Tongue Image Research Articles

Prediction of Dry Mouth Condition Using Radiomics Features from Tongue Diagnosis Image

Xerostomia, commonly known as dry mouth, is characterized by reduced salivary secretion, which can lead to various oral health issues and discomfort. In this paper, we propose a novel, non-invasive method for predicting xerostomia through the analysis of tongue images. To predict salivary gland secretion from tongue images, we collected images from patients who visited the hospital with complaints of dry mouth and measured their saliva secretion. Features were extracted from these tongue images, and correlation analysis was performed using machine learning techniques to assess the relationship between the extracted features and measured saliva secretion. We obtained tongue images and saliva secretion measurements from 176 patients. Images were cropped to 100 × 100 pixels, resulting in 462 features. The dataset was divided into training and test sets, consisting of 160 and 16 samples, respectively. The correlation coefficients for the training and test datasets were 0.9496 and 0.9415, respectively, while the correlation coefficient for the entire dataset was 0.9482. The estimated linear equation was y = 0.9244x + 2.1664. This study aimed to predict salivary gland secretion based on tongue images. By extracting features from color images and employing a neural network machine learning model, we estimated salivary gland secretion. With a sufficiently large dataset of tongue images, further advancements in regression analysis using deep learning techniques could enhance the accuracy of these predictions.

Application of tongue image characteristics and oral-gut microbiota in predicting pre-diabetes and type 2 diabetes with machine learning

BackgroundThis study aimed to characterize the oral and gut microbiota in prediabetes mellitus (Pre-DM) and type 2 diabetes mellitus (T2DM) patients while exploring the association between tongue manifestations and the oral-gut microbiota axis in diabetes progression.MethodsParticipants included 30 Pre-DM patients, 37 individuals with T2DM, and 28 healthy controls. Tongue images and oral/fecal samples were analyzed using image processing and 16S rRNA sequencing. Machine learning techniques, including support vector machine (SVM), random forest, gradient boosting, adaptive boosting, and K-nearest neighbors, were applied to integrate tongue image data with microbiota profiles to construct predictive models for Pre-DM and T2DM classification.ResultsSignificant shifts in tongue characteristics were identified during the progression from Pre-DM to T2DM. Elevated Firmicutes levels along the oral-gut axis were associated with white greasy fur, indicative of underlying metabolic changes. An SVM-based predictive model demonstrated an accuracy of 78.9%, with an AUC of 86.9%. Notably, tongue image parameters (TB-a, perALL) and specific microbiota (Escherichia, Porphyromonas-A) emerged as prominent diagnostic markers for Pre-DM and T2DM.ConclusionThe integration of tongue diagnosis with microbiome analysis reveals distinct tongue features and microbial markers. This approach significantly improves the diagnostic capability for Pre-DM and T2DM.

Tongue dorsum activity in children with velopharyngeal insufficiency vs. typically developing children.

To investigate whether children with velopharyngeal insufficiency (VPI) exhibit increased elevation and retraction of the tongue dorsum. Two quantitative metrics of tongue dorsum activity: Dorsum excursion Index (DEI) and Tongue Constraint Position Index (TCPI) were captured using mid-sagittal images of the tongue obtained from Ultrasound Tongue Imaging. Participants: Six children with velopharyngeal insufficiency (VPI), six children with palate (w/wo cleft lip) without velopharyngeal insufficiency (wo VPI) and ten typically developing children aged 6-15 repeated six different consonants in aCa and iCi contexts five times. A linear mixed-effect model was used to examine the response variables across three groups. Overall, DEI was not significantly higher in the VPI group than in the other two groups. Also, TCPI was not significantly lower in the cleft palate group (VPI and wo VPI). However, significant differences were detected between certain phonetic contexts in the VPI group. In addition, a significant interaction between group and consonant was found in the context of /i/. These findings suggest that the presence of VPI may not lead to a uniform increase in tongue dorsum elevation or retracted position across all speech sounds. Rather, the articulatory behaviours of children with VPI may be influenced by the specific phonetic context and individual variability.

The Relationship Between Computerized Face and Tongue Image Segmentation and Metabolic Parameters in Patients with Type 2 Diabetes Based on Machine Learning.

We aim to examine and reestablish the correlational and linear regression relationships, as well as the predictive value, between the significant facial and tongue features and the metabolic parameters in type 2 diabetes mellitus (T2DM). From March to May 2024, we studied 269 patients with T2DM in the endocrinology department of Shanghai Pudong Hospital. The patients' facial and tongue characteristics were sampling by a tongue imaging device equipped with artificial intelligence (AI) (XiMaLife, Sinology, China) of automated and advanced machine learning algorithms. Then, the imaging features were examined in relation to the blood examination. Multiple facial and tongue features, as well as dimensional facial and tongue color parameters, were significantly correlated with glycated hemoglobin A1c (HbA1c) (r < 0.3, p < 0.05), glycated albumin (GA) (-0.20 < 0.30, p < 0.05), C-peptide (-0.20.20, p < 0.05), plasma insulin (r < 0.30, p < 0.05), fasting plasma glucose (FPG) (r < 0.3, p < 0.05), significant hepatic and renal function indicators (-0.30 < r < 0.20, p<0.05), cardiac injury markers (-0.30 < r < 0.30, p < 0.05), tumor markers (-0.5 < r < 0.5, p < 0.05), thyroid function (-0.15 < r < 0.55, p < 0.05), and blood cell count, including white blood cells (r < 0.2, p < 0.05), and hemoglobin (Hb) (-0.30 < r < 0.3, 0.0001. The correlational results demonstrated that the tongue's characteristics and signsmay be linked with the dynamic of the metabolic status of T2DM. In order to examine the causal relationships, we performed linear regression analyses, which revealed that various facial and tongue imaging parameters partially determined the metabolic indicators. The predictive value of imaging features was evaluated by receiver operating characteristic curve (ROC) to assess metabolic status in T2DM. This study demonstrated that metabolic status, renal and hepatic, cardiac, and thyroid function, the proportion of blood cells, and Hb in T2DM were intimately associated with facial and tongue features. The precise analysis of facial and tongue features through AI and advanced machine learning could be used to predict T2DM's conditions and progression.

Anaemia Detection using Deep Learning by processing Conjunctiva, Fingernails, Palm and Tongue Images

Anaemia Detection using Deep Learning by processing Conjunctiva, Fingernails, Palm and Tongue Images

Chicken swarm algorithm with deep convolutional neural network based tongue image analysis for gastric cancer classification

Tongue images (the size, shape, and colour of tongue and the thickness, colour, and moisture content of tongue coating), reflecting the medical condition of entire body based on the model of traditional Chinese medicine (TCM) are extremely utilized in China for millions of years. Gastric cancer (GC) is great lethal kind of cancer in countries and societies. The screening and analysis of GC yet depend on gastroscopy, however its application was significantly restricted due to its invasive, maximum rate and the requirement for expert endoscopists. Early recognition in GC patients and direct treatment contribute significantly to safety for health. Consequently, this study introduces a Chicken Swarm Algorithm with Deep learningbased Tongue Image Analysis for Gastric Cancer Classification (CSADL-TIAGCC) system. The projected CSADL-TIAGCC approach studies the input tongue images for the identification and classification of GC. To accomplish this, the CSADL-TIAGCC system uses improved U-Net segmentation approach. Besides, residual network (ResNet-34) model-based feature extractor is used. Furthermore, long short term memory (LSTM) approach was exploited for GC classification and its hyperparameters are selected by the CSA. The simulation outcome of the CSADL-TIAGCC algorithm was examined under tongue image database. The experimental outcomes illustrate the enhanced results of the CSADL-TIAGCC technique with respect of different evaluation measures.

A new method for identification of traditional Chinese medicine constitution based on tongue features with machine learning.

The theory of Chinese medicine (TCM) constitution contributes to the optimisation of individualised healthcare programmes. However, at present, TCM constitution identification mainly relies on inefficient questionnaires with subjective bias. Efficient and accurate TCM constitution identification can play an important role in individualised medicine and healthcare. Building an efficient model for identifying traditional Chinese medicine constitutions using objective tongue features and machine learning techniques. The DS01-A device was applied to collect tongue images and extract features. We trained and evaluated five machine learning models: Support Vector Machine (SVM), Decision Tree (DT), Random Forest (RF), LightGBM (LGBM), and CatBoost (CB). Among these, we selected the model with the best performance as the base classifier for constructing our heterogeneous ensemble learning model. Using various performance metrics, including classification accuracy, precision, recall, F1 score, and area under curve (AUC), to comprehensively evaluate model performance. A total of 1149 tongue images were obtained and 45 features were extracted, forming dataset 1. RF, LGBM, and CB were selected as the base learners for the RLC-Stacking. On dataset 1, RLC-Stacking1 achieved an accuracy of 0.8122, outperforming individual classifiers. After feature selection, the classification accuracy of RLC-Stacking2 improved to 0.8287, an improvement of 0.00165 compared to RLC-Stacking1. RLC-Stacking2 achieved an accuracy exceeding 0.85 for identifying each TCM constitution type, indicating excellent identification performance. The study provides a reliable method for the accurate and rapid identification of TCM constitutions and can assist clinicians in tailoring individualized medical treatments based on personal constitution types and guide daily health care. The information extracted from tongue images serves as an effective marker for objective TCM constitution identification.

A systematic review of the application of machine learning techniques to ultrasound tongue imaging analysis.

B-mode ultrasound has emerged as a prevalent tool for observing tongue motion in speech production, gaining traction in speech therapy applications. However, the effective analysis of ultrasound tongue image frame sequences (UTIFs) encounters many challenges, such as the presence of high levels of speckle noise and obscured views. Recently, the application of machine learning, especially deep learning techniques, to UTIF interpretation has shown promise in overcoming these hurdles. This paper presents a thorough examination of the existing literature, focusing on UTIF analysis. The scope of our work encompasses four key areas: a foundational introduction to deep learning principles, an exploration of motion tracking methodologies, a discussion of feature extraction techniques, and an examination of cross-modality mapping. The paper concludes with a detailed discussion of insights gleaned from the comprehensive literature review, outlining potential trends and challenges that lie ahead in the field.

The Articulatory and Acoustic Representation of Second-Language French Vowels.

This study examines how L1 English-L2 French learners use L1 articulatory and acoustic categories to produce L2 vowels that are both similar to and different from their L1 vowels. Previous studies examining the relationship between L1 and L2 sound inventories have found that learners reuse L1 phone categories to produce L2 phones that are perceived as similar, but importantly, there is a lack of articulatory data included in these types of studies, which has reinforced the assumption that vowel categories can be solely represented by their acoustic properties. The present study uses ultrasound tongue imaging data and videos of lip rounding in addition to acoustic data to examine how L1 English-L2 French learners produce the French vowels /i y u e ø o/ compared with their English vowels /i u e o/. The results focus on individual paths to category formation to show how learners articulate L2 vowels, and reveal that they tend to reuse L1 tongue body gestures to produce the French vowels /i u e o/, and lip rounding gestures to produce the round vowels /y u o/. This study demonstrates that transfer of articulatory gestures depends on vowel quality and emphasizes the importance of using articulatory data to inform theories of L2 category formation.

Intelligent tongue diagnosis model for gastrointestinal diseases based on tongue images

BackgroundCurrently, the diagnosis of gastrointestinal diseases relies heavily on electronic endoscopy, which is not suitable for all individuals and insufficient for dynamic patient monitoring. Therefore, there is an urgent need for a convenient and noninvasive examination method to enhance the diagnosis and monitoring of gastrointestinal diseases. MethodsSince the tongue is a significant reflection of the digestive system and closely associated with gastrointestinal diseases, our study aims to develop a diagnostic framework based on tongue features. We have collected a dataset of 2,167 tongue coating images from 949 consecutive patients, including 905 images from healthy individuals and 1,262 images from patients with various gastrointestinal conditions. Notably, each patient sample may represent distinct gastrointestinal diseases. This study introduces a novel approach to information fusion detection, integrating hand-crafted and auto-encoded features, alongside disease detection employing Squeeze and Excitation (SE) and Slot attention mechanisms. These two branches respectively analyze image feature and spatial position information when utilizing tongue images for diagnosing gastrointestinal diseases. The amalgamation of predictions from both aspects yields the final detection outcome. ResultsFor both healthy and diseased cohorts, the optimal classification metrics were achieved: AUC = 0.886, ACC = 0.849, and TPR = 0.965, indicating satisfactory performance. Notably, our framework demonstrated promising results in detecting five common gastrointestinal diseases: Helicobacter pylori infection, bile reflux, reflux esophagitis, gastric erosion, and duodenal erosion. Ablation experiments underscored the efficacy of mixed features in multi-color space, showcasing an increase in AUC and ACC by 13.48 % and 12.05 % respectively. Furthermore, the attention mechanism, by focusing on the middle region of tongue images, contributed to a 6.12 % increase in AUC and a 6.35 % increase in ACC. ConclusionsIn this study, we successfully develop and validate a diagnosis framework for gastrointestinal diseases based on tongue image features. By utilizing tongue images, we achieve intelligent diagnosis of gastrointestinal diseases, establishing tongue diagnosis as a convenient, cost-effective, and noninvasive method for diagnosing and screening gastrointestinal diseases.

A Novel Tongue Coating Segmentation Method Based on Improved TransUNet.

As an important part of the tongue, the tongue coating is closely associated with different disorders and has major diagnostic benefits. This study aims to construct a neural network model that can perform complex tongue coating segmentation. This addresses the issue of tongue coating segmentation in intelligent tongue diagnosis automation. This work proposes an improved TransUNet to segment the tongue coating. We introduced a transformer as a self-attention mechanism to capture the semantic information in the high-level features of the encoder. At the same time, the subtraction feature pyramid (SFP) and visual regional enhancer (VRE) were constructed to minimize the redundant information transmitted by skip connections and improve the spatial detail information in the low-level features of the encoder. Comparative and ablation experimental findings indicate that our model has an accuracy of 96.36%, a precision of 96.26%, a dice of 96.76%, a recall of 97.43%, and an IoU of 93.81%. Unlike the reference model, our model achieves the best segmentation effect. The improved TransUNet proposed here can achieve precise segmentation of complex tongue images. This provides an effective technique for the automatic extraction in images of the tongue coating, contributing to the automation and accuracy of tongue diagnosis.

Development of an artificial intelligent model for pre-endoscopic screening of precancerous lesions in gastric cancer

BackgroundGiven the high cost of endoscopy in gastric cancer (GC) screening, there is an urgent need to explore cost-effective methods for the large-scale prediction of precancerous lesions of gastric cancer (PLGC). We aim to construct a hierarchical artificial intelligence-based multimodal non-invasive method for pre-endoscopic risk screening, to provide tailored recommendations for endoscopy.MethodsFrom December 2022 to December 2023, a large-scale screening study was conducted in Fujian, China. Based on traditional Chinese medicine theory, we simultaneously collected tongue images and inquiry information from 1034 participants, considering the potential of these data for PLGC screening. Then, we introduced inquiry information for the first time, forming a multimodality artificial intelligence model to integrate tongue images and inquiry information for pre-endoscopic screening. Moreover, we validated this approach in another independent external validation cohort, comprising 143 participants from the China-Japan Friendship Hospital.ResultsA multimodality artificial intelligence-assisted pre-endoscopic screening model based on tongue images and inquiry information (AITonguequiry) was constructed, adopting a hierarchical prediction strategy, achieving tailored endoscopic recommendations. Validation analysis revealed that the area under the curve (AUC) values of AITonguequiry were 0.74 for overall PLGC (95% confidence interval (CI) 0.71–0.76, p < 0.05) and 0.82 for high-risk PLGC (95% CI 0.82–0.83, p < 0.05), which were significantly and robustly better than those of the independent use of either tongue images or inquiry information alone. In addition, AITonguequiry has superior performance compared to existing PLGC screening methodologies, with the AUC value enhancing 45% in terms of PLGC screening (0.74 vs. 0.51, p < 0.05) and 52% in terms of high-risk PLGC screening (0.82 vs. 0.54, p < 0.05). In the independent external verification, the AUC values were 0.69 for PLGC and 0.76 for high-risk PLGC.ConclusionOur AITonguequiry artificial intelligence model, for the first time, incorporates inquiry information and tongue images, leading to a higher precision and finer-grained pre-endoscopic screening of PLGC. This enhances patient screening efficiency and alleviates patient burden.

AI: Bridging Ancient Wisdom and Modern Innovation in Traditional Chinese Medicine.

The pursuit of groundbreaking health care innovations has led to the convergence of artificial intelligence (AI) and traditional Chinese medicine (TCM), thus marking a new frontier that demonstrates the promise of combining the advantages of ancient healing practices with cutting-edge advancements in modern technology. TCM, which is a holistic medical system with >2000 years of empirical support, uses unique diagnostic methods such as inspection, auscultation and olfaction, inquiry, and palpation. AI is the simulation of human intelligence processes by machines, especially via computer systems. TCM is experience oriented, holistic, and subjective, and its combination with AI has beneficial effects, which presumably arises from the perspectives of diagnostic accuracy, treatment efficacy, and prognostic veracity. The role of AI in TCM is highlighted by its use in diagnostics, with machine learning enhancing the precision of treatment through complex pattern recognition. This is exemplified by the greater accuracy of TCM syndrome differentiation via tongue images that are analyzed by AI. However, integrating AI into TCM also presents multifaceted challenges, such as data quality and ethical issues; thus, a unified strategy, such as the use of standardized data sets, is required to improve AI understanding and application of TCM principles. The evolution of TCM through the integration of AI is a key factor for elucidating new horizons in health care. As research continues to evolve, it is imperative that technologists and TCM practitioners collaborate to drive innovative solutions that push the boundaries of medical science and honor the profound legacy of TCM. We can chart a future course wherein AI-augmented TCM practices contribute to more systematic, effective, and accessible health care systems for all individuals.

Tongue Disease Prediction Based on Machine Learning Algorithms

The diagnosis of tongue disease is based on the observation of various tongue characteristics, including color, shape, texture, and moisture, which indicate the patient’s health status. Tongue color is one such characteristic that plays a vital function in identifying diseases and the levels of progression of the ailment. With the development of computer vision systems, especially in the field of artificial intelligence, there has been important progress in acquiring, processing, and classifying tongue images. This study proposes a new imaging system to analyze and extract tongue color features at different color saturations and under different light conditions from five color space models (RGB, YcbCr, HSV, LAB, and YIQ). The proposed imaging system trained 5260 images classified with seven classes (red, yellow, green, blue, gray, white, and pink) using six machine learning algorithms, namely, the naïve Bayes (NB), support vector machine (SVM), k-nearest neighbors (KNN), decision trees (DTs), random forest (RF), and Extreme Gradient Boost (XGBoost) methods, to predict tongue color under any lighting conditions. The obtained results from the machine learning algorithms illustrated that XGBoost had the highest accuracy at 98.71%, while the NB algorithm had the lowest accuracy, with 91.43%. Based on these obtained results, the XGBoost algorithm was chosen as the classifier of the proposed imaging system and linked with a graphical user interface to predict tongue color and its related diseases in real time. Thus, this proposed imaging system opens the door for expanded tongue diagnosis within future point-of-care health systems.

Tongue image fusion and analysis of thermal and visible images in diabetes mellitus using machine learning techniques

The study aimed to achieve the following objectives: (1) to perform the fusion of thermal and visible tongue images with various fusion rules of discrete wavelet transform (DWT) to classify diabetes and normal subjects; (2) to obtain the statistical features in the required region of interest from the tongue image before and after fusion; (3) to distinguish the healthy and diabetes using fused tongue images based on deep and machine learning algorithms. The study participants comprised of 80 normal subjects and age- and sex-matched 80 diabetes patients. The biochemical tests such as fasting glucose, postprandial, Hba1c are taken for all the participants. The visible and thermal tongue images are acquired using digital single lens reference camera and thermal infrared cameras, respectively. The digital and thermal tongue images are fused based on the wavelet transform method. Then Gray level co-occurrence matrix features are extracted individually from the visible, thermal, and fused tongue images. The machine learning classifiers and deep learning networks such as VGG16 and ResNet50 was used to classify the normal and diabetes mellitus. Image quality metrics are implemented to compare the classifiers’ performance before and after fusion. Support vector machine outperformed the machine learning classifiers, well after fusion with an accuracy of 88.12% compared to before the fusion process (Thermal-84.37%; Visible-63.1%). VGG16 produced the classification accuracy of 94.37% after fusion and attained 90.62% and 85% before fusion of individual thermal and visible tongue images, respectively. Therefore, this study results indicates that fused tongue images might be used as a non-contact elemental tool for pre-screening type II diabetes mellitus.

S5Utis: Structured State-Space Sequence SegNeXt UNet-like Tongue Image Segmentation in Traditional Chinese Medicine.

Intelligent Traditional Chinese Medicine can provide people with a convenient way to participate in daily health care. The ease of acceptance of Traditional Chinese Medicine is also a major advantage in promoting health management. In Traditional Chinese Medicine, tongue imaging is an important step in the examination process. The segmentation and processing of the tongue image directly affects the results of intelligent Traditional Chinese Medicine diagnosis. As intelligent Traditional Chinese Medicine continues to develop, remote diagnosis and patient participation will play important roles. Smartphone sensor cameras can provide irreplaceable data collection capabilities in enhancing interaction in smart Traditional Chinese Medicine. However, these factors lead to differences in the size and quality of the captured images due to factors such as differences in shooting equipment, professionalism of the photographer, and the subject's cooperation. Most current tongue image segmentation algorithms are based on data collected by professional tongue diagnosis instruments in standard environments, and are not able to demonstrate the tongue image segmentation effect in complex environments. Therefore, we propose a segmentation algorithm for tongue images collected in complex multi-device and multi-user environments. We use convolutional attention and extend state space models to the 2D environment in the encoder. Then, cross-layer connection fusion is used in the decoder part to fuse shallow texture and deep semantic features. Through segmentation experiments on tongue image datasets collected by patients and doctors in real-world settings, our algorithm significantly improves segmentation performance and accuracy.

Association between color value of tongue and T2DM based on dose-response analyses using restricted cubic splines in China: A cross-sectional study.

This study aimed to explore the relationship between international commission on illumination (CIE) L*a*b* color value of tongue and type 2 diabetes mellitus (T2DM). We used restricted cubic spline method and logistic regression method to assess the relationship between CIE L*a*b* color value of tongue and T2DM. A total of 2439 participants (991 T2DM and 1448 healthy) were included. A questionnaire survey and tongue images obtained with tongue diagnosis analysis-1 were analyzed. As required, chi-square and t tests were applied to compare the T2DM and healthy categories. Our findings suggest the 95% confidence interval and odds ratio for body mass index, hypertension, and age were 0.670 (0.531-0.845), 13.461 (10.663-16.993), and 2.595 (2.324-2.897), respectively, when compared to the healthy group. A linear dose-response relationship with an inverse U-shape was determined between CIE L* and CIE a* values and T2DM (P < .001 for overall and P < .001 for nonlinear). Furthermore, U-shaped and linear dose-response associations were identified between T2DM and CIE b* values (P = .0160 for nonlinear). Additionally, in adults, the CIE L*a*b* color value had a correlation with T2DM. This novel perspective provides a multidimensional understanding of traditional Chinese medicine tongue color, elucidating the potential of CIE L*a*b* color values of tongue in the diagnosis of T2DM.

Circadian Rhythms in Tongue Features.

(1) Background: The aim of this study was to investigate the circadian rhythms of tongue features according to the effects of physiological phases over a 24 h period. (2) Methods: Fifteen healthy participants aged 20 to 69 years were recruited. The participants did not have current chronic diseases or past diseases and had to meet the inclusion and exclusion criteria. The participants stayed at the Gil Hospital for a duration of 2 nights and 3 days. On the first day, at 18:00, they consumed their allocated portions of food and water and then completed a questionnaire. At approximately 21:00, their tongue images were acquired using a computerized tongue image acquisition system, following which they slept for 8 h, commencing at 23:00. Measurements were taken from 07:00 through 21:00 on the second day, and the final acquisition was taken at 07:00 on the following morning, resulting in a total of eight images. The circadian rhythm was authenticated and quantified utilizing the single cosinor analysis, a technique for periodic regression analysis for fitting a 24 h cosine curve. (3) Results: Cosinor analysis revealed that all tongue features were significantly related to circadian rhythm. (4) Conclusions: The results of this study may be important for considering the time of day at which the tongue is observed and tongue status is evaluated.

Tongue image feature correlation analysis in benign lung nodules and lung cancer

ObjectiveTo analyze the differences in the correlation of tongue image indicators among patients with benign lung nodules and lung cancer. MethodsFrom July 1, 2020 to March 31, 2022, clinical information of lung cancer patients and benign lung nodules patients was collected at the Oncology Department of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine and the Physical Examination Center of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, respectively. We obtained tongue images from patients with benign lung nodules and lung cancer using the TFDA-1 digital tongue diagnosis instrument, and analyzed these images with the TDAS V2.0 software. The extracted indicators included color space parameters in the Lab system for both the tongue body (TB) and tongue coating (TC) (TB/TC-L, TB/TC-a, and TB/TC-b), textural parameters [TB/TC-contrast (CON), TB/TC-angular second moment (ASM), TB/TC-entropy (ENT), and TB/TC-MEAN], as well as TC parameters (perAll and perPart). The bivariate correlation of TB and TC features was analyzed using Pearson’s or Spearman’s correlation analysis, and the overall correlation was analyzed using canonical correlation analysis (CCA). ResultsSamples from 307 patients with benign lung nodules and 276 lung cancer patients were included after excluding outliers and extreme values. Simple correlation analysis indicated that the correlation of TB-L with TC-L, TB-b with TC-b, and TB-b with perAll in lung cancer group was higher than that in benign nodules group. Moreover, the correlation of TB-a with TC-a, TB-a with perAll, and the texture parameters of the TB (TB-CON, TB-ASM, TB-ENT, and TB-MEAN) with the texture parameters of the TC (TC-CON, TC-ASM, TC-ENT, and TC-MEAN) in benign nodules group was higher than lung cancer group. CCA further demonstrated a strong correlation between the TB and TC parameters in lung cancer group, with the first and second pairs of typical variables in benign nodules and lung cancer groups indicating correlation coefficients of 0.918 and 0.817 (P < 0.05), and 0.940 and 0.822 (P < 0.05), respectively. ConclusionBenign lung nodules and lung cancer patients exhibited differences in correlation in the L, a, and b values of the TB and TC, as well as the perAll value of the TC, and the texture parameters (TB/TC-CON, TB/TC-ASM, TB/TC-ENT, and TB/TC-MEAN) between the TB and TC. Additionally, there were differences in the overall correlation of the TB and TC between the two groups. Objective tongue diagnosis indicators can effectively assist in the diagnosis of benign lung nodules and lung cancer, thereby providing a scientific basis for the early detection, diagnosis, and treatment of lung cancer.

Deep learning-based recognition of stained tongue coating images

ObjectiveTo build a dataset encompassing a large number of stained tongue coating images and process it using deep learning to automatically recognize stained tongue coating images. MethodsA total of 1 001 images of stained tongue coating from healthy students at Hunan University of Chinese Medicine and 1 007 images of pathological (non-stained) tongue coating from hospitalized patients at The First Hospital of Hunan University of Chinese Medicine with lung cancer, diabetes, and hypertension were collected. The tongue images were randomized into the training, validation, and testing datasets in a 7 : 2 : 1 ratio. A deep learning model was constructed using the ResNet50 for recognizing stained tongue coating in the training and validation datasets. The training period was 90 epochs. The model’s performance was evaluated by its accuracy, loss curve, recall, F1 score, confusion matrix, receiver operating characteristic (ROC) curve, and precision-recall (PR) curve in the tasks of predicting stained tongue coating images in the testing dataset. The accuracy of the deep learning model was compared with that of attending physicians of traditional Chinese medicine (TCM). ResultsThe training results showed that after 90 epochs, the model presented an excellent classification performance. The loss curve and accuracy were stable, showing no signs of overfitting. The model achieved an accuracy, recall, and F1 score of 92%, 91%, and 92%, respectively. The confusion matrix revealed an accuracy of 92% for the model and 69% for TCM practitioners. The areas under the ROC and PR curves were 0.97 and 0.95, respectively. Conclusion: The deep learning model constructed using ResNet50 can effectively recognize stained coating images with greater accuracy than visual inspection of TCM practitioners. This model has the potential to assist doctors in identifying false tongue coating and preventing misdiagnosis.