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Journal of Chinese Integrative Medicine ›› 2010, Vol. 8 ›› Issue (12): 1153-1158.doi: 10.3736/jcim20101207

Special Issue: Traditional Chinese Medicine

• Original Clinical Research • Previous Articles     Next Articles

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

Xiao-yan Lia,Ze-huai Wena,b,Wei-xiong Liangb,Wei-hua Xub, Su-yun Lic,Xue-qing Yuc, Hai-feng Wangc   

  1. a Key Unit of Methodology in Clinical Research of Traditional Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
    b National Center for Training of Design, Measurement and Evaluation in Clinical Research, Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China
    c Department of Respiratory Diseases, the First Affiliated Hospital, Henan University of Traditional Chinese Medicine, Zhengzhou 450000, Henan Province, China
  • Received:2010-07-29 Accepted:2010-08-16 Online:2010-12-20 Published:2010-12-15
  • Contact: Ze-huai Wen E-mail:wenzh@gzhtcm.edu.cn

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

"

"

舌苔 腻苔 白苔 黄苔 厚苔 薄苔 滑润苔 干燥苔 花剥苔 无苔
Kappa 值 0. 516 0. 644 0. 674 0. 737 0. 753 1. 000 1 1 1. 000

"

脉象 浮脉 沉脉 缓脉 滑脉 细脉 弦脉 结代脉 数脉
Kappa 值 0. 486 0. 645 0. 658 0. 708 0. 737 0. 737 0. 780 0. 913

"

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
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
白黄厚腻 0 0 0 1 0 0 0 0 0 0 0 1
薄白黄 1 0 0 0 15 0 0 1 0 0 0 17
薄黄腻 0 0 0 0 0 0. 001* 0 0 0 0 0 0
花剥 0 0 0 0 0 0 2 0 0 0 0 2
黄干 0 0 0 0 0 0 0 2 1 0 0 3
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

"

B医生舌苔观察结果
(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) (1) (3) 薄白黄(1) 薄黄 (1)
薄黄 (1) (1)
(1) 黄腻 (1)
黄厚 (1) 白黄厚(1)
黄厚腻(1) 黄厚 (1)
黄腻 (3) 薄黄 (1) (1) 黄厚腻(1)
黄腻干(1) 黄干 (1)

"

B医生切脉结果
-1 沉细 -1
沉滑结代(1) 沉细结代 -1
A 沉细 -3 -1 沉细滑(1) 沉细数(1)
沉细结代(1) 沉细 -1
沉细数 -1 沉细数结代(1)
-4 -1 沉滑 -2 浮 ⑴
-3 沉细 -2 -1
细数 -3 沉细 -1 滑数 -1 细滑数(1)
-2 -1 沉弦 -1
弦滑 -1 沉细 -1
弦细 -2 沉弦细 -1 浮脉 -1
[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.
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