Greasy Tongue Research Articles

Machine learning-based evaluation of application value of traditional Chinese medicine clinical index and pulse wave parameters in the diagnosis of polycystic ovary syndrome

IntroductionPolycystic ovary syndrome (PCOS) is a prevalent endocrine disorder in women that often leads to ovulatory infertility. This study aims to establish and validate an effective predictive model for PCOS and to explore the correlation of features between patients with irregular menstruation and those with PCOS, using pulse wave parameters and traditional Chinese medicine (TCM) clinical indices. MethodsFrom August 2018 to January 2022, women with irregular menstruation were enrolled in this study. Subjects who met the inclusion criteria were categorized into PCOS and non-PCOS groups based on diagnostic criteria. Pulse wave parameters and TCM clinical indices were collected by two medical professionals. After data cleaning, recursive feature elimination with cross-validation (RFECV) was used for feature selection. Four supervised machine learning classifiers were used to build PCOS prediction models, including Extra Trees (ET), Random Forest (RF), Extreme Gradient Boosting (XGB/XGBoost), and Support Vector Machine (SVM). The SHapley Additive exPlanation (SHAP) values based on the optimal model were visualized for further feature explanation. ResultsA total of 450 women with irregular periods were enrolled in the study, consisting of 294 patients with PCOS and 156 without PCOS. Based on RFECV, 31 features, including 12 pulse parameters and 19 TCM clinical indices, were selected for building prediction models. Using pulse and TCM clinical index was superior to using pulse parameters or TCM clinical index alone in prediction. SVM achieved the best PCOS prediction results (accuracy=0.837, AUC=0.878, F1 score=0.878). For pulse parameters, lower values of right As, right h4, left h1, left h3, left h5, left w/t, and higher right t5 showed an obvious positive PCOS predictive effect. Women with PCOS were more likely to experience delayed menstruation, negative emotions, a slightly jelly-like menstrual texture, higher BMI, and a TCM assessment of greasy tongue coating. ConclusionA PCOS prediction model based on the SVM algorithm was established and verified as the best model for distinguishing between patients with PCOS and patients without PCOS with irregular menstruation. The new prediction model that uses pulse wave parameters and TCM clinical indices offers a non-invasive and cost-effective way to diagnose PCOS, and the model provides objective evidence for TCM diagnosis.

Rheumatoid arthritis characteristics and classification of heat and cold patterns–an observational study

IntroductionTraditional Chinese medicine (TCM) has been proven to be an effective complementary therapy in treating rheumatoid arthritis (RA). The cold pattern and the heat pattern were the two main TCM patterns for RA, which is crucial for TCM treatment. The cold pattern is characterized by fear of cold and wind, joint pain with a thin white tongue coating which can be relieved by hot herbs. In contrast, heat pattern patients suffer from severe joint pain with a yellow coating, with red swelling of the skin and high skin temperature which can be relieved by cooling herbs. ObjectiveWe aimed to classify the heat and cold patterns in RA patients with cluster analysis and factor analysis. Moreover, we aimed to explore the association of RA characteristics between these two patterns. Methodsand Design: A cross-sectional observational research method was used, and data was collected on 300 RA patients in Hangzhou in China. Signs and symptoms associated with RA were clustered using SPSS 22.0 software. In addition, factor analysis was also used for the classification. After classification of heat and cold patterns, characteristics and treatment of the RA participants between the two patterns were explored. ResultsRA patients in the study were divided into two categories using cluster analysis. Twenty-two symptoms in the first category were included in the heat pattern of RA patients. After factor analysis, nine principal components were extracted to heat pattern. The component with the highest eigenvalue (2.530) were mainly contributed by shortness of breath, palpitation, heavy limbs, chest tightness and yellow greasy tongue with high factor loading values (0.765, 0.703, 0.504, 0.429 and 0.402, respectively). Ten symptoms in the second category were included in the cold pattern of RA patients. Four principal components were extracted to cold pattern. The component with the highest eigenvalue (2.089) were mainly contributed by joint distension and pain, joint stiffness, fatigue and upset with high factor loading values (0.597, 0.590, 0.491 and 0.481, respectively). Although there were no statistical differences between the levels of rheumatoid factor and anti-cyclic peptide containing citrulline (anti-CCP), the levels of C-reactive protein, platelet count and the disease activity score using 28 joint counts were significantly higher in the heat pattern RA patients compared to the ones in cold pattern. Moreover, heat pattern RA patients were more likely to be prescribed two more disease-modifying anti-rheumatic drugs (DMARDS) combined with Methotrexate (MTX) (70.59% versus 49.72%; P = 0.000). ConclusionsIn conclusion, heat and cold patterns in RA patients could be classified well using cluster analysis and factor analysis. Most of RA patients with heat pattern were active and likely to be prescribed two more DMARDs combined with MTX.

Relationship between thick or greasy tongue-coating microbiota and tongue diagnosis in patients with primary liver cancer.

Tongue diagnosis is a unique aspect of traditional Chinese medicine for diagnosing diseases before determining proper means of treatment, but it also has the disadvantage of relying on the subjective experience of medical practitioners and lack objective basis. The purpose of this article is to elucidate tongue-coating microbiota and metabolic differences in primary liver cancer (PLC) patients with thick or greasy tongue coatings. Tongue-coating samples were analyzed in 60 PLC patients (30 PLC with thick or greasy tongue-coating patients and 30 PLC with tongue-coating neither thick nor greasy) and 25 healthy controls (HC) using 16S rRNA gene sequencing technology. As compared to healthy individuals, tongue coatings of patients with PLC had elevated levels of Firmicutes and Actinobacteria. The abundance of Fusobacteria, SR1_Absconditabacteria_, and Spirochaete were higher in tongue coatings of healthy controls compared to samples in patients with PLC. In addition to site-specific differences, higher abundances of Fusobacteria and Actinobacteria were observed in thick or greasy tongue-coating patients as compared to non-thick and greasy tongue-coating patients. The inferred metagenomic pathways enriched in the PLC tongue-coating patients were mainly those involved in replication, recombination, and repair of protein. We also identify a tongue-coating microbiome signature to discriminate HC and PLC, including 15 variables on genus level. The prediction performance of the signature showed well in the training and validation cohorts. This research illustrates specific clinical features and bacterial structures in PLC patients with different tongue coatings, which facilitates understanding of the traditional tongue diagnosis.

Tongue features of patients with granulomatous lobular mastitis.

Traditional Chinese tongue diagnosis plays an irreplaceable role in disease diagnosis. This study aimed to describe the tongue characteristics of patients with granulomatous lobular mastitis (GLM). Forty GLM patients and 40 non-GLM controls were evaluated using the Traditional Chinese Medicine subjective clinical interpretation and a TDA-1 Tongue Diagnostic and Analysis system. The associations between the image features of the tongue body and coating and the profiling of immune-inflammatory parameters were analyzed. GLM patients were prone to a reddish tongue bodies with thick, white, and greasy coatings. Thick and greasy tongue coating features are risk factors for GLM. GLM patients had higher levels of white blood cells (WBC), platelets, C-reactive protein, interleukin-2, and transforming growth factor-β (TGF-β) than non-GLM controls (P < .05). Also, tongue coating contrast and entropy values were significantly correlated with WBC or TGF-β levels in GLM patients (r < -0.310 and P < .05). We demonstrated that the hot evil and phlegm-dampness constitutions are the main characteristics of GLM. This might provide a reference for GLM diagnosis.

Microbiological characteristics of different tongue coatings in adults

BackgroundTongue coating is an important health indicator in traditional Chinese medicine (TCM). The tongue coating microbiome can distinguish disease patients from healthy controls. To study the relationship between different types of tongue coatings and health, we analyzed the species composition of different types of tongue coatings and the co-occurrence relationships between microorganisms in Chinese adults.From June 2019 to October 2020, 158 adults from Hangzhou and Shaoxing City, Zhejiang Province, were enrolled. We classified the TCM tongue coatings into four different types: thin white tongue fur (TWF), thin yellow tongue fur (TYF), white greasy tongue fur (WGF), and yellow greasy tongue fur (YGF). Tongue coating specimens were collected and used for 16S rRNA gene sequencing using the Illumina MiSeq system. Wilcoxon rank-sum and permutational multivariate analysis of variance tests were used to analyze the data. The microbial networks in the four types of tongue coatings were inferred independently using sparse inverse covariance estimation for ecological association inference.ResultsThe microbial composition was similar among the different tongue coatings; however, the abundance of microorganisms differed. TWF had a higher abundance of Fusobacterium periodonticum and Neisseria mucosa, the highest α-diversity, and a highly connected community (average degree = 3.59, average closeness centrality = 0.33). TYF had the lowest α-diversity, but the most species in the co-occurrence network diagram (number of nodes = 88). The platelet-to-lymphocyte ratio (PLR) was associated with tongue coating (P = 0.035), and the YGF and TYF groups had higher PLR values. In the co-occurrence network, Aggregatibacter segnis was the “driver species” of the TWF and TYF groups and correlated with C-reactive protein (P < 0.05). Streptococcus anginosus was the “driver species” in the YGF and TWF groups and was positively correlated with body mass index and weight (P < 0.05).ConclusionDifferent tongue coatings have similar microbial compositions but different abundances of certain bacteria. The co-occurrence of microorganisms in the different tongue coatings also varies. The significance of different tongue coatings in TCM theory is consistent with the characteristics and roles of the corresponding tongue-coating microbes. This further supports considering tongue coating as a risk factor for disease.

Mining intrinsic information of convalescent patients after suffering coronavirus disease 2019 in Wuhan.

To summarize the potential characteristics of convalescent patients with coronavirus disease 2019 (COVID-19) in China based on emerging clinical tongue data and guide the treatment and recovery of COVID-19 patients from the perspective of Traditional Chinese Medicine tongue diagnosis. In this study, we developed and validated radiomics-based and lab-based methods as a novel approach to provide individualized pretreatment evaluation by analyzing different features to mine the orderliness behind tongue data of convalescent patients. In addition, this study analyzed the tongue features of convalescent patients from clinical tongue qualitative values, including thick and thin, fur, peeling, fat and lean, tooth marks and cracked, and greasy and putrid fur. We included 2164 tongue images in total (34% from day 0, 35.4% from day 14 and 30.6% from day 28) from convalescent patients. The significance results are shown as follows. Firstly, as the recovery time prolongs, the L average values of tongue and coat decrease from 60.21 to 57.18 and from 60.06 to 57.03 respectively. Secondly, the decrease of abnormality rate of tongue coat, included greasy tongue fur, putrid fur, teeth-mark, thick-thin fur, are of significant statistical difference ( < 0.05). Thirdly, the average value of gray-level co-occurrence matrices increases from 0.173 to 0.194, the average value of entropy increases from 0.606 to 0.665, the average value of inverse difference normalized decrease from 0.981 to 0.979, and the average value of dissimilarity decrease from 0.1576 to 0.1828. The details of other radiomics features are describe in results section. Our experiment shows that patients in different recovery periods have a relationship with quantitative values of tongue images, including L color space of the tongue and coat radiomics features analysis. This relationship can help clinical doctors master the recovery and health of patients as soon as possible and improve their understanding of the potential mechanisms underlying the dynamic changes and mechanisms underlying COVID-19.

Constructing tongue coating recognition model using deep transfer learning to assist syndrome diagnosis and its potential in noninvasive ethnopharmacological evaluation

Ethnopharmacological relevanceTongue coating has been used as an effective signature of health in traditional Chinese medicine (TCM). The level of greasy coating closely relates to the strength of dampness or pathogenic qi in TCM theory. Previous empirical studies and our systematic review have shown the relation between greasy coating and various diseases, including gastroenteropathy, coronary heart disease, and coronavirus disease 2019 (COVID-19). However, the objective and intelligent greasy coating and related diseases recognition methods are still lacking. The construction of the artificial intelligent tongue recognition models may provide important syndrome diagnosis and efficacy evaluation methods, and contribute to the understanding of ethnopharmacological mechanisms based on TCM theory. Aim of the studyThe present study aimed to develop an artificial intelligent model for greasy tongue coating recognition and explore its application in COVID-19. Materials and methodsHerein, we developed greasy tongue coating recognition networks (GreasyCoatNet) using convolutional neural network technique and a relatively large (N = 1486) set of tongue images from standard devices. Tests were performed using both cross-validation procedures and a new dataset (N = 50) captured by common cameras. Besides, the accuracy and time efficiency comparisons between the GreasyCoatNet and doctors were also conducted. Finally, the model was transferred to recognize the greasy coating level of COVID-19. ResultsThe overall accuracy in 3-level greasy coating classification with cross-validation was 88.8% and accuracy on new dataset was 82.0%, indicating that GreasyCoatNet can obtain robust greasy coating estimates from diverse datasets. In addition, we conducted user study to confirm that our GreasyCoatNet outperforms TCM practitioners, yet only consuming roughly 1% of doctors’ examination time. Critically, we demonstrated that GreasyCoatNet, along with transfer learning, can construct more proper classifier of COVID-19, compared to directly training classifier on patient versus control datasets. We, therefore, derived a disease-specific deep learning network by finetuning the generic GreasyCoatNet. ConclusionsOur framework may provide an important research paradigm for differentiating tongue characteristics, diagnosing TCM syndrome, tracking disease progression, and evaluating intervention efficacy, exhibiting its unique potential in clinical applications.

The relationship between abnormal tongue features and non-malignant upper gastrointestinal disorders: A hospital-based cross-sectional study

IntroductionInflammation, ulcer, reflux, polyp, and metaplasia or dysplasia of the upper gastrointestinal tract are frequently encountered non-malignant upper gastrointestinal disorders (NUGDs) in clinical practice. Abnormal tongue features (ATFs) are a series of morphological changes occurring on the dorsal surface of the tongue according to traditional Chinese medicine theory. Red tongue, purple tongue, yellowish, greasy tongue, fissured tongue, teeth-printed tongue, ecchymotic tongue, peeled or geographically coated tongue are the most frequently encountered ATFs and show a close relationship to chronic diseases. This study was to investigate the prevalence of ATFs in NUGDs and to explore the potential correlation between them. MethodsThis was a cross-sectional study conducted at China–Japan Friendship Hospital, China. Patients aged over 18 years old and met the standards set for upper gastrointestinal endoscopy in the endoscopic center were included. The tongue images of all the participants were captured using a smart phone. The seven ATFs were determined using a manual-interpretation-based, computer-aided tongue diagnosis method by three TCM practitioners.The participants were then categorized into different NUGDs according to endoscopic findings and pathological examinations. Chi-square test was performed to analyze the distribution differences of ATFs by gender and age. Univariate and multivariate logistic regression analyses were used to determine the relationship between ATFs and NUGDs. ResultsAmong disease manifestations, inflammation (98.2%) and gastroesophageal reflux disease (62.4%) were highly prevalent, whereas fissured tongue (34.3%) was the most common ATF. The prevalence of ATFs was significantly influenced by gender and age. Fissured tongue, red tongue, and yellowish, greasy tongue (all P < 0.01) were more prevalent in men, whereas purple tongue and ecchymotic tongue (all P < 0.001) were more prevalent in women. Multivariate logistic regression analysis revealed fissured tongue as an independent factor for upper gastrointestinal precancerous lesions (UGPLs) (OR, 1.51; 95% CI, 1.04–2.20). ConclusionFissured tongue was found to be related to the UGPLs. Since the participants of this study were from a hospital-based population, a multi-center, community-based study is warranted to confirm these results in the future.

Discussion on the Characteristics and Symptom Classification of COVID-19 in Chinese Medicine

Covid-19 (Novel coronavirus pneumonia, NCP) was characterized by fever, dry cough, fatigue, greasy tongue coating and pulsating pulse. According to the literature, with those four symptoms, examination and identification, it is believed that NCP belongs to the category of “pandemic” in Chinese medicine. The main infection is dampness, infection location in triple energizer, the basic pathogenesis is characterized by “dampness, phlegm, blood stasis heat, toxin and deficiency.” According to the law of blood transfer of symptom differentiation of triple energizer and weiqi-yingxue the treatment is divided into stages, such as early stage, middle stage, severe stage and recovery stage. Most of the patients were early stage and middle stage, which were the direct transmission of the disease. A small number of patients had the reverse transmission of pericardium and the internal and external detachment. The main method of treatment is to remove infection, remove dampness and detoxify. In addition, to grasp the treatment of early stage and middle stage patients, helps to stop the disease from developing, and it is the key to reduce the criticality of the disease, as well as reduce the mortality.

Modeling of diagnosis for metabolic syndrome by integrating symptoms into physiochemical indexes

BackgroundMetabolic syndrome (MS) is a major global health concern comprising a cluster of co-occurring conditions that increase the risk of heart disease, stroke and type 2 diabetes. MS is usually diagnosed using a combination of physiochemical indexes (such as BMI, abdominal circumference and blood pressure) but largely ignores clinical symptoms when investigating prevention and treatment of the disease. Exploring predictors of MS using multiple diagnostic indicators may improve early diagnosis and treatment of MS. Traditional Chinese medicine (TCM) attaches importance to the etiology of disease symptoms and indications using four diagnostic methods, which have long been used to treat metabolic disease. Therefore, in this study, we aimed to develop predictive indicators for MS using both physiochemical indexes and TCM methods. MethodsClinical information (including both physiochemical and TCM indexes) was obtained from a cohort of 586 individuals across 4 hospitals in China, comprising 136 healthy controls and 450 MS cases. Using this cohort, we compared three classic machine learning methods: decision tree (DT), support vector machine (SVM) and random forest (RF) towards MS diagnosis using physiochemical and TCM indexes, with the best model selected by comparing the accuracy, specificity and sensitivity of the three models. In parallel, the best proportional partition of the training data to the test data was confirmed by observing the changes in evaluation indexes using each model. Next, three subsets containing different categories of variables (including both TCM and physicochemical indexes combined – termed the “fused indexes”, only physicochemical indexes, and TCM indexes only) were compared and analyzed using the best performing model and optimum training to test data proportion. Next, the best subset was selected through comprehensive comparative analysis, and then the important prediction variables were selected according to their weight. ResultsWhen comparing the three models, we found that the RF model had the highest average accuracy (average 0.942, 95%CI [0.925, 0.958]) and sensitivity (average 0.993, 95%CI [0.990, 0.996]). Besides, when the training set accounted for 80% of the cohort data, the specificity got the best value and the accuracy and sensitivity were also very high in RF model. In view of the performance of the three different subsets, the prediction accuracy and sensitivity of models analyzing the fused indexes and only physicochemical indexes remained at a high level. Further, the mean value of specificity of the model using fused indexes was 0.916, which was significantly higher than the model with only physicochemical indexes (average 0.822) and the model with only TCM indexes (average 0.403). Based on the RF model and data allocation ratio (8:2), we further extracted the top 20 most significant variables from the fused indexes, which included 14 physicochemical indexes and 6 TCM indexes including wiry pulse, chest tightness, spontaneous perspiration, greasy tongue coating etc. ConclusionCompared with SVM and DT models, the RF model showed the best performance, especially when the ratio of the training set to test set is 8:2. Compared with single predictive indexes, the model constructed by combining physiochemical indexes with TCM indexes (i.e. the fused indexes) exhibited better predictive ability. In addition to common physicochemical indexes, some TCM indexes, such as wiry pulse, chest tightness, spontaneous perspiration, greasy tongue coating, can also improve diagnosis of MS.

Effect of Yiqi Tongnao Decoction on Acute Cerebral Infarction of Qi Deficiency and Blood Stasis

Objective: To explore the method and clinical effect of applying Yiqi Tongnao Decoction in the treatment of patients with acute cerebral infarction of Qi deficiency and blood stasis. Methods: To carry out research work in our hospital, a total of 70 patients with acute cerebral infarction of Qi deficiency and blood stasis who were treated in our hospital from March 2018 to March 2019 were randomly divided into two groups, one of which was given Western Medicine as the control group, and the other group was given Yiqi Tongnao Decoction combined with Western medicine, as the research group, the treatment status of the two groups of patients was compared and observed. Results: When comparing, the research group with skewed mouth and eyes, white greasy tongue coating, shortness of breath and fatigue, and pulse fineness scores were lower than those of the control group. The data difference between the groups was shown as P &lt;0.05. The difference between the research group and the control group is quite large. Before treatment, the NIHSS score of the two groups of patients did not change significantly, P&gt; 0.50. After the treatment intervention, the score of the research group was (5.10 ± 1.24), which was lower than that of the control group, and the difference between the groups was P &lt;0.05. Before receiving treatment, there was no significant difference in blood lipid levels between the two groups of patients, P&gt; 0.05. After treatment, the blood lipid level of the two groups of patients both changed, but in contrast, the degree of change in the research group was significantly greater than that of the control group, P &lt;0.05, in general, the treatment effect of the research group was better. Conclusion: In the treatment of patients with acute cerebral infarction of qi deficiency and blood stasis, Yiqi Tongnao Decoction has significant effects, which can effectively improve the patients' adverse symptoms and has positive significance for clinical development.

"Heterozygous Treatment" Method to Improve the Biased Status of the Damp-heat Constitution and Symptom Integral: Randomized Controlled Trial

Objective: To observe the clinical effect of "heterozygous treatment" intervening the damp-heat constitution. Method: 106 cases with damp-heat constitution were randomly divided into the observation group and control group, 53 cases for each group. Lianpu drink was given to the two groups, and the observation group was treated with scraping, acupuncture, cupping, constitution care and popularization of constitution science for "heterozygous treatment" based on the control group. 70 days later, "constitution classification and determination table of traditional Chinese medicine" was used to determine, and statistics was applied to analyze the change of the symptoms of the two groups before and after the intervention. Results: in the observation group, compared to before the intervention, symptoms like dirty and oily complexion, yellow greasy tongue, bitter taste, dullness and scanty dark urine were significantly improved (P &lt; 0.05), and improvement of the above symptoms was greater than the control group (P &lt; 0.05) .Conclusion: There is no significant difference between the two groups (P &gt; 0.05). Conclusion: the "heterozygous treatment" method can significantly improve the clinical symptoms of people with damp-heat constitution, with a better role in regulating.

Long-term clinical effect of Tangyiping Granules () on patients with impaired glucose tolerance.

To evaluate the long-term clinical effect of Tangyiping Granules (, TYP) on patients with impaired glucose tolerance (IGT) to achieve normal glucose tolerance (NGT) and hence preventing them from conversion to diabetes mellitus (DM). In total, 127 participants with IGT were randomly assigned to the control (63 cases, 3 lost to follow-up) and treatment groups (64 cases, 4 lost to follow-up) according to the random number table. The control group received lifestyle intervention alone, while the patients in the treatment group took orally 10 g of TYP twice daily in addition to lifestyle intervention for 12 weeks. The rates of patients achieving NGT or experiencing conversion to DM as main outcome measure were observed at 3, 12, and 24 months after TYP treatment. The secondary outcome measures included fasting plasma glucose (FPG), 2-h postprandial plasma glucose (2hPG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS), 2-h insulin (2hINS), homeostatic model assessment of insulin resistance (HOMA-IR), blood lipid and patients' complains of Chinese medicine (CM) symptoms before and after treatment. A higher proportion of the treatment group achieved NGT compared with the control group after 3-, 12- and 24-month follow-up (75.00% vs. 43.33%, 58.33% vs. 35.00%, 46.67% vs. 26.67%, respectively, P<0.05). The IGT to DM conversion rate of the treatment group was significantly lower than that of the control group at the end of 24-month follow-up (16.67% vs. 31.67%, P<0.05). Before treatment, FPG, 2hPG, HbA1c, FINS, 2hINS, HOMA-IR, triglyceride (TG), total cholesterol, low- and high-density lipoprotein cholesterol levels had no statistical difference between the two groups (P>0.05). After treatment, the 2hPG, HbA1c, HOMA-IR, and TG levels of the treatment group decreased significantly compared with those of the control group (P<0.05). CM symptoms such as exhaustion, irritability, chest tightness and breathless, spontaneous sweating, constipation, and dark thick and greasy tongue were significantly improved in the treatment group as compared with the control group (P<0.05). No severe adverse events occurred. TYP administered at the IGT stage with a disciplined lifestyle delayed IGT developing into type 2 DM.

Haoqin Qingdan Decoction () and ribavirin therapy downregulate CD14 and toll-like receptor 4 in febrile disease with dampness-heat syndrome in a mouse model.

To evaluate the effect of Chinese medicine Haoqin Qingdan Decoction (, HQD) for febrile disease dampness-heat syndrome (FDDHS). Forty mice were divided into four groups, including normal control, FDDHS (induced by Radix et Rhizoma Rhei recipe and influenza virus A1 FM1 model), HQD, and the ribavirin groups (10 in each). The normal control and FDDHS groups were administered normal saline. HQD and the ribavirin groups were administered HQD and ribavirin intragastrically once daily at a dose of 64 g/(kg d) and 0.07 g/(kg d), respectively for 7 days. Lethargy, rough hair, diarrhea, tongue color and sole color were evaluated for pathological changes in morphology. The tongue and lung tissues were collected for histology. The CD14 and toll-like receptor 4 (TLR4) expression levels were measured using real-time quantitative polymerase chain reaction. More than 80% of the FDDHS mice showed hypokinesia and lethargy, and pathological changes associated with rough hair, diarrhea, tongue color and sole color. With advanced treatment for 7 days, the thick greasy tongue fur of the HQD and ribavirin groups were thinner than that of the FDDHS group (P<0.05), and it was the thinnest in the ribavirin group as compared with that in other groups (P<0.05). The CD14 and TLR4 expression levels in the lung tissues of HQD and ribavirin groups significantly delined compared with the model group (P<0.05 or P<0.01). CD14 was down-regulated more remarkably in the HQD group compared with the ribavirin group (P<0.05), whereas the converse was true with TLR4 (P<0.05). We established a FDDHS mouse model showing systemic clinical symptoms. Both HQD and ribavirin can inhibit the expression of CD14 and TLR4 in FDDHS mice, while the effect of ribavirin might be much more violent. The expression changes of CD14 and TLR4 consistently refers to lipopolysaccharide, the commonly and hotly inducing factor in FDDHS.

반하후박탕(半夏厚朴湯)이 생쥐의 심리적 스트레스에 미치는 영향과 유전자 분석

Objectives: Banhahoobak-tang has been used to treat plum-pit qi, chest and hypochondriac dis-tension, moist or greasy tongue coat, and wiry slow or wiry slippery pulse. It might be used to control coughing and vomiting. We observed that Banhahoobak-tang extract (BHTe) had anti-psychological stress effect. The objective of this study was to determine the effect of BHTe on restoring the transcrip-tional regulation of genes related to psychological stress. Methods: After giving psychological stress to mice, BHTe was orally administered at 100 mg/kg/day for five days. After extracting whole brain tissue from the mice, the gene expression changes were de-termined by microarray. Transcription factor binding site (TFBS) analysis showed up- and down-regu-lated genes related to psychological stress were protected by BHTe and segregated according to the structure of TFBS. We performed text based Pubmed search to select significant target genes involved in psychological stress affected by BHTe.Results: 1. Serum corticosterone level was decreased in the BHTe administered group, although the psychological stress was increased. 2. The BHTe administered group had no significant change in nora-drenaline content in brain tissue, but the psychological stress group had decreased level. 3. The BHTe administered group had increased time of staying at open-arm than the psychological stress group. 4. Microarray revealed that TANK and RARA genes were up-regulated genes while AES, CDC42, FOS, NCL, and PVR were down-regulated genes by psychological stress but restored by BHTe.Key Words: Banhahoobak-tang extract (BHTe), Psychological stress, Anti-anxiety effect, Microarray.

Study on the correlation of tongue manifestation with fibrinogen and neutrophil in acute cerebral infarction patients

To investigate the correlation of tongue manifestation with the fibrinogen level and the neutrophil count in blood of acute cerebral infarction patients. A total of 200 patients with first unilateral cerebral infarction in Neurology Department of Xuanwu Hospital from March, 2008 to February, 2009 were recruited in this study. The correlation of the tongue fur color and texture with the blood fibrinogen level and the neutrophil count was analyzed in these patients. The level of fibrinogen and neutrophil count in thick fur group were significantly higher than that in thin fur group (P<0.05). There was no statistical difference in the level of fibrinogen and neutrophil count found between moist fur and dry fur. Statistical significance existed in the level of fibrinogen between the greasy tongue fur group and non-greasy tongue fur group (P<0.05). The level of fibrinogen and the neutrophil count were compared among different fur color groups, revealing that the level of fibrinogen in yellowish fur group was higher than that of white fur group and normal value with statistical significance (P<0.05) with neutrophil count in yellowish fur group being significantly higher than that in white fur group. Our results suggested that the change of tongue manifestation was associated with the level of fibrinogen and the neutrophil count in the blood of cerebral infarction patients.

Metabolite changes in the greasy tongue coating of patients with chronic gastritis

To explore the changes in metabolites in the greasy tongue coating in patients with chronic gastritis. Forty chronic gastritis patients presenting with greasy tongue coating, 30 chronic gastritis patients presenting with non-greasy tongue coating, and 20 healthy control persons presenting with light red tongues and thin white coating were enrolled, and the tongue coating was detected by combining artificial diagnosis and the Z-BOX Tongue Digital Analyzer's diagnosis. Samples of all the tongue coatings were collected before treatment. The metabolic fingerprinting of the tongue coating samples was obtained using ultra-performance liquid chromatography and mass spectrometry (UPLC-MS), and the metabolic components in the tongue coating samples were detected. After this, principal component analysis, partial least squares discriminant analysis and orthogonal partial least squares discriminant analysis (OPLS-DA) were used to identify potential metabolic markers. Finally, the components were identified using the Chemspider and HMDB searching. UPLC-MS results were analyzed by OPLS-DA and showed that the metabolites among the three groups were distributed in different regions. The different potential metabolic markers between the patients with or without greasy coating were 3-ketolactose, 2-deoxy-D-ribose, UDP-D-galactose metarhodopsin, ascorbate, picolinate and histidine. The different potential metabolic markers between the greasy coating group and the normal group were 3-ketolactose, UDP-D-galactose, leukotriene A4 and vitamin D(2). The metabolites of the greasy coating group, the non-greasy coating group and the normal group show significant differences in energy metabolism, mainly of glucose metabolism. This demonstrated that glucose metabolism may be one of the mechanisms leading to the formation of greasy coating.

Research on the relationship between thick greasy tongue fur formation and vascular endothelial cell permeability with the protein expression of zonula occludens-1

To determine the relationship of thick greasy tongue fur formation and permeability of vascular endothelial cells (ECs) with the protein expression of zonula occludens-1 (ZO-1). Sprague Dawley rats were randomly divided into a model group of severe acute pancreatitis (SAP) and a sham-operated (SO) group. The SAP rats were further divided into two subgroups on the basis of tongue-coating status: a thick greasy tongue fur group (SAP-TGF) and a normal tongue fur group (SAP-NF). Six rats were chosen randomly from every group mentioned above for an Evans blue assay 5 days after model establishment. For the histomorphology analysis, the expressions of ZO-1 protein and mRNA were studied by hematoxylin-eosin (H&E) staining, transmission electron microscope, Western blot, and Q-PCR using blood and tongue tissues, which were collected from 8 rats randomly chosen from each group. The papillae density of the rat tongue surface and the caryocinesis frequency of the basal layer were significantly increased in the SAP-TGF group compared with the SO group (P<0.05). Evans blue levels in the tongue tissue of the SAP-TGF group were significantly higher than that of the SO and SAP-NF groups (P<0.05). Vascular ECs were wider and obviously fissured in the SAP-TGF group under transmission electron microscope observation. The protein and mRNA expression of ZO-1 in the SAP-TGF group were lower than those in the SAP-NF (P<0.05). Reproductive activity enhancement of glossal epithelial cells was one of the main characteristics of thick greasy tongue fur formation. An increase in vasopermeability was closely associated with thick greasy tongue fur formation. Tight junction structural variation of vascular ECs might play an important role in the pathological and physiological process of thick greasy tongue fur formation.

A preliminary epidemiological study and discussion on traditional Chinese medicine pathogenesis of chronic fatigue syndrome in Hong Kong

Our purpose is to conduct an epidemiological study of chronic fatigue syndrome (CFS) and its syndrome types and symptoms of traditional Chinese medicine (TCM) among adults (20-50 years old) in Hong Kong, and to discuss the TCM pathogenesis. Cross-sectional questionnaire survey. Demographic data, CDC (1994) CFS diagnostic criteria, Trudie Chalder fatigue scale, and China national standard for TCM syndrome types criteria. Twenty to fifty years old adults by convenient sampling. One thousand and thirteen subjects were successfully interviewed. Five hundred and eighty-five subjects (57.8%) had different levels of fatigue. Sixty-five subjects (6.4%) met CFS diagnostic criteria. In terms of TCM syndrome types, blood stasis due to qi deficiency had the highest prevalence (35.7%) among CFS. In the 54 symptoms investigated in total, the first eight symptoms in order of appearing rates were soreness of loins and weakness in knees, poor spirit, lassitude, pain, insomnia, forgetting, vessels blood stasis, vertigo and dazzle. The mostly appeared tongue figures were pale and corpulent or pale dim tongue proper, white and white greasy tongue coating, and the mostly appeared pulse figure was sunken-thin. The point prevalence of CFS among adults of 20 to 50 years old was found to be 6.4%. The most prevalent TCM syndrome type was blood stasis due to qi deficiency. The TCM pathogenesis of CFS was deficiency of origin, mainly deficiency of qi and kidney, with excess of superficiality.