O'Brien Kylie A, Abbas Estelle, Zhang Jiansheng, Guo Zhi-Xin, Luo Ruizhi, Bensoussan Alan, Komesaroff Paul A
Faculty of Health, Engineering and Science, Victoria University, Melbourne, Australia.
J Altern Complement Med. 2009 Mar;15(3):259-66. doi: 10.1089/acm.2008.0204.
Chinese medicine distinguishes itself from Western medicine in the differentiation of diseases according to underlying patterns of disharmony, or Chinese medicine (CM) syndromes. CM has its own clinical endpoints that are used as evidence of change in the body. Yet, relatively little is known about the reliability of CM diagnostic techniques, the final diagnosis of a CM syndrome, or the organizing principles used to reach a CM diagnosis such as the Eight Guiding Principles. Information about reliability of CM diagnosis has important implications for clinical practice and research, particularly if CM diagnostic variables or CM syndromes are to be incorporated into study designs.
An inter-rater reliability study was conducted with three CM practitioners to investigate the reproducibility of CM diagnosis according to the Eight Guiding Principles and Zang-Fu Theory. Forty-five (45) adults with mild hypercholesterolemia but who were otherwise healthy participated in the study.
Our results suggest that there is a reasonably good level of agreement between at least two practitioners on the dimensions of the Eight Guiding Principles. Level of agreement between at least two practitioners on CM syndrome diagnosis according to Zang-Fu Theory was very good for one syndrome only, that of Spleen qi deficiency.
Further investigations are needed into the reliability of the CM diagnostic processes from the initial stage of data collection to the final CM syndrome diagnosis.
中医与西医的区别在于根据潜在的失调模式（即中医证候）来辨别疾病。中医有其自身的临床终点，用作身体变化的证据。然而，对于中医诊断技术的可靠性、中医证候的最终诊断，或者用于得出中医诊断的组织原则（如八纲辨证），人们了解得相对较少。中医诊断可靠性的信息对临床实践和研究具有重要意义，特别是如果要将中医诊断变量或中医证候纳入研究设计的话。
对三名中医从业者进行了一项评分者间可靠性研究，以调查根据八纲辨证和脏腑理论进行中医诊断的可重复性。45名患有轻度高胆固醇血症但其他方面健康的成年人参与了该研究。
我们的结果表明，至少两名从业者在八纲辨证的维度上有相当好的一致性水平。根据脏腑理论，至少两名从业者在中医证候诊断上的一致性水平仅在脾气虚这一证候上非常好。
需要进一步研究从数据收集的初始阶段到最终的中医证候诊断这一过程中中医诊断的可靠性。
