Construction of a Standardized Tongue Image Database for Diagnostic Education: Development of a Tongue Diagnosis e-Learning System

Abstract

Tongue examination is an important diagnostic method for judging pathological conditions in Kampo (traditional Japanese medicine), but it is not easy for beginners to learn the diagnostic technique. One reason is that there are few objective diagnostic criteria for tongue examination findings, and the educational method for tongue examination is not standardized in Japan, warranting the need for a tongue image database for e-learning systems that could dramatically improve the efficiency of education. Therefore, we constructed a database comprising tongue images whose findings were determined on the basis of votes given by five Kampo medicine specialists (KMSs) and confirmed the educational usefulness of the database for tongue diagnosis e-learning systems. The study was conducted in the following five steps: development of a tongue imaging collection system, collection of tongue images, evaluation and annotation of tongue images, development of a tongue diagnosis e-learning system, and verification of the educational usefulness of this system. Five KMSs evaluated the tongue images obtained from 125 participants in the following eight aspects: (i) tongue body size, (ii) tongue body color, (iii) tongue body dryness and wetness, (iv) tooth marks on the edge of the tongue, (v) cracks on the surface of the tongue, (vi) thickness of tongue coating, (vii) color of tongue coating, and (viii) dryness and wetness of tongue coating. Medical students (MSs) were given a tongue diagnosis test using an e-learning system after a lecture on tongue diagnosis. The cumulative and individual match rates (%) (individual match rates of 100% (5/5), 80% (4/5), and 60% (3/5) are shown in parentheses, respectively) were as follows: (i) tongue body size: 92.8 (26.4/26.4/40.0); (ii) tongue body color: 83.2 (10.4/20.8/52.0); (iii) tongue body dryness and wetness: 88.8 (13.6/34.4/40.8); (iv) tooth marks on the edge of the tongue: 88.8 (6.4/35.2/47.2); (v) cracks on the surface of the tongue: 96.8 (24.0/35.2/37.6); (vi) thickness of tongue coating: 84.8 (7.2/21.6/56.0); (vii) color of tongue coating: 88.0 (15.2/37.6/35.2); and (viii) dryness and wetness of tongue coating: 74.4 (4.8/19.2/50.4). The test showed that the tongue diagnosis ability of MSs who attended a lecture on tongue diagnosis was almost the same as that of KMSs. We successfully constructed a tongue image database standardized for training specialists on tongue diagnosis and confirmed the educational usefulness of the e-learning system using a database. This database will contribute to the standardization and popularization of Kampo education.

Objective evaluation of tongue diagnosis ability using a tongue diagnosis e-learning/e-assessment system based on a standardized tongue image database

“…The final diagnosis determined by a majority vote of 5 KS-D participants is linked to the tongue image and constructed database. Details have been reported previously ( 10 ). **Five KS-D participants answered the questions of the test (second diagnosis).…”

“…Details regarding the development of the tongue image acquisition device and the construction of the tongue image database were described in a previous report ( 10 ), meaning that they are briefly described below. Five KSs diagnosed the color and morphological characteristics of 125 tongue images from eight viewpoints.…”

“…Next, we developed a tongue diagnosis e-learning/e-assessment system that utilizes images from a quality-guaranteed tongue image database ( 10 ). This system makes it possible to learn without restrictions on time, place, and equipment and perform self-evaluation of tongue diagnostic ability.…”

“…Following examination, the average value of the examinee's grade and all examinees’ grades are displayed on the radar chart for each of the eight viewpoints to ensure that they can objectively grasp the level of their diagnostic ability. The clinical significance of each tongue finding has been previously described ( 10 ).…”

“…We constructed a standardized tongue image database based on the diagnosis results of multiple KSs and developed a tongue diagnosis e-learning system and reported its educational usefulness previously ( 10 ). This study aimed to verify the practicality of this system as an objective evaluation tool for tongue diagnosis.…”