Study On Establishing The Characteristic Database Of The Tongue Of Blood Stasis Of Cardiopathy By The Method Of Information Fusion Technology

The tongue of blood stasis (TBS) is very common in clinic. It is of great clinical significance for the diagnosis and judge of pathological conditions and prognosis of the blood stasis syndrome. This study took the TBS of eardiopathy (TBSC) as the research object, discussed the clinical characteristic and the mechanism of formation of TBSC and initially established the characteristic database of TBSC by means of many kinds of modernized technologies such as image processing, information fusion, nervous network etc. and by the methods of literature research, clinical research, experimental study, image analysis of the tongue and so on, in order to realize the informationization, digitization, standardization of the diagnosis of TBS. The thesis is divided into five parts.Part 1 Literature ResearchReorganized and studied systematically the literatures which were correlated with TBSC of all times and in all countries. The original record of TBS was seen in the book of Synopsis of the Golden Chamber (Jinkui Yaolue) written by Zhang Zhongjing. Doctors in later ages discussed and developed the etiological factors, pathogenesis, diagnosis and treatment of TBS, especially concentrated on the purplish tongue, the bluish tongue, the petechia and ecchymosis on the tongue, the bluish and black sublingual vein. It was thought that the cold, heat, deficiency or excess could cause TBS and the treatment based on syndrome differentiation was necessary in clinic. Doctors in the modern age have studied on TBS from many angles such as clinical observation, experimental study, automatic recognition and analysis by computer, etc. The majority of scholars thought the formation of TBS was the result of synthetic factors such as the change of hemodynamics, hemorheology and microcirculation disturbance etc, which occurred one after another in the body under the functions of all kinds of pathogenic factors. The study on tongue inspection of cardiopathy included experimental study and clinical research. The mechanism of formation of the tongue picture of cardiopathy was discussed in the part of experimental study. The common tongue pictures and the characteristics of dynamic changes of tongue pictures were discussed in the part of clinical research. The results played positive roles on the diagnosis and treatment of TBSC. But there are no reports of systematic researches on TBSC by the method of fusion of the literature research, clinical research, experimental study and information fusion technology, computer intelligence technology and so on.Part 2 Clinical Research1 Clinical Research on TBSCObjective: to explore the clinical characteristics of TBSCObject: 100 cases with TBSC, 30 cases with the tongue of non-blood-stasis of cardiopathy (TNBSC), and 30 cases with the tongue of blood stasis of non-cardiopathy (TBSNC) were observed, 20 healthy cases as control.Method: The rospective study was made. The clinical observation and the automatic recognition and analysis of image by computer were combined.Results and Conclusions: Clinical observation showed that the tongue body of TBS manifested mainly as the darkish red tongue, bluish and purplish tongue, pale purplish tongue, crimson and purplish tongue, petechia and ecchymosis on the tongue. The tongue body of TBSC often manifested as the darkish red tongue (28.0%), bluish and purplish tongue (27.0%), pale purplish tongue (25.0%), and the tongue coating often manifested as the thick and whitish coating (37.0%), thick and yellowish coating (33.0%), and serious abnormality of sublingual vein also existed in patients of TBSC. It was thought that the observation of the tongue body had some significance for the diagnosis of TBSC and its different pathogenesis of blood stasis; the observation of the tongue coating had important value for the diagnosis of different syndrome types in patients of TBSC; And the synthetic observation of the color and luster, diameter, length of stem, shape of stem, filling degree of stem and outer zone of sublingual vein was an important index for the diagnosis of TBS, among which the color and luster of sublingual vein could be the reference to the syndrome differentiation for patients of TBSC. The research on quantitative diagnosis of R, G, B values of the tongue body showed that, different tongue bodies of TBS had different R, G, B values, among which R and G values were of great value to the diagnosis of tongue bodies of TBS; the synthetic observation of R, G and B values could provide the objective basis for the differentiation of different tongue bodies and the diagnosis of different syndrome types in patients of TBSC.2 Research on the tongue temperature of TBSCObjective: to explore the rules of the changes of tongue temperatures in patients of TBSC and its different syndrome types of blood stasisObject: 100 cases with TBSC, 30 cases with TNBSC and 30 cases with TBSNC were observed, 20 healthy cases as control.Method: The tongue temperature was measured on the infrared tongue image photographed by the SAT-HY6000A infrared camera.Results and Conclusions: All in the control group and the different disease groups, the tongue temperature on the root of the tongue was the highest, that on the middle of the tongue was higher, those on the two margins of the tongue were lower, and that on the tip of the tongue was the lowest. The tongue temperature in the TBSC group was significantly lower than that in the control group and TNBSC group (P＜0.01), which demonstrated that the change of the tongue temperature reflected pathological changes in the body and the tongue temperature could be used as the reference index to discriminate TBS from TNBS. The temperatures of different tongue bodies of TBSC decreased progressively from the pink tongue to the darkish red tongue to the purplish crimson tongue to the bluish and purplish tongue to the petechia and ecchymosis tongue to the pale purplish tongue, which indicated that the measurement of the tongue temperature had the value of reference to the diagnosis and distinction of different tongue bodies of TBS. The tongue temperatures in five syndrome types of blood stasis of cardiopathy were significantly different (P＜0.01). The tongue temperature decreased progressively from the normal to the yin deficiency and blood stasis syndrome to the Qi stagnation and blood stasis syndrome to the obstruction due to phlegm stagnation syndrome to the Qi deficiency and blood stasis syndrome to the Yang deficiency and blood stasis syndrome, which explained that the measurement of tongue temperature had important value for the identification of syndromes of cold, heat, deficiency and excess, and it could be used as the reference basis of syndrome differentiation in patients of TBSC. It is simple, fast and direct-viewing to measure the tongue temperature by the method of infrared technology, which should be spreaed and applied positively on research and in clinic.Part 3 Clinical Experimental StudyObjective: to explore the pathologic mechanism of TBSC on the molecular levelObject: 72 cases with TBSC, 20 cases with TNBSC and 20 cases with TBSNC were observed among patients who were selected on the clinical research, 20 healthy cases as control.Method: hemospasia venous blood on fasting to examine the following indexes:(1) Nitri Oxide (NO): nitric acid reducing enzyme method; (2) Endothelin (ET), Thromboxane B₂ (TXB₂), 6-Keto-PGF_1α: RIA;(3) tissue-Plasminogen Activator (t-PA), Plasminogen Activator Inhibitor (PAI-1): ELISA;(4) Hemorheology examination.Results and Conclusions:1 The balance of the levels of ET and NO was destroyed in the bodies of cardiopathy patients, which manifested that the levels of ET, ET/NO was significantly higher than those in the control group, the level of NO was significantly lower than that in the control group, and the increase of the ET level was dominant. The degree of pathological changes in patients of TBSC was more serious than that in patients of TNBSC, and that in the Yang deficiency and blood stasis syndrome was the most serious. It was inferred that the unbalance of the levels of ET and NO, especially the significantly increase of the ET level, was an important factor in the formation of TBSC. It was thought that the levels of ET, NO and ET/NO could be used as the reference indexes of the diagnosis, observation of curative effect and analysis of prognosis for patients of TBSC.2 The activity of fibrinolytic system decreased in the bodies of cardiopathy patients, which manifested that the level of t-PA was significantly lower than that in the control group (P＜0.05～P＜0.01), the levels of PAI-1 and PAI-1/t-PA were significantly higher than those in the controlgroup (P＜0.01), and the blood was in hypercoagulability. The activity of blood coagulation in patients of TBSC was higher than that in patients of TNBSC, and the condition of blood coagulation in the Yang deficiency and blood stasis syndrome was the most serious. It was inferred that the decrease of the activity of fibrinolytic system was one of important factors in the formation of TBSC. It was thought that the synthetic analysis of the levels of t-PA,PAI-1 and PAI-1/t-PA had some value for the diagnosis of TBSC.3 The unbalance of the levels of TXA₂ and PGI₂ existed in the bodies of cardiopathy patients, which manifested that the levels of TXB₂ and TXB₂/6-Keto-PGF_1α were significantly higher than those in the control group (P＜0.05～P＜0.01), the level of 6-Keto-PGF_1α was significantly lower than that in the control group, and the increase of the TXB₂ level was dominant. The risk of thrombosis in patients of TBSC was higher than that in patients of TNBSC, and the risk in the Yang deficiency and blood stasis syndrome was the highest. It was inferred that the unbalance of the levels of TXA₂ and PGI₂, especially the increase of the TXB₂ level, was the critical pathologic basis in the formation of TBSC. It was thought that the unbalance of the levels of TXA₂ and PGI₂ could reflect the pathologic essence of deficiency accompanied with blood stasis in patients of TBSC, and the synthetic observation of the abnormal degree of the levels of TXB₂, 6-Keto-PGF_1α and TXB₂/6-Keto-PGF_1α could be used as an objective index for the diagnosis of TBSC.4 The condition of "viscosity", "thickness", "coagulation" and "aggregation" existed in blood in patients of TBSC, and different syndrome types had the different tendency of "viscosity", "thickness", "coagulation" and "aggregation". The increase of the activity of coagulation and aggregation was the common pathologic basis in different blood stasis syndrome types. The condition of "viscosity" and "aggregation" in blood in the Yang deficiency and blood stasis syndrome was the most serious, the activity of RBC aggregation in blood increased significantly in the obstruction due to phlegm stagnation syndrome and the Qi stagnation and blood stasis syndrome, the ability of RBC disfiguration in blood decreased significantly in the Yang deficiency and blood stasis syndrome and the Qi deficiency and blood stasis syndrome, the increase of the activity of RBC aggregation and the decrease of the ability of RBC disfiguration were both significant in the Yin deficiency and blood stasis syndrome. The condition of "thickness" existed in blood in the obstruction due to phlegm stagnation syndrome, the Qi stagnation and blood stasis syndrome and the Yin deficiency and blood stasis syndrome, the change of thickness in blood is not significant in the Qi deficiency and blood stasis syndrome and the Yang deficiency and blood stasis syndrome. It was inferred that the formation of TBSC is the result of microcirculation disturbance in tongue due to abnormal change of hemorheology to a certain extent. It was thought that the examination of hemorheology could provide the reference to the diagnosis, syndrome differentiation and observation of curative effect for patients of TBSC.5 The formation of TBSC was the result of microcirculation disturbance in tongue due to cardiopathy and the functional disorder of all kinds of correlated physics and chemical factors. The injury of vascular endothelial cell caused by all kinds of factors was the original factor in the formation of TBSC. The unbalance of the levels of ET and NO and the decrease of the activity of fibrinolytic system were the important factors for the formation of TBSC. The unbalance of the levels of TXA₂ and PGI₂ was the critical pathologic basis in the formation of TBSC. The microcirculation disturbance in tongue due to abnormal change of hemorheology was the last link in the formation of TBSC. The abnormality of tongue temperature was the result of the microcirculation disturbance in TBSC.Part 4 Establishment of the Characteristic Database of TBSCObjective: to explore the informationization, digitization, standardization of the diagnosis of TBSC Object: 100 cases with TBSC, 30 cases with TNBSC and 30 cases with TBSNC were observed, 20 healthy cases as control.Method: The characteristic database of TBSC and a kind of intelligent diagnostic inference model of TBS were established initially based on competitive neural network by means of information fusion technology, fuzzy logic inference and neural network technology.Results and Conclusions: The initial establishment of the characteristic database of TBSC and intelligent diagnostic inference model could realize the imitation of the diagnostic inference process of TCM experts. The experimental results indicated that the general diagnostic results were basically concordant between the model and the TCM expert.Part 5 SummaryThe innovation in this study is: (1) This study took TBSC as the research object for the first time, explored the clinical characteristic and the mechanism of formation of TBSC from different levels of entirety, molecule and so on, and provided the objective basis for the diagnosis, treatment, prognosis analysis of TBSC. (2) The characteristic database of TBSC was established by the method of fusion of the image processing technology, information fusion technology, computer intelligence technology and the theory, of TCM, which fulfilled initially the requirement of the digital diagnosis of tongue picture. (3) The study opens up the thought of research on TBS and the blood stasis syndrome, and also explores an important method of establishing diagnostic standard of TBS and carrying out the standard successfully.