The Literature And Clinical Study Of Tongue Characteristic In Adenomyosis

Objective:Adenomyosis (Adenomyosis, AD) is a common and difficult gynecological disease, mainly occurred at the age of 35-50. The clinical manifestations are gradually increasing dysmenorrhea, menorrhagia, prolonged bleeding and infertility. In recent years, the incidence of AD is increasing, and the patient become younger, which means AD has been a frequently-occurring disease influenced female physical and mental health. Clinical practice has proved that Chinese medicine treatment can effectively relieve or eliminate symptoms of dysmenorrhea, improve patient’s quality of life and fertility, with less side effects and long-term effects of stable. The Traditional Chinese Medicine diagnosis and treatment of AD, as well as basic theory and experimental research is worthy in further exploration.Basis on literature studies and analysis of AD, patient’s tongue body, shape, coating and sublingual varix were detected by using digital photography and computer imaging technology in this study. With the clinical case-control study and colorimetric quantitative analysis of tongue color R, G, B values, we provided objective measurements of tongue diagnosis and more references for AD treatment. The above study will contribute to establish an objective standard of tongue criteria in the future.Methods:This study is divided into three parts including literature study、 literature analysis and clinical study.1. Literature studies were to systematic overview of the history of tongue diagnosis, the experimental and clinical study of tongue diagnosis, also sort out the syndromes and the present situation of tongue diagnosis of AD, for the discussion on the characteristics of this disease tongue image provide reference and guidance.2. Literature analysis were to explore the common tongue properties of AD in the literature that have been reported by retrieving all the literature on AD tongue records in China Academic Journal (CNKI) from 2005-2014.3. Clinical Studies were detected in AD patients and non-AD patients each 120 cases for this study. Tongue image recorded by using digital camera photography, and patients medical information were collected in a form. Then all the data and tongue image were input the computer, graphics software and statistical software were used to analyze data in order to quantity analysis tongue characteristics of AD.Results:1. Literature analysisGeneral character of tongue diagnosis in AD:(1) Dark tongue, the overall frequency of occurrence is 77.56%, including five kinds:dark purple tongue, pale dark tongue, dark red tongue, dark tongue, purple tongue, of which the largest share is dark purple tongue, accounting for 42.24%.(2) Ecchymosis tongue, the overall frequency of occurrence is 75.19%.(3) White tongue fur, the overall frequency of occurrence is 71.48%.2. Clinical research result(1) The tongue body in 120 cases of AD patients included pink tongue, pale tongue, red purple tongue, dark red tongue, pale dark tongue and dark purple tongue. According to the proportion in all cases from large to small as follows: pale dark tongue> dark purple tongue> dark red tongue> pale tongue> red purple tongue> pink tongue. The main three tongue body account for 80.83% in total (spread in 97 cases) as followed:the pale dark tongue (30.83%), dark purple tongue (28.33%), dark red tongue (21.67%). There is significant difference of tongue body distribution between AD patients and non-AD patients (P<0.01).(2) The major performance of tongue shape showed as followed, ecchymosis (39.17%), big fat tongue (17.50%) and teeth-printed tongue (16.67%). There is no difference in the distribution of tongue shape between AD group and non-AD group (P>0.05).(3) The main color of tongue coating is white fur-based (62.50%), followed by yellow fur (27.50%), gray fur (10.00%), no black fur founded. The tongue coating nature showed as thin fur (37.50%) and greasy fur (23.33%), followed declining by thick fur> Run fur> dry fur> stripping fur> rot fur. There is no difference in the distribution of tongue coating color and nature compared AD group with non-AD group (P>0.05).(4) Performance of lingual vein was as follows:purple (49.17%), purple-black (34.17%); width 2-2.6mm (39.17%),≥2.7mm (55.00%); trunk length exceeds 3/5 (73.33%); limitations of varicose(65.00%), diffuse of varicose (33.33%); full rise(51.67%), significant uplift or cylindrical(48.33%); SAC cylindrical, thick branches, bunches of grapes (45.00%). By using Chen’s integral method to calculate the total points were 14.13+1.92. Compared AD group with non-AD group of patients in the above sub-lingual vein, the total score showed significant differences (P<0.01).(5) Six different syndromes showed in AD patients, among these qi-stagnation and blood stasis syndrome is the largest share (accounting for 42.50%), followed by the kidney deficiency and blood stasis syndrome (accounting for 21.67%), the third is Qi-deficiency and blood stasis syndrome (accounting for 13.33%), the proportion of the remaining syndromes were less than 10%. Integrated three major syndromes of tongue manifestation, can be summarized as pale dark tongue, dark purple tongue, dark red tongue, mainly accompanied with petechiae or fat big teeth-printed tongue, thin-white or white, greasy fur, with obviously abnormal appereance of lingual vein.(6) The tongue diagnosis in different syndromes in AD have common and different characteristics. In Qi-stagnation and blood stasis syndrome, mainly in dark purple tongue, ecchymosed; in kidney deficiency and blood stasis syndrome, mainly in pale dark tongue, big fat tongue; in Qi-deficiency and blood stasis syndrome, mainly in pale tongue, teeth-printed tongue; in phlegm stasis mixed syndrome, mainly in pale dark tongue, big fat with teeth-printed tongue, greasy fur; in heat burn and blood stasis syndrome, mainly in red purple tongue, prick crack tongue, yellow dry fur; in cold condensation and blood stasis syndrome, mainly in pale dark tongue, ecchymosed, white run fur.(7) The study on tongue color showed significant difference in R, G, B values between AD and non AD patient(P<0.01), especially in R and B values of dark pale tongue, purple dark tongue, red dark tongue between two groups (P <0.01).Conclusion:1. Tongue manifestation in AD patients (covering 80.83% in the total number of samples) was dark tongue, including pale dark tongue, dark purple tongue and dark red tongue, characterized by tongue color darkens, lack luster. Above these reflects blood stasis is one of the internal essence of the pathological in AD.2. The feature of tongue shape was ecchymosis (accounting for 39.17% in the total number of AD samples). Ecchymosis always showed in light and dark tongue or dark purple tongue.3. White, thin and greasy fur gave the priority character of tongue coating in AD. Tongue coating showed less relationship with blood stasis syndrome, but closely associated with turbid-phlegm syndrome. Observation of tongue fur had a certain reference value for analyzing clinical syndrome type.4. Abnormal lingual vein showed in AD was more serious, which belonged to the typical tongue character for blood stasis syndrome. Such as purple and purple-black color, the main varicose uplift and the high score (14.13±1.92).5. Color characteristics of tongue mainly showed the R value decreases, B values increased in AD, such as pale blue, purple and dark which indicated blood stasis syndrome. These data showed widespread disturbance of blood circulation in AD was more serious than other patients with gynecological disease.6. The tongue diagnosis in different syndromes in AD matched with the corresponding pathogenesis, we think that comprehensive observation of tongue body, tongue shape, tongue coating and lingual vein will help us to distinguish the different syndromes of AD, and to judge the pathology changes of cold heat deficiency solid syndromes.7. Above all tongue analysis results showed that blood stasis is the central part of the lesion; phlegm is another factor that should not be ignored; the deficiency of kidney is the root of disease. Tongue features could reflect pathology patterns based on kidney deficiency syndrome and companied with blood stasis syndrome.