Kim Juyeon, Han Gajin, Ko Seok-Jae, Nam Dong-Hyun, Park Jae-Woo, Ryu Bongha, Kim Jinsung
Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Kyung Hee dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Kyung Hee dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
J Ethnopharmacol. 2014 Aug 8;155(1):709-13. doi: 10.1016/j.jep.2014.06.010. Epub 2014 Jun 13.
Tongue diagnosis is a significant procedure to examine the physiological and pathological changes of the human body in oriental medicine. However, the conventional method of tongue diagnosis including direct observation of tongue has limitations because of various external factors and subjective factors. Therefore, the current study investigated the usefulness of the tongue diagnosis system (TDS) as a diagnostic tool for evaluating tongue coating thickness (TCT) by assessing the agreement between the TDS and a gold standard established by assessors using the conventional method.
The present study was designed as a prospective clinical trial including 60 patients with functional dyspepsia. The TDS was used to capture tongue images twice within a 30-min interval to assess its reproducibility. Tongue coating percentage was measured by the TDS, and TCT was classified as either no coating, thin coating, or thick coating according to the existing diagnostic criteria. After both TDS examinations, the weight of tongue coating was quantitatively measured, and the correlation between the actual quantity of tongue coating and the percentage of the coating measured by the TDS was analyzed using Pearson׳s correlation. After collecting tongue images in all 60 patients, tongue coating was evaluated using a conventional method by 5 well-trained assessors to establish the gold standard for evaluating TCT, which allowed us to assess the diagnostic agreement between the TDS and the gold standard. After 2 weeks, TCT evaluation was repeated by the same assessors using the same images but in a random order.
The agreement between the TDS and the gold standard for evaluating TCT was almost perfect (weighted kappa, 0.840), as was the reproducibility of the TDS (weighted kappa, 0.851). The percentage of tongue coating measured by the TDS was significantly correlated with the weight of tongue coating (r=0.442, p <0.001). The levels of intra-rater reliability ranged from substantial to almost perfect (range of weighted kappa, 0.777-0.923). The inter-rater reliability of 5 assessors was moderate (weighted kappa, 0.563).
The present study demonstrated that the TDS can be used as a diagnostic tool for the objective and standardized evaluation of TCT in actual clinical practice.
舌诊是中医检查人体生理和病理变化的重要手段。然而，传统的舌诊方法，包括直接观察舌头，由于各种外部因素和主观因素存在局限性。因此，本研究通过评估舌诊系统（TDS）与评估者使用传统方法建立的金标准之间的一致性，探讨了TDS作为评估舌苔厚度（TCT）的诊断工具的有效性。
本研究设计为一项前瞻性临床试验，纳入60例功能性消化不良患者。使用TDS在30分钟间隔内采集两次舌图像，以评估其可重复性。通过TDS测量舌苔百分比，并根据现有诊断标准将TCT分为无苔、薄苔或厚苔。在两次TDS检查后，定量测量舌苔重量，并使用Pearson相关性分析实际舌苔量与TDS测量的舌苔百分比之间的相关性。在收集所有60例患者的舌图像后，由5名训练有素的评估者使用传统方法评估舌苔，以建立评估TCT的金标准，从而使我们能够评估TDS与金标准之间的诊断一致性。2周后，相同的评估者使用相同的图像，但以随机顺序重复进行TCT评估。
TDS与评估TCT的金标准之间的一致性几乎完美（加权kappa值，0.840），TDS的可重复性也是如此（加权kappa值，0.851）。TDS测量的舌苔百分比与舌苔重量显著相关（r = 0.442，p <0.001）。评分者内信度水平从高到几乎完美（加权kappa值范围，0.777 - 0.923）。5名评估者的评分者间信度为中等（加权kappa值，0.563）。
本研究表明，在实际临床实践中，TDS可作为客观、标准化评估TCT的诊断工具。
