关键词: 广泛性焦虑障碍, 上热下寒, 层次聚类, 症状网络

Abstract: 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.

Key words: generalized anxiety disorder, Upper-heat and Lower-cold, hierarchical clustering, symptom network