Study On Relationship Between TCM Syndrome Typing In Patients With Middle-advanced Stage Of Pulmonary Cancer And Cytochemistry Of Coating Tongue

ObJective: To explore and discuss the relationship between TCMsyndrome differentiation of middle-advanced stage of primary bronchogeniccarcinoma and its TNM classification by detecting morphology index(MI andMV) and chemical index(LDH,SDH,-SH and ACP) of coated tongueexfoliated cells,so that we can provide an obJective basis for TCM syndromedifferentiation of clinical middle-advanced stage of primary bronchogeniccarcinoma.Methods: Put140examples patients who were in middle-advanced stageof primary bronchogenic carcinoma into different standard types according toTCM syndrome. Morphology index(MI and MV) and chemical index(LDH,SDH,-SH and ACP) of coated tongue exfoliated cells that were from patientsof each Syndrome type and30of cases normal people were detected viaexperimental techniques of tongue printing slides and modern cytochemistry.All the datas were analyzed by statistical software of SPSS13.0for windows.For measurement datas,we adopt one-factor analysis of variance,one-wayANOVA to make comparison among groups and use LSD to make comparisonbetween two groups. Enumeration data were statistical analyzed by line×column chi-square test.Results:1The distribution difference in the TNM syndrome of middle-advancedstage of primary bronchogenic carcinoma,had a high statistical significantmeaning. Patients in ⅡB period mostly belonging to Qi-deficiency andphlegmatic hygrosis,holds72.42%. Patients in ⅢA period mostly belong toQi-Blood stagnant,occupies52.17%. Patients in ⅢB period mostly belongingto Yin-deficiency and toxic heat,takes up for66.67%. Patients in IV period mostly belong to Qi-Yin deficiency,holding90.0%. The incidence rate ofasthenia syndrome and Qi-Yin deficiency was increased gradually with theprogression of TNM staging.2Compared to normal people,the proportion in middle-advanced stageof primary bronchogenic carcinoma is higher while lower of superficial cells.The MV of coated tongue exfoliated cells of each group was smaller than ofnormal group (P<0.01). The alterations of MI and MV in Qi-Blood stagnantgroup were most obvious and that in Yin-deficiency and toxic heat group werenot significant. From the most obvious MV to the least,it had an alteredtendency of MV in all groups,which were Qi-Blood stagnant group,Qi-Yindeficiency group, Qi-deficiency and phlegmatic hygrosis group,Yin-deficiency and toxic heat group and normal group. The variance amongall groups had statistical significance (P<0.05or P<0.01),while the variancebetween Qi-Yin deficiency group and Qi-deficiency and phlegmatic hygrosisgroup was not significant.3The activity of LDH,SDH and ACP was higher in Yin-deficiency andtoxic heat group while lower in other groups than that in normal group,with ahigh level of-SH in the former and a low level in the latter groups. There wasmost obvious dimish of LDH,SDH and-SH in Qi-Yin deficiency group andQi-deficiency and phlegmatic hygrosis group,of ACP in Qi-deficiency andphlegmatic hygrosis group (P<0.01).Conclusion:1There was a certain some correlation between TCM syndromes ofpulmonary cancer and TNM staging,that the difference stands in the differentTNM stage.The incidence rate of asthenia syndrome and Qi-Yin deficiencywas increased gradually with the progression of TNM staging. It may beconcerned with the mechanism that the invasion of pathogen toward theinterior and consuming of healthy Qi, followed by hypofunction oftransmitting and distributing the fluids,with the appearance of endogenouspathogenic damp and obstructed stagnant blood in collaterals. Pathologicphlegm and stagnant blood may be transformed to pyretic toxicity,which consurnes Qi and Yin day after day.2The alteration of MI and MV was concerned with TCM syndrome,and the variance of MV was significant between different syndromes(P<0.01),with the lowest MV in Qi-Blood stagnant group. The mechanismsmay be Qi-Blood stagnant,obstructed transportation of essence of water andgrain and tongue dystrophy,which resulted in the slower hyperplasia ofglossal epithelium and desquamation when they were not mature. There was aslightest reduction of MV in Yin-deficiency and toxic heat group and thevariance was significant compared with Qi-Blood stagnant group. It maybecause that pyretic toxicity was prosperous in patients' body,in which it wasa pathologic metabolic prosperity and a relative acceleration of growth,differentiation and apoptosis in coated tongue exfoliated cells. It reveals thatMI and MV can be one of the basis for diagnosis of middle-advanced stage ofpulmonary cancer and offers methods for study in tongue inspection andmechanism of tongue presentations formation.3There were certain inherent connections between LDH, SDH, ACPand-SH of coated tongue exfoliated cells and TCM syndrome ofmiddle-advanced stage of pulmonary cancer. The index varied in differentsyndromes. The LDH,SDH and ACP in Yin-deficiency and toxic heat grouphad higher activity than that in normal group and so did levels of-SH. Themechanisms may be that patients in Yin-deficiency and toxic heat group hadpyretic toxicity in their body,which led to Yin deficiency Yang hyperactivitiesand bubbling up of Qi and blood. The metabolism of patients were pathologicexcited and they were in the state of Yin deficiency,which led to the reductionof material basis for nourishing coated tongue cells, hornification andexfoliation of coated tongue exfoliated cells,and finally the dynamic balanceof alternation of glossal epithelial cells was destructed. The activity of LDH,SDH and ACP in Qi-deficiency and phlegmatic hygrosis group,Qi-Yindeficiency group and Qi-Blood stagnant group was declined compared to thatin normal group,and the level of-SH was also descend. It may due to that thepatients had asthenia syndrome or blocking state of evil domination. The somatic metabolic material basis was reduced or transportation andtransformation of Qi-blood was influenced by blocking state of evildomination, so that coated tongue epithelial growth, differentiation,hornification and exfoliation of patients was slower than that in normal people.The amount of ACP was the lowest in Qi-deficiency and phlegmatic hygrosisgroup (P<0.01),which may be concerned with the abnormal transporting ofbody fluids,converting into pathologic phlegm and obstructing of activities ofQi. All these pathologic production led to the slowly exfoliating of glossalepithelial cells,showing a white and greasy coated tongue. Thus,it wasspecific to inspect the cellular chemical index of coated tongue exfoliated cellsand these index can be a reference of objective basis for TCM syndromedifferentiation to middle-advanced stage of pulmonary cancer.