| Study backgroundOur research team had started investigation on objectifying tongue diagnosis since 2002, and had accumulated a large amount of clinical data, also had gradually standardized the method of tongue data collection. But with all sorts of condition limit, the tongue comparation analysis was unable to be made. At present, traditional Chinese medicine (TCM) "preventive treatment of disease" has been launched in the health examination center. How to give full play to the role of TCM diagnostic methods in the evaluation of health status has become an important subject. Tongue diagnosis is an important part of the inspection in TCM. By observing the tongue, where health status of the body could be noticed. Recently, our research team has done a great deal of general and large sample clinical data gathering, including health inspection people’s tongue photo, tongue diagnosis, health examination data, and TCM constitution questionnaire. In the health examination center, health inspection population was relatively fixed, and had provided the condition for tongue comparation. Meanwhile, in order to put tongue inspection into the health examination process, to explore the ways for tongue inspection information storage, analysis, observing points and how to compare the tongue inspection information of several times health examination were needed. This thesis was written based on the former studies of our research team. Health inspection people who had their health examinations twice were recuited as subjects, and their two-time tongue color and tongue tip details were collected and analyzed. Based on analyzing the tongue photos, using colorimetry method, first quantified different tongue color’s chromatic values, and investigated the influence of the parameters of peripheral red blood cell (pRBC) to tongue color. Then in the basis of the chromatic values of different tongue color, the red tongue tip colorimetric analysis of different tongue color was made, and chromatic values of red tongue tip were preliminarily presented, also the significance of red tongue tip in heat diagnosis was discussed.Literature reviewThe literature review has a total of two. Firstly investigated the ancient and modern TCM theory on tongue tip inspection, and generalized modern researches on tongue tip. Secondly retrospected the new rising research on the clinical application on tongue diagnosis in TCM constitution, outlined the tongue diagnosis in TCM constitution classification of different scholars, and also expounded the few articles about the correlation study of TCM constitution, tongue and modern health examination indexes.Clinical StudyObjectiveTo summarize health inspection subjects’ two-time tongue color and tongue tip changes; to investigate the correltion of changes in tongue color chromatic values and changes in the parameters of peripheral red blood cell; to measure tongue tip and tongue edge color chromatic values and color difference, to provide quantitative evidence for tongue tip diagnosis, and to evaluate the clinical value of red tongue tip diagnosis in heat differentiation.Methods1539 health inspection people who had their health examination done from June 2010 till February 2014 were recuited as subjects. All subjects’ tongue features were recorded, with their tongue photo taken and corrected. Firstly the changes of tongue color and tongue tip features in two-time health examination were summarized. Then each photo’s tongue color and tongue tip color chromatic values were extracted for further statistical analysis. Venous blood samples were collected, from which the parameters of peripheral white blood cell (pWBC) and pRBC were measured and recorded. A correlation analysis between tongue color change and pRBC change, and a correlation analysis among red tongue tip and pWBC, in addition of the results in TCM constitution questionnaire were conducted. Suitable statistical analysis methods were chosen according to the need, by using SPSS 20.0 (including chi-square test, nonparametric test, correlation test, k-means clustering analysis, logical stepwise regression analysis).Results1、In the health inspection subjects, tongue color and red tongue tip were relatively stable tongue features (the change rates were 33.66% and 11.63% respectively). These tongue feature changes were related to gender, age and the time separation between two health examinations.2、Pink tongue, red tongue and dark red tongue were most seen in general, their changes of color were not common. Most tongue color changes were seen to become pink tongue, red tongue and dark red tongue.3、From the age of 50, the occurance of pale tongue, pale purple tongue decreased, the appearance of dark red tongue enhanced.4、Pale tongue’s L*, b*, h° was the highest, crimson tongue’s a*, C*was the highest among all tongue colors. When the tongue color did not change, except for dark purple tongue, all tongue colors’b, C, h° had reduced. When the tongue color changes, except for dark red tongue turned to pink or red tongue, pale purple tongue turned to pink or pale tongue, and originally dark purple or purple tongue, all changed tongue colors’b* had reduced.5、The chromatic values of tongue color were related to gender and age. Compared to female, male tongue’s L*, b*, h° were lower and a* were higher. As the age increased, tongue’s L*, b*, h° reduced. This kind of tongue color change was related to the elevation of HGB, HCT and MCV, and was more significant as the age grew.6、The tongue tip and edge had color difference itself. In normal pink tongue, the color difference of tongue tip and tongue was 2.99. In abnormal tongue color with no red tongue tip, the color difference of tongue tip and tongue was between 2.99-3.64. After k-means cluster analysis, normal tongue tip subects’ tongue color and tongue tip color difference had a clustering center of 2.93. For red tongue tip subjects, the color difference of tongue tip and tongue was from 7.86-10.61, the mean color difference was 8.90, where the pale purple tongue subjects with red tongue tip had the highest color difference of 10.61. After k-means cluster analysis, red tongue tip subects’tongue color and tongue tip color difference had a clustering center of 6.18. 7、 The occurance rate of red tongue tip of red tongue was only 7.71%, and the color difference of tongue tip and tongue in red tongue with red tongue tip subjects was 7.86, which was the lowest among all red tongue tip tongue color subjects. Also, for red tongue with red tongue tip subjects, their average scores of yin deficiency and blood stasis constitution in the TCM constitution survey were higher than red tongue with no red tongue tip subjects.8、 Red tongue tip subjects has a relatively higher LYM% and LYM#, red tongue with no red tongue tip subjects has a relatively higher NEU#, crimson tongue subjects’ WBC, NEU#, LYM# were relatively the lowest of all, and had a negative correlation to the elevation of WBC, NEU#, LYM#. The appearance of these three types of tongue subjects had positive correlations to the abnormal heat symptoms, and the heat situation of the three was gradually increasing. For red tongue tip subjects, they were related to damp-heat symptoms and some minor yin defiency symptoms. For red tongue with no red tongue tip subjects, they were related to yin defiency symptoms with a higher OR score, also related to some heat-based abnormal emotion symptoms, and some qi defiency symptoms which were caused by long term of abnormal heat in the body. For crimson tongue subjects, the correlation to abnormal heat was the most obvious, and was related to severe symptoms such as frenetic movement of hot blood.9、 In pale tongue, dark purple tongue, purple tongue and pale purple tongue subjects with red tip tongue, the peripheral white blood cell parameters were higher than other tongue color subjects weith red tongue tip. Yet these 4 types of tongue color with red tongue tip were negatively related or did not show relation to the abnormal heat symptoms.10、 According to the tongue tip form, red tongue tip subjects could be separated into red tongue tip with no spots and red spots tongue tip two groups. The red tongue tip with no spots group was seen mostly in pale tongue and all types of purple tongue. It had a higher disappearing rate, and WBC, NEU, LYM, HGB and HCT count. The red spots tongue tip group lasted longer, and was more related to damp-heat, yin defiency symptoms.Conclusions1、Is In the two-time health examination comparision of tongue features showed that tongue color and red tongue tip were relatively stable tongue features, yet there were still certain degrees of changes. Where pink tongue, red tongue, dark red tongue and red tongue tip spots tongue were relatively stable tongue features, and pale tongue, all types of purple tongue, crimson tongue and red tongue tip without spot tongue were relatively unstable tongue features.2、 Each tongue colors had its own chromatic values and pRBC count. The change of tongue color was mostly related to the changed of HGB, HCT and MCV count. Also, the chromatic values of tongue color were influenced by gender and age factors.3、For normal pink tongue subjects, the mean color difference of tongue tip and tonge edge was 2.99. For the abnormal tongue color subjects with no red tongue tip, their mean color difference of tongue tip and tongue edge was inbetween 2.99-3.64. The mean color difference of tongue tip and tongue edge of red tongue tip subjects was 8.90. This color difference was related to the tongue edge color.4、In pink tongue, red tongue, dark red tongue subjects with red tongue tip, their tongue tip form were most likely to be seen as red tongue tip spots. The appearance of these 3 types of tongue was the performance of a long term heat condition in the body. In pale tongue, dark purple tongue, purple tongue, pale purle tongue subjects with red tongue tip, their tongue tip form were most likely to be seen as red tongue tip with no spots. The occurrence of these 4 types of tongue was not likely to be the performance of a long term heat condition in the body.5、Through the correlation studies of the tongue color and tongue tip chromatic values, peripheral blood cell parameters and the heat related symptoms in the TCM constitution questionnaire in the health inspection people, it was concluded that the appearance of red tongue and red tongue tip was the performance of heat type constitution.6、Through the quantitative analysis of tongue tongue and red tongue tip, combining the correlation analysis results of peripheral blood cell parameters and TCM constitution questionnaire to support the reasons for the colormetry differences occurred in different tongue color and red tongue tip, can provide the basis of guidance of the health status in TCM tongue diagnosis. |
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