Correlation Study Of Tongue Picture And Symptoms In Patients With Type 2 Diabetes And Hypertension

Part 1 Research on Visualization and Bibliometrics of Domestic Tongue Examination Literature Objective:Focusing on "tongue diagnosis",use Cite Space software to carry out systematic bibliometric and visual analysis,sort out the research situation in the field of tongue diagnosis in China,and analyze the current situation and trend of tongue diagnosis research.Methods:Using China Knowledge Network(CNKI)as the data source,we retrieved and screened the publicly published literature from January 2001 to December 2020.The search formula was "Subject = Tongue Diagnosis or Tongue Image"(precise).The authors,institutions,and keywords included in the literature are analyzed for co-occurrence and a visualized knowledge map is obtained.Results : In the past 20 years,the overall research on tongue diagnosis has shown an increasing trend.The results of the knowledge map show that there are 1,217 major researchers in this field,forming 4 high-yield teams represented by Wang Yiqin,Liang Rong,Xu Jiatuo,and Chen Qun.The research strength is concentrated In Shanghai,Beijing,Tianjin,and Guangzhou,it is mainly based on research institutes of traditional Chinese medicine.Through keyword clustering,the modularity Q value of the cluster(Modularity Q)=0.256,and the mean silhouette S value(Mean Silhouette)=0.9042,indicating that the keywords obtained through this clustering can accurately reflect the research hotspots in this field.Mainly include the objectification of tongue diagnosis,the correlation between tongue condition and syndrome types and diseases,and tongue diagnosis literature research.The syndrome types with higher correlation are mainly damp-heat syndrome and blood stasis syndrome.The diseases mainly involved are chronic gastritis,diabetes,and Coronary heart disease,hypertension and a variety of malignant tumors,there are few related studies on common diseases and their common complications.Conclusion: In the field of tongue diagnosis,the cooperation between research teams and institutions is relatively close,and there is a trend of multidisciplinary integration.At present,the number of diseases involved in the study of tongue picture correlation is relatively small.Future research can strengthen cooperation among various disciplines and deeply explore the correlation between tongue diagnosis and clinical diseases.Part 2 Correlative study of tongue picture and clinical symptoms in patients with type 2 diabetes mellitus and hypertension Objective:Analyze the changes of tongue picture in patients with type 2 diabetes mellitus and hypertension in different gender,smoking history,course of disease,modern medical indicators and other factors,and explore the syndrome classification of the disease.Methods:Information collection was conducted on 710 patients with type 2 diabetes and hypertension.The information collection form mainly included the basic information of the questionnaire,the informed consent form,the basic patient information form,the clinical diagnosis record form of traditional Chinese medicine and the clinical data confirmation form.The TDA-1 tongue imager developed by Shanghai University of Traditional Chinese Medicine is used to collect the image of the patient’s tongue and make a preliminary judgment of the patient’s tongue.The judgment content mainly includes the patient’s tongue color,tongue shape,tongue state,coating color,and coating quality.Tongue color,coating color,part of the tongue shape,coating quality and patient gender,smoking history,course of disease and modern medical indicators were analyzed.Extract the 25 most frequently occurring symptoms and 10 tongue features from the TCM clinical diagnosis record table,and explore the distribution of syndromes of type 2 diabetes with hypertension through cluster analysis of patient symptoms and tongue features.Results:(1)Tongue picture study results: According to gender,the male group and the female group have statistical differences in white,yellow,black,cracked,thick,thin,and greasy fur(P<0.05),female White moss and thin moss accounted for higher proportions in men,and yellow moss,black moss,cracks,thick moss,and greasy moss in men accounted for higher proportions than women.Based on the history of smoking,the two groups were divided into white,black,cracked,thin moss.There was a statistical difference in greasy fur(P<0.05).Among them,the proportion of white fur and thin fur in the non-smoking group was higher than that in the smoking history group,and the patients in the smoking history group had black fur,cracks,and The proportion of greasy coating was higher than that in the non-smoker group;if the course of diabetes was used as the grouping group,there were statistical differences in the pale red tongue,crimson tongue and black coating(P < 0.05),and the course of diabetes ≤10 At the age of 10 years,the proportion of patients with pale red tongue was relatively high,and when the course of diabetes was more than 10 years,the proportion of patients with red crimson tongue was relatively high;if the course of hypertension was used as the grouping,the different groups were in pale red tongue,dark red tongue,and cracked tongue.There are statistical differences in thin coatings(P<0.05).When the course of hypertension is less than 5 years,the proportion of patients in the pale red tongue is relatively high.When the course of hypertension is ≥5 years,the patients are in dark red tongue,cracks,and thin coatings.When fasting blood glucose is used as the grouping,there is a statistical difference in tooth scars and thin fur(P<0.05).When fasting blood glucose ≥ 7mmol/L,the patient has a higher percentage of tooth scars and thin fur;systolic blood pressure is used as the grouping There was a statistically significant difference in red crimson tongue between patients(P<0.05).When systolic blood pressure was less than 140 mmg H,the proportion of patients in crimson tongue was higher;when diastolic blood pressure was used as the group,there was a statistical difference in black and thin fur.(P<0.05).When the diastolic blood pressure is ≥90mmg H,the proportion of patients in black fur and thin fur is higher.(2)Results of clustering study of clinical symptoms and tongue picture: According to the results of cluster analysis combined with the theory of traditional Chinese medicine,it is most reasonable to divide the clusters into two categories.Cluster 1 includes the following symptoms and tongue signs: "sticky mouth","night sweats","backache","constipation","numbness of the limbs","head weight","dizziness","thirst and polydipsia","more " Sweat "," dry throat "," night urine "," loose teeth "," palpitations "," chest tightness "," insomnia "," irritability "," red tongue "," red crimson tongue "," tip of tongue " " Red "," tooth marks "," yellow fur "," greasy fur ",cluster 2 includes the following symptoms and tongue signs:" tiredness "," fatigue "," hearing loss "," tinnitus "," crack "," Petechiae,"Dry mouth","Bitter mouth","Fuzzy vision","Dry eyes","Dizziness","Thin moss","White moss".Conclusion:(1)Tongue characteristics of patients with type 2 diabetes and hypertension are statistically different with different genders.Men are more likely to have yellow,black,cracked,thick and greasy coatings than women,which are closely related to the physiological characteristics and lifestyle of the patients.;(2)The tongue picture of patients with type 2 diabetes and hypertension is statistically different from smoking history,and smoking has a certain degree of influence on the tongue picture of patients with this disease;(3)There are statistical differences in tongue picture and disease course,blood sugar and blood pressure in patients with type 2 diabetes and hypertension.The changes in patient’s disease course,blood sugar and blood pressure are reflected to a certain extent in tongue picture,suggesting that tongue picture may help clinically One of the characteristic indicators of TCM diagnosis;(4)According to the cluster analysis of symptoms and tongue picture,the disease is classified into two syndrome types,namely Qi and Yin deficiency syndrome and liver and kidney Yin deficiency syndrome.Most of the patients included in this study are elderly and have a longer course of disease.The condition is stable and related.By classifying the patient’s syndrome type,it is helpful to provide a basis for clinical syndrome differentiation and treatment.Part 3 Study on the Correlation between Tongue Parameters and Symptoms in Patients with Type 2 Diabetes and Hypertension Objective:Further study the tongue picture of patients with type 2 diabetes mellitus and hypertension,explore the correlation between the parameters of the tongue picture of patients with this disease and the clinical symptoms of traditional Chinese medicine,and explore the rules.Methods:The TDA-1 tongue imager developed by Shanghai University of Traditional Chinese Medicine was used to collect tongue images of 710 patients with type 2 diabetes and hypertension,and the tongue parameters were further extracted through software.The software was independently developed by Tianjin University of Traditional Chinese Medicine.Image Intelligent Aided Diagnosis System",the main extraction content includes tongue tip(R,G,B),tongue quality(R,G,B),tongue coating(R,G,B),number of tooth marks,maximum tooth mark area,number of cracks,The longest crack length,the number of pricks,the largest prick area,the number of ecchymosis,the largest ecchymosis area.Spearman’s correlation analysis between the tongue parameters extracted by the software and the 25 most frequently occurring symptoms in the TCM clinical diagnosis record table was carried out to obtain the correlation between the tongue parameters and the clinical symptoms of TCM.Results:(1)Tongue tip and symptom analysis results: tongue tip R,G,B are negatively correlated with thirst and polydipsia,mouth stickiness;tongue tip R and B are negatively correlated with dry mouth,irritability and irritability;tongue tip R is associated with faint vision,Excessive sweating is positively correlated;tongue tip G is positively correlated with fatigue.(2)Tongue quality and symptoms analysis results: tongue quality R,G,B are negatively correlated with dry mouth,irritability,loose teeth,thirst and polydipsia;tongue quality R and G are negatively correlated with mouth pain;tongue quality G and B are negatively correlated with limb numbness and mouth stickiness;tongue quality R is positively correlated with insomnia and negatively correlated with vertigo;tongue quality G is positively correlated with fatigue;tongue quality B is positively correlated with nocturia;ecchymosis number and maximum stasis Spot area is positively correlated with dry throat,negatively correlated with dry eyes,and the number of ecchymosis is positively correlated with irritability.(3)Tongue coating and symptom analysis results: tongue coating R,G,B are negatively correlated with tooth looseness and mouth stickiness,and positively correlated with insomnia;tongue coating R and G are negatively correlated with fatigue,irritability,and tongue coating G,B and mouth Dryness was negatively correlated;tongue coating G was positively correlated with spontaneous perspiration;tongue coating area was negatively correlated with dry eyes,hearing loss,and chest tightness,and positively correlated with dry throat.(4)Tongue shape and symptom analysis results: The number of tooth scars and the largest tooth scar area are positively correlated with fatigue,and the largest tooth scar area is positively correlated with fatigue;the longest crack length is negatively correlated with tooth looseness,and is positively correlated with irritability and backache;the number of pricks and the maximum prick area It is positively correlated with night sweats.Conclusion:Tongue parameters can reflect the changes in patients’ clinical symptoms,and provide a reference for the clinical diagnosis and treatment of type 2 diabetes with hypertension.