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Introduction. Breast cancer (BC) is the most common cancer in women and patients with BC often undergo complex treatment. In Taiwan, nearly 80% of patients with BC seek traditional Chinese medicine (TCM) during adjuvant chemotherapy to relieve discomfort and side effects. This study investigated tongue features and pattern differentiation through noninvasive TCM tongue diagnosis in patients with BC. Materials and Methods. This cross-sectional, case-controlled, retrospective observational study collected patient data through a chart review. The tongue features were extracted using the automatic tongue diagnosis system (ATDS). Nine tongue features, including tongue shape, tongue color, fur thickness, fur color, saliva, tongue fissures, ecchymoses, teeth marks, and red dots, were analyzed. Results and Discussion. Objective image analysis techniques were used to identify significant differences in the many tongue features between BC patients and non-BC individuals. A significantly larger proportion of patients with BC had a small tongue ( p < 0.001 ), pale tongue ( p < 0.001 ), thick fur ( p < 0.001 ), yellow fur ( p < 0.001 ), wet saliva ( p < 0.001 ), thick tongue fur ( p < 0.001 ), fissures ( p = 0.040 ), and ecchymoses in the heart-lung area ( p = 0.013 ). According to logistic regression, small tongue shape, pale tongue color, yellow fur color, wet saliva, and the amounts of fissures were associated with a significantly increased odds ratio for BC. Conclusions. This study showed significant differences in tongue features, such as small tongue shape, pale tongue color, thick fur, yellow fur color, wet saliva, fissure, and ecchymoses in the heart-lung area in patients with BC. These tongue features would imply yin deficiency, deficiencies of blood, stagnation of heat, and phlegm/blood stasis in TCM theory. There is a need to investigate effective and safe treatment to enhance the role of TCM in integrated medical care for patients with BC.

Intradialytic hypotension (IDH) may lead to a poor life quality and was associated with cardiovascular mortality in patients under hemodialysis. This study investigated the autonomic nerve and cardiovascular function in the IDH episodes. In this case-control study, 70 end stage renal disease patients (198 visits) were recruited. Pulse wave analysis and heart rate variability were evaluated before hemodialysis. Two definitions of IDH were confirmed by medical records. IDH-f indicated a drop of systolic blood pressure or mean arterial pressure, accompanied with symptoms; IDH-n indicated a low nadir systolic pressure during the hemodialysis. All parameters were evaluated for the possible predisposing factors under each definition. A total of 24 IDH-f and 37 IDH-n were noted in 177 visits. For both definitions, central pulse pressure seemed to be a consistent predisposing factor. Furthermore, lower sympathetic activity (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.35–0.87), lower pulse pressure (OR 0.95; 95% CI 0.92–0.98), and higher augmentation index (OR 17.36; 95% CI 1.48–204.10) were the possible predisposing factors for IDH-f. On the contrary, lower mean arterial pressure (OR 0.87; 95% CI 0.78–0.98) was identified as the possible factor for IDH-n. It was suggested that the lower central pulse pressure and sympathetic activity might be involved in the development of IDH.

Background: Traditional Chinese medicine (TCM) describes physiological and pathological changes inside and outside the human body by the application of four methods of diagnosis. One of the four methods, tongue diagnosis, is widely used by TCM physicians, since it allows direct observations that prevent discrepancies in the patient’s history and, as such, provides clinically important, objective evidence. The clinical significance of tongue features has been explored in both TCM and modern medicine. However, TCM physicians may have different interpretations of the features displayed by the same tongue, and therefore intra- and inter-observer agreements are relatively low. If an automated interpretation system could be developed, more consistent results could be obtained, and learning could also be more efficient. This study will apply a recently developed deep learning method to the classification of tongue features, and indicate the regions where the features are located.Methods: A large number of tongue photographs with labeled fissures were used. Transfer learning was conducted using the ImageNet-pretrained ResNet50 model to determine whether tongue fissures were identified on a tongue photograph. Often, the neural network model lacks interpretability, and users cannot understand how the model determines the presence of tongue fissures. Therefore, Gradient-weighted Class Activation Mapping (Grad-CAM) was also applied to directly mark the tongue features on the tongue image. Results: Only 6 epochs were trained in this study and no graphics processing units (GPUs) were used. It took less than 4 minutes for each epoch to be trained. The correct rate for the test set was approximately 70%. After the model training was completed, Grad-CAM was applied to localize tongue fissures in each image. The neural network model not only determined whether tongue fissures existed, but also allowed users to learn about the tongue fissure regions.Conclusions: This study demonstrated how to apply transfer learning using the ImageNet-pretrained ResNet50 model for the identification and localization of tongue fissures and regions. The neural network model built in this study provided interpretability and intuitiveness, (often lacking in general neural network models), and improved the feasibility for clinical application.

All daily physiological activities have some effects on the body, and traditional Chinese medicine believes that pulse diagnosis can reflect the circulation of qi and blood throughout the body. This study aimed to explore the effects of five physiological activities, namely, sleep, exercise, ingestion, defecation, and shower, on pulse waves of the radial artery. Thirty test subjects were recruited for the study, and a wearable pulse signal measurement device was used for self-measurement of radial artery pulses before and after various physiological activities. All collected data were subjected to fast Fourier analysis, which transformed each wave from its time domain to frequency domain of 10 harmonics to describe the changes in pulse waves. The results were as follows: exercise and sleep had larger but opposite effects on the pulse waves; defecation and sleep relaxed the body and had the same trend of effect on the pulse waves. Both exercise and ingestion require energy to proceed, and both exert a burden on the body, and the pulse waves showed the same trend of changes. In contrast, shower had a little effect on the pulse waves. Preliminary observation in this study showed that relaxation of the body could increase high-level harmonics, whereas stress could increase low-level harmonics. Further studies are warranted to unravel the physiological significance of this finding.

This study, an important groundwork for clinical tongue diagnosis and future traditional Chinese medicine (TCM) research, tested the hypothesis that some tongue features vary significantly between different gender and age groups by utilizing an automatic tongue diagnosis system (ATDS). A cross-sectional study of 1487 participants from a community-based population was performed. Study subjects with ages ranging from 20 to 92 were categorized into 3 groups

Diabetes mellitus (DM) is a public problem closely associated with numerous oral complications, such as coated tongue, xerostomia, salivary dysfunction, etc. Tongue diagnosis plays an important role in clinical prognosis and treatment of diabetes in the traditional Chinese medicine (TCM). This study investigated discriminating tongue features to distinguish between type 2 DM and non-DM individuals through non-invasive TCM tongue diagnosis. The tongue features for 199 patients with type 2 DM, and 372 non-DM individuals, serving as control, are extracted by the automatic tongue diagnosis system (ATDS). A total of 9 tongue features, namely, tongue shape, tongue color, fur thickness, fur color, saliva, tongue fissure, ecchymosis, teeth mark, and red dot. The demography, laboratory, physical examination, and tongue manifestation data between 2 groups were compared. Patients with type 2 DM possessed significantly larger covering area of yellow fur (58.5% vs 22.5%, P

Monitoring heart rates using conventional electrocardiogram equipment requires patients to wear adhesive gel patches or chest straps that can cause skin irritation and discomfort. Commercially available pulse oximetry sensors that attach to the fingertips or earlobes also cause inconvenience for patients and the spring-loaded clips can be painful to use. Therefore, a novel robust face-based heart rate monitoring technique is proposed to allow for the evaluation of heart rate variation without physical contact with the patient. Face reflectance is first decomposed from a single image and then heart rate evaluation is conducted from consecutive frames according to the periodic variation of reflectance strength resulting from changes to hemoglobin absorptivity across the visible light spectrum as heartbeats cause changes to blood volume in the blood vessels in the face. To achieve a robust evaluation, ensemble empirical mode decomposition of the Hilbert-Huang transform is used to acquire the primary heart rate signal while reducing the effect of ambient light changes. Our proposed approach is found to outperform the current state of the art, providing greater measurement accuracy with smaller variance and is shown to be feasible in real-world environments.

Objectives Our study aimed to correlate pulse wave parameters such as augmentation index (AI) and heart rate variability with traditional Chinese medicine (TCM) constitution for evaluating health status. Design Out of 177 subjects, 69 healthy subjects were enrolled in the present study, and others were excluded because of cardiovascular, liver, kidney, or other diseases. Each subject was invited to complete pulse wave examination and the Constitution in Chinese Medicine Questionnaire. Independent Student's t -tests, Mann-Whitney tests, and binary logistic regression analysis were used to analyse the correlation between pulse wave parameters and TCM constitution. Results Qi-deficient individuals had higher AI (p=0.006) and lower diastolic blood pressure (p=0.011); yang-deficient individuals had lower dP/dt max (p=0.030), systolic blood pressure (p=0.020), and pulse pressure (p=0.048); and damp-heat individuals had higher subendocardial viability index (SEVI) scores (p=0.011). We then categorized the phlegm dampness and yang-deficiency individuals into the cold group and those with damp-heat and yin-deficiency into the heat group. A comparison of the two constitution groups showed higher AI in the cold group (p=0.026). Binary logistic regression analysis demonstrated that only AI was a determinant, as evidenced by the finding that an increase of one unit in AI corresponded to an increase of 5% in the odds ratio for individuals to have a cold constitution (p=0.026). Conclusions Individuals with qi-deficient and cold constitutions had higher AI and lower SEVI, potentially reflecting an increase in arterial stiffness. This study can provide a basis for further investigation of the physiological indicators of TCM constitutions in modern medicine.

We apply the recently developed adaptive non-harmonic model based on the wave-shape function, as well as the time-frequency analysis tool called synchrosqueezing transform (SST) to model and analyze oscillatory physiological signals. To demonstrate how the model and algorithm work, we apply them to study the pulse wave signal. By extracting features called the spectral pulse signature, {and} based on functional regression, we characterize the hemodynamics from the radial pulse wave signals recorded by the sphygmomanometer. Analysis results suggest the potential of the proposed signal processing approach to extract health-related hemodynamics features.