Zhang Grant G, Lee Wen-Lin, Lao Lixing, Bausell Barker, Berman Brian, Handwerger Barry
Center For Integrative Medicine, School of Medicine, University of Maryland, Baltimore, USA.
Altern Ther Health Med. 2004 Jan-Feb;10(1):58-63.
The consistency of diagnosis made among Traditional Chinese Medicine (TCM) practitioners and the relationship between TCM diagnosis and Chinese herbal prescription have not been adequately examined.
To investigate the degree of consistency with which TCM diagnoses and herbal prescriptions can be made by practitioners examining rheumatoid arthritis (RA) patients. To survey TCM diagnostic patterns and to examine the correlation between herbal prescriptions and these diagnoses for a sample of RA patients.
A prospective survey.
General Clinical Research Center, University of Maryland Hospital System, Baltimore, MD.
Rheumatoid arthritis patients. PRACTITIONERS: Licensed acupuncturists with a minimum of 5 years licensure and education in Chinese herbs.
Three TCM practitioners examined the same 39 RA patients separately, following the traditional "Four Diagnostic Methods." Patients filled out a questionnaire to serve as the data for the "Inquiry" component. They then underwent a physical examination, including the tongue and pulse, conducted by each of the practitioners. Based upon the examination results, each practitioner provided both a TCM diagnosis and a herbal prescription. These diagnoses/prescriptions were then examined with respect to the rate of agreement among the 3 practitioners.
The average agreement with respect to the TCM diagnoses among the 3 pairs of TCM practitioners was 28.2% (25.6 to 33.3% with kappas ranging from 0.23 to 0.30). The degree to which the herbal prescriptions agreed with textbook recommended practice of each TCM diagnosis was 93.2% (range = 87.2 to 100%).
The total agreement on TCM diagnosis on RA patients among 3 TCM practitioners was low. When less stringent, but theoretically justifiable, criteria were employed, greater consensus was obtained among the 3 practitioners. The correspondence between the TCM diagnosis and the herbal formula prescribed for that diagnosis was high, although there was little agreement among the 3 practitioners with respect to the herbal formulas prescribed for individual patients.
中医从业者做出的诊断的一致性以及中医诊断与中药处方之间的关系尚未得到充分研究。
调查中医从业者对类风湿性关节炎（RA）患者进行中医诊断和开具中药处方的一致程度。对中医诊断模式进行调查，并检查RA患者样本中中药处方与这些诊断之间的相关性。
前瞻性调查。
马里兰大学医院系统综合临床研究中心，巴尔的摩，马里兰州。
类风湿性关节炎患者。从业者：具有至少5年中药执照和教育经历的持牌针灸师。
三名中医从业者按照传统的“四诊法”分别对39名相同的RA患者进行检查。患者填写一份问卷作为“问诊”部分的数据。然后他们接受每位从业者进行的体格检查，包括舌诊和脉诊。根据检查结果，每位从业者给出中医诊断和中药处方。然后检查这些诊断/处方在三名从业者之间的一致率。
在三对中医从业者之间，中医诊断的平均一致率为28.2%（卡帕值范围为0.23至0.30时，一致率为25.6%至33.3%）。中药处方与每种中医诊断的教科书推荐做法的一致程度为93.2%（范围=87.2%至100%）。
三名中医从业者对RA患者的中医诊断总体一致性较低。当采用不太严格但理论上合理的标准时，三名从业者之间获得了更高的共识。中医诊断与针对该诊断开具的中药方剂之间的对应性较高，尽管三名从业者在针对个体患者开具的中药方剂方面几乎没有一致性。
