Cold-Heat and Excess-Deficiency Pattern Identification Based on Questionnaire, Pulse, and Tongue in Cancer Patients: A Feasibility Study

Yujin Choi; Soo-Dam Kim; Ojin Kwon; Hyo-Ju Park; JiHye Kim; Woosu Choi; Myung-Hyun Ko; Su-Jeung Ha; Si-Yeon Song; So-Jung Park; Hwa-Seung Yoo; Mi-Kyung Jeong; Choi, Yujin; Kim, Soo-Dam; Kwon, Ojin; Park, Hyo-Ju; Kim, JiHye; Choi, Woosu; Ko, Myung-Hyun; Ha, Su-Jeung; Song, Si-Yeon; Park, So-Jung; Yoo, Hwa-Seung; Jeong, Mi-Kyung

doi:10.13048/jkm.21001

JKM > Volume 42(1); 2021 > Article

Choi, Kim, Kwon, Park, Kim, Choi, Ko, Ha, Song, Park, Yoo, and Jeong: Cold-Heat and Excess-Deficiency Pattern Identification Based on Questionnaire, Pulse, and Tongue in Cancer Patients: A Feasibility Study

Original Article

The Journal of Korean Medicine 2020; 42(1): 1-11.

Published online: March 01, 2021

DOI: https://doi.org/10.13048/jkm.21001

Cold-Heat and Excess-Deficiency Pattern Identification Based on Questionnaire, Pulse, and Tongue in Cancer Patients: A Feasibility Study

Yujin Choi¹^{, †}

, Soo-Dam Kim²^{, †}

, Ojin Kwon¹

, Hyo-Ju Park¹

, JiHye Kim¹

, Woosu Choi³

, Myung-Hyun Ko²

, Su-Jeung Ha²

, Si-Yeon Song²

, So-Jung Park²

, Hwa-Seung Yoo⁴^{, *}

, Mi-Kyung Jeong¹^{, *}

¹Clinical Medicine Division, Korea Institute of Oriental Medicine

²East West Cancer Center, Daejeon Korean Medicine Hospital of Daejeon University

³Future Medicine Division, Korea Institute of Oriental Medicine

⁴East West Cancer Center, Seoul Korean Medicine Hospital of Daejeon University

Correspondence to: 유화승 서울시 송파구 법원로 11길 32 대전대학교 서울한방병원 Tel：+82-2-2222-8100, Fax：+82-2-2222-8111, E-mail: altyhs@dju.kr

Correspondence to: 정미경 대전광역시 유성구 유성대로 1672 한국한의학연구원 임상의학부 Tel：+82-42-868-9475, Fax：+82-42-869-2724, E-mail: oiny2000@kiom.re.kr

† Y Choi and SD Kim contributed equally this work

Received September 01, 2020 Revised October 27, 2020 Accepted November 12, 2020

Abstract

Objectives

This pilot study aimed to evaluate the agreement between traditional face-to-face Korean medicine (KM) pattern identification and non-face-to-face KM pattern identification using the data from related questionnaires, tongue image, and pulse features in patients with cancer.

Methods

From January to June 2020, 16 participants with a cancer diagnosis were recruited at the one Korean medicine hospital. Three experienced Korean medicine doctors independently diagnosed the participants whether they belong to the cold pattern or not, heat pattern or not, deficiency pattern or not, and excess pattern or not. Another researcher collected KM pattern related data using questionnaires including Cold-Heat Pattern Identification (CHPI), tongue image analysis system, and pulse analyzer. Collected KM pattern related data without participants’ identifier was provided for the three Korean medicine doctors in random order, and non-face-to-face KM pattern identification was carried out. The kappa value between face-to-face and non-face-to-face pattern identification was calculated.

Results

From the face-to-face pattern identification, there were 13/3 cold/non-cold pattern, 4/12 heat/non-heat pattern, 14/2 deficiency/non-deficiency pattern, and 0/16 excess/non-excess pattern participants. In cold/non-cold pattern, kappa value was 0.455 (sensitivity: 0.85, specificity: 0.67, accuracy: 0.81). In heat/non-heat pattern, the kappa value was 0.429 (sensitivity: 0.75, specificity: 0.72, accuracy: 0.75). The kappa value of deficiency/non-deficiency and excess/non-excess pattern was not calculated because of the few participants of non-deficiency, and excess pattern.

Conclusions

The agreement between traditional face-to-face pattern identification and non-face-to-face pattern identification seems to be moderate. The non-face-to-face pattern identification using questionnaires, tongue, and pulse features may feasible for the large clinical study.

Keywords: Pattern identification, Syndrome differentiation, Cold-Heat pattern, Deficiency-Excess pattern, Telemedicine, Non-face-to-face pattern identification

Table 1

General Characteristics of the Participants

	Male (N=4)	Female (N=12)	Total (N=16)
Age (year)	58.5 ± 8.50	54.42 ± 11.82	55.44 ± 10.97

Age Group, n (%)
~39	-	1 (8)	1 (6)
40~49	1 (25)	3 (25)	4 (25)
50~59	1 (25)	4 (33)	5 (31)
60~69	2 (50)	2 (17)	4 (25)
70~79	-	2 (17)	2 (13)

Height (cm)	168.5 ± 9.47	158.36 ± 4.69	160.89 ± 7.39

Weight (kg)	65.65 ± 14.53	54.35 ± 6.99	57.18 ± 10.18

Cancer Type, n (%)
Breast Cancer	-	5 (42)	5 (31)
Colon Cancer	-	2 (17)	2 (13)
Gastric Cancer	1 (25)	1 (8)	2 (13)
Other Cancer*	3 (75)	4 (33)	7 (44)

Treatment History, n (%)
Surgery	1 (25)	10 (83)	11 (69)
Chemotherapy	2 (50)	7 (58)	9 (56)
Radiation	-	1 (8)	1 (6)

Data are presented as n (%) or mean ± standard deviation.

* Other cancer includes: Prostate cancer, Thyroid cancer, Ampullar of vater cancer, lymphoma, Endometrial cancer, Lung cancer, Uterine sarcoma.

Table 2

The Pulse and Tongue Features and Questionnaire Score according to Face-To-Face (FTF) Cold-Heat Pattern Identification

	Cold			Heat

	Yes (N=13)	No (N=3)	P value	Yes (N=4)	No (N=12)	P value
Sex			0.999			0.505
Male	3 (23.1)	1 (33.3)		2 (50.0)	2 (16.7)
Female	10 (76.9)	2 (66.7)		2 (50.0)	10 (83.3)
Age	57.7 ± 10.7	45.7 ± 6.1	0.086	48.8 ± 7.9	57.7 ± 11.2	0.166
BMI	21.6 ± 1.5	22.0 ± 6.2	0.947	22.3 ± 4.4	21.5 ± 1.5	0.765

Pulse Features

SBP	125.8 ± 10.5	107.5 ± 7.8	0.035	117.0 ± 17.3	125.0 ± 10.5	0.312
DBP	78.5 ± 10.7	61.5 ± 4.9	0.050	69.3 ± 14.0	77.9 ± 11.0	0.268
Pulse rate	77.4 ± 11.4	85.5 ± 7.8	0.354	88.3 ± 7.4	76.0 ± 10.7	0.084
Pulse size	123.8 ± 23.3	120.0 ± 14.1	0.827	130.0 ± 20.0	121.7 ± 22.9	0.575
Pulse depth	76.9 ± 21.4	90.0 ± 14.1	0.425	80.0 ± 20.0	78.3 ± 21.7	0.906
Pulse shape	93.1 ± 11.8	105.0 ± 21.2	0.241	103.3 ± 15.3	92.5 ± 12.2	0.209

Tongue Features
Tongue body color			0.330			0.202
Pale	1 (7.7)	0 (0.0)		0 (0.0)	1 (8.3)
Light red	7 (53.8)	3 (100.0)		4 (100.0)	6 (50.0)
Red	5 (38.5)	0 (0.0)		0 (0.0)	5 (41.7)

Tongue coating			0.986			0.641
Thin	4 (30.8)	1 (33.3)		2 (50.0)	3 (25.0)
Normal	4 (30.8)	1 (33.3)		1 (25.0)	4 (33.3)
Thick	5 (38.5)	1 (33.3)		1 (25.0)	5 (41.7)

Tongue coating color			0.999			0.999
Normal	13 (100.0)	3 (100.0)		4 (100.0)	12 (100.0)
Yellow	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)

Tooth mark			0.620			0.999
Normal	9 (69.2%)	1 (33.3%)		2 (50.0%)	8 (66.7%)
Yes	4 (30.8%)	2 (66.7%)		2 (50.0%)	4 (33.3%)

Questionnaires*

Cold	27.2 ± 4.8	19.7 ± 5.5	0.032	20.8 ± 5.0	27.4 ± 4.9	0.034
Heat	16.2 ± 4.1	24.0 ± 2.6	0.009	23.5 ± 2.4	15.8 ± 3.9	0.003
Deficiency	84.6 ± 17.9	79.0 ± 8.7	0.611	81.2 ± 8.4	84.3 ± 18.6	0.758
Excess	68.5 ± 16.3	66.7 ± 10.1	0.860	68.8 ± 9.3	67.9 ± 16.9	0.928
Qi-De	12.3 ± 4.8	12.0 ± 3.0	0.918	12.5 ± 2.6	12.2 ± 5.0	0.902
Blood-De	7.8 ± 2.4	6.0 ± 1.7	0.23	6.5 ± 1.7	7.8 ± 2.5	0.340
Yin-De	7.0 [6.0; 9.0]	6.0 [5.0; 7.0]	0.191	6.0 ± 1.6	8.2 ± 2.2	0.091
Yang-De	7.7 ± 2.5	4.0 ± 1.7	0.031	4.5 ± 1.7	7.8 ± 2.6	0.031

Data are presented as n (%) or mean ± standard deviation.

FTF: Face to face

* Questionnaires: Cold (8 items), Heat (7 items), Deficiency (20 items), Excess (20 items), Qi-Deficiency (5 items), Blood-Deficiency (3 items), Yin-Deficiency (4 items), Yang-Deficiency (3 items)

Table 3

The Agreement Between Face-To-Face (FTF) Pattern Identification and CHPI Questionnaire

	CHPI	Yes	No	Sensitivity	Specificity	Accuracy	Kappa

	FTF
Cold	Yes	11	2	0.85	0.67	0.81	0.455
Cold	No	1	2	0.85	0.67	0.81	0.455

Heat	Yes	4	0	1.00	0.83	0.88	0.714
Heat	No	2	10	1.00	0.83	0.88	0.714

CHPI: Cold-Heat Pattern Identification (15 items), FTF: Face to face

Table 4

The Agreement between Face-To-Face (FTF) and non FTF Pattern Identification

	Non FTF	Yes	No	Sensitivity	Specificity	Accuracy	Kappa

	FTF
Cold	Yes	11	2	0.85	0.67	0.81	0.455
Cold	No	1	2	0.85	0.67	0.81	0.455

Heat	Yes	3	1	0.75	0.75	0.75	0.429
Heat	No	3	9	0.75	0.75	0.75	0.429

Deficiency	Yes	14	0	1.00	0.00	0.88	-
Deficiency	No	2	0	1.00	0.00	0.88	-

Excess	Yes	0	0	-	0.69	0.69	-
Excess	No	5	11	-	0.69	0.69	-

Qi-Deficiency	Yes	12	0	1.00	0.50	0.88	0.600
Qi-Deficiency	No	2	2	1.00	0.50	0.88	0.600

Yin-Deficiency	Yes	5	2	0.71	0.78	0.71	0.492
Yin-Deficiency	No	2	7	0.71	0.78	0.71	0.492

FTF: Face to face

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