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Wang RR, Chen JL, Duan SJ, Lu YX, Chen P, Zhou YC, Yao SK. Noninvasive Diagnostic Technique for Nonalcoholic Fatty Liver Disease Based on Features of Tongue Images. Chin J Integr Med 2024; 30:203-212. [PMID: 38051474 DOI: 10.1007/s11655-023-3616-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To investigate a new noninvasive diagnostic model for nonalcoholic fatty liver disease (NAFLD) based on features of tongue images. METHODS Healthy controls and volunteers confirmed to have NAFLD by liver ultrasound were recruited from China-Japan Friendship Hospital between September 2018 and May 2019, then the anthropometric indexes and sampled tongue images were measured. The tongue images were labeled by features, based on a brief protocol, without knowing any other clinical data, after a series of corrections and data cleaning. The algorithm was trained on images using labels and several anthropometric indexes for inputs, utilizing machine learning technology. Finally, a logistic regression algorithm and a decision tree model were constructed as 2 diagnostic models for NAFLD. RESULTS A total of 720 subjects were enrolled in this study, including 432 patients with NAFLD and 288 healthy volunteers. Of them, 482 were randomly allocated into the training set and 238 into the validation set. The diagnostic model based on logistic regression exhibited excellent performance: in validation set, it achieved an accuracy of 86.98%, sensitivity of 91.43%, and specificity of 80.61%; with an area under the curve (AUC) of 0.93 [95% confidence interval (CI) 0.68-0.98]. The decision tree model achieved an accuracy of 81.09%, sensitivity of 91.43%, and specificity of 66.33%; with an AUC of 0.89 (95% CI 0.66-0.92) in validation set. CONCLUSIONS The features of tongue images were associated with NAFLD. Both the 2 diagnostic models, which would be convenient, noninvasive, lightweight, rapid, and inexpensive technical references for early screening, can accurately distinguish NAFLD and are worth further study.
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Affiliation(s)
- Rong-Rui Wang
- Graduate School of Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jia-Liang Chen
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Shao-Jie Duan
- Graduate School of Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Ying-Xi Lu
- Nanjing Linkwah Micro-electronics Institute, Beijing, 100191, China
- Institute of Microelectronics, Tsinghua University, Beijing, 100084, China
| | - Ping Chen
- Institute of Microelectronics, Tsinghua University, Beijing, 100084, China
| | - Yuan-Chen Zhou
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100029, China
| | - Shu-Kun Yao
- Graduate School of Beijing University of Chinese Medicine, Beijing, 100029, China.
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, 100029, China.
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Gao Q, Zhu M, Wang J, Wang S, Zhou J, Zhang J. Literature review and prospect on oral cognition and disease diagnosis and treatment between Han and Tang dynasties. Hua Xi Kou Qiang Yi Xue Za Zhi 2023; 41:604-612. [PMID: 37805686 PMCID: PMC10580222 DOI: 10.7518/hxkq.2023.2023183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/25/2023] [Indexed: 10/09/2023]
Abstract
Chinese medicine entered a significant period from foundation to maturity between Han and Tang dynasties when the Chinese traditional stomatology was a key stage. Sorting and analysis of existing literature and research outcomes have showed that current research on stomatology between Han and Tang dynasties focuses on oral physiology, pathology, diagnosis and treatment, and health care. It also involves stomatology history and explanation of termino-logies related to mouth and teeth recorded in medical books, use of simple methods, and thinking with citation and analysis of literature simply listed and reasoning preliminarily deducted. From the macro perspective, current research has not unveiled the whole picture of stomatology between the two dynasties and left a series of key issues unresolved. Thus, new methods should be developed and employed to carry out medical research on stomatology between Han and Tang dynasties given that is has a prosperous future.
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Affiliation(s)
- Qin Gao
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Mengdi Zhu
- Dept. of General Dentistry and Emergency Dental Care, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Jiabo Wang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Songling Wang
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing 100069, China
| | - Jian Zhou
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing 100069, China
- Dept. of VIP Dental Service, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Jingqiu Zhang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
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3
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Shenyi J, Yahua L, Xu H, Mengjie C, Jiatuo XU, Hao LU, Qingguang C. Dark red tongue color formation caused by hyperglycemia is attributed to decreased blood flow of tongue tissue partially due to nuclear factor-kappa B pathway activation. J TRADIT CHIN MED 2023; 43:1118-1125. [PMID: 37946474 PMCID: PMC10623255 DOI: 10.19852/j.cnki.jtcm.20231018.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/16/2022] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To investigate the potential mechanisms underlying the dark red tongue color formation induced by hyperglycemia. METHODS A high-fat diet and intraperitoneal injection of streptozotocin were used to establish a diabetes model. The color and blood flow of tongues were analyzed by the Tongue Diagnosis Analysis System and laser Doppler flowmetry, respectively. Inflammatory factors and adhesion factors were measured in the circulation and tongue tissue by an enzyme-linked immunosorbent assay. Western blotting was employed to evaluate nuclear factor-kappa B (NF-κB) p50 and inhibitor of kappa B kinase protein expression levels in the tongue. Then, the NF-κB inhibitor, pyrrolidine dithiocarbamic acid ammonium salt was utilized to repress NF-κB pathway activation to validate that the NF-κB pathway plays a key role in blood flow and dark red tongue color formation. RESULTS The diabetic rats displayed a dark red tongue color that was accompanied by NF-κB pathway activation and decreased blood flow in the tongue. These effects could be reversed by the NF-κB inhibitor. CONCLUSIONS Our investigation demonstrated that hyperglycemia led to dark red tongue color formation by decreasing blood flow in the tongue, which was partly due to NF-κB pathway activation.
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Affiliation(s)
- Jin Shenyi
- Department of Endocrinology, Diabetes Institute, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Liu Yahua
- Department of Endocrinology, Diabetes Institute, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Han Xu
- Department of Endocrinology, Diabetes Institute, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Cai Mengjie
- Department of Endocrinology, Diabetes Institute, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - X U Jiatuo
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - L U Hao
- Department of Endocrinology, Diabetes Institute, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Chen Qingguang
- Department of Endocrinology, Diabetes Institute, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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Wang W, Zeng W, He S, Shi Y, Chen X, Tu L, Yang B, Xu J, Yin X. A new model for predicting the occurrence of polycystic ovary syndrome: Based on data of tongue and pulse. Digit Health 2023; 9:20552076231160323. [PMID: 37346080 PMCID: PMC10281487 DOI: 10.1177/20552076231160323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/12/2023] [Indexed: 09/20/2023] Open
Abstract
Background and objective Polycystic ovary syndrome is one of the most common types of endocrine and metabolic diseases in women of reproductive age that needs to be screened early and assessed non-invasively. The objective of the current study was to develop prediction models for polycystic ovary syndrome based on data of tongue and pulse using machine learning techniques. Methods A dataset of 285 polycystic ovary syndrome patients and 201 healthy women were investigated to identify the significant tongue and pulse parameters for predicting polycystic ovary syndrome. In this study, feature selection was performed using least absolute shrinkage and selection operator regression. Several machine learning algorithms (multilayer perceptron classifier, eXtreme gradient boosting classifier, and support vector machine) were used to construct the classification models to predict the presence of polycystic ovary syndrome. Results TB-L, TB-a, TB-b, TC-L, TC-a, h3, and h4/h1 in tongue and pulse parameters were statistically associated with polycystic ovary syndrome presence. Among the several machine learning techniques, the support vector machine model was optimal for the comprehensive evaluation of this dataset and deduced the area under the receiver operating characteristic curve, DeLong test, calibration curve, and decision curve analysis. Conclusion The machine learning model with tongue and pulse factors can predict the existence of polycystic ovary syndrome precisely.
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Affiliation(s)
- Weiying Wang
- Department of Gynecology and
Obstetrics, Shuguang Hospital Affiliated to Shanghai University of Chinese Medicine,
Shanghai, P.R. China
| | - Weiwei Zeng
- Department of Gynecology and
Obstetrics, Shuguang Hospital Affiliated to Shanghai University of Chinese Medicine,
Shanghai, P.R. China
| | - Shunli He
- Department of Gynecology and
Obstetrics, Shuguang Hospital Affiliated to Shanghai University of Chinese Medicine,
Shanghai, P.R. China
| | - Yulin Shi
- Basic Medical College, Shanghai
University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Xinmin Chen
- Department of Gynecology and
Obstetrics, Shuguang Hospital Affiliated to Shanghai University of Chinese Medicine,
Shanghai, P.R. China
| | - Liping Tu
- Basic Medical College, Shanghai
University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Bingyi Yang
- Department of Gynecology and
Obstetrics, Shuguang Hospital Affiliated to Shanghai University of Chinese Medicine,
Shanghai, P.R. China
| | - Jiatuo Xu
- Basic Medical College, Shanghai
University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Xiuqi Yin
- Department of Gynecology and
Obstetrics, Shuguang Hospital Affiliated to Shanghai University of Chinese Medicine,
Shanghai, P.R. China
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Morita A, Murakami A, Noguchi K, Watanabe Y, Nakaguchi T, Ochi S, Okudaira K, Hirasaki Y, Namiki T. Combination Image Analysis of Tongue Color and Sublingual Vein Improves the Diagnostic Accuracy of Oketsu (Blood Stasis) in Kampo Medicine. Front Med (Lausanne) 2022; 8:790542. [PMID: 35308037 PMCID: PMC8928869 DOI: 10.3389/fmed.2021.790542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Aim In tongue diagnosis, a dark purple tongue and enlarged sublingual vein are important findings of Oketsu (blood stasis). However, the association between the tongue color and the sublingual vein has not been reported. This study investigated the association between the tongue color values and the sublingual vein width using tongue image analyzing system (TIAS) for the objective assessment of blood stasis. Methods A total of 38 patients (age 68.7 ± 11.3 years, 14 men and 24 women) who visited the Department of Kampo Medicine at Chiba University Hospital were included. Physical findings, blood test results, blood stasis score from medical records, and tongue images obtained with TIAS were analyzed. The patients were classified into two groups: patients with a sublingual vein width of ≤2.5 mm (20 patients) and those with a width of >2.5 mm (18 patients). The physical findings and the blood test results of the two groups were analyzed by Wilcoxon's rank-sum test or χ2-test, whereas logistic regression analysis was used to determine the association between the tongue color values and sublingual vein width. Receiver operating characteristic (ROC) analysis was used to differentiate blood stasis. Results The color values significantly related to the sublingual vein width (mm) were the P1-L* and P4-L* (darkness of the tongue edge and tongue apex) and the P1-b* and P2-b* (blueness of the tongue edge and tongue posterior). The area under the curve was greater for the combination of the tongue color values and the sublingual vein width than that for either of them. Conclusion This study demonstrated an objective evaluation of blood stasis in the tongue of patients with dark-blue discoloration and an enlarged sublingual vein. In addition, the combination of the tongue color and the sublingual vein is expected to facilitate a more reliable diagnosis of blood stasis.
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Affiliation(s)
- Akira Morita
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Aya Murakami
- Faculty of Pharmacy, Center for Pharmaceutical Education, Yokohama University of Pharmacy, Yokohama, Japan
| | - Keigo Noguchi
- Department of Medical Engineering, Graduate School of Science and Engineering, Chiba University, Chiba, Japan
| | - Yuki Watanabe
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshiya Nakaguchi
- Department of Research and Development, Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| | - Sadayuki Ochi
- Faculty of Pharmacy, Center for Pharmaceutical Education, Yokohama University of Pharmacy, Yokohama, Japan
| | - Kazuho Okudaira
- Faculty of Pharmacy, Center for Pharmaceutical Education, Yokohama University of Pharmacy, Yokohama, Japan
| | - Yoshiro Hirasaki
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takao Namiki
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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Shi Y, Yao X, Xu J, Hu X, Tu L, Lan F, Cui J, Cui L, Huang J, Li J, Bi Z, Li J. A New Approach of Fatigue Classification Based on Data of Tongue and Pulse With Machine Learning. Front Physiol 2022; 12:708742. [PMID: 35197858 PMCID: PMC8859319 DOI: 10.3389/fphys.2021.708742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fatigue is a common and subjective symptom, which is associated with many diseases and suboptimal health status. A reliable and evidence-based approach is lacking to distinguish disease fatigue and non-disease fatigue. This study aimed to establish a method for early differential diagnosis of fatigue, which can be used to distinguish disease fatigue from non-disease fatigue, and to investigate the feasibility of characterizing fatigue states in a view of tongue and pulse data analysis. METHODS Tongue and Face Diagnosis Analysis-1 (TFDA-1) instrument and Pulse Diagnosis Analysis-1 (PDA-1) instrument were used to collect tongue and pulse data. Four machine learning models were used to perform classification experiments of disease fatigue vs. non-disease fatigue. RESULTS The results showed that all the four classifiers over "Tongue & Pulse" joint data showed better performances than those only over tongue data or only over pulse data. The model accuracy rates based on logistic regression, support vector machine, random forest, and neural network were (85.51 ± 1.87)%, (83.78 ± 4.39)%, (83.27 ± 3.48)% and (85.82 ± 3.01)%, and with Area Under Curve estimates of 0.9160 ± 0.0136, 0.9106 ± 0.0365, 0.8959 ± 0.0254 and 0.9239 ± 0.0174, respectively. CONCLUSION This study proposed and validated an innovative, non-invasive differential diagnosis approach. Results suggest that it is feasible to characterize disease fatigue and non-disease fatigue by using objective tongue data and pulse data.
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Affiliation(s)
- Yulin Shi
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Pudong, China
| | - Xinghua Yao
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Pudong, China
| | - Jiatuo Xu
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Pudong, China
| | - Xiaojuan Hu
- Shanghai Innovation Center of TCM Health Service, Shanghai University of Traditional Chinese Medicine, Pudong, China
| | - Liping Tu
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Pudong, China
| | - Fang Lan
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Pudong, China
| | - Ji Cui
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Pudong, China
| | - Longtao Cui
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Pudong, China
| | - Jingbin Huang
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Pudong, China
| | - Jun Li
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Pudong, China
| | - Zijuan Bi
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Pudong, China
| | - Jiacai Li
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, Pudong, China
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7
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Segawa M, Iizuka N, Ogihara H, Tanaka K, Nakae H, Usuku K, Hamamoto Y. Construction of a Standardized Tongue Image Database for Diagnostic Education: Development of a Tongue Diagnosis e-Learning System. Front Med Technol 2022; 3:760542. [PMID: 35047962 PMCID: PMC8757883 DOI: 10.3389/fmedt.2021.760542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/26/2021] [Indexed: 11/13/2022] Open
Abstract
Tongue examination is an important diagnostic method for judging pathological conditions in Kampo (traditional Japanese medicine), but it is not easy for beginners to learn the diagnostic technique. One reason is that there are few objective diagnostic criteria for tongue examination findings, and the educational method for tongue examination is not standardized in Japan, warranting the need for a tongue image database for e-learning systems that could dramatically improve the efficiency of education. Therefore, we constructed a database comprising tongue images whose findings were determined on the basis of votes given by five Kampo medicine specialists (KMSs) and confirmed the educational usefulness of the database for tongue diagnosis e-learning systems. The study was conducted in the following five steps: development of a tongue imaging collection system, collection of tongue images, evaluation and annotation of tongue images, development of a tongue diagnosis e-learning system, and verification of the educational usefulness of this system. Five KMSs evaluated the tongue images obtained from 125 participants in the following eight aspects: (i) tongue body size, (ii) tongue body color, (iii) tongue body dryness and wetness, (iv) tooth marks on the edge of the tongue, (v) cracks on the surface of the tongue, (vi) thickness of tongue coating, (vii) color of tongue coating, and (viii) dryness and wetness of tongue coating. Medical students (MSs) were given a tongue diagnosis test using an e-learning system after a lecture on tongue diagnosis. The cumulative and individual match rates (%) (individual match rates of 100% (5/5), 80% (4/5), and 60% (3/5) are shown in parentheses, respectively) were as follows: (i) tongue body size: 92.8 (26.4/26.4/40.0); (ii) tongue body color: 83.2 (10.4/20.8/52.0); (iii) tongue body dryness and wetness: 88.8 (13.6/34.4/40.8); (iv) tooth marks on the edge of the tongue: 88.8 (6.4/35.2/47.2); (v) cracks on the surface of the tongue: 96.8 (24.0/35.2/37.6); (vi) thickness of tongue coating: 84.8 (7.2/21.6/56.0); (vii) color of tongue coating: 88.0 (15.2/37.6/35.2); and (viii) dryness and wetness of tongue coating: 74.4 (4.8/19.2/50.4). The test showed that the tongue diagnosis ability of MSs who attended a lecture on tongue diagnosis was almost the same as that of KMSs. We successfully constructed a tongue image database standardized for training specialists on tongue diagnosis and confirmed the educational usefulness of the e-learning system using a database. This database will contribute to the standardization and popularization of Kampo education.
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Affiliation(s)
- Makoto Segawa
- Department of Kampo Medicine, Yamaguchi University Hospital, Ube, Japan
| | - Norio Iizuka
- Department of Kampo Medicine, Yamaguchi University Hospital, Ube, Japan.,Yamaguchi Health Examination Center, Yamaguchi, Japan
| | - Hiroyuki Ogihara
- Division of Electrical, Electronic and Information Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Ube, Japan
| | - Koichiro Tanaka
- Department of Traditional Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Hajime Nakae
- Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Koichiro Usuku
- Department of Medical Information Science and Administrative Planning, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshihiko Hamamoto
- Division of Electrical, Electronic and Information Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Ube, Japan
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Xie J, Jing C, Zhang Z, Xu J, Duan Y, Xu D. Digital tongue image analyses for health assessment. Med Rev (Berl) 2021; 1:172-198. [PMID: 37724302 PMCID: PMC10388765 DOI: 10.1515/mr-2021-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/13/2021] [Indexed: 09/20/2023]
Abstract
Traditional Chinese Medicine (TCM), as an effective alternative medicine, utilizes tongue diagnosis as a major method to assess the patient's health status by examining the tongue's color, shape, and texture. Tongue images can also give the pre-disease indications without any significant disease symptoms, which provides a basis for preventive medicine and lifestyle adjustment. However, traditional tongue diagnosis has limitations, as the process may be subjective and inconsistent. Hence, computer-aided tongue diagnoses have a great potential to provide more consistent and objective health assessments. This paper reviewed the current trends in TCM tongue diagnosis, including tongue image acquisition hardware, tongue segmentation, feature extraction, color correction, tongue classification, and tongue diagnosis system. We also present a case of TCM constitution classification based on tongue images.
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Affiliation(s)
- Jiacheng Xie
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
- Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO, USA
| | - Congcong Jing
- School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ziyang Zhang
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
- Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO, USA
| | - Jiatuo Xu
- School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ye Duan
- Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO, USA
| | - Dong Xu
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
- Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO, USA
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Kim MJ, Bose S, Shin NR, Park S, Kwon O, Song EJ, Nam YD, Koo BS, Nam DH, Lee JH, Kim H. The Herbal Formula CWBSD Improves Sleep Quality Dependent on Oral Microbial Type and Tongue Diagnostic Features in Insomnia. J Pers Med 2021; 11:325. [PMID: 33919176 DOI: 10.3390/jpm11050325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 12/25/2022] Open
Abstract
Cheonwangbosim-dan (CWBSD) is a traditional Korean herb formula that has been widely prescribed for insomnia patients with a heart-yin deficiency (HYD) pattern. Several studies have reported that heart function and insomnia are interrelated, and few have explored associations between insomnia, oral microbiota, and tongue diagnosis. This study aimed to evaluate the effects of CWBSD on primary insomnia, tongue diagnosis, and oral microbiota. At baseline, 56 patients with primary insomnia were assigned to two groups, a HYD group and a non-HYD (NHYD) group and they took CWBSD for 6 weeks. During the study, Pittsburgh Sleep Quality Indices (PSQIs) and Insomnia Severity Indices (ISIs) decreased significantly in both groups. However, the PSQI reduction observed in the HYD group was greater than in the NHYD group and sleep times increased only in the HYD group. As sleep quality improved, the amount of tongue coating increased at the posterior tongue, where heart function appears. At baseline, the HYD and NHYD group had a specific oral microbiota (Veillonella at genus level), but no significant change was observed after taking CWBSD. Additionally, subjects were divided into two oral microbiota types ("orotypes"). The genera Prevotella, Veillonella, or Neisseria were abundant in each orotype. The reduction in PSQI in orotype 1 during the 6-week treatment period was greater than in orotype 2. In conclusion, this study shows that CWBSD could be used to treat primary insomnia in patients with a HYD pattern as determined using tongue diagnosis and oral microbiota distributional patterns.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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11
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Tang YS, Guo JC, Xu L, Zhang XN, Shen XP, Hai YM, Mao YF, Hu YY, Zhao Y. Pathological Change of Chronic Hepatitis B Patients with Different Tongue Coatings by Circular Multi-Omics Integrated Analysis. Chin J Integr Med 2020. [PMID: 32915427 DOI: 10.1007/s11655-020-3275-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the circular pathological changes of chronic hepatitis B (CHB) patients according to the tongue diagnosis. METHODS Totally 41 CHB patients with typical white tongue coating (WTC) or yellow tongue coating (YTC) were enrolled and 14 healthy volunteers with normal tongue manifestation served as controls. The mRNA expression of peripheral leukocytes was detected by GeneChips, and 9 genes were randomly selected for expression validation. Circular metabolites were detected by gas chromatographymass spectrometry. Biological information was analyzed based on ingenuity pathways analysis or metabolomics database and the integrated networks were constructed by ClueGO. RESULTS A total of 945 and 716 differentially expressed genes were found in patients with WTC and YTC relative to healthy volunteers respectively. The biological information analysis indicated that CHB patients had obviously increased functions in cell death, apoptosis and necrosis (Z-score ⩾2, P<0.05) and decreased activation in T lymphocytes (Z-score ⩽-2, P<0.05), regardless of the tongue manifestation. Compared to patients with WTC, the YTC patients were predicted to be more active in functions related to virus replication (Z-score ⩾2, P<0.05), and the content of circular fatty acids, such as oleic acid (P=0.098) and lauric acid (P=0.035), and citric acid cycle-related metabolites were higher in the YTC patients (P<0.1). The integrated analysis based on differential genes and metabolites indicated that the most difference in the biological function network between the WTC and YTC patients was tumor necrosis factor receptor associated factor 6 mediated-nuclear factor kappa-B activation process. CONCLUSIONS CHB patients with YTC had more severe inflammation and fatty acids metabolism aberrant than patients with WTC. The results facilitate the modern pathological annotation of Chinese medicine tongue diagnosis theory and provide a reference for the interpretation of pharmacological mechanisms of Chinese medicine treatment.
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12
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Liang K, Huang X, Chen H, Qiu L, Zhuang Y, Zou C, Bai Y, Huang Y. Tongue diagnosis and treatment in traditional Chinese medicine for severe COVID-19: a case report. Ann Palliat Med 2020; 9:2400-2407. [PMID: 32692238 DOI: 10.21037/apm-20-1330] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Abstract
As one of the most urgent public health events, coronavirus disease 2019 (COVID-19) has attracted worldwide attention. This case highlighted the importance of close coordination between Chinese medicine and western medicine in the diagnosis and treatment, as well as the need for rapid dissemination of clinical information related to patient care with this emerging infection. We reported a COVID-19 case confirmed in China and described the identification, diagnosis, clinical course, and management of the case. The patient had initial mild symptoms at presentation; it progressed to severe pneumonia on the 10th day of onset. This cured case supplied a time series analysis of tongue characteristics found in severe COVID-19. Chinese medicine formulae were tweaked by tongue characteristics, which include tongue color, fur thickness, and fur color. Tongue images were obtained every two days, and the changes were firmly related to the progression of COVID-19. These tongue characteristics could be used as effective, non-intrusive indices for the distinct stages of COVID-19 stages. Our study was the first time tongue diagnosis was applied in time series analysis of the progression of COVID-19 disease. We found that tongue color, fur thickness, and fur color were closely related to the progression of COVID-19 by analyzing various tongue images obtained regularly. Based on this success, we will further apply tongue diagnosis to tongue characteristics of COVID-19 patients to help limit the risk of COVID-19.
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Affiliation(s)
- Keji Liang
- Department of Chinese Medicine, Maoming City people's Hospital, Maoming, China
| | - Xiaodan Huang
- Major in Nephrology, Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Hua Chen
- Department of Oncology, Maoming City People's Hospital, Maoming, China
| | - Liling Qiu
- Department of Endocrine, Zhongshan City People's Hospital (Zhongshan Hospital Affiliated to Sun Yat-sen University), Zhongshan, China
| | - Yanshan Zhuang
- Teaching and Research Office of Traditional Chinese Medicine, Maoming Academy of Health, Maoming, China
| | - Chuan Zou
- Major in Nephrology, Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yunpeng Bai
- Center of Scientific Research, Maoming People's Hospital, Maoming, China
| | - Yisheng Huang
- Department of Oncology, Maoming City People's Hospital, Maoming, China.
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13
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Wu TC, Lu CN, Hu WL, Wu KL, Chiang JY, Sheen JM, Hung YC. Tongue diagnosis indices for gastroesophageal reflux disease: A cross-sectional, case-controlled observational study. Medicine (Baltimore) 2020; 99:e20471. [PMID: 32702810 PMCID: PMC7373596 DOI: 10.1097/md.0000000000020471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Traditional Chinese medicine tongue diagnosis can mirror the status of the internal organ, but evidence is lacking regarding the accuracy of tongue diagnosis to gastroesophageal reflux disease (GERD). This study was to investigate the association between GERD and tongue manifestation, and whether tongue imaging could be initial diagnosis of GERD noninvasively.We conducted a cross-sectional, case-controlled observational study at Kaohsiung Chang Gung Memorial Hospital in Taiwan from January 2016 to September 2017. Participants aged over 20 years old with GERD were enrolled and control group without GERD were matched by sex. Tongue imaging were acquired with automatic tongue diagnosis system, then followed by endoscope examination. Nine tongue features were extracted, and a receiver operating characteristic (ROC) curve, analysis of variance, and logistic regression were used.Each group enrolled 67 participants. We found that the saliva amount (P = .009) and thickness of the tongue's fur (P = .036), especially that in the spleen-stomach area (%) (P = .029), were significantly greater in patients with GERD than in those without. The areas under the ROC curve of the amount of saliva and tongue fur in the spleen-stomach area (%) were 0.606 ± 0.049 and 0.615 ± 0.050, respectively. Additionally, as the value of the amount of saliva and tongue fur in the spleen-stomach area (%) increased, the risk of GERD rose by 3.621 and 1.019 times, respectively. The tongue fur in the spleen-stomach area (%) related to severity of GERD from grade 0 to greater than grade B were 51.67 ± 18.72, 58.10 ± 24.60, and 67.29 ± 24.84, respectively.The amount of saliva and tongue fur in the spleen-stomach area (%) might predict the risk and severity of GERD and might be noninvasive indicators of GERD. Further large-scale, multi-center, randomized investigations are needed to confirm the results.Trial registration: NCT03258216, registered August 23, 2017.
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Affiliation(s)
- Tzu-Chan Wu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Cheng-Nan Lu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
- Fooyin University College of Nursing, Kaohsiung
- Kaohsiung Medical University College of Medicine
| | - Keng-Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine
| | - John Y. Chiang
- Department of Computer Science and Engineering, National Sun Yat-sen University, Taiwan
| | - Jer-Ming Sheen
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Yu-Chiang Hung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
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14
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Ioannis S, Maria H, Hong M, Liang Y. Boym's "De Indiciis Morborum ex Linguae Coloribus et Affectionibus": The Earliest Chinese Tongue Diagnosis Manual Published in Europe, Identification of Original Chinese Text, Peculiarities of Printed Edition and Its Impact on European Medicine. Chin J Integr Med 2020; 27:379-383. [PMID: 31903533 DOI: 10.1007/s11655-019-3227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Indexed: 12/01/2022]
Abstract
Upon his untimely death, Michal Boym (1612-1659) left behind an enormous written legacy; covering a diverse range of interests in fields such as Chinese linguistics, cartography, botany, zoology, philosophy and medicine. This article attempts to examine Boym's De indiciis morborum ex linguae coloribus & affectionibus (The signs of disease on the tongue, colors and affections), a translation of a previously unidentified Chinese text. The text specifically deals with the subject of tongue diagnosis, in relation to contagious diseases that were still raging in the 17th century China. Arriving to China at the end of the Ming Dynasty (1368-1644), Boym was able to personally witness the early development of tongue examination as an independent specialty; he recognized its significance and tried to incorporate it into his ultimately unfinished Chinese medical corpus. Boym's work eventually facilitated the assimilation of tongue observation in European medicine during the 19th century.
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Affiliation(s)
- Solos Ioannis
- Foundation for PIHMA Research and Education, Phoenix, AZ, USA.,Phoenix Institute of Herbal Medicine and Acupuncture, Phoenix, AZ, USA
| | - Helioti Maria
- Phoenix Institute of Herbal Medicine and Acupuncture, Phoenix, AZ, USA
| | - Mei Hong
- Institute of Chinese Medical History and Literature, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Yuan Liang
- Institute of Basic Theory in Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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16
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Watanabe S, Toyama T, Sato T, Suzuki M, Morozumi A, Sakagami H, Hamada N. Kampo Therapies and the Use of Herbal Medicines in the Dentistry in Japan. Medicines (Basel) 2019; 6:medicines6010034. [PMID: 30823475 PMCID: PMC6473445 DOI: 10.3390/medicines6010034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 01/03/2023]
Abstract
Dental caries and periodontal disease are two major diseases in the dentistry. As the society is aging, their pathological meaning has been changing. An increasing number of patients are displaying symptoms of systemic disease and so we need to pay more attention to immunologic aggression in our medical treatment. For this reason, we focused on natural products. Kampo consists of natural herbs-roots and barks-and has more than 3000 years of history. It was originated in China as traditional medicine and introduced to Japan. Over the years, Kampo medicine in Japan has been formulated in a way to suit Japan's natural features and ethnic characteristics. Based on this traditional Japanese Kampo medicine, we have manufactured a Kampo gargle and Mastic Gel dentifrice. In order to practically utilize the effectiveness of mastic, we have developed a dentifrice (product name: IMPLA CARE) and treated implant periodontitis and severe periodontitis.
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Affiliation(s)
- Shuji Watanabe
- Division of Microbiology, Department of Oral Science, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka 238-8580, Japan.
- Odoriba Medical Center, Totsuka Green Dental Clinic, 1-10-46 Gumizawa, Totsuka-ku, Yokohama 245-0061, Japan.
| | - Toshizo Toyama
- Division of Microbiology, Department of Oral Science, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka 238-8580, Japan.
| | - Takenori Sato
- Division of Microbiology, Department of Oral Science, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka 238-8580, Japan.
| | - Mitsuo Suzuki
- Division of Microbiology, Department of Oral Science, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka 238-8580, Japan.
- Dental Design Clinic, 3-7-10 Kita-aoyama, Minato-ku, Tokyo 107-0061, Japan.
| | - Akira Morozumi
- Morozumi Dental Clinic, 1-3-1 Miyamaedaira, Miyamae-ku, Kawasaki 216-0006, Japan.
| | - Hiroshi Sakagami
- Meikai University Research Institute of Odontology (M-RIO), 1-1 Keyakidai, Sakado, Saitama 350-0283, Japan.
| | - Nobushiro Hamada
- Division of Microbiology, Department of Oral Science, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka 238-8580, Japan.
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17
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Tsai CC, Lo YC, Chiang JY, Sainbuyan N. Digital education and dynamic assessment of tongue diagnosis based on Mashup technique. Chin J Integr Med 2017:10.1007/s11655-016-2733-5. [PMID: 28116661 DOI: 10.1007/s11655-016-2733-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the digital education and dynamic assessment of tongue diagnosis based on Mashup technique (DEDATD) according to specifific user's answering pattern, and provide pertinent information tailored to user's specifific needs supplemented by the teaching materials constantly updated through the Mashup technique. METHODS Fifty-four undergraduate students were tested with DEDATD developed. The effificacy of the DEDATD was evaluated based on the pre- and post-test performance, with interleaving training sessions targeting on the weakness of the student under test. RESULTS The t-test demonstrated that signifificant difference was reached in scores gained during pre- and post-test sessions, and positive correlation between scores gained and length of time spent on learning, while no signifificant differences between the gender and post-test score, and the years of students in school and the progress in score gained. CONCLUSION DEDATD, coupled with Mashup technique, could provide updated materials fifiltered through diverse sources located across the network. The dynamic assessment could tailor each individual learner's needs to offer custom-made learning materials. DEDATD poses as a great improvement over the traditional teaching methods.
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Affiliation(s)
- Chin-Chuan Tsai
- The School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan, 82445, China
- Department of Chinese Medicine, E-DA Hospital, Kaohsiung, Taiwan, 82445, China
| | - Yen-Cheng Lo
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan, 80424, China
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan, 80424, China.
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan, 80708, China.
| | - Natsagdorj Sainbuyan
- Department of Mechanical Engineering, Cheng Shiu University, Kaohsiung, Taiwan, 83347, China
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