Improving color and shape repeatability of tongue images for diagnosis by using feedback gridlines

Challenges and Solutions in Automated Tongue Diagnosis Techniques: A Review

Tongue diagnosis is used in various traditional medicine cultures as a non-invasive method for assessing an individual's health. Tongue image analysis has the potential for assessing the metabolism and functionality of the internal organs, making it a quick method of diagnosis. As automated systems give quantitative and objective results thereby effective in facilitating diagnosis, a review was conducted to evaluate literature on current methods of tongue diagnosis. Different methods of tongue diagnosis in the literature were identified and compared. Information on automated tongue diagnosis system, such as image acquisition, color correction, segmentation, feature extraction and classification, particularly in traditional medicine were reviewed. The aim of the review was to identify effective image processing techniques to be compatible with automated system for tongue diagnosis using some easily available to all imaging device rather than a dedicated state of art acquisition systems, which may not be easily accessible to general public. All methods identified were either being researched or developed and no specific system was identified that is currently available for routine use in clinics or home monitoring for patients. The healthcare sector could benefit from access to validated and automated tongue diagnosis systems. The feasibility of a mobile enabled platform to intelligently make use of this traditional method of diagnosis should be explored. In order to provide cheap and quick preliminary diagnosis for clinical practice automation of this noninvasive traditional technique can prove to be a boon for health care sector.

Association between tongue coating thickness and ultraviolet fluorescence in patients with functional dyspepsia: A prospective observational study

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.

Association of Cold-Heat Patterns with Tongue Features, Body Composition, Anthropometric Indices, and Blood Parameters in Tae-Eum Type

Introduction

The purpose of this study was to elucidate the relationship between cold-heat patterns and body composition, anthropometric indices, blood parameters, and tongue features in Tae-Eum type subjects. We also sought to determine whether significant indicators could be used as risk factors for predicting cold-heat patterns in a clinic.

Methods

This prospective, case-control pilot study was conducted at a single center. The subjects were males and females aged 19 years or older who had been analyzed as the Tae-Eum type. After screening, subject allocation was performed. The body composition, 11 anthropometric indices, blood parameters, and tongue features of the subjects were measured by well-trained practitioners. An independent t-test was conducted to compare the cold- and heat-pattern groups. Binary logistic regression was performed to determine significant differences between the two groups after adjusting for age, sex, and systolic blood pressure, with a focus on identifying significant indicators.

Results

Eighty-nine participants were recruited, 39 of whom were excluded from the analysis. Ultimately, 20 cold-pattern and 30 heat-pattern subjects were included in the final analysis. We found that alanine aminotransferase and all anthropometric indices, except for neck and forehead circumference, were significant predictive factors in both groups according to the binary regression analysis. Additionally, the tongue body color in the cold-pattern group was significantly paler than that in the heat-pattern group.

Conclusions

This study found that cold and heat patterns were significantly associated with body composition, anthropometric indices, blood parameters, and tongue features. We suggest that these factors could thus be used as objective indicators and predictors of cold-heat patterns. Our findings provide fundamental but also applicable data that will be useful for diagnosing and monitoring cold-heat patterns in Tae-Eum type patients.

Reliability, Accuracy, and Use Frequency of Evaluation Methods for Amount of Tongue Coating

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.

Advances in automated tongue diagnosis techniques

Tongue diagnosis can be an effective, noninvasive method to perform an auxiliary diagnosis any time anywhere, which can support the global need in the primary healthcare system. This work reviews the recent advances in tongue diagnosis, which is a significant constituent of traditional oriental medicinal technology, and explores the literature to evaluate the works done on the various aspects of computerized tongue diagnosis, namely preprocessing, tongue detection, segmentation, feature extraction, tongue analysis, especially in traditional Chinese medicine (TCM). In spite of huge volume of work done on automatic tongue diagnosis (ATD), there is a lack of adequate survey, especially to combine it with the current diagnosis trends. This paper studies the merits, capabilities, and associated research gaps in current works on ATD systems. After exploring the algorithms used in tongue diagnosis, the current trend and global requirements in health domain motivates us to propose a conceptual framework for the automated tongue diagnostic system on mobile enabled platform. This framework will be able to connect tongue diagnosis with the future point-of-care health system.

Objective research on tongue manifestation of patients with eczema

BACKGROUND

Tongue observation often depends on subjective judgment, it is necessary to establish an objective and quantifiable standard for tongue observation.

OBJECTIVE

To discuss the features of tongue manifestation of patients who suffered from eczema with different types and to reveal the clinical significance of the tongue images.

METHODS

Two hundred patients with eczema were recruited and divided into three groups according to the diagnostic criteria. Acute group had 47 patients, subacute group had 82 patients, and chronic group had 71 patients. The computerized tongue image digital analysis device was used to detect tongue parameters. The L*a*b* color model was applied to classify tongue parameters quantitatively.

RESULTS

For parameters such as tongue color, tongue shape, color of tongue coating, and thickness or thinness of tongue coating, there was a significant difference among acute group, subacute group and chronic group (P< 0.05). For Lab values of both tongue and tongue coating, there was statistical significance among the above types of eczema (P< 0.05).

CONCLUSIONS

Tongue images can reflect some features of eczema, and different types of eczema may be related to the changes of tongue images. The computerized tongue image digital analysis device can reflect the tongue characteristics of patients with eczema objectively.