Research Progress of TCM Tongue Diagnosis in Spleen and Stomach Disease

Feng-Xian Bai, Ya-Hui HuangShaanxi University of Traditional Chinese Medicine, Xianyang 7046, China； Xi'an Traditional Chinese Medicine Hospital Affiliated to Shaanxi University of Traditional Chinese Medicine, Xi'an 70000, Shaanxi, China.

Abstract According to the theory of traditional Chinese medicine, the tongue is thought to be an outer manifestation of the status of the viscera. It can be divided to spleen-stomach area, liver-gall area, kidney area, and heart-lung area.The tongue coating is formed by stomach-Qi. the tongue, especially spleen-stomach area, and the tongue coating may reflect the status of the spleen and stomach. This article summarizes the research overview of TCM tongue diagnosis in spleen and stomach disease.

Keywords: Tongue diagnosis, Spleen and stomach disease, Review

Introduction

Spleen-Stomach theory is an important constituent of the theoretical basis of traditional Chinese medicine(TCM). TCM regards the spleen and stomach as the acquired foundation of life. the Spleen here is not synonymous with the Spleen in western medicine anatomically, physiologically or pathophysiologically[1]. Its main physiological functions are governing transportation and transformation of nutrient essence and body fluid, controlling blood flow and supporting the muscles and four limbs [2]. Stomach is considered a reservoir which empties into the intestine. The spleen meridian communicates with the stomach creating an exterior and interior relationship. Thus, these two organs influence each other closely. The important signs in spleen and stomach diseases are poor appetite,gastric pain, vomiting, belching, hiccups, abdominal distention and pain, diarrhea, loose stools, general swelling and bleeding disorders. This disease is mainly related to the weakness of spleen and stomach,emotional disorders, improper diet, drugs, exogenous pathogens (Helicobacter pylori infection), and other factors； the above factors damage the spleen and stomach, resulting in transport and loss of division, rise and fall disorders, and the occurrence of Qi stagnation,wet resistance, cold coagulation, fire depression, blood stasis, etc [3]. Wang Li [4] and Xia Mengmeng [5] have shown that emotion is closely related to the occurrence and development of spleen stomach disease, which has become a physical and mental disease and deserves further attention.

Chronic gastritis, peptic ulcer, gastroesophageal reflux disease, functional dyspepsia, irritable bowel syndrome, functional constipation and other digestive system diseases of modern medicine belong to spleen and stomach diseases [6]. With the continuous progress of modern medical technology, disease diagnosis is becoming more and more accurate. Now it mainly depends on electronic gastroenteroscopy and pathological examination for diagnosis, while diagnosis in TCM is based on 4 procedures, observation, smelling or listening, inquiry, and palpation. Compared with western medicine diagnosis technology, it is simpler,cheaper, non-invasive and more acceptable for patients.According to the theory of TCM, the tongue is thought to be an outer manifestation of the status of the viscera,and can be divided to spleen-stomach area, liver-gall area, kidney area, and heart-lung area. The tongue coating is formed by “stomach-Qi” and the 5 organs(“Wu-Zang” in Chinese) are also supplied by the stomach [7]. Therefore, the tongue, especially spleenstomach area, and the tongue coating may reflect the status of the spleen and stomach [8]. However,the traditional tongue diagnosis is affected by many factors such as subjective judgments and surrounding environment, which has certain subjectivity and inaccuracy. The appearance of tongue diagnosis instrument brings a new way of modernization and objectification to tongue diagnosis of traditional Chinese medicine [9]. The application of tongue diagnosis in spleen and stomach disease provides a more powerful basis for further treatment.

Application of tongue image in syndrome differentiation and classification of spleen and stomach disease

Syndrome differentiation and treatment is the characteristic of TCM, which has different syndrome types in different stages of disease development. The common TCM syndromes of spleen and stomach disease include spleen and stomach weakness, spleen and stomach dampness and heat, deficiency of stomach yin, stagnation of stomach collaterals, disharmony of liver and stomach. Wang Deyuan et al. [10] and Ye Haixiao et al. [11] showed that the fat tongue was mostly found in spleen stomach weakness syndrome and spleen stomach damp heat syndrome, while the thin tongue was mostly found in stomach yin deficiency syndrome and stomach collaterals stasis syndrome； the wet moss was mostly found in spleen stomach weakness syndrome and spleen stomach damp heat syndrome, and the dry moss was mostly found in stomach yin deficiency syndrome, liver stomach disharmony syndrome and stomach collaterals stasis syndrome； the yellow moss was mostly found in spleen stomach damp heat syndrome and liver stomach disharmony syndrome, and the less moss was more common deficiency of stomach yin. Chen Wenwen et al. [12] studied the relationship between the syndrome differentiation and the changes of tongue image in 129 cases with peptic ulcer, and concluded that the pale white tongue is more common in the syndrome of deficiency of spleen and stomach, the pale red tongue is more common in the syndrome of disharmony of liver and stomach, the syndrome of cold and heat, the red (crimson) tongue is more common in the syndrome of deficiency of stomach yin, the pale tongue is more common in the syndrome of stagnation of stomach collaterals and cold and heat, Fang Huazhen et al. [13]in the study of 102 cases of peptic ulcer, the correlation between syndrome differentiation and tongue image was also pointed out the spleen stomach weakness syndrome was characterized by teeth mark on the fat side of tongue, pale white tongue and white fur； the spleen stomach damp heat syndrome was characterized by teeth mark or prick on the tongue side, fat big tongue and cracked tongue, red tongue and yellow fur；the stomach yin deficiency syndrome was characterized by thin tongue with cracks, red tongue and thin fur； the liver stomach disharmony syndrome was characterized by teeth on the fat side of tongue mark, tongue light,moss thin； stomach collaterals blood stasis syndrome mainly see tongue purple dark have petechiae, moss thin yellow or black gray.

The correlation between the changes of tongue image and the clinical stages of spleen stomach disease

The change of tongue image can further predict the severity of the disease. The tongue coating changes from white to yellow, and the tongue color changes from light to red or purple dark, all of which indicate that the pathogenic factors change from exterior to interior, from cold syndrome to heat syndrome. Chuai Shengwu et al. [14] found that the change of tongue quality and tongue coating was of great significance to the stage of peptic ulcer； red tongue and yellow thick coating were common in the active stage, light white tongue and thin yellow coating were common in the healing stage, and light red tongue and thin white coating were common in the scar stage. Guo ningyue et al. [15] studied the correlation between the development of gastric cancer and the changes of tongue image, and pointed out that in the development of gastric cancer, the tongue body was mostly fat with teeth marks, the tongue was purple, and the fur was thin and white, but after chemotherapy, the teeth marks,the fat tongue, the thick or greasy fur were significantly increased, and the main changes were in the middle of the tongue.

Correlation between tongue picture and Helicobacter pylori infection (HP)

Wang Changhong [16] et al. analyzed the HP infection of 518 patients with gastric disease and concluded that the yellow moss rate of HP positive patients was significantly higher than that of HP negative patients.Wei Xueqin et al. [17] also found that HP infection was related to tongue coating, most of which were white and yellow greasy, followed by yellow. Ye Haixiao[18] believed that there was no significant difference in tongue color between HP positive and HP negative,but there was a significant difference in tongue coating body fluid between the two； HP positive patients had more yellow coating and less Tianjin, so the main heat syndrome and empirical； HP negative patients had more thin white coating and peeling off, and the peeling off patients had more intestinal metaplasia in gastroscopy. Li Jianzhen [19] et al. studied the changes of tongue image of 102 CAG patients before and after HP eradication treatment, and pointed out that there was no statistical significance in the changes of tongue color before and after HP eradication treatment； after HP eradication, the tongue coating changed from yellow greasy, thin yellow and white greasy to thin white or thin yellow. Hu houqin et al. [20] found that in the study of the relationship between HP and tongue image, pale tongue was positively related to HP, but not to tongue with tooth mark. At the same time, when HP was positive, thin yellow fur and yellow greasy fur were more common, which was consistent with most of the studies. It is further pointed out that the formation of yellow fur is closely related to the degree of inflammation in the stomach； no matter HP is negative or positive, when the inflammation is mild, thin white fur is more common than white greasy fur； when HP is positive with severe inflammation, yellow greasy fur is more common than thin yellow fur, while when HP is negative with severe inflammation, thin yellow fur is more common than yellow greasy fur. Therefore, the tongue image of TCM can reflect the degree of gastric mucosa damage under gastroscope to some extent,whether there is HP infection and the law of disease change. Generally, the patients with deep or greasy fur are more likely to infect HP than those with light or thin fur.

Correlation between tongue image and endoscopic mucosa in patients with spleen stomach disease

Chen Zhongqian et al. [21] studied the relationship between tongue image and mucosa under gastroscope,and found that the patients with white mucosa or blood vessels under gastroscope were mainly light red tongue, thin white or white greasy fur, while the patients with bile reflux were mainly light red tongue and yellow greasy fur； the tongue with rough mucosa or granular hyperplasia was mostly ecchymosis and ecchymosis or purplish tongue, and the tongue fur was mostly thin white or little or no fur； the patients with mucosa erosion were mostly red red tongue and yellow greasy fur. Xin Fang et al. [22] collected 208 patients with cnag diagnosis, and summarized the relationship between mucosa, tongue texture and tongue coating under gastroscope. It was pointed out that in gastroscope, erythema of mucosa was dominant,light red and thin white fur were common in tongue；in gastroscope, congestion and edema of mucosa were dominant, light white and thick fur were common；blood spots or erosion of mucosa and rough mucosa were dominant, red or purple dark, thin yellow or thick fur were common in tongue. Lu shiting et al. [23]found through clinical epidemiological investigation that most of the patients with gastric mucosal edema were dark red tongue； most of the patients with erosion were old tongue and red tongue； most of the patients with bleeding were red tongue, greasy fur and peeling fur； most of the patients with hyperplasia were cracked tongue； most of the patients with bile reflux had moist tongue and thick fur. Zhu Cuizhu et al. [24] observed the tongue image of 600 patients with upper digestive tract, among them, 41 patients with CAG had dark tongue and greasy tongue coating； if the mucosa was thickened under gastroscope, there was a sense of granule or erosion, and the pathology confirmed that there was intestinal or atypical hyperplasia, the tongue was dark and yellow. The above research shows that through the changes of tongue body, tongue quality and tongue coating, we can know the pathological changes of gastric mucosa and the development stage of the disease, which once again proves that "tongue is the syndrome outside the spleen and stomach" and "tongue is the fumigation of stomach qi".

Conclusion

Tongue diagnosis, as an important part of observation,has always been valued by doctors for its simplicity,intuitiveness, non-invasive and close relationship with viscera, meridians and collaterals. Therefore, it plays an irreplaceable role in the four diagnosis of traditional Chinese medicine. It also provides an important role in the analysis of the cause of disease, the depth of disease location, the nature of disease pathogen, the rise and fall of pathogenic factors, the advance and retreat of disease situation, and the evaluation of curative effect Clues. However, with the continuous development and progress of modern medicine, tongue diagnosis has not been submerged by various detection methods. On the contrary, it has also been further developed from cell and molecular level to microecology and other micro angles with the continuous development of the medical field. The combination with the accurate detection methods of modern medicine is bound to provide a more accurate basis for diagnosis. Therefore, the role of TCM tongue diagnosis in spleen and stomach disease will be further studied, and it will have an unprecedented application prospect.