Study On The Difference Of TCM Syndrome Differentiation And Tongue Picture In Patients With Chronic Gastritis And Gastric Cancer

ObjectiveThe aim of this study was to explore the differences in the distribution of the Traditional Chinese Medicine(TCM)syndromes and tongue images between chronic gastritis and gastric cancer(GC)patients through analyzing the clinical symptoms,tongue images,esophagogastroduodenoscopy(EGD)images and clinical data of the patients.We also observed the relationship between the tongue images and the EGD findings in this study.MethodsA prospective observational study was conducted from November 2016 till January 2017 on patients diagnosed with non-atrophic chronic gastritis(NACG),chronic atrophic gastritis(CAG)and GC from Xiyuan Hospital,China Academy of Chinese Medical Sciences and Cancer Hospital,Chinese Academy of Medical Sciences.Clinical symptoms,tongue images,EGD and pathological reports and clinical data were collected.Photos of tongues were taken and processed using software.Qualitative analysis of the tongue indexes such as the color and shape of tongue proper and the color and property of the tongue coating were carried out.Finally,the relationship between tongue images and EGD findings of chronic gastritis and gastric cancer patients was explored.ResultsData were collected from 146 patients as follow: 68 NACG patients,30 CAG patients and 48 GC patients.The main TCM syndromes in NACG were as follow: spleen-stomach weakness syndrome(31%),liver-stomach heat stagnation syndrome(27%)and liver-stomach qi stagnation syndrome(15%).The main TCM syndromes of CAG were spleen-stomach weakness syndrome(37%),liver-stomach heat stagnation syndrome(30%)and liver-stomach qi stagnation syndrome(13%).The GC patients were staged according to TNM classification based on the the 7th edition of AJCC Cancer Staging Manual for gastric cancer and their distribution of TCM syndrome were as follows: qi-blood deficiency syndrome(36%),liver qi invading stomach syndrome(29%),qi-blood deficiency syndrome(36%),and qi stagnation and blood stasis syndrome(37%)were found to be the most prominent syndromes in stage?,?,? and ? respectively.30% preoperative gastric cancer patients had liver qi invading stomach syndrome while postoperative patients had qi-blood deficiency syndrome(36-43%)as the main syndrome.In the study of tongue image,146 patients were divided into 4 groups,namely,NACG(68 patients),CAG(31 patients),GC stage ?&?(18 patients)and GC stage ?&?(30 patients).All 4 groups had purple color as the most common color of tongue proper(90%,93%,89% and 88% respectively).This study also found that the differences in color at the right lateral side of the tongue and shapes of the tongue between all 4 groups were statistically significant(p<0.01).The differences in thickness of tongue coating between all 4 groups were statistically significant(p<0.05).NCAG and CAG had thin tongue coating(47% and 43% respectively)while GC stage ?&? and GC stage ?&? had greasy tongue coating(44%and 40% respectively).The main color of tongue coating for all 4 groups was white.This research compared the EGD findings with the tongue images of 98 chronic gastritis patients and 30 preoperative GC patients.The results revealed that the endoscopic findings were related to the differences in shape of the tongue and thickness of the tongue coating in chronic gastritis patients.The difference in shape of tongue between the normal and abnormal mucosal fold groups was statistically significant(p<0.01).The difference in shape of tongue between the erosive mucosal group and the non-erosive mucosal group was statistically significant(p<0.01).The difference in thickness of the tongue coating between the granular mucosal group and the non-granular mucosal group was statistically significant(p<0.05).The relationship between the EGD findings and the tongue images in GC patients was not statistically significant.ConclusionsThe distribution of TCM syndromes in chronic gastritis and GC patients indicated that both diseases share a common characteristic: they are both deficiency in nature and closely related to the TCM spleen,stomach and liver.The difference of right lateral tongue color(p<0.01),shape of tongue proper(p<0.01)and thickness of tongue coating(p<0.05)between chronic gastritis and GC patients were statistically significant.Most NACG patients had dark purple color at the right lateral side of the tongue while most GC stage III&IV patients had light purple color.Most chronic gastritis patients had spots and prickles on their tongue while normal tongue shape was observed in most GC patients.Most chronic gastritis patients had thin tongue coating and most GC patients had greasy tongue coating.The purple color tongue(83-93%)and the abnormality of sublingual vein(30-50%)were commonly observed in chronic gastritis and GC patients.The endoscopic features of the gastric mucosa(abnormal mucosal fold,mucosal erosion and granulation)may be related to the shape of the tongue and thickness of the tongue coating.