Status and prospect of international standardization of TCM diagnosis.

The present study aimed to review the current status and development of international standards in the domain of traditional Chinese medicine (TCM) diagnosis. Moreover, the roles and relevant work of different organizations in developing such standards were explored, and the difficulties and challenges encountered were analyzed. The study further elaborated on the approaches to establish a complete set of international standards on TCM diagnosis. It also provided a promising solution for the development of international standards on TCM diagnosis.

[Research progress in original species identification in industry chain of Rhei Radix et Rhizoma].

Rhei Radix et Rhizoma is a kind of commonly used Chinese medicinal materials. Due to the overharvesting, the wild resource is endangering. Large market demand caused severely adulterant of commercial Rhei Radix et Rhizoma medicinal materials and decoction pieces. This manuscript reviewed the advances of the original species authentication in the industrial chain of Rhei Radix et Rhizoma during the latest decade, including characteristics and microscopic features, phytochemical analysis on anthraquinones, and molecular authentication based on DNA barcoding. Accordingly, an original species authentication route for the industrial chain of Rhei Radix et Rhizoma was summarized:(1)the identification of seeds and seedlings by DNA barcoding;(2) the selection of high variable sites based on the chloroplast genome;(3)biomonitoring of the Rhei Radix et Rhizoma medicinal materials and decoction pieces by two-dimensional DNA barcode;(4)traceability of Chinese patent medicines by third-generation sequencing. In conclusion, the combination of molecular identification and traditional identification methods provides a new idea for the identification of the original species of Rhei Radix et Rhizoma in the industrial chain and a essential guidance for the research of drug safety and efficacy of Rhei Radix et Rhizoma.

Classifying syndromes in Chinese medicine using multi-label learning algorithm with relevant features for each label.

OBJECTIVE: To develop an effective Chinese Medicine (CM) diagnostic model of coronary heart disease (CHD) and to confifirm the scientifific validity of CM theoretical basis from an algorithmic viewpoint. METHODS: Four types of objective diagnostic data were collected from 835 CHD patients by using a self-developed CM inquiry scale for the diagnosis of heart problems, a tongue diagnosis instrument, a ZBOX-I pulse digital collection instrument, and the sound of an attending acquisition system. These diagnostic data was analyzed and a CM diagnostic model was established using a multi-label learning algorithm (REAL). RESULTS: REAL was employed to establish a Xin (Heart) qi defificiency, Xin yang defificiency, Xin yin defificiency, blood stasis, and phlegm fifive-card CM diagnostic model, which had recognition rates of 80.32%, 89.77%, 84.93%, 85.37%, and 69.90%, respectively. CONCLUSIONS: The multi-label learning method established using four diagnostic models based on mutual information feature selection yielded good recognition results. The characteristic model parameters were selected by maximizing the mutual information for each card type. The four diagnostic methods used to obtain information in CM, i.e., observation, auscultation and olfaction, inquiry, and pulse diagnosis, can be characterized by these parameters, which is consistent with CM theory.

[Transcriptome characterization of Ephedra sinica with 454 ESTs].

Using the latest 454 GS FLX platform and Titanium regent, a substantial expressed sequence tag (ESTs) dataset of Ephedra sinica was produced, and the profile of gene expression and function gene of which were investigated. A total of 48 389 reads with an average length of 373 bp were generated. These 454 reads were assembled into 18 801 unigenes, which were all 454 sequencing identified. A total number of 10 531 unigenes(56.0%) were annotated using BLAST searches (E-value≤1×10⁻5) against the Nr, Nt, TAIR, SwissProt and KEGG databases. With respect to genes related to ephedrine biosynthesis, 19 unigenes(encoding 9 enzymes) were found. A total of 97 putative genes encoding cytochrome P450s were also discovered. Data presented in this study will provide an important resource for the scientific community that is interested in the functional genomics and secondary metabolism of E. sinica.

Pulse signal analysis of patients with coronary heart diseases using Hilbert-Huang transformation and time-domain method.

OBJECTIVE: To explore characteristic of pulse signal to distinguish patients with coronary heart diseases (CHD) from patients without CHD and healthy adults, and accordingly evaluate the potential role of pulse signal to diagnosis CHD. METHODS: Totally 407 patients enrolled from 4 collaborating medical centers were assigned to a CHD group (205 patients) and a non-CHD group (202 patients). The healthy control group (62 adults) enrolled from Shanghai University of Traditional Chinese Medicine. Pulse signals were collected using the synchronous multiplex pulse signal acquisition system. The pulse signals were analyzed and extracted using Hilbert-Huang transformation (HHT) and time-domain, respectively. The time-domain parameters of pulse signal were processed by the analysis of variance (SNK test). RESULTS: Special patterns in the CHD group pulse signal were found in this study: (1) time-domain parameters of pulse signal, h1, h3, h4, h3/h1, ts, t4/t were increased and w was wider; (2) 44% of C2 waves in HHT were chaotic and disordered and 72% of C waves were exhibited irregularly with average amplitude over 10 g-forces, which were all significantly different from controls. CONCLUSION: Characteristic wave and time-domain parameters of pulse signal were extracted using HHT and time-domain which could be served as a non-invasive approach for assessing patients with CHD.

Analysis of the diagnostic consistency of Chinese medicine specialists in cardiovascular disease cases and syndrome identification based on the relevant feature for each label learning method.

OBJECTIVE: To analyze the diagnostic consistency of Chinese medicine (CM) specialists in patients with cardiovascular disease and to study syndrome classification and identification based on the multi-label learning method. METHODS: Using self-developed CM clinical scales to collect cases, inquiry information, complexity, tongue manifestation and pulse manifestation were assessed. The number of cases collected was 2,218. Firstly, each case was differentiated by two CM specialists according to the same diagnostic criteria. The consistency of the diagnosis based on Cohen's Kappa coefficient was analyzed. Secondly, take the same diagnosis syndromes of two specialists as the results of the cases. According to injury information in the CM scale "yes" or "no" was assigned "1" or "0", and according to the syndrome type in each case "yes" or "no" was assigned "1" or "0". CM information data on cardiovascular disease cases were established. We studied CM syndrome classification and identification based on the relevant feature for each label (REAL) learning method, and the diagnostic rate of the syndrome was studied using the REAL method when the number of features selected was 5, 10, 15, 20, 30, 50, 70, and 100, respectively. RESULTS: The syndromes with good diagnostic consistency were Heart (Xin)-qi deficiency, Heart-yang deficiency, Heart-yin deficiency, phlegm, stagnation of blood and stagnation of qi. Syndromes with poor diagnostic consistency were heart-blood deficiency and blood deficiency of Heart and Liver (Gan). The highest diagnostic rates using the REAL method were Heart-yang deficiency followed by Heart-qi deficiency. A different number of features, such as 5, 10, 15, 20, 30, 40, 50, 70, and 100, respectively, were selected and the diagnostic accuracy based on five features showed the highest diagnostic accuracy. The top five features which had a strong correlation with the syndromes were in accordance with the CM theory. CONCLUSIONS: CM syndrome differentiation is strongly subjective and it is difficult to obtain good diagnostic consistency. The REAL method fully considers the relationship between syndrome types and injury symptoms, and is suitable for the establishment of models for CM syndrome classification and identification. This method can probably provide the prerequisite for objectivity and standardization of CM differentiation.

Objective Auscultation of TCM Based on Wavelet Packet Fractal Dimension and Support Vector Machine.

This study was conducted to illustrate that auscultation features based on the fractal dimension combined with wavelet packet transform (WPT) were conducive to the identification the pattern of syndromes of Traditional Chinese Medicine (TCM). The WPT and the fractal dimension were employed to extract features of auscultation signals of 137 patients with lung Qi-deficient pattern, 49 patients with lung Yin-deficient pattern, and 43 healthy subjects. With these features, the classification model was constructed based on multiclass support vector machine (SVM). When all auscultation signals were trained by SVM to decide the patterns of TCM syndromes, the overall recognition rate of model was 79.49%; when male and female auscultation signals were trained, respectively, to decide the patterns, the overall recognition rate of model reached 86.05%. The results showed that the methods proposed in this paper were effective to analyze auscultation signals, and the performance of model can be greatly improved when the distinction of gender was considered.

New oleanane-type triterpenoid saponins isolated from the seeds of Celosia argentea.

Three new oleanane-type triterpenoid saponins named celosins H, I, and J were isolated from the seeds of Celosia argentea L. Their structures were characterized as 3-O-ß-D-xylopyranosyl-(1 → 3)-ß-D-glucuronopyranosyl-polygalagenin 28-O-ß-D-glucopyranosyl ester, 3-O-ß-D-glucuronopyranosyl-medicagenic acid 28-O-ß-D-xylcopyranosyl-(1 → 4)-α-L-rhamnopyranosyl-(1 → 2)-ß-D-fucopyranosyl ester, and 3-O-ß-D-glucuronopyranosyl-medicagenic acid 28-O-α-L-arabinopyranosyl-(1 → 3)-[ß-D-xylcopyranosyl-(1 → 4)]-α-L-rhamnopyranosyl-(1 → 2)-ß-D-fucopyranosyl ester by NMR, MS, and chemical evidences, respectively. In our opinion, celosins H-J could be used as chemical markers for the quality control of C. argentea seeds.

Research on zheng classification fusing pulse parameters in coronary heart disease.

This study was conducted to illustrate that nonlinear dynamic variables of Traditional Chinese Medicine (TCM) pulse can improve the performances of TCM Zheng classification models. Pulse recordings of 334 coronary heart disease (CHD) patients and 117 normal subjects were collected in this study. Recurrence quantification analysis (RQA) was employed to acquire nonlinear dynamic variables of pulse. TCM Zheng models in CHD were constructed, and predictions using a novel multilabel learning algorithm based on different datasets were carried out. Datasets were designed as follows: dataset1, TCM inquiry information including inspection information; dataset2, time-domain variables of pulse and dataset1; dataset3, RQA variables of pulse and dataset1; and dataset4, major principal components of RQA variables and dataset1. The performances of the different models for Zheng differentiation were compared. The model for Zheng differentiation based on RQA variables integrated with inquiry information had the best performance, whereas that based only on inquiry had the worst performance. Meanwhile, the model based on time-domain variables of pulse integrated with inquiry fell between the above two. This result showed that RQA variables of pulse can be used to construct models of TCM Zheng and improve the performance of Zheng differentiation models.

[Metabolite changes in the greasy tongue coating of patients with chronic gastritis].

OBJECTIVE: To explore the changes in metabolites in the greasy tongue coating in patients with chronic gastritis. METHODS: Forty chronic gastritis patients presenting with greasy tongue coating, 30 chronic gastritis patients presenting with non-greasy tongue coating, and 20 healthy control persons presenting with light red tongues and thin white coating were enrolled, and the tongue coating was detected by combining artificial diagnosis and the Z-BOX Tongue Digital Analyzer's diagnosis. Samples of all the tongue coatings were collected before treatment. The metabolic fingerprinting of the tongue coating samples was obtained using ultra-performance liquid chromatography and mass spectrometry (UPLC-MS), and the metabolic components in the tongue coating samples were detected. After this, principal component analysis, partial least squares discriminant analysis and orthogonal partial least squares discriminant analysis (OPLS-DA) were used to identify potential metabolic markers. Finally, the components were identified using the Chemspider and HMDB searching. RESULTS: UPLC-MS results were analyzed by OPLS-DA and showed that the metabolites among the three groups were distributed in different regions. The different potential metabolic markers between the patients with or without greasy coating were 3-ketolactose, 2-deoxy-D-ribose, UDP-D-galactose metarhodopsin, ascorbate, picolinate and histidine. The different potential metabolic markers between the greasy coating group and the normal group were 3-ketolactose, UDP-D-galactose, leukotriene A4 and vitamin D(2). CONCLUSION: The metabolites of the greasy coating group, the non-greasy coating group and the normal group show significant differences in energy metabolism, mainly of glucose metabolism. This demonstrated that glucose metabolism may be one of the mechanisms leading to the formation of greasy coating.

Nonlinear Analysis of Auscultation Signals in TCM Using the Combination of Wavelet Packet Transform and Sample Entropy.

Auscultation signals are nonstationary in nature. Wavelet packet transform (WPT) has currently become a very useful tool in analyzing nonstationary signals. Sample entropy (SampEn) has recently been proposed to act as a measurement for quantifying regularity and complexity of time series data. WPT and SampEn were combined in this paper to analyze auscultation signals in traditional Chinese medicine (TCM). SampEns for WPT coefficients were computed to quantify the signals from qi- and yin-deficient, as well as healthy, subjects. The complexity of the signal can be evaluated with this scheme in different time-frequency resolutions. First, the voice signals were decomposed into approximated and detailed WPT coefficients. Then, SampEn values for approximated and detailed coefficients were calculated. Finally, SampEn values with significant differences in the three kinds of samples were chosen as the feature parameters for the support vector machine to identify the three types of auscultation signals. The recognition accuracy rates were higher than 90%.

Study on intelligent syndrome differentiation in traditional Chinese medicine based on multiple information fusion methods.

Numerous researchers have taken the solid step forward towards the objectification research of Traditional Chinese Medicine (TCM) four diagnostic methods. However, it is deficient in studies on information fusion of the four diagnostic methods. We establish four-diagnosis syndrome differentiation model of TCM based on information fusion technology. The objective detection instruments of four-diagnostic method are applied to collect four-diagnosis objective information of 506 cases of clinical heart-system patients. Then multiple information fusion methods are adopted to establish recognition model of syndromes. The results of our experiments show that recognition rates of the six syndromes using multi-label learning is better than OCON artificial neural network and multiple support vector machine.

[Feature extraction and recognition of traditional Chinese medicine pulse based on hemodynamic principles].

In this paper, factors contributing to the formation of pulse wave were analyzed based on hemodynamic principles. It is considered that formation of pulse wave was related to its propagation and reflection characteristics. Propagation of the pulse wave was characterized by pulse wave velocity, and reflection of the pulse wave was characterized by reflection coefficient. Pulse wave velocity and reflection coefficient were proposed as the eigenvectors of pulse wave in pulse diagnosis of traditional Chinese medicine, and support vector machine (SVM) was used to recognize slippery pulse, stringy pulse and plain pulse. Pulse wave velocity and reflection coefficient of the slippery, stringy and plain pulses in healthy people were calculated in this study, and SVM with Gaussian radial basis function was used for classifying. Results showed that pulse wave velocity and reflection coefficient with physiological and pathological significance had advantages in distinguishing slippery pulse, stringy pulse and plain pulse, which offered a new idea for recognizing pulse condition.

[Dysphagia after stroke treated with acupuncture or electric stimulation: a randomized controlled trial].

OBJECTIVE: To compare the therapeutic effects between acupuncture and electric stimulation on post-stroke dysphagia on the basis of rehabilitation training. METHODS: Ninety-seven patients with post-stroke dysphagia were randomly divided into an acupuncture group (group A, n = 32), an electric stimulation group (group B, n = 35) and a rehabilitation training group (group C, n = 30). In group C, the conventional therapy (conventional therapy of neurologic internal medicine and rehabilitation training) was applied. In group A, the combination of conventional therapy and acupuncture was applied. The acupoints of Fengchi (GB 20), Futu (LI 18), three-needles on the forehead, etc. were selected. In group B, the combination of conventional therapy and electric stimulation was adopted. Watian drinking water experiment, stethocatharsis function scoring and video fluoroscopic swallowing study (VFSS) were used to evaluate swallowing function of patients. RESULTS: After treatment, the total effective rate was 96.95 (31/32) in group A and was 94.3% (33/35) in group B, which was superior to that of 66.7% (20/30) in group C (P < 0.01). After treatment, the swallowing function in group A, group B and group C were all improved significantly as compared with that before treatment (all P < 0.05). After treatment, the effects in group A and B were superior to that in group C (both P < 0.05). CONCLUSION: The therapeutic effect of the combination of either acupuncture or electric stimulation with rehabilitation training is better than that of simple rehabilitation training. The efficacy on dysphagia is equal between acupuncture and electric stimulation.

[Changes of tongue and pulse parameters in 50 lung cancer patients treated with integrated traditional Chinese and Western medicine].

OBJECTIVE: To observe the changes of tongue and pulse parameters in lung cancer patients after combined treatment with integrated traditional Chinese and Western medicine, and to probe into the application of the tongue and pulse parameters in evaluation of integrated traditional Chinese and Western medicine therapy on lung cancer patients. METHODS: Electropulsograms and tongue pictures of 50 lung cancer patients were examined by TP-I digital electropulsography. The tongue and pulse parameters of the patients, including the indexes of moistness and dryness, thinness and thickness, fissure, swollenness and emaciation, greasiness and likeness of curd, and power spectral ratios (PSRs) 1, 2, 3, 4 and cepstrum spectral ratios (CSRs) 1, 2, 3, 4, were observed after 1-month and 2-month treatment with Yifei Kangliu Oral Liquid (a compound traditional Chinese herbal medicine) plus chemotherapy, respectively. The above parameters of the lung cancer patients were compared before and after the treatment. RESULTS: PSR1 increased, while PSR2 decreased significantly after 1-month and 2-month treatment as compared with before treatment (P < 0.05). PSR1 decreased, while PSR2 increased after 2-month treatment as compared with after 1-month treatment (P < 0.05). PSR4 after 1-month treatment was lower than before treatment (P < 0.05). The tongue parameters including the indexes of moistness and dryness, and greasiness and likeness of curd increased significantly after 1-month and 2-month treatment as compared with before treatment (P < 0.05). The index of thinness and thickness decreased, while the index of fissure increased significantly after 1-month treatment as compared with before treatment (P < 0.05). CONCLUSION: Tongue and pulse parameters can be regarded as one of reference indexes in evaluation of integrated traditional Chinese and Western medicine therapy on lung cancer patients.

[Development and evaluation of an inquiry scale for diagnosis of heart system syndromes in traditional Chinese medicine].

OBJECTIVE: To develop an inquiry scale for diagnosis of heart system syndromes, and to discuss the provisional standardization of the inquiry method in traditional Chinese medicine (TCM). METHODS: Based on scale-making method, Chinese medicine theory and literature searching, an inquiry scale for diagnosis of heart system syndromes in TCM was developed. Statistics method, frequency counting and Delphi method were used for analysis. The inquiry scale was revised and tested repeatedly to check the test reliability, internal consistency reliability, and content validity, etc. RESULTS: The inquiry scale for diagnosis of heart system syndromes mainly covered basic data, chief complaint, history of present illness (accompanying symptoms) and past history, with appendix of inspection and palpation information as well as diagnosis made according to traditional Chinese and Western medicine. Among them, general inquiries covered fever and chills, sweating, head-body and chest-belly symptoms, taste and diet, stool and urine, sleep, mood, and gynecologic symptoms, which were scaled in 8 dimensions. And 66 symptom variables were screened finally. The scale had a good content validity and its coefficient alpha was 0.82. For the results of test-retest reliability, the Kappa values of using the scale for diagnosis of heart-qi deficiency, heart-yang deficiency, turbid phlegm, and cold coagulation twice by the same doctor ranged from 0.74 to 1, showing that the consistency of the scale was relatively high. The Kappa values of evaluation of scorer reliability in diagnosis of heart-qi deficiency, heart-yang deficiency, and heart-yin deficiency were also high, which were 0.63, 0.72, 1 and 0.48 respectively. Other results of diagnosis had low-consistency or even no diagnostic agreement. CONCLUSION: The research on the scale for inquiry in TCM indicates that it is feasible for the standardization of inquiry scale for diagnosis of heart system syndromes in TCM, offering a reference for research on the inquiry scales for other systems.