基于中医证候量表探讨建立智能化中医药临床决策与疗效评价模式的设想

中医证候量表日益成为中医证候转化为临床疗效评价指标的载体,但其仍然面临着标准化程度不够高、临床应用推广不够充分、"辨证-诊断-治疗-评价"一体化程度不强等瓶颈问题,如何将中医证候量表有效服务于临床成为值得关注和解决的问题.人工智能对于大数据的深度学习和融合能力带来的启示,使笔者提出将已有成功研制的量表、研制量表的方法学成果与人工智能有机融合的设想,试图将中医证候量表作为中医人工智能获取深度学习资料的途径,将人工智能作为中医证候量表临床推广应用的载体,为智能化中医药临床决策与疗效评价模式的构建提供思路.     

病证结合模式下中医证候疗效评价量表研制的实践与策略

证候疗效评价量表可为客观评价中医证候疗效提供依据，丰富中医临床疗效评价体系。目前尚缺乏统一、规范的证候疗效评价量表研制方法。借鉴国际量表研制规范及中医量表研究思路，依据中医证候特点，基于已研制的慢性阻塞性肺疾病稳定期证候疗效评价量表（COPD-STES），初步提出中医证候疗效评价量表研制基本流程及关键技术，包括7个主要环节（成立研究小组、预设量表基本特征、构建理论框架及条目池、筛选条目、初步形成量表、确定条目权重及量表的考核）、3项关键技术（基于关联规则及隐结构分析的数据挖掘技术，基于经典测量理论与项目反应理论的条目筛选方法，基于随机森林法、因子分析法及百分权重法的条目赋权法），可为其他相关研究提供参考。     

高等中医药院校学生考试心理应激反应状态及中医证候分布规律的初步调查研究

[目的]初步了解高等中医药院校学生考试心理应激反应状态及中医证候分布的规律。[方法]随机抽取高等中医药院校大学二年级本科中医、中药专业的250名学生,在考试后立即进行问卷调查,量表评定。[结果]多数学生出现了不同程度的情绪异常以及头项症状和脉象、舌象的异常,睡眠和饮食症状也非常突出。学生表现出的中医心、肝、脾胃的症状明显多于其他脏腑症状,其中定位在心、肝、脾胃的各证型中,又以心脾两虚证、心气阴两虚证、心气虚证、肝气犯脾证为多见。[结论]考试作为大学生重要的心理应激源,可以对学生的心身健康产生一定的负面影响,不同的学生亦可表现出不同的中医证候。提示对考试心理应激的不良反应可以采用中医药手段进行调治。     

神经根型颈椎病中医证候研究进展

证候规范化与客观化是中医药现代化的重要研究内容。从辨证分型、临床疗效评价、证候基础研究方面综述了神经根型颈椎病(CR)中医证候的研究现状,认为目前该病中医证候研究方面存在证候诊断标准不统一、疗效评价欠规范、证候基础研究缺乏系统性等问题。通过比较现有的国家标准与行业标准,提出可优先参考中华中医药学会颁布的《神经根型颈椎病中医诊疗指南》作为证候诊断标准;关于疗效评价建议遵循国际研究规范,至少选择1项公认的疾病疗效评价指标,根据证候特点选择合适的评价量表;建立公认的CR病证结合动物模型,从动物、组织、细胞层面运用系统生物学技术对中医药干预措施的作用机制进行说明,比较CR不同证候患者临床特征与生化指标等表达差异。      

运用相关性分析方法探讨抑郁症中医核心病机的研究

目的 通过相关性分析方法分析抑郁症的核心症状与多个中医证候的关系,根据相关性的强弱明确抑郁症的中医核心病机.方法 运用汉密尔顿抑郁量表(HAMD)对患者的抑郁症状进行评定,并根据文献和专家经验,选取115项中医症状作为评定指标,制订《抑郁症中医证候观察表》,进行中医症状评定,对1 221例患者进行中医症状和西医量表评价...     

中医证候量表的研究现状

中医辨证论治、疗效判定无量化或客观标准,在一定程度上桎梏了中医辨证论治体系的继承及发展。借鉴在现代医学、心理学中运用较多的量表方法,根据中医辨证的特色和思维规律,研制出符合中医基本理论和临床实际的中医证候量表,已成为中医药研究的热点与难点。文章通过对有关文献进行整理,综述证候量表研制中几个关键环节的现状。     

中医证候量表的研究现状

中医辨证论治、疗效判定无量化或客观标准,在一定程度上桎梏了中医辨证论治体系的继承及发展。借鉴在现代医学、心理学中运用较多的量表方法,根据中医辨证的特色和思维规律,研制出符合中医基本理论和临床实际的中医证候量表,已成为中医药研究的热点与难点。文章通过对有关文献进行整理,综述证候量表研制中几个关键环节的现状。     

心理应激反应人群中医证候形成的相关因素分析

目的探究心理应激反应人群中医证候形成的相关影响因素。方法采用横断面流行病学调查方法。采用90项症状自评量表、自评焦虑量表、自评抑郁量表筛选心理应激人群,采用生活事件量表、特质应对方式问卷、领悟社会支持量表、中医五态性格测量表测评应激原及性格心理特质,采用中医四诊信息采集表采集中医证候信息并进行辨证分型。结果 2 156例心理应激反应人群中,有典型证候者1 233例,无典型证候者923例。在负性生活事件刺激量、工作相关问题、家庭相关问题这3个应激原的得分方面,在中医五态性格的太阳、少阳、太阴及阴阳平和这4个因子得分方面,在艾森克个性问卷的内外向因子、情绪稳定性因子方面,以及在特质应对方式和社会家庭支持度方面,有典型证候人群与无典型证候人群比较,以及具有不同类型证候的心理应激反应人群之间比较,差异均具有统计学意义(P0.05,或P0.01)。结论心理应激反应人群中医证候的形成与人群的心理特质及社会因素有关。     

问卷在中医证候研究中的应用与思考

问卷法,是社会调查的科学研究方法之一,是调查者运用事先设计好了的问卷向被调查者了解情况或征询意见.问卷主要是评定被调查者的"主观感受"("软"指标),与中医问诊的内容相似.而对于通过问诊获得的这些主观症状和模糊概念的收集与系统化研究,一直是当前中医界证候研究的难点.为了解决这一问题,近年来有更多的学者通过研制症状调查问卷,开展对中医症状、证候的研究,以期获得突破,达到对中医症状的系统性收集和证候的规范化研究,实现中医问诊和辨证的规范化、客观化.     

胃癌调查表的初步研制

目的研制出能够客观反映胃癌中医证候分布规律及能够建立其证候诊断标准的调查表。方法采用文献调查和病案回顾性调查相结合之法,遵循实证法的量表编制思路,明确研究对象及目的,确定了调查表的基本结构;通过德尔菲法问卷调查,选择了条目池并对条目进行了初步的筛选;借鉴生命质量量表对症状进行分级与量化。结论该调查表的研制,能够揭示出胃癌中医证候特征、分布规律,为建立起胃癌中医证候诊断标准提供依据。     

中医心系问诊量表的研制及评价

目的：研制中医心系问诊量表,初步探讨中医问诊的规范化研究方法。 方法：运用量表制作方法,以中医理论为指导,在文献梳理的基础上,研制中医心系问诊量表。借助频次、Delphi法和卡方检验等多元统计学方法筛选症状,反复修改心系问诊量表,并进行重测信度、内部一致性信度和内容效度等评价。 结果：中医心系问诊量表主要包括基本信息、主诉、现病史（伴随症状）和既住史,并附望、切诊信息及中西医诊断结论。其中一般问诊包括寒热、汗、头身胸腹、饮食口味、二便、睡眠、情绪、妇女等8个维度,最终筛选出66个症状变量。经专家讨论,量表具有较好的内容效度;整个量表一致性检验的克朗巴赫系数。为0．82。同一专家前后两次诊断的一致性结果显示心气虚、心阳虚、痰浊和寒凝的辨证诊断一致性较高,同一医生前后两次测量的Kappa值均在0．74～1之间;评分者信度评价中心气虚、心阳虚、心血虚和心阴虚的诊断一致性较高,Kappa值分别为0．63、0．72、1和0．48,其余的诊断一致性较低或不能说具有一致性。 结论：运用量表制作方法对中医问诊进行规范化研究具有一定的可行性,心系问诊量表的研制,还可为其他脏腑问诊量表的研制提供参考。     

Diagnostic Accuracy of Chinese Medicine Diagnosis Scale of Phlegm and Blood Stasis Syndrome in Coronary Heart Disease: A Study Protocol

Background Phlegm and blood stasis syndrome (PBSS) is one of the main syndromes in coronary heart disease (CHD). Syndromes of Chinese medicine (CM) are lack of quantitative and easy implementation diagnosis standards. To quantify and standardize the diagnosis of PBSS, scales are usually applied. Objective: To evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. Methods: Six hundred patients with stable angina pectoris of CHD, 300 in case group and 300 in control group, will be recruited from 5 hospitals across China. Diagnosis from 2 experts will be considered as the "gold standard". The study design consists of 2 phases: pilot test is used to evaluate the reliability and validity, and diagnostic test is used to assess the diagnostic accuracy of the scale, including sensitivity, specificity, likelihood ratio and area under the receiver operator characteristic (ROC) curve. Discussion: This study will evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. The consensus of 2 experts may not be ideal as a "gold standard", and itself still requires further study. (No. ChiCTR-OOC-15006599).     

Identification of Hypertension Subgroups through Topological Analysis of Symptom-Based Patient Similarity

Objective: To obtain the subtypes of the clinical hypertension population based on symptoms and to explore the relationship between hypertension and comorbidities. Methods: The data set was collected from the Chinese medicine (CM) electronic medical records of 33,458 hypertension inpatients in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine between July 2014 and May 2017. Then, a hypertension disease comorbidity network (HDCN) was built to investigate the complicated associations between hypertension and their comorbidities. Moreover, a hypertension patient similarity network (HPSN) was constructed with patients'' shared symptoms, and 7 main hypertension patient subgroups were identified from HPSN with a community detection method to exhibit the characteristics of clinical phenotypes and molecular mechanisms. In addition, the significant symptoms, diseases, CM syndromes and pathways of each main patient subgroup were obtained by enrichment analysis. Results: The significant symptoms and diseases of these patient subgroups were associated with different damaged target organs of hypertension. Additionally, the specific phenotypic features (symptoms, diseases, and CM syndromes) were consistent with specific molecular features (pathways) in the same patient subgroup. Conclusion: The utility and comprehensiveness of disease classification based on community detection of patient networks using shared CM symptom phenotypes showed the importance of hypertension patient subgroups.     

Analysis of the Diagnostic Consistency of Chinese Medicine Specialists in Cardiovascular Disease Cases and Syndrome Identification Based on the Relevant Feature for Each Label Learning Method

Objective:To analyze the diagnostic consistency of Chinese medicine(CM) specialists in patients with cardiovascular disease and to study syndrome classification and identification based on the multi-label learning method.Methods:Using self-developed CM clinical scales to collect cases,inquiry information,complexity,tongue manifestation and pulse manifestation were assessed.The number of cases collected was 2,218.Firstly,each case was differentiated by two CM specialists according to the same diagnostic criteria.The consistency of the diagnosis based on Cohen’s Kappa coefficient was analyzed.Secondly,take the same diagnosis syndromes of two specialists as the results of the cases.According to injury information in the CM scale "yes" or "no" was assigned "1" or "0",and according to the syndrome type in each case "yes" or "no" was assigned "1" or "0".CM information data on cardiovascular disease cases were established.We studied CM syndrome classification and identification based on the relevant feature for each label(REAL) leaming method,and the diagnostic rate of the syndrome was studied using the REAL method when the number of features selected was 5,10,15,20,30,50,70,and 100,respectively.Results:The syndromes with good diagnostic consistency were Heart(Xin)-qi deficiency,Heart-yang deficiency,Heart-yin deficiency,phlegm,stagnation of blood and stagnation of qi.Syndromes with poor diagnostic consistency were heartblood deficiency and blood deficiency of Heart and Liver(Gan).The highest diagnostic rates using the REAL method were Heart-yang deficiency followed by Heart-qi deficiency.A different number of features,such as 5,10,15,20,30,40,50,70,and 100,respectively,were selected and the diagnostic accuracy based on five features showed the highest diagnostic accuracy.The top five features which had a strong correlation with the syndromes were in accordance with the CM theory.Conclnsions:CM syndrome differentiation is strongly subjective and it is difficult to obtain good diagnostic consistency.The REAL method fully considers the relationship between syndrome types and injury symptoms,and is suitable for the establishment of models for CM syndrome classification and identification.This method can probably provide the prerequisite for objectivity and standardization of CM differentiation.     

糖尿病患者中医证候特点及其相关因素探讨

目的 探讨糖尿病患者中医证候特点及其相关因素.方法 问卷调查糖尿病患者症状以判断中医证候,同时调查患者一般情况、多种生化检查结果及糖尿病相关问题并作统计分析.结果 糖尿病患者证候中肾虚证、痰湿证和血瘀证最多见,阴虚证和气虚证亦占有较大比例,相应地与之相关的多证候出现的几率亦较高,而传统所认为的燥热证并不多见.结论 糖尿病患者中医证候特点较之传统的认识已有很大的变化,应引起临床工作者的重视.     

中医症状术语规范化研究现状

症状术语的规范化,是中医证名规范化、病名规范化,乃至整个中医体系规范化的前提和基础。但目前症状信息采集及规范化的过程中仍存在诸多问题,如症名不统一、一症多名,多症一名、复合症状较多、症状描述精确度不够、症状信息采集不规范等,需要从以下几个方面进一步加强研究:首先,在规范症状术语名称方面,应建立在继承中医典籍的基础上,遵循单义性、简明性、科学性、专业性、准确性等原则,制定出公众广泛认可的、可供临床实际应用的规范化症名表。其次,症状术语规范化研究的组织之间应加强沟通,成立统一的协会及小组委员会,制定公众一致认可的规范化症名表,并定期更新。再次,在症状信息采集方面,通过网络培训使医生掌握相同的信息采集方法;借助相应的舌诊、脉诊等辅助仪器对四诊信息进行收集;同时适当借鉴西医理化检查方法,弥补中医四诊采集信息的不足。     

Chinese medicine for menopausal syndrome: Current status, problems and strategies

The use of Chinese medicine(CM) for the management of menopausal syndrome is considered effective both at home and abroad,and more and more clinical studies are confirming its efficacy.However,many problems still exit in current studies,such as the standard of CM syndrome differentiation,the design methodology and criteria to assess the quality of clinical trials and the efficacy of interventions.In this paper,the authors present the CM research and treatment strategies for menopausal syndrome with concepts explaining the CM understanding of the mechanism of the disorder.It is concluded that CM is effective for menopausal syndrome,but improvement in both study methodology and treatment strategy is needed.In detail,it is firstly necessary to conduct clinical studies to evaluate the difference of various CM treatments for menopausal syndrome manifesting different symptoms,so as to establish a comprehensive treatment protocol of CM.Secondly, an acknowledged evaluation system needs to be founded,which embodies the characteristics of CM,and covers appropriate endpoint indices and parameters to objectively evaluate the effect and study quality of CM.Finally, an epidemiological survey with large sample size should be implemented with robust statistical design and CM expertise to collect data for establishing diagnostic criteria for menopause in different stages and with different symptoms.     

血瘀证诊断标准：标准化模式识别的思考

Pattern identification(PI),also called Bian Zheng(辨证),syndrome differentiation,pattern diagnosis,or pattern classification,is the basic principle and the key concept of Chinese medicine(CM).The core of PI is CM syndrome,on which CM theory,therapeutic method,prescribing formula and the use of Chinese herbal medicine are basically based.PI,in fact,is another classification method anticipated to improve the clinical efficacy.How to make an exact PI seems to be very important for taking full advantage of PI in clinical practice.Therefore,the establishment of diagnostic criterion of pattern has been the prerequisite for the standardization of PI.In recent years,a lot of diagnostic criteria of different CM patterns have been formulated.Taking the diagnostic criteria for blood-stasis syndrome as a model,the methodologies and considerations in establishing a pattern diagnostic criterion were discussed in this paper,which might be of great reference value in future PI standardization research.     

证候研究规范化与中医全球化

辨证论治是中医理论体系的精髓,证候是中医立法处方的依据,证候诊断客观化、标准化是辨证论治规范化的前提和基础。阐明中医学的科学内涵,证候实质是关键,证候实质的研究应以证候的规范化为基础,证候的规范化研究是证候研究的一个重要方面,也是中医学走向世界必不可少的。中医证候规范化研究应以传统规范为依据,按照制定规范应有的要求,以四诊资料及客观指标为立足点,以临床实践为准绳,综合运用多学科交叉知识、多途径相结合的方法,对疾病的证候分布规律、证候的标准、证候的时相性、证候的本质开展深入研究,从而制定出证候的标准化规范,对指导辨证论治和促进中医学术发展有着重要的临床意义,也是中医学规范化、全球化的必由之路。