Application of Thermal Science to Tongue Inspection in Traditional Chinese Medicine

The study on Traditional Chinese Medicine (TCM)by the technology and method of thermal science is a new cut in point in interdisciplinary science, and its purpose is to study the tongue inspection in TCM from the view of the bio heat transfer theory. In this paper human tongues were studied with the infrared thermal imaging technology. And the characteristic relationship between temperature distribution and age, tongue color as well as infrared thermal tongue image concerning the characteristic of viscera was analyzed by the experimental data,which confirms that the change in temperature distribution in different positions of the tongue is related to the diseases of different internal organs of the body. From a series of invasive experiments in animals, the blood perfusion rate was measured with the equipment of CBI 8000 Doppler Blood Flow Meter and MP 100 Physiologic Research System for the first time and the characteristic relationship curve between the temperature on the surface of the tongue and the blood perfusion rate was obtained. From the experiments the temperature on the surface of the tongue reflects objectively the tongue color which is influenced by the blood perfusion rate. This will help to develop some new cognition in the theory of TCM.

Application of Computer-Aided Tongue Inspection for Preliminary Screening of Esophageal Cancer

Objective： To differentiate patients with esophageal cancer or premalignant lesions from the high-risk population for preliminary screening of esophageal cancer using a feature index determined by a computer-aided tongue information acquisition and processing system （DS01-B）. Methods： Totally, 213 patients diagnosed with esophageal cancer or premalignant lesions and 2,840 normal subjects were collected including primarily screened and reexamined, all of them were confirmed with histological examinations. Their tongue color space values and manifestation features were extracted by DS01-B and analyzed. Firstly, the analysis of variance was performed to differentiate normal subjects from patients with esophageal cancer and premalignant lesions. Secondly, the logistic regression was conducted using 10 features and gender, age to get a predictive equation of the possibility of esophageal cancer or premalignant lesions. Lastly, the equation was tested by subjects undergoing primary screening. Results： Saturation （S） values in the HSV color space showed significant differences between patients with esophageal cancer and normal subjects or those with mild atypical hyperplasia （P〈0.05）; blue-to-yellow （b） values in the Lab color space showed significant differences between patients with esophageal cancer or premalignant lesions and normal subjects （P〈0.05）. Logistic regression analysis showed that the computer-aided tongue inspection approach had an accuracy of 72.3% （2008/2776） in identifying patients with esophageal cancer or premalignant lesions for preliminary screening in high-risk population. Conclusion： Computer-aided tongue inspection, with descriptive and quantitative profile as described in this study, could be applied as a cost- and time- efficient, non-invasive approach for preliminary screening of esophageal cancer in high-risk population.

Objective Tongue Inspection on 142 Liver Cancer Patients with Damp-Heat Syndrome

Objective： To establish the diagnosis evidence of objective tongue inspection for liver cancer （LC） patients with damp-heat syndrome （DHS） by dynamically observing their tongue figures using modern tongue image analytic apparatus, and to explore the effect of intervention on the tongue figures. Methods： Tongue figures were collected from 142 LC patients with DHS by tongue image analytic apparatus. Red （R）, green （G） and blue （B） values were analyzed. The r and g values were calculated requesting r=R/（R＋G＋B）, g=G/（R＋G＋B）, and b=l-r-g, and scored in combination with Chinese medical symptoms scale. The tongue figure and correlated scores were collected from 59 of them 3 days after transcatheter arterial chemoembolization intervention. Results： The range of objective tongue inspection of LC patients with DHS was as follows： as for tongue fur, 0.360〈r〈0.402 and 0.280〈g〈0.322; as for tongue proper, 0.404〈r〈0.470 and 0.243〈g〈0.301. The tongue figures and the average scores of quality of life, DHS, poor appetite, aggravated pain, decreased sleep quality and aggravated fever were obviously changed in the 59 LC patients with DHS after intervention, showing statistical difference when compared with before intervention （P〈0.05 or P〈0.01）. Conclusion： The range of objective tongue inspection of LC patients with DHS could be known by collecting and analyzing objective indicator of tongue figures, thus laying foundation for further studies with analysis of correlation between intervention and Chinese medicine based on tongue figures.

Purple-bluish tongue is associated with platelet counts, and the recurrence of epithelial ovarian cancer

OBJECTIVE： To evaluate the relationship between purple-bluish tongue and platelet counts, and further to examine their associations with the recurrence of epithelial ovarian cancer.METHODS： A total of 82 epithelial ovarian cancer patients were enrolled in this study. Cluster analysis was used for grouping patients＇ P_（RGB）（Red-R;Green-G; Blue-B; Average percentage of RGB, P_（RGB））values. Receiver operating characteristic（ROC）curve was performed for detecting the diagnostic standard of purple-bluish tongue. χ~2 test was used to assess the relationship between purple-bluishtongue and platelet counts, and the recurrence of epithelial ovarian cancer. The perioperative（preoperative） platelet level was examinedwith tongue image and disease recurrence.RESULTS： Tongue images were classified into two groups basing on P_（RGB） values of images by cluster analysis. The numbers of cases in cluster ＂1＂（normal color tongue） was 16 and cluster ＂2＂（purple-bluish tongue） was 66. Two groups of P_（RGB） values, classified by cluster analysis, were significantly correlated with vision-based tongue color recognition（Kappa = 0.852, P 0.001）. ROC curve showed that the ratio of P_B to PRhad the highest diagnostic value. The sensitivity and the specificity of the ratio of P_B to P_R were 95.3% and 88.9% respectively and the optimal cut-off point was 0.71. Purple-bluish tongue was significantly correlated with increased platelet counts（P 0.001）. Both the increased platelet counts（P = 0.01） and purple-bluish tongue were associated with recurrence of epithelial ovarian cancer（P 0.001）.CONCLUSION： The ratio of P_B to P_R greater than 0.71 could serve as an indicator for purple-bluish tongue diagnosing used in symptom pattern identification in Traditional Chinese Medicine. Purple-bluish tongue, associated with increased platelet counts, was also closely correlated with the recurrence of epithelial ovarian cancer.

Tongue diagnosis: relationship between sublingual tongue morphology in three tongue protrusion angles and menstrual clinical symptoms

OBJECTIVE：The morphological and color characteristics of the tongue sublingual veins（SLVs）can manifest differently within the subjects,depending on the way their tongue is curled upward.This study was conducted in order to investigate the clinical relevancy of tongue SLV diagnosis in relation to menstrual clinical symptoms（pain,clots,heavy,and scanty）,using three different inspection procedures（IP1,IP2,and IP3）.METHODS：Three-hundred and seventy-seven female patients were asked to stick out their tongues in three specifi c ways which were intended to create different tongue protrusion angles.The SLV parameters for thickness（TK）,length（LE）,color（CL）,shape（SP）,and nodules（ND）were then evaluated.RESULTS：According to the results of the Waldχ2test,IP1 provides the best model for pain（R2=0.155）,IP3 for clots（R2=0.437）,IP2 for heavy（R2=0.268）,and scanty（R2=0.192）.Abnormal SLV diagnostic parameters were most strongly associated with the clinical symptom of clots（R2=0.492）.CONCLUSION：While the study showed the relations between tongue SLV features and menstrual clinical symptoms,as well it showed that IP2 was the best overall predictor for the symptomatic indexes used in this study,and using one particular SLV inspection procedure may not be suffi cient.The application of a particular inspection method alone may cause under-or over-estimation of SLV abnormalities.

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.

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

OBJECTIVE: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.METHODS: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.RESULTS: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(P<0.05).Thirdly,the average value of gray-level cooccurrence 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.CONCLUSIONS: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.