An expert analysis of diagnostic criteria for traditional Chinese medicine syndromes of chronic obstructive pulmonary disease at acute exacerbation stage

Abstract

Objective To investigate the common syndromes, clinical symptoms and characteristics of chronic obstructive pulmonary disease at acute exacerbation stage (AECOPD). Methods Delphi method was used to organize the AECOPD expert questionnaire. This questionnaire was distributed to 30 selected experts of respiratory diseases. The resulting data were statistically analyzed by Chi-square test and statistical description such as mean, coefficient of variation and ratio of full marks. Common syndrome: mean≥3. 00,coefficient of variation ＜30％ and ratio of full marks≥ 10％ and common clinical symptoms: for major symptoms present, the index mean≥4.00 and coefficient of variation ＜30％ and for minor symptom, index mean≥3. 00 and coefficient of variation ＜30％ were used as criteria. Results Twenty-nine valid expert questionnaires were received. The coefficient of positivity was 96. 67％, of authority was 0. 835 and of coordination equals 0. 359 (x2= 463. 15, P = 0. 001). The mean, coefficient of variation and ratio of full marks for AECOPD syndrome of wind and cold invasion of lung（风寒束肺证）were 4.12, 21.50％, and 34.48％, respectively. Those for syndrome of exogenous cold-evil and fluid-retention（外寒内饮证）were 4. 39, 14. 32％, 48.28％; those for syndrome of wind and heat invasion of lung（风热犯肺证）were 3.54,30. 77％, 6.90％；those for syndrome of phlegm-heat obstructionof the lung（痰热壅肺证）were 4.85,9.23％, 89. 66％; those for syndrome of pulmonary stagnation of phlegm（痰湿阻肺证）were 4.36,15.57％, 48. 28％；those for syndrome of external cold and internal heat（表寒里热证）were 4.59, 16.27％,65.52％; those for syndrome of retention of phlegm and blood stasis in the lung（痰瘀阻肺证）were 4.54,12.70％, 55.17％；those for syndrome of qi deficiency of the lung and spleen（肺脾气虚证）were 3.25,27.30％, 13. 79％; those for syndrome of qi deficiency of the lung and kidney（肺肾气虚证）were 3.32,27. 24％, 13. 79％；those for syndrome of qi-yin deficiency of the lung and kidney（肺肾气阴两虚证）were 3. 29, 28. 98％, 24.14％；those for syndrome of yin deficiency of the lung and kidney（肺肾阴虚证）were 2. 98, 32.71％,3.45％; those for syndrome of blood stasis（血瘀证）were 4.67, 10.29％, 62.07％ and those for syndrome of fu shi（腑实证）were 3.07, 30. 01％,6.90％, all respectively. The blood stasis and fu shi were accompanying syndromes. Conclusion Seven common syndromes of AECOPD are wind and cold invasion of lung, exogenous cold-evil and fluid-retention, phlegm-heat obstruction in the lung, pulmonary stagnation of phlegm qi deficiency of the lung and spleen, qi deficiency of the lung and kidney, as well as qi-yin deficiency of the lung and kidney. One additional syndrome that accompanies many of the afore-mentioned syndromes was blood stasis. Key words: Chronic obstructive pulmonary disease; Acute exacerbation stage; Syndrome; Delphi method