4Bull. Soc. Photogr. Imag. Japan. (2018) Vol. 28 No. 1: 4–8

Technical Report

Effect of Fixing a Tiny Wearable Display on a Tongue Imaging Analyzing System(TIAS) to Improve Stability of Tongue Presentation
Takayuki Uchidaa*, Kei Yoshiharaa, Shuhei Uedaa, Toshiya Nakaguchib, Koichi Sakauec, Takao Namikid,
Yoichi Miyakea,bAbstract:

The tongue is said to express the condition of the entire body. Therefore, tongue diagnosis is an important diagnosis method in Kampo Medicine. Changes in the color of different parts of the tongue reflect different health conditions. Digital tongue image capturingsystems such as the tongue image analyzing system (TIAS), are aimed at performing diagnosis at a low cost, before the occurrence ofillness. We successfully acquired a digital tongue image using the TIAS. However, it is difficult to designate the same analysis region
among datasets owing to instability of tongue indication by participants (human subjects) without shape normalization.
In this study, we examined the effect of attaching a small viewer to a TIAS to improve the stability of tongue presentation and theaccuracy of color evaluation.

Key words:

tongue diagnosis, tongue imaging, oriental medicine, pre–illness, diagnosis by color

1. Introduction
Tongue diagnosis is one of the diagnostic methods used in Japanese traditional Kampo medicine. In Kampo medicine, it is considered that the condition of the tongue reflects that of the whole body.
It is possible to diagnose the physical condition of patients fromvarious tongue characteristics, including color, shape, wetness, tongue
coating, and texture. In addition, when making a tongue diagnosis,
there are cases in which diagnosis is performed by looking at thecolor of the tongue after dividing it into specific areas rather thanlooking at the entire tongue.
Multiple studies have reported a correlation between the shapeand color of the tongue and an individual’s health1, 2). However, mostpeople are unaware of how to present their tongues and therefore
require practice and guidance for proper tongue indication. We attempted to improve tongue imaging diagnosis for the general population by attaching a tiny monitor to a tongue imaging analyzing
system (TIAS).

2. Method
Tongue images were obtained by using TIAS3) and digitized into
8×3 bits and 1024×1280 pixels, as shown in Figure 1(a). The diffuse
illumination required to obtain tongue images is provided in TIAS
using an integrating sphere. This enables tongue imaging without
Received 7th August, 2018; Accepted 17th August, 2018

aTokyo Polytechnic University, Atsugi Kanagawa, JAPANb

Center for Frontier Medical Engineering, Chiba University, Chiba, JAPANc

Takano Co., Ltd., Nagano, JAPANdGraduate School of Medicine, Chiba University, Chiba, JAPANE-mail : uchida@mega.t-kougei.ac.jp

glare. In this case, the doctor can see the image of the tongue of thesubject on the computer monitor, but the subject cannot see the image of their tongue. The measurement time is only approximately
20–100 s; however, the subject may feel uneasy owing to his/hermouth being opened wide and unfamiliarity with the required behavior (showing the tongue). This can cause tongue presentation tobe unstable.
To improve conditions, some studies were performed with tongue
shape normalization4). In this study, we tried to fix a tiny display to aTIAS to improve the stability of tongue indication itself. The firstchallenge of this method, as shown in Figure 1(a), was that there wasno space for fixing the monitor to the TIAS. To this end, we researched recently developed wearable displays. Figure 1(b) shows acommercially available wearable display. In the first scenario, wewore the wearable display (Glasses). This was useful for getting animage of our own tongue. However, it was difficult to wear it if already wearing other glasses. Additionally, lack of contact is a desirable medical treatment quality to eliminate the threat of possible
infection.
In the second scenario, we tried fixing the wearable display to theside of the device and used one eye to view the display, as shown inFigure 2. Since the position of the eyes of the examinee differs from
one individual to another, the position could be adjusted by using
the universal arm, as shown in Figure 3. The subject could see theirown tongue image real-time, as shown in Figure 4(c). Figure 4(a)Fig. 1Fig. 1
Takayuki Uchida, Kei Yoshihara, Shuhei Ueda, Toshiya Nakaguchi, Koichi Sakaue, Takao Namiki, Yoichi MiyakeFig.
Fig. 11

Fig. 2
Fig. 2
Figure 1

Effect of Fixing a Tiny Wearable Display on a Tongue Imaging Analyzing System (TIAS) to Improve Stability of Tongue Presentation

(a)
(a)

(b)
(b)

(a)
(a)

(b)
(b)

(a) Image of TIAS for a human participant. (b) TIAS with wearable display.

Fig.
Fig. 22

Figure 2

(a)
(a)

(b)
(b)

Fig. 3

Concept picture of TIAS using one eye of the wearable display.

(a)(a)
shows a photograph of the TIAS using one eye of the wearable display, Figure 4(b) shows the tongue image that the doctor sees on acomputer, and Figure 4(c) shows the image of the tongue on thewearable display that the examinee sees.
By using one eye of the wearable display as shown Figure 4, we
tried to confirm the effect of affixing a tiny wearable display to aTIAS. Figure 5(a) shows tongue shapes with the wearable display
and Figure 5(b) shows tongue shapes without the wearable display.
In this case, vertical rate of change of tongue outline at 5 and 20 s
was 5.9% without the display and 1.3% with the display.
2a. Usability of wearable display
In this study, we used smart glass (OLED display) with a resoluFig. 4(b)(b)

8888Figure 3

Photograph of TIAS using one eye of the wearable display.

56Fig. 4

Fig. 5

Bull. Soc. Photogr. Imag. Japan. Vol. 28 No. 1 (2018)

Figure 4(a) Photograph of TIAS using one eye of the wearable display, (b) tongue image indicated on themedical practitioner’s computer, and (c) tongue image on the wearable display (subject person side).

9(a)Figure 5(b) xample of tongue shape at 5 and 20 s, (a) with the wearable display, (b) without the wearE
able display.

Fig.of61280 × 720 dot and 8×3 bit, respectively. However,tion and color
this device is a multifunctional pair of smart glasses not suitable fora use as an external monitor. Because image data is wirelessly transmitted to the main body, instances such as display delay or disconnection of images are likely to occur. We thus changed the resolution
to 960 × 540 dot (LCOS display). This tiny wearable display has a
HDMI input, and therefore, is easy to use for TIAS, as shown inFigure 6.

3. Results and Discussion
Effect of fixing a tiny wearable display to a TIAS
By using the tiny wearable display shown in Figure 6, we confirmed the effectiveness of the display. Images of the tongue of eightsubjects were obtained with and without the display. The tongue indication could be influenced by familiarity and experience with theprocess. Therefore, first, images were obtained with glasses for four
subjects (subjects A–D) and then images were obtained without
glasses for the four remaining subjects (subjects E–H).
Figure 7(a) shows one of the tongue images, and Figure 7(b)shows the changes in tongue shape every 5 s over a total of 100 s. By
using this data, we measured each tongue width (mm), tongue
height (mm), and integrated tongue area (mm2). For example, thechange in tongue size versus time is shown in Figure 8. The datawith the tiny display was smaller than the data without it, as shownin Figure 8. The average reduction ratio of the width, height, andarea was 91.7%, 86.9%, and 77.5% respectively. Because it is not appropriate to compare the standard deviations as it is, we calibrated
each value with the display at each reduction ratio.
To calculate the temporal fluctuation of the size of the tongue,
standard deviations were obtained with respect to changes in size.
Table 1 includes the standard deviations of each. To compare theresults with and without tiny displays, we highlighted those with lessfluctuation in Table 1.
We confirmed that the tiny wearable display is a useful device forTIAS. By using the device, the stability of the subject's tongue
movement improved. The greatest advantage is that the subject gains
a sense of security during imaging of the tongue. These evaluations
include many subjective factors, but further studies are planned using objective indicators of the human body.

Takayuki Uchida, Kei Yoshihara, Shuhei Ueda, Toshiya Nakaguchi, Koichi Sakaue, Takao Namiki, Yoichi Miyake

Fig. 6Figure 6

Effect of Fixing a Tiny Wearable Display on a Tongue Imaging Analyzing System (TIAS) to Improve Stability of Tongue Presentation

Photograph of TIAS using one eye of the wearable display with HDMI signal input.

Fig. 710(a)Figure 7(b)(a) One of the tongue images and (b) changes in tongue shape over 100 s.

Fig. 8×105600

7.05006.0Tongue	  width	  (pixel)	  [with]

4003003.0100Tongue	  height	  (pixel)	  [w/o]5.04.0200Tongue	  width	  (pixel)	  [w/o]

2.0

1.0

Area	  	  (pixel)	  [with]
Area	  	  (pixel)	  [w/o]Area	  (mm2)

Width, Height (mm)Tongue	  height	  (pixel)	  [with]78×10460

7.050

6.0
5.040

4.030
3.020

Tongue height[with]
Tongue width [w/o]Tongue height [w/o]Area [with]
Area [w/o]2.0100Tongue width [with]

Area	  (mm2)

Width,	  Height	  (mm)Bull. Soc. Photogr. Imag. Japan. Vol. 28 No. 1 (2018)

1.00204060800.0100

Time (sec)Figure 8Table 1

Changes in tongue size (width, height, and area) versus time.

FIg8 taking account of width, height, area reduction rate) over 100 s. These data were highlighted against less fluctuation.
Calibrated standard deviation
The measurements were first performed with glasses for four subjects (subjects A–D) and without glasses for four subjects (subjects E–H).
Calibrated standard deviation taking account of width, height, area reduction rate

With tiny display[Calibrated]

ATongue width (mm) Tongue height (mm)

BCDEFGH

Averege

0.6

1.6

0.9

1.1

2.0

1.2

0.6

2.6

1.6

1.0

1.3

1.6

717.6

0.6

950.3

2.014.7

1.7

1.107.2

3.8

1.7

0.5

0.9

1.3

659.5

2.3

1.7

Area (mm2)

572.3

1.3

1.288.4

1.4

1.167.8

4.0

2.9

3.7

3.7

2.5

1.682.0

2.787.0

1.512.1

2.265.9

1.869.9

1.643.2

References

4. Acknowledgments
This work was supported by “FY2016 MEXT Private University
Research Branding Project”.

1.2

1.9

1.039.2

2.8

1.7

1.5

700.6

1.877.3

1.2

Tongue width (mm) Tongue height (mm)

898.7

3.2

1.3

Without tiny display

Area (mm2)

1)
2)
3)
4)

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