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JKM > Volume 35(1); 2014 > Article
Oh, Lee, Kim, Song, Shin, Han, Lu, and Lee: Study on the Development of a Standard Instrument of Diagnosis and Assessment for Spleen Qi Deficiency Pattern

Abstract

Objectives

The purpose of this study was to develop a standard instrument of diagnosis and assessment for spleen qi deficiency pattern.

Methods:

Reports published in Korea and China related to spleen qi deficiency pattern were selected. Assessments of selected references were performed to select major symptoms of spleen qi deficiency pattern. Korean translation and review by a Korean linguist were performed to create a draft of [Standard instrument of diagnosis and assessment for spleen qi deficiency (for subject)]. The final [Standard instrument of diagnosis and assessment for spleen qi deficiency (for subject)] was completed after assessment on inclusion or exclusion, on importance of items and on validity of translation by an expert committee, consisting of professors from the National College of Korean Medicine.

Results & Conclusions:

  1. 14 major symptoms were selected by frequency from 45 references which were related to standard identification of spleen qi deficiency pattern, translated into Korean and reviewed by a Korean linguist.

  2. 11 symptoms were selected after assessment on inclusion yes or no by the expert group. Items were listed in order of importance: tiredness of extremities (肢体倦怠), sallow complexion (面色萎黄), reduced appetite (食欲减退), abdominal distension after eating (腹胀食後尤甚), inability to eat (納少), pale tongue and white fur (舌淡苔白), lethargy (神疲), emaciation (消瘦), loose stool (大便溏薄), shortness of breath and reluctance to speak (少氣懶言), and weak pulse (脈緩弱).

  3. Final [Standard instrument of diagnosis and assessment for spleen qi deficiency (for subject)] was completed after assessment of translation validity, reflection of individual opinions by the expert committee, and application of weighted value computed from assessment on importance of items.

Table 1
The List of the Analyzed References
No Title
1 中医虚证辨证参考标准 (沈自尹/中西医结合杂志/1983)3)
2 中医诊断学 (长春中医学院/吉林人民出版社/1984)13)
3 中医虚证辨证参考标准 (沈自尹 외/中西医结合杂志/1986)4)
4 中医诊断学 (邓铁涛/人民卫生出版社/1987)14)
5 中医诊断学 (广州中医学院/中医古籍出版社/1987)15)
6 实用中医诊断学 (邓铁涛/上海科学技术出版社/1988)16)
7 中医诊断学 (李丽霞/广东高等教育出版社/1988)17)
8 中医诊断学 (张恩勤/上海中医学院出版社/1988)18)
9 中医诊断学 (陕西中医学院/贵州人民出版社/1988)19)
10 中药治疗脾虚证的临床研究指导原则 (中华人民共和国卫生部药政局/中国医药学报/1988)5)
11 中医诊断学 (北京中医学院/贵州人民出版社/1990)20)
12 脾虚证计量诊断的探讨 (邱向红/广州中医学院学报/1990)21)
13 中医诊断学 (伏天云/华夏出版社/1991)22)
14 中医诊断学 (成都中医学院/四川科学技术出版社/1991)23)
15 中医病证诊断疗效标准 (国家中医药管理局医政司/南京大学出版社出版/1994)24)
16 中医诊断学 (朱文锋/上海科学技术出版社/1995)25)
17 新编中医诊断学 (靳士英 외/人民军医出版社/1997)26)
18 中医诊断学 (李绍良/中国工人出版社/1997)27)
19 “脾虚综合征”一种新的诊断学概念 (危北海 외/中国中医基础医学杂志/1997)28)
20 中医诊断学 (北京中医药大学/学苑出版社/1998)29)
21 中医诊断学 (吴秀芬/人民卫生出版社/1999)30)
22 中医诊断学 (季绍良/人民卫生出版社/2002)31)
23 中医诊断学 (南京中医药大学/上海中医药大学出版社/2002) 32)
24 中医诊断学 (杨在纲 외/中医古籍出版社/2002)33)
25 中医诊断学 (朱文锋/中国中医药出版社/2002)34)
26 中药新药临床研究指导原则:试行 (郑筱萸主編/中国医葯科技出版社/2002)6)
27 中西医结合诊断学 (陈群/科学出版社/2003)35)
28 实用中医诊断学 (邓铁涛/人民卫生出版社/2004)36)
29 中医诊断学 (王忆勤/中国中医药出版社/2004)37)
30 中医诊断学 (廖福义/人民卫生出版社/2005)38)
31 中医诊断学 (刘毅/高等教育出版社/2005)39)
32 中医诊断学 (邓铁涛/上海科学技术出版社/2006)40)
33 中医诊断学 (吴承玉/上海科学技术出版社/2006)41)
34 中医常见证诊断标准(上) (中华中医药学会中医诊断学分会/湖南中医药大学学报/2008)7)
35 中医诊断学 (李晶/科学出版社/2011)42)
36 中医诊断学 (朱文锋/人民卫生出版社/2011)43)
37 中医诊断学 (广东中医学院/上海科学技术出版社/2012)44)
38 中医诊断学 (郭振球/上海科学技术出版社/2013)45)
39 脾虚证诊断标准文献系统评价研究 (赵平 외/辽宁中医杂志/2013)8)
40 한의학원론 (김완희/성보사/1990)46)
41 한의진단명과 진단요건의 표준화연구(I) (양기상/한국학의학연구소47)
42 기의 의학적 연구 (신순식/한국한의학연구원/2000)48)
43 漢方診斷學 (이봉교 외/성보사/2004)49)
44 한방병리학 (한방병리학교재편찬위원회/한의문화사/2008)2)
45 비계내과학 (전국한의과대학비계내과학교실/군자출판사/2009)1)
Table 2
The Extracted Major Items of Spleen Qi Deficiency
Ratio (frequency) Rank* Original expression (frequency) Extracted items
95.6 (43/45) 舌診 舌淡苔白 31; 舌淡 3; 舌质淡, 舌体胖或有齿印, 苔白薄 2; 舌多淡白 1; 舌淡, 舌淡胖, 舌边齿印, 舌苔薄白, 舌苔白 1; 舌淡, 舌胖嫩/胖大, 舌边有齿痕 1; 舌色較淡 1;舌质淡或胖嫩, 有齿印, 舌苔白润 1; 舌质淡或胖嫩有齿痕, 苔白润 1; 舌质淡红, 舌体胖肿, 舌苔薄白或有齿痕, 或有细裂纹 1 舌淡苔白
95.6 (43/45) 脈診 脈緩弱 21; 脈弱 7; 脉缓或弱 2; 脉多虚缓 1; 脈濡軟 1; 脉象沉缓或细软 1; 脉细 1; 脉细弱 1; 脉细或弱 1; 脉缓, 脉虚 1; 脉缓细弱 1; 脉缓弱或沉细弱或虚大 1; 脈濡緩 1 脈緩弱
100.0 (45/45) 1 大便溏薄 20; 大便溏 11; 大便溏薄或先干后溏 2; 大便溏泄 2; 大便不正常(溏, 烂, 先硬后溏, 时溏时硬) 2; 经常腹泄, 经常便溏 1; 大便溏泻 1; 大便溏稀 2; 大便薄 1; 泄泻 1; 泄瀉 또는 便溏 1; 或有便溏, 大便溏薄 1 大便溏薄
100.0 (45/45) 2 腹胀, 食后尤甚 13; 食后腹胀 11; 食入难化, 脘腹胀满,食后尤甚 2; 皖腹胀痛, 食后尤甚 1; 皖腹胀满, 食后胀甚, 或饥时饱胀 1; 胃皖隐痛喜按,腹胀,食后胀甚 1; 脘腹坠胀, 食后益甚 1; 食后皖腹胀满 1; 食后或下午腹胀 1; 食後或午後腹脹, 脘闷1; 食后饱胀或腹胀 1; 食後脘腹脹悶 1; 食后痞胀,腹胀 1; 食后不易消化, 腹胀时减 1; 食后腹胀, 喜按 1; 食后腹胀, 或下午腹胀,脘闷 1; 腹胀,食后胀甚,胃脘隐痛喜按 1; 腹胀 2; 脘腹不舒, 또는 隱隱作痛 1; 脘腹经常胀满 1; 腹部隐痛喜按, 腹胀 1 腹胀, 食后尤甚
95.6 (43/45) 3 肢体倦怠 12; 倦怠乏力 7; 四肢倦怠 4; 体倦乏力 3; 乏力 3; 倦怠 2; 无力 2; 四肢無力 1; 四肢无力, 倦怠嗜卧 1; 四肢乏力 1; 身重肢怠 1; 全身易于疲乏, 四肢无力酸软 1; 肢体困倦 1; 肢体怠倦 1; 肢怠乏力 1; 疲乏無力 1; 乏力, 困倦 1 肢体倦怠
88.9 (40/45) 4 納少 17; 食少 5; 食少納呆 5; 纳呆 4; 饮食减少 2; 纳谷少食 1; 納食減少, 食入不舒 1; 食纳呆钝 1; 胃纳减少 1; 飮食不振 1; 长期食少 1; 进食减少 1 納少
88.9 (40/45) 5 面色萎黄 22; 面色萎黄或淡白 3; 面色无华 2; 面色少華 2; 面色萎黄不华 2; 面色萎黄或㿠白 2; 面黃 2; 面色淡白, 面色白光白, 面色萎黄 1; 面色淡白无华 1; 面色淡黄或萎黄 1; 面色微黄或㿠白 1; 面色萎黄或苍白 1 面色萎黄
82.2 (37/45) 6 少气懒言 24; 懒言 11; 少气 2 少气懒言
68.9 (31/45) 7 消瘦 14; 体形(形体)消瘦 13; 肌瘦 2; 肌肉消瘦 2 消瘦
64.4 (29/45) 8 或浮腫 21; 或肢體浮腫 6; 或水肿 1; 或虚肿 1 或浮腫
40.0 (18/45) 9 神疲乏力 7; 神疲 7; 神倦 2; 精神疲乏 2 神疲
22.2 (10/45) 10 食欲减退 4; 不欲食 2; 食欲不振 2; 食欲减退, 口淡乏味 1; 或食欲差 1 食欲减退
22.2 (10/45) 11 气短 8; 短氣 2 气短
22.2 (10/45) 12 或肥胖 7; 或虚胖 1; 或体胖 1; 形体肥胖 1 或肥胖

* Tongue and pulse diagnosis were excluded

Table 3
The Major Items of Spleen Qi Deficiency, Translated into Korean and Reviewed by Korean Linguist
Rank Items Proposed translation
1 大便溏薄 평소 대변이 무르거나, 최근 대변이 물러졌다.
2 腹胀, 食后尤甚 평소 윗배가 더부룩하고 식사 후 더부룩함이 심하였거나, 최근 윗배가 더부룩해지고 식사 후에 심해진다.
3 肢体倦怠 평소 온몸이 나른하고 힘이 없거나, 최근 온몸이 나른해지고 힘이 없어졌다.
4 納少 평소 식사량이 적거나, 최근 식사량이 줄어들었다.
5 面色萎黄 평소 얼굴이 초췌하고 얼굴빛이 누렇거나, 최근 얼굴이 초췌해지고 얼굴빛이 누렇게 됬다
6 少氣懶言 평소 기운이 없어 말할 힘이 없거나, 최근 기운이 없어져 말할 힘이 없다.
7 消瘦 평소 저체중이거나, 최근 살이 빠졌다.
8 或浮腫 평소 몸이 잘 붓거나, 최근 몸이 잘 붓는다.
9 神疲 평소 집중력이 쉽게 떨어지고 의욕이 없거나, 최근 집중력 또는 의욕이 떨어졌다.
10 食欲减退 평소 입맛(또는 밥맛)이 없거나, 최근 입맛(또는 밥맛)이 줄었다.
11 气短 평소 숨이 가쁘거나, 최근 숨이 가빠졌다.
12 或肥胖 평소 살이 찌거나, 최근 살이 쪘다.
Table 4
The Results of Assessment on Inclusion or Exclusion by Expert Committee
Items Included Excluded
大便溏薄 11 (100)* 0 (0)
腹胀,食後尤甚 11 (100) 0 (0)
肢体倦怠 11 (100) 0 (0)
納少 10 (91) 1 (9)
面色萎黄 11 (100) 0 (0)
少氣懶言 11 (100) 0 (0)
消瘦 11 (100) 0 (0)
或浮腫 9 (82) 2 (18)
神疲 11 (100) 0 (0)
食欲减退 11 (100) 0 (0)
气短 9 (82) 2 (18)
或肥胖 6 (55) 5 (45)
脈緩弱 11 (100 0 (0)
舌淡苔白 11 (100 0 (0)

* n(%)

Table 5
The Estimation of Weights of Items in the Spleen Qi deficiency
No Items Mean(Xi) ± Standard deviation(Si) Weight(Zi) Rank
S1 大便溏薄 3.91 ± 0.94 6.36 9
S2 腹胀, 食後尤甚 4.10 ± 0.57 11.09 4
S3 肢体倦怠 4.73 ± 0.47 15.54 1
S4 納少 4.30 ± 0.67 9.78 5
S5 面色萎黄 4.09 ± 0.54 11.65 2
S6 少氣懶言 3.91 ± 0.94 6.36 9
S7 消瘦 3.27 ± 0.79 6.39 8
S8 神疲 3.27 ± 0.65 7.77 7
S9 食欲减退 4.09 ± 0.54 11.65 2
O1 脈緩弱 3.55 ± 1.13 4.83 11
O2 舌淡苔白 3.91 ± 0.70 8.57 6
Table 6
The Results of Validity Inquiry of the Korean-Translated Major Items of the Spleen Qi Deficiency
Items Drafts Validity inquiry* Revision comment Acceptance or adaptation

1 2 3
大便溏薄 평소 대변이 무르거나, 최근 대변이 물러졌다. 10 (91) 1 (9) 0 (0.0) “무르거나 풀어진다.” 대변이 무르다‘가 ’대변이 풀어진다‘를 포괄하는 것으로 판단
腹胀,食後尤甚 평소 윗배가 더부룩하고 식사 후 더부룩함이 심하였거나, 최근 윗배가더부룩해지고 식사 후에 심해진다. 7 (64) 3 (27) 1 (9) “윗배가 더부룩하고 가스가 차며”‘윗배’를 ‘배’로 변경허증의 창만은 실증과 달리 식후뿐만 아니라, 아침기상 후에도 창만이 남아 있다. ‘더부룩하다’가 ‘가스가 찬다’를 포괄하는 것으로 판단문헌검토 결과 ‘脘腹’이라 지칭한 표현이 많으며, ‘脘腹’을 ‘윗배’로 표현수정의견을 수용하여 “늘 윗배가 더부룩하고...“로 개작
肢体倦怠 평소 온몸이 나른하고 힘이 없거나, 최근 온몸이 나른해지고 힘이 없어졌다. 11 (100) 0 (0) 0 (0) 수정의견 없음. 원안 채택
納少 평소 식사량이 적거나, 최근 식사량이 줄어들었다. 10 (91) 1 (9) 0 (0) “소화가 잘 안되고 식사량이 줄었다.” ‘納少’는 소화상태가 아닌 식사량만 관련된 표현으로 판단
面色萎黄 평소 얼굴이 초췌하고 얼굴빛이 누렇거나, 최근 얼굴이 초췌해지고 얼굴빛이 누렇게 됐다 9 (82) 2 (18) 0 (0) ‘초췌’는 삭제가 필요하다.‘초췌하다’ 말이 어려우므로, “ 윤기가 없고 핏기가 없다” 등으로 수정이 필요함. 수정의견을 수영하여 ‘얼굴에 윤기나 핏기가 없고, 얼굴빛이 누렇다’로 변경
少氣懶言 평소 기운이 없어 말할 힘이 없거나, 최근 기운이 없어져 말할 힘이 없다. 10 (91) 1 (9) 0 (0) “말을 많이 하면 힘이 빠진다.” 추가 필요함. 수정의견을 수영하여 ‘기운이 없어 말할 힘이 없거나, 말을 많이 하면 기운이 빠진다’로 변경
消瘦 평소 저체중이거나, 최근 살이 빠졌다. 10 (91) 1 (9) 0 (0) “평소 저체중”은 제외 수정의견을 수영하여 ‘저체중’이라는 표현은 삭제
神疲 평소 집중력이 쉽게 떨어지고 의욕이 없거나, 최근 집중력 또는 의욕이 떨어졌다. 11 (100) 0 (0) 0 (0) “정신적으로 피곤하거나” 수정의견을 수영하여 ‘정신적으로 쉽게 피곤해지거나, 집중력이나 의욕이 쉽게 떨어진다.’ 로 변경
食欲减退 평소 입맛(또는 밥맛)이 없거나, 최근 입맛(또는 밥맛)이 줄었다. 11 (100) 0 (0) 0 (0) 수정의견 없음. 원안 채택

* 1: proper; 2: proper, but need to be amended; 3: improper, and need to be amended

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