A two-stage segmentation of sublingual veins based on compact fully convolutional networks for Traditional Chinese Medicine images.

As one of the key methods of Traditional Chinese Medicine inspection, tongue diagnosis manifests the advantages of simplicity and directness. Sublingual veins can provide essential information about human health. In order to automate tongue diagnosis, sublingual veins segmentation has become one important issue in the field of Chinese medicine medical image processing. At present, the primary methods for sublingual veins segmentation are traditional feature engineering methods and the feature representation methods represented by deep learning. The former, which mainly based on colour space, belongs to unsupervised classification method. The latter, which includes U-Net and other deep neural network models, belongs to supervised classification method. Current feature engineering methods can only capture low dimensional information, which makes it difficult to extract efficient features for sublingual veins. On the other hand, current deep learning methods use down-sampling structures, which manifest weak robustness and low accuracy. So, it is difficult for current segmentation approaches to recognize tiny branches of sublingual veins. To overcome the above limits, this paper proposes a novel two-stage semantic segmentation method for sublingual veins. In the first stage, a fully convolutional network without down-sampling is used to realize the accurate segmentation of the tongue that includes the sublingual veins to be segmented in the next stage. During the tongue segmentation, the proposed networks can effectively reduce the loss of medical images spatial feature information. At the same time, in order to expand the receptive field, the dilated convolution has been introduced to the proposed networks, which can capture multi-scale information of segmentation images. In the second stage, another fully convolutional network has been used to segment the sublingual veins on the base of the results from the first stage. In this model, proper dilated convolutional rates have been selected to avoid gridding issue. In order to keep the quality of the images to be segmented, several particular data pre-processing and post-processing have been used, which includes specular highlight removal, data augmentation, erosion and dilation. Finally, in order to evaluate the performance of the proposed model, segmentation results have been compared with the state-of-the-art methods on the base of the dataset from Shanghai University of Traditional Chinese Medicine. The effectiveness of sublingual veins segmentation has been proved.

Classification of facial diagnosis gloss in Chinese medicine based on different algorithms.

OBJECTIVE: To design a face gloss classification model and to provide an automatic and quantitative approach for the diagnosis of Chinese medicine (CM) based on the face images. METHODS: To classify the face gloss images into two groups (gloss and non-gloss), feature extraction methods were applied to the original images. The original images were supposed to obtain a more ideal representation in which gloss information was better revealed in four color spaces [including red, green, blue (RGB), hue, saturation, value (HSV), Gray and Lab]. Principal component analysis (PCA), 2-dimensional PCA (2DPCA), 2-directional 2-dimensional PCA [(2D)2PCA], linear discriminant analysis (LDA), 2-dimensional LDA (2DLDA), and partial least squares (PLS) were used as the feature extraction methods of face gloss. k nearest neighbor was used as the classifification method. RESULTS: All the six feature extraction methods were useful in extracting information of face gloss, especially LDA, which had the best prediction accuracy in the 4 color spaces. The average accuracy of LDA in the Lab was 7%-10% higher than that of PCA, 2DPCA, (2D)2PCA and 2DLDA P<0.05). The prediction accuracy of LDA reached 98% in the Lab color space and showed practical usage in clinical diagnosis. The consistent rate between the CM experts and the facial diagnosis system was 81%. CONCLUSION: A computer-assisted classifification model was designed to provide an automatic and quantitative approach for the gloss diagnosis of CM based on the face images.

The Metabonomic Studies of Tongue Coating in H. pylori Positive Chronic Gastritis Patients.

In Traditional Chinese Medicine (TCM), tongue diagnosis (TD) has been an important diagnostic method for the last 3000 years. Tongue coating can be used as a very sensitive marker to determine the progress of chronic gastritis. Therefore, the scientific, qualitative, and quantitative study for the pathophysiologic basis of tongue coating (TC) emerged as a major direction for the objective research of TD. In our current report, we used GC/MS technology to determine the potential changes of metabolites and identify special metabolic biomarkers in the TC of H. pylori infected chronic gastritis patients. Four discriminative metabolites were identified by GC/MS between the TC of H. pylori infection (G + H) and without H. pylori infection (G - H) patients: ethylene, cephaloridine, γ-aminobutyric acid, and 5-pyroglutamic acid, indicating that changes in amino acid metabolism are possibly involved in the formation of TC, and the amino acid metabolites are part of the material components of TC in G + H patients.

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.

Qualitative and quantitative analysis for facial complexion in traditional Chinese medicine.

Facial diagnosis is an important and very intuitive diagnostic method in Traditional Chinese Medicine (TCM). However, due to its qualitative and experience-based subjective property, traditional facial diagnosis has a certain limitation in clinical medicine. The computerized inspection method provides classification models to recognize facial complexion (including color and gloss). However, the previous works only study the classification problems of facial complexion, which is considered as qualitative analysis in our perspective. For quantitative analysis expectation, the severity or degree of facial complexion has not been reported yet. This paper aims to make both qualitative and quantitative analysis for facial complexion. We propose a novel feature representation of facial complexion from the whole face of patients. The features are established with four chromaticity bases splitting up by luminance distribution on CIELAB color space. Chromaticity bases are constructed from facial dominant color using two-level clustering; the optimal luminance distribution is simply implemented with experimental comparisons. The features are proved to be more distinctive than the previous facial complexion feature representation. Complexion recognition proceeds by training an SVM classifier with the optimal model parameters. In addition, further improved features are more developed by the weighted fusion of five local regions. Extensive experimental results show that the proposed features achieve highest facial color recognition performance with a total accuracy of 86.89%. And, furthermore, the proposed recognition framework could analyze both color and gloss degrees of facial complexion by learning a ranking function.

Computerized tongue image segmentation via the double geo-vector flow.

BACKGROUND: Visual inspection for tongue analysis is a diagnostic method in traditional Chinese medicine (TCM). Owing to the variations in tongue features, such as color, texture, coating, and shape, it is difficult to precisely extract the tongue region in images. This study aims to quantitatively evaluate tongue diagnosis via automatic tongue segmentation. METHODS: Experiments were conducted using a clinical image dataset provided by the Laboratory of Traditional Medical Syndromes, Shanghai University of TCM. First, a clinical tongue image was refined by a saliency window. Second, we initialized the tongue area as the upper binary part and lower level set matrix. Third, a double geo-vector flow (DGF) was proposed to detect the tongue edge and segment the tongue region in the image, such that the geodesic flow was evaluated in the lower part, and the geo-gradient vector flow was evaluated in the upper part. RESULTS: The performance of the DGF was evaluated using 100 images. The DGF exhibited better results compared with other representative studies, with its true-positive volume fraction reaching 98.5%, its false-positive volume fraction being 1.51%, and its false-negative volume fraction being 1.42%. The errors between the proposed automatic segmentation results and manual contours were 0.29 and 1.43% in terms of the standard boundary error metrics of Hausdorff distance and mean distance, respectively. CONCLUSIONS: By analyzing the time complexity of the DGF and evaluating its performance via standard boundary and area error metrics, we have shown both efficiency and effectiveness of the DGF for automatic tongue image segmentation.

The role of central nervous system on hypoglycemia and the feasibility of the brain theory in traditional Chinese medicine on treatment of diabetes mellitus.

The central nervous system (CNS) plays a key regulatory role in glucose homeostasis. In particular, the brain is important in initiating and coordinating protective counterregulatory responses when blood glucose levels fall. This may due to the metabolic dependency of the CNS on glucose, and protection of food supply to the brain. In healthy subjects, blood glucose is normally maintained within a relatively narrow range. Hypoglycemia in diabetic patients can increase the risk of complications, such as heart disease and diabetic peripheral neuropathy. The clinical research finds that the use of traditional Chinese medicine (TCM) has a positive effect on the treatment of hypoglycemia. Here the authors reviewed the current understanding of sensing and counterregulatory responses to hypoglycemia, and discuss combining traditional Chinese and Western medicine and the theory of iatrogenic hypoglycemia in diabetes treatment. Furthermore, the authors clarify the feasibility of treating hypoglycemia on the basis of TCM theory and CNS and have an insight on its clinical practice.

Metabolic markers and microecological characteristics of tongue coating in patients with chronic gastritis.

BACKGROUND: In Traditional Chinese Medicine (TCM), tongue diagnosis has been an important diagnostic method for the last 3000 years. Tongue diagnosis is a non-invasive, simple and valuable diagnostic tool. TCM treats the tongue coating on a very sensitive scale that reflects physiological and pathological changes in the organs, especially the spleen and stomach. Tongue coating can diagnose disease severity and determine the TCM syndrome ("Zheng" in Chinese). The biological bases of different tongue coating appearances are still poorly understood and lack systematic investigation at the molecular level. METHODS: Tongue coating samples were collected from 70 chronic gastritis patients and 20 normal controls. 16S rRNA denatured gradient gel electrophoresis (16S rRNA-DGGE) and liquid chromatography and mass spectrometry (LC-MS) were designed to profile tongue coatings. The statistical techniques used were principal component analysis and partial least squares-discriminate analysis. RESULTS: Ten potential metabolites or markers were found in chronic gastritis patients, including UDP-D-galactose, 3-ketolactose, and vitamin D2, based on LC-MS. Eight significantly different strips were observed in samples from chronic gastritis patients based on 16S rRNA-DGGE. Two strips, Strips 8 and 10, were selected for gene sequencing. Strip 10 sequencing showed a 100% similarity to Rothia mucilaginosa. Strip 8 sequencing showed a 96.2% similarity to Moraxella catarrhalis. CONCLUSIONS: Changes in glucose metabolism could possibly form the basis of tongue coating conformation in chronic gastritis patients. The study revealed important connections between metabolic components, microecological components and tongue coating in chronic gastritis patients. Compared with other diagnostic regimens, such as blood tests or tissue biopsies, tongue coating is more amenable to, and more convenient for, both patients and doctors.

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.

Computer-assisted lip diagnosis on Traditional Chinese Medicine using multi-class support vector machines.

BACKGROUND: In Traditional Chinese Medicine (TCM), the lip diagnosis is an important diagnostic method which has a long history and is applied widely. The lip color of a person is considered as a symptom to reflect the physical conditions of organs in the body. However, the traditional diagnostic approach is mainly based on observation by doctor's nude eyes, which is non-quantitative and subjective. The non-quantitative approach largely depends on the doctor's experience and influences accurate the diagnosis and treatment in TCM. Developing new quantification methods to identify the exact syndrome based on the lip diagnosis of TCM becomes urgent and important. In this paper, we design a computer-assisted classification model to provide an automatic and quantitative approach for the diagnosis of TCM based on the lip images. METHODS: A computer-assisted classification method is designed and applied for syndrome diagnosis based on the lip images. Our purpose is to classify the lip images into four groups: deep-red, red, purple and pale. The proposed scheme consists of four steps including the lip image preprocessing, image feature extraction, feature selection and classification. The extracted 84 features contain the lip color space component, texture and moment features. Feature subset selection is performed by using SVM-RFE (Support Vector Machine with recursive feature elimination), mRMR (minimum Redundancy Maximum Relevance) and IG (information gain). Classification model is constructed based on the collected lip image features using multi-class SVM and Weighted multi-class SVM (WSVM). In addition, we compare SVM with k-nearest neighbor (kNN) algorithm, Multiple Asymmetric Partial Least Squares Classifier (MAPLSC) and Naïve Bayes for the diagnosis performance comparison. All displayed faces image have obtained consent from the participants. RESULTS: A total of 257 lip images are collected for the modeling of lip diagnosis in TCM. The feature selection method SVM-RFE selects 9 important features which are composed of 5 color component features, 3 texture features and 1 moment feature. SVM, MAPLSC, Naïve Bayes, kNN showed better classification results based on the 9 selected features than the results obtained from all the 84 features. The total classification accuracy of the five methods is 84%, 81%, 79% and 81%, 77%, respectively. So SVM achieves the best classification accuracy. The classification accuracy of SVM is 81%, 71%, 89% and 86% on Deep-red, Pale Purple, Red and lip image models, respectively. While with the feature selection algorithm mRMR and IG, the total classification accuracy of WSVM achieves the best classification accuracy. Therefore, the results show that the system can achieve best classification accuracy combined with SVM classifiers and SVM-REF feature selection algorithm. CONCLUSIONS: A diagnostic system is proposed, which firstly segments the lip from the original facial image based on the Chan-Vese level set model and Otsu method, then extracts three kinds of features (color space features, Haralick co-occurrence features and Zernike moment features) on the lip image. Meanwhile, SVM-REF is adopted to select the optimal features. Finally, SVM is applied to classify the four classes. Besides, we also compare different feature selection algorithms and classifiers to verify our system. So the developed automatic and quantitative diagnosis system of TCM is effective to distinguish four lip image classes: Deep-red, Purple, Red and Pale. This study puts forward a new method and idea for the quantitative examination on lip diagnosis of TCM, as well as provides a template for objective diagnosis in TCM.

[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.

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.

[Automatic classification of lip color based on SVM in traditional Chinese medicine inspection].

The lip color of a person is closely related to his or her health in the visual diagnosis of traditional Chinese medicine (TCM). The traditional method to judge the color of lips is through observing by a TCM doctor. The diagnosis result is affected not only by the doctor's knowledge and diagnosis experience, but also by the light, temperature and other environmental impacts. For these reasons, sometimes different doctors may make different judgement for the same lips. So it is urgently needed that an objective evaluation as reference for doctors can be obtained. A method based on support vector machine (SVM) that classifies lip color by computer automatically is presented in the present paper. Firstly, nine features of lip color in Hue, Saturation and Intensity (HSI) color space were extracted. Then, according to different combinations of these features five different experiments were conducted. By comparing the results of these experiments, it was discovered that the mean value is one of the most important features for the lip color. The overall effect of classification is better when the mean value and variance of HSI were chosen than other characteristics. In addition, experiments results demonstrated that the accuracy rate of classification is not improved when more features were adopted. The objective of the present paper is to select the appropriate characteristics and to combine them effectively to classify lip colors.

[Research of the EEMD method to pulse analysis of traditional Chinese medicine based on different amplitudes of the added white noise].

The ensemble empirical mode decomposition (EEMD) can be used to overcome the mode mixing problem of empirical mode decomposition (EMD) effectively. The EEMD method and Hilbert-Huang Transform (HHT) can be used to analyze pulse signals of Traditional Chinese Medicine (TCM). The amplitudes of the added white noise were about 0.1 and 0.2 time standard deviation of the investigated signal respectively. The difference of average frequency and average energy of every mode between normal pulse, slippery pulse, wiry pulse and wiry-slippery pulse were demonstrated based on different amplitudes of the added white noise. The results showed that it is more in line with clinical practice when the amplitude of the added white noise is about 0.2 time standard deviation of the investigated signal.

[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.

Objective research of auscultation signals in Traditional Chinese Medicine based on wavelet packet energy and support vector machine.

This study aims at utilising Wavelet Packet Transform (WPT) and Support Vector Machine (SVM) algorithm to make objective analysis and quantitative research for the auscultation in Traditional Chinese Medicine (TCM) diagnosis. First, Wavelet Packet Decomposition (WPD) at level 6 was employed to split more elaborate frequency bands of the auscultation signals. Then statistic analysis was made based on the extracted Wavelet Packet Energy (WPE) features from WPD coefficients. Furthermore, the pattern recognition was used to distinguish mixed subjects' statistical feature values of sample groups through SVM. Finally, the experimental results showed that the classification accuracies were at a high level.

[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.

[Serum proteomics study of chronic gastritis with dampness syndrome in traditional Chinese medicine].

OBJECTIVE: To explore microcosmic information in chronic gastritis dampness syndrome by using serum proteomics of patients with chronic gastritis dampness syndrome. METHODS: Serum proteomics of 18 dampness syndrome cases, 17 non-dampness syndrome cases in chronic gastritis patients and 8 normal controls were analyzed by surface enhanced laser desorption/ionization-time of flight (SELDI-TOF) protein-chip. RESULTS: There was a high expression trend in three ratios of charge (of an electron) to mass (M/S) of 3.2 kD, 6.4 kD and 8.1 kD of protein expression spectrum from patients with chronic gastritis dampness syndrome, and the wave peak value was over 10 units. There was a low expression trend in above-mentioned sites of protein expression spectrum from patients with chronic gastritis non-dampness syndrome and normal group. The wave peak value of patients with chronic gastritis non-dampness syndrome was about or below 10 units, and the wave peak value in normal group was below 5 units. CONCLUSION: There exists a certain significance to explore biologic theory basis of chronic gastritis dampness syndrome by analyzing the serum proteomics.

[Immunological mechanism of exfoliative tongue fur in children with asthma].

OBJECTIVE: To explore the immunological mechanism of exfoliative tongue fur in children with asthma. METHODS: Thirty-nine children with asthma, twenty-eight children with repetitive respiratory tract infection (non-asthma) and eleven healthy children were divided into five groups, which were asthma with exfoliative fur or with non-exfoliative fur groups, non-asthma with exfoliative fur or with non-exfoliative fur groups and normal control group. The concentrations of keratin 13 and bcl-2 in cells exfoliated from tongue fur were detected by immunohistochemical method. The expression levels of blood cell chemokine receptor-3 (CCR-3) and CD4(+) were examined by flow cytometry, and the levels of serum cortisol and IgE were detected by radioimmunoassay. RESULTS: The levels of blood CD4(+) and CCR-3 of children with asthma and exfoliative fur were higher than those in the asthma with non-exfoliative fur group and the normal control group (P<0.05). The serum level of cortisol in the groups of asthma with exfoliative fur and non-asthma with exfoliative fur were lower than that in the other groups (P<0.05). The serum levels of IgE in asthma with exfoliative fur or with non-exfoliative fur groups were higher than that in the other groups (P<0.05). Concentrations of keratin 13 in the cells exfoliated from tongue fur in the groups of asthma or non-asthma with exfoliative fur were lower than that of the other groups (P<0.05). There was no significant difference of expression level of bcl-2 in the cells exfoliated from tongue fur among these five groups. CONCLUSION: There is a reasonably close relationship between the formation of exfoliative tongue fur and the immune system such as low level of serum cortisol and high levels of blood CD4(+) and CCR-3, which may all promote the formation of exfoliative fur. The disability of keratinization and apoptosis of epithelial cells of tongue may also be one cause for its formation.