Printer Friendly

Exploratory Factor Analysis for Validating Traditional Chinese Syndrome Patterns of Chronic Atrophic Gastritis.

1. Background

Chronic atrophic gastritis (CAG) is an inflammatory disease of the stomach from various etiologies [1-3]. Typical symptoms, when present, include epigastric pain, fullness, belching, anorexia, and other nonspecific symptoms [3]. CAG can lead to mucosal atrophy, intestinal metaplasia (IM), and gastric intraepithelial dysplasia (GED), also known as intraepithelial neoplasia, which is defined as the precancerous stage of gastric carcinoma [1,4,5]. Global cancer statistics for 2012 estimated that there were 951,600 new cases of stomach cancer worldwide [6]. The transition from chronic gastritis to gastric cancer is a typical disease model of uncontrolled inflammation leading to malignant transformation [7-10]. Active treatment of CAG arrests further malignant transformation, and thus prevents gastric cancer [11,12].

Traditional Chinese medicine (TCM) has a long history in treating gastritis. Numerous basic and clinical studies have demonstrated that Chinese medicine can effectively treat CAG, including resolving mucosal inflammation and reversing glandular atrophy, as well as inhibiting or even reversing intestinal metaplasia and gastric epithelial dysplasia [13-24]. Modern-day TCM treatment of CAG remains based on the time-honored core principle of syndrome pattern differentiation to identify and treat the root of illness. When differentiating a patient's syndrome pattern, the TCM practitioner systematically collects comprehensive information about the presenting signs and symptoms, using the four diagnostic methods of looking, listening/smelling, asking, and palpating. The collocated information is then evaluated according to TCM theory and clinical experience to identify the physical condition and nature of pathologic changes during the current stage of the disease. Treatment is then applied in accordance with conclusions drawn from the pattern differentiation process.

Factor analysis (FA) is a statistical analytic method for reducing data, that is, the redundancy of variables, and to detect the structure (relationships) among the variables being measured. FA has been applied in TCM to develop usable dimensional taxonomies, by which large numbers of observed variables can be remodeled as linear combinations of a smaller number of the underlying factors. There are two modes of FA. Exploratory factor analysis (EFA) is an exploratory data-driven tool that generates solutions for developing theories. Its aim is to explore the relationships among the variables without a specific hypothesis or a priori fixed number of factors. Confirmatory factor analysis (CFA) is a method for theory testing that requires the researcher to have substantive knowledge and a firm idea about the number of factors that will be come upon during analysis. In the field of TCM, EFA is being used increasingly for data mining of measured variables such as clinical information obtained during syndrome pattern differentiation. Through EFA features of the distribution of syndromes can be ascertained.

Although various studies have demonstrated that TCM can effectively treat CAG [13-24], there has been a lack of consensus across studies on syndrome differentiation, treatment strategy, and elaboration of herbal prescriptions [2527]. This is likely due to the complexity of CAG pathogenesis in TCM. Results of literature reviews have confirmed the lack of agreement in CAG syndrome features [28-33] with only a few studies focusing mainly on CAG. This situation is not conducive to standardization of syndrome differentiation and improvement in treatment efficacy of CAG. The present study explored syndrome pattern features and core TCM pathogenesis of CAG by applying EFA to provide evidence for establishment of TCM treatment principles and standardization of syndrome differentiation for chronic atrophic gastritis.

2. Methods

2.1. Study Design and Participants. This study was conducted between September 2010 and October 2012 based on participant survey. Outpatients and inpatients who visited the hospital for upper gastrointestinal endoscopy and were diagnosed with CAG were recruited by simple random sampling from medical centers in Beijing and Xiamen, China: Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Peking Union Medical College Hospital Affiliated to the Chinese Academy of Medical Sciences, Beijing Hospital Affiliated to the National Health and Family Planning Commission of China, and Xiamen Traditional Chinese Medicine Hospital. All participants signed consent forms. Ethics approval of the present study was given by the Medical Ethics Committee of Beijing University of Chinese Medicine.

2.2. Diagnostic Criteria. Diagnostic criteria of CAG were based on Chinese Society of Gastroenterology, Chinese Medical Association, guidelines [1].

2.3. Inclusion and Exclusion Criteria. Inclusion criteria were as follows: (1) meeting the diagnostic criteria of CAG with detailed medical records and diagnostic reports, (2) age: 2075 years old, (3) willing to participate in the investigation and sign informed consent, and (4) capable of completing the clinical observation questionnaire and responding to the investigator queries.

Exclusion criteria were as follows: (1) unclear diagnosis or not meeting the diagnostic criteria of CAG, (2) not meeting the age criteria; (3) cognitive difficulty such that four diagnostic methods cannot be completed accurately; (4) other digestive disease or neurologic, circulatory, respiratory, and endocrine disease.

2.4. Case Report Form Content and Administration. Content of the CAG case report form (CRF) was based on literature research, on expert advice, and on standard Chinese guidelines [34-37]. CRF content included general information (name, sex, and age), disease data (complaint, history of present illness, past medical history, family medical history, and endoscopy results), information from the four diagnoses (symptoms, physical signs, tongue appearance, and pulse reading), western medicine diagnosis, and TCM diagnosis.

Disease history and results of the four diagnostic methods were collected and recorded. Records that met the following criteria were deemed acceptable: all general information filled in except address and contact details and complete information for CAG and four diagnostic methods.

The study was carried out with strict quality control. All investigators were specialized in TCM or integrated Chinese and Western medicines and trained in standard operating procedures of the study. Each study participant was examined and followed up by at least two resident physicians or graduate students who filled in the CRFs. At least two senior staff physicians supervised the interview sessions to ensure consistency and authenticity of data collection to reduce measurement bias.

2.5. Data Analysis. Frequency analysis was performed on data collected from the four diagnostic methods. Exploratory factor analysis (EFA) was performed on syndrome element extraction (Figure 1). All statistical analyses in this study were processed by SPSS software (version 17.0, SPSS Inc., Chicago, IL, USA).

3. Results

3.1. Characteristics of Participants. A total of 135 CRFs were distributed, and 131 were completed and returned, with a return rate of 97%. There were 120 forms, that is, patients, that were deemed eligible for the study after eliminating questionnaires with incomplete information, thus, with the acceptance rate of 92%. Among the participants, 62 were male and 58 were female, with an average age of 52.56 and a standard deviation of 12.45.

3.2. Distribution Characteristics of Results from the Four Diagnostic Methods. Information from the four diagnostic methods was collected and 53 entries with >10% frequency were tabulated based on the distribution frequency (Table 1).

Data were preanalyzed and ultimately 40 diagnostic variables with more than 21% frequency of occurrence were chosen to judge the applicability of the data for EFA, so as to determine the number of common factors to be extracted for formal analysis.

3.3. Suitability Test. KMO and Bartlett's test of sphericity were used to evaluate suitability of collocated diagnostic variables for EFA. The Kaiser-Meyer-Olkin (KMO) test assesses partial correlation between variables, and if the KMO value is >0.5, the variable will be more suitable for EFA. In addition, the closer the KMO value is to 1, the stronger the correlation is between variables. Bartlett's test of sphericity assesses the null hypothesis and whether the correlation matrix is rejected as a unit matrix. Only when variables are relatively nonindependent (P < 0.05) can theybe used for EFA.

In this study, the KMO value of the partial correlation of variables was 0.549 > 0.5 (Table 2), indicating a certain degree of partial correlations between variables, such that EFA could be carried out. The approximate chi-square value of Bartlett's test of sphericity was 1589.24 and P < 0.001, indicating strong correlation between variables, rejection of the hypothesis of independence of variables, and that the variables could be applied to EFA.

3.4. Assessment of Common Factors. Characteristic root value is an index to evaluate the influence of extracted common factors; that is, introduction of this common factor can explain and evaluate the information of the original variables. Variance contribution rate is the proportion of communality in all variances, and the value is positively correlated with carrying capacity of comprehensive information. The cumulative variance contribution rate is the accumulation of variance contribution rate of first N common factors, which represents the proportion of information of all variables whose first N common factors is covered. Results of characteristic root values and variance contribution rate of common factors were tabulated (Table 3). Principal component analysis was applied to extract common factors. Characteristic root values of the first 15 common factors were greater than 1, and their cumulative variance contribution rates reached 70.795, good overall data interpretation capability.

Scree plot displayed relevance of common factors and characteristic root values (Figure 2). The number of common factors was shown on the x-axis and the characteristic values on the y-axis. Scatter locations of first 15 common factors were steep, and characteristic root values of the last 25 common factors were small as revealed by the leveling off of the curve's slope. Thus, the number of extracted common factors in formal calculation was 15.

3.5. Factor Rotation and Transformation. Factor rotation was performed to allow the factor load absolute value of the new common factor for each of the four diagnostic results to polarize to 0 or 1 and thus more clearly display the load of all common factor variables, as well as maintaining the variance of all common factors in the corresponding row unchanged. This allows for a more reasonable explanation for the extraction of all common factors. Principal component analysis was used to extract 15 common factors, and the factor rotation method used was varimax rotation. Rotation was converged after 20 iterations and results of the factor load matrix after rotation transformation is shown in Table 4.

3.6. Common Factor Extraction. In Table 4, the factor load value was the coefficient values of each common factor that were used to reflect the closeness between common factors and variables. The essence of factor load values was the correlation coefficient between them. A positive factor load value from the four diagnostic methods' information represents a positive correlation, and a negative factor load value represents a negative correlation. Correlation between them had a positive correlation with factor load value. Load coefficients that were positive and larger or equal to 0.25 of the four diagnostic methods' information were selected into the corresponding factors.

Through consultation with TCM gastroenterology experts throughout China, the diagnostic variables, nature of disease, and disease location obtained from the four diagnostic methods' information were assigned to 15 common factors (F) (Table 5).

3.7. Extraction of Syndrome Patterns. Next, the 15 common factors were combined based on syndrome pattern and organ location. Ultimately, six syndrome patterns were established (Table 6).

3.8. Distribution of Syndrome Patterns. The corresponding common factor score of each participant's six syndrome patterns was calculated based on the factor score coefficient, according to which all syndrome patterns of each participant were estimated. Distribution of all syndrome patterns was tabulated (Figure 3).

Factor load after rotation and transformation yielded a syndrome pattern with the highest score, which was taken as the primary syndrome pattern. Distribution of primary syndrome patterns was shown in Figure 4.

4. Discussion

EFA is a multivariate statistical analytic method to explain original variable correlation with potential variables from the perspective of original variable correlation information. The fundamental concept is to project high-dimensional information onto a lower plain to explore internal structure and essential characteristics through dimensionality reduction. EFA applies principal component analysis to extract common factors. Constant factor variance and difference maximization (relative load of squares) are achieved by factor rotation. Finally, complex original data set information is summarized to a limited number of unmeasurable latent variables (common factors) to describe information of most variables. Based on this, the relationship where original measured variables are governed by a small number of independent factors is explored, and the nature of the original variables is clarified by a linear combination of common factors [38-42].

The holistic theory that TCM is based on determines the complex multivariate nonlinear, that is, multicollinear, relationship of the variables of the four diagnostic methods' information. In this study using EFA to assess TCM syndrome characteristics of CAG the four diagnostic variables were the original variables and had significantly higher dimensional characteristics. The syndrome patterns and other syndrome information were extracted from the common factors (four diagnostic variables with specific combination of features), which were the governing correlations of the four diagnostic variables, so as to achieve dimensionality reduction and elimination of multicollinearity.

The four diagnostic methods' information that were detected with high frequency were further assessed to rule out any noise interference after frequency statistics. EFA was applied to extract the syndrome patterns, organ location, and other common factors related to the four diagnostic methods' information. All information the common factors belonged to was appraised based on professional knowledge to extract the syndrome patterns. The distribution features of all syndrome patterns and their corresponding primary syndrome patterns were determined. Thus, EFA showed a total of 15 extracted common factors comprised 6 syndrome patterns (qi deficiency, qi stagnation, blood stasis, phlegm turbidity, heat, and yang deficiency) as well as disease location in the liver, spleen, or stomach.

In TCM, the syndrome pattern is the basic pathogenetic unit for evaluating a disease [43, 44]. Extraction of the aforementioned 6 syndrome patterns suggests that they form the core pathogenesis of CAG and should thus be the fundamental diagnostic elements taken into account during differentiation of CAG. It follows that, when formulating a prescription to treat CAG, the 6 strategies that should be considered depending on the presenting syndrome pattern are regulating qi (tonification of qi and moving of qi), activating blood, resolving turbidity, clearing heat, removing toxin, and warming yang. Furthermore, target organs of treatment should be the liver, spleen, and stomach.

In this study, EFA results indicated that the syndrome pattern blood stasis was highly associated with qi deficiency, qi stagnation, phlegm turbidity, and heat, whereas association of yang deficiency with the same syndrome patterns was significantly lower. However, in terms of distribution of the primary syndrome pattern, the detected frequency was significantly lower than that of qi deficiency, qi stagnation, phlegm turbidity, blood stasis, and yang deficiency. Thus, from two seemingly contradictory results, it can be inferred that blood stasis, similar to qi deficiency, qi stagnation, phlegm turbidity, and heat, has a wide distribution as a fundamental syndrome pattern and has a high frequency of detection even in patients who have mild blood stasis. For this reason, of all the syndrome patterns, blood stasis had the lowest distribution frequency. This suggests that, in terms of treatment of CAG, formulation of prescriptions should focus on the combination of tonification and moving of qi, activating blood and resolving stasis, clearing phlegm to resolve turbidity, clearing heat and removing toxin, and activating blood to resolve stasis. However, herbs that activate blood to resolve stasis should be prescribed in lesser amounts.

Interestingly, analysis of all syndrome patterns showed that frequency of yang deficiency was significantly lower than that of qi deficiency, qi stagnation, phlegm turbidity, and heat. EFA of primary syndrome patterns indicated that distribution frequency of yang deficiency was similar to that of qi deficiency, qi stagnation, phlegm turbidity, and heat, and was significantly higher than that of blood stasis. Thus, unlike qi deficiency, qi stagnation, phlegm turbidity, and heat, yang deficiency was not widely detected in CAG patients as a fundamental syndrome pattern. Although overall distribution was narrow, once yang deficiency took hold in the body, its presence was intense and detectable, thus occupying a considerable proportion of the primary syndrome distribution. Therefore, in formulating a prescription, in the early stage of yang deficiency type CAG, herbs that tonify yang should receive less prominence than herbs that focus on tonifying and regulating qi, activating blood, resolving phlegm turbidity, clearing heat, and removing toxin. If yang deficiency persists, yang-tonifying herbs should be used to some extent.

Other investigations have not been consistent on TCM syndrome patterns and disease site of CAG [28-32]. For example, Gan and colleagues' [28] conclusion regarding disease site (stomach, spleen, and liver) concurred with our findings. However, their results on primary syndrome patterns of CAG (combined deficiency and excess and combined cold and heat) differed from our results of six patterns. Literature reviews have also confirmed the lack of agreement among TCM authors regarding disease site and primary syndrome patterns of CAG [30, 31], indicating the complexities of both the disease nature and progression of CAG as well as the differentiation of its syndrome patterns. Thus, our study applied EFA in an attempt to describe the network of relationships among the four diagnostic variables in order to understand the main syndrome patterns and thus disease sites of CAG.

There are some limitations of this study. Selection bias may exist because all data were derived from participants in hospitals in only two cities with a relatively small sample and therefore are likely not representative of the four diagnostic variables in CAG patients in the rest of China. Future multicentered study which includes large samples is required to verify the conclusions of the present study. In terms of data mining methodology, in EFA each variable or common factor has only one chance to be included in a single category, which means multiple correspondence between variables and categories cannot be created. These flaws may result in an inability to accurately describe the internal property or external relevance of TCM variables from a multidimensional and multilinear perspective to some extent. So in this process, multicollinearity is eliminated by reducing the dimension, from which information may be lost by the so-called dimension effect. It should be noted that Bartlett's test of sphericity approximate chi-square value of EFA was 1589.243 (P < 0.001) and the KMO value was 0.549 > 0.5, indicating that EFA was acceptable. However, the degree of perfection was not satisfactory such that the results need to be validated with other supervised data mining methods.

5. Conclusions

EFA is a valuable methodology for developing usable dimensional taxonomies in TCM, by which observed syndrome-related variables can be remodeled as linear combinations of the underlying factors. Application of EFA can provide evidence for treatment principles and standardization of syndrome differentiation of chronic atrophic gastritis. Results of this study found that the core pathogenesis of CAG is a combination of qi deficiency, qi stagnation, blood stasis, phlegm turbidity, and heat and yang deficiency. TCM treatment of CAG should therefore focus on regulating qi, activating blood, resolving turbidity, clearing heat and removing toxin, and warming yang.
Abbreviations

CAG:    Chronic atrophic gastritis
TCM:    Traditional Chinese medicine
EFA:    Exploratory factor analysis.


http://dx.doi.org/10.1155/2016/6872890

Competing Interests

The authors declare that they have no competing interests.

Authors' Contributions

Xia Ding and Yin Zhang conceived, designed, and coordinated the study. Yin Zhang and Yue Liu designed the case report form and trained investigators at each medical center on standard operating procedures of this study. Yin Zhang, Ying Zhao, Leilei Sun, and Ajian Zhou performed the data analysis. Yin Zhang, Ajian Zhou, Ying Zhao, and Yue Liu wrote the manuscript with contributions from all other authors. All authors carried out the clinical investigation and approved the final manuscript. Yin Zhang, Ajian Zhou, Yue Liu, and Ying Zhao contributed equally to this work; they are the co-first authors.

Acknowledgments

This study was supported by the National Natural Science Foundation of China (nos. 91129714, 81270466, 81173424, and 81373796), Science Research Foundation of Beijing University of Chinese Medicine (no. 2014-JYBZZ-XS-134), National Undergraduates Innovating Experimentation Project of the China Ministry of Education (no. 081002609), and Specialized Research Fund for the Doctoral Program of Higher Education of China (no. 20120013110014). The authors thank Professor Wenpeng Zhang of the China Academy of Chinese Medical Sciences for his helpful discussions during the course of this study and his critical review of this manuscript. The authors are grateful to Nissi S. Wang, M.S., for the reviewing and the developmental editing of the manuscript.

References

[1] J. Y. Fang, W. Z. Liu, Z. S. Li et al., "Consensus on chronic gastritis in China (9-10 November 2012 Shanghai)," American Journal of Digestive Disease, vol. 1, no. 1, pp. 3-21, 2014.

[2] M. N. Weck and H. Brenner, "Prevalence of chronic atrophic gastritis in different parts of the world," Cancer Epidemiology Biomarkers and Prevention, vol. 15, no. 6, pp. 1083-1094, 2006.

[3] M. Feldman and E. L. Lee, "Gastritis," in Sleisinger and Fordtran's Gastrointestinal and Liver Disease, M. Feldman, Ed., chapter 52, pp. 870-872, Elsevier Saunders, Philadelphia, Pa, USA, 10th edition, 2016.

[4] C. Nathan and A. Ding, "Nonresolving Inflammation," Cell, vol. 140, no. 6, pp. 871-882, 2010.

[5] J. Misdraji and G. Y. Lauwers, "Gastric epithelial dysplasia," Seminars in Diagnostic Pathology, vol. 19, no. 1, pp. 20-30,2002.

[6] L. A. Torre, F. Bray, R. L. Siegel, J. Ferlay, J. Lortet-Tieulent, and A. Jemal, "Global cancer statistics, 2012," CA: Cancer Journal for Clinicians, vol. 65, no. 2, pp. 87-108, 2015.

[7] M. Krajcovic, N. B. Johnson, Q. Sun et al., "A non-genetic route to aneuploidy in human cancers," Nature Cell Biology, vol. 13, no. 3, pp. 324-330, 2011.

[8] P. Correa and M. B. Piazuelo, "The gastric precancerous cascade," Journal of Digestive Diseases, vol. 13, no. 1, pp. 2-9, 2012.

[9] C. Chao and M. R. Hellmich, "Gastrin, inflammation, and carcinogenesis," Current Opinion in Endocrinology, Diabetes and Obesity, vol. 17, no. 1, pp. 33-39, 2010.

[10] J. K. Kundu and Y.-J. Surh, "Inflammation: gearing the journey to cancer," Mutation Research/Reviews in Mutation Research, vol. 659, no. 1-2, pp. 15-30, 2008.

[11] S. Nobili, L. Bruno, I. Landini et al., "Genomic and genetic alterations influence the progression of gastric cancer," World Journal of Gastroenterology, vol. 17, no. 3, pp. 290-299, 2011.

[12] V. Conteduca, D. Sansonno, G. Lauletta, S. Russi, G. Ingravallo, and F. Dammacco, "H. pylori infection and gastric cancer: state of the art (review)," International Journal of Oncology, vol. 42, no. 1, pp. 5-18, 2013.

[13] W. D. Zhang, Z. S. Chen, and B. H. Wei, "Treatment plan for integrated traditional Chinese medicine and western medicine on chronic gastritis," World Chinese Journal of Digestology, vol. 12, no. 11, pp. 2697-2700, 2004 (Chinese).

[14] J. M. Yang, F. S. Zhu, T. T. Xu et al., "Yiqi Huoxue Decoction in the treatment of 31 cases of chronic atrophic gastritis," Jiangsu Journal of Traditional Chinese Medicine, vol. 46, no. 12, pp. 1618, 2014 (Chinese).

[15] L. P. Teng, "Yiqi Huoxue Decoction in the treatment of 40 cases of chronic atrophic gastritis," Yunnan Journal of Traditional Chinese Medicine and Materia Medica, vol. 32, no. 6, pp. 56-57, 2011 (Chinese).

[16] X. D. Niu, K. M. Niu, M. H. Xuet al., "Regulating qi, invigorating blood, resolving toxicity strategy in treatment of 30 cases of atrophic gastritis with intestinal metaplasia atypical hyperplasia," Journal of Medicine & Pharmacy of Chinese Minorities, vol. 23, no. 12, pp. 8-10, 2009 (Chinese).

[17] X. F. Liu, D. G. Li, S. P. Wang et al., "Huazhuo Jiedu Formula for treatment of chronic atrophic gastritis with intestinal metaplasia," Hebei Journal of Traditional Chinese Medicine, vol. 33, no. 8, pp. 1139-1141, 2011 (Chinese).

[18] S. F. Gao, D. G. Li, and J. Cui, "Efficacy of Huazhuo Jiedu Hewei Decoction in the treatment of chronic atrophic gastritis precancerous lesions," Chinese Journal of Gerontology, vol. 30, no. 4, pp. 460-462, 2010 (Chinese).

[19] C. Y. Gu, J. J. Liu, X. B. Liu et al., "Efficacy of Yiqi Huoxue Formula for treatment of chronic atrophic gastritis," Hebei Journal of Traditional Chinese Medicine, vol. 34, no. 1, pp. 1416, 2012 (Chinese).

[20] H. Yan, D. J. Sun, S. Wang et al., "Jianpi Huoxue Qudu Decoction in treatment of H. pylori chronic atrophic gastritis," Shandong Medical Journal, vol. 54, no. 42, pp. 79-81, 2014 (Chinese).

[21] H. Y. Bai, L. F. Guo, and Y. R. Du, "Jiedu Huoxue Decoction in the treatment of chronic atrophic gastritis with mild to moderate intestinal metaplasia," Shanghai Journal of Traditional Chinese Medicine, vol. 41, no. 6, pp. 37-38, 2007 (Chinese).

[22] M. Wei, J. X. Yang, H. M. Yang et al., "Effect of benefiting qi, transforming stasis, relieving toxicity strategy in the rat model of chronic atrophic gastritis with dysplasia," Chinese Journal of Gastroenterology and Hepatology, vol. 21, no. 10, pp. 916-919, 2011 (Chinese).

[23] J. Zhao, J. Meng, and J. X. Yang, "Effect of Xiaopi Granules on proliferation and apoptosis in the gastric mucosa of chronic atrophic gastritis rats with atypical hyperplasia," Journal of Traditional Chinese Medicine, vol. 53, no. 24, pp. 2118-2121,2012 (Chinese).

[24] J. Q. Li, C. Li, X. Liu, J. Wang, and J. N. Sun, "Improvement in gastric mucosal lesions in the rat model of chronic atrophic gastritis following administration of Shenqi Xiaopi Granules," Jiangsu Journal of Traditional Chinese Medicine, vol. 45, no. 5, pp. 69-71, 2013 (Chinese).

[25] S. S. Zhang, Q. G. Li, X. D. Tang et al., "Consensus on Chinese medicine diagnosis and treatment of chronic atrophic gastritis (2009 Shenzhen)," Chinese Journal of Integrated Traditional and Western Medicine on Digestion, vol. 18, no. 5, pp. 345-349, 2010 (Chinese).

[26] W. D. Zhang, J. X. Li, Z. S. Chen et al., "Consensus on integrated Chinese and Western medicine diagnosis and treatment of chronic gastritis (2011 Tianjin)," Modern Digestion & Intervention, vol. 17, no. 3, pp. 172-177, 2011 (Chinese).

[27] X. D. Tang, Z. H. Li, B. S. Li et al., "Guideline of treatment and diagnosis of chronic gastritis," Chinese Modern Distance Education of China, vol. 9, no. 10, pp. 123-125, 2011 (Chinese).

[28] H. J. Gan, L. L. Liang, M. L. Han, S. R. Guo, and X. J. Lin, "Relationship between syndrome distribution and sex in chronic atrophic gastritis," China Journal of Traditional Chinese Medicine and Pharmacy, vol. 30, no. 7, pp. 2456-2459, 2015 (Chinese).

[29] W. G. Lin, L. L. Liang, M. L. Han, S. R. Guo, and X. J. Lin, "Association between syndrome element qi stagnation and disease site in chronic gastritis," China Journal of Traditional Chinese Medicine and Pharmacy, vol. 11, no. 30, pp. 4074-4076, 2015 (Chinese).

[30] M. L. Han, X. J. Lin, H. J. Gan, and S. Gao, "Literature review of Chinese medicine syndrome distribution rules of chronic gastritis," China Journal of Traditional Chinese Medicine and Pharmacy, vol. 29, no. 3, pp. 900-903, 2014 (Chinese).

[31] P. C. Li, X. Ding, Q. Guo, and Z. Q. Su, "Literature review of Chinese medicine syndromes and syndrome element distribution features of chronic gastritis," Liaoning Journal of Traditional Chinese Medicine, vol. 41, no. 12, pp. 2532-2534,2014 (Chinese).

[32] R. H. Chen, G. Zhang, Z. Q. Su, X. Y. Zong, P. C. Li, and X. Ding, "Chinese medicine syndrome classification of Helicobacter pylori associated gastritis," Journal of Beijing University of Traditional Chinese Medicine, vol. 37, no. 3, pp. 156-159, 2014 (Chinese).

[33] Z. Q. Su, P. C. Li, Q. Guo et al., "Syndrome pattern transformation in chronic gastritis," Journal of Beijing University of Traditional Chinese Medicine, vol. 38, no. 11, pp. 762-771, 2015 (Chinese).

[34] X. Y. Zheng, Clinical Guideline of New Drugs for Traditional Chinese Medicine (Trial), China Medical Science Press, 1997 (Chinese).

[35] State Bureau of Technical Supervision and State Administration of Traditional Chinese Medicine, Consensus Statement on Chronic Gastritis, China Medical Science Press, 1997 (Chinese).

[36] Spleen and Stomach Disease Association of China Association of Chinese Medicine, "Consensus statement on traditional Chinese treatment of chronic atrophic gastritis," Journal of Traditional Chinese Medicine, vol. 51, no. 8, pp. 749-753, 2010 (Chinese).

[37] D. L. Tian, Traditional Chinese Internal Medicine, Chinese Medicine Press, Beijing, China, 2005 (Chinese).

[38] S. P. Reise, N. G. Waller, and A. L. Comrey, "Factor analysis and scale revision," Psychological Assessment, vol. 12, no. 3, pp. 287297, 2000.

[39] M. L. Kelton, C. A. LeardMann, B. Smith et al., "Exploratory factor analysis of self-reported symptoms in a large, population-based military cohort," BMC Medical Research Methodology, vol. 10, no. 1, article 94, 2010.

[40] R. J. Wirth and M. C. Edwards, "Item factor analysis: current approaches and future directions," Psychological Methods, vol. 12, no. 1, pp. 58-79, 2007.

[41] C. Van Der Eijk and J. Rose, "Risky business: factor analysis of survey data-assessing the probability of incorrect dimensionalisation," PLoS ONE, vol. 10, no. 3, Article ID e0118900, 2015.

[42] R. L. Scheier, "Finding pearls in an ocean of data," Computerworld, vol. 35, no. 30, pp. 49-50, 2001.

[43] L. Guo, Y. Y. Wang, and Z. B. Zhang, "Annotations on the concept of syndrome," Journal of Beijing University of Chinese Medicine, vol. 26, no. 2, pp. 5-8, 2003 (Chinese).

[44] Y. H. Li, "Syndrome factors and formula factors," China Journal of Traditional Chinese Medicine and Pharmacy, vol. 24, no. 2, pp. 117-121, 2009 (Chinese).

Yin Zhang, (1,2) Ajian Zhou, (3) Yue Liu, (1) Ying Zhao, (4) Li Zhang, (5) Leilei Sun, (6) Shiyu Du, (7) Qiang Yang, (8) Xin Song, (9) Chaoyang Liang, (10) and Xia Ding (1)

(1) Beijing University of Chinese Medicine, Chaoyang District, Beijing 100029, China

(2) Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Dongcheng District, Beijing 100700, China

(3) School of Humanities, Beijing University of Chinese Medicine, Chaoyang District, Beijing 100029, China

(4) Institute of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Chaoyang District, Beijing 100029, China

(5) Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing 100029, China

(6) Institute of Systems Engineering, Faculty of Management and Economics, Dalian University of Technology, Ganjingzi District, Dalian 116024, China

(7) Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China

(8) Department of Pathology, China-Japan Friendship Hospital, Chaoyang District, Beijing 100029, China

(9) Department of General Surgery, China-Japan Friendship Hospital, Chaoyang District, Beijing 100029, China

(10) Department of Thoracic Surgery, China-Japan Friendship Hospital, Chaoyang District, Beijing 100029, China

Correspondence should be addressed to Xia Ding; dingx@bucm.edu.cn

Received 30 July 2016; Accepted 31 October 2016

Academic Editor: Giuseppe Caminiti

Caption: Figure 1: Flow chart of EFA based CAG syndrome patterns extraction.

Caption: Figure 2: Scree plot of characteristic root value of common factors.
Table 1: Four diagnostic variables' frequency for chronic atrophic
gastritis (N = 120).

Frequency           Four diagnostic variables           Distribution
sequence                                                 frequency
                                                            (%)

1                          Wiry pulse                       75.8
2                          Dark tongue                       65
3             Distention and fullness of the stomach        64.2
4                      Thin tongue coating                  61.7
5                     White tongue coating                  59.2
6                     Greasy tongue coating                 56.7
7                           Belching                        54.2
8                   Stomach aversion to cold                54.2
9                      Acid regurgitation                    50
10                      Lack of strength                     50
11                          Dry mouth                       49.2
12                          Heartburn                       46.7
13                        Irritability                       45
14                  Bitter taste in the mouth                45
15                    Yellow tongue coating                 44.2
16                         Red tongue                       39.2
17                          Insomnia                        35.8
18                       Pale red tongue                    34.2
19                         Loose stool                      33.3
20                  Profuse dreaming at night               33.3
21                        Constipation                      32.5
22                       Enlarged tongue                    32.5
23              Sensation of coldness of the body           31.7
                            and limbs
24                      Fetid mouth odor                     30
25                        Choppy pulse                       30
26               Stifling sensation in the chest            28.3
27                        Poor appetite                     28.3
28                         Night sweat                      28.3
29                    Thick tongue coating                  28.3
30                      Frequent sighing                    25.8
31                    Abdominal distention                  24.2
32                        Palpitations                      23.3
33                        Listlessness                      23.3
34                     Teeth-marked tongue                  23.3
35                         Fine pulse                       23.3
36                          Tinnitus                        22.5
37                    Sharp pain in stomach                 21.8
38                           Nausea                         21.8
39                    Tongue with petechiae                 21.8
40                       Slippery pulse                     21.8
41                      Sallow complexion                   21.8
42                     Hypochondriac pain                   20.8
43                          Dry stool                       20.8
44                           Hiccups                        20.8
45                         Rapid pulse                      20.8
46               Distending pain in the stomach              20
47                 Stomach noises (grumbling)                20
48                 Thirst and desire to drink                20
49                       Emotional upset                    19.2
50                    Reddish yellow urine                  19.2
51              Feeling of heaviness of the body            19.2
52                  Dull ache in the stomach                18.3
53               Distention and fullness in the             16.7
                      hypochondriac region
54                       Dark complexion                    16.7
55                     Shortness of breath                  15.8
56                         Borborygmus                      15.8
57                  Thin and shrunken tongue                 15
58                        Sticky mouth                      13.3
59                         Flatulence                       12.5
60                        Sunken pulse                      12.5
61                  Bland taste in the mouth                10.8

Table 2: KMO and Bartlett's test of sphericity.

Kaiser-Meyer-Olkin measure of sampling adequacy      0.549

Bartlett's test of sphericity
Approx. chi-square                                  1589.24
df                                                    780
Sig                                                  0.000

Table 3: Characteristic root values and variance contribution
rate of common factors.

                        Initial characteristic root value

                                     Variance      Cumulative
                 Characteristic    contribution     variance
Common factor      root value        rate (%)     contribution
                                                    rate (%)

1                     3.830           9.576          9.576
2                     3.382           8.454          18.030
3                     2.832           7.080          25.110
4                     2.507           6.268          31.378
5                     2.132           5.330          36.708
6                     1.987           4.967          41.675
7                     1.671           4.176          45.852
8                     1.575           3.937          49.789
9                     1.443           3.608          53.396
10                    1.296           3.239          56.636
11                    1.262           3.155          59.791
12                    1.218           3.044          62.836
13                    1.106           2.765          65.601
14                    1.055           2.638          68.239
15                    1.022           2.556          70.795
16                    .956            2.391          73.186
17                    .852            2.130          75.316
18                    .810            2.025          77.341
19                    .805            2.013          79.354
20                    .774            1.934          81.288
21                    .696            1.740          83.028
22                    .666            1.665          84.693
23                    .624            1.560          86.253
24                    .591            1.476          87.729
25                    .526            1.315          89.044
26                    .495            1.239          90.283
27                    .451            1.127          91.410
28                    .437            1.093          92.503
29                    .421            1.053          93.555
30                    .351             .878          94.433
31                    .336             .839          95.272
32                    .323             .807          96.079
33                    .294             .734          96.813
34                    .257             .643          97.456
35                    .236             .589          98.044
36                    .212             .529          98.574
37                    .194             .484          99.058
38                    .157             .392          99.451
39                    .139             .348          99.798
40                    .081             .202         100.000

                           Variance extraction load

                                     Variance      Cumulative
                 Characteristic    contribution     variance
Common factor      root value        rate (%)     contribution
                                                    rate (%)

1                     3.830           9.576          9.576
2                     3.382           8.454          18.030
3                     2.832           7.080          25.110
4                     2.507           6.268          31.378
5                     2.132           5.330          36.708
6                     1.987           4.967          41.675
7                     1.671           4.176          45.852
8                     1.575           3.937          49.789
9                     1.443           3.608          53.396
10                    1.296           3.239          56.636
11                    1.262           3.155          59.791
12                    1.218           3.044          62.836
13                    1.106           2.765          65.601
14                    1.055           2.638          68.239
15                    1.022           2.556          70.795
16                    .956            2.391          73.186
17                    .852            2.130          75.316
18                    .810            2.025          77.341
19                    .805            2.013          79.354
20                    .774            1.934          81.288
21                    .696            1.740          83.028
22                    .666            1.665          84.693
23                    .624            1.560          86.253
24                    .591            1.476          87.729
25                    .526            1.315          89.044
26                    .495            1.239          90.283
27                    .451            1.127          91.410
28                    .437            1.093          92.503
29                    .421            1.053          93.555
30                    .351             .878          94.433
31                    .336             .839          95.272
32                    .323             .807          96.079
33                    .294             .734          96.813
34                    .257             .643          97.456
35                    .236             .589          98.044
36                    .212             .529          98.574
37                    .194             .484          99.058
38                    .157             .392          99.451
39                    .139             .348          99.798
40                    .081             .202         100.000

                       Variance load after rotation

                                     Variance      Cumulative
                 Characteristic    contribution     variance
Common factor      root value        rate (%)     contribution
                                                    rate (%)

1                     1.988           4.970           4.970
2                     1.903           4.756           9.726
3                     1.107           2.768          12.494
4                     1.035           2.588          15.082
5                     1.028           2.570          17.651
6                     1.027           2.568          20.219
7                     1.027           2.567          22.786
8                     1.026           2.566          25.352
9                     1.025           2.564          27.915
10                    1.025           2.562          30.478
11                    1.022           2.556          33.034
12                    1.018           2.546          35.580
13                    1.018           2.546          38.126
14                    1.018           2.544          40.669
15                    1.017           2.542          43.212
16                    1.017           2.542          45.754
17                    1.017           2.541          48.295
18                    1.014           2.536          50.831
19                    1.014           2.534          53.365
20                    1.011           2.527          55.892
21                    1.008           2.520          58.412
22                    1.007           2.517          60.929
23                    1.005           2.512          63.441
24                    1.004           2.509          65.950
25                    1.002           2.504          68.455
26                    1.001           2.502          70.957
27                    1.001           2.502          73.459
28                    .997            2.493          75.952
29                    .997            2.492          78.444
30                    .993            2.482          80.926
31                    .981            2.453          83.379
32                    .975            2.439          85.817
33                    .965            2.413          88.230
34                    .959            2.397          90.627
35                    .935            2.337          92.964
36                    .907            2.267          95.232
37                    .863            2.159          97.390
38                    .767            1.918          99.308
39                    .184             .459          99.767
40                    .093             .233         100.000

Note. Extraction method: principal component analysis. Rotation
method: Kaiser standardized orthogonal. Rotation was converged
after 20 iterations.

Table 4: Factor load matrix after rotation transformation.

                                                        Component

Four diagnostic variables                        1        2        3

Distention and fullness of the stomach         -.028     .005     .015
Palpitations                                    .544     .021     .195
Stifling sensation in the chest                 .140     .020     .136
Loose stool                                    -.073     .128    -.047
Stomach tingling Sharp pain in stomach         -.095    -.170     .356
Frequent sighing                                .629     .281     .050
Constipation                                   -.205    -.081     .089
Irritability                                    .017    -.024     .248
Bitter taste in the mouth                       .047    -.010     .049
Poor appetite                                  -.050     .013    -.037
Abdominal distention                            .060    -.009    -.027
Fetid mouth odor                                .078     .041    -.075
Belching                                        .142     .009    -.192
Sallow complexion                               .029     .041     .029
Acid regurgitation                              .012    -.098    -.097
Stomach aversion to cold                        .670     .150    -.146
Heartburn                                       .065    -.203     .152
Listlessness                                    .388    -.002    -.032
Sensation of coldness of the body and limbs     .795     .169    -.088
Nausea                                          .174     .056     .028
Lack of strength                               -.011     .010     .038
Insomnia                                       -.163    -.054    -.079
Profuse dreaming at night                       .110    -.112     .020
Dry mouth                                       .066     .063     .204
Tinnitus                                        .395     .082    -.018
Pale red tongue                                 .042    -.122    -.040
Red tongue                                      .015    -.006     .386
Dark tongue                                     .099     .170    -.160
Enlarged tongue                                 .100     .160    -.122
Tongue with petechiae                          -.013    -.069    -.057
Teeth-marked tongue                             .258     .296     .080
White tongue coating                            .092    -.035     .893
Yellow tongue coating                          -.037     .100     .895
Thick tongue coating                            .080     .889    -.043
Thin tongue coating                             .014     .849    -.095
Greasy tongue coating                           .080     .685     .135
Wiry pulse                                      .463     .059     .156
Fine pulse                                      .085    -.003    -.055
Choppy pulse                                    .021     .140    -.117
Slippery pulse                                 -.039     .128     .090

                                                        Component

Four diagnostic variables                        4        5        6

Distention and fullness of the stomach          .056     .332    -.026
Palpitations                                    .136     .051     .242
Stifling sensation in the chest                 .017     .139     .010
Loose stool                                     .416     .113    -.086
Stomach tingling Sharp pain in stomach          .048    -.014     .201
Frequent sighing                               -.060    -.121    -.100
Constipation                                    .502     .145     .026
Irritability                                    .013    -.118     .590
Bitter taste in the mouth                       .133     .282     .622
Poor appetite                                   .087    -.253     .095
Abdominal distention                            .142     .101     .235
Fetid mouth odor                               -.034     .165     .044
Belching                                        .074     .425    -.027
Sallow complexion                               .005    -.057     .005
Acid regurgitation                              .149     .794     .075
Stomach aversion to cold                        .000     .208     .074
Heartburn                                      -.143     .702     .183
Listlessness                                    .730     .024    -.021
Sensation of coldness of the body and limbs     .125     .068    -.043
Nausea                                          .325     .064    -.181
Lack of strength                                .738    -.005     .190
Insomnia                                       -.081     .161     .561
Profuse dreaming at night                      -.112     .062     .349
Dry mouth                                       .070     .102     .569
Tinnitus                                        .316    -.135     .032
Pale red tongue                                 .105    -.117     .045
Red tongue                                     -.015    -.031     .182
Dark tongue                                    -.082     .088    -.097
Enlarged tongue                                 .312    -.126    -.018
Tongue with petechiae                           .079     .056     .083
Teeth-marked tongue                            -.181     .182    -.279
White tongue coating                           -.074     .052    -.133
Yellow tongue coating                          -.066     .035     .039
Thick tongue coating                            .044    -.112    -.016
Thin tongue coating                            -.041     .208    -.083
Greasy tongue coating                          -.076     .083    -.127
Wiry pulse                                     -.007     .168    -.036
Fine pulse                                     -.121    -.010     .063
Choppy pulse                                    .196     .166     .020
Slippery pulse                                  .090     .094    -.055

                                                        Component

Four diagnostic variables                        7        8        9

Distention and fullness of the stomach          .121     .024     .160
Palpitations                                    .167    -.057     .046
Stifling sensation in the chest                 .096    -.019    -.091
Loose stool                                     .209    -.075     .449
Stomach tingling Sharp pain in stomach          .478     .214     .041
Frequent sighing                                .058     .046     .016
Constipation                                   -.038    -.195     .133
Irritability                                    .164     .079    -.132
Bitter taste in the mouth                      -.074    -.156    -.056
Poor appetite                                  -.097    -.065    -.158
Abdominal distention                            .195    -.051     .187
Fetid mouth odor                                .078     .064    -.007
Belching                                        .065     .016     .018
Sallow complexion                               .116    -.039     .775
Acid regurgitation                              .006     .010     .006
Stomach aversion to cold                       -.074     .011     .068
Heartburn                                       .126    -.158    -.052
Listlessness                                    .066     .159     .093
Sensation of coldness of the body and limbs     .052     .058    -.047
Nausea                                          .050     .213    -.004
Lack of strength                               -.033     .098    -.047
Insomnia                                       -.129     .088     .426
Profuse dreaming at night                      -.112     .004     .068
Dry mouth                                       .081    -.068    -.014
Tinnitus                                        .345    -.127     .315
Pale red tongue                                -.073     .860     .023
Red tongue                                     -.034    -.724     .017
Dark tongue                                     .768    -.033    -.046
Enlarged tongue                                -.083     .251     .479
Tongue with petechiae                           .669    -.058     .266
Teeth-marked tongue                            -.056     .254     .357
White tongue coating                            .056     .145     .044
Yellow tongue coating                          -.094    -.108     .025
Thick tongue coating                            .002    -.040    -.053
Thin tongue coating                             .006     .074    -.093
Greasy tongue coating                           .160    -.014     .178
Wiry pulse                                      .177     .096    -.077
Fine pulse                                      .001     .034    -.039
Choppy pulse                                    .450    -.101     .106
Slippery pulse                                  .051     .121    -.007

                                                        Component

Four diagnostic variables                        10       11       12

Distention and fullness of the stomach          .694     .093    -.202
Palpitations                                    .026     .029    -.130
Stifling sensation in the chest                 .034     .041    -.021
Loose stool                                    -.049     .180     .068
Stomach tingling Sharp pain in stomach          .185    -.060     .101
Frequent sighing                                .035     .074     .251
Constipation                                    .324     .142     .141
Irritability                                   -.327     .136    -.095
Bitter taste in the mouth                       .094    -.200     .024
Poor appetite                                   .720    -.014     .008
Abdominal distention                            .187     .114     .200
Fetid mouth odor                               -.020    -.054    -.033
Belching                                        .172     .131     .458
Sallow complexion                              -.024     .007     .010
Acid regurgitation                             -.112     .027     .041
Stomach aversion to cold                       -.139    -.093     .216
Heartburn                                       .106    -.059    -.004
Listlessness                                   -.035    -.059     .126
Sensation of coldness of the body and limbs     .022    -.012    -.096
Nausea                                         -.061    -.270     .462
Lack of strength                                .166     .014     .318
Insomnia                                        .035     .353    -.082
Profuse dreaming at night                       .040     .027    -.071
Dry mouth                                       .341    -.129     .173
Tinnitus                                       -.035     .180     .100
Pale red tongue                                 .038     .035     .061
Red tongue                                      .175    -.131    -.012
Dark tongue                                    -.190     .045    -.019
Enlarged tongue                                 .014    -.226    -.138
Tongue with petechiae                           .180    -.110     .061
Teeth-marked tongue                             .217    -.072    -.108
White tongue coating                            .013    -.039     .047
Yellow tongue coating                          -.024     .036    -.076
Thick tongue coating                           -.021    -.005     .001
Thin tongue coating                            -.015     .000    -.078
Greasy tongue coating                           .035     .132    -.094
Wiry pulse                                      .073    -.532    -.051
Fine pulse                                     -.127     .139     .794
Choppy pulse                                   -.129     .500    -.162
Slippery pulse                                  .036     .783     .110

                                                        Component

Four diagnostic variables                        13       14       15

Distention and fullness of the stomach          .008    -.053    -.009
Palpitations                                    .321     .359    -.109
Stifling sensation in the chest                 .056     .833     .072
Loose stool                                     .027     .034     .192
Stomach tingling Sharp pain in stomach          .341    -.076     .213
Frequent sighing                                .080     .119     .215
Constipation                                    .363    -.105     .142
Irritability                                    .161    -.141     .101
Bitter taste in the mouth                       .036    -.061     .195
Poor appetite                                   .024     .064     .035
Abdominal distention                            .295     .124     .414
Fetid mouth odor                               -.054     .039     .814
Belching                                       -.180     .051     .017
Sallow complexion                               .032    -.092    -.046
Acid regurgitation                              .050     .131     .143
Stomach aversion to cold                       -.064     .008     .056
Heartburn                                       .090     .013     .070
Listlessness                                   -.175     .040    -.092
Sensation of coldness of the body and limbs     .191    -.017    -.055
Nausea                                          .363     .395     .021
Lack of strength                               -.044     .037    -.024
Insomnia                                        .168     .130    -.072
Profuse dreaming at night                       .786     .051    -.031
Dry mouth                                       .161     .175    -.086
Tinnitus                                        .131     .163     .127
Pale red tongue                                 .051    -.081     .011
Red tongue                                      .111    -.133    -.068
Dark tongue                                     .046     .044     .237
Enlarged tongue                                 .016     .000     .293
Tongue with petechiae                          -.180     .153    -.117
Teeth-marked tongue                             .110    -.187     .112
White tongue coating                            .089    -.067     .079
Yellow tongue coating                           .088     .108    -.033
Thick tongue coating                           -.028     .089     .051
Thin tongue coating                             .105    -.096    -.083
Greasy tongue coating                           .074     .333    -.134
Wiry pulse                                      .046    -.100    -.193
Fine pulse                                     -.008    -.047    -.009
Choppy pulse                                    .113    -.323    -.085
Slippery pulse                                  .070    -.068    -.113

Note. Extraction method: principal component analysis. Rotation
method: Kaiser standardized orthogonal. Rotation was converged
after 20 iterations. Factor load values that were positive and
larger or equal to 0.25 are depicted in bold.

Table 5: Common factors and their corresponding four diagnostic
variables, disease nature, and organ locations.

Common factor    Four diagnostic variables (a)

F1               Palpitations (.544); frequent sighing (.629);
                 stomach aversion to cold, listlessness (.388);
                 sensation of coldness of the body and limbs (.795);
                 tinnitus (.395)

F2               Teeth-marked tongue (.258); thick tongue coating
                 (.889); greasy tongue coating (.685)

F3               Severe stomach pain (.356); red tongue (.386);
                 yellow tongue coating (.895)

F4               Loose stool (.416); constipation (.502);
                 listlessness (.730); lack of strength (.738);
                 tinnitus (.312); enlarged tongue (.312)

F5               Distention and fullness of the stomach (.332);
                 bitter taste in the mouth (.282); belching (.425);
                 acid regurgitation (.794); heartburn (.702)

F6               Irritability (.590); bitter taste in the mouth
                 (.622); insomnia (.561); profuse dreaming at night
                 (.349); dry mouth (.569)

F7               Sharp pain in stomach (.478); tinnitus (.345); dark
                 tongue (.768); tongue with petechiae (.669); choppy
                 pulse (.450);

F8               pale red tongue (.860); enlarged tongue (.251);
                 teeth-marked tongue (.254)

F9               Loose stool (.449); sallow complexion (.775);
                 insomnia (.426); enlarged tongue (.479); tongue with
                 petechiae (.266); teeth-marked tongue (.357)

F10              Distention and fullness in the stomach (.694);
                 constipation (.324); poor appetite (.720); dry mouth
                 (.341)

Fll              Insomnia (.353); slippery pulse (.783)

F12              Frequent sighing (.251); abdominal distention
                 (.200); belching (.458); nausea (.462); fine pulse
                 (.794)

F13              Constipation (.363); abdominal distention (.295);
                 nausea (.363); profuse dreaming at night (.786)

F14              Palpitation (.759); stifling sensation in the chest
                 (.833); nausea (.395)

F15              Abdominal distention (.414); fetid mouth odor
                 (.814); enlarged tongue (.293)

Common factor        Syndrome pattern       Organ location of disease

F1                   Yang deficiency           Spleen and stomach

F2                   Phlegm turbidity          Spleen and stomach

F3                Heat and blood stasis              Stomach

F4                    Qi deficiency                  Spleen

F5                    Qi stagnation             Liver and stomach

F6                         Heat                       Liver

F7                     Blood stasis                  Stomach

F8                    Qi deficiency                  Spleen

F9                    Qi deficiency                  Spleen

F10                   Qi stagnation            Spleen and stomach

Fll                  Phlegm turbidity          Spleen and stomach

F12                   Qi stagnation             Liver and stomach

F13                  Phlegm turbidity                Spleen

F14                  Phlegm turbidity          Spleen and stomach

F15               Heat and qi stagnation       Spleen and stomach

(a) Values in parentheses are results of factor load matrix after
rotation transformation.

Table 6: Syndrome pattern and their corresponding common factors
and four diagnostic variables.

                      Syndrome pattern        Common factors

Disease nature            Organ location

F1 (qi deficiency)            Spleen            F4, F8, F9

                          Liver Stomach
F2 (qi stagnation)                             F5, F10, F12

F3 (blood stasis)            Stomach              F3, F7

                          Spleen Stomach
F4 (phlegm turbidity)                       F2, F11, F13, F14

                              Spleen
F5 (heat)                     Liver            F3, F6, F15
                             Stomach

F6 (yang deficiency)          Spleen                F1
                             Stomach

Syndrome pattern         Four diagnostic variables

Disease nature

F1 (qi deficiency)       Loose stool, constipation, listlessness, lack
                         of strength, tinnitus, sallow complexion,
                         insomnia, pale red tongue, enlarged tongue,
                         teeth-marked tongue, tongue with petechiae

F2 (qi stagnation)       Distention and fullness of the stomach,
                         bitter taste in mouth, belching, acid
                         regurgitation, heartburn, poor appetite,
                         nausea, frequent sighing, abdominal
                         distention, dry mouth, constipation, fine
                         pulse

F3 (blood stasis)        Severe stomach pain, tinnitus, dark tongue,
                         tongue with petechiae, choppy pulse, red
                         tongue, yellow tongue coating

F4 (phlegm turbidity)    Constipation, abdominal distention, nausea,
                         stifling sensation in the chest, palpitation,
                         insomnia, profuse dreaming at night, teeth-
                         marked tongue, thick tongue coating, greasy
                         tongue coating, slippery pulse

F5 (heat)                Severe stomach pain, irritability, bitter
                         taste in mouth, insomnia, profuse dreaming at
                         night, abdominal distention, fetid mouth
                         odor, dry mouth, red tongue, yellow tongue
                         coating, enlarged tongue

F6 (yang deficiency)     Stomach aversion to cold, listlessness,
                         sensation of coldness of the body and limbs,
                         palpitation, frequent sighing, tinnitus,
                         teeth-marked tongue

Figure 3: Distribution of all syndrome patterns (N = 120).

                          Distribution frequency (%)

F1 (qi deficiency)        95     79.2%
F2 (qi stagnation)        99     82.5%
F3 (blood stasis)         92     76.7%
F4 (phlegm turbidity)     101    84.2%
F5 (heat)                 98     81.7%
F6 (yang deficiency)      51     42.5%

Note: Table made from bar graph.

Figure 4: Distribution of primary syndrome patterns (N = 120).

                          Distribution frequency (%)

F1 (qi deficiency)        22     18.3%
F2 (qi stagnation)        22     18.3%
F3 (blood stasis)         10      8.3%
F4 (phlegm turbidity)     25     20.8%
F5 (heat)                 22     18.3%
F6 (yang deficiency)      19     15.8%

Note: Table made from bar graph.
COPYRIGHT 2017 Hindawi Limited
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2017 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Research Article
Author:Zhang, Yin; Zhou, Ajian; Liu, Yue; Zhao, Ying; Zhang, Li; Sun, Leilei; Du, Shiyu; Yang, Qiang; Song,
Publication:Evidence - Based Complementary and Alternative Medicine
Date:Jan 1, 2017
Words:8155
Previous Article:Standardized Kaempferia parviflora Extract Inhibits Intrinsic Aging Process in Human Dermal Fibroblasts and Hairless Mice by Inhibiting Cellular...
Next Article:Sinomenine Hydrochloride Attenuates Renal Fibrosis by Inhibiting Excessive Autophagy Induced by Adriamycin: An Experimental Study.
Topics:

Terms of use | Privacy policy | Copyright © 2021 Farlex, Inc. | Feedback | For webmasters |