Reliability and validity of tongue color analysis in the prediction of symptom patterns in terms of East Asian Medicine

OBJECTIVE:To examine whether color parameters of tongue inspection(TI)using a digital camera was reliable and valid,and to examine which color parameters serve as predictors of symptom patterns in terms of East Asian medicine(EAM).METHODS:Two hundred female subjects'tongue substances were photographed by a mega-pixel digital camera.Together with the photographs,the subjects were asked to complete Yin deficiency,Phlegm pattern,and Cold-Heat pattern questionnaires.Using three sets of digital imaging software,each digital image was exposure-and white balance-corrected,and finally L*(luminance),a*(red-green balance),and b*(yellow-blue balance)values of the tongues werecalculated.To examine intra-and inter-rater reliabilities and criterion validity of the color analysis method,three raters were asked to calculate color parameters for 20 digital image samples.Finally,four hierarchical regression models were formed.RESULTS:Color parameters showed good or excellent reliability(0.627-0.887 for intra-class correlation coefficients)and significant criterion validity(0.523-0.718 for Spearman's correlation).In the hierarchical regression models,age was a significant predictor of Yin deficiency(β=0.192),and b*value of the tip of the tongue was a determinant predictor of Yin deficiency,Phlegm,and Heat patterns(β=-0.212,-0.172,and-0.163).Luminance(L*)was predictive of Yin deficiency(β=-0.172)and Cold(β=0.173)pattern.CONCLUSION:Our results suggest that color analysis of the tongue using the L*a*b*system is reliable and valid,and that color parameters partially serve as symptom pattern predictors in EAM practice.

Traditio,nal East Asian Medicine:How to Understand and Approach Diagnostic Findings and Patterns in A Modern Scientific Framework?

Research into the diagnostic methods and patterns of traditional East Asian medical （TEAM） systems of practice such as acupuncture and herbal medicine face certain challenges due to the nature of thinking in TEAM and the subjective basis of judgments made in practice. The TEAM-based diagnosis can take into account various findings and signs such as the appearance of the tongue, palpable qualities of the radial pulses, palpable qualities and findings on the abdomen, the complexion of the patient and so on. Both diagnostic findings and the patterns of diagnosis cannot be assumed to have objective bases or to be causally related to the complaints of the patient. However, the diagnoses of TEAM based acupuncture and herbal medicine have tended to look at pictures of the whole patient and rather than focus on a particular symptom, they have looked across a myriad of signs and symptoms to decide or identify the ＇pattern＇ of diagnosis according to the theory in question. Although open for selective and subjective biases each diagnosis pattern always comes with a prescribed treatment tailored to the pattern. Further, the same research requirements needed for the validation of the diagnoses are needed also for these clinical observations and judgments. Hence, it is necessary, albeit challenging for research on TEAM diagnoses to first address these issues before proceeding to more complex investigations such as the development of instruments for making diagnostic observations, instruments for forming diagnostic conclusions or studies investigating the physiological bases of the diagnostic patterns. Preliminary work has started and instruments have been made, but we suggest that any instrumentation must necessarily be first validated by matching of the calibrated or scaled observations or judgments to observations made and agreed upon by relevant experts. Reliability of all observations and judgments are needed before any other tool, technology or more advanced approach can proceed and also whenever the natural system of diagnosis-treatment is applied in clinical trials. In this paper the authors highlight the core problems and describe a step wise process for addressing them.

Cardiff acne disability index： cross-cultural translation in Korean and its relationship with clinical acne severity, pathological patterns, and general quality of life

OBJECTIVE: To culturally translate the cardiff acne disability index(CADI) into Korean, and to examine its relationship with clinical acne severity,pathological patterns, and general quality of life(Qo L).METHODS: The CADI was culturally and lin-guistically translated into Korean via translation,back-translation, and face validity test process. Two hundred and fifty-four Korean adolescents were asked to complete the Korean version of the CADI(K-CADI), the Phlegm Pattern, the Cold-Heat Pattern, and the Korean version of the General Health Questionnaires. A clinician estimated acne severity for the adolescents, using the Korean Acne Grading System. Finally, reliability and validity of the K-CADI was examined, and the relationships between acne severity, Phlegm, Cold, and Heat patterns, and Qo L level were examined via pathway analysis.RESULTS: The K-CADI had satisfactory internal consistency(α = 0.827). The examination of construct validity indicated that the K-CADI had one factor(explaining 59.6% of the total variance). Pathway analysis showed satisfactory model fit(normal fit index = 0.960 and comparative fit index = 0.983),and acne-related Qo L was determinant to Phlegm,Heat, and Cold patterns(0.13-0.27 of β), and Phlegm and Heat patterns lowered one's Qo L level(0.17-0.34 of β).CONCLUSION: The K-CADI is a valid and reliable instrument. Phlegm and Heat patterns should be managed when treating acne since they have a moderating effect on general Qo L aggravation.

A survey on the real-world clinical utilization of a traditional acupuncture in Republic of Korea:Sa-am acupuncture

Objective This study investigated the clinical details and usage of Sa-am acupuncture in Korean medicine clinics and explored how practicing Korean medicine doctors(KMDs)think about Sa-am acupuncture.Methods We conducted a questionnaire-based survey of KMDs who utilize Sa-am acupuncture in their practice.The study comprehensively investigated issues related to clinical application of Sa-am acupuncture,needling techniques used during treatment,training methods,and directions for its future improvement.Results We analyzed 572 responses.An average of 50%of the patients visiting Korean medicine clinics were receiving Sa-am acupuncture.The most prevalent indication for Sa-am acupuncture use was digestive disorders.The patients’appetite level and digestive function were most frequently used indicators for selecting acupuncture points.Regarding prescription compositions,Jung-Gyuk formulas were more frequently used than Seung-Gyuk formulas.Inserting the needle along the flow of the channel or against the flow of the channel was most popular.The acupuncture style most frequently used in combination with Sa-am acupuncture was Ashi point acupuncture.Strengths of Sa-am acupuncture included its versatility,easy application,and good outcomes.Limitations included the lack of rigorous education and training programs,difficulty in applying the principles for beginners,and insufficient clinical research evidence.Conclusion In clinics where Sa-am acupuncture is available,KMDs were providing Sa-am acupuncture to about half of their patients.Practitioners were not using all of the tonification and sedation techniques which may be due to time constraints or simply a lack of necessity.Sa-am acupuncture demonstrated high utility in clinical practice and high satisfaction based on the efficacy and safety.More training programs and high-quality research are needed to help expand the use of Sa-am acupuncture.

A systematic review of herbal medicines for the treatment of cancer cachexia in animal models

Objective: The aim of this study is to summarize preclinical studies on herbal medicines used to treat cancer cachexia and its underlying mechanisms. Methods: We searched four representing databases, including Pub Med, EMBASE, the Allied and Complementary Medicine Database, and the Web of Science up to December 2016. Randomized animal studies were included if the effects of any herbal medicine were tested on cancer cachexia. The methodological quality was evaluated by the Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies(CAMARADE) checklist. Results: A total of fourteen herbal medicines and their compounds were identified, including Coptidis Rhizoma, berberine, Bing De Ling, curcumin, Qing-Shu-Yi-Qi-Tang, Scutellaria baicalensis, Hochuekkito, Rikkunshito, hesperidin, atractylodin, Sipjeondaebo-tang, Sosiho-tang, Anemarrhena Rhizoma, and Phellodendri Cortex. All the herbal medicines, except curcumin, have been shown to ameliorate the symptoms of cancer cachexia through anti-inflammation, regulation of the neuroendocrine pathway, and modulation of the ubiquitin proteasome system or protein synthesis. Conclusions: This study showed that herbal medicines might be a useful approach for treating cancer cachexia. However, more detailed experimental studies on the molecular mechanisms and active compounds are needed.