Chinese medicine syndrome differentiation—kidney deficiency syndrome (KDS) for women during pregnancy: Delphi expert consensus on a self-reported KDS symptoms scale followed by psychometric properties evaluation

doi:10.19852/j.cnki.jtcm.2026.01.023

Journal of Traditional Chinese Medicine ›› 2026, Vol. 46 ›› Issue (1): 236-244.DOI: 10.19852/j.cnki.jtcm.2026.01.023

• Original Articles • Previous Articles Next Articles

Chinese medicine syndrome differentiation—kidney deficiency syndrome (KDS) for women during pregnancy: Delphi expert consensus on a self-reported KDS symptoms scale followed by psychometric properties evaluation

CHEN An¹^,², ZHANG Jiawen¹, GAO Du¹, ZHOU Tianyi³, LOU Hongshan⁴, GUO Lanzhong⁴, QU Fan³()

1 School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310000, China
2 University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, Helsinki 00330, Finland
3 Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
4 Department Traditional Chinese Medicine, Dongyang Maternal and Child Hospital, Dongyang 322100, China

Received:2025-01-14 Accepted:2025-05-14 Online:2026-02-15 Published:2026-01-28
Contact: QU Fan, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China. syqufan@zju.edu.cn;Telephone: +86-13429119143
Supported by:
National Natural Science Foundation of China: to Explore the Intergenerational Effects of Bu-Shen-Tian-Jing Therapeutic Principle on the Offspring of Hyper-Androgenic Polycystic Ovary Syndrome Based on Regulating Rhythmic Iron Death in the Ovarian Granulosa Cells Mediated by Fos Proto-Oncogene-Retinoic Acid Receptor-Related Orphan Receptor A-Solute Carrier Family 7 Member 11(82274564);National Natural Science Foundation of China: the Underlying Mechanism of Bu-Shen-Jian-Pi Therapeutic Principle in Regulating Ovarian Granulosa Cells Autophagy Mediated by Short-chain Fatty Acids-forkhead Box O1 Pathway and its Effects on the Development of Offspring of Polycystic Ovary Syndrome(82074476);Open Fund Project of Zhejiang Key Laboratory of Maternal and Infant Health, Women’s Hospital, School of Medicine, Zhejiang University: Mediating Role of Kidney Deficiency in the Relationship between Fear of Childbirth and Delivery Modes: an Exploratory Investigation Grounded in the Classic Traditional Chinese Medicine Theories of “Fear Injuring Kidney” and “Kidney Storing Essence”(ZDFY2024-MI-2)

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Abstract

Abstract:

OBJECTIVE: To develop an expert consensus on kidney deficiency syndrome (KDS) in pregnant women and construct a validated self-reported KDS Patient-Reported Measures Pregnancy Scale (KDS-PRMs-Pregnancy Scale) for early identification and management.

METHODS: The study was conducted in three phases. First, a comprehensive review of Traditional Chinese Medicine (TCM) literature and diagnostic criteria was performed, generating initial KDS symptoms for pregnancy. Second, a two-round Delphi survey, involving 21 experts from TCM, obstetrics, and gynaecology, assessed importance, relevance, and appropriateness of the items. Third, a psychometric evaluation was conducted, including exploratory factor analysis and internal consistency assessment.

RESULTS: In the first Delphi round, 19 items were flagged for revision or removal due to expert variability, with 12 items deemed irrelevant. In the second round, consensus was reached, resulting in a 25-item scale. After psychometric evaluation, seven items were removed due to poor factor loadings, leaving an 18-item scale. Three factors—physiological discomfort, fatigue & weakness, and excretion abnormalities—accounted for 78.4% of the variance. The final scale demonstrated excellent internal consistency (Cronbach’s alpha = 0.959).

CONCLUSION: The validated 18-item KDS-PRMs-Pregnancy Scale is a reliable tool for assessing KDS in pregnant women. Future research should focus on validation in diverse populations and exploring its predictive validity for pregnancy outcomes.

Key words: kidney deficiency, pregnancy, expert consensus, patient-reported measures, Delphi method

CHEN An, ZHANG Jiawen, GAO Du, ZHOU Tianyi, LOU Hongshan, GUO Lanzhong, QU Fan. Chinese medicine syndrome differentiation—kidney deficiency syndrome (KDS) for women during pregnancy: Delphi expert consensus on a self-reported KDS symptoms scale followed by psychometric properties evaluation[J]. Journal of Traditional Chinese Medicine, 2026, 46(1): 236-244.

Figures/Tables 3

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No.	Item
1	Do you feel weak in your low back or knees?
2	Do you feel cold or pain in your lower back or knees?
3	Do you have cold hands and feet, or feelings of cold intolerance?
4	Do you experience warmth in your palms and soles, along with a feeling of heat in your chest and mind?
5	Do you feel lethargic and lacking in energy?
6	Do you feel mentally exhausted?
7	Do you feel a sense of whole-body weakness and inability to exert strength?
8	Do you feel chest tightness and emotional irritability?
9	Do you feel that your reactions to the external environment are slower than those of a normal person?
10	Do you feel that your movements are slow?
11	Do you feel that your memory is declining or that you have difficulty remembering things?
12	Do you feel dryness in your throat or lips?
13	Do you have symptoms of redness on your cheeks?
14	Do you have symptoms of dizziness, lightheadedness, or vertigo?
15	Do you find your vision less clear than before?
16	Do you have difficulty falling asleep, or do you wake up easily after falling asleep, have trouble falling back asleep, or suffer from insomnia through the night?
17	Do you have symptoms of excessive cold sweat?
18	Do you experience excessive sweating during the day without control?
19	Do you have symptoms of feeling hot at fixed times (often in the afternoon or evening) or night sweats while sleeping?
20	Do you have symptoms of small to moderate amounts of urinary leakage?
21	Do you notice a significant increase in urination frequency?
22	Do you have symptoms of increased urination at night?
23	Do you feel that you are unable to completely empty your bladder?
24	Do you experience increased urine volume but with pale urine color?
25	Do you have symptoms of your urine becoming darker yellow in color?
26	Do you have symptoms of reduced urine output or difficulty urinating?
27	Do you have symptoms of dry stools and constipation?
28	Do you have symptoms of unformed or loose stools?
29	Do you experience abdominal pain, bowel sounds, or diarrhea around dawn (around 4 or 5 a.m.)?
30	Do you have symptoms of swelling below the waist, where pressing leaves a pit that does not recover quickly?
31	Do you have symptoms of facial swelling or swollen eyelids?
32	Do you have symptoms of gradual weight loss?
33	Do you have symptoms of thinning hair, greying hair, and lack of luster?
34	Do you have symptoms of loose or wobbly teeth?
35	Do you have symptoms of tinnitus?
36	Do you experience a decline in hearing?

No.	Item
1	Do you feel weak in your low back or knees?
2	Do you feel cold or pain in your lower back or knees?
3	Do you have cold hands and feet, or feelings of cold intolerance?
4	Do you experience warmth in your palms and soles, along with a feeling of heat in your chest and mind?
5	Do you feel lethargic and lacking in energy?
6	Do you feel mentally exhausted?
7	Do you feel a sense of whole-body weakness and inability to exert strength?
8	Do you feel chest tightness and emotional irritability?
9	Do you feel that your reactions to the external environment are slower than those of a normal person?
10	Do you feel that your movements are slow?
11	Do you feel that your memory is declining or that you have difficulty remembering things?
12	Do you feel dryness in your throat or lips?
13	Do you have symptoms of redness on your cheeks?
14	Do you have symptoms of dizziness, lightheadedness, or vertigo?
15	Do you find your vision less clear than before?
16	Do you have difficulty falling asleep, or do you wake up easily after falling asleep, have trouble falling back asleep, or suffer from insomnia through the night?
17	Do you have symptoms of excessive cold sweat?
18	Do you experience excessive sweating during the day without control?
19	Do you have symptoms of feeling hot at fixed times (often in the afternoon or evening) or night sweats while sleeping?
20	Do you have symptoms of small to moderate amounts of urinary leakage?
21	Do you notice a significant increase in urination frequency?
22	Do you have symptoms of increased urination at night?
23	Do you feel that you are unable to completely empty your bladder?
24	Do you experience increased urine volume but with pale urine color?
25	Do you have symptoms of your urine becoming darker yellow in color?
26	Do you have symptoms of reduced urine output or difficulty urinating?
27	Do you have symptoms of dry stools and constipation?
28	Do you have symptoms of unformed or loose stools?
29	Do you experience abdominal pain, bowel sounds, or diarrhea around dawn (around 4 or 5 a.m.)?
30	Do you have symptoms of swelling below the waist, where pressing leaves a pit that does not recover quickly?
31	Do you have symptoms of facial swelling or swollen eyelids?
32	Do you have symptoms of gradual weight loss?
33	Do you have symptoms of thinning hair, greying hair, and lack of luster?
34	Do you have symptoms of loose or wobbly teeth?
35	Do you have symptoms of tinnitus?
36	Do you experience a decline in hearing?

Characteristic	n	Percentage (%)
Gender
Female	17	81.0
Male	4	19.0
Academic background
Gynecology in Traditional Chinese Medicine	12	57.1
Chinese and Western Integrative Medicine	4	19.1
Obstetrics and Gynecology	2	9.5
Traditional Chinese Medicine	3	14.3
Education
Bachelor	5	23.8
Master	5	23.8
Doctorate	11	52.4
Years of work experience
Less than 10 years	2	9.5
Between 10 and 20 years	8	38.1
More than 20 years	11	52.4
Professional and technical titles
Chief physician	15	71.4
Associate chief physician	2	9.5
Attending doctor	3	14.3
Resident doctor	1	4.8

Characteristic	n	Percentage (%)
Gender
Female	17	81.0
Male	4	19.0
Academic background
Gynecology in Traditional Chinese Medicine	12	57.1
Chinese and Western Integrative Medicine	4	19.1
Obstetrics and Gynecology	2	9.5
Traditional Chinese Medicine	3	14.3
Education
Bachelor	5	23.8
Master	5	23.8
Doctorate	11	52.4
Years of work experience
Less than 10 years	2	9.5
Between 10 and 20 years	8	38.1
More than 20 years	11	52.4
Professional and technical titles
Chief physician	15	71.4
Associate chief physician	2	9.5
Attending doctor	3	14.3
Resident doctor	1	4.8

Factor	Item	Corrected item-total correlation (item-rest correlation)	Cronbach’s alpha if item deleted
Physiological discomfort	36. Do you experience a decline in hearing?	0.747	0.957
	35. Do you have symptoms of tinnitus?	0.727	0.958
	33. Do you have symptoms of thinning hair, graying hair and no luster?	0.743	0.957
	29. Do you experience abdominal pain, bowel sounds, or diarrhea around dawn (around 4 or 5 a.m.)?	0.778	0.957
	31. Do you have symptoms of facial swelling or swollen eyelids?	0.722	0.957
	13. Do you have symptoms of redness on your cheeks?	0.745	0.957
Fatigue and weakness	6. Do you feel mentally exhausted?	0.811	0.956
	5. Do you feel lethargic and lacking in energy?	0.808	0.956
	7. Do you feel a sense of whole-body weakness and inability to exert strength?	0.830	0.956
	8. Do you feel chest tightness and emotional irritability?	0.832	0.956
	10. Do you feel that your movements are slow?	0.790	0.956
	1. Do you feel weak in your low back or knees?	0.679	0.958
	11. Do you feel that your memory is declining or that you have difficulty remembering things?	0.782	0.956
Excretion abnormalities	27. Do you have symptoms of dry stools and constipation?	0.645	0.959
	24. Do you experience increased urine volume but with pale urine color?	0.759	0.957
	28. Do you have symptoms of unformed or loose stools?	0.753	0.957
	23. Do you feel that you are unable to completely empty your bladder?	0.749	0.957
	21. Do you notice a significant increase in urination frequency?	0.624	0.960

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Chinese medicine syndrome differentiation—kidney deficiency syndrome (KDS) for women during pregnancy: Delphi expert consensus on a self-reported KDS symptoms scale followed by psychometric properties evaluation

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