Traditional Chinese Medicine Constitution Identification Based on Objective Facial and Tongue Features: A Delphi Study and a Diagnostic Nomogram for Blood Stasis Constitution

Abstract

Objective. The aim of this study was to systematically summarize and form an expert consensus on the theoretical experience of tongue and facial features for the identification of nine types of traditional Chinese medicine (TCM) constitution. Additionally, we sought to explore the feasibility of TCM constitution identification through objective tongue and facial features. Methods. We used Delphi method to investigate the opinions of experts on facial and tongue feature items for identifying TCM constitution. We developed and validated a diagnostic nomogram for blood stasis constitution (BSC) based on objective facial and tongue features to demonstrate the reliability of expert consultation. Results. Eleven experts participated in two rounds of expert consultation. The recovery rates of the two rounds of expert consultation were 100.0% and 90.9%. After the first round, 39 items were screened out from 147 initial items, and 2 items were supplemented by experts. In the second round, 7 items were eliminated, leaving 34 items for 8 types of TCM constitution. The coefficient of variation in the first round was 0.11–0.49 for the 147 items and 0.11–0.29 for the included items. The coefficient of variation in the second round was 0.10–0.27 for the 41 items and 0.10–0.20 for the included items. The W value was 0.548 ( P < 0.001 ) in the first round and 0.240 ( P < 0.001 ) in the second round. Based on expert consultation, we selected BSC as an example and developed and validated a diagnostic nomogram consisting of six indicators: sex, hair volume, lip color-dark purple, susceptibility-facial pigmentation/chloasma/ecchymosis, zygomatic texture-red blood streaks, and sublingual vein-varicose and dark purple. The nomogram showed good discrimination (AUC: 0.917 [95% confidence interval [CI], 0.877–0.956] for the primary dataset, 0.902 [95% CI, 0.828–0.976] for the validation dataset) and good calibration. Decision curve analysis demonstrated that the nomogram was clinically useful. Conclusion. This is the first study to systematically summarize the existing knowledge and clinical experience to form an expert consensus on the tongue and facial features of nine types of TCM constitution. Our results will provide important prior knowledge and expert experience for future constitution identification research. Based on expert consultation, this study presents a nomogram for BSC that incorporates objective facial and tongue features, which can be conveniently used to facilitate the individualized identification of BSC.

Prospective Visual Inspection of the Ventrum of Tongue (VIVOT) Vasculature Predicts the Presence of Esophageal Varices

“…Despite many and varying EV interventions, detection is an important first step and likely cost-effective with VIVOT. While it would be difficult to summarize the traditional Chinese literature regarding the role of tongue evaluation, there is a recent enlightening publication [16] where a nomogram of facial and sublingual features yields an indication of "blood stasis constitution". Certainly, the detection of EVs by traditional Chinese medicine would be an exemplar of a static blood system with venous distention.…”

A New Method for Identification of Traditional Chinese Medicine Constitutions Based on Data of Tongue features with Machine Learning

“…It is possible to distinguish TCM constitution by tongue image with the objective development of tongue image. Many scholars [13] have studied the feasibility of "distinguishing TCM constitution by tongue image" by extracting the features data of tongue image by computer. For example, Xi Guan et al [14] compared the differences in tongue characteristics among people with Yin de ciency, Yang de ciency, and balanced constitution by statistical methods.…”