| [Objective] It has been more than 2,000 years for the history of the applications of tongue diagnosis since the period of "Nei Jing". The status of health and disease can be objectively reflected from the changes of tongue manifestation. It is a mirror of the lesions. In recent years, malignant tumors have become the serious disease which greatly threatens our people's health and life. In human spectrum of disease, malignancies have become an important cause of death, the first in the city, and the second in rural areas.1/5 of all deaths caused by diseases are contributed to cancer. The research of cancer has caused wide public concern. With the development of the modern concept of comprehensive treatment of cancer, Chinese medicine has played a more and more important role in the diagnosis and treatment of tumors. Tongue diagnosis,-one of four diagnostic methods of TCM-, is the most unique diagnostic method, especially for the diagnosis and prognosis of malignancies has important significance. Studies have shown that the tongue manifestations varied abnormally compared with healthy people and patients suffering form other diseases. This study also found that there are differences and characteristics in the distribution of tongue manifestations of patients with various types of malignancies in the clinical observation. Using clinical research methods, this subject aims to discuss and analyze the distribution of tongue manifestations of patients with various types of malignancies and provide an objective basis for clinical diagnosis.[Method] Using chemotherapy and radiotherapy as a means of intervention, this clinical research was conducted by two or more deputy chief physicians.250 cases of common types of cancer patients were observed in natural light before and after radiotherapy, and their changes of the tongue manifestations were recorded by the Canon A480 camera.[Results] The results of clinical study I showed that, in various types of tumors, dark tongue classes (dark red tongue, pale dark tongue, dark purple tongue) account for a great proportion (71.2% on average), while the average ratio of pink tongue possesses a 16.8%; Among dark purple tongue liver cancer is the highest (33.33%), followed by renal cell carcinoma (25.00%).The prick tongue accounts for a considerable proportion in breast and ovarian cancer (19.05% and 34.38%, respectively), while the proportion in other tumors accounts much less (no more than 4.76%). We also found that tooth-marked tongue occupies a certain proportion in various kinds of tumors (30% on average), while the proportion is larger in ovarian cancer(37.50%), liver cancer(35.90%), stomach and esophageal cancer (34.48%), lung cancer (30.77%). The proportion of tongue petechiae is highest in liver cancer, colorectal cancer, breast cancer; each of them is 19.05%. Fissured tongue shows more in lung cancer (30.77%), followed by breast (21.43%), stomach and esophageal cancer (20.69%). The highest proportion of sublingual varices can be seen in liver cancer (52.38%), and it is also high in the remaining types of tumors (35.2% on average). The rate of liver gall line appears in HCC patients is 19.05%, while there are only 2 cases in colorectal cancer among other tumors (4.76%).The ratio of thin white coat account for an average of 23.2% in the various types of tumors; little or no coating highest in the stomach and esophageal cancer, accounting for 13.79%; The proportions of white greasy tongue coat are higher among the various types of cancer (average 46.4%), especially more pronounced in HCC (57.14%), ovarian cancer (56.25%), renal cell carcinoma (50.00%); yellow greasy coat are more in breast cancer (21.43%), colorectal cancer (19.05%%) and renal cell carcinoma (16.67%) as compared with other cancers; stripping and greasy coat is more obvious in the lung (15.38%), stomach and esophageal cancer (13.79%), and rare in other tumors.The ratio of normal tongue is 12.8% on average in the various types of tumors, indicating that even in the patients with malignant tumors, there are a certain percentage of the normal tongue.Clinical Research II shows the dark tongue (36.84%) and the pink tongue (26.32%)is the most common tongue proper before chemotherapy, and dark purple tongue (47.37%) and dark tongue(26.32%) are dominated after chemotherapy; the normal tongue is the most before chemotherapy, which is up to (26.32%), while after chemotherapy, the tongue petechiae (31.58%), large tongue(26.32%) and tooth-marked tongue(26.32%) are the most; for changes of the coating, the proportion of yellow and white greasy coating are significantly increased after chemotherapy from 26.32% and 15.79% respectively to a 47.37% and 26.32%, accounting for 73.68% of the total.Before radiotherapy, the dark red tongue (26.09%) and pink tongue (21.74%) are the most common, however, after radiotherapy the dark red tongue (30.43%) and red tongue (21.74%) are dominated; the normal tongue-shaped tongue (26.09%) and tongue petechiae (21.74%) are usual before radiotherapy, with fissured tongue and prick tongue (both 26.09%) after radiotherapy; the tongue with a thin white coating (39.13%) and greasy tongue coating (26.09%) were Lord before radiotherapy, exfoliated coating(30.43%) and white dry coating(26.09%) are dominated after radiotherapy.[Conclusion]The results show that in various types of tumors, the dark tongue classes, greasy tongue coating and sublingual varices accounted for a considerable proportion, which describes that coagulated phlegm and blood stasis is an important tumor pathological product, and confirms a "chronic illness responsible for sputum and stasis" theory. It suggests that dampness phlegm and blood stasis drug application should be noted in the clinical use of drugs. Among the various types of cancer, liver cancer patients have the highest proportion of dark purple tongue, sublingual varices, petechiae, and greasy tongue coating, suggesting that there are more closely links between the pathogenesis of liver cancer and blood stasis and coagulated phlegm. This is consistent with the findings of other scholars. But even in the patients with cancers, pink tongue, normal, thin white coating and normal shaped tongue also occupies a certain proportion, indicating that although TCM tongue diagnosis of the tumor plays an important role, but not absolutely accurate, it should be applied with other means to facilitate the application of treatment.Besides the common tongue, the various types of cancer also have their relatively characteristic tongue manifestation. For instance, the tooth-marked tongue, fissured tongue and stripping and greasy coating are the common tongue manifestation of lung cancer. Tooth-marked tongue is the performance of spleen dysfunction due to dampness and fissured tongue is the performance of body fluid deficiency, suggesting that lung dryness due to yin deficiency and spleen dysfunction due to dampness are the major syndromes of lung cancer. Similarly, the tooth-marked tongue, fissured tongue and the little-or-no coating are common tongue manifestations of the stomach and esophageal cancer, suggesting that their pathogens are similar to lung cancer. There was not only spleen dysfunction due to dampness, but also the deficiency of stomach yin. It should be noticed that stripping and greasy coating is the characteristic tongue manifestation in both lung and stomach cancer patients, which indicates the complexity of cancer pathogenesis. There was not only the lack of Qi and Yin, but also the spleen dysfunction due to phlegm.the lung is the metal and water organ, the stomach is the Yangming dry soil, they both like the humid and hate the dry. As a result, the spleen dysfunction leads to the deficiency lung and stomach yin, and exfoliated and greesy coating appears. This suggests that in the clinical treatment we should supple qi and nourish yin, as well as dispelling phlegm and promoting diuresis, weigh the advantages and disadvantages for the appropriate medication.In the study, we also note the liver gall line—the characteristic performance of HCC, its appearance in HCC patients is higher, suggesting that it has certain significance in the diagnosis of liver cancer. Liver is the wood of the Jue Yin organ, and the key of the transformation from yin and yang. From the perspective of modern medicine, there are metabolic abnormalities in the patients with HCC, anticoagulant factors are damaged, blood is thick, sticky and easy to form a condensate state, which is dark pathology purple tongue and liver gall lines. The liver gall lines may be the secondary changes after long-term stasis in HCC, and the general performance of the disorders of local microcirculation.In patients with colorectal cancer and renal cell carcinoma, the appearance of yellow and greasy tongue coating are higher, and the rate dark purple tongue in renal cell carcinoma is right behind the emergence rate of liver cancer. The rates in the appearance of the ecchymosis on tongue in colorectal cancer and HCC are both the first, indicating blood stasis and damp heat pathological factors counts a certain proportion in the related cancer patients. In addition, the rate of white greasy coating in patients with renal cell carcinoma is also very high. The kidney is the water and fire organ, so the ecchymosis on tongue and greasy coating are easy to be seen.The prick tongue concentrates in breast and ovarian cancer patients, whit a possession of relatively small proportion of other tumors, which is of specificity. The prick is darker, mainly found in the tip of the tongue; it was also known as "blood spots".Dark tongue prick is the performance of heart fire. As both cancer patients are female, who are easily depressed or angry, indicating that we should focus on the relieving qi stagnancy in heart. In addition, yellow greasy coating accounts for the highest proportion in breast cancer patients, it is because women's breasts belong to the liver, and greasy coating appear in a higher proportion of ovarian cancer, only second to liver cancer, suggesting that moisture is important in the pathology of ovarian cancer product, which is closely related to ascites in ovarian cancer.After chemotherapy the characteristics of tongue manifestation in patients with cancers,--purple tongue and the ecchymosis on the tongue--, is more obvious. There is the pathogenesis of blood stasis and Stagnation of Qi in cancer patients, and chemotherapy drugs are easy to damage the stomach and suppress the bone marrow. And this will lead to the deficiency of liver and kidney Yin and Blood deficiency, blood dryness. Besides, TCM theory believes that "Prolonged illness enters into venation", which will lead to the weakness and stasis, thus the degree of blood stasis will be further increased. This suggest that we can add some herbs for the treatment of Qi and blood circulation such as air-Astragalus, Codonopsis, Atractylodes, Poria, Angelica, Cuidium Officiuale, peach kernel, safflower, red sage root, red peony root, notoginseng, turmeric, Yuan Hu, frankincense, myrrh, Tri, Zedoary, pangolins, soap thorn, Zeeland, Scorpion, Eupolyphaga insects, leeches,etc. Chinese medicine of strengthening the spleen and replenishing qi can reduce the gastrointestinal side effects of chemotherapy, protect the liver and kidney functions, as well as improving immune function. At the same time, it suggests that, in the intermittent chemotherapy the application of Curcuma, Salvia, Panax, Achyranthes and other blood circulation herbs has the effect of anticoagulant and anti-metastasis.After chemotherapy, the large and tooth-marked tongues are the main tongue shape. The result also shows that the changes before and after chemotherapy are the thick and white greesy coating and the the thickness of middle tongue coating changes significantly, which is related to the damage caused by the chemotherapy drugs,so that patients are often accompanied by epigastric discomfort, fatigue, weakness. We can add some drugs of supplement qi and activate Blood circulation in the treatment. Tongue can explain that chemotherapy can increase the blood stasis syndrome, also increases the incidence of blood stasis. After chemotherapy, some pink tongue turn into purple and scarlet tongue, so that purple tongue and the proportion of the tongue with petechiae are significant increased. A part of the normal tongue turns into the tooth-marked tongue, the original thin tongue disappeared. From the TCM point of view, the metabolism of blood and body fluid are abnormal during the chemotherapy, and blood stasis and fluid retention are the key elements of pathogenesis. The change in tongue in the process of chemotherapy also embodies the degree of chemotherapy damage to the body and the body's response. As for the thickening of the tongue, TCM can adjust the body to the positive direction by tonifying Spleen and resolving Dampness. Purple tongue is related to status of the body circulatory system. Blood stasis is not conducive to the body repair, and even is the key elements of disease. Thus, according to TCM analysis of the pathogenesis and syndrome diagnosis, the use of supplement qi and activate Blood circulation and other reasonable methods, there may be an effective measure to enhanced body's ability to repair and against injury.And after radiotherapy, the patients'tongue manifestations do not change significantly, however, fissured tongue and stripping coating ratio has increased over the previous, suggesting that the major impact of the radiation is injuring Yin, which confirms the saying "radiation is toxic heat,". Radiotherapy injurs lung and stomach yin, and therefore during the process of radiotherapy we can add some herbs to tonifying Lung and stomach, such as Codonopsis, Astragalus, Chinese yam, Ophiopogon, Asparagus, heterophylla, wolfberry, Ligustrum lucidum, Eclipta prostrata, Rehmannia, etc. |
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