1
|
Lu JJ, Ma J, Wu JJ, Zhen XM, Xiang YT, Lu HY, Zheng MX, Hua XY, Xu JG. Tongue coating-dependent superior temporal sulcus remodeling in amnestic mild cognitive impairment. Brain Res Bull 2024; 214:110995. [PMID: 38844172 DOI: 10.1016/j.brainresbull.2024.110995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/23/2024] [Accepted: 06/01/2024] [Indexed: 06/10/2024]
Abstract
Tongue coating affects cognition, and cognitive decline at early stage also showed relations to functional and structural remodeling of superior temporal sulcus (STS) in amnestic mild cognitive impairment (aMCI). The potential correlation between disparate cognitive manifestations in aMCI patients with different tongue coatings, and corresponding mechanisms of STS remodeling remains uncharted. In this case-control study, aMCI patients were divided into thin coating (n = 18) and thick coating (n = 21) groups. All participants underwent neuropsychological evaluations and multimodal magnetic resonance imaging. Group comparisons were conducted in clinical assessments and neuroimaging measures of banks of the STS (bankssts). Generalized linear models were constructed to explore relationships between neuroimaging measures and cognition. aMCI patients in the thick coating group exhibited significantly poorer immediate and delayed recall and slower information processing speed (IPS) (P < 0.05), and decreased functional connectivity (FC) of bilateral bankssts with frontoparietal cortices (P < 0.05, AlphaSim corrected) compared to the thin coating group. It was found notable correlations between cognition encompassing recall and IPS, and FC of bilateral bankssts with frontoparietal cortices (P < 0.05, Bonferroni's correction), as well as interaction effects of group × regional homogeneity (ReHo) of right bankssts on the first immediate recall (P < 0.05, Bonferroni's correction). aMCI patients with thick coating exhibited poor cognitive performance, which might be attributed to decreased FC seeding from bankssts. Our findings strengthen the understanding of brain reorganization of STS via which tongue coating status impacts cognition in patients with aMCI.
Collapse
Affiliation(s)
- Juan-Juan Lu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Ma
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Jia Wu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Min Zhen
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yun-Ting Xiang
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hao-Yu Lu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mou-Xiong Zheng
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Xu-Yun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China.
| |
Collapse
|
2
|
Kim J, Choi W, Kim KH, Nam DH. Circadian Rhythms in Tongue Features. J Clin Med 2024; 13:3549. [PMID: 38930077 PMCID: PMC11204453 DOI: 10.3390/jcm13123549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/17/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: The aim of this study was to investigate the circadian rhythms of tongue features according to the effects of physiological phases over a 24 h period. (2) Methods: Fifteen healthy participants aged 20 to 69 years were recruited. The participants did not have current chronic diseases or past diseases and had to meet the inclusion and exclusion criteria. The participants stayed at the Gil Hospital for a duration of 2 nights and 3 days. On the first day, at 18:00, they consumed their allocated portions of food and water and then completed a questionnaire. At approximately 21:00, their tongue images were acquired using a computerized tongue image acquisition system, following which they slept for 8 h, commencing at 23:00. Measurements were taken from 07:00 through 21:00 on the second day, and the final acquisition was taken at 07:00 on the following morning, resulting in a total of eight images. The circadian rhythm was authenticated and quantified utilizing the single cosinor analysis, a technique for periodic regression analysis for fitting a 24 h cosine curve. (3) Results: Cosinor analysis revealed that all tongue features were significantly related to circadian rhythm. (4) Conclusions: The results of this study may be important for considering the time of day at which the tongue is observed and tongue status is evaluated.
Collapse
Affiliation(s)
- Jihye Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, Yuseongdae-ro 1672, Yuseong-gu, Daejeon 34054, Republic of Korea; (J.K.); (W.C.); (K.H.K.)
| | - Woosu Choi
- Digital Health Research Division, Korea Institute of Oriental Medicine, Yuseongdae-ro 1672, Yuseong-gu, Daejeon 34054, Republic of Korea; (J.K.); (W.C.); (K.H.K.)
| | - Keun Ho Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, Yuseongdae-ro 1672, Yuseong-gu, Daejeon 34054, Republic of Korea; (J.K.); (W.C.); (K.H.K.)
| | - Dong-Hyun Nam
- Department of Biofunctional Medicine and Diagnosis, College of Korean Medicine, Sangji University, Sangjidae-gil 83, Wonju 26382, Republic of Korea
| |
Collapse
|
3
|
Deep Learning Based Tongue Prickles Detection in Traditional Chinese Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5899975. [PMID: 36185091 PMCID: PMC9522517 DOI: 10.1155/2022/5899975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022]
Abstract
Tongue diagnosis is a convenient and noninvasive clinical practice of traditional Chinese medicine (TCM), having existed for thousands of years. Prickle, as an essential indicator in TCM, appears as a large number of red thorns protruding from the tongue. The term “prickly tongue” has been used to describe the flow of qi and blood in TCM and assess the conditions of disease as well as the health status of subhealthy people. Different location and density of prickles indicate different symptoms. As proved by modern medical research, the prickles originate in the fungiform papillae, which are enlarged and protrude to form spikes like awn. Prickle recognition, however, is subjective, burdensome, and susceptible to external factors. To solve this issue, an end-to-end prickle detection workflow based on deep learning is proposed. First, raw tongue images are fed into the Swin Transformer to remove interference information. Then, segmented tongues are partitioned into four areas: root, center, tip, and margin. We manually labeled the prickles on 224 tongue images with the assistance of an OpenCV spot detector. After training on the labeled dataset, the super-resolutionfaster-RCNN extracts advanced tongue features and predicts the bounding box of each single prickle. We show the synergy of deep learning and TCM by achieving a 92.42% recall, which is 2.52% higher than the previous work. This work provides a quantitative perspective for symptoms and disease diagnosis according to tongue characteristics. Furthermore, it is convenient to transfer this portable model to detect petechiae or tooth-marks on tongue images.
Collapse
|
4
|
Zhang Q, Zhou J, Zhang B. Computational Traditional Chinese Medicine diagnosis: A literature survey. Comput Biol Med 2021; 133:104358. [PMID: 33831712 DOI: 10.1016/j.compbiomed.2021.104358] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Traditional Chinese Medicine (TCM) diagnosis is based on the theoretical principles and knowledge, where it is steeped in thousands of years of history to diagnose various types of diseases and syndromes. It can be generally divided into four main diagnostic approaches: 1. Inspection, 2. Auscultation and olfaction, 3. Inquiry, and 4. Palpation, which are widely used in TCM hospitals in China and around the world. With the development of intelligent computing technology in recent years, computational TCM diagnosis has grown rapidly. METHODS In this paper, we aim to systematically summarize the development of computational TCM diagnosis based on four diagnostic approaches, mainly focusing on digital acquisition devices, collected datasets, and computational detection approaches (algorithms). Furthermore, all related works of this field are compared and explored in detail. RESULTS This survey provides the principles, applications, and current progress in computing for readers and researchers in terms of computational TCM diagnosis. Moreover, the future development direction, prospect, and technological trend of computational TCM diagnosis will also be discussed in this study. CONCLUSIONS Recent computational TCM diagnosis works are compared in detail to show the pros/cons, where we provide some meaningful suggestions and opinions on the future research approaches in this area. This work is useful for disease detection in computational TCM diagnosis as well as health management in the smart healthcare area. INDEX TERMS Computational diagnosis, Traditional Chinese Medicine, survey, smart healthcare.
Collapse
Affiliation(s)
- Qi Zhang
- The PAMI Research Group, Department of Computer and Information Science, Faculty of Science and Technology, University of Macau, Macau SAR, People's Republic of China
| | - Jianhang Zhou
- The PAMI Research Group, Department of Computer and Information Science, Faculty of Science and Technology, University of Macau, Macau SAR, People's Republic of China
| | - Bob Zhang
- The PAMI Research Group, Department of Computer and Information Science, Faculty of Science and Technology, University of Macau, Macau SAR, People's Republic of China.
| |
Collapse
|
5
|
Matos LC, Machado JP, Monteiro FJ, Greten HJ. Can Traditional Chinese Medicine Diagnosis Be Parameterized and Standardized? A Narrative Review. Healthcare (Basel) 2021; 9:177. [PMID: 33562368 PMCID: PMC7914658 DOI: 10.3390/healthcare9020177] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 12/14/2022] Open
Abstract
The integration of Traditional Chinese Medicine (TCM) in Western health systems and research requires a rational communicable theory, scientific proof of efficacy and safety, and quality control measures. The existence of clear definitions and the diagnosis standardization are critical factors to establish the patient's vegetative functional status accurately and, therefore, systematically apply TCM therapeutics such as the stimulation of reflex skin areas known as acupoints. This science-based conceptualization entails using validated methods, or even developing new systems able to parameterize the diagnosis and assess TCM related effects by objective measurements. Traditionally, tongue and pulse diagnosis and the functional evaluation of action points by pressure sensitivity and physical examination may be regarded as essential diagnostic tools. Parameterizing these techniques is a future key point in the objectification of TCM diagnosis, such as by electronic digital image analysis, mechanical pulse diagnostic systems, or the systematic evaluation of acupoints' electrophysiology. This review aims to demonstrate and critically analyze some achievements and limitations in the clinical application of device-assisted TCM diagnosis systems to evaluate functional physiological patterns. Despite some limitations, tongue, pulse, and electrophysiological diagnosis devices have been reported as a useful tool while establishing a person's functional status.
Collapse
Affiliation(s)
- Luís Carlos Matos
- Faculdade de Engenharia da Universidade do Porto, 4200-465 Porto, Portugal;
- CBSIn—Centro de Biociências em Saúde Integrativa, Atlântico Business School, 4405-604 Vila Nova de Gaia, Portugal;
- CTEC—Centro Transdisciplinar de Estudos da Consciência da Universidade Fernando Pessoa, 4249-004 Porto, Portugal
| | - Jorge Pereira Machado
- CBSIn—Centro de Biociências em Saúde Integrativa, Atlântico Business School, 4405-604 Vila Nova de Gaia, Portugal;
- ICBAS—Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal;
| | - Fernando Jorge Monteiro
- Faculdade de Engenharia da Universidade do Porto, 4200-465 Porto, Portugal;
- INEB—Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal
| | - Henry Johannes Greten
- ICBAS—Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal;
- German Society of Traditional Chinese Medicine, 69126 Heidelberg, Germany
| |
Collapse
|
6
|
Huang X, Zhang H, Zhuo L, Li X, Zhang J. TISNet-Enhanced Fully Convolutional Network with Encoder-Decoder Structure for Tongue Image Segmentation in Traditional Chinese Medicine. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:6029258. [PMID: 32831901 PMCID: PMC7428885 DOI: 10.1155/2020/6029258] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/07/2020] [Accepted: 06/15/2020] [Indexed: 11/24/2022]
Abstract
Extracting the tongue body accurately from a digital tongue image is a challenge for automated tongue diagnoses, as the blurred edge of the tongue body, interference of pathological details, and the huge difference in the size and shape of the tongue. In this study, an automated tongue image segmentation method using enhanced fully convolutional network with encoder-decoder structure was presented. In the frame of the proposed network, the deep residual network was adopted as an encoder to obtain dense feature maps, and a Receptive Field Block was assembled behind the encoder. Receptive Field Block can capture adequate global contextual prior because of its structure of the multibranch convolution layers with varying kernels. Moreover, the Feature Pyramid Network was used as a decoder to fuse multiscale feature maps for gathering sufficient positional information to recover the clear contour of the tongue body. The quantitative evaluation of the segmentation results of 300 tongue images from the SIPL-tongue dataset showed that the average Hausdorff Distance, average Symmetric Mean Absolute Surface Distance, average Dice Similarity Coefficient, average precision, average sensitivity, and average specificity were 11.2963, 3.4737, 97.26%, 95.66%, 98.97%, and 98.68%, respectively. The proposed method achieved the best performance compared with the other four deep-learning-based segmentation methods (including SegNet, FCN, PSPNet, and DeepLab v3+). There were also similar results on the HIT-tongue dataset. The experimental results demonstrated that the proposed method can achieve accurate tongue image segmentation and meet the practical requirements of automated tongue diagnoses.
Collapse
Affiliation(s)
- Xiaodong Huang
- Faculty of Information Technology, Beijing University of Technology, Beijing 100124, China
- Beijing Key Laboratory of Computational Intelligence and Intelligent System, Beijing University of Technology, Beijing 100124, China
- Henan University of Science and Technology, Luoyang 471000, China
| | - Hui Zhang
- Faculty of Information Technology, Beijing University of Technology, Beijing 100124, China
- Beijing Key Laboratory of Computational Intelligence and Intelligent System, Beijing University of Technology, Beijing 100124, China
| | - Li Zhuo
- Faculty of Information Technology, Beijing University of Technology, Beijing 100124, China
- Beijing Key Laboratory of Computational Intelligence and Intelligent System, Beijing University of Technology, Beijing 100124, China
| | - Xiaoguang Li
- Faculty of Information Technology, Beijing University of Technology, Beijing 100124, China
- Beijing Key Laboratory of Computational Intelligence and Intelligent System, Beijing University of Technology, Beijing 100124, China
| | - Jing Zhang
- Faculty of Information Technology, Beijing University of Technology, Beijing 100124, China
- Beijing Key Laboratory of Computational Intelligence and Intelligent System, Beijing University of Technology, Beijing 100124, China
| |
Collapse
|
7
|
Kim J, Kim J, Yeo I, Kim J, Kim J, Nam DH. Association between tongue coating thickness and ultraviolet fluorescence in patients with functional dyspepsia: A prospective observational study. Medicine (Baltimore) 2019; 98:e16106. [PMID: 31305393 PMCID: PMC6641834 DOI: 10.1097/md.0000000000016106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to examine the correlation between the tongue coating thickness (TCT) and ultraviolet (UV) fluorescence and propose a new method for the estimation of TCT using a computerized tongue image acquisition system (CTIS).In this prospective and observational single-center study, we acquired tongue images under visible light and near-UV light for 60 patients with functional dyspepsia. Tongue images were acquired twice within a 30-minute interval to assess the reliability of CTIS. Then, the tongue coating was scraped and weighed to derive the wet weight of the tongue coating (WWTC). The percentage of the tongue coating area was calculated from the tongue images acquired under visible light. Mean color values (mCVs) for the UV fluorescence of the dorsal surface of the tongue were also computed.The reliabilities of the derived mCVs and percentage of the tongue coating area were acceptable (intraclass correlation coefficients, 0.907-0.947). The mCVs were more strongly correlated with WWTC than with the area, with mCV of modified lightness showing the strongest association (r = 0.785, P < .01). Finally, we suggested an estimation model for TCT based on the results.The results of this study suggest that both UV fluorescence of the dorsal tongue and the distribution area of tongue coating are useful parameters for the quantitative assessment of tongue coating. We believe that these findings will contribute to the development of a clinically useful CTIS.
Collapse
Affiliation(s)
- Jihye Kim
- Department of Biofunctional Medicine and Diagnosis, College of Korean Medicine, Sangji University, Wonju-si, Gangwon-do
- Future Medicine Division, Korea Institute of Oriental Medicine, Yuseong-gu, Daejeon
| | - Jiwon Kim
- Department of Biofunctional Medicine and Diagnosis, College of Korean Medicine, Sangji University, Wonju-si, Gangwon-do
| | - Inkwon Yeo
- Department of Statistics, Sookmyung Women's University, Yongsan-gu
| | - Juyeon Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Jinsung Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Dong-Hyun Nam
- Department of Biofunctional Medicine and Diagnosis, College of Korean Medicine, Sangji University, Wonju-si, Gangwon-do
| |
Collapse
|
8
|
Baek SW, Lee JM, Park YB, Park YJ. Relationship between Tongue Temperature Estimated by Infrared Thermography, Tongue Color, and Cold-Heat Pathological Patterns: A Retrospective Chart Review Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:6841460. [PMID: 29977315 PMCID: PMC5994269 DOI: 10.1155/2018/6841460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/25/2018] [Accepted: 05/14/2018] [Indexed: 12/13/2022]
Abstract
Tongue diagnosis is a technique used to determine cold-heat pathologic patterns (CHPPs). Herein, we reviewed electronic medical records of tongue temperature measured using infrared thermography (IRT), tongue color (luminance, green/red, and blue/yellow balance), cold-heat pattern questionnaires (CHPQ), and body temperature for 134 women with gynecological problems (age, 38.97 ± 11.49 years). The temperatures of seven tongue regions (root, center, tip, and both sides of the center and root) were determined, and the effects of age, regional differences, and their correlations with color parameters were examined. Factor analysis was conducted separately with the 10 cold pattern (CP) and 10 heat pattern (HP) items. Tongue temperature showed an age effect (β; -0.198 to -0.210) and regional differences (both sides of the root > center and root > tip). Tongue temperature was positively correlated with luminance (r: 0.236-0.246), indicating that a higher temperature was associated with a brighter color. The factor analysis extracted two factors (cold sensitivity-pain and discharge-complexion factors) from the CP items and three factors (heat sensation-pain, discharge-breath, and cold preference-thirst factors) from the HP items. Tongue temperature was negatively correlated with the discharge-complexion factor of CP and the discharge-breath factor of HP (r: -0.171 to -0.203), indicating that a lower tongue temperature may be a consequence of emission of excessive heat in HP and a lower blood perfusion in CP. Body temperature did not correlate with the CHPQ factor scores. In conclusion, tongue temperatures measured using IRT may be a partial indicator of CHPPs.
Collapse
Affiliation(s)
- Seung-Won Baek
- Department of Biofunctional Medicine and Diagnostics, College of Korean Medicine, Kyung Hee University, Republic of Korea
- Department of Diagnosis and Biofunctional Medicine, Kyung Hee University Hospital at Gangdong, Republic of Korea
| | - Jin-Moo Lee
- Department of Women's Health Clinic, Kyung Hee University Hospital at Gangdong, Republic of Korea
- Department of Gynecology, College of Korean Medicine, Kyung Hee University, Republic of Korea
| | - Young-Bae Park
- Department of Biofunctional Medicine and Diagnostics, College of Korean Medicine, Kyung Hee University, Republic of Korea
- Department of Diagnosis and Biofunctional Medicine, Kyung Hee University Hospital at Gangdong, Republic of Korea
| | - Young-Jae Park
- Department of Biofunctional Medicine and Diagnostics, College of Korean Medicine, Kyung Hee University, Republic of Korea
- Department of Diagnosis and Biofunctional Medicine, Kyung Hee University Hospital at Gangdong, Republic of Korea
| |
Collapse
|
9
|
Kim SR, Nam DH. Reliability, Accuracy, and Use Frequency of Evaluation Methods for Amount of Tongue Coating. Chin J Integr Med 2018; 25:378-385. [PMID: 29700763 DOI: 10.1007/s11655-018-2552-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/06/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To classify the evaluation methods for amount of tongue coating (TC) and investigate their reliability, accuracy, and frequency of use. METHODS Articles published from 1985 to 2015 were searched for evaluation methods for the amount of TC in PubMed and the Cochrane Library. Only clinical researches were included except protocol articles. The methods were classified according to their characteristics. RESULTS Finally, 113 articles were selected. The evaluation method for the amount of TC from the articles was classified into 4 types: intuitive, specificative, computerized, and weighing TC. The reliability in the intuitive and specificative methods (κ =0.33-0.92) showed varying levels among the studies. In general, the amount of TC calculated by the specificative method (Spearman's r=0.68-0.80) was more strongly related to the directly measured value than to the value estimated by the computerized method (Pearson's r=0.442). The number of articles published on this topic has increased consistently, and the specificative method was the most frequently used. Despite the higher reliability of the computerized method, it has not been widely used. CONCLUSIONS The high prevalence of the specificative method would continue in clinical practice because of its convenience and accuracy. However, to establish higher reliability, the limitation of the subjectivity of the assessors should be overcome through calibration training. In the computerized method, novel algorithms are needed to obtain a higher accuracy so that it can help the practitioners confidently estimate the amount of TC.
Collapse
Affiliation(s)
- Su-Ryun Kim
- Department of Biofunctional Medicine and Diagnosis, College of Korean Medicine, Sangji University, Wonju, 26339, Republic of Korea
| | - Dong-Hyun Nam
- Department of Biofunctional Medicine and Diagnosis, College of Korean Medicine, Sangji University, Wonju, 26339, Republic of Korea.
| |
Collapse
|
10
|
Differences in the Tongue Features of Primary Dysmenorrhea Patients and Controls over a Normal Menstrual Cycle. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017. [PMID: 28642801 PMCID: PMC5469986 DOI: 10.1155/2017/6435702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background The aims of this study were to investigate the relationships between tongue features and the existence of menstrual pain and to provide basic information regarding the changes in tongue features during a menstrual cycle. Methods This study was conducted at the Kyung Hee University Medical Center. Forty-eight eligible participants aged 20 to 29 years were enrolled and assigned to two groups according to their visual analogue scale (VAS) scores. Group A included 24 females suffering from primary dysmenorrhea (PD) caused by qi stagnation and blood stasis syndrome with VAS ≥ 4. In contrast, Group B included 24 females with few premenstrual symptoms and VAS < 4. All participants completed four visits (menses-follicular-luteal-menses phases), and the tongue images were taken by using a computerized tongue image analysis system (CTIS). Results The results revealed that the tongue coating color value and the tongue coating thickness in the PD group during the menstrual phase were significantly lower than those of the control group (P = 0.031 and P = 0.029, resp.). Conclusions These results suggest that the tongue features obtained from the CTIS may serve as a supplementary means for the differentiation of syndromes and the evaluation of therapeutic effect and prognosis in PD. Trial Registration This trial was registered with Clinical Research Information Service, registration number KCT0001604, registered on 27 August 2015.
Collapse
|
11
|
Park YJ, Lee JM, Yoo SY, Park YB. Reliability and validity of tongue color analysis in the prediction of symptom patterns in terms of East Asian Medicine. J TRADIT CHIN MED 2016; 36:165-72. [DOI: 10.1016/s0254-6272(16)30023-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
12
|
Kainuma M, Furusyo N, Urita Y, Nagata M, Ihara T, Oji T, Nakaguchi T, Namiki T, Hayashi J. The association between objective tongue color and endoscopic findings: results from the Kyushu and Okinawa population study (KOPS). BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:372. [PMID: 26474972 PMCID: PMC4609076 DOI: 10.1186/s12906-015-0904-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022]
Abstract
Background The relation between tongue color and gastroesophageal disease is unclear. This study was done to investigate the associations between tongue color (TC), endoscopic findings, Helicobacter.pylori infection status, and serological atrophic gastritis (SAG). Methods The participants were 896 residents of Ishigaki Island, Okinawa, aged 28–86 years. The tongue was photographed, esophagogastroduodenoscopy was done, and serum antibody to H.pylori was measured. SAG was defined as a serum Pepsinogen (PG)Ilevel ≤70 ng/ml and a PGI/IIratio ≤3.0. TC was measured by the device-independent international commission on Illumination 1976 L*a*b* color space standards at four points: (1) edge, (2) posterior, (3) middle, and (4) apex. We also calculated the ratio of the tongue edge to the three other measured points to examine the association between the coating of the tongue and the endoscopic and laboratory findings. Results Participants were excluded who had two or more endoscopic findings (n = 315) or who had SAG without seropositivity to H.pylori (n = 33). The remaining 548 participants were divided into three groups: SAG and seropositive to H.pylori (n = 67), seropositive to H.pylori alone (n = 56), and without SAG and seronegative for H.pylori (n = 425). We divided 425 residents into a single endoscopic finding positive group (n = 207) and a negative group, which served as a control (n = 218). The most frequent single endoscopic finding was esophageal hernia (n = 110), followed by erosive esophagitis (n = 35) and erosive gastritis (EG) (n = 45). EH was significantly associated with TC (2b*/1b*) (P < 0.05). EG was significantly associated with TC (3a*, 3b*) (P < 0.05). Seropositivity to H.pylori was significantly associated with TC (3 L*, 3 L*/1 L*) (P < 0.05, <0.01), and seropositivity to both H.pylori and SAG was significantly associated with TC (3 L*/1 L*) (P < 0.05). Multivariate analysis extracted TC (3a*, 3b*) as an independent factor associated with a differential diagnosis of EG (Odds ratio (OR) 2.66 P = 0.008, OR 2.17 P = 0.045). Conclusions The tongue body color of the middle area reflects acute change of gastric mucosa, such as erosive gastritis. Tongue diagnosis would be a useful, non-invasive screening tool for EG.
Collapse
|
13
|
Hsieh SF, Shen LL, Su SY. Tongue color changes within a menstrual cycle in eumenorrheic women. J Tradit Complement Med 2015; 6:269-74. [PMID: 27419092 PMCID: PMC4936755 DOI: 10.1016/j.jtcme.2015.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 06/30/2015] [Accepted: 07/14/2015] [Indexed: 12/02/2022] Open
Abstract
Tongue color (舌色 shé sè) has been used to diagnose abnormal body conditions for thousands of years in traditional Chinese Medicine (中醫 zhōng yī). However, it is not clear whether tongue color alters with physiological changes within a normal menstrual cycle (月經周期 yuè jīng zhōu qī). This study investigated difference in tongue color between the follicular phase and luteal phase in eumenorrheic women. Tongue surface photographs were taken in the follicular phase and the luteal phase of thirty-two volunteers with biphasic basal body temperature. Color values on five areas of the tongue surface were examined and comparisons of color values were made between the two phases according to the red–green–blue (RGB), hue–saturation–brightness (HSB), luminance-a-b (Lab), and cyan–magenta–yellow–black (CMYK) models. Based on the RGB model, the values of green and blue in the tip area were larger in the follicular phase than both in the luteal phase. The values of magenta and yellow based in the CMYK model were smaller in the tip area in the follicular phase than that in the luteal phase. The saturation in the tip area was smaller in the follicular phase than that in the luteal phase. Based on the Lab model, b value in the middle area was smaller in the follicular phase than that in the luteal phase. The data revealed that tongue color varied within a eumenorrheic menstrual cycle, suggesting that tongue color differences between the follicular and luteal phases need to be considered while practicing tongue diagnosis (舌診 shé zhěn) or performing clinical studies among childbearing women.
Collapse
Key Words
- B (in HSB), brightness
- B (in RGB), blue
- BBT, basal body temperature
- C, cyan
- CMYK model
- CMYK, cyan–magenta–yellow–black
- E2, estradiol
- G, green
- H, hue
- HSB model
- HSB, hue–saturation–brightness
- K, black
- L, luminance
- Lab model
- Lab, luminance-a-b
- M, magenta
- Menstrual cycle
- R, red
- RGB model
- RGB, red–green–blue
- S, saturation
- TCM, traditional Chinese Medicine
- Tongue inspection
- Y, yellow
Collapse
Affiliation(s)
- Shu-Feng Hsieh
- Department of Traditional Chinese Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Li-Ling Shen
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan
| | - Shan-Yu Su
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan; School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
| |
Collapse
|
14
|
RiYang L, HangYing Y, JunYan Q, YaYu L, YuHui W, YaZhen Y, JiaZhen Y, Jin Y, Jun N, DongRong Y. Association between tongue coating thickness and clinical characteristics among idiopathic membranous nephropathy patients. JOURNAL OF ETHNOPHARMACOLOGY 2015; 171:125-130. [PMID: 25997785 DOI: 10.1016/j.jep.2015.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 04/22/2015] [Accepted: 05/04/2015] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Tongue coating diagnosis is a useful tool to examine the changes of a human body in Chinese Medicine. Tongue coating varies in thickness in kidney disease. However, little information exists regarding the association between clinical characters and tongue coating thickness in CKD patients. AIM OF THE STUDY This study was carried out to determine whether there is an association between tongue coating thickness and laboratory, histological variables in idiopathic membranous nephropathy patients: one group with thin tongue coating, the other with thick tongue coating. MATERIALS AND METHODS During July 2012-March 2014, idiopathic membranous nephropathy patients(CKD 1-2 stage) with tongue coating thickness Score ≤7, or ≥11, were enrolled as thin tongue coating group or thick tongue coating group, from Hangzhou Hospital of TCM. Laboratory variables (Hemoglobin (Hb), albumin (Alb); eGFR; alanine transferase (ALT); aspartate aminotransferase (AST); triglyceride (TG); total cholesterone (TC); high density lipoprotein (HDL); low density lipoprotein (LDL); immunoglobin A, G, M; Complement 3, 4) and renal histological data (glomerular lesions; tubular-interstitial damage) were compared, between these two groups. RESULTS 12 idiopathic MN patients (CKD 1-2 stage) with thin tongue coating (tongue coating thickness score ≤7) and 11 with thick tongue coating (tongue coating thickness score ≥11) were enrolled in our study. We found a significant lower level of TC and LDL, a significant lower level of AST, ALT in those thick tongue coating patients, compared with thin. No significant difference was observed in pathological lesion between thick and thin tongue coating patients. CONCLUSION Tongue coating thickness is associated with lipid metabolism in idiopathic MN patients (CKD 1-2 stages).
Collapse
Affiliation(s)
- Lin RiYang
- Nephrology Department, Hangzhou Hospital of TCM, Hangzhou, Zhejiang Province, China.
| | - Yu HangYing
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Qin JunYan
- Xixi Community Health Center, Hangzhou, Zhejiang Province, China
| | - Li YaYu
- Nephrology Department, Hangzhou Hospital of TCM, Hangzhou, Zhejiang Province, China
| | - Wang YuHui
- Nephrology Department, Hangzhou Hospital of TCM, Hangzhou, Zhejiang Province, China
| | - Yang YaZhen
- Nephrology Department, Hangzhou Hospital of TCM, Hangzhou, Zhejiang Province, China
| | - Yin JiaZhen
- Nephrology Department, Hangzhou Hospital of TCM, Hangzhou, Zhejiang Province, China
| | - Yu Jin
- Nephrology Department, Hangzhou Hospital of TCM, Hangzhou, Zhejiang Province, China
| | - Ni Jun
- Nephrology Department, Hangzhou Hospital of TCM, Hangzhou, Zhejiang Province, China
| | - Yu DongRong
- Nephrology Department, Hangzhou Hospital of TCM, Hangzhou, Zhejiang Province, China
| |
Collapse
|
15
|
Ko SJ, Lee H, Kim SK, Kim M, Kim J, Lee BJ, Park JW. Development of the Quantitative Indicator of Abdominal Examination for Clinical Application: A Pilot Study. J Altern Complement Med 2015; 21:358-63. [DOI: 10.1089/acm.2014.0185] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Seok-Jae Ko
- Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyunju Lee
- Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seul-Ki Kim
- Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Minji Kim
- Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jinsung Kim
- Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Beom-Joon Lee
- Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jae-Woo Park
- Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| |
Collapse
|
16
|
Proposal for a new noncontact method for measuring tongue moisture to assist in tongue diagnosis and development of the tongue image analyzing system, which can separately record the gloss components of the tongue. BIOMED RESEARCH INTERNATIONAL 2015; 2015:249609. [PMID: 25699260 PMCID: PMC4324740 DOI: 10.1155/2015/249609] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 11/09/2014] [Indexed: 12/11/2022]
Abstract
Tongue diagnosis is a noninvasive diagnosis and is traditionally one of the most important tools for physicians who practice Kampo (traditional Japanese) medicine. However, it is a subjective process, and its results can depend on the experience of the physician performing it. Previous studies have reported how to measure and evaluate the shape and color of the tongue objectively. Therefore, this study focused on the glossy component in order to quantify tongue moisture in tongue diagnosis. We hypothesized that moisture appears as a gloss in captured images and measured the amount of water on the tongue surface in 13 subjects. The results showed a high correlation between the degree of gloss and the amount of water on the tongue surface and suggested that the moisture on the tongue can be estimated by the degree of gloss in a captured image. Because the moisture level on the tongue changes during the course of taking photos, it became clear that we had to wait at least 3 minutes between photos. Based on these results, we established the tongue image analyzing system (TIAS), which can consistently record the gloss and color of the tongue surface simultaneously.
Collapse
|
17
|
Kim J, Han G, Ko SJ, Nam DH, Park JW, Ryu B, Kim J. Tongue diagnosis system for quantitative assessment of tongue coating in patients with functional dyspepsia: a clinical trial. JOURNAL OF ETHNOPHARMACOLOGY 2014; 155:709-713. [PMID: 24933221 DOI: 10.1016/j.jep.2014.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/19/2014] [Accepted: 06/04/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Tongue diagnosis is a significant procedure to examine the physiological and pathological changes of the human body in oriental medicine. However, the conventional method of tongue diagnosis including direct observation of tongue has limitations because of various external factors and subjective factors. Therefore, the current study investigated the usefulness of the tongue diagnosis system (TDS) as a diagnostic tool for evaluating tongue coating thickness (TCT) by assessing the agreement between the TDS and a gold standard established by assessors using the conventional method. MATERIALS AND METHODS The present study was designed as a prospective clinical trial including 60 patients with functional dyspepsia. The TDS was used to capture tongue images twice within a 30-min interval to assess its reproducibility. Tongue coating percentage was measured by the TDS, and TCT was classified as either no coating, thin coating, or thick coating according to the existing diagnostic criteria. After both TDS examinations, the weight of tongue coating was quantitatively measured, and the correlation between the actual quantity of tongue coating and the percentage of the coating measured by the TDS was analyzed using Pearson׳s correlation. After collecting tongue images in all 60 patients, tongue coating was evaluated using a conventional method by 5 well-trained assessors to establish the gold standard for evaluating TCT, which allowed us to assess the diagnostic agreement between the TDS and the gold standard. After 2 weeks, TCT evaluation was repeated by the same assessors using the same images but in a random order. RESULTS The agreement between the TDS and the gold standard for evaluating TCT was almost perfect (weighted kappa, 0.840), as was the reproducibility of the TDS (weighted kappa, 0.851). The percentage of tongue coating measured by the TDS was significantly correlated with the weight of tongue coating (r=0.442, p <0.001). The levels of intra-rater reliability ranged from substantial to almost perfect (range of weighted kappa, 0.777-0.923). The inter-rater reliability of 5 assessors was moderate (weighted kappa, 0.563). CONCLUSIONS The present study demonstrated that the TDS can be used as a diagnostic tool for the objective and standardized evaluation of TCT in actual clinical practice.
Collapse
Affiliation(s)
- Juyeon Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Kyung Hee dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
| | - Gajin Han
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Kyung Hee dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
| | - Seok-Jae Ko
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Kyung Hee dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
| | - Dong-Hyun Nam
- Department of Biofunctional Medicine and Diagnosis, College of Korean Medicine, Sangji University, Sangjidae-gil 83, Wonju 220-702, Republic of Korea.
| | - Jae-Woo Park
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Kyung Hee dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
| | - Bongha Ryu
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Kyung Hee dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
| | - Jinsung Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Kyung Hee dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
| |
Collapse
|
18
|
Jung CJ, Kim KH, Jeon YJ, Kim J. Improving color and shape repeatability of tongue images for diagnosis by using feedback gridlines. Eur J Integr Med 2014. [DOI: 10.1016/j.eujim.2014.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
19
|
Color distribution differences in the tongue in sleep disorder. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:323645. [PMID: 24868237 PMCID: PMC4020389 DOI: 10.1155/2014/323645] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 04/07/2014] [Indexed: 12/15/2022]
Abstract
Introduction. According to traditional East Asian medicine (TEAM) theory, the tongue represents conditions of qi and blood. In the present study, the relationship between the tongue and the qi and blood in conditions with no apparent disease was investigated. Methods. A total of 454 elderly people with no apparent disease were recruited. Two Korean oriental medicine doctors classified subjects into a normal group (n = 402) and a sleep disorder group (n = 52). Three to five weeks after the experiment, 153 subjects were rerecruited for a second experiment. Two-dimensional color histograms, whose seven variables represent the color distribution in Commission Internationale de l'Éclairage 1976 (L∗, a∗, b∗) color space, were produced from tongue images. Results. The color of the tongue body in the sleep disorder group appeared paler than that in the normal group, and the tongue coating in the normal group was less widely distributed compared with that in the sleep disorder group. The differences in tongue color between the normal at first experiment and sleep disorder at second experiment conditions were similar to the differences between the normal and the sleep disorder groups. Conclusions. The tongue states in the sleep disorder group indicate a qi and blood deficiency according to TEAM theory.
Collapse
|
20
|
Study of factors involved in tongue color diagnosis by kampo medical practitioners using the farnsworth-munsell 100 hue test and tongue color images. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:783102. [PMID: 24808919 PMCID: PMC3997959 DOI: 10.1155/2014/783102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/14/2014] [Indexed: 12/22/2022]
Abstract
In traditional Japanese medicine (Kampo medicine), tongue color is important in discerning a patient's constitution and medical conditions. However, tongue color diagnosis is susceptible to the subjective factors of the observer. To investigate factors involved in tongue color diagnosis, both color discrimination and tongue color diagnosis were researched in 68 Kampo medical practitioners. Color discrimination was studied by the Farnsworth-Munsell 100 Hue test, and tongue color diagnosis was studied by 84 tongue images. We found that overall color discrimination worsened with aging. However, the color discrimination related to tongue color regions was maintained in subjects with 10 or more years of Kampo experience. On the other hand, tongue color diagnosis significantly differed between subjects with <10 years of experience and ≥10 years of experience. Practitioners with ≥10 years of experience could maintain a consistent diagnosis of tongue color regardless of their age.
Collapse
|
21
|
Diabetes with pyogenic liver abscess—A perspective on tongue assessment in traditional Chinese medicine. Complement Ther Med 2014; 22:341-8. [DOI: 10.1016/j.ctim.2013.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/27/2013] [Accepted: 12/22/2013] [Indexed: 11/23/2022] Open
|
22
|
Kurande V, Bilgrau AE, Waagepetersen R, Toft E, Prasad R. Interrater reliability of diagnostic methods in traditional Indian ayurvedic medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:658275. [PMID: 24191170 PMCID: PMC3803118 DOI: 10.1155/2013/658275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/14/2013] [Accepted: 08/23/2013] [Indexed: 11/18/2022]
Abstract
This study assesses the interrater reliability of Ayurvedic pulse (nadi), tongue (jivha), and body constitution (prakriti) assessments. Fifteen registered Ayurvedic doctors with 3-15 years of experience independently examined twenty healthy subjects. Subjects completed self-assessment questionnaires and software analyses for prakriti assessment. Weighted kappa statistics for all 105 pairs of doctors were computed for the pulse, tongue, and prakriti data sets. According to the Landis-Koch scale, the pairwise kappas ranged from poor to slight, slight to fair, and fair to moderate for pulse, tongue, and prakriti assessments, respectively. The average pairwise kappa for pulse, tongue, and prakriti was 0.07, 0.17, and 0.28, respectively. For each data set and pair of doctors, the null hypothesis of random rating was rejected for just twelve pairs of doctors for prakriti, one pair of doctors for pulse examination, and no pairs of doctors for tongue assessment. Thus, the results demonstrate a low level of reliability for all types of assessment made by doctors. There was significant evidence against random rating by software and questionnaire use and by the diagnosis preferred by the majority of doctors. Prakriti assessment appears reliable when questionnaire and software assessment are used, while other diagnostic methods have room for improvement.
Collapse
Affiliation(s)
- Vrinda Kurande
- Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Frederik Bajers Vej 7D, 9220 Aalborg East, Denmark
| | - Anders Ellern Bilgrau
- Department of Mathematical Sciences, Aalborg University, Frederik Bajers Vej 7G, 9220 Aalborg East, Denmark
- Department of Haematology and Aalborg Hospital Science and Innovation Center (AHSIC), Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark
| | - Rasmus Waagepetersen
- Department of Mathematical Sciences, Aalborg University, Frederik Bajers Vej 7G, 9220 Aalborg East, Denmark
| | - Egon Toft
- Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Frederik Bajers Vej 7D, 9220 Aalborg East, Denmark
| | - Ramjee Prasad
- Center for TeleInFrastruktur (CTIF), Aalborg University, Niels Jernes Vej 12, 9220 Aalborg East, Denmark
| |
Collapse
|
23
|
Availability of tongue diagnosis system for assessing tongue coating thickness in patients with functional dyspepsia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:348272. [PMID: 24159343 PMCID: PMC3789501 DOI: 10.1155/2013/348272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/15/2013] [Indexed: 11/18/2022]
Abstract
Tongue diagnosis is an important procedure in traditional Korean medicine (TKM). In particular, tongue coating thickness (TCT) is deemed to show the progression of the disease. However, conventional tongue diagnosis has limitations because of various external factors. Therefore, it is necessary to investigate the availability of tongue diagnosis system (TDS) in the assessment of TCT. This study has been designed as a prospective clinical trial involving 60 patients with functional dyspepsia. Tongue images will be obtained by TDS twice with a 30 min interval. The system will measure the percentage of TCT and classify it as either no coating, thin coating, or thick coating according to the existing diagnostic criteria. After finishing the collection of 60 patients' tongue images, TCT on the images will be simultaneously evaluated by the conventional method to establish the gold standard for assessing TCT by 5 well-trained clinicians. The evaluation will be repeated by the same clinicians after 2 weeks, but the order of the images will be changed. This trial is expected to provide clinical evidence for the availability of TDS as a diagnostic tool and to contribute to the standardization of the diagnosis system used in TKM. This trial is registered with ClinicalTrials.gov NCT01864837.
Collapse
|
24
|
Liang W, Li X, Li Y, Li C, Gao B, Gan H, Li S, Shen J, Kang J, Ding S, Lin X, Liao L. Tongue coating microbiome regulates the changes in tongue texture and coating in patients with post-menopausal osteoporosis of Gan-shen deficiency syndrome type. Int J Mol Med 2013; 32:1069-76. [PMID: 24026106 DOI: 10.3892/ijmm.2013.1485] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 09/02/2013] [Indexed: 11/06/2022] Open
Abstract
Tongue inspection is a unique and important method of diagnosis in traditional Chinese medicine (TCM). It is a diagnostic approach which involves observing the changes in the tongue proper and tongue coating in order to understand the physiological functions and pathological changes of the body. However, the biological basis of TCM tongue diagnosis remains to be poorly understood and lacks systematic investigation at the molecular level. In this study, we evaluated the effects of tongue coating microbiome on changes in the tongue texture and coating in patients with post-menopausal osteoporosis (PMO) of Gan‑shen deficiency syndrome type. Our aim was to delineate the mechanisms of tongue coating microbiome-induced changes in the tongue texture and coating by investigating the histomorphological changes and performing a bacterial analysis of the tongue coating. We found that the number of intermediate cells in the red tongue with a thin coating was higher, while the number of superficial cells in the red tongue with a thin coating was lower. The maturation value (MV) of tongue exfoliated cells in the red tongue with a thin coating decreased, compared with that in the pale red tongue with a thin white coating. Furthermore, the total bacterial count, oral streptococcus, Gram‑positive (G+) and Gram‑negative (G-) anaerobic bacteria in the red tongue with a thin coating was significantly decreased compared with the pale red tongue with a thin white coating. The results of ultrastructural examination demonstrated that the number of epithelial cells and bacteria in the red tongue with a thin coating decreased compared with that in the pale red tongue with a thin white coating. These observations indicate that the tongue coating microbiome may be an important factor contributing to changes in the tongue in patients with PMO of Gan‑shen deficiency syndrome type.
Collapse
Affiliation(s)
- Wenna Liang
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, P.R. China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Kurande VH, Waagepetersen R, Toft E, Prasad R. Reliability studies of diagnostic methods in Indian traditional Ayurveda medicine: An overview. J Ayurveda Integr Med 2013; 4:67-76. [PMID: 23930037 PMCID: PMC3737449 DOI: 10.4103/0975-9476.113867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 03/21/2013] [Accepted: 04/15/2013] [Indexed: 11/04/2022] Open
Abstract
Recently, a need to develop supportive new scientific evidence for contemporary Ayurveda has emerged. One of the research objectives is an assessment of the reliability of diagnoses and treatment. Reliability is a quantitative measure of consistency. It is a crucial issue in classification (such as prakriti classification), method development (pulse diagnosis), quality assurance for diagnosis and treatment and in the conduct of clinical studies. Several reliability studies are conducted in western medicine. The investigation of the reliability of traditional Chinese, Japanese and Sasang medicine diagnoses is in the formative stage. However, reliability studies in Ayurveda are in the preliminary stage. In this paper, examples are provided to illustrate relevant concepts of reliability studies of diagnostic methods and their implication in practice, education, and training. An introduction to reliability estimates and different study designs and statistical analysis is given for future studies in Ayurveda.
Collapse
Affiliation(s)
| | | | - Egon Toft
- Department of Health Science and Technology, Aalborg University, Denmark
| | - Ramjee Prasad
- Center for TeleInFrastructure, Aalborg University, Denmark
| |
Collapse
|