基于专家经验和临床信息的中风病辨证量表条目筛选方法的研究
摘要
目的:
通过专家问卷的方式,参照德尔菲法(Delphi),获取专家认为对于中风病临床常见证候要素具有诊断意义的四诊信息,筛选专家经验辨证量表条目,并结合应用统计方法分析临床四诊信息,初步探讨专家经验与临床信息相结合,筛选中风病辨证量表条目的有效方法。
方法:
本研究是国家重点基础研究发展计划(973)课题——缺血性中风病证结合的诊断标准与疗效评价体系研究(课题编号:2003CB517102)的一部分。研究以中风病火热证、气虚证为例。主要分为两部分,第一部分,基于专家经验筛选中风病辨证量表条目。参照德尔菲法,以专家问卷的方式征询专家意见,获取专家经验,筛选对于中风病证候要素具有诊断意义的四诊信息(条目),从重要性角度筛选条目;第二部分,基于临床信息筛选中风病辨证量表条目。利用前瞻性、多中心、大样本、动态连续采集的中风病四诊信息,通过卡方检验、因子分析法分析临床四诊信息,获得对证候要素诊断具有意义的四诊信息。将两部分的研究结果共有的四诊信息作为中风病辨证量表的条目。
结果:
1基于专家经验筛选中风病辨证量表条目如下:
1.1专家经验急性期火热证量表条目:躁扰不宁、心烦易怒、谵语、满面通红、目赤、口唇焦裂、痰黄、发热、头胀痛、口臭、口干、渴喜冷饮、大便干燥、大便三日未解、大便五日未解、小便黄赤、黄苔、燥苔、红舌、绛舌、红绛舌、弦数脉、数脉、滑数脉、弦脉。
1.2专家经验急性期气虚证量表条目:神疲乏力、倦怠嗜卧、少气懒言、呼吸微弱、语声低微、稍动汗出、安静汗出、自汗、面色晄白、面色晄白虚浮、口唇淡白、肢体松懈瘫软、轻微活动心悸、活动较多时心悸、胖大舌、齿痕舌、胖大多齿痕、淡舌、脉虚、弱脉。
1.3专家经验恢复期气虚证量表条目:神疲乏力、倦怠嗜卧、少气懒言、语声低微、口唇淡白、肢体松懈瘫软、自汗、稍动汗出、细脉、沉细脉、弱脉、微脉、脉虚、胖大舌、齿痕舌、舌胖大多齿痕、淡舌。
1.4专家经验恢复期火热证量表条目:躁扰不宁、心烦易怒、满面通红、口苦咽干、痰黄、大便干燥、大便三日未解、大便五日未解、小便黄赤、红舌、绛舌、红绛舌、黄苔、燥苔、滑数脉、数脉、弦数脉。
2基于临床信息筛选中风病辨证量表条目如下:
2.1临床信息急性期火热证量表条目:易怒、心烦、躁扰不宁、心中懊憹、手足心热、手背热、微热、身热夜甚、目赤、口唇焦裂、满面通红、两颧潮红、口唇深红、口唇生疮、头跳痛、头胀、耳鸣低调、口臭、口干、舌干、渴喜冷饮、痰色黄、促脉、数脉、滑脉、弦脉、黄苔、燥苔、厚苔、红舌、绛舌、便干、小便黄赤。
2.2临床信息急性期气虚证量表条目:乏力、神疲、少气、短气、呼吸微弱、心悸、胸闷、肌肤不仁、自汗、冷汗、面色晄白、面色萎黄,口唇淡白、小便失禁、便溏、便初硬后溏、手足肿胀、肢体松懈瘫软、手撒、淡舌、淡白舌、淡红舌、齿痕舌、结脉、代脉、弱脉、细脉、沉脉、缓脉、濡脉。
2.3临床信息恢复期气虚证量表条目:神疲、乏力、但欲寐、语声低微、面色萎黄,面色晄白、口唇淡白、心悸、憋气、胸闷、短气、少气、自汗、手肿胀,肢体松懈瘫软、淡白舌、淡红舌、便初硬后溏、小便失禁、缓脉、细脉、沉脉、弱脉。
2.4临床信息恢复期火热证量表条目:心烦、易怒、心中懊憹、满面通红、两颧潮红、目赤、口唇深红、口唇焦裂、头胀、五心烦热、手足心热、身热夜甚、吞酸、渴喜冷饮、舌干、口苦、口干、口臭、黄苔、厚苔、燥苔、红舌、绛舌、小便黄赤、便干、数脉、滑脉。
3中风病辨证量表条目的筛选选择专家经验和临床信息分析共有的条目作为中风病辨证量表的条目。
3.1急性期火热证辨证量表条目:躁扰不宁、心烦易怒、满面通红、目赤、口唇焦裂、口臭、口干、渴喜冷饮、痰黄、大便干燥、小便黄赤、黄苔、燥苔、红舌、绛舌、数脉、弦脉。
3.2急性期气虚证量表条目:乏力、神疲、少气懒言、呼吸微弱、自汗、面色晄白、口唇淡白、肢体松懈瘫软、心悸、齿痕舌、淡舌、弱脉。
3.3恢复期火热证量表条目:心烦易怒、满面通红、便干、小便黄赤、红舌、绛舌、黄苔、燥苔、数脉、口苦。
3.4恢复期气虚证量表条目:神疲乏力、语声低微、口唇淡白、肢体松懈瘫软、自汗、细脉、弱脉、少气。
结论:
1专家经验能够从重要性角度为证候辨证量表提供条目,参照德尔菲法是获取专家经验的有效方法,能够从重要性角度为辨证量表提供条目,是筛选证候辨证量表条目、建立中医证候诊断标准的有效途径之一。
2中医特色量表的建立要将专家经验与临床信息密切结合,互相为用。无论是以专家经验还是以临床信息为基础,最终都要使二者紧密结合。
3中医辨证量表条目的筛选要注重条目重要性、独立性、敏感性与临床可操作性的结合。条目临床出现频率是重要参考。
4中风病辨证量表条目的最终确定,有赖于进一步深入研究,进行临床和专家验证。
Objective
The research is in order to inquire into the useful method of selecting the items of apoplexy scale according to differentiation of symptoms by combining experts’experience with clinical symptoms. To combine the experts’experience with clinical symptoms the research gets the diagnostic significant information of four examination methods of the common syndrome factors in clinic by applying on Delphi method using the specialist questionnaire and using statistical methods to analyze clinical symptoms.
Method
This research is a part of National Emphasis Foundation Research Development Plan(973plan)-- Study of diagnostic standard and the system of curative effect of ischemic stroke by combining syndromes with disease(Project Number: 2003CB517102). Taking the two syndrome factors named QI deficiency and endogenous fire as an example, the research includes two major parts. One part is to select the items of apoplexy scale according to differentiation of symptoms which have the diagnostic significant meaning for the two syndrome factors by applying on Delphi method using the specialist questionnaire. This way may provide items from importance. The other part is to select items of apoplexy scale according to differentiation of symptoms by analyzing clinical symptoms. It gets the diagnostic significant items of the two syndrome factors by analyzing the information of four examination methods which are provided by predictive, many centers, great samples, dynamic continuous case-investigation of apoplexy using Chi-square test and factor analysis. Then choose the items which are selected by both experts and analyzing clinical symptoms as the final items of apoplexy scale according to differentiation of symptoms.
Result
1.The items of apoplexy scale according to differentiation of symptoms selected by experts experience include such items.
1.1 The items of apoplexy scale of differentiation of symptoms for endogenous fire in acute period selected by experts include restlessness, dysphoria and easy angriness, delirium, congested face, conjunctival congestion, dried up lips, yellow phlegm, fever, feel distended and painful on head, bad smell in mouth, dryness of mouth, feeling thirsty with preference to cold drinking, dry defecation, without defecation for three days, without defecation for five days, yellow urination, yellow tongue coating, dry tongue coating, reddened tongue, deep-red tongue, reddened and deep-red tongue, taut and rapid pulse, rapid pulse, smooth and rapid pulse, smooth pulse.
1.2 The items of apoplexy scale of differentiation of symptoms for qi deficiency in acute period selected by experts include tired in mind and weak strength, weariness and feeling like lying in bed, deficiency of qi and not feeling like talking, faint breath, speaking lowly, spontaneous sweating when moving slightly, spontaneous sweating in a quiet state, spontaneous sweating, pale complexion, pale and swollen complexion, pale lip, weak and limp limbs, palpitation when moving a little, palpitation when moving more, fat tongue, tongue with edge covering with teeth prints, fat and covered with teeth prints tongue, light tongue, feeble pulse, weak pulse.
1.3 The items of apoplexy scale of differentiation of symptoms for qi deficiency in period of recovering selected by experts include tired in mind and weak strength, weariness and feeling like lying in bed, deficiency of qi and not feeling like talking, speaking lowly, pale lip, weak and limp limbs, spontaneous sweating, spontaneous sweating when moving slightly, thready pulse, deep and thready pulse, weak pulse, indistinctive pulse, feeble pulse, fat tongue, tongue with edge covering with teeth prints, fat and covered with teeth prints tongue, light tongue.
1.4 The items of apoplexy scale of differentiation of symptoms for endogenous fire in period of recovering selected by experts include restlessness, dysphoria and angriness, congested face, bitter taste and dry throat, yellow phlegm, dry defecation, without defecation for three days, without defecation for five days, yellow urination, reddened tongue, deep-red tongue, reddened and deep-red tongue, yellow tongue coating, dry tongue coating, smooth and rapid pulse, rapid pulse, taut and rapid pulse.
2. The items of apoplexy scale according to differentiation of symptoms selected by analyzing clinical symptoms include such items.
2.1 The items of apoplexy scale of differentiation of symptoms for endogenous fire in acute period selected by analyzing clinical symptoms include easy angry, dysphoria, restlessness, vexation, feverish sensation in the centre of hands and feet, feverish sensation in the back of hands, slight fever, fever seriously at night, conjunctival congestion, dried up lips, congested face, tidal red in two cheekbones, deep-red lips, boil in lip and mouse, feel of pain and beating in head, feeling distended in head, having a low ringing sensation in the ears, bad smell in mouth, dryness of mouth, dry tongue, feeling thirsty with preference to cold drinking, yellow phlegm, abrupt pulse, rapid pulse, smooth pulse, taut pulse, yellow tongue coating, dry tongue coating, thick tongue coating, reddened tongue, deep-red tongue, dry defecation, yellow urination.
2.2 The items of apoplexy scale of differentiation of symptoms for qi deficiency in acute period selected by analyzing clinical symptoms include weak strength, tired in mind, deficiency of qi, shortness of breath, faint breath, palpitation, feeling depressed in chest, numbness of skin, spontaneous sweating, cold sweat, pale complexion, sallow complexion, pale lip, incontinence of urine, loose bowels, defecating tight stool firstly then loose stool, swelling in hands and feet, weak and limp limbs, loose hands, light tongue, light and pale tongue, light and red tongue, tongue with edge covered with teeth prints, knotted pulse, intermittent pulse, weak pulse, thready pulse, deep pulse, slow pulse, soft pulse.
2.3 The items of apoplexy scale of differentiation of symptoms for qi deficiency in the period of recovering selected by analyzing clinical symptoms include tired in mind, weak strength, somnolence, speaking lowly, sallow complexion, pale complexion, pale lips, palpitation, feeling suffocated, feeling depressed in chest, shortness of breath, deficiency of qi, spontaneous sweating, swelling in hands, weak and limp limbs, light and pale tongue, light and red tongue, defecating tight stool firstly then loose stool, incontinence of urine, slow pulse, thready pulse, deep pulse, weak pulse.
2.4 The items of apoplexy scale of differentiation of symptoms for endogenous fire in the period of recovering selected by analyzing clinical symptoms include dysphoria,easy angry,vexation,congested face, tidal red in two cheekbones ,conjunctival congestion,deep-red lips,dried up lips,feeling distended in head,dysphoria with feverish sensation in chest, palms and soles,feverish sensation in the centre of hands and feet, serious fever in night,acid regurgitation,feeling thirsty with preference to cold drinking, dry tongue,bitter taste, dryness of mouth,bad smell in mouth, yellow tongue coating, thick tongue coating,dry tongue coating, reddened tongue,deep-red tongue, yellow urination, dry defecation, rapid pulse, smooth pulse.
3. Sellection of the items of apoplexy scale according to differentiation of symptoms The final items of apoplexy scale according to differentiation of symptoms include such items which are selected by both experts and analyzing clinical symptoms.
3.1 The final items of apoplexy scale according to differentiation of symptoms for endogenous fire in acute period include restlessness, dysphoria and easy angriness, congested face, conjunctival congestion, dried up lips, bad smell in mouth, dryness of mouth, feeling thirsty with preference to cold drinking, yellow phlegm, dry defecation, yellow urination, yellow tongue coating, dry tongue coating, reddened tongue, deep-red tongue, rapid pulse, taut pulse.
3.2 The final items of apoplexy scale according to differentiation of symptoms for qi deficiency in acute period include weak strength, tired in mind, deficiency of qi and not feeling like talking, faint breath, spontaneous sweating, pale complexion, white lip, weak and limp limbs, palpitation, tongue with edge covered with teeth prints, light tongue, weak pulse.
3.3 The final items of apoplexy scale according to differentiation of symptoms for endogenous fire in the period of recovering include dysphoria and easy angriness, congested face, dry defecation, yellow urination, reddened tongue, deep-red tongue, yellow tongue coating, dry tongue coating, rapid pulse, bitter taste in mouth.
3.4 The final items of apoplexy scale according to differentiation of symptoms for qi deficiency in the period of recovering include tired in mind and weak strength, speaking lowly, white lip, weak and limp limbs, spontaneous sweating, thready pulse, weak pulse, deficiency of qi.
Conclusion
1. Selecting items of scale according to differentiation of symptoms by experts can provide items from importance. It is an useful way to consult and follow Delphi method in order to get the experts’experience which can provide items from importance. So consulting and following Delphi is a valid method to select items of scale of differentiation of symptoms and build up the diagnosis standard of syndromes.
2. It is necessary for building up the scale of differentiation of symptoms to combine experts’experience with clinical symptoms tightly.
3. To select the items of scale according to differentiation of symptoms it is important to consider the importance, independence, sensitivity and clinical operation. And it is an important thing to consider the rate of appearance in clinic.
4. It is needed that to be researched deeply and be verified by experts and clinical study in order to confirm the final items of apoplexy scale of differentiation of symptoms.
通过专家问卷的方式,参照德尔菲法(Delphi),获取专家认为对于中风病临床常见证候要素具有诊断意义的四诊信息,筛选专家经验辨证量表条目,并结合应用统计方法分析临床四诊信息,初步探讨专家经验与临床信息相结合,筛选中风病辨证量表条目的有效方法。
方法:
本研究是国家重点基础研究发展计划(973)课题——缺血性中风病证结合的诊断标准与疗效评价体系研究(课题编号:2003CB517102)的一部分。研究以中风病火热证、气虚证为例。主要分为两部分,第一部分,基于专家经验筛选中风病辨证量表条目。参照德尔菲法,以专家问卷的方式征询专家意见,获取专家经验,筛选对于中风病证候要素具有诊断意义的四诊信息(条目),从重要性角度筛选条目;第二部分,基于临床信息筛选中风病辨证量表条目。利用前瞻性、多中心、大样本、动态连续采集的中风病四诊信息,通过卡方检验、因子分析法分析临床四诊信息,获得对证候要素诊断具有意义的四诊信息。将两部分的研究结果共有的四诊信息作为中风病辨证量表的条目。
结果:
1基于专家经验筛选中风病辨证量表条目如下:
1.1专家经验急性期火热证量表条目:躁扰不宁、心烦易怒、谵语、满面通红、目赤、口唇焦裂、痰黄、发热、头胀痛、口臭、口干、渴喜冷饮、大便干燥、大便三日未解、大便五日未解、小便黄赤、黄苔、燥苔、红舌、绛舌、红绛舌、弦数脉、数脉、滑数脉、弦脉。
1.2专家经验急性期气虚证量表条目:神疲乏力、倦怠嗜卧、少气懒言、呼吸微弱、语声低微、稍动汗出、安静汗出、自汗、面色晄白、面色晄白虚浮、口唇淡白、肢体松懈瘫软、轻微活动心悸、活动较多时心悸、胖大舌、齿痕舌、胖大多齿痕、淡舌、脉虚、弱脉。
1.3专家经验恢复期气虚证量表条目:神疲乏力、倦怠嗜卧、少气懒言、语声低微、口唇淡白、肢体松懈瘫软、自汗、稍动汗出、细脉、沉细脉、弱脉、微脉、脉虚、胖大舌、齿痕舌、舌胖大多齿痕、淡舌。
1.4专家经验恢复期火热证量表条目:躁扰不宁、心烦易怒、满面通红、口苦咽干、痰黄、大便干燥、大便三日未解、大便五日未解、小便黄赤、红舌、绛舌、红绛舌、黄苔、燥苔、滑数脉、数脉、弦数脉。
2基于临床信息筛选中风病辨证量表条目如下:
2.1临床信息急性期火热证量表条目:易怒、心烦、躁扰不宁、心中懊憹、手足心热、手背热、微热、身热夜甚、目赤、口唇焦裂、满面通红、两颧潮红、口唇深红、口唇生疮、头跳痛、头胀、耳鸣低调、口臭、口干、舌干、渴喜冷饮、痰色黄、促脉、数脉、滑脉、弦脉、黄苔、燥苔、厚苔、红舌、绛舌、便干、小便黄赤。
2.2临床信息急性期气虚证量表条目:乏力、神疲、少气、短气、呼吸微弱、心悸、胸闷、肌肤不仁、自汗、冷汗、面色晄白、面色萎黄,口唇淡白、小便失禁、便溏、便初硬后溏、手足肿胀、肢体松懈瘫软、手撒、淡舌、淡白舌、淡红舌、齿痕舌、结脉、代脉、弱脉、细脉、沉脉、缓脉、濡脉。
2.3临床信息恢复期气虚证量表条目:神疲、乏力、但欲寐、语声低微、面色萎黄,面色晄白、口唇淡白、心悸、憋气、胸闷、短气、少气、自汗、手肿胀,肢体松懈瘫软、淡白舌、淡红舌、便初硬后溏、小便失禁、缓脉、细脉、沉脉、弱脉。
2.4临床信息恢复期火热证量表条目:心烦、易怒、心中懊憹、满面通红、两颧潮红、目赤、口唇深红、口唇焦裂、头胀、五心烦热、手足心热、身热夜甚、吞酸、渴喜冷饮、舌干、口苦、口干、口臭、黄苔、厚苔、燥苔、红舌、绛舌、小便黄赤、便干、数脉、滑脉。
3中风病辨证量表条目的筛选选择专家经验和临床信息分析共有的条目作为中风病辨证量表的条目。
3.1急性期火热证辨证量表条目:躁扰不宁、心烦易怒、满面通红、目赤、口唇焦裂、口臭、口干、渴喜冷饮、痰黄、大便干燥、小便黄赤、黄苔、燥苔、红舌、绛舌、数脉、弦脉。
3.2急性期气虚证量表条目:乏力、神疲、少气懒言、呼吸微弱、自汗、面色晄白、口唇淡白、肢体松懈瘫软、心悸、齿痕舌、淡舌、弱脉。
3.3恢复期火热证量表条目:心烦易怒、满面通红、便干、小便黄赤、红舌、绛舌、黄苔、燥苔、数脉、口苦。
3.4恢复期气虚证量表条目:神疲乏力、语声低微、口唇淡白、肢体松懈瘫软、自汗、细脉、弱脉、少气。
结论:
1专家经验能够从重要性角度为证候辨证量表提供条目,参照德尔菲法是获取专家经验的有效方法,能够从重要性角度为辨证量表提供条目,是筛选证候辨证量表条目、建立中医证候诊断标准的有效途径之一。
2中医特色量表的建立要将专家经验与临床信息密切结合,互相为用。无论是以专家经验还是以临床信息为基础,最终都要使二者紧密结合。
3中医辨证量表条目的筛选要注重条目重要性、独立性、敏感性与临床可操作性的结合。条目临床出现频率是重要参考。
4中风病辨证量表条目的最终确定,有赖于进一步深入研究,进行临床和专家验证。
Objective
The research is in order to inquire into the useful method of selecting the items of apoplexy scale according to differentiation of symptoms by combining experts’experience with clinical symptoms. To combine the experts’experience with clinical symptoms the research gets the diagnostic significant information of four examination methods of the common syndrome factors in clinic by applying on Delphi method using the specialist questionnaire and using statistical methods to analyze clinical symptoms.
Method
This research is a part of National Emphasis Foundation Research Development Plan(973plan)-- Study of diagnostic standard and the system of curative effect of ischemic stroke by combining syndromes with disease(Project Number: 2003CB517102). Taking the two syndrome factors named QI deficiency and endogenous fire as an example, the research includes two major parts. One part is to select the items of apoplexy scale according to differentiation of symptoms which have the diagnostic significant meaning for the two syndrome factors by applying on Delphi method using the specialist questionnaire. This way may provide items from importance. The other part is to select items of apoplexy scale according to differentiation of symptoms by analyzing clinical symptoms. It gets the diagnostic significant items of the two syndrome factors by analyzing the information of four examination methods which are provided by predictive, many centers, great samples, dynamic continuous case-investigation of apoplexy using Chi-square test and factor analysis. Then choose the items which are selected by both experts and analyzing clinical symptoms as the final items of apoplexy scale according to differentiation of symptoms.
Result
1.The items of apoplexy scale according to differentiation of symptoms selected by experts experience include such items.
1.1 The items of apoplexy scale of differentiation of symptoms for endogenous fire in acute period selected by experts include restlessness, dysphoria and easy angriness, delirium, congested face, conjunctival congestion, dried up lips, yellow phlegm, fever, feel distended and painful on head, bad smell in mouth, dryness of mouth, feeling thirsty with preference to cold drinking, dry defecation, without defecation for three days, without defecation for five days, yellow urination, yellow tongue coating, dry tongue coating, reddened tongue, deep-red tongue, reddened and deep-red tongue, taut and rapid pulse, rapid pulse, smooth and rapid pulse, smooth pulse.
1.2 The items of apoplexy scale of differentiation of symptoms for qi deficiency in acute period selected by experts include tired in mind and weak strength, weariness and feeling like lying in bed, deficiency of qi and not feeling like talking, faint breath, speaking lowly, spontaneous sweating when moving slightly, spontaneous sweating in a quiet state, spontaneous sweating, pale complexion, pale and swollen complexion, pale lip, weak and limp limbs, palpitation when moving a little, palpitation when moving more, fat tongue, tongue with edge covering with teeth prints, fat and covered with teeth prints tongue, light tongue, feeble pulse, weak pulse.
1.3 The items of apoplexy scale of differentiation of symptoms for qi deficiency in period of recovering selected by experts include tired in mind and weak strength, weariness and feeling like lying in bed, deficiency of qi and not feeling like talking, speaking lowly, pale lip, weak and limp limbs, spontaneous sweating, spontaneous sweating when moving slightly, thready pulse, deep and thready pulse, weak pulse, indistinctive pulse, feeble pulse, fat tongue, tongue with edge covering with teeth prints, fat and covered with teeth prints tongue, light tongue.
1.4 The items of apoplexy scale of differentiation of symptoms for endogenous fire in period of recovering selected by experts include restlessness, dysphoria and angriness, congested face, bitter taste and dry throat, yellow phlegm, dry defecation, without defecation for three days, without defecation for five days, yellow urination, reddened tongue, deep-red tongue, reddened and deep-red tongue, yellow tongue coating, dry tongue coating, smooth and rapid pulse, rapid pulse, taut and rapid pulse.
2. The items of apoplexy scale according to differentiation of symptoms selected by analyzing clinical symptoms include such items.
2.1 The items of apoplexy scale of differentiation of symptoms for endogenous fire in acute period selected by analyzing clinical symptoms include easy angry, dysphoria, restlessness, vexation, feverish sensation in the centre of hands and feet, feverish sensation in the back of hands, slight fever, fever seriously at night, conjunctival congestion, dried up lips, congested face, tidal red in two cheekbones, deep-red lips, boil in lip and mouse, feel of pain and beating in head, feeling distended in head, having a low ringing sensation in the ears, bad smell in mouth, dryness of mouth, dry tongue, feeling thirsty with preference to cold drinking, yellow phlegm, abrupt pulse, rapid pulse, smooth pulse, taut pulse, yellow tongue coating, dry tongue coating, thick tongue coating, reddened tongue, deep-red tongue, dry defecation, yellow urination.
2.2 The items of apoplexy scale of differentiation of symptoms for qi deficiency in acute period selected by analyzing clinical symptoms include weak strength, tired in mind, deficiency of qi, shortness of breath, faint breath, palpitation, feeling depressed in chest, numbness of skin, spontaneous sweating, cold sweat, pale complexion, sallow complexion, pale lip, incontinence of urine, loose bowels, defecating tight stool firstly then loose stool, swelling in hands and feet, weak and limp limbs, loose hands, light tongue, light and pale tongue, light and red tongue, tongue with edge covered with teeth prints, knotted pulse, intermittent pulse, weak pulse, thready pulse, deep pulse, slow pulse, soft pulse.
2.3 The items of apoplexy scale of differentiation of symptoms for qi deficiency in the period of recovering selected by analyzing clinical symptoms include tired in mind, weak strength, somnolence, speaking lowly, sallow complexion, pale complexion, pale lips, palpitation, feeling suffocated, feeling depressed in chest, shortness of breath, deficiency of qi, spontaneous sweating, swelling in hands, weak and limp limbs, light and pale tongue, light and red tongue, defecating tight stool firstly then loose stool, incontinence of urine, slow pulse, thready pulse, deep pulse, weak pulse.
2.4 The items of apoplexy scale of differentiation of symptoms for endogenous fire in the period of recovering selected by analyzing clinical symptoms include dysphoria,easy angry,vexation,congested face, tidal red in two cheekbones ,conjunctival congestion,deep-red lips,dried up lips,feeling distended in head,dysphoria with feverish sensation in chest, palms and soles,feverish sensation in the centre of hands and feet, serious fever in night,acid regurgitation,feeling thirsty with preference to cold drinking, dry tongue,bitter taste, dryness of mouth,bad smell in mouth, yellow tongue coating, thick tongue coating,dry tongue coating, reddened tongue,deep-red tongue, yellow urination, dry defecation, rapid pulse, smooth pulse.
3. Sellection of the items of apoplexy scale according to differentiation of symptoms The final items of apoplexy scale according to differentiation of symptoms include such items which are selected by both experts and analyzing clinical symptoms.
3.1 The final items of apoplexy scale according to differentiation of symptoms for endogenous fire in acute period include restlessness, dysphoria and easy angriness, congested face, conjunctival congestion, dried up lips, bad smell in mouth, dryness of mouth, feeling thirsty with preference to cold drinking, yellow phlegm, dry defecation, yellow urination, yellow tongue coating, dry tongue coating, reddened tongue, deep-red tongue, rapid pulse, taut pulse.
3.2 The final items of apoplexy scale according to differentiation of symptoms for qi deficiency in acute period include weak strength, tired in mind, deficiency of qi and not feeling like talking, faint breath, spontaneous sweating, pale complexion, white lip, weak and limp limbs, palpitation, tongue with edge covered with teeth prints, light tongue, weak pulse.
3.3 The final items of apoplexy scale according to differentiation of symptoms for endogenous fire in the period of recovering include dysphoria and easy angriness, congested face, dry defecation, yellow urination, reddened tongue, deep-red tongue, yellow tongue coating, dry tongue coating, rapid pulse, bitter taste in mouth.
3.4 The final items of apoplexy scale according to differentiation of symptoms for qi deficiency in the period of recovering include tired in mind and weak strength, speaking lowly, white lip, weak and limp limbs, spontaneous sweating, thready pulse, weak pulse, deficiency of qi.
Conclusion
1. Selecting items of scale according to differentiation of symptoms by experts can provide items from importance. It is an useful way to consult and follow Delphi method in order to get the experts’experience which can provide items from importance. So consulting and following Delphi is a valid method to select items of scale of differentiation of symptoms and build up the diagnosis standard of syndromes.
2. It is necessary for building up the scale of differentiation of symptoms to combine experts’experience with clinical symptoms tightly.
3. To select the items of scale according to differentiation of symptoms it is important to consider the importance, independence, sensitivity and clinical operation. And it is an important thing to consider the rate of appearance in clinic.
4. It is needed that to be researched deeply and be verified by experts and clinical study in order to confirm the final items of apoplexy scale of differentiation of symptoms.
引文
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