[an error occurred while processing this directive]

Journal of Chinese Integrative Medicine ›› 2008, Vol. 6 ›› Issue (11): 1109-1116.doi: 10.3736/jcim20081103

• Original Clinical Research • Previous Articles     Next Articles

Statistical validation of strategies for Zang-Fu single patterndifferentiation

de Sá FERRE Arthur1,2()   

  1. 1. Physical Therapy Research Group, Department of Physical Therapy, Centro Universitario Augusto Motta, Rio de Janeiro, Brazil
    2. Department of Physical Therapy, Universidade Salgado de Oliveira, Rio de Janeiro, Brazil
  • Received:2008-07-30 Online:2008-11-20 Published:2008-11-15

RichHTML

1

PDF (PC)

111

Like

Objective: To propose and validate a method to aid traditional Chinese medicine (TCM) physicians in differentiation of Zang-Fu single patterns.
Methods: The procedure started with data collection and search on a knowledge database. Candidate patterns were selected and ranked according to the relative amount of explained exam's manifestations. Diagnosis identification was performed on a list of diagnostic hypotheses. Validation was conducted with 96 600 simulations of manifestation profiles obtained from database. Statistical performance based on confusion matrices was assessed for individual methods including inspection, auscultation and olfaction, inquiry, and palpation. Combined methods (inspection+auscultation and olfaction, inspection+auscultation and olfaction+inquiry) and four methods (inspection+auscultation and olfaction+inquiry+palpation) were also tested.
Results: The highest accuracy was obtained with the inquiry method (89.7%), followed by inspection (70.7%), auscultation and olfaction (59.9%), and palpation (56.1%). The same sequence was found for both sensitivity and negative predictive values. Specificity and positive predictive values were almost equal and high (>99%) among individual exam methods. The combination of all methods provided the highest accuracy (93.2%), sensitivity (86.5%), and negative predictive value (88.1%), while sustained high specificity (99.9%) and positive predictive value (99.8%). The four methods presented the higher performance compared to combination of two or three exam methods as well as all single exam methods.
Conclusion: The proposed strategies present statistical evidence of its diagnostic performance and can be used to aid TCM physicians in making single pattern diagnosis according to Zang-Fu theory.

Key words: diagnosis, traditional Chinese medicine, sensitivity and specificity

CLC Number: 

  • R241

Figure 1

Scheme for traditional Chinese medicine diagnosis separated by exam method"

Figure 2

Flowchart of the proposed method for Zang-Fu single pattern differentiation"

"

Single pattern Single pattern
1. Deficiency-cold in the bladder 36. Phlegm-fluids obstructing the lungs
2. Kidney-qi deficiency 37. Heart-yang deficiency
3. Cold invading the large intestine 38. Phlegm-heat obstructing the lungs
4. Large intestine dryness 39. Heart-yin deficiency
5. Cold invading the stomach 40. Retention of food in the stomach
6. Liver-blood deficiency 41. Heat in the large intestine
7. Collapse of the large intestine 42. Deficiency-cold in the small intestine
8. Liver-blood stasis 43. Heat obstructing the large intestine
9. Damp-cold in the bladder 44. Small intestine qi pain
10. Liver-fire blazing upwards 45. Infestation of worms in the small intestine
11. Damp-cold invading the spleen 46. Small intestine qi tied
12. Liver-qi stagnation 47. Invasion of the large intestine by cold
13. Damp-heat in the liver and gall-bladder 48. Spleen not controlling blood
14. Liver-wind agitating within, deficient liver-blood causing wind 49. Invasion of the lungs by wind-cold
15. Damp-heat in the bladder 50. Spleen-qi deficiency
16. Liver-wind agitating within, extreme heat generating wind 51. Invasion of the lungs by wind-heat
17. Damp-heat in the gall-bladder 52. Spleen-qi sinking
18. Liver-wind agitating within, liver-yang rising causing wind 53. Invasion of the lungs by wind-water
19. Damp-heat in the large intestine 54. Spleen-yang deficiency
20. Liver-yang rising 55. Kidney-essence deficiency
21. Damp-heat invading the spleen 56. Stagnation of cold in the liver channel
22. Liver-yin deficiency 57. Kidney-qi not firm
23. Full-heat in the small intestine 58. Stasis of blood in the stomach
24. Lung dryness 59. Kidneys failing to receive qi
25. Gall-bladder deficiency 60. Deficiency-cold in the stomach
26. Lung-qi deficiency 61. Kidney-yang deficiency
27. Heart-blood deficiency 62. Stomach-fire
28. Lung-yin deficiency 63. Kidney-yang deficiency, water overflowing to the heart
29. Heart-blood stasis 64. Stomach-qi deficiency
30. Phlegm misting the mind 65. Kidney-yang deficiency, water overflowing to the lungs
31. Heart-fire blazing 66. Stomach-qi rebelling upwards
32. Phlegm-damp obstructing the lungs 67. Kidney-yin deficiency
33. Heart-qi deficiency 68. Stomach-yin deficiency
34. Phlegm-fire harassing the heart 69. Kidney-yin deficiency, empty-fire
35. Heart-yang collapse

"

Diagnosis method Accuracy Sensitivity Specificity Negative predictive value Positive predictive value
Single method
A. Inspection 70.7% 41.5% 99.9% 63.1% 99.8%
B. Auscultation and olfaction 59.9% 19.8% 100.0% 55.5% 99.8%
C. Inquiry 89.7% 79.4% 99.9% 82.9% 99.9%
D. Palpation 56.1% 12.3% 99.9% 53.2% 99.4%
Combined method
Method A 70.7% 41.5% 99.9% 63.1% 99.8%
Methods A+B 74.3% 48.7% 99.8% 66.1% 99.7%
Methods A+B+C 92.0% 84.1% 99.9% 86.3% 99.9%
Methods A+B+C+D 93.2% 86.5% 99.9% 88.1% 99.8%
[1] Wang XW, Qu HB, Liu P , et al. A self-learning expert system for diagnosis in traditional Chinese medicine[J]. Expert Syst Appl, 2004,26(4):557-566
doi: 10.1016/j.eswa.2003.10.004
[2] Feng Y, Wu Z, Zhou X , et al. Knowledge discovery in traditional Chinese medicine: state of the art and perspectives[J]. Artif Intell Med, 2006,38(3):219-236
doi: 10.1016/j.artmed.2006.07.005 pmid: 16930966
[3] Huang MJ, Chen MY . Integrated design of the intelligent web-based Chinese Medical Diagnostic System(CMDS)—Systematic development for digestive health[J]. Expert Syst Appl, 2007,32(2):658-673
doi: 10.1016/j.eswa.2006.01.037
[4] Bob F. The classic of difficulties(4th ed)[M]. Boulder, Colorado: Blue Poppy Press,2004,(4th ed)
[5] Yang SZ. Master Hua's classic of the central viscera[M]. Boulder, Colorado: Blue Poppy Press,2003:
[6] Luo XW. Synopsis of prescriptions of The golden chamber with 300 cases[M]. Beijing: New World Press,1995:
[7] Yang SZ, Charles C. The systematic classic of acupuncture and moxibustion[M]. Boulder, Colorado: Blue Poppy Press,2004:
[8] Yang SZ, Li JY. Treatise on the spleen and stomach[M]. Boulder, Colorado: Blue Poppy Press,1993:
[9] Bellavite P, Semizzi M, Lussignoli S , et al. A computer model of the five elements' theory of traditional Chinese medicine[J]. Complement Ther Med, 1998,6(3):133-140
doi: 10.1016/S0965-2299(98)80005-8
[10] Li CH, Yuen PC . Regularized color clustering in medical image database[J]. IEEE Trans Med Imaging, 2000,19(11):1150-1155
doi: 10.1109/42.896791 pmid: 11204852
[11] Li CH, Yuen PC . Tongue image matching using color content[J]. Pattern Recognit, 2002,35(2):407-419
doi: 10.1016/S0031-3203(01)00021-8
[12] Chiu CC, Lan CY, Chang YH . Objective assessment of blood stasis using computerized inspection of sublingual veins[J]. Comput Methods Programs Biomed, 2002,69(1):1-12
doi: 10.1016/S0169-2607(01)00181-X pmid: 12088588
[13] Fu SE, Lai SP . A system for pulse measurement and analysis of Chinese medicine[J]. Eng Med Biol Soc, 1989,5(9-12):1695-1696
doi: 10.1109/IEMBS.1989.96411
[14] Yang XB, Liang ZH, Zhang G , et al. A classification algorithm for TCM syndromes based on P-SVM[J]. Mach Learn Cybern, 2005,6(18-21):3692-3697
[15] Wang QC . Research direction for syndromes of traditional Chinese medicine: differentiating diseases from syndromes and differentiating syndromes from diseases[J]. Zhong Xi Yi Jie He Xue Bao, 2006,4(3):221-224
王翘楚 . 中医“证”研究的发展方向——证中求病, 病中求证[J]. 中西医结合学报, 2006,4(3):221-224
[16] Zhou CL, Zhang ZF . Progress and prospects of research on information processing techniques for intelligent diagnosis of traditional Chinese medicine[J]. Zhong Xi Yi Jie He Xue Bao, 2006,4(6):560-566
周昌乐, 张志枫 . 智能中医诊断信息处理技术研究进展与展望[J]. 中西医结合学报, 2006,4(6):560-566
[17] Zhu WF, Yan JF, Huang BQ . Application of Bayesian network in syndrome differentiation system of traditional Chinese medicine[J]. Zhong Xi Yi Jie He Xue Bao, 2006,4(6):567-571
朱文锋, 晏峻峰, 黄碧群 . 贝叶斯网络在中医证素辨证体系中的应用[J]. 中西医结合学报, 2006,4(6):567-571
[18] McSherry D . Strategic induction of decision trees[J]. Knowl Based Syst, 1999,12(5-6):269-275
doi: 10.1007/978-1-4471-0835-1_2
[19] Zhang NL, Yuan S, Chen T , et al. Statistical validation of traditional Chinese medicine theories[J]. J Altern Complement Med, 2008,14(5):583-587
doi: 10.1089/acm.2007.7019 pmid: 18554082
[20] Jekel JF, Elmore JG, Katz DL .Epidemiologia, bioestatistica e medicina preventiva[M].Porto Alegre: Artmed, 1999:
[21] Zuzek A, Biasizzo A, Novak F . Sequential diagnosis tool[J]. Microprocessors Microsyst, 2000,24(4):191-197
doi: 10.1016/S0141-9331(00)00073-9
[22] Wolff JG . Medical diagnosis as pattern recognition in a framework of information compression by multiple alignment, unification and search[J]. Decis Supp Syst, 2006,42(2):608-625
doi: 10.1016/j.dss.2005.02.005
[23] Maciocia G .Os fundamentos da medicina Chinesa: um texto abrangente para acupunturistas e fitoterapeutas[M].Rio de Janeiro: Roca, 1996:
[24] Harding WT, Redmond RT . Compilers and knowledge dictionaries for expert systems: inference engines of the future[J]. Expert Syst Appl, 1996,10(1):91-98
doi: 10.1016/0957-4174(95)00036-4
[25] Altman DG, Bland JM . Diagnostic tests.1: Sensitivity and specificity[J]. BMJ, 1994,308(6943):1552
doi: 10.1136/bmj.308.6943.1552
[26] Zhang GG, Lee W, Bausell B , et al. Variability in the traditional Chinese medicine(TCM) diagnosis and herbal prescriptions provided by three TCM practitioners for 40 patients with rheumatoid arthritis[J]. J Altern Complement Med, 2005,11(3):415-421
doi: 10.1089/acm.2005.11.415
[27] Zhang GG, Singh B, Lee W , et al. Improvement of agreement in TCM diagnosis among TCM practitioners for persons with the conventional diagnosis of rheumatoid arthritis: effect of training[J]. J Altern Complement Med, 2008,14(4):381-386
doi: 10.1089/acm.2007.0712
[1] Claudia Maria Sous, Mario Goncalves, Jorge Machado, Thomas Efferth, Tobias Greten , Petra Froeschen , Henry J. Greten. Effects of qigong on performance-related anxiety and physiological stress functions in transverse flute music schoolchildren: A feasibility study. Journal of Chinese Integrative Medicine, 2012, 10(8): 858-865.
[2] C. Matos Luís, J. Goncalves Mário, R. Silva António, G. Mendes Joaquim, P. Machado Jorge, J. Greten Henry. Assessment of Qigong-related effects by infrared thermography: A case study. Journal of Chinese Integrative Medicine, 2012, 10(6): 663-666.
[3] Christoph A. Doenitz, Ana Anjos, Thomas Efferth , Tobias Greten, Henry J. Greten. Can heat and cold be parameterized? Clinical data of a preliminary study. Journal of Chinese Integrative Medicine, 2012, 10(5): 532-537.
[4] Hanjo Lehmann. A Westerner’s question about traditional Chinese medicine: are the Yinyang concept and the Wuxing concept of equal philosophical and medical rank?. Journal of Chinese Integrative Medicine, 2012, 10(3): 237-248.
[5] Dong-tao Li, Jian Wang , Hong-yang Jiang , Feng-lei Shi , Fu-yu Li , Ji-hong Liu , Yong-mei Cheng , Nan Yan , Ai-hua Hu, Mei-zeng Zhang , Jie Li, Ling-bo Wei , Rong-qin Jiang. Quantitative evaluation of the degrees of traditional Chinese medicine qualitative syndromes of osteoporosis. Journal of Chinese Integrative Medicine, 2012, 10(11): 1254-1262.
[6] Yan-ming Xie, Xing Liao, Yong-yan Wang. Introduce the idea of comparative effectiveness research to clinical research of Chinese medicine. Journal of Chinese Integrative Medicine, 2011, 9(8): 813-818.
[7] Liang-ping Hu, Xiao-lei Bao, Xue Guan, Qi Wang. How to appropriately choose observed indexes. Journal of Chinese Integrative Medicine, 2011, 9(5): 491-494.
[8] Zhi-rong Zhu, Chang-chun Zeng, Li Yang, Han-ping Liu, Song-hao Liu. Influence of brightness value of supranasal point and apex nasi on dominant wavelength and excitation purity in complexion inspection of healthy adults. Journal of Chinese Integrative Medicine, 2011, 9(12): 1333-1338.
[9] Li Dong-tao, Li Fu-yu, Wang Jian, Liu Ji-hong, Yan Nan, Cheng Yong-mei, Hu Ai-hua, Jiang Hong-yang, Shi Feng-lei, Zhang Mei-zeng, Li Jie, Wei Ling-bo, Jiang Rong-qin. A study of diagnostic criteria for traditional Chinese medicine syndromes in osteoporosis. Journal of Chinese Integrative Medicine, 2011, 9(12): 1326-1332.
[10] Hong-cai Shang, Jin-ling Huang, Li-wei Han, Ling-peng Pei, Lin Guo, Na Lin, Chang-en Wang . Applications and approved projects on traditional Chinese medicine in National Natural Science Foundation of China in 2010. Journal of Chinese Integrative Medicine, 2011, 9(10): 1045-1050.
[11] Jin-gen Lu, Chen Wang, Yong-qing Cao, Yi-bo Yao. Thread-dragging and pad pressure therapy in traditional Chinese medicine for treatment of pilonidal sinus: A case report. Journal of Chinese Integrative Medicine, 2011, 9(1): 36-37.
[12] Si-cheng Wang, Jian-ping Liu, Hui Li, He Yu. Guidelines for evidence-based Chinese medicine clinical pathway report. Journal of Chinese Integrative Medicine, 2010, 8(9): 819-823.
[13] JM Zeng. A cognitive interpretation of diachronic difference in translating traditional Chinese medicine terminology into English: a conceptual integration perspective. Journal of Chinese Integrative Medicine, 2010, 8(9): 896-900.
[14] Cai-feng Du , Tian-fang Wang, Xiu-yan Wu, Yan Zhao, Qing-guo Wang. Common syndrome factors of menopausal syndrome based on questionnaire investigation among experts. Journal of Chinese Integrative Medicine, 2010, 8(8): 757-761.
[15] Zhao-guo Li. Comparative study on WHO Western Pacific Region and World Federation of Chinese Medicine Societies international standard terminologies on traditional medicine: Syndrome Differentiation According to Eight Principles (Part three). Journal of Chinese Integrative Medicine, 2010, 8(6): 594-597.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] Jin-zhou Tian, Jing Shi, Xin-qing Zhang, Qi Bi, Xin Ma, Zhi-liang Wang, Xiao-bin Li, Shu-li Shen, Lin Li, Zhen-yun Wu, Li-yan Fang, Xiao-dong Zhao, Ying-chun Miao, Peng-wen Wang, Ying Ren, Jun-xiang Yin, Yong-yan Wang, Beijing United Study Group on MCI of the Capital Foundation of Medical Developments. An explanation on "guiding principles of clinical research on mild cognitive impairment (protocol)". Journal of Chinese Integrative Medicine, 2008, 6(1): 15-21
[2] Yi-ting He, Qing-lin Zha, Jian-ping Yu, Yong Tan, Cheng Lu, Ai-ping Lv. Principal factor analysis of symptoms of rheumatoid arthritis and their correlations with efficacy of traditional Chinese medicine and Western medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 32-36
[3] Jun Cai, Hua Wang, Sheng Zhou, Bin Wu, Hua-rong Song, Zheng-rong Xuan. Effect of Sijunzi Decoction and enteral nutrition on T-cell subsets and nutritional status in patients with gastric cancer after operation: A randomized controlled trial. Journal of Chinese Integrative Medicine, 2008, 6(1): 37-40
[4] Wei Zhang, Xiang-feng Lu, Xiao-mei Zhang, Jian-jun Wu, Liang-duo Jiang. A rat model of pulmonary fibrosis induced by infusing bleomycin quickly through tracheal intubation. Journal of Chinese Integrative Medicine, 2008, 6(1): 60-67
[5] A-gao Zhou, Yong Zhang, Gang Kui, De-Yun Kong, Hai-liang Ge, Qiu-hua Ren, Jia-rong Dong, Sheng Hong, Xu-ming Mao, Yin Wang, Hui-zheng Zhang, Shu-jun Wang. Influence of traditional Chinese compound recipes with different efficacy on body weight, tumor weight and immune function in H22 cancer-bearing mice. Journal of Chinese Integrative Medicine, 2008, 6(1): 77-82
[6] Guo-hong Yuan, Xiao-jing Pang, He-chao Ma. Synergic effects of Danggui Buxue Decoction in reducing toxicity of cytoxan in tumor-bearing mice. Journal of Chinese Integrative Medicine, 2008, 6(1): 83-88
[7] Li Zhou, Hong-xing Zhang, Ling-guang Liu, Wen-jun Wan. Effect of electro-acupuncture at Fenglong (GV 16) on nitric oxide and endothelin in rats with hyperlipidemia. Journal of Chinese Integrative Medicine, 2008, 6(1): 89-92
[8] Jin-zhou Tian, Jing Shi, Xin-qing Zhang, Qi Bi, Xin Ma, Zhi-liang Wang, Xiao-bin Li, Shu-li Shen, Lin Li, Zhen-yun Wu, Li-yan Fang, Xiao-dong Zhao, Ying-chun Miao, Peng-wen Wang, Ying Ren, Jun-xiang Yin, Yong-yan Wang, Beijing United Study Group on MCI of the Capital Foundation of Medical Developments. Guiding principles of clinical research on mild cognitive impairment (protocol). Journal of Chinese Integrative Medicine, 2008, 6(1): 9-14
[9] Xin-jun Wang, Ling-ling Wang . A mechanism of endogenous opioid peptides for rapid onset of acupuncture effect in treatment of depression. Journal of Chinese Integrative Medicine, 2010, 8(11): 1014-1017
[10] Bo Wang , Wei Yan , Li-hui Hou, Xiao-ke Wu. Disorder of Tiangui (kidney essence) and reproductive dysfunction in patients with polycystic ovary syndrome. Journal of Chinese Integrative Medicine, 2010, 8(11): 1018-1022
[an error occurred while processing this directive]