溃疡性结肠炎常见证候要素对应症在其诊断中贡献度的专家问卷调查研究

doi:10.3736/jcim20120408

Abstract

Objective: To define the weighting coefficients of the symptoms and signs in the diagnosis of corresponding traditional Chinese medicine (TCM) syndrome elements of ulcerative colitis based on expert questionnaire investigation.
Methods: The questionnaire included eight syndrome elements of location and 11 syndrome elements relating to disease characteristics. Experts who answered the questionnaire were titled as associate chief physician or above, and had been practicing as professionals in general practice of medicine of digestive system for a long time. They came from 15 third-grade class-A hospitals (6 provinces and Beijing) in China. The weighting coefficients of the symptoms and signs in the diagnosis of corresponding TCM syndrome elements of ulcerative colitis were identified preliminarily based on consent degree of the experts (mean value and variation coefficient).
Results: There were 9, 6, 14, 5, 9, 8, 12 and 2 symptoms and signs corresponding to 8 TCM syndrome elements related to disease location and the ranges of weighting coefficients were listed as follows: liver, from 7.49 to 4.18; heart, from 6.90 to 5.51; spleen, from 7.96 to 5.55; lung, from 6.30 to 5.27; kidney, from 7.82 to 5.71; stomach, from 7.53 to 6.15; large intestine, from 8.40 to 6.70; bowel collaterals, from 8.49 to 6.41. Numbers of symptoms and signs corresponding to 11 TCM syndrome elements related to disease nature were 13, 8, 17, 18, 17, 18, 6, 11, 2, 10 and 11 and the ranges of weighting coefficients were listed as follows: qi deficiency, from 7.44 to 5.60; blood deficiency, from 7.90 to 5.59; yin deficiency, from 6.88 to 4.91; yang deficiency, from 7.54 to 5.57; dampness, from 7.91 to 4.96; excess heat (fire), from 7.13 to 5.69; excess cold, from 7.51 to 6.14; qi stagnation, from 7.38 to 5.88; qi sinking, from 7.65 to 7.43; blood stasis, from 7.60 to 5.79; fluid retention, from 7.08 to 4.46.
Conclusion: On the basis of previous document research and clinical research in ulcerative colitis, the expert questionnaire can collect consensus opinions of experts. The weighting coefficients of the symptoms and signs in the diagnosis of corresponding TCM syndrome elements of ulcerative colitis are defined preliminarily. Thereby it will lay the foundation for establishing differentiation criteria of ulcerative colitis based on TCM syndrome elements.

Key words: colitis, ulcerative, symptoms and signs, syndrome complex, questionnaires

Jia-jia Wang , Tian-fang Wang , Xiu-yan WU , Yah Zhao , Xiao-lin Xue , Qing-guo Wang. Weighting coefficients of symptoms and signs in the diagnosis of corresponding TCM syndrome elements of ulcerative colitis based on expert questionnaire investigation. Journal of Chinese Integrative Medicine, 2012, 10(4): 398-405.

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URL: http://www.jcimjournal.com/EN/10.3736/jcim20120408

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Figures/Tables 2

Table 1

Weighting coefficient distribution of symptoms and signs in the diagnosis of the corresponding traditional Chinese medicine syndrome elements related to disease location(mean/coefficient of variation)"

Syndrome element	Symptom and sign	Weighting
Liver肝	Emotional depression精神抑郁	7.49/0.29
	Irritability急躁易怒	7.17/0.33
	Stringy pulse脉弦	7.02/0.38
	Distension and fullness in chest and hypochondrium胁肋胀满	6.96/0.42
	Deep sighing善太息	6.28/0.45
	Hypochondriac pain胁肋疼痛	6.26/0.50
	Bitter taste in the mouth口苦	6.21/0.39
	Distension and fullness in the lateral lower abdomen少腹胀满	6.18/0.38
	Oppression in the chest胸闷	4.18/0.56
Heart心	Palpitation心悸	6.90/0.46
	Vexation心烦	6.16/0.39
	Insomnia失眠	6.14/0.36
	Dreaminess多梦	5.74/0.42
	Oppression in the chest胸闷	5.58/0.51
	Shortness of breath气短	5.51/0.48
Spleen脾	Loose stool便溏	7.96/0.25
	Diarrhea腹泻	7.79/0.25
	Teeth-printed tongue舌有齿痕	7.47/0.30
	Plump tongue舌胖大	7.43/0.30
	Anorexia纳呆	7.24/0.30
	Stool sometimes sloppy and sometimes bound大便溏结不调	7.17/0.29
	Sallow complexion面色萎黄	7.16/0.29
	Abdomen distention腹胀	6.94/0.31
	Abdominal pain腹痛	6.35/0.34
	Soft pulse脉濡	6.26/0.39
	Mucous stools黏液便	6.24/0.40
	Moderate pulse脉缓	5.95/0.39
	Stools containing pus and blood脓血便	5.74/0.48
	Thready pulse脉细	5.55/0.48
Lung肺	Susceptibility to colds易感冒	6.30/0.39
	Shortness of breath气短	6.10/0.40
	Aversion to wind恶风	6.03/0.39
	Spontaneous sweating自汗	6.02/0.37
	Oppression in the chest胸闷	5.27/0.44
Kidney肾	Diarrhea before dawn五更泄	7.82/0.29
	Aching and weakness of waist and knees腰膝酸软	7.47/0.34
	Frequent urination at night夜尿频多	7.13/0.36
	Aching pain in waist and knees腰膝酸痛	6.97/0.38
	Weak pulse at the chi portion尺脉弱	6.89/0.34
	Fear of cold in lower limbs下肢怕冷	6.83/0.30
	Deep pulse脉沉	6.47/0.36
	Diarrhea with undigested food完谷不化	6.30/0.40
	Tinnitus耳鸣	5.71/0.44
Stomach胃	Distension and fullness in the stomach胃脘胀满	7.53/0.32
	Stuffiness and fullness in the stomach胃脘痞满	7.41/0.33
	Epigastric pain胃脘疼痛	7.15/0.38
	Belching嗳气	6.59/0.40
	Vomiting呕吐	6.26/0.47
	Anorexia厌食	6.29/0.35
	Nausea恶心	6.27/0.41
	Acid regurgitation泛酸	6.15/0.43
Large intestine 大肠	Stools containing pus and blood脓血便	8.40/0.23
	Mucous stool黏液便	8.15/0.26
	Diarrhea腹泻	7.76/0.26
	Difficult defecation and sticky stools大便黏滞不爽	7.51/0.32
	Loose stool便溏	7.27/0.32
	Burning pain in the anus肛门灼热	7.20/0.32
	Borborygmus肠鸣漉漉	7.18/0.27
	Stool sometimes sloppy and sometimes bound大便溏结不调	7.03/0.33
	Constipation便秘	6.94/0.36
	Abdominal pain腹痛	6.91/0.29
	Abdomen distention腹胀	6.82/0.29
	Increased flatus矢气增多	6.70/0.32
Bowel collaterals 肠络	Stools containing pus and blood脓血便	8.49/0.19
	Black stools黑便	6.41/0.40

Table 1

Table 2

Weighting coefficient of symptoms and signs in the diagnosis of the corresponding traditional Chinese medicine syndrome elements related to disease nature(mean/coefficient of variation)"

Syndrome element	Symptom and sign	Weighting
Qi deficiency气虚	Qi deficiency and disinclination to talk少气懒言	7.44/0.33
	Spiritlessness神疲	7.31/0.29
	Weakness乏力	7.31/0.32
	Spontaneous sweating自汗	7.04/0.36
	Teeth-printed tongue舌有齿痕	7.02/0.34
	Pale white complexion面色淡白	6.92/0.32
	Weak pulse脉弱	6.90/0.34
	Feeble pulse脉虚	6.90/0.33
	Pale tongue舌淡白	6.77/0.35
	Sallow complexion面色萎黄	6.60/0.34
	Thready pulse脉细	6.25/0.41
	Dizziness头晕	5.98/0.35
	Dull pain in the abdomen腹部隐痛	5.60/0.41
Blood deficiency血虚	Pale lips, nails and eyelids唇/甲/眼睑色淡	7.90/0.30
	Pale tongue舌淡白	7.17/0.34
	Sallow complexion面色萎黄	7.14/0.30
	Pale white complexion面色淡白	7.11/0.33
	Thready pulse脉细	6.98/0.35
	Dizziness头晕	6.44/0.34
	Scanty menstruation经少	6.10/0.39
	Amenorrhea经闭	5.59/0.46
Yin deficiency阴虚	Dysphoria with feverish in the chest, palms and soles五心烦热	6.88/0.42
	Little fur苔少	6.84/0.42
	Thready and rapid pulse脉细数	6.75/0.42
	No fur苔无	6.66/0.51
	Eroded fur苔剥脱	6.57/0.45
	Night sweating盗汗	6.47/0.44
	Fissured tongue舌有裂纹	6.46/0.42
	Dry mouth and throat口咽干燥	6.25/0.39
	Mild fever in the night入夜低热	6.14/0.45
	Mild fever in the afternoon午后低热	6.13/0.43
	Thin tongue舌瘦薄	6.07/0.45
	Red tongue舌红	5.94/0.45
	Hectic cheek颧红	5.92/0.49
	Deep red tongue舌绛	5.53/0.51
	Constipation便秘	5.19/0.44
	Dull pain in the abdomen腹部隐痛	4.96/0.46
	Dizziness头晕	4.91/0.44
Yang deficiency阳虚	Cold limbs四肢不温	7.54/0.30
	Fear of cold畏寒	7.51/0.32
	Diarrhea before dawn五更泄	7.50/0.35
	Abdominal pain, alleviated by heat and pressure腹痛, 喜温喜按	7.38/0.28
	Clear urine in large amounts小便清长	7.09/0.35
	Bright pale complexion面色白	7.01/0.36
	Frequent urination at night夜尿频多	7.01/0.35
	Diarrhea with undigested food完谷不化	6.93/0.34
	Plump tongue舌胖大	6.74/0.32
	Feeble pulse脉虚	6.73/0.35
	Teeth-printed tongue舌有齿痕	6.56/0.35
	Pale tongue舌淡白	6.35/0.37
	Slow pulse脉迟	6.28/0.40
	Slippery fur苔滑	6.05/0.39
	Moist fur苔润	5.95/0.38
	Spontaneous sweating自汗	5.76/0.41
	Bland taste in the mouth with no desire for drinking口淡不渴	5.75/0.39
	Pale purple tongue舌淡紫	5.57/0.44
Dampness湿	Mucous stools黏液便	7.91/0.23
	Greasy fur苔腻	7.74/0.32
	Difficult defecation and mucous stools大便黏滞不爽	7.43/0.27
	Sticky slimy sensation in the mouth口黏腻	7.39/0.32
	Stools containing pus and blood, more pus and less blood脓血便, 白多赤少	7.38/0.28
	Borborygmus肠鸣漉漉	6.47/0.34
	Tenesmus里急后重	6.45/0.37
	Stools containing pus and blood, blood as much as pus脓血便, 赤白并重	6.42/0.38
	Slippery pulse脉滑	6.41/0.42
	Teeth-printed tongue舌有齿痕	6.21/0.37
	Plump tongue舌胖大	6.02/0.39
	Thirst without a desire to drink渴不欲饮	5.98/0.40
	Soft pulse脉濡	5.88/0.43
	Stuffiness and fullness in the stomach胃脘痞满	5.75/0.39
	Moderate pulse脉缓	5.75/0.42
	Analeptic嗜睡	5.26/0.46
	Thready pulse脉细	4.96/0.53
Excessive heat (fire)实热 (火)	Burning sensation in the anus肛门灼热	7.13/0.34
	Yellow fur苔黄	7.11/0.39
	Rapid pulse脉数	7.05/0.38
	Stools containing pus and blood, more blood and less pus脓血便, 赤多白少	6.94/0.34
	Halitosis口臭	6.82/0.38
	Dark urine小便短黄	6.72/0.35
	Dry fur苔燥	6.70/0.43
	Bitter taste in the mouth口苦	6.51/0.40
	Stools containing pus and blood, blood as much as pus脓血便, 赤白并重	6.47/0.36
	Red complexion面色红赤	6.41/0.46
	Red tongue舌红	6.40/0.44
	Dry stools大便干结	6.35/0.41
	Deep red tongue舌绛	6.19/0.44
	Thirst口渴	6.07/0.43
	Slippery pulse脉滑	6.07/0.42
	Fever发热	5.91/0.46
	Dry mouth口干	5.83/0.41
	Tenesmus里急后重	5.69/0.45
Excessive cold实寒	Cold abdominal pain, worse by pressure腹冷痛, 拒按	7.51/0.33
	Tight pulse脉紧	6.55/0.42
	Cold limbs四肢不温	6.44/0.36
	Slow pulse脉迟	6.20/0.42
	Stools containing pus and blood, more pus and less blood脓血便, 白多赤少	6.32/0.36
	White fur苔白	6.14/0.36
Qi stagnation 气滞	Distending pain in the abdomen腹胀痛	7.38/0.27
	Abdominal distention腹胀	7.36/0.28
	Stringy pulse脉弦	6.92/0.38
	Distension and fullness in hypochondrium胁肋胀满	6.83/0.38
	Distending pain of hypochondrium胁肋胀痛	6.81/0.40
	Distending pain in the stomach胃脘胀痛	6.77/0.37
	Distension and fullness in the stomach胃脘胀满	6.76/0.38
	Emotional depression精神抑郁	6.70/0.33
	Tenesmus里急后重	6.51/0.41
	Irritability急躁易怒	6.13/0.38
	Oppression in the chest胸闷	5.88/0.44
Qi sinking 气陷	Tenesmus feeling of anus肛门下坠	7.65/0.30
	Tenesmus feeling of abdomen腹部下坠	7.43/0.31
Blood stasis血瘀	Ecchymosis on tongue舌有瘀斑瘀点	7.60/0.37
	Deep purple tongue舌紫暗	7.48/0.37
	Abnormal sublingual vessel舌下络脉异常	7.34/0.39
	Hesitant pulse脉涩	6.91/0.41
	Impalpable abdominal pain with fixed location腹痛拒按、痛有定处	6.75/0.39
	Cyanotic lips口唇青紫	6.59/0.45
	Squamous and dry skin肌肤甲错	6.54/0.48
	Dim complexion面色晦暗	6.47/0.39
	Mass in the abdomen腹部有痞块	6.33/0.46
	Black stools黑便	5.79/0.46
Fluid retention饮	Borborygmus肠鸣漉漉	7.08/0.30
	Slippery fur苔滑	6.58/0.38
	Slippery pulse脉滑	6.39/0.44
	Greasy fur苔腻	6.34/0.38
	Diarrhea腹泻	6.30/0.37
	Plump tongue舌胖大	6.16/0.37
	Stuffiness and fullness in the stomach胃脘痞满	5.43/0.42
	Distention in the abdomen腹胀	5.39/0.43
	Deep pulse脉沉	5.26/0.51
	Stringy pulse脉弦	4.91/0.51
	Tight pulse脉紧	4.46/0.57

Table 2

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Weighting coefficients of symptoms and signs in the diagnosis of corresponding TCM syndrome elements of ulcerative colitis based on expert questionnaire investigation

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