Study On The Changes Of Tongue Image And Its Relation With Physicochemical Indexes Of Damp-turbid Syndrome Of Chronic Kidney Disease

Objective: To study the tongue changes after treatment in patients with dampturbid syndrome of chronic kidney disease and its relation with physicochemical indexes,to provide reference for clinical application of tongue diagnosis in chronic kidney disease with damp-turbid syndrome.Methods: From October 2017 to September 2018,99 inpatients with damp-turbid syndrome stage 2-5 of chronic kidney disease were selected from the nephrology department of Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine.Canon 70 days was used to photograph the tongue image of the patient at admission,in hospital and out of hospital.Physicochemical indicators of the patient’s routine laboratory were collected at the same time.On the basis of artificially interpreting the features of tongue images,the parameters of the tongue images were analyzed by using Shanghai Daosheng Four Diagnostic Instruments.SPSS20.0 software was used to analyze the parameters of tongue image,and on this basis to analyze the characteristics of tongue image changes in patients with CKD damp-turbid syndrome before and after treatment.The characteristics of tongue changes and laboratory indicators were analyzed to find the relation between them.Results: 1.Characteristics of tongue image changes after treatment of CKD damp-turbid syndrome in different stages 1.1 The proportion of pink tongue and pale tongue was the largest in stage 2 patients,and there was no significant change in the proportion of differenttongue colors after treatment.Before treatment,the greatest tongue coating proportion of tongue coating was slippery tongue coating,which decreased with the improvement of the disease.On the contrary,the proportion of greasy tongue coating increased.The tongue shape of patients in this period is still normal.1.2 In patients with CKD3 stage,before treatment,pale tongue color accounted for the largest proportion.After treatment,the proportion of pale white decreased,and the proportion of pink tongue increased.The proportion of slippery tongue coating and greasy tongue coating in tongue coating increased with the treatment,while that of dry tongue coating decreased.The proportion of thin tongue coating increased gradually with the treatment,while that of thick tongue coating decreased gradually.From this period,abnormal tongue shape was the main tongue shape,accounting for 69.4% of the total patients.1.3 In stage 4 patients,pale tongue was the most common tongue color,followed by purple tongue.With the progress of treatment,the overall proportion of pale red increased,accounting for 48.27% of discharged patients.In terms of tongue coating,comparisons between admission and discharge,the proportion of thin tongue coating patients increased,while tongue the proportion of thick tongue coating patients decreased,the proportion of yellow tongue coating patients increased,and the proportion of white tongue coating patients decreased.The greasy tongue coating is the main tongue coating of the patients at this stage.1.4 In CKD5 patients,pale tongue accounted for the largest proportion,but pink tongue increased from 9.09% to 31.82%.Among tongue coating,greasy tongue coating increased from 54.5% at admission to 81.8% at discharge.White tongue coating decreased from 77.3% to 59.1%,yellow tongue coating from 4.5% to 31.8%,thin tongue coating from 13.6% to 31.8%,thick tongue coating from 59.1% to 50%.2.Tongue color parameters 2.1 The R value at discharge of patients with CKD5 was higher than that at admission(P < 0.05).The R and L value at discharge of patients with CKD3 washigher than that at admission(P<0.05).The R and L value at admission of patients with CKD4 was higher than that at admission,and the G and B values were lower than that at admission(P<0.05).2.2 The R,S,L values of CKD patients were higher at discharge than at admission(P<0.05),and G values were lower than at admission(P<0.05).3.The relationship between the changes of laboratory indicators and tongue image in cases with this subject 3.1 With the decrease of red blood cells and white blood cells in routine urine examination of CKD2 cases,the R value of tongue color parameter increased correspondingly.3.2 In CKD3 cases,with the decrease of the number of red blood cells and white blood cells in Scr,BUN and urine routine examination,the main change of tongue color tends to be pale tongue to pink tongue,dark purple tongue and purple tongue to pale purple tongue.The main change trend of tongue coating is that thick tongue coating changes into thin tongue coating,while that of dry tongue coating decreases,and the tongue parameters color show the increase of R and L values.With the decrease of Scr and BUN in cases with CKD4,the change trend of tongue image is the same as that in cases with CKD3.In terms of tongue color parameters,except for the increase of R and L values in tongue color parameters of CKD4,and the G and B values of CKD4 cases decreased.3.3 There was no significant correlation between tongue image changes and laboratory indicators in cases with CKD5.Starting from CKD3 cases,HGB and RBC were lower than normal at admission,and anemia index did not rise to normal at discharge.This suggests that the common complication of this disease is anemia.The tongue color of cases with CKD3 was mainly pale tongue at discharge and admission.When Scr and BUN increased abnormally,the tongue coating was mainly thick tongue coating and greasy tongue coating,and the abnormal tongue shape was mainly fat tongue.The number of red blood cells in urine of cases with CKD2 and CKD3 decreased,and the R value of cases with CKD2 and CKD3 increased.Interms of L value,in urine examination of CKD3 and CKD4 cases,the L value increased with the decrease of the number of red blood cells.Conclusion: 1.CKD with damp-turbid syndrome had no obvious pathological changes in tongue color before and after treatment in stage 2;patients with stage 3-5 had pale,purple and purple tongue color.However,with the effective progress of treatment,patients’ tongue color mainly changed from pale tongue to pink tongue,from dark purple to light purple.Meanwhile,after treatment,the R and L values of tongue color parameters of patients at all stages increased,and the change of tongue color parameters also confirmed the trend of patients’ tongue color turning red and bright.The change trend of tongue coating is that thick tongue coating changes into thin tongue coating.2.The changes of tongue image and tongue color parameters were correlated with the changes of erythrocyte count in Scr,BUN and urine examination,so the changes of tongue image could reflect the changes of renal function to a certain extent.3.The physicochemical indexes of patients before and after treatment showed that the total effective rate was 50% in stage 2,83% in stage 3,68% in stage 4 and 54.5% in stage 5.Because some patients are getting worse and worse,the total effective rate of the disease is gradually decreasing,suggesting that the condition of the disease is complex and changeable,and the disease is easy to repeat.Although the effective rate of the second stage patients is 50%,the serum creatinine of the second stage patients is within the normal range before and after treatment.The renal function indexes of patients in each stage were slightly improved compared with those before treatment.The overall change trend of tongue image was consistent with the signs of improvement of TCM disease.The change of tongue image was consistent with the indication of laboratory indicators.Therefore,the change of tongue picture in TCM can reflect the severity and prognosis of damp-turbid syndrome in chronic kidney disease.Tonguediagnosis can be used as an objective index to evaluate the curative effect of damp-turbid syndrome in chronic kidney disease.