Thang, C. et al.

Paper:

A Proposed Model of Diagnosis and Prescription in Oriental Medicine Using RBF Neural Networks
Cao Thang , Eric W. Cooper , Yukinobu Hoshino , Katsuari Kamei , and Nguyen Hoang Phuong
School of Science and Engineering, Ritsumeikan University 1-1-1 Noji-Higashi, Kusatsu, Shiga 525-8577, Japan E-mail: thangc@spice.ci.ritsumei.ac.jp 21st Century Center of Excellence Program, Ritsumeikan University 1-1-1 Noji-Higashi, Kusatsu, Shiga 525-8577, Japan E-mail: cooper@se.ritsumei.ac.jp College of Information Science and Engineering, Ritsumeikan University 1-1-1 Noji-Higashi, Kusatsu, Shiga 525-8577, Japan E-mail: hoshino, kamei @ci.ritsumei.ac.jp Center of Health Information Technology, Ministry of Health of Vietnam The 9 oors Building, 134 Nui Truc Lane, Ba Dinh Dist., Hanoi, Vietnam E-mail: nhphuong@fmail.vnn.vn [Received June 14, 2005; accepted October 9, 2005]
Graduate

In this paper, we present a computing model for diagnosis and prescription in oriental medicine. Inputs to the model are severities of symptoms observed on patients and outputs from the model are a diagnosis of disease states and treatment herbal prescriptions. First, having used rule inference with a Gaussian distribution, the most serious disease state in which the patient appears to be infected is determined. Next, an herbal prescription written in suitable herbs with reasonable amounts for treating the infected disease state is given by RBF neural networks. Finally, we show some experiments and their evaluations, and then describe our future works.

make full use of their brains and sensory organs for clinical observations and judgments. To get a right diagnosis and a suitable treatment prescription, clinical experiences of the physicians are extremely important. Accurate diagnoses and treatment prescriptions have an important role in treating diseases. Applying suitable computing models and then building successful Decision Support System (DSS) based on knowledge from skilled OM physicians can help to moderate subjective evaluations in diagnosis and prescription processes, and consequently it will help to provide the right treatments to the right patients and to improve the quality of health care services.

Keywords: decision support system, oriental medicine, RBF neural networks

2. The Proposed Model for Diagnosis and Prescription in Oriental Medicine

In OM, a disease has some specied states and each state is cured by standard herbal prescriptions. Such prescriptions are easily found in medical text books or OM reference books. For a concrete patient, some herbs in the standard prescription are too strong while some are weak. Because of herbal properties and the body status of each patient, simply reducing or increasing the herbal amounts sometimes can not moderate the effects of the strong or weak herbs. Thus the total effect of the herbs in the ingredient is often moderated by changing their amounts, together with adding some additional herbs. These herbal adjustments are often based on the severities of observed symptoms on the patient [1]. Only experienced physicians can give patients suitable prescriptions with reasonable adjustments. In a treatment prescription, there are three main kinds of herbs: Treating, Catalyzing and Additional Herbs as Vol.10 No.4, 2006

1. Introduction
In the oriental countries, especially in China and Vietnam, there are two therapeutic ways for treating diseases: Oriental Medicine (OM), which has been used for thousands years, and Western Medicine (WM), which was introduced at the end of the 19 th century. WM is based on antibiotic, compound drugs and advanced equipment while OM relies on acupuncture, herbal remedies and accumulated popular experiences. According to OM, the organs of peoples bodies are closely related. When a disease is infected, some abnormal symptoms will appear in the external organs. The severities of the infected diseases are expressed by severities of observed symptoms. Without the benet of advanced science and technology, OM physicians have to 458

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A Proposed Model of Diagnosis and Prescription in Oriental Medicine Using RBF Neural Networks

Fig. 2. DSS for diagnosis and prescription by OM.

Fig. 1. An herbal treatment prescription.

shown in Fig.1. Treating herbs directly cure the infected symptoms while catalyzing herbs help patients organisms to easily absorb herbal effects. Amounts of treating herbs are often adjusted by severities of the observed symptoms whereas amounts of catalyzing herbs are normally unchanged as in the standard prescriptions. Treating and catalyzing herbs, with their standard amounts, are listed in standard prescriptions. Depending on the patients body status and the severity of disease states, experienced doctors often add some additional herbs to the standard prescription to enhance its efciency. The processes of above diagnosis and prescription could be assisted with the proposed DSS model as shown in Fig.2 [2]. Roles of the functional parts in Fig.2 are as follows: Knowledge Acquisition: Surveys symptoms, explanations, sample prescriptions and importance values of symptoms. Knowledge Base: Consists of symptoms, disease states, inference rules, training data and explanations. Rule Inference: Checks rules, calculates severities and advises the most serious disease state. RBF Neural Networks: Gives prescriptions with reasonable amounts of herbs. User Interface: Obtains symptoms and their severities from users and shows inferential results. Developer Interface: Obtains importance values of symptoms, severities, and sample prescriptions from experienced doctors and knowledge engineers. Explanation: Helps users to understand the diagnosed diseases and explains the results.

2.1. Rule Inference In OM, physicians usually give herbal prescriptions based on severities of clinical symptoms such as high body temperature, moderately yellow urine etc. These vague expressions of symptoms make it unsuitable for traditional quantitative approaches to build DSS in OM. Fuzzy sets, known for their abilities to deal with vague variables using membership functions rather than with crisp values, have proven to be a suitable approach to resolve this problem [36]. However, using fuzzy rules, a DSS may require thousands of rules with many combinations of symptoms in premises to obtain reasonable inference results. The large number of rules would require not only a lot of time for developers to accomplish the rule acquisition but also much effort for the domain experts to revise all of the rules. In this proposed model, we use severities of observed symptoms and a Gaussian distribution to infer the most serious infected disease state that the patient has. Then in the prescription stage, the observed severities will be put into RBF neural networks to get an appropriate herbal prescription.
2.1.1. Symptom and Rule Expression Suppose that the considered disease has m clinical symptoms, l disease states. A disease state is determined by n clinical symptoms. O O O Let SO S1 S2 Sm be a set of observed symptoms on a patient. Let H H1 H2 Hl be a set of the disease states. R R R Sn j be a set of symptoms in Let SR j S1 j S2 j premise of rule R j j 1 2 l , where R j is generally described in the following form: and S n j IF S1 j and S2 j and THEN disease state is H j
R R R

. . . .
R

(1)

Let the following certainty values in S iO and Si j be deVol.10 No.4, 2006 Journal of Advanced Computational Intelligence and Intelligent Informatics 459

Thang, C. et al.

ned:

SO 0 1 : truth value of S iO given by doctors when i diagnosing, where SO 1 means SiO clearly appears i on the patient, SO 0 means SiO does not appear on i the patient, and 0 SO 1 means SiO appears on the i patient with the severity SO . i SR j 0 1 importance value of S i j for the prescripi tion of disease state H j given by skilled doctors via survey in advance, where
R

Fig. 3. Inference process of rule R j .

i 1

Rj

. . . . . . . . . .

(2) 0 j 2 when S S S . With the value of 1 0, j R j always 1 when S S 0. R 0 when S S S means that if there are no matched the distribution and should be chosen so that the R j
O Rj Rj j O Rj j O Rj Rj

Si R j SR j
i

and 0 i factor SR j .
i

R 0 means Si j has absolutely no affect on H j , R 1 means Si j is the only symptom affecting H j , R SR j 1 means Si j affects H j with certainty

The importance values are introduced because different symptoms affect disease states differently. For a disease state, some symptoms are more important than the others while some do not. The sum in Eq.(2) equals 1, which means the maximum belief degree of symptoms in the premise of rule R j is 1. This sum is also a boundary, so that experienced doctor should consider the importance values within this boundary, avoiding many doctors freely express the importance of each symptom with their own view. 2.1.2. Rule Inference Process If an observed symptom S iO is found in the premise of rule R j , actual effect of this symptom to the premise is calculated as:

0, R j will close to 0. The formula symptoms (4) means that when SjO close to SR j , R j will close to 1, or the rule R j decides the most serious disease state. When SjO close 0, R j will close to 0, or the disease state decided by rule R j is less serious. Fig.3 illustrates the inference process of rule R j . Then the most serious disease state H having the largest R j value among l disease states will be determined:

SjO

Hk Rk

max R j
j

. . . . . . (5)

SjO
i

SO SR j i
i

. . . . . . . . . .

(3)

SO SR4 0 75 0 3 0 225. 1 1 If symptoms in S of R j match with observed symptoms SO , the serious degree R j of the disease state H j is calculated as:
4 premise of R4 is SO
1

Where is a product operator. We apply the multiO plication as the product. For example, symptom S 1 observed on the patient with severities SO 0 75. This 1 symptom affects Disease state 4 with the importance value SR4 0 3. The actual effect of this symptom in
1

Rj

R j

exp

j S

S
2 21

Rj

. . . . . (4)

SjO is a vector representing the actual effect of observed symptoms in premises of R j . SR j is the center vector of a Gaussian distribution, representing effects of symptoms
on the disease state H j decided by R j . SjO SR j

2 rep

2 resents how well SjO closes to SR j . 1 is the variance of

2.2. RBF Neural Networks and Prescription NN is an effective technique to help doctors to analyze, model and make sense of complex clinical data across a broad range of medical applications [7, 8]. Based on typical sample prescriptions from experienced doctors, NN can generalize prescription rules and relations between severities of symptoms and herbal amounts. After training, NN can give suitable herbal prescriptions in accordance with the severities of symptoms observed on the patient. Architectures of NNs widely used are Multi-Layer Perceptron neural network (MLP) and Radial Basis Function neural network (RBF). MLP has a good generalization when training data is enough and consistent, but it early encounters over-tting problem when fewer or inconsistent training data are used. The training procedure of MLP is often slow and it may need to reset from the beginning when a new training data is added. RBF learns fast, can approximate any function, can be trained for new cases without having to redo old cases, and can learn with some coniction in the training data. RBF has low incidence of false positive (without normalization) or wide output coverage (with normalization). The disadvantages of RBF are that it requires more hidden neurons than MLP for a good approximation of functions in large datasets [911]. Typical treatment prescriptions can be collected from
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A Proposed Model of Diagnosis and Prescription in Oriental Medicine Using RBF Neural Networks

is calculated as: ck WkP WkT W ck W . . . . . . . . . . . . . . . . . . . . . . (6) (7)

where WkT is amount of herb k in training data, and W is the maximum amount of an herb in the prescription. For the same disease state, prescriptions by different doctors might not look similar because some doctors use some herbs but others prefer equivalent herbs that also give the same effects but come in different amounts. To avoid using many equivalent herbs for the same prescriptions in training data, lists of herbs in the standard prescriptions from OM text books should be used and claried by experienced doctors.

Fig. 4. One RBF for a prescription.

experienced doctors. However, the number of the collected prescriptions is often not large, and there are also some valid prescriptions that are conict with each other. The prescriptions usually can not be quickly collected because the process of prescription acquisition is accumulated over time. For these reasons, we proposed RBF for the herbal prescription described above. Trained by herbal treatment prescriptions collected from skilled OM doctors, RBFs are used to give herbal prescriptions with reasonable amounts. Each disease state uses a dedicated RBF as shown in Fig.4. Inputs to RBF are severities of the state-specied symptoms and outputs are coefcients of herbal amounts for treating the disease state. Each basis function of RBF can be regarded as being centered on a vector of a severity group of observed symptoms. For the inputs, there are two types of symptoms. The rst type is associated with Boolean values: Yes (true coded by 1) and No (false coded by 0). Observed severities in the second type are associated with 5 linguistic values in company with certainty intervals: no (0.00), slightly (0.25), moderately (0.50), relatively (0.75), clearly (1.00). For the outputs, the total number of herbs in a treatment prescription is often from 9 to 15. The number of observed symptoms used to adjust herbs in a standard prescription is often from 5 to 16. In training data for the RBFs, symptoms affecting herbal adjustments are used for inputs and all of the Treating, Catalyzing and Additional herbs are used for outputs. Depending on each disease state, the amounts of herbs in prescriptions often vary from 2 to 60 grams. The error in the adjusted amounts of an herb accepted by doctors is usually 0.5 gram for small amounts, 1 gram for medium amounts and 2 gram large amounts. Amounts of herbs in training data are normalized as coefcients in 0 1 . The coefcient ck of amounts of herb k in training data, and the actual amount WkP of herb k in the prescription results Vol.10 No.4, 2006

2.3. Explanation An important feature of DSSs is their capabilities to offer explanations. Logical explanations from DSSs can help users to deeply understand inference results. Explanations also make it easier for domain experts to revise related sample cases in training data. In our model we propose general and detailed explanations. General Explanation: After the rule inference process, from the knowledge base, the system obtains a general explanation about the most appropriate disease state, and then shows this explanation with a graph of all related states and the serious degree R j of the rules. Detailed Explanation: The case based reasoning technique is used here to give detailed explanations about similar cases. In training data, the system nds similar cases that have the closest severities of observed symptoms and the same infected disease states with the diagnosed patient, and then shows prescriptions of these cases and their explanations from experienced doctors. The similarity dv between the current diagnosed case and a case in training data is given by the Euclidean distance between these two cases: 1 n j dv v vT 2 . . . . . . . . . (8) i n i i 1
where v j is the severity feature vectors, represented by observed severities of the current diagnosed case, v T are the severity feature vectors of the comparing case in training data, and n is the number of symptom features in the infected disease state.

3. Experiments and Evaluations

We conducted an experiment with acute arthritis, a disease state of rheumatism. This disease state has 16 specied symptoms and 33 treatment herbs. We gathered 80 real herbal prescriptions from experienced doctors, with typical severities and herbal adjustments, and then put these prescriptions to a RBF. The number of training data is 80% (64 prescriptions), and the number of testing data is 20% (16 prescriptions). Basic function centers are ran2 domly selected from training data sets, and variance 2 is 461

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Thang, C. et al.

Fig. 5. Error graphs of MLP (upper) and RBF (lower) trained in 1000 iterations.

Fig. 7. Interface of advised prescription.

Fig. 6. An example of serious degrees of 12 infected disease states.

the average distance between the basic function centers. After training, all of prescription rules and relations between severities of symptoms and herbal amounts were well learnt by RBF, within an accuracy of 10 2 mean square error with both training and testing data (equivalent to mean error of 0.1 gram for each herb). With the same data, MLP quickly encounter the over-tting problem. Fig.5 shows the error graph of MLP (upper) and RBF (lower) trained in 1000 iterations. Data is real 80 herbal prescriptions with 16 inputs and 33 outputs. MLP has 33 hidden neurons with learning rate 0 08. RBF has 60 Gaussian neurons with learning rate 0 0075 2 and variance 2 0 06. The inference rule given by Eq.(1) is equivalent to the following fuzzy rule: IF fuzzy severities of symptoms R R and S n j is SR j S1 j is SR j and n 1 THEN Disease state is H j with certainty factor R j

Fig. 8. Interface of prescription acquisition.

. .

(9)

A DSS using the rule form given by Eq.(9) may need thousands of inference rules with many combinations of symptoms in premises. Our model uses just l inference rules by using the rule Eq.(1) with Eqs.(2), (3) and (4). Experienced physicians have conrmed that it was easy to review the knowledge presented by the rules. 462

In the rst phase, we applied the proposed model to rheumatism disease that we already have 460 real prescriptions from experienced doctors. Figs.7, 8 and 9 show interfaces of the application for advised prescription, prescription acquisition and diagnosis, respectively. In case of unknown inputs, system shows the graph of the serious degree R j of infected disease, recommends the most proper state in which the patient seems to be infected and gives the closest sample case in training data, then shows an advised prescription with appropriate herbal amounts by RBF. Fig.6 shows the serious degrees of infected disease states, applied in rheumatism which 2 has 12 disease-states, and the variance 1 0 05 in the distribution of the serious degree is chosen after some experiments. Experienced physicians have also conrmed that it was easy to understand the serious of the infected disease states via the graph and advised prescription via the closest case in training data. Vol.10 No.4, 2006

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A Proposed Model of Diagnosis and Prescription in Oriental Medicine Using RBF Neural Networks
[11] A. Bezerianos, S. Papadimitriou, and D. Alexopoulos, Radial basis function neural networks for the characterization of heart rate variability dynamics, Articial Intelligence in Medicine, 15(3), pp. 215-234, 1999.

Name:
Cao Thang

Afliation:

Fig. 9. Interface of diagnosis.

Graduate School of Science and Engineering, Ritsumeikan University

4. Conclusions
We proposed a computing model of DSSs for diagnosis and prescription in OM, tested it with a set of real rheumatic prescriptions. The results conrmed that this model has high performance and high applicability for disease diagnoses and herbal prescriptions. However, if a patient has other diseases, doctors cannot solely rely on this system since they do not have evidence to control potential effects of the herbal ingredient on the other concurrent diseases. Hence, it is recommended that the system be used only for patients with the specic disease alone, not for those with other concurrent diseases. Our future works are to apply GA in nding the best sets of RBF parameters, to complete this DSS model for diagnosis and prescription of other diseases, and then to re-evaluate the system in the real patients and compare systems results with the doctors diagnoses.
References:
[1] T. Tran, D. N. Pham, and B. C. Hoang, Hanoi Medical University Lectures in Oriental Medicine, Medicine Pub., Hanoi, 2002. [2] J. Durkin, Expert System Design and Development, Prentice Hall Inc., New York, 1994. [3] F. A. Maysam, D. G. von Keyserlingk, and D. A. Linkens, Mahdi Mahfouf: Survey of utilization of fuzzy technology in Medicine and Healthcare, Fuzzy Sets and Systems, 120, pp. 331-349, 2001. [4] H. P. Nguyen, T. T. Nguyen, C. Thang, and T. H. Duong, Building a fuzzy expert system for syndrome differentiation in the oriental traditional medicine, Proceedings of the Hanoi International Symposium on Medical Informatics and Fuzzy Technology (MIF99), pp. 436-441, 1999. [5] H. P. Nguyen, S. Pratit, and K. Hirota, Fuzzy Modeling for Modifying Standard Prescriptions of Oriental Traditional Medicine, Journal of Advanced Computational Intelligence and Intelligent Informatics, Vol.7, No.3, pp. 339-347, 2003. [6] M. B. Serrano, C. Sierra, and R. Lopez de Mantaras, RENOIR: An expert system using fuzzy logic for rheumatology diagnosis, Internat. J. Intell. Systems, 9 (11), pp. 985-1000, 1994. [7] R. Dybowski, and V. Gant, Clinical applications of Articial neural networks, Cambridge University Press, 2001. [8] C. Thang, E. W. Cooper, Y. Hoshino, and K. Kamei, A Proposed Model of Soft Computing in Diagnosing Diseases and Prescribing Herbal Prescriptions by Oriental Medicine, Proceedings of the First International Conference on Complex Medical Engineering (CME2005), pp. 904-908, 2005. [9] C. M. Bishop, Neural Networks for Pattern Recognition, Oxford University Press, 2005. [10] S. Haykin, Neural Networks, A Comprehensive Foundation, Prentice Hall, 1994.

Address:
1-1-1 Noji-Higashi, Kusatsu, Shiga 525-8577, Japan

Brief Biographical History:

1994 Bachelor of Electronics, Hanoi University of Technology 2005 M.S., Graduate School of Science and Engineering, Ritsumeikan University

Main Works:

A Decision Support System for Rheumatic Evaluation and Treatment in Oriental Medicine Using Fuzzy Logic and Neural Network, Lecture Notes in Articial Intelligence (LNAI), Vol.3558, pp. 399-409, Springer-Verlag, Berlin, Heidelberg, 2005.

Membership in Learned Societies:

Vietnamese Fuzzy Society

Name:
Eric W. Cooper

Afliation:
21st Century Center of Excellence (COE) Program, Ritsumeikan University

Address:
1-1-1 Noji-Higashi, Kusatsu, Shiga 525-8577, Japan

Brief Biographical History:

1998- M.S., Computer Science, Ritsumeikan University Graduate Studies 2002- Ph.D. (Engineering), Ritsumeikan University 2003- Joined COE program as post-doctoral researcher

Main Works:

E. W. Cooper, Y. Ishida, and K. Kamei, Modeling Designers Color Decision Processes Through Emotive Choice Mapping, Lecture Notes in Computer Science, Springer-Verlag, Vol.3558, pp. 410-421, 2005.

Membership in Learned Societies:

Human Interface Society Institute of Systems, Control and Information Engineers

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Thang, C. et al.

Name:
Yukinobu Hoshino

Name:
Nguyen Hoang Phuong

Afliation:
Assistant Professor, Human and Computer Intelligence, College of Information Science and Engineering, Ritsumeikan University

Afliation:
Professor, Director, Center of Health Information Technology, Ministry of Health of Vietnam

Address:
1-1-1 Noji-Higashi, Kusatsu, Shiga 525-8577, Japan

Address:
The 9 oors Building, 134 Nui Truc Lane, Ba Dinh Dist., Hanoi, Vietnam

Brief Biographical History:

2002- Doctor of Engineering from Ritsumeikan University 2002- Assistant Professor in Ritsumeikan University

Brief Biographical History:

1979 M.Sc. in Computer Science, Tashkent State University, Ex.USSR 1979 Joined the National Center for Natural Science and Technology, Hanoi, Vietnam 1986-1988 Visiting Scientist, International Lab on AI, Institute of Cybernetic Technology, Slovak Academy of Sciences, Bratislava 1994-1996 Visiting Researcher on COPERNICUS-MUM project Managing uncertainty in medicine, Institute of Computer Science, Czech Academy of Sciences, Prague 1996 Dr. Tech. in Computer Sciences, Technical University of Vienna, Austria 2000.3-6 Visiting researcher, Rio Grande Institute for Soft Computing (RioSoft), NMSU, USA 2001.6-2002.10 Visiting professor, Assumption University, Bangkok, Thailand 2003.3-8 Visiting professor, Kyungpook National University, Daegu, Korea

Main Works:

An Application of FEERL (Fuzzy Environment Evaluation Reinforcement Learning) to LightsOutGame and Avoidance of Detour Actions in Search, Transactions of the Institute of Systems, Control and Information Engineers, Vol.14, No.8, pp. 395-401, 2001. A Proposal of Reinforcement Learning with Fuzzy Environment Evaluation Rules and Its Application to Chess, Journal of Japan Society for Fuzzy Theory and Systems, Vol.13, No.6, pp. 626-632, 2001.

Membership in Learned Societies:

Japan Society for Fuzzy Theory and Systems The Institute of Systems, Control and Information Engineers The Society of Instrument and Control Engineers Japan Society of Kansei Engineering

Main Works:

Name:
Katsuari Kamei

Design of a fuzzy system for diagnosis and treatment of integrated Western and Eastern medicine, Int. J. General Systems, Vol.30, No.2, pp. 219-239, 2001. Fuzzy Logic and Its applications in medicine, Int. J. Medical Informatics, Vol.62, pp. 165-173, 2001. Computational Intelligence: Introduction, Science and Technics Pub. House, 2002 (in Vietnamese).

Membership in Learned Societies:

Afliation:
Professor, Human and Computer Intelligence, College of Information Science and Engineering, Ritsumeikan University

Vietnam Fuzzy System Society (VFSS), president International Fuzzy Systems Association (IFSA) (Vietnam Chapter president) Asian Pacic Association of Medical Informatics (APAMI) (Vietnam representative)

Address:
1-1-1 Noji-Higashi, Kusatsu, Shiga 525-8577, Japan

Brief Biographical History:

1983- Assistant Professor, Ritsumeikan University 1993- Associate Professor, Ritsumeikan University 1998- Professor, Ritsumeikan University

Main Works:

Development of Townscape Evaluation System for Colour Planning Support, Proceedings of 11th International Conference on Human-Computer Interaction (HCII 2005), 1279.pdf in CD-ROM (9 pages), Las Vegas, USA, July, 2005. Modeling Designers Color Decision Processes through Emotive Choice Mapping, Lecture Notes in Articial Intelligence, Vol.3558, pp. 410-420, Springer-Verlag, Berlin, Heidelberg, 2005.

Membership in Learned Societies:

Japan Society for Fuzzy Theory and intelligent informatics (SOFT) The Institute of Systems, Control and Information Engineers (ISCIE) Human Interface Society (HIS) Japan Society of Kansei Engineering (JSKE) IEEE Computational Intelligence Society (CIS)

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