【作者】 武哲丽；

【导师】 陈群；

【作者基本信息】 广州中医药大学 ， 中医诊断学， 2006， 博士

【摘要】 舌诊是中医诊断学中重要的内容,通过诊察舌象可判断人体脏腑气血的盛衰,区别疾病的性质、分辨病位的深浅,推断疾病的预后,因此加强中医舌诊研究对提高临床中医诊断水平,突出中医特色具有很大的意义。血瘀证是临床最常见、同时也是中医研究最深入的中医证候,且舌诊在血瘀证的诊断中具有非常重要的价值,因此,将血瘀证的研究成果拓展到中医舌诊领域,以瘀血舌象为突破口,系统开展对瘀血舌象的定量研究,将对舌诊的研究产生重大的影响。本研究以瘀血舌象为切入点,以肝病瘀血舌患者为研究对象,采用多学科的技术和手段,包括分子水平的检测、信息融合技术、神经网络技术等,以求能够更深入地探索肝病瘀血舌的形成机制。论文分为五部分: 第一部分 文献研究 舌诊是中医最具特征的一种诊疗方法,瘀血舌象在临床很常见,对临床诊断血瘀证具有重要的意义。瘀血舌象包括舌质淡紫、绛紫、青紫、瘀斑、瘀点等舌色及舌下静脉曲张等特征。本文系统研究了古今中外与肝病瘀血舌象相关的文献。瘀血舌最早见于张仲景的《金匮要略》,后世医家多围绕其论述。瘀血舌象的现代研究在现代科技的促进下,进行了舌尖微循环、血液流变学等生化指标以及舌色、舌下络脉、舌温等方面的临床观察。但对肝病瘀血舌象的研究从分子水平到信息融合技术等多方法、多层次、多水平的系统研究尚未见报道。 第二部分 瘀血舌象的特征信息库建立 目的:运用信息融合技术建立肝病瘀血舌象的特征信息库 研究对象:正常组与肝病瘀血舌患者 方法: 一、通过融合模糊逻辑推理、神经网络技术,建立一种基于竞争神经网络的智能推理模型。 二、舌象数据库的遵循原则: (一)满足对海量信息的快速存取。 (二)满足对交叉信息的准确定位。 (三)满足每个病例舌象图像信息的完整性和一致性。 结果:智能推理模型与瘀血舌象特征信息库实现了对中医专家诊断推理过程的模拟。模糊神经网络的竞争网络的学习样本集,依据专家的经验建立。竞争网络通过学习,其权值矩阵存储专家经验。实验结果表明,在输入数据完备的情况下,对一般的辨证诊断可以与专家辨证诊断结果基本一致;在输入数据不完备的情况下,诊断准确率会更多还原

【Abstract】 Diagnosis of the tongue(DT) is the serious part of diagnostics of TCM, it is considered as a comprehensive conclusion of pathogen, nature, position and tendency of disease. It is enhanced study’s position of DT, so we should say that enhancing the DT is significant on enhancing the diagnositic level and enlightening the special feature of TCM. Blood stasis syndrome(BSS) is a commonly seen and lucubrated syndrome, and the works of DT are of great social importance. Accordingly, we expand the researching result of BSS to the field of DT, use the tongue of blood stasis(TBS) as a breakthrough, and launch systematicly quantitive research on the TBS;the results of our study will have an deep impact on the research of DT. We applied hepatopathy TBS, and then we targeted on it to further explore the possible molecular mechanism .In order to achieve these goals, we adopted multidisciplinary techniques such as data fusion, neural network, the test of molecular, etc. It is carried out in five parts.Part 1 Document researchTongue Inspection (TI) is an identical method to diagnose the diseases in diagnostics of Tradition Chinese Medicine. TBS is a significant tongue manifestation to diagnose the blood stasis. Tongue includes different kinds of color of tongue, such as light-purple, deep red-purple, bluish-purple, ecchymose, petechiae crooked-dilated vein, etc. The history BST is very long we collect all the documentation in relation to hepatopathy TBS. Its original literature is showed up in the book of Synopsis of Prescriptions of the Golden Chamber. With development of modern science and technology, scientists have dealed with the clinical studies such as proglossis microcirculation, haemorheology, the color and temperature of tongue. But the report of the molecular and data fusion study on TBS indifferent methods and levels is unseen.Part 2 Study on construction of the characteristic informationdatabase of hepatopathy TBSObjective: Construction of the characteristic information database of the hepatopathy TBS by the method of data fusion techniqueSubject investigated: The normal group and the patient of hepatopathy TBSMethod:1. The intelligent inference model based on competitive neural network was constructed through merging fuzzy logic inference and neural network control technology.2. Following this principle in the building process of tongue image database :2.1 To fulfill certain requirement accessing information quickly from mass information database.2.2 Crossed information was located with precision.2.3 Fulfilling certain requirement to be completeness and uniformity with tongue image information of every case.Result: An expert system was designed to emulate the reasoning process of an experimental TCM expert by the intelligent reasoning model and characteristic database of hepatopathy TBS, The learning swatches was constructed according to the experimental expert that follow the soft neural network based on competition network, the experimental expert was stored up with quantitative value matrix through competition network learning. The experiment led up to the fact that the system exact diagnosis is accomplished 100% in line with differentiation of syndromes according to the expert under the circumstances that the data is self-contained, exactness of system diagnosis add up to 96% in short of data of 10%.It proves to be that neural network system is characteristics of better fault tolerant.Part 3 Clinical observationSection 1 Image analysis of tongue color of TBSObjective: to explore the stasis degree of hepatopathy TBS, quantitative examination is researched by means of the theory color space.Subject investigated: Normal control group (n=10)and tongue image of hepatopathy TBS (n=100)Result: R of tongue color of BSS was significantly lower than that of light red tongue(P<0.05 or P<0.01) ,B of tongue color of BSS was significantly higher than that of lightred tongue (P<0.05 or P<0.01) : R of tongue color of bluish-purple was significantlylower than the others (P<0.05 or P<0.01) , B of tongue color of bluish-purple was significantly higher than the others (P<0.05 or P<0.01) .Section 2 Study of sublingual collateral hepatopathy TBSObjective: to explore the stasis degree of hepatopathy TBS.Subject investigated: Normal control group (n=10)and tongue image of hepatopathy TBS (n=100) Result:2.1 We observed the sublingual veins of patients in different hepatopathy group, and find that sublingual veins of patients is differentiated as normal control group, that it is 66.7 %both double branch and many ones, double branches accounted for 32.3% of all of hepatopathy TBS, many branches made up 35.4%,distributing of trunk shape was all increased significantly compared with normal group(P<0.01);The sublingual veins of satiation and crook amounted for 50%, accending flatness was 26.9%, distributing of full trunk was all increased significantly compared with normal group(P<0.01).2.2 We observed the sublingual veins of patients different hepatopathy BSS finding that, sublingual veins of patients was differentiated from normal control group, dampness and heat and blood stasis syndrome(DHBSS) amounted for 91.4% in the sublingual veins of satiation and crook, distributing of full trunk was all increased significantly compared with normal group(P<0.01);Sublingual veins of patients differentiated as normal control group was increased than normal group in both double branch and many ones, DHBSS accounted for 60 % of many branches, qi and blood stasis syndrome(QBSS) made up 64.7 % distributing of trunk shape was all increased significantly compared with normal group(P<0.01).Part 4 Clinical empirical observationObjective: to explore the pathology mechanism of hepatopathy TBS on molecule levelSubject investigated: Normal control group (n=10)and tongue image of hepatopathy TBS (n=100)Section 1 Study of ET and NO of the hepatopathy TBS1.1 ET and NO and NO/ET of all the hepatopathy group were risen significant^ compared with normal group(P<0.05 or P<0.01). There was significant difference between Group Qi deficiency and blood stasis syndrome(QDBSS) and Groupblood stasis syndrome(PBSS) as well as Group Qi and blood stasis syndrome(QBSS) and Group QDBSS (P<0.05) .1.2 ET and NO and NO/ET of all the hepatopathy BSS group were risen significantly compared with normal group(P<0.01).Section 2 Study of TXB2 and 6-keto-PGFi, of the hepatopathy TBS2.1 TXB2 and TXB2 /6-KETO-PGFia of all the hepatopathy group were risen significantly compared with normal group(P<0.01), 6-KETO-PGFia of all the hepatopathy group were sharp dropped compared with normal group(P<0.01).2.2 On the indexes of TXB2 and TXB2 /6-KETO-PGFia, there was significant difference between BSS group and normal group(P<0.01), there was very marked difference between Qi deficiency and blood stasis syndrome (QDBSS)and the others (P< 0.01) .Section 3 Study of MDA and SOD and GSH-Px of the hepatopathy TBS3.1 There was significant difference among MDA and SOD and GSH-Px of all the hepatopathy group and those of normal group(P<0.01).3.2 MDA of all the hepatopathy BSS group were risen significantly compared with normal group (P<0.05 or P<0.01) , there was very marked difference between QDBSS and the others (P<0.05 orP<0.01) .Section 4 Study of hemorheology of the hepatopathy TBS4.1 Hepatopathy group was compared with normal group in hemorheologyThere was significant difference among whole blood viscosity and hematocrit of hepatopathy group and those of normal group(P<0.01).4.2 Hepatopathy BSS group was compared with normal group in hemorheology There was significant difference among DHBSS, PBSS, QBSS and normal group onthe index of hemorheology (P<0.05 or P< 0.01) .4.3 Hepatopathy BSS group was compared with QDBSS group in hemorheologyOn the indexes of Plasma viscosity and hematocrit and whole blood viscosity, hemorheology of DHBSS and PBSS and QBSS group were risen significantly compared with QDBSS group (P<0.01).Section 5 Study of tongue temperature of the hepatopathy TBSObjective: To observe the characteristic changes of red tongue temperature on patients of different hepatopathy TBS and BSS types.Subject investigated: Normal control group (n=10)and tongue image of hepatopathy TBS (n=40)Experiment apparatus: Thermoviewer SAT-HY6000A Result:5.1 The temperature of whole tongue of normal group falls down in turn, as follows:root of tongue, margin of the tongue, middle surface of tongue, apex of tongue, The temperature of tongue of all the hepatopathy group was sharp dropped compared with normal group(P<0.05 or P<0.01).5.2 The temperature of tongue of all the hepatopathy BSS group was sharp dropped compared with normal group(P<0.01), The temperature of tongue of DHBSS and QBSS and PBSS was decreased significantly compared with QDBSS group(P<0.05 or P<0.01).Part 5 Brief summaryConclusion:The data mentioned above would be concluded as follows:1. The intelligent inference model and characteristic database of hepatopathy TBS were constructed through merging fuzzy logic inference and neural network control technology, which has succeeded in imitating the Traditional Chinese Medicine specialist’s Diagnose inference.2. Experiments showed that the stronger blood stasis the more B of tongue color, R of tongue color of bluish-purple was significantly lower than the others , B of tongue color of bluish-purple was significantly higher than the others. The stasis degree of tongue color of bluish-purple was significantly higher than the others by means of quantitative examination of RGB of different tongue color in tongue of blood stasis of hepatopathy.3. DHBSS was characterized by the sublingual veins of satiation and crook and many branches. Experiments showed that sublingual veins of tongue of blood stasis of hepatopathy may be an applicable clinic index in judgment various BSS syndrome type.4. Tongue of blood stasis of hepatopathy and blood stasis syndrome and mechanism of their formation were probed by means of the test of molecular and prospective study.4.1 ET and NO and NO/ET of all the hepatopathy group and BSS group are risen significantly compared with normal group, experiments showed that they were risen relating to liver cell inorders. There was significant difference among PBSS and QBSS and QDBSS. It illuminated that PBSS was stronger than others in the extent of blood stasis, so ET and NO and NO/ET are the indexes of blood stasis degree of tongue of blood Stasis of hepatopathy.4.2 TXB2and TXB2 /6-KETO-PGFiaof all the hepatopathy group and BSS group are risen significantly compared with normal group, 6-KETO-PGFiawas dropped significantly, the balance inorder of TXA2 and PGI2 blood plasma is closely bound up with development and consequences of BSS, the content of TXB2 and 6-KETO-PGFia may reflect the mechanism of their formation between tongue of blood stasis of hepatopathy and blood stasis syndrome.4.3 On the indexes of MDA and SOD and GSH-Px, there was significant difference between hepatopathy group and normal group as well as BSS group and normal group, experiments showed that the system of defense of antioxidant may eliminate pathogen, so-called "free radical", and O2" and H2O2 and lipid peroxide . So the experimental results bear out MDA and SOD and GSH-Px can reflect waxing-waning of vital Qi and pathogen of the body and these are the indexes that we identify blood stasis syndrome according as their contest.4.4 On the index of hemorheology, there was significant difference between hepatopathy group and normal group as well as BSS group and normal group. The result was verified by the experiment that it was characterized by or possessing qualities generally that attributed to tongue of blood stasis of different syndrome based on different biochemical substance and physics and chemistry and pathology. Experiments showed that transformation of biochemical substance of tongue of blood stasis was closely allied to BSS, Its findings provide the scientific foundation for syndrome differentiation and clinic appliance of the medicine with promoting blood circulation to remove blood stasis.4.5 Tongue temperature of all the hepatopathy group and BSS group was dropped significantly compared with normal group, resulted in tongue microcirculation disorder and the deficiency of blood flow and quantity of heat generating;PBSS and QBSS and DHBSS were dropped significantly compared with QDBSS, the stronger tongue microcirculation disorder, the lower blood flow and tongue temperature. It is evident that red tongue diagram of temperature in various TCM syndrome types has different characteristics. This method is directly perceived, repeated. It may be a convenient and applicable clinic index for various TCM syndrome type and judgment of curative effect.To sum up, the formation tongue of blood stasis of hepatopathy owes to the result of multi-factor unbalancing between liver microcirculation disorder and biochemical factor. And then, tongue temperature deficiency was resulted in tongue microcirculation disorder, and the imbalance of TXB2 and 6-KETO-PGFia was the critical factor that it was the pathological mechanism of TBS, the imbalance of ET and NO was an important factor to support the formation of TBS, free radical can differentiate the excess an deficiency of TBS,hemorrheological indexes reflected the essence of TBS. Points of creation:1. For the first time characteristic database of hepatopathy TBS were constructed by the method of information fusion technology, it provides a solid foundation for further study of the system of disease differentiation and syndrome classification with TBS of the five Zang-organs and a large body of definitive and circumstantial experimental data for the acquisition of characteristic information of TBS.2. We applied hepatopathy TBS and different BSS to irradiate formation mechanism of hepatopathy TBS and BSS on holistic and molecular level, the temperature of tongue testing may be a convenient and applicable clinic index for various BSS syndrome type and judgment of curative effect.3. The research is helpful for widening the study way of TBS and BSS, throwing light on traditional Chinese medicine theory or empirical science connotation, along with clinic application of hepatopathy, and it provide the scientific treatment foundation for clinic drugs of hepatopathy BSS.更多还原