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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

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%
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