评测中医临床医生观察舌象及脉象一致性的研究

doi:10.3736/jcim20101207

Abstract

Objective

To evaluate the consistency of tongue manifestation and pulse condition observed by traditional Chinese medicine clinicians.

Methods

Field investigation and direct inquiry were performed in the study. Two physicians from the same department judged tongue manifestation and pulse condition independently. The consistency among observers was assessed by means of Kappa statistics.

Results

A total of 55 patients were included in the study. There were 13 inconsistent cases (23. 6%) in tongue body observation and 7 cases (12.7%) in form of the tongue observation. The observation consistency of tongue body (Kappa=0.649) and form of the tongue (Kappa=0.752) were good. There were 24 inconsistent cases (43.6%) in tongue fur observation, the consistency of which was moderate (Kappa = 0. 525). There were 22 inconsistent cases (40%) in pulse condition diagnosis, the diagnosis consistency of which was also moderate (Kappa=0.562).

Conclusion

Observation and diagnosis consistency of tongue manifestation and pulse condition were moderately the same between different clinicians. By analyzing the reasons of inconsistency, it is necessary to improve the consistency in three aspects, such as the detailed-oriented criterion, the attitude of researchers and better training of researchers.

Key words: Consensus, Statistics, Nonparametric, Tongue presentations, Pulse presentations, Traditional Chinese medicine

Xiao-yan Li , Ze-huai Wen, Wei-xiong Liang , Wei-hua Xu, Su-yun Li, Xue-qing Yu , Hai-feng Wang. Evaluation of consistency of tongue and pulse signs observed by traditional Chinese medicine clinicians. Journal of Chinese Integrative Medicine, 2010, 8(12): 1153-1158.

/ / Recommend

Add to citation manager EndNote| Reference Manager|ProCite|BibTeX|RefWorks

URL: http://www.jcimjournal.com/EN/10.3736/jcim20101207

http://www.jcimjournal.com/EN/Y2010/V8/I12/1153

[1]	Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C , Rodriguez-Roisin R, van Weel C, Zielinski J; Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am[J] Respir Crit Care Med. 2007 ; 176(6) : 532-555. doi: 10.1164/rccm.200703-456SO
[2]	COPD Group of Chinese Society of Respiratory Diseases. Guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease (2007 revised edition). Zhonghua Jie He He Hu Xi Za Zhi. 2007; 30(1):8-17. Chinese.
	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2007年修订版).中华结核和呼吸杂志. 2007; 30(1):8-17.
[3]	Wang YY, Chao EX. Chinese internal medicine today . Beijing: People ’ s Medical Publishing House. 2000: 119-238. Chinese.
	王永炎, 晁恩祥 . 今日中医内科.北京: 人民卫生出版社. 2000: 119-238.
[4]	Wang YY, Lu ZL. Chinese internal medicine . Beijing: People’s Medical Publishing House. 2005: 178-196. Chinese.
	王永炎, 鲁兆麟 . 中医内科学.北京: 人民卫生出版社. 2005: 178-196.
[5]	Zhang BY . Chinese internal medicine. 5th ed. Shanghai : Shanghai Scientific and Technical Publishers. 1988 : 1988: 65-71. Chinese.
	张伯臾 . 中医内科学.第5版.上海:上海科学技术出版社. 1988: 65-71.
[6]	State Administration of Traditional Chinese Medicine of the People’ s Republic of China. Criteria of diagnosis and therapeutic effect evaluation for internal diseases and syndromes in traditional Chinese medicine. Nanjing: Nanjing University Press. 1994: 4-5 Chinese.
	国家中医药管理局. 中华人民共和国中医药行业标准•中医内科病证诊断疗效标准. 南京: 南京大学出版社. 1994: 4-5.
[7]	Sim J, Wright CC . The kappa statistic in reliability studies : use, interpretation, and sample size requirements. Phys Ther. 2005; 85(3):257-268.
[8]	Blackman NJ, Koval JJ . Interval estimation for Cohen ⁵ s kappa as a measurse of agreement . Stat Med. 2000; 19(5):723-741. doi: 10.1002/(ISSN)1097-0258
[9]	Li JA, Wang JX, Su BH , Zhu CQ. Kappa analysis of multiple categories and multiple observers. Zhong guo Wei Sheng Tong Ji. 1995; 12(6) : 20-22. Chinese with abstract in English.
	栗建安, 王纪宪, 苏炳华, 朱长青 . 多类别多评估者的 kappa分析.中国卫生统计. 1995 ; 12(6) : 20-22.
[10]	Landis JR, Koch GG . The measurement of observer agreement for categorical data. Biometrics . 1977 ; 33:159-174. doi: 10.2307/2529310
[11]	Veldhuyzen van Zanten SJ, Hijdra A . The use of kappa in the study of variability between observers. Ned Tijdschr Geneeskd. 1988; 132(5):199-202.
[12]	Hua L, Yan Y , Zhang J. The discussion on Kappa coefficient for diagnosis coherence. Shu Li Yi Yao Xue Za Zhi. 2006; 19(5):518-520. Chinese.
	华琳, 阎岩, 张建 . 关于对诊断一致性Kappa系统的探讨.数理医药学杂志. 2006; 19(5):518-520.
[13]	Li Y, Linde K, Dai J, Zhang J, Hager S, Sailer R, Melchart D . On the reliability of the description of morphological characteristics in traditional Chinese tongue diagnostics. Forsch Komplementmed. 2009 ; 16(2):98-104.
[14]	Shi Q . Consistency in observing tongue manifestation by different traditional Chinese medicine doctors. Jiangsu Zhong Yi Yao. 2007; 39(8) : 60-61. Chinese.
	石强 . 不同中医师对舌象观察结果一致性的研究.江苏中医药. 2007; 39(8) : 60-61.
[15]	Hong MH . Consistency analysis in clinical research of new drugs. Zhongguo Lin Chuang Yao Li Xue Yu Zhi Liao Xue. 1996; 1(2):149-151. Chinese.
	洪明晃 . 新药临床研究中的一致性分析.中国临床药理学与治疗学. 1996; 1(2):149-151.
[16]	Wu XL , Lu XZ. Analysis of tongue colour in atlas of tongue picture in 230 patients by practitioners of traditional Chinese medicine. Tianjin Zhong Yi Yao. 2005; 22(5):388-390. Chinese.
	伍喜良, 陆小左 . 230例舌象图谱中舌色诊断结果分析.天津中医药. 2005; 22(5):388-390.
[17]	Zhang GG, Singh B, Lee W, Handwerger B, Lao L, Berman B . Improvement of agreement in TCM diagnosis among TCM practitioners for persons with the conventional diagnosis of rheumatoid arthritis: effect of training.[J] Altern Complement Med. 2008; 14(4):381-386. doi: 10.1089/acm.2007.0712
[18]	Kim M, Cobbin D, Zaslawski C . Traditional Chinese medicine tongue inspection: an examination of the inter- and intrapractitioner reliability for specific tongue characteristics.[J] Altern Complement Med. 2008; 14(5):527-536. doi: 10.1089/acm.2007.0079
[19]	Zhang XR, Li SX, Zhang QS. Current situation and development of electropulsograph. Zhong Yi Yan Jiu. 2008; 21(5):3-6. Chinese.
	张晓然, 李素香, 张勤善 . 脉象仪的发展现状与思考. 中医研究. 2008; 21(5):3-6.

Related Articles 15

[1]	Wan-jun Guo, Yi Wang, Yu Deng, Lin-yan Cheng, Xin Liu, Ruo-fan Xi, Sheng-jie Zhu, Xin-yi Feng, Liang Hua, Kan Ze, Jian-yong Zhu, Dong-jie Guo, Fu-lun Li. Therapeutic effects of the extract of Sancao Formula, a Chinese herbal compound, on imiquimod-induced psoriasis via cysteine-rich protein 61. Journal of Integrative Medicine, 2022, 20(4): 376-384.
[2]	Shang-jin Song, Xuan Liu, Qing Ji, Da-zhi Sun, Li-juan Xiu, Jing-yu Xu, Xiao-qiang Yue. Ziyin Huatan Recipe, a Chinese herbal compound, inhibits migration and invasion of gastric cancer by upregulating RUNX3 expression. Journal of Integrative Medicine, 2022, 20(4): 355-364.
[3]	Marisa Casal. Improving the health and treatment success rates of in vitro fertilization patients with traditional chinese medicine: need for more robust evidence and innovative approaches. Journal of Integrative Medicine, 2022, 20(3): 187-192.
[4]	Ning Guo, Fei Wu, Mei Wu, Yuan Wang, Qing Lang, Xiao Lin, Yi Feng. Progress in the design and quality control of placeboes for clinical trials of traditional Chinese medicine . Journal of Integrative Medicine, 2022, 20(3): 204-212.
[5]	Yan-jun Lin, Kun-li Jiao, Bo Liu, Lu Fang, Shu Meng. Antiplatelet and myocardial protective effect of shexiang tongxin dropping pill in patients undergoing percutaneous coronary intervention: A randomized controlled trial. Journal of Integrative Medicine, 2022, 20(2): 126-134.
[6]	Jia-jia Li, Qing Liang, Guang-chun Sun. Traditional Chinese medicine for prevention and treatment of hepatocellular carcinoma: A focus on epithelial-mesenchymal transition. Journal of Integrative Medicine, 2021, 19(6): 469-477.
[7]	Rui-jin Qiu, Min Li, Jia-yuan Hu, Jing Chen, Hong-cai Shang. Methods for development of a core outcome set for clinical trials integrating traditional Chinese medicine and Western medicine. Journal of Integrative Medicine, 2021, 19(5): 389-394.
[8]	Mao-xing Pan, Chui-yang Zheng, Yuan-jun Deng, Kai-rui Tang, Huan Nie, Ji-qian Xie, Dong-dong Liu, Gui-fang Tu, Qin-he Yang, Yu-pei Zhang. Hepatic protective effects of Shenling Baizhu powder, a herbal compound, against inflammatory damage via TLR4/NLRP3 signalling pathway in rats with nonalcoholic fatty liver disease . Journal of Integrative Medicine, 2021, 19(5): 428-438.
[9]	Ning Zhang, Xiao-he Xiao. Integrative medicine in the era of cancer immunotherapy: Challenges and opportunities. Journal of Integrative Medicine, 2021, 19(4): 291-294.
[10]	Thomas Efferth, An-long Xu, Roxana Damiescu, Mita Banerjee, Norbert W. Paul, David Y.W. Lee. Can eastern wisdom resolve western epidemics? Traditional chinese medicine therapies and the opioid crisis. Journal of Integrative Medicine, 2021, 19(4): 295-299.
[11]	Si-qi Tang, Yun-liang Wang, Zi-ye Xie, Yang Zhang, Yi Guo, Kang-li Gao, Tang-you Mao, Chun-e Xie, Jun-xiang Li, Xiao-yan Gao. Serum metabolic profiling of traditional Chinese medicine syndromes in patients with diarrhea-predominant irritable bowel syndrome. Journal of Integrative Medicine, 2021, 19(3): 274-281.
[12]	Miao-yan Shi, Shi-qi Sun, Wei Zhang, Xing Zhang, Gui-hua Xu, Xuan Chen, Zi-jian Su, Xiu-ming Song, Lu-jiong Liu, Yi-bao Zhang, Yi-le Zhang, Meng Sun, Qi Chen, Yan Xue, Hua Lü, Wei-an Yuan, Xiao-rong Chen, Yun-fei Lu. Early therapeutic interventions of traditional Chinese medicine in COVID-19 patients: a retrospective cohort study. Journal of Integrative Medicine, 2021, 19(3): 226-231.
[13]	Shu-jun Wei, Qing-man He, Qing Zhang, Kang-hua Fu, Ruo-lan Li, Wei Peng, Yong-xiang Gao. Traditional Chinese medicine is a useful and promising alternative strategy for treatment of Sjogren's syndrome: A review. Journal of Integrative Medicine, 2021, 19(3): 191-202.
[14]	Yi Xia, Lu-shao-bo Shi, Jing-hui Chang, Hua-zhang Miao, Dong Wang. Impact of the COVID-19 pandemic on intention to use traditional Chinese medicine: A cross-sectional study based on the theory of planned behavior. Journal of Integrative Medicine, 2021, 19(3): 219-225.
[15]	Na Zhi, Qian Mo, Shuo Yang, Yuan-xing Qin, Hao Chen, Zeng-guang Wu, Cai-hong Lan, Jun Zhang, Yin-long Li. Treatment of pulmonary fibrosis in one convalescent patient with corona virus disease 2019 by oral traditional Chinese medicine decoction: A case report. Journal of Integrative Medicine, 2021, 19(2): 185-190.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Comments

Recommended 10

[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

						B医生舌苔观察结果							合计
		白干	白厚腻	白黄滑	白黄厚腻	薄白黄	薄黄腻	花剥	黄干	黄厚腻	黄腻干	无苔	合计
	白干	2	2	0	0	0	0	0	1	0	0	0	5
	白厚腻	0	6	0	1	2	1	0	1	0	0	0	11
A	白黄滑	0	0	1	0	0	0	0	0	0	0	0	1
医	白黄厚腻	0	0	0	1	0	0	0	0	0	0	0	1
生	薄白黄	1	0	0	0	15	0	0	1	0	0	0	17
壬	薄白黄	1	0	0	0	15	0	0	1	0	0	0	17
〇	薄黄腻	0	0	0	0	0	0. 001*	0	0	0	0	0	0
苔	薄黄腻	0	0	0	0	0	0. 001*	0	0	0	0	0	0
观	花剥	0	0	0	0	0	0	2	0	0	0	0	2
察	花剥	0	0	0	0	0	0	2	0	0	0	0	2
结	黄干	0	0	0	0	0	0	0	2	1	0	0	3
果	黄厚腻	0	0	0	1	1	0	0	1	8	0	0	11
	黄腻干	0	0	0	0	0	0	0	1	0	0. 001*	0	1
	无苔	0	0	0	0	0	0	0	0	0	0	3	3
	合计	3	8	1	3	18	1	2	7	9	0	0	55


白	(2)	白厚	(1)	白腻	(1)
白干	(1)	黄干	(1)
白黄滑(1)		白滑	(1)
白腻	(6)	白厚	(1)	白黄厚(1)		薄黄 (2)	薄黄腻(1)
薄白	(6)	白	(1)	薄	(3)	薄白黄(1)	薄黄 (1)
薄黄	(1)	黄	(1)
黄	(1)	黄腻	(1)
黄厚	(1)	白黄厚(1)
黄厚腻(1)		黄厚	(1)
黄腻	(3)	薄黄	(1)	黄	(1)	黄厚腻(1)
黄腻干(1)		黄干	(1)

			B医生切脉结果
	沉	-1	沉细	-1
	沉滑结代(1)		沉细结代	-1
A	沉细	-3	沉	-1	沉细滑(1)		沉细数(1)
医	沉细结代(1)		沉细	-1
生	沉细数	-1	沉细数结代(1)
切	滑	-4	沉	-1	沉滑	-2	浮 ⑴
脉	细	-3	沉细	-2	滑	-1
结	细数	-3	沉细	-1	滑数	-1	细滑数(1)
果	弦	-2	沉	-1	沉弦	-1
	弦滑	-1	沉细	-1
	弦细	-2	沉弦细	-1	浮脉	-1

Evaluation of consistency of tongue and pulse signs observed by traditional Chinese medicine clinicians

RichHTML

PDF (PC)

Like

Abstract

Cite this article

Share this article

TrendMD

Figures/Tables 6

References 19

Related Articles 15

Metrics

Comments

Recommended 10