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AJTCVM Vol 8, No.1, February 2013 77

Pearls from TCVM Practice

The Use of Sherwin-Williams® Paint Swatches as a

Reference for Tongue Color in Dogs and Horses

Karlene Stange DVM

From: Durango, Colorado

Examination of the tongue is an essential component of the traditional Chinese medicine examination.1-3 For both human and non-human animals tongue characteristics such as color, coating and shape provide important information about health status. In traditional Chinese veterinary medicine (TCVM), the tongue color is an essential component of the examination used to form a pattern diagnosis and treatment strategy.4,5

Since tongue parameters were evaluated in TCVM prior to the scientific method, conventional medical practitioners view the diagnostic variables of lingual diagnostics with skepticism.5 The results of tongue evaluations have been criticized for being too subjective and not repeatable. Research in TCVM is making progress toward a more scientific evaluation of tongue parameters by using a variety of devices.6-10 However, no uniform tool is currently in use with veterinary patients.

In TCVM practice, tongue color is usually described in simple, but vague terms such as: pale, red and purple (Table 1).4,5 The author finds the use of Sherwin-Williams® paint swatches to be a more objective and repeatable method for direct comparison of tongue color.

The benefits of using paint swatches are many. Client communication is one important factor. Once the client and veterinarian agree that an animal has a particular color on an initial examination, even subtle changes in color can be appreciated on subsequent visits. The procedure of holding the color chart next to the tongue provides a more objective measurement of color, since lighting effects both at the same time. In the author’s experience, evaluation of tongue color with no standard color chart sometimes proves to be wrong, once the paint swatch is held next to the mouth for comparison. Communication between veterinarians also improves, since the names of the paint colors are specific. TCVM practitioners may find the paint swatch technique helpful since it provides a frame of reference for tongue color.

The author is not the first to use color charts to match tongue color. Dr. Kejia Zhang, the former Director of the TCVM Department, College of Veterinary Medicine, Beijing Agricultural University, Beijing, China and past president of the TCVM Society in China, was using art colors to match tongue colors before his death in 2009.11 Unfortunately his work was not completed and documented, but his interest in the concept highlights the importance of using standardized color charts for tongue diagnosis today.

ABSTRACT Tongue color is an important diagnostic observation in traditional Chinese veterinary medicine (TCVM). Often described in simple but vague terms, such as pale, red and purple, tongue color may vary with individual visual interpretation. For the past 10 years, the author has used a color chart, created from Sherwin-Williams® paint color swatches, to detect subtle variations in these basic tongue color descriptions. In the author’s experience, comparing the tongue color to a standard color chart provides a more objective and repeatable method to evaluate tongue color, than visual interpretation alone. Sherwin-Williams® paint swatch colors are standard among the nearly 4,000 stores nationwide, readily available and free. According to the company, the names of the colors are unlikely to change over time. TCVM practitioners can create their own color chart by collecting 8 Sherwin-Williams® paint color swatches. Each of the 8 paint swatches contains 1 or more related colors and the author presents the tongue colors in 246 dogs and 43 horses using 22 Sherwin-Williams® paint swatch color names. In the author’s experience, normal dog tongues are Sherwin-Williams® “Memorable Rose” in color and normal horse tongues are Sherwin-Williams® “Resounding Rose” in color. The author and the animal’s caretaker decide together which paint swatch best matches the tongue color. The tongue color is recorded in the medical record for future reference to more accurately detect subtle color changes. Further studies are needed to compare specific Sherwin-Williams® tongue colors to the TCVM pattern diagnoses.

Key words: tongue diagnosis, tongue color, paint swatch, dog, horse, traditional Chinese veterinary medicine, TCVM

Copyright © 2013 by AJTCVM. All Rights Reserved.

78 AJTCVM Vol 8, No.1, February 2013

Research in Tongue Diagnosis Tongue color in humans and other animals is a

function of tongue temperature and microcirculation.12 A study involving a laser Doppler rheometer and CBI-8000 physiology research system to measure blood perfusion rates in humans and pigs showed that different tongue colors can reflect tongue temperature and blood perfusion rate.12 Tongue temperatures were computed by a numerical method. Thermal video was used to measure tongue temperature in patients with Yin Deficiency, which provided a statistically higher value for temperature in patients with Yin Deficiency than in healthy persons.2 Another study of tongue tip microcirculation, evaluated by observing the hemodynamics in the microvasculature of tongue papillae, demonstrated that tongue color changes with disease.13 Using B mode ultrasound to measure circulation of the tongue body, the width of intralingual vein and tissue sound transmission was displayed and significant differences were found between a group of the healthy humans and those with Blood Stasis.14 Another study of myocardial ischemia using mini-swine showed that tongue color changes with ischemia.15 Tongue color in a rat model of myocardial ischemia, measured by colorometric analysis of images of auricle and plantar tongue and hemorrheologic indices, also showed a correlation between tongue color and circulation.16

Chinese researchers have used various other methods to apply scientific measurement to tongue characteristics including digital camera, tongue image

analysis instrument (TIAI), color differentiation meters and spectrophotometer.1,6-10 Photoelectric integration has been applied to detect and analyze the colorimetric tongue pictures of 200 humans in hopes of providing a more quantitative assessment of tongue color.7 Tongue image analysis software has been developed that measures hue, saturation and the values of red, green and blue.8 Using hyperspectral medical tongue images with support vector machines, digital cameras and software with chromatic aberration correction, colors have been analyzed and classified by visible reflection spectrum in the range from 590 nm to 780 nm.9 Digitalized tongue images have been analyzed using a chromatic algorithm and 2-D Gabor wavelet transformation with a statistical method to identify the colors of each pixel.10 An algorithm has been presented based on edge detection and Gradient vector flow (GVF) active contour for tongue area segmentation and another algorithm based on unsupervised segmentation of color-texture for homogenous regions of the tongue.3 As scientific as the above research models are, they are not helpful in clinical practice.

Clinical Tongue Diagnosis Utilizing a Standardized Color Chart

The author has used Sherwin-Williams® standard paint color swatches to compare and name tongue colors of animals for over 10 years. All animals presented for a TCVM examination in that time period and had the tongue color compared to the colors on the swatches. The animal’s caretaker and the veterinarian agreed on the color that was then recorded on a TCVM diagnostic sheet. If the tongue color did not match any of the colors on the swatches, the closest color to the tongue color was agreed upon and a note that the tongue color was lighter or darker than a particular color was made or a color was determined to be between two colors on a swatch. The tongue color was compared on subsequent visits. Because several colors may occur on different areas of a tongue, a note was made regarding the body color and areas such as the tip or sides that had another color.

Tongue colors were matched to Sherwin-Williams® paint swatch names for 246 dogs and 43 horses and recorded on their TCVM medical record (Figures 1-12, Tables 2 and 3). TCVM practitioners must obtain the actual paint swatches from a Sherwin-Williams® dealer to create an accurate color chart to compare and name the tongue color of animals in clinical practice. Figures 1-12 are included for illustration purposes only as the color becomes altered during to the photographing and printing processes. The reasons for TCVM evaluation within a paint swatch color category are included in Tables 2 and 3 to demonstrate variations for different problems, rather than to draw conclusions about tongue color for a specific complaint. Only the body color was considered. Although information about cats was not included here, in the author’s experience, the normal and other common tongue colors for cats appear to be similar

Table 1: Typical tongue colors for TCVM pattern diagnoses*

Color TCVM Diagnosis

Pale Qi Deficiency (wet)

Blood Deficiency (dry)

Red

Yin Deficiency

Excess Heat

Heart Fire (red tongue tip)

Liver Heat or Fire (red tongue sides)

Deep Red Severe Yin Deficiency

Severe Excess Heat

Purple Qi or Blood Stagnation

Excess Cold

Yellow Spleen Qi Deficiency (dull yellow)

Liver Damp-Heat (bright yellow) Blue-Black/Purple-Black

Near death

*Adapted from: Xie H, Preast V. Traditional Chinese Veterinary Medicine. Volume I Fundamental Principles. Reddick, FL: Jing Tang 2002:256.



Figure 1: Sherwin-Williams® paint color swatch containing the colors Memorable Rose (SW 6311) and Redbud (SW 6312); although the SW number may change the names do not

Figure 2: Sherwin-Williams® paint color swatch containing the color Rose Embroidery (SW 6297); although the SW number may change the names do not

Figure 3: Sherwin-Williams® paint color swatch containing the colors Concerto (SW 6298) and Fine Wine (SW 6299) on the same color strip as Rose Embroidery (Figure 2); although the SW number may change the names do not

Figure 4: Sherwin-Williams® paint color swatch containing the colors Pressed Flower (SW 6304) and Rambling Rose SW (6305); although the SW number may change the names do not

Figure 5: Sherwin-Williams® paint color swatch containing the colors Cordial (SW 6306) and Fine Wine (SW 6307) on the same color strip as Pressed Flower (SW 6304) and Rambling Rose SW (6305); although the SW number may change the names do not

Figure 6: Sherwin-Williams® paint color swatch containing the colors Irresistible (SW 6562), Rosebay (SW 6563) and Red Clover (SW 6564); although the SW number may change the names do not

Figure 7: Sherwin-Williams® paint color swatch containing the colors Delightful (SW 6289), Rose’ (SW 6290) and Moss Rose (SW 6291); although the SW number may change the names do not



Figure 8: Sherwin-Williams® paint color swatch containing the color Berry Bush (SW 6292) which is on the same color strip as Delightful, Rose’ and Moss Rose (Figure 5); although the SW number may change the names do not

Figure 9: Sherwin-Williams® paint color swatch containing the color Plum Dandy (SW 6284); although the SW number may change the names do not

Figure 10: Sherwin-Williams® paint color swatch containing the color Cyclamen (SW 6571); although the SW number may change the names do not

Figure 11: Sherwin-Williams® paint color swatch containing the color Charming Pink (SW 6309) although the SW number may change the names do not

Figure 12: Sherwin-Williams® paint color swatch containing the colors Gracious Rose (SW 6317), Resounding Rose (SW 6318) and Reddish (SW 6319); although the SW number may change the names do not

to those for dogs. In the case examples, a wide variety of dog breeds

are represented, but 24.8% (61/246) are mix breed dogs, most likely typical of the general population. Of the purebred dogs the most prominent were: 8.5% (21/246) Golden Retrievers, 8.1% (20/246) Australian Shepherds, 7.7% (19/246) Labradors Retrievers, 5.7% (14/246) German Shepherds and 4.0% (10/246) Border Collies. Other breeds represented included are: Heeler, American Pit Bull Terrier, Chihuahua, Great Dane, Springer Spaniel, Dachshund, Jack Russell Terrier, Beagle, Lhasa Apso, Doberman Pincher, Maltese, Tibetan Terrier, Boxer, Rhodesian Ridgeback, Pomeranian, Bichon Frise, Wolf hybrid, Wolf, Welch Corgi, Airedale, Akita, Anatolian Shepherd, Basenji, English Setter, American Eskimo, Newfoundland, Catahoula, Bernese Mountain Dog, Airedale, Yorkshire Terrier, Chesapeake Bay Retriever, Australian Cattle Dog, Fox Terrier, Kelpie, and Great Pyrenees. The age of the dogs ranged from 2 months to 15 years. Twenty different paint colors were matched to tongue colors.

The clinical impression of the author is that the normal or ideal color for the average healthy dog is Sherwin-Williams® “Memorable Rose” (Figure 1). A healthy adult Bernese mountain dog with a normal tongue color of Sherwin-Williams® “Memorable Rose” is illustrated in Figure 13. The same dog was presented years later with the diagnosis of mast cell tumors and the

tongue color had changed to a hue between “Rose Embroidery” and “Rosebay” and the tongue tone had become more flaccid (Figures 2, 6 and 14).

Horse breeds represented are: 25% (11/43) Quarter Horses, 18.6% (8/43) Arabians, 11.6% (5/43) Morgans, 9.3% (4/43) Mixed breeds, 6.9% (3/43) Mustangs, 4.7% (2/43) Thoroughbreds, 4.7% (2/43) Danish Warmbloods, 2.3% (1/43) Tennessee Walker, 2.3% (1/43) Fox Trotter, 2.3% (1/43) Welch Cobb and 2.4% (1/42) Pony. The author’s clinical impression, after more than10 years experience comparing horse tongue colors to Sherwin-Williams® paint swatches, is that the normal color for a horse tongue is Sherwin-Williams® “Resounding Rose.”

The most common reasons for TCVM evaluation for the dogs were chronic internal medicine problems, spinal disease, behavior problems and chronic lameness. The most common reasons for TCVM evaluation for the horses were wellness examinations, lameness and thoracolumbar pain. The greater number of wellness examinations may explain why more horses than dogs had normal tongue colors.

A change in color from abnormal to normal was observed frequently, sometimes occurring quickly and sometimes over a period of weeks to months. A 12-year-old Labrador Retriever presented with weakness and a Sherwin-Williams® “Rose Bay” tongue color (Figure 6). After one week of electro-acupuncture for thoracolumbar pain and the Chinese Herbal medicine Bu



Figure Paint Swatch

Color and Number* Number of

Dogs

Average Age

(years) Reasons for TCVM Evaluation

1

Memorable Rose 6311

20 4 Wellness examination, acute lameness and behavior problems

Red Bud 6312

4 6 Keratitis sicca, autoimmune disease, vomiting, diarrhea

2 Rose Embroidery

6297 9 9

Paralysis, weakness, cardiac disease, chronic lameness, chronic diarrhea

3

Concerto 6298

44 8 Paresis, cruciate tears, seizures

Aged Wine 6299

1 5 Masses, anxiety

4

Pressed Flower 6304

16 4 Seizures, autoimmune disease, congenital deafness, luxating patellas, wellness examination, atopy

Rambling Rose 6305

34 4 Atopy, aggression, seizures, lameness, cough, weakness, diabetes mellitus

5

Cordial 6306

1 5 Seizures

Fine Wine 6307

1 10 Atopy, seizures, lameness

6

Irresistible 6562

1 1 Pancreatic insufficiency

Rosebay 6563

30 7 Masses, weakness, lameness, atopy, anxiety

Red Clover 6564

27 6 Wellness examination, lameness, atopy, anxiety, weakness, paresis, seizures

7

Delightful 6289

2 10 Otitis, constipation, weakness

Rose’ 6290

9 8 Chromic lameness, seizures, masses, anxiety, paresis, anemia, atopy

Moss Rose 6291

30 6 Aggression, stiffness, incontinence, lameness, vomiting, diarrhea, paresis, autoimmune disease, seizures

8 Berry Bush

6292 1 12 Paraparesis, confusion

9 Plum Dandy

6284 2 8 Seizures, masses, alopecia, dermatitis

10 Cyclamen

6571 11 7

Incontinence, lameness, masses, atopy, anxiety, wellness examination, paresis

11 Charming Pink

6309 1 14 Hypoadrenocorticism

12 Reddish

6319 2 7 Seizures, lameness

Table 2: Sherwin-Williams® paint color swatches used to determine tongue colors in 246 dogs with average age and reasons for TCVM evaluation

*A company representative said that the numbers may change over time, but the names are projected to remain the same18

Yang Huan Wu given at a dose of 0.5 grams for every 10 pounds of body weight twice daily, the dog was happier and more energetic with a normal tongue color of Sherwin-Williams® “Memorable Rose” (Figure 1). Another Labrador Retriever presented with a complaint of seizures had a tongue color that was Sherwin-

Williams® “Rambling Rose” with a Sherwin-Williams® “Cordial” tongue tip (Figures 4 and 5). One year later, after monthly acupuncture and the administration the Chinese herbal medicines Di Tan Tang and Tao Hong Si Wu Tang (both at a dose of 0.5 grams for every 10 pounds of body weight twice daily for six months with a



Figure Sherwin-Williams®

Paint Swatch Color and Number*

Number of Horses

Average Age

(years) Reasons for TCVM Evaluation*

1

Memorable Rose 6311

1 4 Back pain

Red Bud 6212

1 8 Gastrointestinal ulcers

3 Concerto

6298 2 16 Back pain, chronic lameness, masses

4 Pressed Flower

6304 14 14

Wellness examinations, hyperadrenocorticism, lameness, paresis, cervical pain, back pain

6 Rosebay

6563 1 6 Chronic allergies, lameness

7

Rose’ 6290

2 18 Weight loss, diarrhea

Moss Rose 6291

1 20 Cervical pain

12

Gracious Rose 6317

2 16 Cloudy eyes, chronic cough

Resounding Rose 6318

17 11 Wellness examinations, chiropractic treatment, lameness

Reddish 6319

2 20 Lameness, colic

Table 3: Sherwin-Williams® paint color swatches used to determine tongue colors in 43 horses with average ages and reasons for TCVM evaluation

*A company representative said that the numbers may change over time, but the names are projected to remain the same18

Figure 13: A healthy adult Bernese mountain dog with a normal tongue color of Sherwin-Williams® “Memorable Rose” (Figure 1)

Figure 14: The same dog as pictured in Figure 13 was presented years later with the diagnosis of mast cell tumors and the tongue color had changed to a hue between “Rose Embroidery” and “Rosebay” as seen in Figures 2 and 6 and the tongue tone had become more flaccid



gradual decrease and discontinuation of Tao Hong Si Wu Tang) the tongue color was Sherwin-Williams® “Memorable Rose” (Figure 1).

There are few problems encountered when using the Sherwin-Williams® paint color swatches to identify tongue color. Two main challenges are: 1) description of a color that is not on the color chart and 2) a tongue that has multiple colors. Not every tongue color is on the swatches, but a hue nearest the tongue color can still be identified and used as a reference. The abnormal horse tongue provides the most complexity observed, when comparing the tongue color to the paint swatch colors. A 22 year old Quarter horse with chronic foot pain is shown in Figure 15. The tongue is swollen, the body color is pale like Sherwin-Williams® “Pressed Flower”, but the tongue edges are darker red, but not as dark as Sherwin-Williams® “Rambling Rose” (Figures 5 and 15). Color choice becomes more subjective, when the tongue color does not exactly match a paint swatch. In that case the veterinarian and caretaker can still come to an agreement on the best color match and then note if the tongue is darker or lighter in shade to the specific color swatch. When multiple colors are present, the color at various locations is noted.

Caretakers seem to enjoy their participation in

matching paint swatches to their animal’s tongue color. They also become more aware of the importance of tongue color, as a way to evaluate health in their animal companions. Once a person compares the color of an animal’s tongue to the normal color, they also better understand the meaning of terms like “Stagnation” or “Blood Deficiency.” The importance of client-doctor communication cannot be over stated. Another helpful reason for using paint swatches is to aid in teaching. A TCVM student with questions about a case can communicate more clearly and confidently with a teacher regarding tongue color, when using a specific color name from the Sherwin-Williams® paint color swatches.

Sherwin-Williams® paint swatch colors are free, readily available and standard among the nearly 4000 stores nationwide.17 Each of the Sherwin-Williams® paint swatches illustrated contains at least 1 related color for use in dogs and horses and TCVM practitioners can create their own color chart by collecting these (Figures 1-12). There are 20 Sherwin-Williams® paint swatch colors useful in TCVM practice to determine tongue color of dogs and 10 colors useful for horses (Tables 2 and 3). A recent telephone conversation with a company representative indicated that the names of the colors had not changed in the last 10 years and are not likely to change in the near future.18 The numbers on the Sherwin-Williams® paint color swatches may change over time, but the name is predicted to remain the same. A rigorous process is used to maintain color integrity within the Sherwin-Williams® company. The author compared Sherwin-Williams® paint color swatches used from ten years ago with new Sherwin-Williams® paint swatches and finds no visibly discernible change in color over that period of time. The color swatches should be stored away from sunlight to avoid fading. The Sherwin-Williams® paint color swatches are 10.5” long by 3” wide.

CONCLUSION

The main benefits of using standard Sherwin-Williams® paint color swatches to determine tongue colors is to: 1) have a specific tool to assign a standard name to the tongue color, 2) the ability to have a specific color reference for comparison to future TCVM evaluations, 3) improved communication about tongue color with caretakers and colleagues. This simple tool is readily available, free and a more specific measuring device than simple visual interpretations of color. Further studies are needed to compare the specific Sherwin-Williams® paint swatch tongue color names to the TCVM pattern diagnoses.

REFERENCES 1. Lu LM, Chen X, Xu JT. Determination methods for

inspection of the complexion in traditional Chinese medicine: a review. Zhong Xi Yi Jie He Xue Bao 2009; 7(8):701-5. (in Chinese)

Figure 15: A 22 year old Quarter horse with chronic foot pain. The tongue is swollen, the body color is pale like Sherwin-Williams® “Pressed Flower, but the tongue edges are darker red, but not as dark as Sherwin-Williams® “Rambling Rose” (Figure 5)



2. Zhang SQ. Tongue temperature of healthy persons and patients with Yin deficiency by using thermal video. Zhong Xi Yi Jie He Za Zhi 1990; 10(12):732-3,709. (in Chinese)

3. Wang Y, Yang J, Zhou Y, Wang Y. Image segmentation in tongue characteristics. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2005; 22(6):1128-33. (in Chinese)

4. Xie H, Preast V. Traditional Chinese Veterinary Medicine. Volume I Fundamental Principles. Reddick, FL: Jing Tang 2002:251-254, 256.

5. O’Brien KA, Abbas E, Zhang J et al. Understanding the reliability of diagnostic variables in a Chinese Medicine examination, J Altern Complement Med 2009; 15(7):727-34.

6. Wei BG, Shen LS, Wang YQ et al. A digital tongue image analysis instrument for Traditional Chinese Medicine. Zhongguo Yi Liao Qi Xie Za Zhi 2002; 26(3):164-6,169. (in Chinese)

7. Han XM, Yu YM. Quantitative analysis of 200 human tongue pictures. Zhongguo Zhong Xi Yi Jie He Za Zhi 1993; 13(2):110-1,70. (in Chinese)

8. Zhu FL, Gu C, Zhang ZF et al. Evaluation of therapeutic effects of Chinese materia medica by tongue image analysis software 1.0 based on tongue colors. Zhong Xi Yi Jie He Xue Bao, 2006; 4(2):152-5. (in Chinese)

9. Kong M, Zeng CC, Liu YZ, Liu SH. Quantitative analysis and classification of tongue inspection based on the visible reflection spectrum. Zhong Xi Yi Jie Xue Bao, 2011; 9(1):29-35. (in Chinese)

10. Zhou Y, Yang J, Shen L. Methodological study on digitalization of tongue image in traditional Chinese medical diagnosis. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi, 2004 Dec; 21(6):917-20. (in Chinese)

11. KJ Zhang, GJ Hu. The tongue color in horses and mules and hemorrheologic indices. Journal of Traditional Chinese Veterinary Medicine 1986; 5:5. (in Chinese)

12. Wei F, He J, Li Y et al. Study on the application of bio-heat transfer science to the quantitative analysis of tongue inspection. Zhong Xi Yi Jie He Xue Bao, 2003; 1(2):135-7. (in Chinese)

13. Qin JH, Liu B. Tongue tip microcirculation in patients with different symptoms. Zhong Xi Yi Jie He Za Zhi 1990; 10(10):606-8 581. (in Chinese)

14. Li N, Zhang YF, Wang SY. Tongue picture of blood stasis syndrome-complex. Zhong Xi Yi Jie He Za Zhi 1991; 11(1):28-30, 5. (in Chinese)

15. Xu WY, Wang W, Guo SZ et al. Duplication of an animal model of myocardial ischemia with blood stasis syndrome in mini-swines. Zhong Xi Yi Jie He Xue Bao 2008; 6(4):409-13. (in Chinese)

16. Qiu Q, Li C, Wang Y. Evaluation of blood-stasis pattern related information in myocardial ischemic rat model. Zhongguo Zhong Xi Yi Jie He Za Zhi 2010; 30(9):974-7. (in Chinese)

17. The Sherwin Williams company; http://www.Sherwin-Williams.com

18. Personal interview by telephone with a Sherwin-Williams technician in the paints division at 800-474-3794 (2012).

ABSTRACT

Ha Y, Kim M, Nah J, Suh M, Lee Y. Measurements of Location-Dependent Nitric Oxide Levels on Skin Surface in relation to Acupuncture Point. Evid Based Complement Alternat Med. 2012; Epub 2012 Sep 24. Location-dependent skin surface's partial nitric oxide pressure (pNO) is studied using highly sensitive amperometric NO microsensor with a small sensing area (diameter = 76 μm). The pNO level of LI4 (Hegu) acupuncture point is measured and compared with the pNO level of nonacupuncture point. In addition, the mapping of pNO is carried out over the left wrist skin area one- as well as two-dimensionally. Statistically higher pNO levels near the position of acupuncture points than non-acupuncture points are observed consistently, implying tight relationship between the level of NO release of skin and acupuncture points. The amperometric planar NO microsensor successfully monitors the heterogeneity of skin pNO distribution in high spatial resolution due to its advantageous features such as high sensitivity and small sensing dimension. The current study suggests the direct connection between NO and acupuncture points and possibly provides beneficial information to understand physiological roles and basis of the acupuncture points.


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