Identification of Chinese medicine syndromes in persistent insomnia associated with major depressive disorder: a latent tree analysis

Abstract

BackgroundChinese medicine (CM) syndrome (zheng) differentiation is based on the co-occurrence of CM manifestation profiles, such as signs and symptoms, and pulse and tongue features. Insomnia is a symptom that frequently occurs in major depressive disorder despite adequate antidepressant treatment. This study aims to identify co-occurrence patterns in participants with persistent insomnia and major depressive disorder from clinical feature data using latent tree analysis, and to compare the latent variables with relevant CM syndromes.MethodsOne hundred and forty-two participants with persistent insomnia and a history of major depressive disorder completed a standardized checklist (the Chinese Medicine Insomnia Symptom Checklist) specially developed for CM syndrome classification of insomnia. The checklist covers symptoms and signs, including tongue and pulse features. The clinical features assessed by the checklist were analyzed using Lantern software. CM practitioners with relevant experience compared the clinical feature variables under each latent variable with reference to relevant CM syndromes, based on a previous review of CM syndromes.ResultsThe symptom data were analyzed to build the latent tree model and the model with the highest Bayes information criterion score was regarded as the best model. This model contained 18 latent variables, each of which divided participants into two clusters. Six clusters represented more than 50 % of the sample. The clinical feature co-occurrence patterns of these six clusters were interpreted as the CM syndromes Liver qi stagnation transforming into fire, Liver fire flaming upward, Stomach disharmony, Hyperactivity of fire due to yin deficiency, Heart–kidney noninteraction, and Qi deficiency of the heart and gallbladder. The clinical feature variables that contributed significant cumulative information coverage (at least 95 %) were identified.ConclusionLatent tree model analysis on a sample of depressed participants with insomnia revealed 13 clinical feature co-occurrence patterns, four mutual-exclusion patterns, and one pattern with a single clinical feature variable.Electronic supplementary materialThe online version of this article (doi:10.1186/s13020-016-0076-y) contains supplementary material, which is available to authorized users.

Corni Fructus: a review of chemical constituents and pharmacological activities

“…In addition to the anti-apoptotic activity, pharmacological activities of CF on the regulation of autophagy can be further explored. Furthermore, many classic Chinese medicinal formulae have been used to treat neurological disorders belonging to liver and kidney deficiency [ 70 – 72 ]. For example, Liuwei Dihuang Wan treats insomnia, Zuogui Wan (左归丸) treats epilepsy and vertigo, Dabu Yinjian (大补阴煎) treats a headache, Zuogui Wan and Dihuang Yinzi (地黄饮子) treats stroke, and Huanshao Dan (还少丹) treats dementia.…”

Blood and urinary metabolomic evidence validating traditional Chinese medicine diagnostic classification of major depressive disorder

“…One key approach to diagnosis is the differentiation of etiopathological pattern which is generally defined by a comprehensive analysis of clinical symptoms and signs collected through inspection, auscultation, olfaction, interrogation, and palpation of the pulses [ 6 ]. Over the past decade, several large-scale studies have revealed 12 different TCM patterns of MDD on the basis of the modern psychiatric diagnostic instruments and analysis tools, such as latent tree model analysis [ 7 – 12 ]. Despite disagreements on some patterns, a consensus on clinical diagnostic criteria for the two most common and opposing patterns, Liver Qi Stagnation (LQS) and Heart and Spleen Deficiency (HSD), which account for approximately 2/3 of depressed patients, have been reached as shown in Table 1 [ 7 , 9 , 10 ].…”

Evaluating traditional Chinese medicine diagnostic instruments for functional dyspepsia: A systematic review on measurement properties

“… 25 Nevertheless, considering the absence of a gold standard test in TCM pattern diagnosis, 45 , 46 , 47 , 48 as well as the poor inter-rater agreement among TCM practitioners in pattern diagnosis, 49 it is doubtful whether diagnoses made by TCM practitioners should serve as the gold standard for criterion validity assessments of TCM diagnostic instruments. Latent class analysis is commonly performed nowadays to explore TCM patterns, with examples from studies conducted among patients with systemic lupus erythematosus, 50 cardiovascular disease, 51 depression, 52 persistent insomnia, 53 and vascular mild cognitive impairment. 48 Since the construct of TCM patterns revealed by latent class analysis may not be a linear combination of relevant TCM signs and symptoms, 35 , 48 , 54 factor analysis may not be suitable for evaluating the structural validity of those diagnostic instruments.…”