基于层次聚类与复杂症状网络的广泛性焦虑障碍之上热下寒证的症状关系

目的 全面系统地探究广泛性焦虑障碍(generalized anxiety disorder, GAD)之上热下寒证的症状特点。方法 使用广泛性焦虑障碍中医证候调查表评估首都医科大学附属北京安定医院门诊收治的168例GAD患者的中医四诊信息与西医精神症状信息。专家判定其中100例为上热下寒证患者,68例为非上热下寒证患者。通过频数分析研究上热下寒证的常见寒、热症状分布特点。通过层次聚类分析GAD之上热下寒证的病位证素、病性证素。再通过提取GAD之上热下寒证的核心症状,进行核心症状间的复杂症状网络分析,探究上热与下寒症状间的内在逻辑关系。最后联合聚类分析与复杂网络分析结果,探寻GAD之上热下寒证的核心病机。结果 GAD上热下寒证的患者较非上热下寒证的患者病程更长,焦虑程度显著较高,常见症状(频率>30%)更多。GAD上热下寒证常见(频率>30%)的寒、热症状有:口舌干燥、舌苔白、两目干痒、下肢不温、面部洪热潮热、口苦、口渴欲饮、小腹畏寒、腰凉、盗汗、头热汗出、脉滑、手热足冷、足胫寒冷、面部多汗。GAD上热下寒证的病位证素为:心、胃、肾、督脉、脾、胆;病性证素为:火热、寒凝、气滞、气虚、阳虚。精神焦虑在核心症状的复杂症状网络中的作用最大。结论 精神症状在GAD上热下寒证的症状中占据主导地位,其潜在的核心病机可能是“君火失明,相火离位”,其治疗则为清热安神,辅以温阳。

Relationship between Upper-heat and Lower-cold syndrome of generalized anxiety disorder based on hierarchical clustering and complex symptom network

Objective To comprehensively and systematically explore the symptom characteristics of generalized anxiety disorder (GAD) with Upper-heat and Lower-cold syndrome. Methods The questionnaire about traditional Chinese medicine (TCM) syndrome of GAD was developed to collect the information of TCM four diagnosis and western medicine mental symptoms of 168 patients with GAD in the outpatient clinic of Beijing Anding Hospital ,Capital Medical University. Among them, 100 cases were diagnosed as Upper-heat and Lower-cold syndrome and 68 as non Upper-heat and Lower-cold syndrome.Frequency analysis was used to display the distribution characteristics of two groups. Hierarchical Clustering analysis was used to analyze the syndrome elements of disease location and disease syndrome of Upper-heat and Lower-cold syndrome of GAD.Then through the extraction of the core symptoms of the Upper-heat and Lower-cold syndrome of GAD. The complex symptom network analysis of the core symptoms was carried out to explore the inherent logical relationship within the Upper-heat and Lower-cold syndrome. Finally, we combined the results of cluster analysis and complex network analysis, the core pathogenesis of the Upper-heat and Lower-cold syndrome of GAD was explored. Results The GAD patients with the Upper-heat and Lower-cold syndrome have a longer course of disease and a significantly higher degree of anxiety than those with non Upper-heat and Lower-cold syndrome. The common cold and heat symptoms of the Upper-heat and Lower-cold syndrome of GAD included dry tongue, white tongue coating, dry and itchy eyes, lukewarm lower limbs, facial hot flashes, bitter mouth, thirst and thirst, cold abdomen, cold waist, night sweats, head hot sweating, slippery pulse, hot hands and cold feet, cold feet and shins, and sweating on the face. The syndrome elements of disease location in the Upper-heat and Lower-cold syndrome of GAD included heart, stomach, kidney, governor-vessel, spleen, and gallbladder. The disease syndrome elements included fire-heat, cold-coagulation, Qi-stagnation, Qi-deficiency, and Yang-deficiency. Psychiatric symptoms of anxiety played the most important role in the core complex symptom network. The core pathogenesis of the syndrome of Upper-heat and Lower-cold in GAD may be the deficiency of Ministerial fire caused by excessive consumption of monarch fire. Conclusion Psychiatric symptoms of anxiety occupy a dominant position in the symptoms of Upper-heat and Lower-cold syndrome, so the core pathogenesis of GAD may be “Monarch fire loss of purity, Ministerial fire being offside”, the treatment principle is to clear heat and calm the mind supplemented by warm Yang.