Journal of Integrative Medicine 19 (2021) 395–407

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Journal of Integrative Medicine

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Methodology

Application of an extreme learning machine network with particle

swarm optimization in syndrome classification of primary liver cancer
Liang Ding a, Xin-you Zhang a,⇑, Di-yao Wu b, Meng-ling Liu a
a
School of Computer, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, Jiangxi Province, China
b
School of Pharmacy, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, Jiangxi Province, China

a r t i c l e i n f o a b s t r a c t

Article history: Objective: By optimizing the extreme learning machine network with particle swarm optimization, we
Received 16 July 2020 established a syndrome classification and prediction model for primary liver cancer (PLC), classified
Accepted 2 March 2021 and predicted the syndrome diagnosis of medical record data for PLC and compared and analyzed the
Available online 4 August 2021
prediction results with different algorithms and the clinical diagnosis results. This paper provides modern
technical support for clinical diagnosis and treatment, and improves the objectivity, accuracy and rigor of
Keywords: the classification of traditional Chinese medicine (TCM) syndromes.
Primary liver cancer
Methods: From three top-level TCM hospitals in Nanchang, 10,602 electronic medical records from
Syndrome type
Particle swarm
patients with PLC were collected, dating from January 2009 to May 2020. We removed the electronic
Extreme learning machine medical records of 542 cases of syndromes and adopted the cross-validation method in the remaining
Fuzzy mathematics 10,060 electronic medical records, which were randomly divided into a training set and a test set.
Based on fuzzy mathematics theory, we quantified the syndrome-related factors of TCM symptoms
and signs, and information from the TCM four diagnostic methods. Next, using an extreme learning
machine network with particle swarm optimization, we constructed a neural network syndrome classi-
fication and prediction model that used ‘‘TCM symptoms + signs + tongue diagnosis information + pulse
diagnosis information” as input, and PLC syndrome as output. This approach was used to mine the non-
linear relationship between clinical data in electronic medical records and different syndrome types. The
accuracy rate of classification was used to compare this model to other machine learning classification
models.
Results: The classification accuracy rate of the model developed here was 86.26%. The classification accu-
racy rates of models using support vector machine and Bayesian networks were 82.79% and 85.84%,
respectively. The classification accuracy rates of the models for all syndromes in this paper were between
82.15% and 93.82%.
Conclusion: Compared with the case of data processed using traditional binary inputs, the experiment
shows that the medical record data processed by fuzzy mathematics was more accurate, and closer to
clinical findings. In addition, the model developed here was more refined, more accurate, and quicker
than other classification models. This model provides reliable diagnosis for clinical treatment of PLC
and a method to study of the rules of syndrome differentiation and treatment in TCM.

Please cite this article as: Ding L, Zhang XY, Wu DY, Liu ML. Application of an extreme learning machine
network with particle swarm optimization in syndrome classification of primary liver cancer. J Integr
Med. 2021; 19(5): 395–407.
Ó 2021 Shanghai Yueyang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine.
Published by ELSEVIER B.V. All rights reserved.

1. Introduction
Primary liver cancer (PLC) is one of the most common clinical
malignant tumor diseases. According to the most recent data,
⇑ Corresponding author.
E-mail address: xinyouzhang@jxutcm.edu.cn (X.Y. Zhang).
China ranks first in the world for the number of new PLC patients
and deaths from PLC [1–3], and the morbidity and mortality rates
are increasing year by year. The treatment of PLC with traditional
Chinese medicine (TCM) emphasizes both the symptoms and root
causes. This can improve the patient’s symptoms and reduce the
occurrence of complications and the pain experienced by patients.
TCM does not produce negative side effects, but it improves patient

https://doi.org/10.1016/j.joim.2021.08.001
2095-4964/Ó 2021 Shanghai Yueyang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. Published by ELSEVIER B.V. All rights reserved.
L. Ding, X.Y. Zhang, D.Y. Wu et al. Journal of Integrative Medicine 19 (2021) 395–407

quality of life and can effectively increase survival time. However, records of concurrent syndrome. TCM electronic medical records
there are many possible TCM syndrome differentiation patterns of data were all in text form.
PLC. In general, there is not one standard systematic way to catego-
rize the symptoms and signs of TCM, and the information from the 2.2. Criteria for syndrome differentiation
TCM four diagnostic methods [4–6]. These possible uncertainties
can affect the therapeutic outcomes of TCM on PLC. Thus, to more To make the model effectively classify TCM symptom data and
objectively and accurately reflect the characteristics of the disease, other information from the clinical medical records, it was neces-
and to improve the accuracy rate of TCM clinical syndrome differ- sary to establish criteria for the syndrome classification of PLC. In
entiation and treatment, this study focuses on the nonlinear char- addition, the information data such as TCM symptoms and signs,
acteristics of syndrome-related factors and syndrome types, such and information from the TCM four diagnostic methods in the
as symptoms, signs, tongue diagnosis, and pulse diagnosis of model were uniformly named as the syndrome-related factors.
TCM, and establishes a model for diagnosis and classification of Based on the TCM texts Diagnostics of Traditional Chinese Medi-
PLC. Wang et al. [7] took chronic fatigue syndrome as an example, cine [5], Differential Diagnosis of Traditional Chinese Medicine Symp-
and a multi-objective machine learning task based on random for- toms [17] and Internal Medicine of Traditional Chinese Medicine [6],
est was established to provide valid confidence evaluation in the and the clinical experience of the chief physicians of TCM, we con-
identification of chronic fatigue syndrome. Liu et al. [8] used the structed the ‘‘Questionnaire of Primary Liver Cancer Symptom.”
characteristics of different syndromes of chronic gastritis in TCM The frequencies of 126 syndrome-related factors (symptoms and
to establish the deep learning syndrome diagnosis model, Deep signs of TCM) in 10,060 patients with PLC were counted. The 36
Belief Network, which helped to establish diagnostic standards syndromes with the highest frequencies were selected for use in
for chronic gastritis and diagnostic models for TCM. Xu et al [9] col- the model, as shown in Table 1. After statistical analysis, aside from
lected 18,471 complete data sets of real clinical records of chronic the common sleep problems, anorexia, and fatigue in patients with
obstructive pulmonary disease and established an intelligent diag- chronic diseases, the most common clinical manifestations of
nosis model with symptoms and signs as input and syndrome patients with PLC were weight loss, abdominal distension, abdom-
types as output. Thus, neural networks offer a method to establish inal pain, and distending pain. According to the analysis of 10,060
intelligent models for processing TCM syndrome differentiation medical records, the color of tongue body was most commonly
and treatment. classified into light red, red, and dark; the color of the tongue coat-
Based on previous experience, the present work combined an ing was classified as thin white, yellow greasy and white greasy,
extreme learning machine (ELM) network [10–13] which has fast and the pulse was classified as stringy, wiry and thin, and wiry
calculation speed and good generalization performance with the and slippery. The statistics of syndrome-related factors are shown
particle swarm optimization (PSO) [14–16] method. This ELM net- in Table 2.
work based on PSO was used to build a classification model of PLC The syndrome classification and syndrome-related factors of
syndrome. First, fuzzy mathematics theory has been used to PLC were determined, as shown in Table 3, based on Standards
rationally quantify the data contained in electronic medical for Diagnosis and Treatment of Primary Liver Cancer (2017, 2015
records. Data processing is also carried out on the influence of and 2011 editions) [18–20], Diagnostics of Traditional Chinese Medi-
the principal certificate and concurrent issuance of different certifi- cine [5], and Internal Medicine of Traditional Chinese Medicine [6].
cate types. The magnitude of TCM symptoms has been reasonably
explained. The structure of electronic medical records and the 2.3. Syndrome factors of fuzzy mathematics quantification
standardization of clinical data have been well realized. Secondly,
this paper used the PSO-ELM diagnostic model which is faster, In modern medicine, many conditions exist that defy traditional
and has higher accuracy and better performance than other classi- Boolean classification. There is no inherent limit to the quality or
fication models. The PSO-ELM algorithm provides an effective degree of these conditions, and they are better described by fuzzy
model for clinical diagnosis of TCM. Thirdly, through the combina-
Table 1
tion of fuzzy mathematics, PSO and ELM, the PLC syndrome classi-
Statistics of syndrome-related factors (symptoms and signs of traditional Chinese
fication and diagnosis model constructed here not only provided medicine) in 10,060 medical records.
effective technical support for clinical diagnosis, but also improved
Syndrome-related Frequency Syndrome-related Frequency
the accuracy of TCM syndrome classification over other models.
factor (count) factor (count)
Additionally, for the first time, association rules were used to test
Poor food intake 7745 Abdominal 6802
the degree of conformity of the syndrome factors. The syndrome
distension
factors obtained by fuzzy mathematics were compared with the Poor sleep 6245 Fatigue 3250
syndrome factors present in diagnosis textbooks. These two sets Dry mouth 3141 Weight loss 2978
of syndrome factors have a higher degree of consistency. This ver- Abdominal pain 2931 Abdominal lump 2577
ification method not only provided an effective way to verify the pain
Yellowish urine 2511 Abnormal mood 2239
quantification of electronic medical record data, but also proved Distending pain 2133 Less urination 1898
the validity of using fuzzy mathematics to quantify TCM electronic Loose stool 1690 Hypochondriac pain 1682
medical record data. Dry stool 1521 Lower limb swelling 1138
Dry bitter 1167 Nausea 1099
Dull pain 1056 Jaundice 992
Abdominal fullness and 848 Bloating 834
2. Data preprocessing distention
Sored waist and knees 826 Eructation 719
2.1. Data source Low back pain 594 Chest tightness 561
Cough 437 Vomiting 362
Poor urine 322 Dizziness 260
We collected 10,602 clinical electronic medical records of Shortness of breath 245 Dim and blackish 244
patients diagnosed with PLC from Jiangxi Provincial Hospital of complexion
TCM, the Second Affiliated Hospital of Jiangxi University of TCM, Headache 229 Diarrhea 217
and Hongdu Hospital of TCM. Records were dated between January Black stool 184 Frequency of 182
micturition
2009 and May 2020. We excluded 542 cases of electronic medical
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L. Ding, X.Y. Zhang, D.Y. Wu et al. Journal of Integrative Medicine 19 (2021) 395–407

Table 2
Statistics of syndrome-related factors (tongue proper, tongue coating and pulse) in 10,060 medical records.

Tongue proper Frequency (count) Tongue coating Frequency (count) Pulse Frequency (count)
Light red 3071 Thin white 2977 String 2268
Red 2756 Yellow greasy 2004 Wiry and thin 2069
Dark 1205 White greasy 1490 Wiry and slippery 2297
Dark red 892 Less moss 1197 Taut and uneven 1201
Dim 822 Thin yellow 926 Thready rapid 982
Dark purple 493 Stripping 662 Slippery and rapid 486
Pale enlarged 420 Thin and white greasy 279 Small and weak 328
Dark 250 Yellow and thick 247 Deep and thin 218

Tongue body, tongue coating, and pulse are selected from the top eight syndrome-related factors in frequency.

Therefore, fuzzy mathematics is needed to quantify medical data.

Table 3
In this paper, a fuzzy mathematical quantification approach previ-
Syndrome factors of primary liver cancer and their proportions.
ously described in the literature [24–26] is used to quantify the
Syndrome factor Syndrome-related factors Frequency Ratio symptoms, signs, and other information from the TCM four diag-
(count) (%)
nostic methods.
Damp-heat retention Dry bitter and dry mouth, 3003 29.85 According to the collected medical records, there were eight
syndrome nausea, abdominal distension,
syndrome differentiation types of PLC. These types were
chest tightness, less urine,
yellowish urine, slippery pulse, recorded as L1, L2, L3, L4, L5, L6, L7, and L8. The syndrome factors
dry stool, red tongue, yellow- of each syndrome type, with a total number of 74, are recorded
greasy tongue coating as w1, w2, w3. . .w74. Different syndrome factors of the same syn-
Liver depression and Hypochondriac pain, abnormal 1115 11.08
drome type have different effects on the syndrome type. Thus, in
spleen deficiency mood, eructation, loose stool,
syndrome thin white, wiry and thin,
this analysis we evaluated the weight of the syndrome factor of
tongue light red, abdominal each syndrome type following previously described methods
distension [27–31] and assignment by experts. The evaluation is shown in
Qi stagnation and Abdominal pain, abdominal 1004 9.98 Table 4.
blood stasis distension, abdominal lump
The clinical manifestations of damp-heat retention syndrome
syndrome pain, chest tightness,
eructation, dim and blackish are bitter mouth w1, dry mouth w2, nausea w3, abdominal disten-
complexion, tongue dark sion w4, chest tightness w5, decreased urine output w6, yellowish
purple, thin white, taut and urine w7, dry stool w8, red tongue w9, yellow-greasy tongue coating
uneven w10, and slippery pulse w11. According to the expert assignment
Vital qi deficiency Abdominal lump pain, dull 948 9.42
and binding of pain, poor food intake, weight
method, eight experts, with years of clinical experience in the
static blood loss, fatigue, tongue lilac, less PLC of TCM were invited to fill out Table 4, and the following eight
syndrome moss or stripping, thready scoring matrices were obtained.
rapid pulse or wiry and thin 0 1 0 1
Liver qi stagnation Hypochondriac pain, 1166 11.59 9 0 0 0 6 0 0 0
syndrome abdominal distension, B9 0 0 0C B 0 8 0 0C
B C B C
distending pain, abnormal B C B C
B0 6 0 0CC B 0 0 7 0C
mood, eructation, dry stool, B B C
B8 C B 0 6 0 0C
abdominal lump pain, tongue B 0 0 0C B C
light red, thin white, pulse B C B C
B0 0 7 0C B 0 6 0 0C
string B C B C
B C B C
Liver and kidney yin Abdominal lump pain, 955 9.49 C1 ¼ B 0 6 0 0 CC2 ¼ B 0 6 0 0C
deficiency hypochondriac pain, dizziness, B C B C
B0 0 8 0C B 0 6 0 0C
syndrome sored waist and knees, low B C B C
B C B C
back pain, night sweat, tongue B0 8 0 0C B 0 6 0 0C
B C B C
red, less moss, thready rapid B9 0 0 0C B 10 0 0 0C
pulse B C B C
B C B C
Phlegm and blood Dim and blackish complexion, 906 9.01 @9 0 0 0A @ 10 0 0 0A
stasis syndrome abdominal distension,
8 0 0 0 7 0 0 0
abdominal fullness and 0 1 0 1
distention, hypochondriac 8 0 0 0 9 0 0 0
pain, dull pain, tongue dark B6 0 0 0C B0 8 0 0C
B C B C
purple, yellow greasy, wiry B C B C
B0 0 8 0C B0 8 0 0C
and slippery or taut and B C B C
uneven B0 C B C
B 0 6 0C B0 8 0 0C
Spleen deficiency Abdominal distension, 963 9.57 B C B C
B0 0 0 7C B0 0 7 0C
and dampness distending pain, bloating, B C B C
B C B C
syndrome lower limb swelling, loose C3 ¼ B 0 0 8 0 C C4 ¼ B 0 8 0 0 C
stool, tongue pale enlarged, B C B C
B0 7 0 0CC B C
white greasy, pulse string B B0 0 9 0C
B C B C
B6 0 0 0C B0 8 0 0C
B C B C
B0 7 0 0C B0 8 0 0C
B C B C
B C B C
@8 0 0 0A @9 0 0 0A
words, such as minor, serious, important, and occasional. Quantify-
9 0 0 0 8 0 0 0
ing these conditions by their presence or absence (0 or 1) would
reduce the accuracy of the model classification results [21–23].

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L. Ding, X.Y. Zhang, D.Y. Wu et al. Journal of Integrative Medicine 19 (2021) 395–407

Table 4
Syndrome-related factors weight assignment score table.

Syndrome-related factor Very important Important General Unimportant

Assignment criteria 1.00 0.75 0.5 0.25

0 1 0 1
0 8 0 0 7 0 0 0 The calculated unnormalized weight k = 0.5 was used as a stan-
B 0 7 0 0C B 0 9 0 0C dard to classify the main syndrome factor and the secondary syn-
B C B C
B C B C drome factor. Thus, we determined that the major syndrome
B 0 0 6 0CC B 0 6 0 0C
B B C
B 0 C B 0 7 0 0C
factors of damp-heat retention syndrome were bitter mouth
B 0 7 0C B C
B C B C (w1), dry mouth (w2), dry stool (w8), red tongue (w9), yellow-
B 0 0 0 8C B 0 0 6 0C
B C B C greasy tongue coating (w10), and slippery pulse (w11). The sec-
B C B C
C5 ¼ B 7 0 0 0 CC6 ¼ B 0 0 9 0C ondary syndrome factors are nausea (w3), abdominal distension
B C B C
B 0 7 0 0C B 0 0 7 0C (w4), chest tightness (w5), decreased urine output (w6), and yel-
B C B C
B C B C lowish urine (w7).
B 7 0 0 0C B 0 6 0 0C
B C B C Then, we normalized the weights of the syndrome factors:
B 10 0 0 0CC B 0 9 0 0C
B B C A = 1/6.73115B
B C B C
@ 10 0 0 0A @ 10 0 0 0A =(0.1095 0.0965 0.0631 0.0733 0.0468 0.0714 0.0668 0.0919
10 0 0 0 9 0 0 0 0.1183 0.1355 0.1262)
0 1 0 1
8 0 0 0 0 8 0 0 The grade of each syndrome type was generally classified into
B0 8 0 0C B 7 0 0 0C three levels: mild (V1), moderate (V2), and severe (V3). Here we
B C B C
B C B C refer to the quantitative level of the syndrome type as H(wi). The
B0 0 9 0C B 0 0 8 0C
B C B C main syndrome type was quantitatively assigned values of 2, 4,
B0 0 8 0C B 0 7 0 0C
B C B C and 6. The values of the secondary syndrome factor were 1, 2,
B C B C
B0 0 8 0C B 0 0 6 0C and 3. The resulting expression is shown in Equation 2-1:
B C B C
B C B C 8
C7 ¼ B 0 0 9 0 CC8 ¼ B 0 0 7 0C
B C B C >
< V 1 2or1
B0 0 6 0C B 0 8 0 0C
B C B C Hðwi Þ ¼ V 2 4or2i ¼ ð1; 2; :::74Þ ð2-1Þ
B C B C >
B8 0 0 0C B 0 8 0 0C :
B C B C V 3 6or3
B0 9 0 0C B 10 0 0 0C
B C B C
B C B C If there was no symptom level indicated in the medical record,
@9 0 0 0A @ 8 0 0 0A
or there was a syndrome factor that was not the main factor for
8 0 0 0 9 0 0 0
syndrome differentiation, the following expression was formed:
Then, the sum of the scoring matrix of all experts was: 
no0
0 1 Hðwi Þ ¼ i ¼ ð1; 2; :::74Þ ð2-2Þ
47 16 0 0 yes0:1
B 22 0 C
B 40 0 C The syndrome factors of each syndrome type were normalized
B C
B 0 20 38 0 C one by one, and the weights of the syndrome factors corresponding
B C
B 8 0 C to the different syndrome types were obtained. Finally, the quanti-
B 28 21 C
B C tative data closer to TCM syndrome factors were obtained. Then,
B 0 6 34 15 C
P B C we used these conditioned data in the classification model of the
8
B C
C¼ Ci ¼ B 7 20 33 0 C
B C PSO-ELM, setting the data foundation for the next step in building
i¼1
B 0 28 30 0 C
B C the model.
B C
B 21 38 0 0 C
B C
B 39 33 0 0 C
B C 3. Algorithm design
B C
@ 73 0 0 0 A
68 0 0 0 3.1. ELM algorithm

Then, we found the weighted average scoring matrix: ELM is the feedforward neural network of a single hidden layer
0 1 [32,33], which has the characteristics of high learning speed,
47 16 0 0 strong generalization ability, and strong global search ability. For
B 22 0 C
B 40 0 C N different training samplesfðxi ; yi ÞgNi¼1 , xi ¼ ½xi1 ; xi2 ; :::; xim T is the
B C
B 0 20 38 0 C
B C training sample feature vector, the label information of the corre-
B 8 0 C
B 28 21 C sponding training sample xi is yi ¼ ½yi1 ; yi2 ; :::; yim T . The network
B C
B 0 6 34 15 C structure diagram of the ELM for an activation function g(x) with
1 BB
C
C L hidden layer nodes is shown in Fig. 1.
B¼ B 7 20 33 0 Cð 1 0:75 0:5 0:25 Þ
80 B C Its mathematical expression is the equation 3–1:
B 0 28 30 0 C
B C
B C X
B 21 38 0 0 C L
B C bi gðW i  X j þ bi Þ ¼ Oj ; j ¼ 1; :::N ð3-1Þ
B 39 33 0 0 C
B C
B C i¼1
@ 73 0 0 0 A
In 3-1, W i ¼ ½W i1 ; W i2 ; :::; W im T is the input weight, bi is the out-
68 0 0 0
put weight, and bi is the offset of the i hidden layer unit. Wi*Xj rep-
=(0.7375 0.65 0.425 0.49375 0.3156 0.48125 0.45 0.61875 resents the inner product of Wi and Xj. N equations of Equation 3–1
0.7968 0.9125 0.85) are simplified and combined and can be expressed as Equation 3-2.
398
L. Ding, X.Y. Zhang, D.Y. Wu et al. Journal of Integrative Medicine 19 (2021) 395–407

W11 β11 3.2. PSO algorithm

g(x), b1 In the past few decades, scholars have proposed many opti-
mization algorithms inspired by nature. Mirjalili et al. [34] was
X1 yi1
inspired by the gray wolf’s social hierarchy and hunting behavior.
The gray wolf algorithm has good applications in path selection,
industrial manufacturing, and automation control [35–37]. Jain
X2 g(x), b2 yi2 et al. [38] imitated the southern flying squirrel’s winter dynamic
foraging behavior and its effective gliding movement and proposed
a squirrel optimization algorithm, which has significantly
improved accuracy and convergence speed. It is applied to energy
monitoring, air quality prediction, and electricity production [39].
Mirjalili et al. [40] proposed the salp algorithm, based on the prin-
ciple of the marine food chain, in which the leading individual of
this colonial organism guides the population to find food at sea.
Seyedali et al. [41] simulated the hunting behavior of humpback
X3 yin
whales and proposed a whale optimization algorithm. This algo-
rithm used random or best search agents to simulate hunting
g(x), b3 behavior and used spirals to simulate the bubble net attack mech-
anism of humpback whales. It has a wide range of applications in
the image field, photovoltaic industry, and statistics [42–44]. Labbi
WmL βLn
et al. [45] created an optimization algorithm that mimics the
behavior of tree roots. Based on strategies employed by plant roots
Fig. 1. The network structure of extreme learning machine.
to effectively find water in the soil, this function improves the
robustness and efficiency of non-linear functions [46,47]. Studies
Hb¼T ð3-2Þ have shown that various optimization algorithms have been suc-
cessfully applied in various fields, such as industrial manufactur-
where H represents the output matrix of the hidden layer, b repre- ing, environmental engineering, and biomedicine.
sents the weight matrix, and T represents the expected output In this paper, a particle swarm algorithm was used to optimize
matrix: the ELM; it was based on the general characteristics of particle
swarm algorithms, but employed fewer parameters, had simpler
2 3 evolution, and was easier to fit to the situation. PSO was proposed
gðW 1  X 1 þ b1 Þ:::gðW 1  X L þ b1 Þ
6 7 by Kennedy and Eberhart [48] and imitates the foraging behavior
H¼4   5 ð3-3Þ
of birds. In this algorithm, each individual ‘‘bird” is abstracted as
gðW 1  X N þ b1 Þ:::gðW 1  X N þ bL Þ NL a massless and volumeless particle, and the group is composed of
all individuals, called the population. Each particle represents a
2 3 2 3 possible solution to the optimization problem. In the PSO process,
bT1 T T1
6 . 7 6 . 7 each particle is comprehensively analyzed, based on its own indi-
b¼6
4 .. 5
7 T¼6
4 .. 5
7 ð3-4Þ vidual experience and the group experience of neighboring parti-
cles. According to the results of the analysis, the speed and
bTL Lm T TL Nm position of individual particles are dynamically adjusted, and an
Network training for ELM is equivalent to the following opti- iterative search is continuously performed in multi-dimensional
mization problem: space to find the best position for each particle to fly. The algorithm
tries to find the individual optimal solution pbest and the global
^ optimal solution gbest. Then, we constantly adjust their own flight
k H b T k ¼ Min k Hb  T k ð3-5Þ direction and speed according to pbest and gbest. The updated speeds
b
and positions of these particles are as follows:
When g(x) is infinitely differentiable, with random parameters Wi V iþ1
i ¼ dv ti þ c1 r1 ðpti  zti Þ þ c2 r 2 ðoti  zti Þ ð3-7Þ
and bi, the ELM model training process can be approximated as
solving the least squares solution of linear Hb = T, as shown in Equa- ztþ1
i ¼ zti þ v tþ1
i ð3-8Þ
tion 3–6.
dmax  dmin
d ¼ dmax  t ð3-9Þ
^
t max
þ
b ¼H T ð3-6Þ where pi represents the individual optimal position of the particle,
oi represents the global optimal position, dmax and dmin represent
where H+ is the generalized inverse of Moore-Penrose pseudoin- the maximum and minimum values of the inertia weight, c1 and
verse of the hidden layer output matrix H. The ELM model randomly c2 are the learning factors, r1 and r2 are random numbers between
generates the input weight matrix and the threshold of the hidden [0,1], tmax and t represent the maximum number of iterations and
layer neurons. The network output value can be analytically calcu- the current number of iterations, respectively.
lated without iterative adjustment, and the optimal solution of the
input layer weight can be obtained. However, the random genera- 3.3. PSO-ELM
tion of parameters brings uncertainties to the network prediction
accuracy and generalization ability [11], and it is easy to produce The initial values and thresholds of the ELM are random, which
a poor classification effect. Therefore, here we combined the PSO greatly affects the outcome of training. Therefore, the ELM input
algorithms and optimized the ELM network parameters Wi and bi weights Wi and the hidden layer neuron bias bi were used as par-
to eliminate or reduce the instability of the ELM algorithm output. ticles of the PSO algorithm to avoid random training of the ELM
399
L. Ding, X.Y. Zhang, D.Y. Wu et al.
model. We first initialized the particle swarm parameters, includ-
ing particle swarm size, spatial dimension (d) and number of iter-
ations (n). Then, we randomly generated the inertia parameter (w)
according to the sample data and selected the best learning factors
(c1 and c2). The mean square errors of the ELM learning sample out-
put and actual output were used as the fitness function to calculate
the fitness value of each particle. The speed and position of parti-
cles were updated until the minimum error or the maximum num-
ber of iterations was reached. Thus, the ELM network parameters
optimized by PSO were found.
3.3.1. Particle coding
Since the electronic medical records of Chinese medicine are
discrete data, this study used binary logic to represent particles.
Table 5 shows the expression for binary particles in this study. In
this paper, the particle was composed of two parts: the input fea-
ture, R (discrete value), and the value of the number of hidden neu-
rons, M (continuous value). If each feature existed, it was
represented with a 1. And if not, it was represented with a 0. S1–
S30 represented the feature mask, H1–Hn represented the value of
the number of hidden neurons, and n was the number of bits rep-
resenting the number of hidden neurons. In this paper, a 40-bit
code was used to encode the number of hidden neurons and the
feature mask, where the feature mask was 30 bits, and the hidden
layer neuron had 10 layers.
3.3.2. Learning factor
It can be seen from equation 3-7 that the learning factors c1 and
c2 control the ‘‘cognitive” part and the ‘‘social” part, respectively.
When using the PSO algorithm to optimize certain problems, in
the initial stage, it is always hoped that individuals can search
and optimize in the entire space to avoid prematurely falling into
local values. At the end stage, the convergence accuracy and speed
of the algorithm can be improved. Therefore, in this study, we used
an adaptive update method, the fitness value of the particle, the
distance between the current particle and the global optimal par-
ticle, and the number of iterations to achieve the adaptive adjust-
ment of the learning factor [49]. Therefore, the particles had
different characteristics in different states. The learning factor
update method was used to improve the performance of learning
factor optimization.
f ¼ fit þ d
 
d ¼ di  dgbest 
f  f min
f ¼
f max  f min
t 1
c1 ¼ 2f  ð1 þ Þ 
T 2
1 t 1
c2 ¼ ð þ 1Þ  ð1 þ Þ 
2f T 2
d is the distance between the current particle and the global opti-
mal particle; di is the current particle; dgbest is the global optimal
particle, and f is the current particle state.
When the value of f is small, the particle is far from its optimal
solution; in response, the value of c1 would be increased and the
value of c2 would be decreased to strengthen the algorithm’s ability
Table 5
Particle representation.
Feature mask The number of hidden layer neuron
S1 . . .Sk. . . S30 H1 . . .Hk. . .
Journal of Integrative Medicine 19 (2021) 395–407
to explore the global parameter space. When the value of f is large,
the distance between the particle and the optimal solution is rela-
tively small. In this case, the value of c2 would be increased, and the
value of c1 would be decreased to strengthen the ability of the algo-
rithm to search the local parameter space. Therefore, the design
equation 3-13 is an increasing function, and the design equation
3-14 is a decreasing function.
3.3.3. Pseudocode
The pseudocode of PSO-ELM algorithm is shown in Fig. 2.
3.4. Association rules verify the accuracy of the certification factors
For the association rule algorithm, strong association rules are
generally determined by three indicators of support, confidence,
and lift. Support means the probability of an itemset appearing
in the total itemsets, which is used to eliminate itemsets with
low frequency. The confidence is the probability of occurrence of
an event under the premise of another event (that is, in the itemset
containing X , the probability of the existence of Y), which can be
used to express the relationship between itemsets, as follows:
SupportðX ! YÞ ¼ PðX; YÞ=PðX; YÞ ¼ PðX; YÞ=PðIÞ ð3-15Þ
ConfidenceðX ! YÞ ¼ PðYjxÞ ¼ PðX; YÞ=PðXÞ ð3-16Þ
According to three textbooks of Diagnostics of Traditional Chinese
Medicine [5], ‘‘Internal Medicine of Traditional Chinese Medicine [6]
and Differential Diagnosis of Traditional Chinese Medicine Symptoms
[17], we used fuzzy mathematics to quantified the criteria for the
PLC with damp-heat retention, liver depression and spleen defi-
ciency syndrome, qi stagnation and blood stasis syndrome, vital
qi deficiency and binding of static blood syndrome, liver qi stagna-
tion syndrome, liver and kidney yin deficiency syndrome, phlegm
and blood stasis syndrome, spleen deficiency and dampness
PSO-ELM
Step1 Start.
Step2 Determine the network topology.
Step3 Random initialization of ELM weights and thresholds.
Step4 Generate randomly an initial swarm of size S.
Step5 Initialize randomly the velocity vectors vi (i = 1, 2, . . ., S) associated with the S
particles.
Step6 For each position Pi(i=1,2,3,...s) use MSE as the fitness function, and Calculate
ð3-10Þ the fitness value.
Step7 Detect the best global position pbest in the swarm exhibit-ing the maximum
ð3-11Þ value of the considered fitness function over all explored trajectories.
Step8 According to formula 3-7,3-9 update the velocity of each particle
Step9 According to formula 3-8, update the position of each particle
ð3-12Þ Step10 According to formula 3-10, 3-11, 3-12, 3-13, 3-14, update learning factor
Step11 For each candidate particle pi, calculate the corresponding fitness function, and
update the maximum fitness function value of the current best position pbest of each
particle.
ð3-13Þ while not stop
for i=1 to N
If fun(xL)<=fun(xR) Xi=xL; Else Xi=xR; End if
ð3-14Þ if fit(Xi)<fit(pBesti) pBest=Xi and Faili=0; else Faili=Faili+1; End if
If Faili Threshold reached from gbest select Xi and Faili=0; end if
if fit(pBesti)<fit(gBest) gBest=pBesti; end if
end for
end while
Step 12 If the maximum number of iterations is not yet reached,return to step 7, else
go to step 13.
Step 13 Select the best global position gbest in the swarm and train an ELM classifier
fed with the subset of detected features mapped by gbest and modeled with the
number of hidden neurons encoded in the same position.
Step14 Build the ELM network and initialize.
Step15 Training ELM network.
Step16 Predictive result.
Step17 End.
Hn Fig. 2. Pseudocode algorithm process of PSO-ELM. PSO-ELM: particle swarm
optimization-extreme learning machine.
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syndrome. Next, the association rule method was used to mine and
analyze the quantitative data from the 10,060 medical records.
This helped to judge whether the criteria from the textbooks were
suitable for the dataset used in this article, and to verify the accu-
racy of the model.
4. Experimental results and analysis
was 100. The inertia weight (w) was randomly generated during
the iteration process, and ranged from 0.4 to 0.8. The initial value
of the learning factor was c1 = c2 = 2 [49–52]. The number of hidden
layer nodes was optimized and compared with an increasing func-
tion from 1–300. Finally, when the hidden layer node was 100, the
overall classification accuracy rate of the model reached the great-
est value, and the results are shown in Fig. 3.

100
4.1. Quantification result from fuzzy mathematics

Classifiication accuracy (%)

80
Using the quantification operation, each syndrome factors was
sequentially quantified using fuzzy mathematics. The results are 60
shown in Table 6.
40
4.2. PSO-ELM model parameters
20

The basic settings of the PSO-ELM model were as follows: TCM

symptoms and signs, pulse diagnosis information, and tongue 0
0 20 40 60 80 100 120
diagnosis information were set as input terminals, and eight types
Hidden layer node
of syndromes were set as output terminals. The softmax function
was selected as the optimal activation function. The population Fig. 3. The number of hidden layer nodes of particle swarm optimization-extreme
number was 30, and the number of iterations for the particle group learning machine.

Table 6
Normalized numerical table of syndrome-related factors.

Syndrome factor Main syndrome-related factor Minor syndrome-related factor

Damp-heat retention syndrome Dry bitter 0.1095 Nausea 0.0631
Dry mouth 0.0965 Abdominal distension 0.0733
Dry stool 0.0919 Chest tightness 0.0468
Tongue red 0.1183 Decreased urine output 0.0714
Yellow greasy 0.1355 Yellowish urine 0.0688
Wiry and slippery 0.1262
Liver depression and spleen deficiency syndrome Distending pain 0.1297 Abdominal pain 0.0942
Abnormal mood 0.1967 Loose stool 0.0778
Abdominal distension 0.1215 Tongue light red 0.0915
Thin white 0.1256
Wiry and thin 0.1625
Qi stagnation and blood stasis syndrome Abdominal lump pain 0.1560 Abdominal pain 0.0932
Dim and blackish complexion 0.1378 Chest tightness 0.0963
Tongue lilac 0.1597 Thin white 0.0876
Taut and uneven 0.1707
Eructation 0.1048
Vital qi deficiency and binding of static blood syndrome Abdominal lump pain 0.1362 Dry stool 0.0814
Dull pain 0.1470 Less moss or stripping 0.0831
Fatigue 0.1308
Wiry and thin or thin and rapid 0.1383
Poor food intake 0.1382
Weight loss 0.1427
Liver Qi stagnation syndrome Abnormal mood 0.1399 Dry stool 0.0832
Hypochondriac pain 0.1419 Eructation 0.0793
Abdominal distension 0.1336 Wiry and thin 0.0803
Distending pain 0.0961 Thin white 0.0647
Abdominal lump pain 0.1033 Tongue light red 0.0831
Liver and kidney yin deficiency syndrome Sored waist and knees 0.1663 Hypochondriac pain 0.0932
Low back pain 0.1575 Abdominal lump pain 0.0722
Night sweats 0.1312 Dizziness 0.0700
Tongue red 0.1181
Less moss 0.1400
Thready rapid pulse 0.1444
Phlegm and blood stasis syndrome Dim and blackish complexion 0.1194 Abdominal distension 0.0753
Wiry and slippery 0.1012 Dull pain 0.0792
Abdominal fullness and distention 0.0927
Hypochondriac pain 0.1247
Yellow greasy 0.1332
Dark purple 0.1364
Taut and uneven 0.1363
Spleen deficiency and dampness syndrome Abdominal distension 0.1654 Loose stool 0.0948
Bloating 0.1675 Tongue red 0.0462
Lower limb swelling 0.1228 String 0.0839
Fatigue 0.1227 Distending pain 0.0742
White greasy 0.1218

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Table 7
Comparative analysis table of accuracy rates of PSO-ELM and other classification algorithms.

Syndrome factor PSO-ELM Support vector machines Bayesian network 0–1 PSO-ELM
Training Testing Training Testing Training Testing Training Testing
(mean ± SD) (mean ± SD) (mean ± SD) (mean ± SD)
Damp-heat retention syndrome 82.27 82.15 ± 0.01 84.24 83.11 ± 0.02 85.15 82.33 ± 0.02 65.08 63.12 ± 0.01
Liver depression and spleen deficiency 87.13 86.58 ± 0.01 82.05 80.34 ± 0.02 87.88 84.42 ± 0.02 72.13 71.43 ± 0.01
syndrome
Qi stagnation and blood stasis syndrome 88.29 87.53 ± 0.01 85.97 84.13 ± 0.02 87.56 86.15 ± 0.01 77.98 77.01 ± 0.01
Vital qi deficiency and binding of static blood 85.21 84.21 ± 0.01 77.13 76.47 ± 0.01 85.93 85.62 ± 0.02 80.01 78.65 ± 0.01
syndrome
Liver qi stagnation syndrome 89.18 88.94 ± 0.01 83.19 81.41 ± 0.02 87.55 86.93 ± 0.02 73.16 72.31 ± 0.01
Liver and kidney yin deficiency syndrome 93.77 92.62 ± 0.01 90.72 89.74 ± 0.02 91.28 90.56 ± 0.02 80.27 79.43 ± 0.01
Phlegm and blood stasis syndrome 88.06 87.21 ± 0.01 82.37 81.37 ± 0.02 84.67 83.31 ± 0.02 74.53 73.31 ± 0.01
Spleen deficiency and dampness syndrome 94.46 93.82 ± 0.01 86.27 85.77 ± 0.02 92.38 91.84 ± 0.02 81.32 80.11 ± 0.01
Model accuracy (micro-average) 86.26 82.79 85.84 72.01

PSO-ELM: particle swarm optimization-extreme learning machine; SD: standard deviation. Data represent accuracy rates (%).

Table 8
Comparative analysis table of recall rates and F1-scores of PSO-ELM and other classification algorithms in the test set.

Syndrome factor PSO-ELM Support vector Bayesian network 0–1 PSO-ELM

machines
Recall rate F1-score Recall rate F1-score Recall rate F1-score Recall rate F1-score
Damp-heat retention syndrome 97.28 88.49 94.86 88.60 96.14 88.70 90.75 74.45
Liver depression and spleen deficiency syndrome 82.69 84.59 78.43 79.37 81.96 83.17 66.67 68.96
Qi stagnation and blood stasis syndrome 80.01 83.50 74.82 79.20 78.47 82.13 66.12 71.14
Vital qi deficiency and binding of static blood syndrome 88.95 86.46 81.25 78.79 85.09 85.35 76.17 77.39
Liver qi stagnation syndrome 74.98 81.37 76.22 78.73 77.38 81.88 62.35 66.96
Liver and kidney yin deficiency syndrome 89.27 90.82 86.04 87.85 86.65 88.56 71.24 75.11
Phlegm and blood stasis syndrome 83.93 85.49 78.57 79.94 84.24 83.77 69.82 71.52
Spleen deficiency and dampness syndrome 81.84 87.16 73.99 79.44 81.39 86.30 60.99 69.25

PSO-ELM: particle swarm optimization-extreme learning machine. Data are expressed as percentage.

4.3. PSO-ELM classification prediction model

PSO-ELM SVM Bayesian network 0-1 PSO-ELM

The PSO-ELM classification prediction model was obtained 100

95
according to the model parameters in Section 3.2. The classification 90
Recall rate/(%)

accuracy rates, recall rates and F1-score were used as the evaluation 85
80
indexes. In addition, the evaluation indexes of each syndrome type 75
were calculated and compared with values obtained by other clas- 70

sification algorithms. The results are shown in Tables 7 and 8 and 65

60
Figs. 4, 5 and 6. Secondly, the PSO-ELM was compared with the
Damp-heat retention

Liver depression and spleen

Vital Qi deficiency and

Qi stagnation and blood

Liver Qi stagnation

deficiency syndrome

Phlegm and blood

Spleen deficiency and

dampness syndrome
Liver and kidney yin

stasis syndrome
blood syndrome
binding of static

same type of neural network algorithm. For this, the hidden layer
deficiency syndrome

stasis syndrome
syndrome

syndrome

node was set to 100, the learning rate was 0.01, druopt = 0.5 and
the optimizer selected Adam. These results are shown in Tables 9
and 10 and Figs. 7, 8 and 9. Finally, the different optimization algo-
rithms were combined with the ELM algorithm. Genetic algorithm
(Ga) parameters were set as follows: population size = 30, maxi-
Fig. 5. Comparative analysis of the recall rates of classification algorithms in the
mum number of iterations = 100, crossover probability = 0.7, muta- test set. PSO-ELM: particle swarm optimization-extreme learning machine; SVM:
tion probability = 0.1. Seeker optimization algorithm (SOA) support vector machine.
parameters were set as follows: population size = 30, maximum

PSO-ELM SVM PSO-ELM SVM Bayesian network 0-1 PSO-ELM

1.00
Bayesian network 0-1 PSO-ELM
0.95
100
95 0.90
F1-score

90 0.85
Accuracy/(%)

85 0.80
80 0.75
75
0.70
70
0.65
65
60 0.60
Damp-heat retention
Damp-heat retention

Liver depression and spleen

Liver depression and spleen

Vital Qi deficiency and

Vital Qi deficiency and

Qi stagnation and blood

Qi stagnation and blood

Liver Qi stagnation
Liver Qi stagnation

deficiency syndrome
deficiency syndrome

Phlegm and blood

Spleen deficiency and

Phlegm and blood

Spleen deficiency and

dampness syndrome
dampness syndrome

Liver and kidney yin

Liver and kidney yin

stasis syndrome
stasis syndrome

blood syndrome
blood syndrome

binding of static
binding of static

deficiency syndrome
deficiency syndrome

stasis syndrome
stasis syndrome

syndrome
syndrome

syndrome
syndrome

Fig. 4. Comparative analysis of the accuracy rates of classification algorithms in the Fig. 6. Comparative analysis of F1-score of classification algorithms in the test set.
test set. PSO-ELM: particle swarm optimization-extreme learning machine; SVM: PSO-ELM: particle swarm optimization-extreme learning machine; SVM: support
support vector machine. vector machine.

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Table 9
Comparative analysis table of accuracy rates of PSO-ELM and other neural network algorithm.

Syndrome factor PSO-ELM Back propagation Deep neural network Extreme learning machine
Training Testing Training Testing Training Testing Training Testing
(mean ± SD) (mean ± SD) (mean ± SD) (mean ± SD)
Damp-heat retention syndrome 82.27 82.15 ± 0.01 81.34 80.12 ± 0.02 83.15 82.76 ± 0. 01 88.13 79.13 ± 0.03
Liver depression and spleen deficiency 87.13 86.58 ± 0.01 84.28 83.17 ± 0.02 87.92 87.58 ± 0.01 87.42 82.11 ± 0.04
syndrome
Qi stagnation and blood stasis syndrome 88.29 87.53 ± 0.01 87.76 86.26 ± 0.02 88.61 87.41 ± 0.02 88.56 83.15 ± 0.03
Vital qi deficiency and binding of static blood 85.21 84.21 ± 0.01 85.37 84.31 ± 0.02 86.73 85.86 ± 0.01 90.41 85.11 ± 0.03
syndrome
Liver qi stagnation syndrome 89.18 88.94 ± 0.01 89.15 88.96 ± 0.02 89.97 88.09 ± 0.01 89.68 82.78 ± 0.03
Liver and kidney yin deficiency syndrome 93.77 92.62 ± 0.01 91.26 90.03 ± 0.01 92.03 91.28 ± 0.01 88.73 83.14 ± 0.03
Phlegm and blood stasis syndrome 88.06 87.21 ± 0.01 85.53 84.62 ± 0.01 89.76 88.15 ± 0.01 83.53 78.65 ± 0.04
Spleen deficiency and dampness syndrome 94.46 93.82 ± 0.01 80.46 89.71 ± 0.02 94.58 93.34 ± 0.01 95.63 90.72 ± 0.04
Model accuracy (micro-average) 86.26 84.72 86.82 82.65

PSO-ELM: particle swarm optimization-extreme learning machine; SD: standard deviation. Data represent accuracy rates (%).

Table 10
Comparative analysis table of recall rates and F1-scores of PSO-ELM and other neural network algorithm in the test set.

Syndrome factor PSO-ELM Back propagation Deep neural network Extreme learning
machine
Recall rate F1-score Recall rate F1-score Recall rate F1-score Recall rate F1-score
Damp-heat retention syndrome 97.28 88.49 95.93 87.31 96.42 89.07 95.49 86.54
Liver depression and spleen deficiency syndrome 82.69 84.59 81.53 82.34 81.87 84.63 79.63 80.85
Qi stagnation and blood stasis syndrome 80.01 83.50 78.15 82.01 80.31 83.71 76.67 81.57
Vital qi deficiency and binding of static blood syndrome 88.95 86.46 87.32 85.79 89.93 87.84 83.87 84.48
Liver Qi stagnation syndrome 74.98 81.37 78.91 83.64 79.61 83.63 74.23 79.59
Liver and kidney yin deficiency syndrome 89.27 90.82 83.47 86.63 89.60 90.43 85.20 86.64
Phlegm and blood stasis syndrome 83.93 85.49 82.18 83.39 84.35 86.21 81.18 79.87
Spleen deficiency and dampness syndrome 81.84 87.16 77.26 83.02 81.69 86.64 78.57 84.21

PSO-ELM: particle swarm optimization-extreme learning machine. Data are expressed as percentage.

PSO-ELM BP DNN ELM PSO-ELM BP DNN ELM

100
95
95
Recall rate/(%)

90
90 85
80
75
Accuracy (%)

85 70
65
60
80
Damp-heat retention

Liver depression and spleen

Vital Qi deficiency and

Qi stagnation and blood

Liver Qi stagnation

deficiency syndrome

Phlegm and blood

Spleen deficiency and

dampness syndrome
Liver and kidney yin

stasis syndrome
blood syndrome
binding of static
deficiency syndrome

stasis syndrome
syndrome

syndrome

75

70
Damp-heat retention

Liver depression and spleen

Vital Qi deficiency and

Qi stagnation and blood

Liver Qi stagnation

deficiency syndrome

Phlegm and blood

Spleen deficiency and

dampness syndrome
Liver and kidney yin

stasis syndrome
blood syndrome
binding of static
deficiency syndrome

stasis syndrome
syndrome

syndrome

Fig. 8. Comparison and analysis of the recall rates of neural network algorithms in
the test set. PSO-ELM: particle swarm optimization-extreme learning machine; BP:
back propagation; DNN: deep neural network.

PSO-ELM BP DNN ELM

1.00
Fig. 7. Comparison and analysis of the accuracy rates of neural network algorithms
0.95
in the test set. PSO-ELM: particle swarm optimization-extreme learning machine;
BP: back propagation; DNN: deep neural network. 0.90
F1-score

0.85

0.80
number of iterations = 100, maximum membership value 0.75
Umax = 0.95, minimum membership value Umin = 0.01, maximum 0.70
weight Wmax = 0.9, minimum weight Wmin = 0.1. The differential
Damp-heat retention

Liver depression and spleen

Vital Qi deficiency and

Qi stagnation and blood

Liver Qi stagnation

deficiency syndrome

Phlegm and blood

Spleen deficiency and

dampness syndrome
Liver and kidney yin

stasis syndrome
blood syndrome
binding of static
deficiency syndrome

stasis syndrome

evolution (DE) algorithm parameters were set as follows: popula-

syndrome

syndrome

tion size = 30, maximum number of iterations = 100, scaling fac-

tor = 0.5, and cross probability = 0.7. The above parameter
settings were from the literature [53–58]. The results are shown
in Tables 11 and 12 and Figs. 10, 11 and 12. The different running
time of each algorithm is shown in Table 13. Fig. 9. Comparison and analysis of F1-score of neural network algorithms in the test
The software environment used for this study was the Windows set. PSO-ELM: particle swarm optimization-extreme learning machine; BP: back
10 64-bit operating system, running on a 3.60 GHz Intel Core i5 propagation; DNN: deep neural network.

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L. Ding, X.Y. Zhang, D.Y. Wu et al. Journal of Integrative Medicine 19 (2021) 395–407

Table 11
Comparative analysis table of accuracy rates of PSO-ELM and other optimization algorithms.

Syndrome factor PSO-ELM Genetic algorithm-ELM Differential evolution-ELM Seeker optimization

algorithm-ELM
Training Testing Training Testing Training Testing Training Testing
(mean ± SD) (mean ± SD) (mean ± SD) (mean ± SD)
Damp-heat retention syndrome 82.27 82.15 ± 0.01 83.08 82.75 ± 0.01 83.11 82.43 ± 0.01 82.96 82.11 ± 0.01
Liver depression and spleen deficiency 87.13 86.58 ± 0.01 85.46 84.31 ± 0.01 84.25 83.76 ± 0.01 83.07 82.96 ± 0.01
syndrome
Qi stagnation and blood stasis syndrome 88.29 87.53 ± 0.01 86.38 85.44 ± 0.02 86.97 86.13 ± 0.01 87.12 86.19 ± 0.01
Vital qi deficiency and binding of static blood 85.21 84.21 ± 0.01 85.31 84.12 ± 0.01 86.31 85.49 ± 0.01 87.04 86.23 ± 0.01
syndrome
Liver qi stagnation syndrome 89.18 88.94 ± 0.01 90.17 89.72 ± 0.01 89.42 88.75 ± 0.01 89.88 89.01 ± 0.01
Liver and kidney yin deficiency syndrome 93.77 92.62 ± 0.01 92.62 91.09 ± 0.01 91.27 90.79 ± 0.01 91.54 90.84 ± 0.01
Phlegm and blood stasis syndrome 88.06 87.21 ± 0.01 97.45 86.77 ± 0.01 88.22 87.41 ± 0.01 87.27 86.93 ± 0.01
Spleen deficiency and dampness syndrome 94.46 93.82 ± 0.01 91.97 91.28 ± 0.01 92.89 92.13 ± 0.01 92.18 91.77 ± 0.01
Model accuracy (micro-average) 86.26 85.82 86.09 85.94

PSO: particle swarm optimization; ELM: extreme learning machine. Data represent accuracy rates (%).

Table 12
Comparative analysis table of recall rates and F1-score of PSO-ELM and other optimization algorithms in the test set.

Syndrome factor PSO-ELM Genetic algorithm-ELM Differential evolution- Seeker optimization

ELM algorithm-ELM
Recall rate F1-score Recall rate F1-score Recall rate F1-score Recall rate F1-score
Damp-heat retention syndrome 97.28 88.49 95.91 88.84 96.04 88.71 95.76 88.41
Liver depression and spleen deficiency syndrome 82.69 84.59 82.38 83.35 83.22 83.49 82.51 82.73
Qi stagnation and blood stasis syndrome 80.01 83.50 80.01 82.64 82.36 84.21 80.16 83.06
Vital qi deficiency and binding of static blood syndrome 88.95 86.46 86.34 86.23 85.17 85.33 87.47 86.84
Liver Qi stagnation syndrome 74.98 81.37 76.78 82.74 76.93 82.42 78.79 83.59
Liver and kidney yin deficiency syndrome 89.27 90.82 85.19 88.04 87.66 89.19 85.41 88.04
Phlegm and blood stasis syndrome 83.93 85.49 86.27 86.52 84.87 86.12 86.10 86.51
Spleen deficiency and dampness syndrome 81.84 87.16 81.91 86.34 80.85 86.13 79.76 85.34

PSO: particle swarm optimization; ELM: extreme learning machine. Data are expressed as percentage.

PSO-ELM DE-ELM Ga-ELM SOA-ELM

PSO-ELM DE-ELM Ga-ELM SOA-ELM
100 100

95
95

90
Accuracy (%)

Recall rate/(%)

90
85
85
80
80
75
75
70
Damp-heat retention

70
Liver depression and spleen

Vital Qi deficiency and

Qi stagnation and blood

Liver Qi stagnation

deficiency syndrome

Phlegm and blood

Spleen deficiency and

dampness syndrome
Liver and kidney yin

stasis syndrome
blood syndrome
binding of static
deficiency syndrome

stasis syndrome

Damp-heat retention

Liver depression and spleen

Vital Qi deficiency and

syndrome

Qi stagnation and blood

syndrome

Liver Qi stagnation

deficiency syndrome

Phlegm and blood

Spleen deficiency and

dampness syndrome
Liver and kidney yin

stasis syndrome
blood syndrome
binding of static
deficiency syndrome

stasis syndrome
syndrome

syndrome

Fig. 10. Comparative analysis of the accuracy rates of other optimization algo-
rithms in the test set. PSO-ELM: particle swarm optimization-extreme learning Fig. 11. Comparative analysis of the recall rates of other optimization algorithms in
machine; DE: differential evolution; Ga: genetic algorithm; SOA: seeker optimiza- the test set. PSO-ELM: particle swarm optimization-extreme learning machine; DE:
tion algorithm. differential evolution; Ga: genetic algorithm; SOA: seeker optimization algorithm.

processor with 8G of RAM. This experiment was programmed in ratio of syndrome-related factors that met the textbook judgment
the MATLAB environment (Version 2018a; The Math Works, Inc, criteria to the total number of judgment criteria in the set of syn-
Natick, MA, USA). All experimental results are the average of 50 drome factors that frequently appeared in the syndrome type.
experimental results. From the point of view of coincidence, it was more than 80%
Fuzzy mathematics is not used to process the experimental (Table 14). This shows that the data set meets the criteria for
data. Existence is 1 and nonexistence is 0; we call it 0–1 PSO-ELM. determining the type of syndrome in the textbooks of TCM used
in the ‘‘Twelfth Five-Year Plan,” and has both rigor and accuracy.
4.4. Accuracy of syndrome factors verified by association rules This verifies the validity of the fuzzy mathematical quantitative
data in this paper and provides a strong theoretical support for
We set both support and confidence to 0.7, and the results are the further construction of the PSO-ELM classification prediction
shown in Table 8. The coincidence in values was triggered by the model.
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PSO-ELM DE-ELM Ga-ELM SOA-ELM 4.5. Statistical test

1.00

0.95 It can be seen from the above data that the distinction among
0.90
syndrome types is determined by syndrome type factors; TCM syn-
drome types are composed of syndrome factors. Therefore, this
F1-score

0.85
paper proved the difference between syndrome types from the dif-
0.80 ferences between syndrome factors. In this study, the chi-square
0.75
Table 15
0.70 Chi-square statistical analysis of different syndrome types.
Damp-heat retention

Liver depression and spleen

Vital Qi deficiency and

Qi stagnation and blood

Syndrome-related factor Chi- Degree of freedom P

Liver Qi stagnation

deficiency syndrome

Phlegm and blood

Spleen deficiency and

dampness syndrome
Liver and kidney yin

stasis syndrome
blood syndrome
binding of static
deficiency syndrome

stasis syndrome
syndrome

syndrome
square (K) value
Jaundice 79.05 7 0.000
Bloating 160.87 7 0.000
Eructation 349.01 7 0.000
Dim and blackish complexion 32.82 7 0.000
Dry mouth 142.88 7 0.000
Fig. 12. Comparative analysis of the F1-score of other optimization algorithms in Dry bitter 157.28 7 0.000
the test set. PSO-ELM: particle swarm optimization-extreme learning machine; DE: Nausea 213.98 7 0.000
differential evolution; Ga: genetic algorithm; SOA: seeker optimization algorithm. Hypochondriac pain 165.55 7 0.000
Headache 49.36 7 0.000
Table 13 Dizziness 140.82 7 0.000
Different algorithm time complexity and training time. Chest tightness 222.91 7 0.000
Abdominal pain 84.74 7 0.000
Algorithm Training Time Abnormal mood 374.73 7 0.000
time (s) complexity (o) Abdominal lump pain 217.73 7 0.000
Particle swarm optimization-extreme 88.98 mnlogn Abdominal fullness and 206.71 7 0.000
learning machine distention
Back propagation 249.854 mn2 Lower limb swelling 254.47 7 0.000
Deep neural network 1199.271 mn2 Abdominal distension 357.43 7 0.000
Extreme learning machine 0.4926 mn Sored waist and knees 648.66 7 0.000
Support vector machines 1898.511 mn3 Low back pain 265.5 7 0.000
Bayesian network 1255.877 mn2 Dull pain 251.54 7 0.000
Genetic algorithm-extreme learning 123.855 mn2 Fatigue 170.131 7 0.000
machine Distending pain 83.320 7 0.000
Seeker optimization algorithm-extreme 1210.711 mn3logn Weight loss 192.822 7 0.000
learning machine Poor sleep 25.738 7 0.000
Differential evolution-extreme learning 155.362 mn2 Poor urine 34.135 7 0.000
machine Less urination 126.516 7 0.000
Yellowish urine 266.271 7 0.000
n represents the dimension of the input vector; m represents the number of output Dry stool 414.161 7 0.000
categories. PSO-ELM: particle swarm optimization-extreme learning machine. Loose stool 165.260 7 0.000

Table 14
Comparison and analysis of frequent collection and textbook judgment standard.

Syndrome factor Frequent set Judgement standard Coincidence

rate (%)
Damp-heat retention Dry bitter, dry mouth, dry stool, less urination, yellowish Dry bitter, dry mouth, abdominal distension, chest tightness, 81.2
syndrome urine, abdominal distension, fatigue, tongue red, yellow less urination, yellowish urine, dry stool, tongue red, yellow
greasy, wiry and slippery greasy, wiry and slippery, nausea
Liver depression and Hypochondriac pain, abnormal mood, eructation, fatigue, Hypochondriac pain, abnormal mood, eructation, loose stool, 88.9
spleen deficiency tongue light red, thin white, wiry and thin, loose stool, thin white, wiry and thin, tongue light red, abdominal
syndrome distending pain distension
Qi stagnation and Abdominal lump pain, abdominal pain, abdominal Abdominal pain, abdominal lump pain, chest tightness, 88.9
blood stasis distension, yellowish urine, loose stool, weight loss, tongue eructation, dim and blackish complexion, abdominal
syndrome dark purple, tongue light red, thin white, taut and uneven, distension, taut and uneven, tongue dark purple, thin white
wiry and thin
Vital qi deficiency and Fatigue, abdominal distension, poor food intake, yellowish Abdominal lump pain, dull pain, poor food intake, weight 80
binding of static urine, tongue light red, stripping, string, wiry and thin, loss, fatigue, tongue lilac, less moss or stripping, thready
blood syndrome thready rapid pulse, abdominal lump pain, abdominal pain, rapid pulse or wiry and thin
thin white, less moss
Liver Qi stagnation Abdominal lump pain, abdominal distension, distending pain, Hypochondriac pain, abdominal distension, distending pain, 100
syndrome abnormal mood, dry stool, tongue light red, thin white, string, abnormal mood, eructation, dry stool, abdominal lump pain,
wiry and thin, wiry and slippery tongue light red, thin white, pulse string
Liver and kidney yin Hypochondriac pain, sored waist and knees, low back pain, Abdominal lump pain, hypochondriac pain, dizziness, sored 88.9
deficiency abdominal lump pain, tongue red, tongue light red, less moss, waist and knees, low back pain, night sweat, tongue red, less
syndrome stripping, thready rapid pulse, wiry and thin moss, thready rapid pulse
Phlegm and blood Abdominal distension, distending pain, abdominal fullness Complexion, abdominal distension, hypochondriac pain, dull 88.9
stasis syndrome and distention, dull pain, hypochondriac pain, tongue dark pain, tongue dark purple, yellow greasy, wiry and slippery or
purple, yellow greasy, thin white, wiry and slippery taut and uneven, dim and blackish, abdominal fullness and
distention
Spleen deficiency and Abdominal distension, bloating, distending pain, lower limb Abdominal distension, bloating, distending pain, lower limb 100
dampness swelling, hypodynamia, loose stool, pale-enlarged tongue, swelling, hypodynamia, loose stool, tongue pale-enlarged
syndrome red tongue, white-greasy tongue coating, wiry pulse, slippery tongue, red tongue, white-greasy tongue coating, wiry pulse,
pulse slippery pulse

405
L. Ding, X.Y. Zhang, D.Y. Wu et al.
test method was used to verify the differences of all the syndrome
factors in section 4.3. Finally, it shows that there are differences
between different syndrome types.
H0: We assume that there is no significant relationship between
syndrome type factors and syndrome types.
The P value was less than 0.05 for all syndrome factors and dif-
ferent syndrome types, then we believe that the result shown by
the sample is a small probability event. If H0 is not true, it indicates
that there is a significant difference between syndrome factors and
different syndrome types. Therefore, it can be proved that there are
differences between different syndrome types (Table 15).
5. Discussion
Using the three evaluation indicators, classification accuracy
rates, recall rates and F1-scores, different classification algorithms
were compared and analyzed. From Tables 7–13 and Figs. 5–12,
the neural network model was better than other traditional classi-
fication models. When dealing with multiclass nonlinear Chinese
medicine problems, the neural network was able to directly map
the input data to different classes through a network, which
matched human classification thinking and had certain cognitive
capabilities. Further, its excellent flexibility and parallel computing
capabilities can solve big data problems well. As a binary classifier,
the support vector machine (SVM) approach maps nonlinear data
from low-dimensional input space to high-dimensional linear sep-
arable feature space. When using the ‘‘one-to-one” method to
make the binary classifier suitable for multiclass problems, n
(number of classes) binary classifiers should be constructed for
SVM, and SVM should construct n(n–1)/2 binary classifiers. When
the number of categories increases, the complexity of the entire
classifier also increases, and the classification accuracy decreases.
Therefore, SVM is not suitable for dealing with the problem of
multiclass nonlinear Chinese medicine. The experimental results
show that Bayesian networks can handle complex, fuzzy and
uncertain problems well and can also handle TCM problems well.
The recall rate, accuracy rate and F1-score values for the Bayesian
network was similar to those of the neural network algorithm.
Table 13 shows that the training time and time complexity of the
neural network were lower than for those of Bayesian network.
Therefore, in processing big data, as the number of network nodes
increases, the Bayesian network will face the problem of reduced
accuracy or increased network complexity, resulting in a decrease
in classification efficiency. The neural network algorithm has a
strong advantage when processing nonlinear medical data.
In Tables 9, 10, and 13 and Figs. 8–10, it can be seen that the
training time of the ELM was the shortest, and the training time
of deep neural network (DNN) was the longest, while the training
time of PSO-ELM was intermediate. From the perspective of
classification accuracy, the standard deviation of ELM fluctuated
greatly, indicating poor model stability, while PSO-ELM had the
smallest standard deviation and good model stability. From the per-
spective of recall rates and F1-score, DNN and PSO-ELM were sim-
ilar and higher than other feedforward neural networks. The results
show that although the classification accuracy of DNN was slightly
better than that of PSO-ELM, the classification efficiency was rela-
tively low due to its relatively complex network structure and
longer computing time. The PSO-ELM network structure was rela-
tively compact, and the classification performance and efficiency
were both excellent, compared to other neural networks.
From Tables 11–13 and Figs. 11 and 12, it can be seen that PSO-
ELM had the lowest training time, but the traditional ELM had
lower training time than the ELMs for the four heuristic optimiza-
tion algorithms. From the perspective of classification accuracy and
standard deviation, PSO-ELM had the highest test accuracy and the
smallest test standard deviation. From the perspective of recall rate
406
Journal of Integrative Medicine 19 (2021) 395–407
and F1-score, the four types of ELM classification efficiency based
on heuristic optimization algorithms were very similar. Firstly,
from the perspective of the parameter settings of different opti-
mization algorithms, the PSO algorithm had fewer parameters
and a simpler structure and was easy to fit to the diagnosis prob-
lem. Secondly, PSO did not have population crossover and muta-
tion. While there was no complicated evolutionary operation,
PSO relied on particle speed to complete the search. Compared
with the genetic algorithm, SOA and DE, its search speed was fas-
ter. Additionally, PSO was memorable. When combined with the
neural network algorithm, it was able to improve the generaliza-
tion ability and stability of the model. Therefore, the classification
efficiency of PSO-ELM was better than the ELM model optimized
using other optimization algorithms.
Based on the fuzziness and complexity of TCM electronic medical
record data, this study uses fuzzy logic, establishes a fuzzy relation-
ship matrix, and then uses fuzzy mathematics calculation methods
to scientifically quantify TCM electronic medical record data. From
Tables 7 and 8 and Figs. 5–7, the Chinese medicine diagnostic discrim-
inant model that combined fuzzy mathematics and PSO-ELM
achieved better results than the 0–1 PSO-ELM model in the categories
of classification accuracy rate, recall rate and F1-score evaluation.
6. Conclusion
In this paper, according to the combination of fuzzy mathematics,
PSO and ELM methods, a classification prediction model for the diag-
nosis of PLC syndrome was developed. PSO was used to optimize
ELM input connection weights and hidden layer bias, avoiding the
instability of classification results and low accuracy caused by the
random initialization of parameters. This ensured that the classifica-
tion accuracy rates of various types of syndromes were between
82.15% and 93.82%, and the overall classification accuracy rate of
the model reached 86.26%. Experiments showed that the
syndrome-related factors of PLC in the clinical medical records
agreed with the judgment factors [5,6,17] of the classification of
TCM in current textbooks by more than 80%. This verifies the appli-
cability of the PSO-ELM model to the collected raw data of medical
records. In addition, the accuracy of the classification results was
confirmed by the association rules method, supporting the use of
this model in the study of classification of TCM syndromes. This
model not only provides an effective algorithm for the classification
of PLC, but also provides justification for structuring electronic med-
ical records, standardization of clinical data and the objectification
of TCM diagnosis. However, for the study of learning methods based
on PSO-ELM, we have only done some limited exploration, and there
are still many issues that need further study. For example, the fur-
ther optimization of the PSO-ELM network structure. Reducing the
complexity of the network should improve the generalization per-
formance of the network, and reduce the computational complexity,
improving the efficiency of the PSO-ELM algorithm. Since the PSO
algorithm is optimized iteratively, and the PSO is used to optimize
the random feedforward neural network, the process increases cal-
culation time. To maximize search performance, the convergence
speed will be improved as much as possible. These questions provide
direction for further study.
Authors’ contribution
XYZ and DYW designed the hypotheses and the experiments,
and LD performed the experiments and their analysis. LD and
MLL were responsible for data collection. LD participated in data
analysis. All authors participated in data interpretation and manu-
script review and writing. All authors were responsible for prepa-
ration of the tables and figures. All authors contributed to the
scientific discussion of the data and the manuscript.
L. Ding, X.Y. Zhang, D.Y. Wu et al.
Funding
This work was financially supported by the National Natural
Science Foundation (No. 81660727).
Declaration of competing interest
The authors declare that they have no known competing finan-
cial interests or personal relationships that could have appeared
to influence the work reported in this paper.
References
[1] Chen WQ, Zheng RS, Baade PD, Zhang SW, Zeng HM, Bray F, et al. Cancer
statistics in China, 2015. Ca Cancer J Clin 2016;66(2):115–32.
[2] Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer
incidence and mortality worldwide: sources, methods and major patterns in
GLOBOCAN 2012. Int J Cancer 2015;136(5):E359–86.
[3] Bray F, Ferlay J, Laversanne M, Brewster DH, Gombe Mbalawa C, Kohler B, et al.
Cancer incidence in five continents: inclusion criteria, highlights from Volume
X and the global status of cancer registration. Int J Cancer 2015;137
(9):2060–71.
[4] Cyranoski D. Why Chinese medicine is heading for clinics around the world.
Nature 2018;561(7724):448–50.
[5] Chen JX, Zou XJ. Diagnostics of traditional Chinese medicine. Beijing: People’s
Medical Publishing House; 2012: 139–44,165–9 [Chinese].
[6] Zhang BL, Xue BY. Internal medicine of traditional Chinese medicine. Beijing:
People’s Medical Publishing House; 2015: 199–228 [Chinese].
[7] Wang HZ, Liu X, Lv B, Yang F, Hong YZ. Reliable multi-label learning via
conformal predictor and random forest for syndrome differentiation of chronic
fatigue in traditional Chinese medicine. PLoS One 2014;9(6):e99565.
[8] Liu GP, Yan JJ, Wang YQ, Zheng W, Zhong T, Lu X, et al. Deep learning based
syndrome diagnosis of chronic gastritis. Comput Math Methods Med
2014;2014:938350.
[9] Xu Q, Tang W, Teng F, Peng W, Zhang Y, Li W, et al. Intelligent syndrome
differentiation of traditional Chinese medicine by ANN: a case study of chronic
obstructive pulmonary disease. IEEE Access 2019;7:76167–75.
[10] Huang GB, Zhu QY, Siew CK. Extreme learning machine: theory and
applications. Neurocomputing 2006;70(1–3):489–501.
[11] Huang GB, Zhou HM, Ding XJ, Zhang R. Extreme learning machine for
regression and multiclass classification. IEEE Trans Syst Man Cybern B
Cybern 2012;42(2):513–29.
[12] Ding SF, Xu XZ, Nie R. Extreme learning machine and its applications. Neural
Comput Appl 2014;25(3–4):549–56.
[13] Li K, Kong XF, Lu Z, Liu WY, Yin JP. Boosting weighted ELM for imbalanced
learning. Neurocomputing 2013;128(5):15–21.
[14] Dong J, Zhao Y, Liu C. Constrained PSO based center selection for RBF networks
under concurrent fault situation. Neural Process Lett 2020;51(3):2437–51.
[15] Zeng B, Li C. Improved multi-variable grey forecasting model with a dynamic
background-value coefficient and its application. Comput Indust Eng
2018;118:278–90.
[16] Zhou Z, Li F, Abawajy JH, Gao C. Improved PSO algorithm integrated with
opposition-based learning and tentative perception in networked data centres.
IEEE Access 2020;8:55872–80.
[17] Yao NL. Differential diagnosis of traditional Chinese medicine symptoms.
Beijing: People’s Medical Publishing House; 2004: 72–98, 129–54 [Chinese].
[18] National Health and Family Planning Commission of the People’s Republic
of China. Standards for diagnosis and treatment of primary liver cancer
(2017 edition). Lin Chuang Gan Dan Bing Za Zhi 2017; 33(8): 1419–31
[Chinese].
[19] Ministry of Health of the People’s Republic of China. Standards for diagnosis
and treatment of primary liver cancer (2011 edition). Lin Chuang Gan Dan Bing
Za Zhi 2011; 20(10): 929–46 [Chinese].
[20] Wu MC, Tang ZY, Liu TH, Cong WM, Bu H, Chen J, et al. Guidelines for
standardized pathological diagnosis of primary liver cancer (2015 edition). Lin
Chuang Gan Dan Bing Za Zhi 2015; 31(6): 833–9 [Chinese].
[21] Lin YY, Xue YY, Yu J, Wang YH, Sun W, Sun YY, et al. A quantification model of
traditional Chinese medicine syndromes in children with idiopathic
precocious puberty and early puberty. J Tradit Chin Med 2013;33(5):630–6.
[22] Maji P, Mahapatra S. Rough-fuzzy circular clustering for color normalization of
histological images. Fund Inform 2019;164(1):103–17.
[23] Yin S, Jiang Y, Tian Y, Kaynak O. A data-driven fuzzy information granulation
approach for freight volume forecasting. IEEE Trans Ind Electron 2017;64
(2):1447–56.
[24] Romero-Córdoba R, Olivas JA, Romero FP, Alonso-Gonzalez F, Serrano-
Guerrero J. An application of fuzzy prototypes to the diagnosis and
treatment of fuzzy diseases. Int J Intell Syst 2016;1:1–17.
[25] Lim JS, Wang D, Kim YS, Gupta S. A neuro-fuzzy approach for diagnosis of
antibody deficiency syndrome. Neurocomputing 2006;69(7–9):969–74.
[26] Dikshit-Ratnaparkhi A, Bormane D, Ghongade R. A framework for optimal
attribute evaluation and selection in hesitant fuzzy environment based on
enhanced ordered weighted entropy approach for medical dataset. J Biomed
Phys Eng 2019;9(3):327–34.
407
Journal of Integrative Medicine 19 (2021) 395–407
[27] Yang XB, Long SQ, Wu WY, Deng H, Pan ZQ, He WF, et al. Single factor and
multifactor analysis of prognosis of primary liver cancer treated with spleen
and qi regulating method. Zhongguo Zhong Xi Yi Jie He Za Zhi 2014;34
(2):162–6 [Chinese with abstract in English].
[28] Shao F, Zeng PH, Zeng G, Gao WH, He ZM, Xia SS, et al. Distribution
characteristics of traditional Chinese medicine syndrome in 628 patients with
advanced liver cancer. Zhonghua Zhong Yi Yao Za Zhi 2019;34(8):3439–42
[Chinese with abstract in English].
[29] Yang GB. Research on the differentiation and treatment of primary liver cancer
based on data mining. Hubei: Hubei University of Traditional Chinese
Medicine; 2019:1–49 [Chinese].
[30] Guo T, He YH. Experience summary and discussion of chief physician Yong-he
He in treating primary liver cancer with traditional Chinese medicine. Beijing:
Beijing University of Chinese Medicine; 2019:1–53 [Chinese].
[31] Ashtari S, Pourhoseingholi MA, Sharifian A, Zali MR. Hepatocellular carcinoma in
Asia: prevention strategy and planning. World J Hepatol 2015;7(12):1708–17.
[32] Jiang Y, Yin S. Recent advances in key-performance-indicator oriented
prognosis and diagnosis with a MATLAB toolbox: DB-KIT. IEEE Trans Ind
Inform 2019;15(5):2849–58.
[33] Huang GB, Zhu QY, Siew CK. Real-time learning capability of neural networks.
IEEE Trans Neural Netw 2006;17(4):863–78.
[34] Mirjalili S, Mirjalili SM, Lewis A. Grey wolf optimizer. Adv Eng Softw 2014;69
(3):46–61.
[35] Mirjalili S, Saremi S, Mirjalili SM, Coelho LDS. Multi-objective grey wolf
optimizer: a novel algorithm for multi-criterion optimization. Expert Syst Appl
2016;47:106–19.
[36] Mirjalili S. How effective is the grey wolf optimizer in training multi-layer
perceptrons. Appl Intell 2015;43(1):150–61.
[37] Mirjalili S, Mirjalili SM, Hatamlou A. Multi-verse optimizer: a nature-inspired
algorithm for global optimization. Neural Comput Appl 2016;27(2):495–513.
[38] Jain M, Singh V, Rani A. A novel nature-inspired algorithm for optimization:
squirrel search algorithm. Swarm Evolu Comput 2019;44:148–75.
[39] Basu M. Squirrel search algorithm for multi-region combined heat and power
economic dispatch incorporating renewable energy sources. Energy 2019;182
(1):296–305.
[40] Mirjalili S, Gandomi AH, Mirjalili SZ, Saremi S, Faris H, Mirjalili SM. Salp swarm
algorithm: a bio-inspired optimizer for engineering design problems. Adv Eng
Softw 2017;114:163–91.
[41] Mirjalili S, Lewis A. The whale optimization algorithm. Adv Eng Softw
2016;95:51–67.
[42] Aziz MAE, Ewees AA, Hassanien AE. Whale optimization algorithm and moth-
flame optimization for multilevel thresholding image segmentation. Expert
Syst Appl 2017;83:242–56.
[43] Aljarah I, Faris H, Mirjalili S. Optimizing connection weights in neural networks
using the whale optimization algorithm. Soft Comput 2018;22(1):1–15.
[44] Sahlol AT, Abd Elaziz M, Al-Qaness MAA, Kim S. Handwritten Arabic optical
character recognition approach based on hybrid whale optimization algorithm
with neighborhood rough set. IEEE Access 2020;8:23011–21.
[45] Labbi Y, Attous DB, Gabbar HA, Mahdad B, Zidan A. A new rooted tree
optimization algorithm for economic dispatch with valve-point effect. Int J
Electr Power Energy Syst 2016;79:298–311.
[46] Wadood A, Gholami Farkoush S, Khurshaid T, Kim CH, Yu J, Geem Z, et al. An
optimized protection coordination scheme for the optimal coordination of
overcurrent relays using a nature-inspired root tree algorithm. Appl Sci 2018;8
(9):1664.
[47] Akyol S, Alatas B. Plant intelligence based metaheuristic optimization
algorithms. Artif Intell Rev 2016;47(4):417–62.
[48] Kennedy J, Eberhart R. Particle swarm optimization. IEEE Int 2011;4(8):1942–8.
[49] Qiu FY, Wang JJ. Chaos binary particle swarm optimization algorithm based on
adaptive learning factors. Zhejiang Gong Ye Da Xue Xue Bao 2020;48(4):411–7
[Chinese with abstract in English].
[50] Figueiredo EMN, Ludermir TB. Investigating the use of alternative topologies
on performance of the PSO-ELM. Neurocomputing 2014;127:4–12.
[51] Ling QH. Research on stochastic feedforward neural network based on particle
swarm optimization. Jiangsu: Jiangsu University; 2019 [Chinese].
[52] Raja JB, Pandian SC. PSO-FCM based data mining model to predict diabetic
disease. Comput Methods Programs Biomed 2020;196:105659.
[53] Dziwinski P, Bartczuk L. A new hybrid particle swarm optimization and
genetic algorithm method controlled by fuzzy logic. IEEE Trans Fuzzy Syst
2020;28(6):1140–54.
[54] Kianpour M, Mohammadinasab E, Isfahani TM. Comparison between genetic
algorithm-multiple linear regression and back-propagation-artificial neural
network methods for predicting the LD50 of organo (phosphate and
thiophosphate) compounds. J Chin Chem Soc 2020;67(8):1–11.
[55] Tuba M, Bacanin N. Improved seeker optimization algorithm hybridized with
firefly algorithm for constrained optimization problems. Neurocomputing
2014;143:197–207.
[56] Feng J, Zhang J, Wang C, Xu M. Self-adaptive collective intelligence-based
mutation operator for differential evolution algorithms. J Supercomput
2020;76(2):876–96.
[57] Shaw B, Mukherjee V, Ghoshal SP. Seeker optimisation algorithm: application
to the solution of economic load dispatch problems. Inst Eng Technol 2011;5
(1):81–91.
[58] Zhuang YC, Li W. Air quality forecast based on PSO optimized extreme learning
machine neural network. Shenyang Gong Ye Da Xue Xue Bao 2020;42
(2):213–7 [Chinese with abstract in English].