中區病舌診定量硏究 = Quantification Study for the Inspection of Tongue in Apoplexy

다국어 초록 (Multilingual Abstract)

Inspection of tongue is an important objective index for the diagnosis in Traditional Chinese Medicine(TCM). We can estimate prosperous or insufficient conditions of Qi and blood in Zang Fu systems, differentiate the property of evils, identify superficial or deep in the position of diseases, forejudge the development and prognosis of diseases, according to the changes of both the fur and the nature of the tongue. In TCM, Inspection of tongue pays an important role in the diagnosis of apoplexy. But the recent studies of the inspection of tongue for apoplexy are almost confined to observation only by unaided eye , or laid particular emphasis on its local pathology and substance basis by the half-quantification methods such as color-compared or score-counted, they may reduced the accuracy and objectivity of the diagnosis. Toward to quantify inspection of tongue , provide evidence for clinical diagnosis of apoplexy, we made an deeply investigation of the condition of tongue , and establish the expert's system of inspection of tongue on the basis of the theory of hue and vision in computer.
Patients
All 378 patients were selected from the outpatient and inpatient in neuropathy department, senile diseases deparhnent, emergency department of XIYUAN hospital during Oct , 1999 to Mar, 2000.
Criteria for diagnosis
1. Criteria for diagnosis in west medicine: According to the criteria for the diagnosis of cerebral hemorrhage and cerebral infarction formulated by the fourth academic conference for cerebral vessels diseases in 1995.
2. Criteria for diagnosis in TCM: According to the criteria for the diagnosis of apoplexy formulated by encephalopathy emergency co-operation of Governmental Administration for TCMP in 1995.
3. Criteria for staged diagnosis of apoplexy: According to the criteria of "Guide principle for clinic study in the treatment of apoplexy by new drug of Chinese herbal medicine" issued by China Ministry of Public Health.
4. Criteria for syndrome differentiation of apoplexy: According to the criteria of classification of apoplexy in "ZY/T001.1-001.9-94" issued by Governmental Administration for TCMP.
Materials of patients
All 378 patients (252 men, 126 women; age range 41-48 yr; mean age 60.27+-10.21 yr in cerebral infarction group, and 58.48+-9.81 yr in cerebral hemorrhage group ) were diagnosed according to those criteria above-mentioned.
There were 256 cerebral infarction patients (147 Atherosclerosis thrombus cerebral infarction, 37 cerebral embolism, 72 lacuna cerebral infarction) and 122 cerebral hemorrhage patients (51 basipodite hemorrhage, 30 thalamencephalon hemorrhage, lobe of brain hemorrhage, 5 cerebella hemorrhage,4 brain stem hemorrhage) in our study. All patients could be discerned to 214 cases at acute case period, 98 cases at convalescence period and 66 cases at sequelae period .
Methods
"The expert's system of inspection of tongue in TCM" was the result of "Study on the method of auto-differentiation of Inspection of tongue in TCM " subsidized by Science and Technology Fund of Chinese Government (No. 38705347), and was accomplished by XIYUAN hospital of China academe for TCM , tsinghua university and pulisheng corporation.
Operating system of Windows 98 , application program of Office, camera driver and image manipulation system of Olympus, statistical software of SAS were used in our study.
Results
Quantification study for the nature of the tongue in apoplexy patients.
1. Distribution of color of the tongue in 378 apoplexy patients.
Dim redness tongue of 98 cases(4S.79%) was the most frequent by observing in 214 apoplexy patients at acute period. Secondly was weak dim tongue of 38 cases, had 17.76 percentage. There was a statistically significant difference between the rate of dim redness and other colors tongue at acute period (P<0.01). Weak dim tongue was detected in 45 cases, had the highest rate of 45.92% in patients at convalescence period. 16 cases (16.33%) showed dim redness tongue . Statistically significant difference was obtained between weak dim tongue and other colors tongue in patients at convalescence period (P<0.01). Weak dim tongue also had the highest percentage (23 cases ,34.85%) in 66 patients at sequelae period, but this difference was not statistically significant when compared to other colors tongue (P>0.05).
2. Distribution of the nature and shape of the tongue in apoplexy patients.
In terms of the corpulent or thin to judged a condition of the tongue body in all of the patients, we found corpulent tongue had the highest percentage of 28.57% in convalescence period groups, thin tongue had the highest percentage of 12.12% in sequelae period groups, but no statistically significant differences were obtained when compared respectively between the groups (P>0.05). In terms of the tongue having teeth marks or not , we found that 30 cases (45.45%) displayed the tongue with teeth marks at convalescence period, and were more common than did at other periods , but this difference was not statistically significant (P>0.05).
The results also indicated :
(1)Dim redness tongue of 128 cases (33.86%) was the most frequent by observing among all of the 378 apoplexy patients . Statistically significant difference was found between dim redness tongue which had lower values of R, G, B compared with weak dim tongue , pale tongue and weak redness tongue (P<0.01).
(2)There were 106 cases (28.04%) with weak dim tongue among all of the 378 apoplexy patients . Statistically significant difference was found between weak dim tongue which had lower values of R, G, B compared with pale tongue(P<0.01).
(3)Crimson tongue was detected in 37 cases (9.79%) among all of the 378 patients. Crimson tongue had lower values of R, G, B with statistically significant difference (P<0.05, P<0.01) compared with dim redness tongue , weak dim tongue , pale tongue, weak redness tongue respectively.
(4)Pale tongue was detected in 36 cases (9.52%) among all of the 378 patients. The R, G, B values of pale tongue were higher than those of dim redness tongue , weak dim tongue ,weak redness tongue, crimson tongue , purple redness tongue , livor tongue, and statistically significant differences were found(P<0.05,P<0.01).
(5)Purple redness tongue was detected in 33 cases (8.73%) among all of the 378 patients. The R, G, B values of purple redness tongue were lower than those of crimson tongue , dim redness tongue , weak dim tongue , pale tongue, weak redness tongue, and statistically significant differences were found(P<0.01).
(6)Weak redness tongue was detected in 23 cases (6.09%) among all of the 378 patients. The R, G, B values of weak redness tongue were lower than those of pale tongue, and statistically significant difference was found (P<0.01).
(7)Livor tongue was detected in 15 cases (3.97%) among all of the 378 patients. The R, G, B values of livor tongue were lower than those of purple redness tongue, crimson tongue , dim redness tongue , weak dim tongue , pale tongue, weak redness tongue, and statistically significant differences were found (P<0.01).Quantification study for the fur in apoplexy patients.
1. Distribution of color of the fur over the tongue in apoplexy patients.
(1) Thick, yellow and greasy fur was observed most commonly among the 214 patients at acute period, occupied 66 cases (30.84%). In sequence, thick and yellow fur occupied 44 cases (20.56%); thin, yellow and greasy fur occupied 36 cases (16.32%); thin and yellow fur occupied 16 cases (7.48%); yellow and brown fur occupied 8 cases (3.74%). The cases of thick, yellow and greasy fur, thick and yellow fur, thin and yellow fur showed statistically significant differences (P<O.OS,P<0.01) when compared respectively with other fur among patients at acute period.
(2) Thin and yellow fur occupied a high amount (28 cases, 28.57%) in apoplexy patients at convalescence period. Secondly, thick ,white and greasy fur presented in 17 cases of apoplexy (17.35%). No statistically significant differences were obtained at convalescence period when compared the cases of thin and yellow fur , thick, white and greasy fur with those of other fur (P>0.05).
(3) Among 66 apoplexy patients at sequelae period, 20 cases (30.30%) showed thin, white and greasy fur and occupied the highest amount. In sequence, thick and white fur occupied 12 cases (18.18%); thick, white and greasy fur occupied 11 cases (16.67%); thin and white fur occupied 7 cases (10.61%). Every kinds of white fur totalled up to 50 cases (75.76%) at sequelae period, and every kinds of yellow fur up to 15 cases (22.73%). There was statistically significant difference between the sum of white fur and yellow fur (P<0.01).
2. Feature of the RGB distribution of the fur in apoplexy patients.
Statistically significant differences were obtained from the comparison of R/G and R/B values of every kind of fur in all apoplexy patients by variance analysis (P<0.01). The index of the thickness of thin and white fur ,thin , white and greasy fur, thick and white fur, thick, greasy and white fur showed statistically significant differences in all white fur (P<0.05,P<0.01). There were statistically similar differences between the index of the thickness of thin and yellow fur ,thin, yellow and greasy fur , thick and yellow fur , thick , yellow and greasy fur , yellow and brown fur in all yellow fur (P<0.01).
Study for RGB values of the nature of the tongue and the fur in various kinds of Syndromes of apoplexy patients.
Study for RGB values of the nature of the tongue in every Syndrome of 378 apoplexy patients.
We found that the R, G , B values of both the syndrome of deficiency of Qi and blood stasis, and the syndrome of pathogenic wind-phlegm blocked vessels were higher than those of other three kinds of syndromes . Statistically significant differences were obtained (P<0.05).From the comparison of R/G and RB values, statistically significant differences were also obtained between various kinds of syndromes in all of the 378 apoplexy patients (P<0.05,P<0.01). In terms of the index of the thickness about fur , the index of the syndrome of accumulation of phlegm and heat in the Fu-organ was the highest , and presented statistically significant difference when compared with that of other kinds of syndromes (P<0.05).From two aspects of the nature of the tongue and the fur, we prosecuted our studies to quantify the syndrome of apoplexy, in order to provided a basis to the standard and the quantification of the syndrome of apoplexy. We wait for a more deep and more meticulous study, for making a contribution to TCM propagating all over the world.
Key Words: apoplexy inspection of tongue Quantification study

목차 (Table of Contents)

• 英文縮寫詞表 = 1
• 前言 = 2
• 第一部 中風病舌診定量硏究 = 3
• 中文摘要 = 3
• 英文摘要 = 6
• 病例來源쭌 = 10
• 診斷標準 = 10
• 一般臨床資料 = 12
• 硏究方法 = 13
• 結果 = 15
• 詩論 = 21
• 參考文獻 = 24
• 第二部分 文獻綜述 (一) = 25
• 勵代中醫對舌診的論述 = 25
• 中風病舌診硏究發展 = 26
• 參考文獻 = 33
• 文獻綜述 (二) = 36
• 中風的韓方治療 = 36
• 參考文獻 = 43
• 附圖 = 44
• 中醫舌診專家系統簡介 = 64
• 致謝 = 83