trauma combined with mild Pulmonary contusion are different, there are still rules to follow in the changes of the condition.

Through syndrome element differentiation, we can analyze the syndrome differentiation of patients with severe trauma combined with mild Pulmonary contusion from another angle, which can improve the accuracy of syndrome differentiation of doctors to a certain extent. The research results are basically consistent with the clinical syndrome differentiation of modern Chinese medicine and most of the literature research conclusions.

And the use of systematic clustering analysis to combine common traditional Chinese medicine syndrome types greatly reduces the bias caused by doctors' subjective judgments in the past, making the data analysis results more objective and scientific.

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