IJBSCHS (2009-14-01-13)

[Original article]

Biomedical Soft Computing and Human Sciences, Vol.14, No.1, pp.101-108 (2009) Copyright1995 Biomedical Fuzzy Systems Association (Accepted on 2008.10.3)

Visualization System of Herbal Prescription Effects in Oriental Medicine by Self-Organizing Map

Thang CAO*, Katsuari KAMEI ** and Tuan Linh DANG ***
*Graduate School of Science and Engineering, Ritsumeikan University, Japan ** College of Information Science and Engineering, Ritsumeikan University, Japan *** Hanoi University of Technology, Vietnam
(The paper was received on Nov. 1, 2007.)

Abstract. Fairness evaluating effects of prescriptions is indispensably importance in disease treatment. The development of Intelligence Technologies nowadays makes it realizable for a moderation of subjective prescription evaluations in medicine. In this paper, we present an application of Self-Organizing Map (SOM) to visualization of herbal prescription effects in Oriental Medicine (OM). The application is used to estimate influence of herbal ingredients prescribed for patients who have several concurrent diseases. Inputs to the SOM are herbal treatment prescriptions, and an output is a map that shows disease states that can be influenced by these prescriptions. Training data is 133 standard prescriptions with 221 popular herbs in 17 disease groups collected from oriental medical text books by experienced doctors. First, the prescription problem in OM is described. Next, the system structure and implementation of the proposed system are shown. Finally, the visualization abilities of the proposed system verified by experienced doctors are presented. Keywords: Self-Organizing Map, Neural Networks, Oriental Medicine Evaluations of the effects of herbal treatment prescriptions have an important role in OM treatment. If the evaluation is misjudged, the treatment prescription may have a bad influence on patients health conditions as well as on the treatment process. Successful realization of a decision support system for visualization of the herbal effects based on standard prescriptions, popular treatment herbs and knowledge from experienced OM physicians will help to objectively verify evaluations of prescription effects which tend to be subjective. It will indirectly help physicians to provide the right treatment to the right patients while improving the quality of the health care services as a whole. It will also help to reduce the prescription time, to increase positive influence and reduce negative impact of the final treatment prescription, and to assist medical students or young physicians, especially those living and working in remote areas. The visualization of effects of treatment prescriptions can also help doctors to give patients an easily understandable explanation about the treatment process. From the last decades, the advent of the computer greatly stimulated developments of Artificial Intelligence (AI), especially Expert Systems (ES) and Decision Support Systems (DSS) which play the roles of a specialist and assist people in carrying out works requiring specific expertise. Since the beginning of AI, ES and DSS have been 101

1. Introduction
In oriental countries like China, Korea and Vietnam, there are two medicine treatment systems: Oriental Medicine (OM) that has been used for thousands years and Western Medicines (WM) that was introduced since 19th century from western countries. Treatments in WM are based on drug compounds and advanced equipment, while treatments in OM are based on herbal ingredients, acupuncture, physiotherapy, together with physicians accumulated experience. Although WM has been developed quickly and gained many achievements in treating diseases, OM has been still an indispensable part because it has fewer side-effects than WM, does not face antibiotic resistance problems and gives good treatment results. Besides, herbal prescriptions are easy to find and relatively cheap in comparison with western drugs. Currently, the number of OM hospitals in Vietnam is almost equal to that of WM hospitals, and the number of Vietnamese patients treated by OM is about 50% of the national population. 1-1-1 Noji-Higashi, Kusatsu City, Shiga 525-8577, Japan Phone and Fax: + 81 77 561 2861 Email: thangc@spice.ci.ritsumei.ac.jp

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successfully applied to WM, and then to OM with reasoning techniques including Neural Networks [4], Fuzzy Logic [5] and Uncertainty Reasoning [6-7]. Most of ES and DSS in OM focused on problems of disease diagnoses and analyses with the specific characteristics of OM such as four inspection steps, the six internal organs and the viscera, Yin and Yang. A few recent researches dealt with modifying treatment herbal prescriptions in OM using Fuzzy Logic [8] and Multilayer Neural Networks [1-3]. In this paper, we present an application of Self-Organizing Map (SOM) to visualization of herbal effects of oriental treatment prescriptions. The application is used to assess effects of herbal ingredients prescribed for patients who have several concurrent diseases. It is also used to investigate treatment relations among standard prescriptions. Inputs to the SOM are herbal treatment prescriptions, and an output is a map that shows a distribution of prescriptions with their treatment distances. From the location of a specific prescription on the map and its treatment relations with other prescriptions, doctors can easily estimate which disease states can be influenced by the specific prescription.

important and mostly depends on their experience. Only experienced doctors can give patients suitable prescriptions with reasonable adjustments. Fig. 2 illustrates the prescription process in case of concurrent diseases.

3. Neural Networks and Its Application to Herbal Prescription Learning

Neural Networks (NN) is an efficient technique to help doctors to analyze, model and make sense of complex clinical data across a broad range of medical applications [4]. It enables intelligent systems to learn from experience, examples and clinical records, improving performance of the systems over time. Based on knowledge accumulated from experienced doctors and popular treatment prescriptions, NN can wisely give the doctors good decisions, helping to objectively verify subjective evaluations in prescribing diseases. There are two main kinds of NN: supervised and unsupervised NNs. In the supervised NN, the network is provided a set of inputs and appropriate outputs as a teacher for those inputs. A trained supervised NN can assist physicians giving herbal treatment prescriptions with reasonable amounts [1-3].

2. Prescriptions in OM
When prescribing herbal medicines for a patient based on severities of symptoms observed on the patient, first doctors consider which disease state the patient is infected, and then choose a standard prescription that is suitable cure for the infected disease state. Second, the doctors adjust herbal ingredients, add some catalyzing herbs to the standard prescription if necessary, and then adjust all of herbal amounts to make it suitable for the patient condition, so that the positive treatment effects of the prescription on the patient is maximized and negative effects is minimized [15]. Fig. 1 shows a general prescribing procedure in OM. The standard prescriptions for single disease states are easily found in medical books, and it is not so difficult for doctors to prescribe for a patient. However, there are no standard prescriptions for several concurrent diseases in such books because of herbs properties that some herbs have good effects on a disease, but that they may have negative influence on the other concurrent diseases. In some cases, some herbs and some diseases are exclusive and such herbs should not be used for treating those diseases. When a patient has some diseases at the same time, doctors have to carefully consider each among these concurrent diseases, give herbal ingredients, clarify exclusive herbs, add some more catalyzing herbs and then adjust amounts of all herbs to harmonize undesired effects, so that the final prescription that is the most suitable for the main disease has positive influence and less side-effect on the other concurrent diseases. In this case, the visualization of herbal effects to the doctors is quite 102

Clarify severities of observed symptoms

Find suitable standard prescriptions

Consider infected disease states

Adjust herbal ingredient

Give treatment prescription

Fig. 1. The general prescribing procedure in OM

Clarify severities of observed symptoms

Add some more herbs that cure the other concurrent diseases

Clarify the main and secondary diseases

Consider again exclusive herbs and side - effects of the ingredient

Choose some herbs cure for the main disease

Adjust amounts of herbs

Consider effects of selected herbs with the other concurrent diseases

TREATMENT PRESCRIPTI ON Herb 1 x gram .......... Herb k z gram

Fig. 2. Prescription procedure for patients who have several concurrent diseases

Unsupervised NN employs training algorithms that do not make use of desired outputs. The NN itself learns to adapt based on the experience

T. Cao, et al.: Visualization System of Herbal Prescription Effects in Oriental Medicine by Self-Organizing Map

of the training patterns. The unsupervised NN is used to discover structures in the data such as data with clusters or data with relationships among them, and to help to describe the data in a more compact way. A typical method of unsupervised NN is SelfOrganizing Map (SOM). The aim of SOM is to automatically find a mapping from the space of input vectors to a one- or two-dimensional space. The mapping preserves the closeness between data vectors, two close input vectors are mapped to points on the output map keeping the relationship in the input space [9]. The advantages of SOM are simple and easy to understand and good for visualization. Developers can easily train the network and evaluate how well the training is conducted and how similar the objects are. These advantages become more useful in case of high dimensional and complex input data. The disadvantage of SOM is distance accuracy among input vectors. It is easy to see the distribution of input vectors on the map, but it is difficult to evaluate correctly distances and similarities between them. Moreover, if the output dimension and learning algorithms are chosen improperly, similar input vectors may not always close to each other and the trained network may converge to some local optima. So far many useful SOM applications have been developed in many wide areas including the medicine domain [9-14].

may differ from the total amount of the other prescriptions. To make a standard for the amounts of herbs in prescriptions, we normalize the amounts of each herb in a standard prescription as the percentage of amount of the herb for total amount of all herbs in the same prescription. Each herb in a prescription will be assigned a treatment importance that depends on properties of the herb and treatment diseases. Depending on the treatment purposes the prescriptions are divided into groups, e.g. Heart Failure Group, Artery Sclerosis Group, Rheumatism Group etc. Each prescription may belong to one or some groups. Lets suppose the number of prescriptions to be n , the number of herbs to be m and the number of disease groups to be l in the training data. An herb H i has an amount of ai . In medical text books, a standard prescription Pk is described by a pair of herb names and their corresponding amounts such as: Pk ( H 1 , a1 ),..., ( H m , a m ). In our system, Pk is represented by a content vector Rk defined by Eq. (1).

Rk = rH1 ,..., rH m , k = 1,..., n

rH i = 100.0 ai

(1)

4. Visualization System of Herbal Effects by SOM

The effects of herbal treatment prescriptions for concurrent diseases can be suitably visualized by a SOM that are trained by standard herbal treatment prescriptions with standard herbal amounts. Fig. 3 shows an overview of the visualization system of herbal effects in OM by SOM. In the prescription procedure described in Fig. 2, it is easily to evaluate the influence of new treatment prescriptions when the number of used herbs and the number of concurrent infected diseases are few. It becomes much more difficult when many herbs are utilized and patients have many diseases at the same time. In this case, the trained SOM can give doctors a better view on relations among the prescribed herbal treatment prescriptions and diseases that may be cured and influenced by the new prescriptions. 4.1. Amounts and Treatment Effects of Herbs in Prescriptions There are no standard amounts of herbs for all treatment prescriptions though there is a proper amount of herbs in standard prescriptions. An herb may have different amounts in different standard prescriptions. The total amount of one prescription

a
j =1

(2)

where rH i is the rate of amount of the herb H i in Pk

Medical Text Books Reference Books Standard prescripti ons
Evaluate
TRAINING DATA

Experienced Doctors

Self - Organizing Map

New Prescription Herb 1 x gram .......... Herb k z gram

Prescription Distributi on

RECOMMENDATION - Where is the new prescripti on on the map - How the closeness among prescripti ons is - Which diseases can be influenced by the new prescripti on

Fig. 3. An overview of visualization system of herbal effects in OM by SOM

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In a prescription, the treatment importance of herbs is also different. An herb may be the most important in a certain prescription, but it may have less important in other prescriptions. An herb may take a small amount but it has more treatment effect than the other herbs, or an herb may take much amount, but it has just a harmony effect in the same prescription. Normally in the prescription, an herb is more important if it is used in most of prescriptions in the same group. The importance H i of the herb H i in a prescription Pk in disease group Gd is defined as:
G G H d = 1.00 + c ( f H id 1) (d = 1,..., l ) i

Eq. (5) means that in treatment process effects of Pp is closer to disease state cured by Pq when the distance between two content vectors is smaller, and the sum of the herb importance of Pp in the disease group Gq of Pq is bigger. Lets see an example of two standard prescriptions: P for Backache Disease and P2 for 1 Rheumatism Disease as shown on Tabs. 1 and 2. On these Tables, the Herb Name columns are the lists of herbs written in Vietnamese, the Amount columns are the corresponding amounts of herbs in gram, and the Content columns are the values of content vectors of the prescriptions calculated by Eq. (2). Each herb has different treatment importance values on the two disease groups as shown in Treatment Importance of Herbs on Groups column. As shown in Tabs. 1 and 2, P has a total 1 amount of 70 gram and P2 has a total amount of 76 gram. These two prescriptions have 5 similar herbs such as H6, H40, H55, H60 and H62. The content C distance between them is d P1 P2 = 31.09 which means that regardless of properties of herbs, when the total amount of herb in the prescription is normalized by 100.00 gram, the different amounts of herbs in the two prescriptions is 31.09 gram. The treatment distance from P to disease 1
T state cured by P2 (Rheumatism State 3) is d P1 P2 =

(3)

G where f H d is the frequency of use of H i in Gd and

i

c is a positive constant. The value of c is determined by how the treatment importance of the herb increases when it occurs in one more prescription in the same disease group. In our system c = 0.05 . For example in the disease group G9 = Rheumatism Group, the herb H 24 that has science name Xanthium Strumarium is used in 5 standard prescriptions, so
G the importance H9 in prescriptions of this group is

24

1.00 + 0.05 (5 - 1) = 1.20. The herb H17 that has science name Fallopia Multiflora is used in only one standard prescription of group G9 , so the importance
G9 H17

in prescriptions of G9 is 1.00.

In practice, there are a few special herbs that have a very strong effect in some specific prescriptions. In that case the importance of these special herbs is evaluated by experienced doctors instead of Eq. (3).

3.79. The treatment distance from P2 to disease state

T cured by P (Backache State 2) is d P2 P1 = 4.29. The 1

4.2. Distances among Prescriptions

To evaluate differences among the prescriptions we define two distances: content and treatment distances. The content distance d Cq between two p prescriptions Pp and Pq is Euclidean distance (4) between two content vectors:
d C q = R p Rq p

The treatment distance from prescription Pp to disease state that cured by prescription Pq is defined as follows:
d Tq p
=

d Cq p

i =1

Gq Hi

(5)

where H i is an herb in Pp and Gq is disease group containing Pq . 104

distances mean that P and P2 are closer each other if 1 the treatment purpose is Rheumatism and little farther each other if the treatment purpose is Backache. In another word P is stronger on the 1 disease state cured by P2 and P2 is a little weaker on the disease state cured by P . 1 In the case of a new prescription, the importance of an herb in the new prescription will have different values corresponding to the different concurrent diseases because the new prescription is given to treat multi-concurrent diseases. In training process, the content vectors Rk (k = 1,..., n) are put into SOM as feature vectors and the content distances in Eq. (4) are used. After training, the prescriptions are self-regulated on the output map. The prescriptions with a similarity in herbal ingredients will be arranged in the vicinity each other. The disease states treated by similar herbs will be also in the vicinity each other. In the visualization process, vector Rx of a new herbal treatment ingredient Px is put into SOMs input layer, and the location of Px in the output map is displayed.

T. Cao, et al.: Visualization System of Herbal Prescription Effects in Oriental Medicine by Self-Organizing Map

Tab. 1. Backache standard prescription P1 and treatment importance of its herbs in Backache and Rheumatism Groups Treatment Importance Herbs on Amount Groups Content Herb Name (gram) Backache Rheumatism H5 Cam tho 6 8.57 1.00 1.20 H6 Can khng 8 11.43 1.05 1.05 H38 Phc linh 12 17.14 1.05 1.10 H40 Qu chi 8 11.43 1.10 1.35 H55 Thng trut 8 11.43 1.05 1.10 H60 Xuyn khung 16 22.86 1.00 1.15 H62 d 12 17.14 1.05 1.25 TOTAL 70 100.00 7.30 8.20 Tab. 2. Rheumatism standard prescription P2 and treatment importance of its herbs in Backache and Rheumatism Groups Treatment Importance of Herbs on Amount Group Herb Name Content (gram) Rheumatism Backache H6 Can khng 8 10.53 1.05 1.05 H33 Ngu tt 8 10.53 1.25 1.00 H39 Ph t ch 8 10.53 1.15 0.00 H40 Qu chi 8 10.53 1.35 1.10 H53 Thin nin khin 8 10.53 1.05 1.00 H55 Thng trut 8 10.53 1.10 1.05 H58 Uy linh tin 8 10.53 1.05 0.00 H60 Xuyn khung 8 10.53 1.15 1.00 H62 d 12 15.79 1.25 1.05 TOTAL 76 100.00 10.40 7.25 Normally Px is located near prescriptions that have a similarity in its herbal ingredient. And then the treatment influences of Px on disease states calculated by the treatment distances are displayed on the map. the prescriptions that have similarities in herbal ingredients are located closer to each other. Fig. 4 shows an example of the output map when a new herbal treatment ingredient is put into SOM, where the prescriptions are written by their abbreviation on SOMs output. The treatment effects of standard prescriptions and relations among them are also conveniently visualized by the SOM. Fig. 4 also shows the location of a Rheumatism standard prescription and its treatment distances to disease states cured by other standard prescriptions, where the numerals after and beneath the abbreviations mean the disease state numbers and the treatment distance from the selected prescription, respectively. For example, HF2 2.35 means Heart Failure State 2 whose the treatment distance with the selected prescription HR4 (Heart Rheumatism State 4) is 2.35. The map produced by the SOM helps doctors much in their treatment process. It brings a better view on relations among the prescribed herbal treatment ingredients and their influence on diseases that may be cured, helping doctors to evaluate how well herbal ingredients influence the main and concurrent diseases. Based on the map, doctors can estimate the herbal ingredients so that positive effects 105

5. Implementation and Discussion

Based on the OM text books [15] and a preliminary survey on experienced doctors in Thaibinh OM College, we built a system with 133 typical prescriptions, 221 popular herbs in 17 common disease groups: Constipation, Cirrhosis, Hepatitis, Cystitis, Pyelitis, Dysentery, Gastralgia, Artery Sclerosis, Rheumatism, Heart Rheumatism, High Blood Pressure, Backache, Embolism, Bone Tuberculosis, Digestive Disorder, Tracheitis and Anemia. In the training, SOM uses a Gaussian neighborhood function with an adaptive variance and adaptive learning rate. The output map is displayed in the form of both rectangle table and bitmap image. After training, the prescriptions that have unusual herbs are normally located on corners or edges of the map, the prescriptions that have most popular herbs are generally located on middle, and

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of the treatment prescription will be maximized and negative effects will be minimized. As a result, it helps doctors to adjust therapy in treatment process. It also increases the understandability of the treatment HP6 BT1 AN1 HP9 T4 AN3 CO2 HF1

prescriptions for both doctors and patients and the treatment trend of doctors who give the prescription can be fairly evaluated. HP5 4.00 SI11 BI1 AH6 KI3 SI3 SI1

BI2

AH5

CH1

KI7 BI5 C3 CO4 HP7 CI4

CO1 CT1 The disease far in treatment effects T3

CI3 AH4 AH1 AH3 AH2 AH7 CH2 DY4 AR2 BI4 SI6 HR1 R1 HR2 2.97 HR3 2.51 HR7 2.55 HR6 2.63 HF5 CI5 2.55 HF3 C2 2.57 AC4 HP3 C1 C4 CO6 CH4 CO5 A2 CD4 T1 CD3 DD1 C5 T2

AC1

BT4 New prescription on the map CO3 AC3 SI2

HP4 KI8

BI3 The disease close in treatment effects HP2 3.60 AR1 E3

SI12

HP8 3.80 NEW PRES

DY3 DY1 DY2 AC2

HP1 2.70 AP2

AP1 E2 The disease closest in treatment effects DH2 E4 HR5 2.47 AR3 E1

AR4 SI7 Location of a Rheumatism prescription and its treatment distances to other standard prescriptions CT0 KI4 SI5 DC2 SI8 SI4 CH3 SI9 CI1 CT2 R7 B1 B2 R3 KI6 B3 SI14 B4 AC6

SI10 SI13

CH5

CI2 HR4 HF4 AC5 1.88 2.47 BT3 HF2 2.35 DD2 SI15

DC1 DH1 CD1 CD2

KI1

R6

R4

R2 BT2 R5 CI6 KI5 KI2

Fig. 4. Locations of a new treatment prescription and a Rheumatism standard prescription on the output map
Abbreviations in Fig. 4: AR: Arthritis AN: Anemia AC: Artery Sclerosis AH: Acute Hepatitis AP: Arthritis Precaution B: Backache BI: Cystitis Bladder Inflammation BT: Bone Tuberculosis C: Colitis CD: Chronic Dysentery CH: Chronic Hepatitis CI: Cirrhosis CO: Constipation CT: Coronary Thromboses DD: Digestive Disorder DY: Dysentery E: Embolism HF: Heart Failure HP: HR: KI: R: SI: T: High Blood Pressure Heart Rheumatism Pyelitis Kidney Inflammation Rheumatism Gastralgia: Stomach Inflammation and Ulcers State Tracheitis

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6. Conclusions
We proposed the application of SOM to the visualization of treatment effects of herbal medicine and showed the system implementation. We confirmed that the application has high performance, high applicability for the visualization of herbal influences on concurrent diseases and high understandability of the treatment prescriptions. The treatment distance among prescriptions calculated by Eq. (5) is a relative distance which is recommended and accepted by experienced doctors. However, it was reported that in clinical practice the treatment distances are vague distances and they could not be evaluated exactly. In other words, an exact measurement for treatment distances among prescriptions is required in practice. Currently we use the rectangle output map with Euclidean distance. Therefore sometimes it is not easy to visualize the relations of prescriptions located in corners or on edges of the map. The distribution of prescriptions would be easier visualized when the output map is displayed on the surface of a sphere as shown in Fig. 5. Our future work is to use a hyperbolic SOM [16] to visualize prescriptions on surface of a virtual sphere and to add more prescriptions for better evaluation of the influences of the herbal medicine. [4] [5]

[6] [7]

[8]

[9] [10]

[11]

[12] Fig. 5. The distribution of prescriptions would be better when the output map is displayed on the surface of a sphere References [1] Cao Thang, Eric W. C., Y. Hoshino, K. Kamei and N. H. Phuong: An Application of Soft Computing to RETS: Rheumatic Evaluation and Treatment System by Oriental Medicine, J. of Biomedical Soft Computing and Human Sciences, Vol. 11 (1), pp 7-13, 2007 Cao Thang, Eric W. C., Y. Hoshino, K. Kamei and N. H. Phuong: A Proposed Model of Diagnosis and Prescription in Oriental Medicine Using RBF Neural Networks, J. of Advanced Computational Intelligence and Intelligent Informatics, Vol.10 (4), pp 458-464, 2006 Cao Thang, Eric W. C., Y. Hoshino and K. Kamei: A Proposed Model of Soft Computing in Diagnosing Diseases and Prescribing Herbal Prescriptions by Oriental Medicine, Proc. of 107 [14]

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[3]

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Thang CAO He received B.S. in electronics from Hanoi University of Technology, Vietnam in 1994, M.S. and Dr. degrees of engineering from Ritsumeikan University, Japan in 2005 and 2008. His research interests are pattern recognition, decision support systems, computer vision, robotics and applications of soft computing.

Tuan Linh DANG He currently is a student in Faculty of Information Technology, Hanoi University of Technology, Vietnam. His research interests include human interface, Kansei modeling and computational intelligence.

* * *

Katsuari KAMEI He received the B.S. and M.S. degrees in electrical engineering, and the PhD from Ritsumeikan University, Japan in 1978, 1980 and 1983, respectively. He had worked as an assistant professor and an associate professor at Ritsumeikan University since 1983. He has been a professor at the college of Information Science and Engineering, Ritsumeikan University since 1998. His present research interests include development of the emotion processing system (Kansei evaluation and modeling) based on the vital signal measurements. He is a member of BMFSA, Society of Fuzzy Theory and Systems, IEEE, and so on.

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