Search JIM Advanced Search

Journal of Integrative Medicine ›› 2017, Vol. 15 ›› Issue (2): 110-123.doi: 10.1016/S2095-4964(17)60328-5

Special Issue: Traditional Chinese Medicine

• Methodology • Previous Articles     Next Articles

A data-driven method for syndrome type identification and classification in traditional Chinese medicine

Nevin Lianwen Zhanga, Chen Fub, Teng Fei Liua, Bao-xin Chenb, Kin Man Poonc, Pei Xian Chena, Yunling Zhangb   

  1. a Department of Computer Science and Engineering, the Hong Kong University of Science and Technology, Hong Kong, China 
    b Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China 
    c Department of Mathematics and Information Technology, the Education University of Hong Kong, Hong Kong, China
  • Received:2016-08-30 Accepted:2016-11-07 Online:2017-03-15 Published:2017-03-15
  • Contact: Prof. Nevin Lianwen Zhang; E-mail: Prof. Yun-ling Zhang; E-mail:

The efficacy of traditional Chinese medicine (TCM) treatments for Western medicine (WM) diseases relies heavily on the proper classification of patients into TCM syndrome types. The authors developed a data-driven method for solving the classification problem, where syndrome types were identified and quantified based on statistical patterns detected in unlabeled symptom survey data. The new method is a generalization of latent class analysis (LCA), which has been widely applied in WM research to solve a similar problem, i.e., to identify subtypes of a patient population in the absence of a gold standard. A well-known weakness of LCA is that it makes an unrealistically strong independence assumption. The authors relaxed the assumption by first detecting symptom co-occurrence patterns from survey data and used those statistical patterns instead of the symptoms as features for LCA. This new method consists of six steps: data collection, symptom co-occurrence pattern discovery, statistical pattern interpretation, syndrome identification, syndrome type identification and syndrome type classification. A software package called Lantern has been developed to support the application of the method. The method was illustrated using a data set on vascular mild cognitive impairment.

Key words: medicine, Chinese traditional, syndrome, syndrome classification, latent tree analysis, symptom co-occurrence patterns, patient clustering, stand syndrome differentiation

1 Normile D.The new face of traditional Chinese medicine.Science. 2003; 299(5604): 188-190.
2 Zhu WF.Differentiation of syndrome pattern elements. Beijing: People’s Medical Publishing House. 2008: 6-12. Chinese.
3 Zhao GQ.Perplexity and outlet of TCM syndrome essence’s study. Yi Xue Yu Zhe Xue.1999; 20(11): 47-50. Chinese.
4 China State Administration of Traditional Chinese Medicine. Diagnostic and therapeutic effect evaluation criteria of diseases and syndromes in traditional Chinese medicine. Nanjing: Nanjing University Press. 1994. Chinese.
5 China State Bureau of Technical Supervision. National standards on clinic terminology of traditional Chinese medical diagnosis and treatment-—Syndromes, GB/T 16751.2—1997. Beijing: China Standards Press. 1997. Chinese.
6 Wang J, Xiong X, Liu W.Traditional Chinese medicine syndromes for essential hypertension: a literature analysis of 13,272 patients. Evid Based Complement Alternat Med. 2014; 2014: 418206.
7 Liu GP, Li GZ, Wang YL, Wang YQ.Modelling of inquiry diagnosis for coronary heart disease in traditional Chinese medicine by using multi-label learning. BMC Complement Altern Med. 2010; 10: 37.
8 8 Fu C, Zhang NL, Chen BX, Chen ZR, Jin XL, Guo RJ, Chen ZG, Zhang YL. Identification and classification of TCM syndrome types among patients with vascular mild cognitive impairment using latent tree analysis. [2016-08- 26]. . Identification and classification of TCM syndrome types among patients with vascular mild cognitive impairment using latent tree analysis. [2016-08- 26].
9 Xu ZX, Zhang NL, Wang YQ, Liu GP, Xu J, Liu TF,Liu AH.Statistical validation of traditional Chinese medicine syndrome postulates in the context of patients with cardiovascular disease. J Altern Complement Med. 2013; 19(10): 799-804.
10 Pearl J.Probabilistic reasoning in intelligent systems: networks of plausible inference. San Mateo, California: Morgan Kaufmann Publishers. 1988.
11 Zhang NL.Hierarchical latent class models for cluster analysis.J Mach Learn Res. 2004; 5: 697-723.
12 Aldrich J.R.A. Fisher and the making of maximum likelihood 1912-1922.Statistical Sci. 1997; 12(3): 162-176.
13 Schwarz G.Estimating the dimension of model. Ann Statist.1978; 6(2): 461-464.
14 Bartholomew DJ, Knott M.Latent variable models and factor analysis. 2nd ed. London: Arnold. 1999.
15 Mourad R, Sinoquet C, Zhang NL, Liu TF, Leray P.A survey on latent tree models and applications.J Artif Intell Res. 2013; 47: 157-203.
16 Liu TF, Zhang NL, Chen PX, Liu AH, Poon LKM, Wang Y.Greedy learning of latent tree models for multidimensional clustering.Mach Learn. 2013; 98(1): 301-330.
17 Chen T, Zhang NL, Liu TF, Wang Y, Poon LKM.Modelbased multidimensional clustering of categorical data.Artif Intell. 2011; 176(1): 2246-2269.
18 18 Zhang NL, Poon LKM, Liu TF. Lantern software. [2016- 01-18]. . Lantern software. [2016- 01-18].
19 van Smeden M, Naaktgeboren CA, Reitsma JB, Moons KG, de Groot JA. Latent class models in diagnostic studies when there is no reference standard—a systematic review.Am J Epidemiol. 2014; 179(4): 423-431.
20 van Loo HM, de Jonge P, Romeijn JW, Kessler RC, Schoevers RA. Data-driven subtypes of major depressive disorder: a systematic review.BMC Med. 2012; 10: 156.
21 Wasmus A, Kindel P, Mattussek S, Raspe HH.Activity and severity of rheumatoid arthritis in Hannover/FRG and in one regional referral center. Scand J Rheumatol Suppl.1989; 79: 33-44.
22 Sullivan PF, Smith W, Buchwald D.Latent class analysis of symptoms associated with chronic fatigue syndrome and fi bromyalgia.Psychol Med. 2002; 32(5): 881-888.
23 Yang X, Chongsuvivatwong V, Lerkiatbundit S, Ye J, Ouyang X, Yang E, Sriplung H.Identifying the Zheng in psoriatic patients based on latent class analysis of traditional Chinese medicine symptoms and signs.Chin Med. 2014; 9(1): 1.
24 Vermunt JK, Magidson J.Latent class cluster analysis. In: Hagenaars JA, McCutcheon AL. Advances in latent class analysis. Cambridge: Cambridge University Press. 2002: 89-106.
25 Yang WY, Meng FY, Jiang YN, Hu H, Guo J, Fu YL.Diagnostics of traditional Chinese medicine. Beijing: Xueyuan Press. 1998. Chinese.
26 Linstone HA, Turoff M.The Delphi method: techniques and applications. Vol. 29. Boston: Addison-Wesley Publishing Company, Inc. 1975.
27 Zhang NL, Yuan SH, Wang TF, Zhao Y, Wang Y, Liu TF, Wang QG.Latent structure analysis and syndrome differentiation for the integration of traditional Chinese medicine and Western medicine (I): basic principle. Shi Jie Ke Xue Ji Shu Zhong Yi Yao Xian Dai Hua.2011; 13(3): 498-502. Chinese with abstract in English.
28 Zhang GZ, Wang P, Wang JS, Jiang CY, Deng BW, Li P, Zhao YM, Liu WL, Zhai X, Chen WW, Zeng L, Zhou DM, Sun LY, Li YY.Study on the distribution and development rules of TCM syndromes of 2 651 psoriasis vulgaris cases. Zhong Yi Za Zhi.2008; 49(10): 894-896. Chinese with abstract in English.
29 Zhang NL, Zhou XZ, Chen T, He LY, Liu BY. The interpretation variable clustering results in the context of TCM syndrome research. Zhongguo Zhong Yi Yao Xin Xi Za Zhi.2007; 14(7): 102-103. Chinese.
30 Xue J, Wang Y, Han R. Factor analysis on the distribution of Chinese medicine syndromes in patients with hyperlipidemia in Xinjiang region. Zhongguo Zhong Xi Yi Jie He Za Zhi.2010; 30(11): 1169-1172. Chinese with abstract in English.
31 Zhang NL, Yuan SH, Chen T, Wang Y.Latent tree models and diagnosis in traditional Chinese medicine.Artif Intell Med. 2008; 42: 229-245.
32 Zhang NL, Yuan S, Chen T, Wang Y.Statistical validation of traditional Chinese medicine theories.J Altern Complement Med. 2008; 14(5): 583-587.
33 Zhao Y, Zhang NL, Wang T, Wang Q.Discovering symptom co-occurrence patterns from 604 cases of depressive patient data using latent tree models.J Altern Complement Med. 2014; 20(4): 265-271.
34 Zhang NL, Yuan SH. Implicit structure model and research on syndrome differentiation of Chinese medicine (I): Basic thought and analytic tool of implicit structure. Beijing Zhong Yi Yao Da Xue Xue Bao.2006; 29(6): 365-369. Chinese.
35 Zhang NL, Yuan SH, Chen T, Wang Y. Implicit structure model and research on syndrome differentiation of Chinese medicine (II): data analysis of kidney deficiency. Beijing Zhong Yi Yao Da Xue Xue Bao.2008; 31(9): 548-587. Chinese.
36 Zhang L, Yuan SH, Chen T, Wang Y. Implicit structure model and research on syndrome differentiation of Chinese medicine (III): syndrome differentiation from model and syndrome differentiation by experts. Beijing Zhong Yi Yao Da Xue Xue Bao.2008; 31(10): 659-663. Chinese.
37 Wang TF, Zhang NL, Zhao Y, Wang Y, Wu XY, Yuan SH, Wang ZY, Du CF, Yu CG, Chen T, Poon KM, Wang QG. Latent structure models and their applications in TCM syndrome research. Beijing Zhong Yi Yao Da Xue Xue Bao.2009; 32(8): 519-526. Chinese with abstract in English.
38 Zhang NL, Xu ZX, Wang YQ, Liu TF, Liu GP, Li FF, Yan HX, Guo R. Latent structure analysis and syndrome differentiation for the integration of traditional Chinese medicine and Western medicine (II): joint clustering. Shi Jie Ke Xue Ji Shu Zhong Yi Yao Xian Dai Hua. 2012, 14(2):1422-1427. Chinese.
[1] Brody Slostad, Tejinder Khalsa, Kathleen Young, Hildalicia Guerra, Anjali Bhagra. A case-based approach to integrative medicine for cardiovascular disease prevention. Journal of Integrative Medicine, 2020, 18(2): 159-162.
[2] Ameena Yasmeen, Ghulamuddin Sofi, Kaleemullah Khan. Aamar-e-Advia (shelf-lives) of drugs in Unani system of medicine: A conceptual review. Journal of Integrative Medicine, 2020, 18(2): 114-124.
[3] Louisa Sylvia, Emerson West, Allyson M. Blackburn, Carina Gupta, Eric Bui, Tara Mahoney, Geraldine Duncan, Edward C. Wright, Simon Lejeune, Thomas J. Spencer. Acceptability of an adjunct equine-assisted activities and therapies program for veterans with posttraumatic stress disorder and/or traumatic brain injury. Journal of Integrative Medicine, 2020, 18(2): 169-173.
[4] Chang-quan Ling. Traditional Chinese medicine is a resource for drug discovery against 2019 novel coronavirus (SARS-CoV-2). Journal of Integrative Medicine, 2020, 18(2): 87-88.
[5] Sherman Gu, Arthur Yin Fan. Controversial conclusions from two randomized controlled trials for acupuncture's effects on polycystic ovary syndrome or in vitro fertilization support. Journal of Integrative Medicine, 2020, 18(2): 89-91.
[6] Xue-qing Yu, Shu-guang Yang, Yang Xie, Jian-sheng Li. Traditional Chinese medicine in the treatment of idiopathic pulmonary fibrosis based on syndrome differentiation: Study protocol of exploratory trial. Journal of Integrative Medicine, 2020, 18(2): 163-168.
[7] Mohadeseh Ostovar, Abolfazl Akbari, Mohammad Hossein Anbardar, Aida Iraji, Mohsen Salmanpour, Salar Hafez Ghoran, Mojtaba Heydari, Mesbah Shams. Effects of Citrullus colocynthis L. in a rat model of diabetic neuropathy. Journal of Integrative Medicine, 2020, 18(1): 59-67.
[8] Preecha Nootim, Nattiya Kapol, Waranee Bunchuailua, Panoopat Poompruek, Parankul Tungsukruthai . Current state of cancer patient care incorporating Thai traditional medicine in Thailand: A qualitative study. Journal of Integrative Medicine, 2020, 18(1): 41-45.
[9] Sajjad Sadeghi, Farzaneh Ghaffari, Ghazaleh Heydarirad, Mehdi Alizadeh. Galen’s place in Avicenna’s The Canon of Medicine : Respect, confirmation and criticism. Journal of Integrative Medicine, 2020, 18(1): 21-25.
[10] Maryam Naeimia, Narjes Gorjib, Zahra Memarianib, Reihaneh Moeinib, Mohammad Kamalinejadc, Fatemeh Kolangid. Gastroprotective herbs for headache management in Persian medicine: A comprehensive review. Journal of Integrative Medicine, 2020, 18(1): 1-13.
[11] Md. Anzar Alam, Mohd Aleemuddin Quamri, Ghulamuddin Sofi, Barkati Md.Tarique. Understanding hypothyroidism in Unani medicine. Journal of Integrative Medicine, 2019, 17(6): 387-391.
[12] Naghmeh Yazdi, Alireza Salehi, Mina Vojoud, Mohammad Hossein Sharifi, Ayda Hoseinkhani. Use of complementary and alternative medicine in pregnant women: a cross-sectional survey in the south of Iran. Journal of Integrative Medicine, 2019, 17(6): 392-395.
[13] Wen Qiang Lee, Jeremy Teoh, Pei Zheng Kenneth Lee, Zhi Xiong Gerard Low, Xueling Sim, Foong Fong Mary Chong, Norbert Ludwig Wagner. Factors influencing communication of traditional Chinese medicine use between patients and doctors: a multisite cross-sectional study. Journal of Integrative Medicine, 2019, 17(6): 396-403.
[14] Zienab Mahmoudpour, Javad Shokri, Mohammad Kamalinejad, Neda Meftah, Soraya Khafri, Seyyed Ali Mozaffarpur, Hoda Shirafkan. The efficacy of a Persian herbal formulation on functional bloating: A double-blind randomized controlled trial. Journal of Integrative Medicine, 2019, 17(5): 344-350.
[15] Rebecca Kulbida, Alexander Mathes, Johannes Loeser. Beneficial effects of hirudotherapy in a chronic case of complex regional pain syndrome. Journal of Integrative Medicine, 2019, 17(5): 383-386.
Full text



[1] Wei-xiong Liang. Problems-solving strategies in clinical treatment guideline for traditional Chinese medicine and integrative medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 1-4
[2] Jun Cai, Hua Wang, Sheng Zhou, Bin Wu, Hua-rong Song, Zheng-rong Xuan. Effect of Sijunzi Decoction and enteral nutrition on T-cell subsets and nutritional status in patients with gastric cancer after operation: A randomized controlled trial. Journal of Chinese Integrative Medicine, 2008, 6(1): 37-40
[3] Dong Yang, Yong-ping Du, Qing Shen, Wei Chen, Yan Yu, Guang-lei Chen. Expression of alpha-smooth muscle actin in renal tubulointerstitium in patients with kidney collateral stasis. Journal of Chinese Integrative Medicine, 2008, 6(1): 41-44
[4] Guo-hong Yuan, Xiao-jing Pang, He-chao Ma. Synergic effects of Danggui Buxue Decoction in reducing toxicity of cytoxan in tumor-bearing mice. Journal of Chinese Integrative Medicine, 2008, 6(1): 83-88
[5] Jin-zhou Tian, Jing Shi, Xin-qing Zhang, Qi Bi, Xin Ma, Zhi-liang Wang, Xiao-bin Li, Shu-li Shen, Lin Li, Zhen-yun Wu, Li-yan Fang, Xiao-dong Zhao, Ying-chun Miao, Peng-wen Wang, Ying Ren, Jun-xiang Yin, Yong-yan Wang, Beijing United Study Group on MCI of the Capital Foundation of Medical Developments. Guiding principles of clinical research on mild cognitive impairment (protocol). Journal of Chinese Integrative Medicine, 2008, 6(1): 9-14
[6] Ning-qun Wang, Liang-duo Jiang, Zong-xing Li. Research progress in asthma-related quality of life. Journal of Chinese Integrative Medicine, 2008, 6(1): 93-97
[7] Daniel Weber, Janelle M Wheat, Geoffrey M Currie. Inflammation and cancer: Tumor initiation, progression and metastasis,and Chinese botanical medicines. Journal of Chinese Integrative Medicine, 2010, 8(11): 1006-1013
[8] Xin-jun Wang, Ling-ling Wang . A mechanism of endogenous opioid peptides for rapid onset of acupuncture effect in treatment of depression. Journal of Chinese Integrative Medicine, 2010, 8(11): 1014-1017
[9] Bo Wang , Wei Yan , Li-hui Hou, Xiao-ke Wu. Disorder of Tiangui (kidney essence) and reproductive dysfunction in patients with polycystic ovary syndrome. Journal of Chinese Integrative Medicine, 2010, 8(11): 1018-1022
[10] Bing Hu , Hong-mei An , Ke-ping Shen , Qin Du. Senescence-inducing effects of Chinese herbal medicine Tenglong Buzhong Decoction on human colon carcinoma LS-174-T cells and the mechanism. Journal of Chinese Integrative Medicine, 2010, 8(11): 1048-1052