| ObjectiveTo clarify the development and contribution of Lingnan tongue diagnosis through literature research.To reveal the distributional characters of Lingnan tongue image through case analysis.To display tongue diagnostic methods and rules of Lingnan from both the academic and clinical way.Explore the origin and development of Lingnan tongue diagnosis.Summarize the contributions of Lingnan doctors in tongue diagnosis in different period with the clue of history,and extracting the characteristics of Lingnan tongue diagnosis from their cognitive process and their writings. Summarize systematically the academic idea and content of the tongue diagnosis monograph in Lingnan,and extracting clinical treatment characteristics of YuYu Liang.In addition to the research of Lingnan tongue diagnosis literature,stomachache literature records of Lingnan region were while conllected,and by processing the records information and statistical analysis,to discover the pattern and distribution laws of tongue images.Try to use digestive diseases as the carrier,which can sensitively effect the changes of tongue image,to discover the distribution bias of pathological tongue image in Lingnan. Reference to the results of literature research, to analyzing the influence of unique geography and climate environment in Lingnan on changes of tongue image.MethodsThe literature section mainly use the university’s library,network database and all kinds of books,network sources to collect document relates to Lingnan medicine development history and tongue diagnosis of Lingnan. With the key works like"Lingnan medicine","Tongue diagnosis of Lingnan","Tongue diagnosis" to perform keywords research,and use the development process of tongue diagnosis as the clue to discover the contemporary development degree of Lingnan medicine and related cognitions about tongue diseases and tongue diagnosis.Finishing with historical time or logical relationships of inherited academy,and two main ideas formed at last.One is the origin and development of Lingnan tongue diagnosis and doctors’ contributions to tongue diagnosis in all periods,the other one is the clinical characteristic and significance of She Jian Bian Zheng,which is the monograph of Lingnan tongue diagnosis.Tongue distrbutional character research use retrospective method and literature medical records were used as the research objects.Take series of books Lingnan famous doctors of Chinese medicine as the main clue and collect stomachache records in turn according to the name list of doctors in the books.In addition,with the help of network,using medical institutions in GuangDong province as links to search experts name list from hospital of TCM or TCM department in west hospital in different regions.then Using these lists to collect stomachache medical records.According to the Diagnostics Efficacy Standards of TCM Syndrome released in 1994,take in records under the diagnostic standards of stomachache,154 cases were chosen as research objects when considering with inclusion and exclusion criteria.The origin,native place,name,age,gender,TCM diagnosis,tongue image,pulse,differentiation syndrome, prescriptions were recorded with every case.The text information were classified and numbered,converted to informations that computers could recognize.Excel forms were compiled and spss19.0 database were built ultimately.Statistical descriptions were used for general condition and tongue image; pearsonX2 or regulated tests were used for table analysis; Logistic regression analysis was used for the relationships between tongue body and tongue coat;factor analysis was used for the key information extraction of tongue data;sample cluster analysis was used for the classification of four diagnostic information;rank sum test was used for the comparison of syndrome distribution.Through the case analysis and combined with the clinical analysis of main factors effected tongue distribution,summarize the bias of pathological tongue distribution of Lingnan,analyzing the effection of long time nature circumstance in Lingnan region on tongue changes.Results1 General analysisIn the 154 cases,there were 85 male patients occupied 55.2% and 69 females occupied 44.8%,male patients were more than female patients.There were 3 under the age 20 and occupied 1.9%;There were 61 patients between the age 20-40 and occupied 39.6%;69 patients between 40～60 years old and occupied 44.8%;20 patients between 60-80 years old and occupied 13%;1 patient over 80 years old and occupied 0.6%;The cases were mostly distributed in 20-40 and 40～60 ages.The shortest and the longest course of disease for male was 0.019 year and 30 years respectively,the average was 4.341 years; The shortest and the longest course of disease for female was 0.003 year and 40 years respectively,the average was 4.639 years;The whole average time were 4.474 years.Among them,64 patients’course of disease were<1 year,occupied 41.56%;17 patients 1<course of disease<2,occupied 11.04%; 36 patients 2 <course of disease≤5,occupied 23.38%;37 patients course of disease>5 years,occupied 24.03%.2 Tongue distribution analysisThere were 52.6%,81 cases the tongue spirit were luxuriant,while withered tongue spirit were 73 cases and accounted 47.4%.Pale tongue were at most and accounted 44.2%;Red tongue came after and accounted 39%;Pale red tongue accounted 17.5%;Crimson tongue were the least and accounted 1.3%.The enlarged tongue were at most and accounted 31.2%;The tongue with normal shape were 22.1%.Tender-soft tongue came after in pathogenic tongue images and accounted 19.5%; Teeth marked tongue accounted 17.5%;Tongue with stasis spots were accounted 16.2%;Tough tongue were accounted 14.9%;Thin tongue accounted 11.7%;Tongue with expand sublingual collateral vessels were accounted 7.8%.White fur were at most and accounted 54.5%;Yellow fur came after and accounted 39%;Yellow and wihte fur were the least and accounted 6.5%.Thin fur were at most and accounted 42.9%;Slimy fur came after and accounted 38.3%;Then the thick fur were 15.6%,tongue with less fur were 10.4%;Peeling fur,curdy fur,dry fur,slippery fur,moist fur,arid fur were all accounted for small percentage.3 Analysis of Relationship Between Tongue and Gender, Age, Course of DiseaseThere were no significant difference in different tongue shape or tongue color between male and female and these indicate there were no different distributions of tongue shape or tongue color in different gender.There were significant difference in thick fur and little fur in different gender,the male percentage of thick fur were higher than female and the female percentage of little fur were higher than male.There were no distribution differences for other fur color or fur texture in different gender.There were no significant difference in different age groups for tongue texture or tongue fur and these indicate there were no distribution difference in different age groups for all kinds of tongue texture or tongue fur.There were significant differences in different disease courses for normal tongue shape and this indicates normal tongue have different distribution in different course of disease,the percentage were higher in the 1～2 years stage.There were no significant distribution differences in all age stages for other tongue texture and tongue fur variates.4 Laws of Tongue Image Analysis4.1 The Relationship of Tongue Texture and Tongue FurThere were 43.1% enlarged tongue,32.3%tender-soft tongue,26.2%teeth-marked tongue in pale tongue and the proportions were all higher;There were 48.1%normal tongue,25.9% enlarged tongue,18.5% teeth-marked tongue in pale red tongue;There were 25% tough tongue,23.3% thin tongue in red tongue and enlarged tongue and normal tongue followed; 100% percentage crimson tongue were with stasis spots and expand sublingual collateral vessels,the enlarged tongue shape came after and it appeared higher proportions in all kinds of tongue colors.The tough tongue shape and thin tongue shape were mainly appeared in red tongue color.The teeth marked tongue were mainly appeared in pale tongue and pale red tongue colors.The normal tongue shape were mainly appeared in pale red tongue and red tongue colors.There were 72.3% pale tongue appeared with white tongue fur and slimy fur were at most in tongue fur texture,thin fur came secondly;55.6% pale red tongue were appeared with white fur,thin fur were at most in fur texture and slimy fur came after;55% red tongue appeared with yellow fur,48.3% thin fur in fur texture were at most,slimy fur came after;Slimy fur and thin fur were occupied higher proportions in all tongue colors.4.2 Logistic Regression Analysis for Tongue Texture and Tongue FurPale tongue were relates to tender-soft tongue,enlarged tongue and this indicates the hiden pathogenesis for Lingnan stomachache are deficiency of spleen qi and excessive damp; Red tongue relates to thin tongue,yellow fur and this indicate the hiden pathogenesis for Lingnan stomachache are excessive heat,yin deficiency with interior heat,both qi and yin deficiency.For short,the Lingnan stomachache tongue images implicate the pathogenesises are qi deficiency of spleen and stomach,excessive damp,excessive heat,yin deficiency with interior heat and both qi and yin deficiency,and these all indicate the tongue images reflect qi deficiency,damp,yin deficiency and interior heat.4.3 Factor Analysis of Tongue ImagesThere were 7 common factors in all.Common factor 1 indicates the pathogenesis is deficiency and cold.Deficiency equals to both qi and blood deficiency,and cold equals to excessive cold or deficiency cold.This common factor explained 16.067% for the original data and indicates qi deficiency of middle and deficiency cold in middle are the main pathogenisises for Lingnan stomachache.Common factor 2 indicates the pathogenesis is heat and this includes excessive heat and deficiency heat.This common factor explained 12.758% for the original data and excessive heat in middle is the main pathogenesis for Lingnan stomachache.Common factor 3 indicate blood stasis and this common factor explained 10.542% for the original data,so blood stasis is a main pathogenesis for Lingnan stomachache.Common factor 4 indicates damp.Common factor 5 indicate deficiency and this including both qi and yang deficiency,deficiency of spleen qi;Common factor 6 indicates yin deficiency.Common factor 7 indicates the pathogenesis is both qi and yin deficiency.In all, common factors together indicate the basic pathogenesises for Lingnan stomachache are qi deficiency of spleen and stomach,excessive heat,qi deficiency with blood stasis.cold and damp stagnation,yang deficiency with damp,yin deficiency and both qi and yin deficiency.Lingnan stomachache tongue images indicate the information like qi deficiency,heat,blood stasis,damp,yang deficiency and yin deficiency.4.4 Cluster Analysis of Four diagnosisTake the describes from the syndrome part of the national standards of TCM clinical treatment and diagnosis (issued by the national technical supervision bureau GB/T16751-1997) as standards,and the summarized names of syndrome also subject to the syndrome types in the standards.Finally 9 syndrome types were summarized as both qi and yin deficiency,Liver-qi invading stomach,stagnation of heat and damp,Spleen deficiency with excessive Liver qi,qi and damp stagnation,qi deficiency of middld,yang deficiency of middle, Spleen deficiency with damp heat,excessive stomach heat.4.5 Syndrome Distribution Comparison AnalysisAfter the rank-sum test,there were no significant difference between the cluster result and experts’ jugement in syndrome distribution.The result Z=-0.070, P=0.944, P>0.05,so the result of cluster analysis is as same as the experts’ jugement.The expert’s result of syndrome types is reliable and is subject to the cluster analysis’ result.4.6 analysis of Lingnan syndrome characteristicsCompared to the standards of TCM syndrome diagnositic curative effect which issued in 1994 by TCM authority,the syndrome types damp-heat stagnation,qi and yin deficiency,Spleen deficiency with damp-heat are emphasized in Lingnan stomachache types,but the standards emphasized the type cold invading stomach.So the conclusion is Lingnan stomachache emphasize more on factors like damp-heat,qi and yin deficiency,Spleen deficiency with damp-heat,and the stomachache caused by external cold is relatively uncommon.Conclution1 Research Conlusion of Literature Part1.1 The Origin and Characteristic of Lingnan Tongue DiagnosisLingnan tongue diagnosis had shown signs form Jin to Tang dynasty,inherited in Song and Yuan dynasties,developed in Ming and Qing dynasties;Lingnan doctors have inherited ancestor’s experience of tongue diagnosis and emphasizing coreference with tongue and pulse,sometimes consider tongue image and discard pulse in necessity;discuss the diseases with tongue body and tongue coat respectively,pay attention to the differential diagnosis of tongue image with clear mind;attach importance to the ZangFu distribution on the tongue,emphasize the significance of tongue diagnosis on internal diseases;the great attention on tongue image of warm disease and plague were significantly effected by the natural environment,pay attention to the dynamic change of the tongue;pay equal attention to both the tongue and the throat,good at assistant diagnosis of tongue;the great attention on children tongue diagnosis were effected by febrile diseases school,reflect the local features of diseases;emphasize clinical practice,be short of writings but more oral teaching and pragmatic work.1.2 Tongue diagnostic application situation of typical doctorsGuhong has no interpretation on pathological tongue images,used sublingual feeding medicine of Zhongjing many times.He inherited the method using the sublingual collaterals as the treatment points in NeiJing and developed the theory of tongue and viscera related.ChenZhaoYu and etc.gave detailed descriptions to pathological viscera tongue images in Tai Ping Sheng Hui Fang.Listed related tongue image.Fully aware the relationship between tongue and the Heart and the Spleen.Also judging prognosis according the tongue images.Liu Fang developed pediatric inspective methods and reserved lot of medical writings before Song dynasty.His tongue diagnostic methods for pediatric were more collections of experience before Song dynasty.He Meng Yao pay more attention to basic theory of tongue image and dynamic change of febrile disease;He added the tongue feeling diagnosis and interpreted details of febrile disease tongue,and expatiated pathologic of tongue illness.His writings are another summarize and has significant meanings to development of Lingnan tongue diagnosis.Huang Wei Yuan has monograph about plague tongue diagnosis and can judging prognostic according to tongue images.This is the experience of multiple plague in Lingnan and has significant local feature.Chen Fu Zheng judged prognostic and the conditions of heat with tongue colors.He stated that tongue diseases are more relating to the Heart and the Spleen,and explained the pathogenesis and treatment of lapped tongue, stiff tongue and protruded agitated tongue,recorded several simple formular for tongue disease.Cheng Kang Pu raised the primary illness of all tongue colors in pediatric,and stated fatal tongue images in his writing.Yang He Ling talked about children tongue image,stated primary illness for white coat,yellow coat,black coat and no coat.He raised the manifestation and pathogenesis of thrush,and coreference with tongue,pulse and infantile fingerprint.Chen Ren Mei emphasized equal on tongue and pulse,especially the tongue diagnosis.He insisted tongue diagnosis is the best way for febrile disease.He discussed tongue body and coat respectively;tongue body devided into six pairs;tongue color devided into red,purple,blue,gray and black;the texture of coat devided into nine forms;coat color devided into white,yellow,gray,black and caramel color.1.3 Summary of YuYu Liang’s Experience of Tongue DiagnosisYuYu Liang’s She Jian Bian Zheng is the monograph of Lingnan tongue diagnosis and it has significant meanings to Lingnan tongue diagnosis research.Liang considers tongue diagnosis the most important one in the four diagnosis methods,and his writing carries the whole tongue’s ZangFu-distribution at the beginning. The theory of fire spreads in south,the rise of febrile disease school and the academic debate in Lingnan region,all these lead to the emphasizing on tongue diagnosis.Liang has more deeper cogniton about normal tongue image and he emphasized the meanings tongue diagnosis on internal diseases.He inherited family’s experience and has unique understandings about choice of tongue coat color and analysis about images.He pay attention to the differenciation of white tongue and the distinguish diagnosis of black tongue,and he is good at assistant tongue diagnosis ways. Liang broke the tradition and did not rigidly adhere to old sayings.He took the tongue image as the standards,he is good at use drugs cold and cool in nature with correct differenciation and like to make therapy principle according to tongue images.2 Conclutions of Tongue Image Distributional Characterisic ResearchAnalyzing with the tongue body and coat togetherXingnan stomachache has more pathogenesis of deficiency,damp and heat,which compliance to the local pathogenic characteristics.Tongue images of Lingnan stomachache implicate the pathogenesis includeing deficiency of middle qi,excessive damp,excess heat,internal heat due to yin deficiency and deficiency of qi and yin according to the simple and Logistic regression analysis with tongue images.This indicate that the tongue image reflects more element like qi deficiency,damp,yin deficiency and internal heat.Factor analysis indicate the core tongue image information are on behalf of qi deficiency,heat,blood stasis,damp and phlegm,yang deficiency and yin deficiency,and these and cluster analysis can find counterpart in each’s result.Doctors in Lingnan can differenciate correctly and emphasizing on three kinds of pathogenesis,endoretention of damp-heat,deficiency of qi and yin,deficiency of Spleen with damp-heat,the tongue information they take respectively coordinate with the essential tongue image pathogenesis analyzed before.Finally can infer that Lingnan tongue images are featured with damp-heat,deficiency of both qi and yin,and deficient root with overdo superficial.3 SummaryThere have a clear understanding of development of Lingnan tongue diagnosis throuth the literature research.The cognition and contribution to tongue diagnosis of Lingnan doctors appeared mainly after Ming and Qing dynasty.The experience and depth of cognition of local doctors mainly effected by the local special natural circumstance.damp,febrile disease and damp heat and infectious disease are more common in this place due to the damp heat climate in Lingnan,so the development of Lingnan tongue diagnosis effected by the rise of febrile disease theory.Therefore,Lingnan doctors’ contribution to tongue diagnosis can reflect evidently the supporting factos of local background to the use of theory.At the same time,the result of statistics made out the common features of Lingnan tongue image,and highlight the effections of local factors on tongue image from the clinical point of view.Innovation points① Study Lingnan medicine from the perspective of TCM diagnosis for the first time.Summarize systematically the origin of Lingnan tongue diagnosis and the contributions of Lingnan doctors have for tougue diagnosis.Extracting features of Lingnan tongue diagnosis with the various contrast between Lingnan tongue diagnosis monograph and writings before.② Systematiclly collect Lingnan stomachache records in literature for the first time.Extract and analyze the tongue distribution characteristic of stomachache in Lingnan region and the distribution bias of lingnan pathological tongue image by statistical analysis, and there deepened the understanding of Lingnan tongue features from the clinical point of view.③ Compare the tongue diagnosis between domestic and abroad for the first time and analyzing the research trend in both overseas and domestic region. |
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