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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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Gu TY, Yan ZZ, Jiang JH. Classifying Chinese Medicine Constitution Using Multimodal Deep-Learning Model. Chin J Integr Med 2024; 30:163-170. [PMID: 36374441 DOI: 10.1007/s11655-022-3541-8] [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: 07/13/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop a multimodal deep-learning model for classifying Chinese medicine constitution, i.e., the balanced and unbalanced constitutions, based on inspection of tongue and face images, pulse waves from palpation, and health information from a total of 540 subjects. METHODS This study data consisted of tongue and face images, pulse waves obtained by palpation, and health information, including personal information, life habits, medical history, and current symptoms, from 540 subjects (202 males and 338 females). Convolutional neural networks, recurrent neural networks, and fully connected neural networks were used to extract deep features from the data. Feature fusion and decision fusion models were constructed for the multimodal data. RESULTS The optimal models for tongue and face images, pulse waves and health information were ResNet18, Gate Recurrent Unit, and entity embedding, respectively. Feature fusion was superior to decision fusion. The multimodal analysis revealed that multimodal data compensated for the loss of information from a single mode, resulting in improved classification performance. CONCLUSIONS Multimodal data fusion can supplement single model information and improve classification performance. Our research underscores the effectiveness of multimodal deep learning technology to identify body constitution for modernizing and improving the intelligent application of Chinese medicine.
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Affiliation(s)
- Tian-Yu Gu
- School of Communication & Information Engineering, Shanghai University, Shanghai, 200444, China
| | - Zhuang-Zhi Yan
- School of Life Science, Shanghai University, Shanghai, 200444, China.
| | - Jie-Hui Jiang
- School of Life Science, Shanghai University, Shanghai, 200444, China
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Zeng LZ, Cui J, Jiang T, Tu LP, Liu HD, Gong YB, Xu L, Xu JT. Study on the difference and regularity of tongue images in 309 patients with different pathological stages of non-small cell lung cancer. Technol Health Care 2023:THC230372. [PMID: 38043028 DOI: 10.3233/thc-230372] [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] [Indexed: 12/04/2023]
Abstract
BACKGROUND Tongue diagnosis is a crucial traditional Chinese medicine (TCM) inspection method for TCM syndrome differentiation and treatment. OBJECTIVE The primary research focus was on tongue image characteristic parameters of patients with non-small cell lung cancer (NSCLC). Analysis of the tongue image parameters of various pathological stages of NSCLC provides technical support for establishing an integrated Chinese and Western auxiliary diagnosis and efficacy evaluation medicine system for lung cancer that integrates tongue image features. METHODS Tongue image characteristics of 309 patients with NSCLC and 206 controls were collected and analyzed clinically. The T-test or rank sum test and logistic regression analysis were applied to analyze the characteristics of tongue image indicators of different pathological stages of NSCLC. RESULTS There were differences in tongue image characteristics in the NSCLC group compared to the control group. The tongue quality and brightness of the tongue coating in the NSCLC group increased, the red component was reduced, the tongue coating thickened, and the yellow component increased compared to the healthy control group. A comparison of tongue image indexes of NSCLC in different pathological stages showed that stage IV had lower TB-b and higher TB-a than stage I. In addition, stage IV had lower TB-b than stage II + III, showing an increase in the blue and red components of the tongue in stage IV and the appearance of cyanotic tongue features. CONCLUSION The tongue image characteristics of NSCLC patients differed from those of the control group. Tongue imaging indicators can reflect the characteristics of tongue images of patients with NSCLC. The tongue image characteristics of patients with stage IV lung cancer are bluish and purple compared with those with stage I, II, and III. It is suggested that the tongue's image characteristics can be used as a reference for the pathological classification of NSCLC and judgment of the disease process.
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Affiliation(s)
- Ling-Zhi Zeng
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ji Cui
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tao Jiang
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Li-Ping Tu
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hai-Dan Liu
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ya-Bin Gong
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ling Xu
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Tuo Xu
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Shi Y, Guo D, Chun Y, Liu J, Liu L, Tu L, Xu J. A lung cancer risk warning model based on tongue images. Front Physiol 2023; 14:1154294. [PMID: 37324390 PMCID: PMC10267397 DOI: 10.3389/fphys.2023.1154294] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Objective: To investigate the tongue image features of patients with lung cancer and benign pulmonary nodules and to construct a lung cancer risk warning model using machine learning methods. Methods: From July 2020 to March 2022, we collected 862 participants including 263 patients with lung cancer, 292 patients with benign pulmonary nodules, and 307 healthy subjects. The TFDA-1 digital tongue diagnosis instrument was used to capture tongue images, using feature extraction technology to obtain the index of the tongue images. The statistical characteristics and correlations of the tongue index were analyzed, and six machine learning algorithms were used to build prediction models of lung cancer based on different data sets. Results: Patients with benign pulmonary nodules had different statistical characteristics and correlations of tongue image data than patients with lung cancer. Among the models based on tongue image data, the random forest prediction model performed the best, with a model accuracy of 0.679 ± 0.048 and an AUC of 0.752 ± 0.051. The accuracy for the logistic regression, decision tree, SVM, random forest, neural network, and naïve bayes models based on both the baseline and tongue image data were 0.760 ± 0.021, 0.764 ± 0.043, 0.774 ± 0.029, 0.770 ± 0.050, 0.762 ± 0.059, and 0.709 ± 0.052, respectively, while the corresponding AUCs were 0.808 ± 0.031, 0.764 ± 0.033, 0.755 ± 0.027, 0.804 ± 0.029, 0.777 ± 0.044, and 0.795 ± 0.039, respectively. Conclusion: The tongue diagnosis data under the guidance of traditional Chinese medicine diagnostic theory was useful. The performance of models built on tongue image and baseline data was superior to that of the models built using only the tongue image data or the baseline data. Adding objective tongue image data to baseline data can significantly improve the efficacy of lung cancer prediction models.
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Affiliation(s)
- Yulin Shi
- Experimental Education Center of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dandan Guo
- School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yi Chun
- School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiayi Liu
- School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lingshuang Liu
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liping Tu
- School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiatuo Xu
- School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Ma C, Zhang P, Du S, Li Y, Li S. Construction of Tongue Image-Based Machine Learning Model for Screening Patients with Gastric Precancerous Lesions. J Pers Med 2023; 13:jpm13020271. [PMID: 36836505 PMCID: PMC9968136 DOI: 10.3390/jpm13020271] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Screening patients with precancerous lesions of gastric cancer (PLGC) is important for gastric cancer prevention. The accuracy and convenience of PLGC screening could be improved with the use of machine learning methodologies to uncover and integrate valuable characteristics of noninvasive medical images related to PLGC. In this study, we therefore focused on tongue images and for the first time constructed a tongue image-based PLGC screening deep learning model (AITongue). The AITongue model uncovered potential associations between tongue image characteristics and PLGC, and integrated canonical risk factors, including age, sex, and Hp infection. Five-fold cross validation analysis on an independent cohort of 1995 patients revealed the AITongue model could screen PLGC individuals with an AUC of 0.75, 10.3% higher than that of the model with only including canonical risk factors. Of note, we investigated the value of the AITongue model in predicting PLGC risk by establishing a prospective PLGC follow-up cohort, reaching an AUC of 0.71. In addition, we developed a smartphone-based app screening system to enhance the application convenience of the AITongue model in the natural population from high-risk areas of gastric cancer in China. Collectively, our study has demonstrated the value of tongue image characteristics in PLGC screening and risk prediction.
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Affiliation(s)
- Changzheng Ma
- Institute of TCM-X/MOE Key Laboratory of Bioinformatics, Bioinformatics Division, BNRist/Department of Automation, Tsinghua University, Beijing 100084, China
| | - Peng Zhang
- Institute of TCM-X/MOE Key Laboratory of Bioinformatics, Bioinformatics Division, BNRist/Department of Automation, Tsinghua University, Beijing 100084, China
| | - Shiyu Du
- Department of Gastroenterology, China-Japan Friendship Hospital, Chaoyang District, Beijing 100029, China
| | - Yan Li
- Department of Traditional Chinese Medicine, Yijishan Hospital of Wannan Medical College, Wuhu 241000, China
| | - Shao Li
- Institute of TCM-X/MOE Key Laboratory of Bioinformatics, Bioinformatics Division, BNRist/Department of Automation, Tsinghua University, Beijing 100084, China
- Correspondence:
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Liu Q, Li Y, Yang P, Liu Q, Wang C, Chen K, Wu Z. A survey of artificial intelligence in tongue image for disease diagnosis and syndrome differentiation. Digit Health 2023; 9:20552076231191044. [PMID: 37559828 PMCID: PMC10408356 DOI: 10.1177/20552076231191044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/02/2023] [Accepted: 07/13/2023] [Indexed: 08/11/2023] Open
Abstract
The rapid development of artificial intelligence technology has gradually extended from the general field to all walks of life, and intelligent tongue diagnosis is the product of a miraculous connection between this new discipline and traditional disciplines. We reviewed the deep learning methods and machine learning applied in tongue image analysis that have been studied in the last 5 years, focusing on tongue image calibration, detection, segmentation, and classification of diseases, syndromes, and symptoms/signs. Introducing technical evolutions or emerging technologies were applied in tongue image analysis; as we have noticed, attention mechanism, multiscale features, and prior knowledge were successfully applied in it, and we emphasized the value of combining deep learning with traditional methods. We also pointed out two major problems concerned with data set construction and the low reliability of performance evaluation that exist in this field based on the basic essence of tongue diagnosis in traditional Chinese medicine. Finally, a perspective on the future of intelligent tongue diagnosis was presented; we believe that the self-supervised method, multimodal information fusion, and the study of tongue pathology will have great research significance.
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Affiliation(s)
- Qi Liu
- Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
- Shenzhen Institute of Advanced Technology of the Chinese Academy of Science, Shenzhen, Guangdong, China
| | - Yan Li
- Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Peng Yang
- Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Quanquan Liu
- Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Chunbao Wang
- Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Keji Chen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhengzhi Wu
- Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
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Wang ZC, Zhang SP, Yuen PC, Chan KW, Chan YY, Cheung CH, Chow CH, Chua KK, Hu J, Hu Z, Lao B, Leung CC, Li H, Zhong L, Liu X, Liu Y, Liu Z, Lun X, Mo W, Siu SY, Xiong Z, Yeung WF, Zhang RY, Zhang X. Intra-Rater and Inter-Rater Reliability of Tongue Coating Diagnosis in Traditional Chinese Medicine Using Smartphones: Quasi-Delphi Study. JMIR Mhealth Uhealth 2020; 8:e16018. [PMID: 32459647 PMCID: PMC7380897 DOI: 10.2196/16018] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/14/2019] [Accepted: 03/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background There is a growing trend in the use of mobile health (mHealth) technologies in traditional Chinese medicine (TCM) and telemedicine, especially during the coronavirus disease (COVID-19) outbreak. Tongue diagnosis is an important component of TCM, but also plays a role in Western medicine, for example in dermatology. However, the procedure of obtaining tongue images has not been standardized and the reliability of tongue diagnosis by smartphone tongue images has yet to be evaluated. Objective The first objective of this study was to develop an operating classification scheme for tongue coating diagnosis. The second and main objective of this study was to determine the intra-rater and inter-rater reliability of tongue coating diagnosis using the operating classification scheme. Methods An operating classification scheme for tongue coating was developed using a stepwise approach and a quasi-Delphi method. First, tongue images (n=2023) were analyzed by 2 groups of assessors to develop the operating classification scheme for tongue coating diagnosis. Based on clinicians’ (n=17) own interpretations as well as their use of the operating classification scheme, the results of tongue diagnosis on a representative tongue image set (n=24) were compared. After gathering consensus for the operating classification scheme, the clinicians were instructed to use the scheme to assess tongue features of their patients under direct visual inspection. At the same time, the clinicians took tongue images of the patients with smartphones and assessed tongue features observed in the smartphone image using the same classification scheme. The intra-rater agreements of these two assessments were calculated to determine which features of tongue coating were better retained by the image. Using the finalized operating classification scheme, clinicians in the study group assessed representative tongue images (n=24) that they had taken, and the intra-rater and inter-rater reliability of their assessments was evaluated. Results Intra-rater agreement between direct subject inspection and tongue image inspection was good to very good (Cohen κ range 0.69-1.0). Additionally, when comparing the assessment of tongue images on different days, intra-rater reliability was good to very good (κ range 0.7-1.0), except for the color of the tongue body (κ=0.22) and slippery tongue fur (κ=0.1). Inter-rater reliability was moderate for tongue coating (Gwet AC2 range 0.49-0.55), and fair for color and other features of the tongue body (Gwet AC2=0.34). Conclusions Taken together, our study has shown that tongue images collected via smartphone contain some reliable features, including tongue coating, that can be used in mHealth analysis. Our findings thus support the use of smartphones in telemedicine for detecting changes in tongue coating.
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Affiliation(s)
- Zhi Chun Wang
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Shi Ping Zhang
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Pong Chi Yuen
- School of Computing Science, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Kam Wa Chan
- Department of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Yi Yi Chan
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Chun Hoi Cheung
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Chi Ho Chow
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Ka Kit Chua
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Jun Hu
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhichao Hu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Beini Lao
- Guangdong Provincial Hospital of Traditional Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Chun Chuen Leung
- Hong Zhi Tang Chinese Medicine Clinic, Hong Kong, China (Hong Kong)
| | - Hong Li
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Linda Zhong
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Xusheng Liu
- Guangdong Provincial Hospital of Traditional Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Yulong Liu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Zhenjie Liu
- Guangdong Provincial Hospital of Traditional Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Xin Lun
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Wei Mo
- Guang Dong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Sheung Yuen Siu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | | | - Wing Fai Yeung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Run Yun Zhang
- China Academy of Chinese Medical Sciences, Guang An Men Hospital, Beijing, China
| | - Xuebin Zhang
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
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