Temporal changes in tongue color as criterion for tongue diagnosis in Kampo medicine.

BACKGROUND: In Kampo medicine (Japanese traditional herbal medicine), the appearance of the tongue contains a lot of useful information for diagnosis. However, an inspection of the tongue is not considered to be important in modern medical diagnosis, since the skills applied in the examination are difficult to understand. Thus, we developed an imaging system and algorithm for quantitative analysis of the tongue to provide the traditional techniques of Kampo with greater objectivity. MATERIALS AND METHODS: Tongue images were taken from 9 healthy subjects for 3 consecutive weeks (5 days/week), 12 times a day, with 300 images taken successively within 30 s each time. Then, the temporal color changes in 30 s, 1 day, and 3 weeks were measured in the device-independent International Commission on Illumination (CIE) 1976 L*a*b* color space. RESULTS: The tongue color change in 30 s varied between individuals, and it was mainly classified into 3 patterns. This image acquisition system and valid color management should help all tongue-related research, and the 30-s temporal color change might be an important target for further tongue analysis. CONCLUSIONS: We were able to acquire tongue images without specular reflection and with valid color reproduction, and the color change in 30 s was found to vary. Tongue color changes have not been mentioned in the classics of Kampo medicine, since they were certainly impossible to discriminate by the naked eye. The change during 30 s is a new finding based on the electronic devices, and together they are expected to become a new criterion for tongue analysis.

A case of thalamic pain successfully treated with Kampo medicine.

OBJECTIVE: Thalamic pain, one of the central painful poststroke symptoms, is a severe pain that is often intractable. A case of thalamic pain successfully treated with Kampo medicine is presented. SUBJECT: A 65-year-old woman complained of moderate continuous and paroxysmal severe pain in the right upper and lower limbs after she had suffered from stroke. She also complained of sensory disturbance and intermittent involuntary movement. A magnetic resonance imaging scan of the brain showed an old infarction in the left thalamus. INTERVENTIONS AND OUTCOME: Paroxetine was administered, but it was stopped because of nausea. Etizolam was effective in reducing the pain for only about 30 minutes. Sokeikakketsuto decoction, one of the Kampo medicines, was administered orally on the basis of Kampo diagnostic criteria. Ten (10) days later, the pain had almost disappeared, and the other symptoms had also improved. CONCLUSIONS: This result suggested that Sokeikakketsuto could be an option for the treatment of thalamic pain under certain conditions.

A case of mediastinal lymphangioma successfully treated with Kampo medicine.

OBJECTIVE: The authors report a case of mediastinal lymphangioma successfully treated with Kampo medicine. METHODS: A 2-year-old boy with an axillary soft mass consulted our clinic. Physical examination findings were normal except for axillary elastic swelling. The neck and chest magnetic resonance imaging scan (MRI) showed a multilocular mass starting from a cervical lesion and extending above the carina. RESULTS: After 9 months of Kampo administration, MRI showed marked regression of mediastinal lymphangioma. CONCLUSIONS: It was found that Kampo medicine might be safe and effective as an alternative choice of treatment for lymphangiomas.

Principal component vector rotation of the tongue color spectrum to predict "Mibyou" (disease-oriented state).

PURPOSE: Kampo medicine (Japanese traditional herbal medicine) contains concepts useful for preventive medicine. For example, "Mibyou" (disease-oriented state) aims to prevent illness by early recognition. Kampo diagnosis is based on subjective examinations, such as tongue inspection, by trained specialist physicians. An objective metric of the tongue color spectrum was developed as a surrogate for subjective visual inspection. METHODS: Tongue images were acquired with a hyperspectral imaging system, and the uncoated tongue region was segmented automatically. The spectral information of the uncoated tongue area was analyzed by principal component analysis (PCA). The component vector most representative of each clinical symptom was found by rotating the vector on a plane spanned by two arbitrary principal component vectors. RESULTS: The system was tested in human volunteers. Forty-four hyperspectral images were acquired from 30 healthy male subjects for initial testing. The Oketsu (blood stagnation) score was determined by an experienced clinician in Kampo medicine from 27 of 30 subjects. The correlation between respective principal components and Oketsu score was 0.67 at maximum, and increased to 0.73 by linear combination, while it was -0.75 by vector rotation. Significant correlations for many disorders were demonstrated, and vector rotation showed better correlation than linear combination. CONCLUSIONS: A PCA-based algorithm was developed to objectively evaluate patients using color images of the tongue surface. Testing showed that this method was a feasible surrogate for expert visual tongue analysis. This tool should help non-trained people identify "Mibyou" health status for individuals. The algorithm is free of empirical criteria, and it may be it applicable to many hyperspectral image types.

Regional image analysis of the tongue color spectrum.

PURPOSE: Kampo medicine (Japanese traditional herbal medicine) can identify "Mibyou" (disease-oriented state) based on visual tongue inspection by a trained physician. Surface colors of uncoated tongue provide essential features. A hyperspectral imaging system which performs regional image analysis of the tongue color spectrum was developed to automatically inspect the uncoated tongue. METHODS: Hyperspectral tongue surface images were acquired by a camera equipped with an integrating sphere. The color spectrum from 4 tongue areas--uncoated tongue, coated tongue, lip, and perioral areas--were quantified. The average spectrum of each area was determined and 4 images calculated by focusing on the differences between respective spectra; highlight, shadow, tongue coat, and lip-weighted images were calculated. The uncoated tongue area was extracted by subtraction. RESULTS: Reproducibility was evaluated by applying the camera and extraction algorithm to 44 images from human subjects. Eighty-two percentage were judged as acceptable by a Kampo medicine physician expert. CONCLUSIONS: Using a hyperspectral camera and extraction algorithm, the tongue color of the uncoated part was automatically extracted. This technique is suitable for tongue color analysis and may help non-trained users to identify "Mibyou".

Early detection of disease-oriented state from hyperspectral tongue images with principal component analysis and vector rotation.

In this article, we propose an effective colorprocessing algorithm to analyze the hyperspectral image of the tongue and its application to preventive medicine by the concept of Japanese traditional herbal medicine (Kampo medicine). Kampo medicine contains a number of concepts useful for preventive medicine such as "Mibyou" - disease-oriented state - signs of abnormalities. Hyperspectral images of the tongue were taken with the system with an integrating sphere, and tongue area without coating was eliminated automatically. Then, spectral information of the tongue area without coating was analyzed by principal component analysis, and the component vector best representing the clinical symptom was found by rotating the vector on a plane spanned by two arbitrary principal component vectors.

Choto-san prevents occurrence of stroke and prolongs life span in stroke-prone spontaneously hypertensive rats.

The effects of long-term oral administration of choto-san (diao-teng-san in Chinese) extract on the occurrence of stroke and life span were investigated in stroke-prone spontaneously hypertensive rats (SHR-SPs). Twenty-four rats were ramdomized into three groups. From 8 weeks of age, 0.1% and 0.3% choto-san groups were given water containing 0.1% (150 mg/kg/day) and 0.3% (450 mg/kg/day) choto-san extract, respectively. A control group was given only water. The mean survival times of the control group, 0.1% and 0.3% choto-san groups were 122.1, 159.8 and 176.8 days, respectively. The percent survivals of both the 0.1% and 0.3% choto-san groups were significantly enhanced compared to the control (Kaplan-Meier analysis followed by log-rank test; 0.1% choto-san: p < 0.05; 0.3% choto-san: p < 0.05). Furthermore, the cumulative percent occurrence of neurological and behavioral signs accompying stroke in the 0.3% choto-san group was significantly inhibited compared to the control (p < 0.05). These results suggested that choto-san prevents the occurrence of stroke and prolongs the life span of SHR-SPs.