| Lung carcinoma, as one of the malignant tumors with highest occurrence and mortality rates in the developed countries and the large cities in our country, is a carcinoma with highest ccurrence and mortality rates over the world, with largest increasing occurrence and mortality rates among all the carcinomas. Blood stasis syndrome is one of the basic and main syndromes of the tumors, and the tongue manifestation of blood stasis is of significance in the syndrome differentiation, diagnosis and treatment of tumors. In recent years, more and more clinical practice of integrated traditional and western medicine has demonstrated the superiority and advantages in stabilizing the foci, improving the symptoms, prolonging the survival, enhancing the quality of life, etc, which has paid much attention in the medical field at home and abrord. The blood stasis tongue manifestation is one of the commonly seen manifestations of the tumors, which is of significance in the studies of tongue manifestaions. In the present dissertation, based on the research results of early phase of the project, taking the blood stasis tongue manifestations of lung carcinoma as the breakthrough point, with the literature research, clinical practise and experimental study, etc, the colorful pictures of blood stasis tongue manifestation with representatives were taken. By analyzing the clinical distribution characteristics of the blood stasis tongue of lung carcinoma and the correlations with the indexes of the modern medical tests, it provides the scientific basis for the clinical diagnosis and treatment of lung carcinoma. The present dissertation includes three parts.Part 1 Literature research In the present study, with the methods of computer-based comtbined with manual retrievals, the related ancient literatures of the blood stasis tongue, blood stasis syndrome and tumor were systematically discussed. With the methods of computer-based retrieval, the related modern literactures of blood stasis tongue and other tumor studies were systematically analyzed. The literature research indicated that there were rich records of blood stasis tongue manifestations, blood syndrome and tumors in ancient China and there was deep understanding to the close relationships among the three. However, according to these ancient literatures, there were no references of the blood stasis tongue of tumors, which needs further studies. In recent years, increasing research of the blood stasis tongue manifestation of lung carcinoma and other tumors has found that there were some certain rules of the distributions and manifestations of the tongue body, tongue coating and sublingual veins in different phases among the tumor patients. There was hypercoagulability among the patients with lung carcinoma or other tumors, which manifest as abnormal hemorheology, impediment of microcirculation, increasing coagulability of blood, increasing amounts of blood platelet, etc. There was certain relationship between the hypercoagulability of blood and the occurrence, development and metastasis of the carcinoma, and there were certain relationships and rules between the syndrome differentiation and clinical TNM, pathological categories and biolocial indexes (such as hemorheology, four items of coagulation function test, etc).Part 2 Clinical observationObjective:By diagnosing and observing the tongue manifestaions of lung carcinoma, the cases with representative blood stasis tongue manifestation were enrolled and the distribution characteristics of the tongue manifestation were analyzed.Subjects:144 patients with lung carcinoma, including 93 cases in the blood stasis tongue manifestation group and 51 cases in the non-blood stasis tongue manifestation group.Methods:Integration of observation of tongue manifestation by eye and tongue manifestation pictures taken with digital cameras.Results and conclusions2.1 Tongue body2.1.1 Among the 144 cases enrolled, the colors of the tongues manifest as dull-red, pale dark red, red, dark, pale, purple and ecchymosis, with the dull-red, pale red and pale dark the lagest ratio, accounting for 34.03%, 20.83% and 19.44% respectively. The pale red tongue manifestion is normal, but the dark red and pale dark tongue manifestations account for 53.47%, indicating that there were mostly blood stasis signs among the lung carcinoma patients, which was accordance with the TCM understanding to the tumors and the clinical results of syndrome differentiation.2.1.2 With the comparison of the tongue body distribution between the blood stasis tongue group and the non-blood stasis tongue group, there were apparently more blood stasis tongue manifestation in the former group than that in the latter group, with significant difference between the two (P<0.05). In the former group, the tongue manifestations from large to small ratio successively were dull-red, pale dark, pale red, dark, pale, purple and ecchymosis, with the dark red the largest, accounting for 44.09%; pale dark secondly, accounting for 18.28%. In the latter group, the tongue manifestations from large to small ratio successively were pale red, pale dark, dull-red, red, purple, dark, pale and ecchymosis, mainly as the pale red and pale dark, accounting for 31.37% and 21.57% respectively. In the former group, the tongue manifestations were manily characteristic as dark, which was accordance with the syndrome differentiation as blood stasis syndrome due to lung depression, phlegm and blood stasis; in the latter group, the tongue manifestations were manily characteristic as pale, which was accordance with the syndrome differentiation as deficiency syndrome due to spleen deficiency and phlegm-dampness, yin-deficiency and phlegm-heat and dual deficiency of qi and yin.2.1.3 The tongue colors changed with the difference of ages, sexes, metastasis, phases and pathological categories. The distribution characteristics were also different. In the early and middle phases, the cases of blood stasis syndrome of lung carcinoma manifest mainly as dull-red, pale dark and pale red tongue manifestations. However, in the middle and late phases, the ratios of purple and ecchymosis tongue manifestations and sublinguial varicose veins have the tendency of increasing, which maybe was closely related with the serious situation of the patients and the serious blood stasis situation.2.2 Tongue coating2.2.1 Among the 144 cases enrolled, most of the manifestations of the tongue coating were white, thin-white, white-greasy and thin-yellowish, particularly the white, accounting the largest ratio.2.2.2 According to the occurrence frequency of all kinds of the tongue coating, the tongue coating manifestations from large to small ratio in the blood stasis tongue group successively were white, thin-white, thin-yellowish, white-greasy, yellowish, white-thick, yellowish-greasy, yellowish-thick, little coating, yellowish-thick-greasy and peeling coatings. The tongue coating manifestations from large to small ratio in the non-blood stasis tongue group successively were white, white-greasy, little coatings, thin-yellowish, yellowish, peeling coatings, white-thick, white-thick-greasy, yellowish-thick and little coatings. With the statistical management, there was significant difference of the distribution of the tongue coating between the two groups.2.2.3 The distribution characteristics of the tongue coating among the lung carcinoma patients were different with the difference of the ages, sexes, metastasis, phases and the pathological categories.2.3 Sublinguial veinsThe signs of sublinguial veins accounted for 24.73% in the blood stasis tongue group and 5.88% in the non-blood stasis tongue group, with the signs in the former group obviously higher than that in the latter group, which was accordance with the results of the TCM clinical syndrome differentiation. Part 3 Clinical experimental research3.1 Objective:To explore the pathological mechanism of the formation of the blood stasis tongue manifestation of tumors from the experimental aspects.3.2 Subjects:144 lung carcinoma patients (including 93 cases in the blood stasis tongue group and 51 cases in the non-blood stasis tongue group) and 32 healthy people.3.3 Methods:Venous blood before breakfast was collected. The following indexes such as prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), platelet count (PLT) were tested with the Sysmex CA1500 and Sysmex XE2100 Auto-blood analyzer.3.4 Results and conclusions3.4.1 Comparison of the prothrombin time (PT)3.4.1.1 The PT of the blood stasis tongue group and the non-blood stasis tongue group were lower than the healthy group, with no significant difference (P>0.05); the PT of the blood stasis tongue group was lower than the non-blood stasis tongue group, with no significant difference (P>0.05).3.4.1.2 The PT of the non-metastasis group and the metastasis group were lower than the healthy group, with no significant difference (P>0.05); the PT of the non-metastasis group was lower than the metastasis group, with no significant difference (P>0.05).3.4.1.3 The PT of the early phase group and the middle-late phase group were lower than the healthy group, with no significant difference (P>0.05); the PT of the early phase group was lower than the middle-late phase group, with no significant difference (P>0.05).3.4.1.4 Among different Chinese medicine syndrome group, the PT of the lung depression, phlegm and blood stasis group, the spleen deficiency, phlegm and dampness group and the Yin deficiency, phlegm and heat group were lower than the healthy group, with no significant difference (P>0.05); the PT of the Qi and Yin deficiency group was higher than the healthy group, with significant difference (P<0.01);the PT among different Chinese medicine groups were not statistically significant (P>0.05).PT is an important reference index for blood stasis tongue syndrome. The shortening of PT of cancer patients prompted hypercoagulative state of blood. Among the comparison of the PT of the blood stasis tongue group, the non-blood stasis tongue group and the healthy group, the statistical result showed no significant difference.But the result showed as follow:the healthy group > the non-blood stasis tongue group> the blood stasis tongue group.That meaned hypercoagulative state of the blood stasis tongue group was higher than that of the non-blood stasis tongue group, and hypercoagulative state of the non-blood stasis tongue group was higher than that of the healthy group. They are coincide with the understanding of TCM clinical syndrome differentiation for blood stasis tongue syndrome (the lung depression, phlegm and blood stasis syndrome) and non-blood stasis tongue syndrome(the spleen deficiency, phlegm and dampness syndrome, the Yin deficiency, phlegm and heat syndrome and the Qi and Yin deficiency syndrome).3.4.2 Comparision of the activated partial thromboplastin time (APTT)3.4.2.1 The APTT among the blood stasis tongue group, the non-blood stasis tongue group and the healthy group were not statistically significant (P>0.05); The APTT between the blood stasis tongue group and the non-blood stasis tongue group was not statistically significant (P>0.05).3.4.2.2 The APTT between the non-metastasis group, the metastasis group and the healthy group were not statistically significant (P>0.05); The APTT between the non-metastasis group and the metastasis group was not statistically significant (P>0.05).3.4.2.3 The APTT among the early phase group, the middle-late phase group and the healthy group were not statistically significant (P>0.05); The APTT between the early phase group and the middle-late group was not statistically significant (P>0.05).3.4.2.4 The APTT between different TCM syndrome group and the healthy group were not statistically significant(P>0.05); The APTT between different TCM syndrome group were not statistically significant (P>0.05).APTT is an important reference index for blood stasis tongue syndrome. The shortening of APTT often prompted hypercoagulative state of blood. This research showed that the APTT of the blood stasis tongue group was the same as that of the non-blood stasis tongue group. That pointed out APTT was just an important reference index, but not a specificity experimental index.3.4.3 Comparision of the Fibrinogen (FIB)3.4.3.1 The FIB of the blood stasis tongue group was higher than the healthy group, with significant difference(P<0.01); the FIB of the non-blood stasis tongue group was higher than the healthy group, with no significant difference(P>0.05); The FIB of the blood stasis tongue group was higher than the non-blood stasis tongue group, with no significant difference (P>0.05).3.4.3.2 The FIB of the early phase group was higher than the healthy group, with significant difference(P<0.05); the FIB of the middle-late phase group was higher than the healthy group, with significant difference(P<0.05); The FIB of the middle-late phase group was higher than the early phase group, with no significant difference (P>0.05).3.4.3.3 The FIB of the non-metastasis group was higher than the healthy group, with significant difference(P<0.05); the FIB of the metastasis group was higher than the healthy group, with significant difference(P<0.05); the FIB of the metastasis group was higher than the non-metastasis group, with no significant difference(P>0.05).3.4.3.4 The FIB of different TCM syndrome group was higher than the healthy group, with siginificant difference(P<0.05); the comparison of different TCM syndrome group on FIB showed that as follow:the lung depression, phlegm and blood stasis group>the Qi and Yin deficiency group>the Yin deficiency, phlegm and heat group>the spleen deficiency, phlegm and dampness group, with no significant difference (P>0.05).The increasing of the FIB was the important pathologic basis of the formation of blood stasis tongue. The increasing of FIB was related to the occurrence, evolution and metastasis of lung carcinoma. It keeped the blood of lung carcinoma patient in a "thick, sticky, concretionary, congregative" hypercoagulative state. The FIB of blood stasis tongue group was higher than the non-blood stasis group, and was significantly higher than the healthy group. That pointed out the increasing of FIB was the important pathologic basis of the formation of blood stasis tongue.3.4.4 Comparison of Platelet count (PLT)3.4.4.1 The PLT of blood stasis tongue group was higher than the healthy group, with significant difference(P<0.01); The PLT of blood stasis tongue group was higher than the non-blood stasis tongue group, with no significant difference(P>0.05); The PLT of non-blood stasis tongue group was higher than the healthy group, with no significant difference (P>0.05).3.4.4.2 The PLT among the early phase group, the middle-late phase group and the healthy group were statistically significant (P<0.05); the PLT of the early phase group was higher than the healthy group, with significant difference (P<0.05); the PLT of the middle-late phase group was higher than the healthy group, with no significant difference (P>0.05).3.4.4.3 The PLT among the non-metastasis group,the metastasis group and the healthy group were statistically significant (P<0.05); the PLT of the non-metastasis group was higher than the healthy group, with significant difference (P<0.01); the PLT of the metastasis group was higher than the healthy group, with significant difference(P<0.05); the PLT of the non-metastasis group was higher than the metastasis group, with no significant difference(P>0.05). 3.4.4.4 Among different TCM syndrome group, the PLT of the lung depression, phlegm and blood stasis group was higher than the other syndrome group, with no significant difference (P>0.05); the PLT of the lung depression, phlegm and blood stasis group was higher than the healthy group, with significant difference(P<0.01).The increasing of the PLT was an important part of the formation of lung carcinoma blood stasis tongue. The number of PLT increased, the number of PLT in body increased, lots of PLT accumulated, all of that formed the PLT thrombosis. The protein complexes which adhered on the surface of the PLT activated thrombin. That increased the blood coagulability, slowed the blood flow, and the tissue were hypoxia. All of that reflectd in the blood stasis tongue. The PLT of the blood stasis tongue group was higher than the non-blood stasis tongue group, and was significantly higher than the healthy group. That pointed out the increasing of the number of PLT maybe an important part of the formation of lung carcinoma blood stasis tongue.ConclusionInnovation of the present study 4.1 Taking the blood stasis tongue manifestation as the breakthrough point, in the present research, the characteristics, the rules of the clinical distribution and the mechanism of the formation of the tongue manifestation were systematically analyzed. It indicated that the blood stasis tongue manifestations of lung carcinoma were mainly characteristic with dark, mostly were dull-red, pale dark, which were different from the previous literacture reports on the blood stasis manifestations of tumors as green, purple or ecchymosis. It was thought that the dark red tongue and the dark pale tongue was the basic tongue manifestations of the blood stasis syndrome of lung carcinoma, and the blue, purple and ecchymosis petechia tongues were the typtical tongue manifestations of the blood stasis syndrome of lung carcinoma.4.2 In the present study, it was firstly analyzed the micro-mechanism of the blood stasis tongue manifestations of lung carcinoma from the perspective of PT, APTT, FIB and PLT, which consequently broadens the study strategies for the blood stasis tongue manifestations of lung carcinoma. |
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