舌下絡脈判讀模型之建立

Set up Interpretation Model of Sublingual Collateral Vessels

10.6516/TJTCM.202209_25(3).0002

廖振凱(Chen-Kai Liao)；林映筑(Yin-Chu Lin)；謝宗翰(Tsung-Han Hsieh)；胡榮輝(Rong-Huei Hu)；黃琮融(Tsung-Rong Huang)；劉俊賢(Chun-Shien Liu)；游明謙(Min-Chien Yu)

舌下絡脈 ； 舌診 ； 血瘀 ； 舌下靜脈曲張 ； 瘀點 ； Sublingual collateral vessels ； Tongue diagnosis ； Blood stasis ； Sublingual varicose veins ； Petechiae

中醫藥研究論叢

25卷3期（2022 / 09 / 30）

13 - 26

繁體中文

目的：舌診為中醫四診中「望診」的主要內容之一，中醫可以藉由舌象看出寒熱虛實，氣血盛衰輔助判讀疾病的性質及深淺。傳統舌診著重於舌面的診察，但舌下絡脈診法亦是中醫舌診的重要內容，其表現與血瘀症有重要相關性。在舌下絡脈與中醫瘀證的相關研究中，其嚴重程度至今尚未有很好的標準化定義。本研究嘗試建構簡易且有效之舌下絡脈評估模式，將舌下靜脈曲張的嚴重程度分為V1-V4四個層級，而舌下出現的瘀點數分為P0-P2三種嚴重程度，讓舌下絡脈能有客觀化的一致性判讀標準。然而經過建構舌下絡脈判讀模式後，不同拍攝器具、不同醫師判讀之差異性亦需要標準化。方法：本研究使用七種不同手機及一單眼相機拍攝後評估差異。訓練判讀醫師一週後，嘗試建立舌下絡脈判讀之一致性程度。結果：結果顯示，在強制閃光前提下，經過舌下絡脈判讀訓練完善之三位醫師，在不同品牌之智慧型手機與單眼相機對於同一舌下絡脈判讀結果並無明顯差異。舌下絡脈判讀之一致性方面，十位醫學生經一週之教育訓練後，達到良好的可信度，舌下靜脈曲張組內相關係數（Intraclass correlation coefficient; ICC）為0.750，瘀點ICC為0.719。結論：因此本研究所建立舌下絡脈嚴重度之標準化，可提供未來舌下絡脈臨床研究之參考。

Objectives: Tongue diagnosis is one of the main tools of ＂Inspection＂ in the four examinations of Traditional Chinese Medicine (TCM). It is used to diagnose disease's properties and severity based on cold, heat, deficiency, excess, and the exuberance and debilitation of the qi and blood through tongue manifestation. Traditional tongue diagnosis focuses on examining the tongue surface. The diagnosis of sublingual collateral vessels also plays an essential role in the tongue diagnosis of TCM. Its manifestations are strongly related to blood stasis. However, its severity in the research of sublingual collateral vessels and blood stasis has not yet been well standardized. The present study tried to set up effective standards for diagnosing sublingual collateral vessels. The sublingual varicose veins and petechiae were divided into four and three subgroups, V1-V4, and P0-2, respectively, based on their severity. As a result, the diagnosis of sublingual collateral vessels was judged objectively. Moreover, it is also necessary to standardize the difference among shooting types of equipment and evaluate physicians. Methods: Hence, the current study assessed the difference using seven mobile phones and one monocular camera. Each individual was trained for a week to interpret the sublingual collateral vessels to determine the degree of consistency. Results: The results showed that under the premise of compulsory flash, the three physicians who have been well trained in sublingual collateral vessels had no significant differences in the interpretation of the same sublingual collateral vessels with different brands of smartphones and the single-lens camera. In terms of the consistency of performance in sublingual collateral vessels, ten medical students achieved good credibility after a week of education and training. The sublingual varicose vein's intraclass correlation coefficient (ICC) was 0.750, and the ICC of petechiae was 0.719. Conclusions: Therefore, the standardized model established in this study for the severity of sublingual collateral vessels can be used as a reference for future clinical research on sublingual collateral vessels.

1. 黃永昇,孫穆乾,陳嘉允,李聰界,陳瑜亮,林志明,羅綸謙(2017)。腦梗塞患者中醫舌象初探：回溯性研究。中醫藥雜誌，28(1)，e1-e14。
   連結：
2. （宋）施發(2018).察病指南.北京:
3. （清）吳謙(1985).訂正仲景全書傷寒論注.
4. Akkaya, N.,Ölmez, D.,Özkan, G.(2019).Evaluation of the factors associated with sublingual varices: a descriptive clinical study.Folia Morphol (Warsz),78(2),325-330.
5. Al-Shayyab, M. H.,Baqain, Z. H.(2015).Sublingual varices in relation to smoking, cardiovascular diseases, denture wearing, and consuming vitamin rich foods.Saudi Med J,36(3),310-315.
6. Cannon. (2021). Canon 760D Instruction Manual. Available: https://www.devicemanuals.eu/pdf/?pdf=/wp-content/uploads/2016/03/EOS_760D_Instruction_Manual_EN.pdf
7. Chalon, S.,Moreno, H., Jr.,Benowitz, N. L.,Hoffman, B. B.,Blaschke, T. F.(2000).Nicotine impairs endothelium-dependent dilatation in human veins in vivo.Clin Pharmacol Ther,67(4),391-397.
8. Cicchetti, D. V.(1994).Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology.Psychological Assessment,6(4),284-290.
9. Ettinger, R. L.,Manderson, R. D.(1974).A clinical study of sublingual varices.Oral Surg Oral Med Oral Pathol,38(4),540-545.
10. Hedström, L.,Albrektsson, M.,Bergh, H.(2015).Is there a connection between sublingual varices and hypertension?.BMC Oral Health,15,78.
11. Hedström, L.,Bergh, H.(2010).Sublingual varices in relation to smoking and cardiovascular diseases.Br J Oral Maxillofac Surg,48(2),136-138.
12. Hsu, P. C.,Huang, Y. C.,Chiang, J. Y.,Chang, H. H.,Liao, P. Y.,Lo, L. C.(2016).The association between arterial stiffness and tongue manifestations of blood stasis in patients with type 2 diabetes.BMC Complement Altern Med,16(1),324.
13. iPhone 官網（2021）比較 iPhone 機型。Available: https://www.apple.com/tw/iphone/compare/?modelList=iphone8plus,iphone11promax,iphoneSE2ndgen.
14. Lo, L. C.,Chen, C. Y.,Chiang, J. Y.,Cheng, T. L.,Lin, H. J.,Chang, H. H.(2013).Tongue diagnosis of traditional Chinese medicine for rheumatoid arthritis.Afr J Tradit Complement Altern Med,10(5),360-369.
15. O'Brien, K. A.,Birch, S.(2009).A review of the reliability of traditional East Asian medicine diagnoses.J Altern Complement Med,15(4),353-366.
16. Samsung 官網（2021）Galaxy Note10+ 規格。Available: https://www.samsung.com/tw/smartphones/galaxy-note10/specs/
17. Sony 官網（2021）XPERIA XA1 ULTRA規格。Available: https://www.sony.com.tw/zh/electronics/support/mobile-phone-stablets-mobile-phones/xperia-xa1-ultra/specifications.
18. Southam, J. C.,Ettinger, R. L.(1974).A histologic study of sublingual varices.Oral Surg Oral Med Oral Pathol,38(6),879-886.
19. Zhang, G. G.,Singh, B.,Lee, W.,Handwerger, B.,Lao, L.,Berman, B.(2008).Improvement of agreement in TCM diagnosis among TCM practitioners for persons with the conventional diagnosis of rheumatoid arthritis: effect of training.J Altern Complement Med,14(4),381-386.
20. 王嘯,趙文霞(2012)。肝硬化舌下絡脈與食管胃底靜脈曲張關係的研究進展。中國社區醫師（醫學專業），14(19)，9。
21. 高凱(2008)。天津醫科大學。
22. 巢元方(1980).諸病源侯診.
23. 張沛(2015)。北京工業大學。
24. 陳澤霖,謝嘉文(1981)。5403 例正常人舌象檢查分析。中醫雜誌，2，18-22。
25. 楊雅齡,蔣依吾,林正哲(2017)。中醫舌診儀在擬真醫學教育上的應用。台灣擬真醫學教育期刊，4(2)，17-27。
26. 楊維傑(2011).黃帝內經靈樞譯解.
27. 葛洪：肘後備急方。Available: https://www.theqi.com/cmed/oldbook/book35/b35_03.html.
28. 靳士英(1998).舌下絡脈診法的基礎與臨床研究.
29. 趙強(2016)。哈爾濱工業大學。
30. 潘穎(2014)。舌下絡脈診法與血瘀證相關疾病診斷的研究概況。中國當代醫藥，21(26)，194-196。
31. 羅大中(2008)。北京中醫藥大學。