OBJECTIVETo explore the tongue manifestations for the blood-stasis and toxin syndrome in the stable patients of coronary heart disease (CHD) according to the acute cardiovascular events (ACEs) in one-year follow-up which based on the pathogenesis hypothesis of "blood-stasis and toxin causing catastrophe".

METHODSTotally 254 stable CHD cases were enrolled after diagnosed by coronary angiography, their tongue appearances were recorded by the digital camera of uniform type, 29 cases with ACEs during one-year follow-up were assigned in ACEs group. The non-ACEs were matched in proportion of 2:1 according to the gender, age (±2.5 years), diabetes mellitus history and previous acute coronary syndrome hospitalization history in the non-ACEs group, and 54 cases were eligibly included. The differences of tongue appearance between the ACEs and non-ACEs group were compared.

RESULTSFifteen cases manifested with bluish tongue (including bluish-grounding or bluish purple tongue), among which 11 cases (37.9%) in the ACEs group and four cases (7.4%) in the non-ACEs group, and there was significant difference (P<0.002). Twenty six cases showed yellow tongue coating in the non-ACEs group, which was significantly higher than that in the ACEs group (48.1 vs. 10.3%, P=0.001). The tongue of sticky greasy coating was more frequently occurred in the non-ACEs group than that in the ACEs group (66.7% vs. 41.4%, P=0.026). The proportion of purplish-red sublingual vessel was higher in the ACEs group than that in the non-ACEs group (41.4% vs. 20.4%, P=0.041). Odd ratio (OR) analysis showed that the patients with bluish tongue, purplish-red sublingual vessel, dry-greasy or dirty greasy coating were more likely to experience ACEs during one-year follow-up (OR: 11.67, 95%CI: 3.34 year 3.34-40.81, P<0.001; OR: 2.76, 95%CI: 1.02 1.02-7.44, P<0.05; OR: 3.12, 95%, CI: 0.89 0.89-10.92, P=0.066).

CONCLUSIONSThe bluish tongue (including bluish-grounding or bluish purple tongue) and purplish-red sublingual vessel were potential tongue manifestations of blood-stasis and toxin. The tongue coating changing from sticky greasy to dry greasy or dirty greasy was also probably a tongue manifestation of "transforming toxin", which need demonstration by further study.