Key elements for screening kidney deficiency pattern in Traditional Chinese and Korean Medicine: a systematic review and Delphi study

doi:10.19852/j.cnki.jtcm.2025.06.001

Journal of Traditional Chinese Medicine ›› 2025, Vol. 45 ›› Issue (6): 1169-1177.DOI: 10.19852/j.cnki.jtcm.2025.06.001

Key elements for screening kidney deficiency pattern in Traditional Chinese and Korean Medicine: a systematic review and Delphi study

Hyungsun Jun¹, Nahyun Cho², Wonbae Ha³, Junghan Lee⁴, Mi Mi Ko⁵, Young-Eun Kim⁶, Jeeyoun Jung⁵(), Jungtae Leem⁷()

1 Department of Diagnostics, College of Korean Medicine, Dongshin University, Naju 58245, Republic of Korea
2 Department of Diagnostics, College of Korean Medicine, Wonkwang University, Iksan 54538, Republic of Korea
3 Department of Korean Medicine Rehabilitation, College of Korean Medicine, Wonkwang University, Iksan 54538, Republic of Korea
4 Department of Korean Medicine Rehabilitation, College of Korean Medicine, Wonkwang University, Iksan 54538, Republic of Korea; Korea Institute of Integrative Medicine, Jangheung 59338, Republic of Korea
5 Korea Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
6 Korea Medicine Data Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
7 Department of Il-won Integrated Medicine, Wonkwang University Korean Medicine Hospital, Iksan 54538, Republic of Korea; Research Center of Traditional Korean Medicine, College of Korean Medicine, Wonkwang University, Iksan 54538, Republic of Korea

Received:2024-05-12 Accepted:2025-03-26 Online:2025-12-15 Published:2025-11-24
Contact: Jeeyoun Jung, Korea Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea. jjy0918@kiom.re.kr; Jungtae Leem, Department of Il-won Integrated Medicine, Wonkwang University Korean Medicine Hospital, Iksan 54538, Republic of Korea; Research Center of Traditional Korean Medicine, College of Korean Medicine, Wonkwang University, Iksan 54538, Republic of Korea. julcho0908@wku.ac.kr, Telephone: +82-42-868-9272; +82-63-850-6914
Supported by:
Research on the Scientification of Korean Medicine Theory for Healthy Aging(KSN2311021);Network and Big Data Analysis-Based Translational Research for Optimizing Korean Medicine Regimens and Predicting Responders in Heart Failure(RS-2022-NR072366)

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Abstract

Abstract:

OBJECTIVE: To identify key elements for screening kidney deficiency pattern (KDP) through a systematic review and Delphi methodology to detect high-risk KDP groups.

METHODS: We first conducted a systematic review to extract kidney system patterns and then performed four rounds of the Delphi. After the third round, two face-to-face consensus meetings were held to finalize the consensus. The English version of the KDP Screening Questionnaire (KDPScreenQ) was developed through agreement between a bilingual physician and the research team.

RESULTS: A systematic review identified 35 studies that predominantly focused on KDP, KDP-Yin, and KDP-Yang. Twenty-two common symptoms were reported in five or more studies. A panel of ten experts, including specialists in internal medicine and diagnostics, participated in all four rounds of the Delphi process. The final KDPScreenQ comprises 20 key elements. Key elements for KDP include lassitude; weakness, and pain in the lumbar region and knee joints (four items); reduced libido or sexual dysfunction; tinnitus or deafness; urinary incontinence (two items); thinning and loss of hair; forgetfulness; loose teeth and weak gums. Key elements for KDP-Yin include heat sensation in the palms and feet; a sensation of heat and tightness in the chest (particularly in the afternoon); night sweats; and dry mouth. Key elements for KDP-Yang include aversion to cold; edema; early morning diarrhea; and loose stools.

CONCLUSION: The KDPScreenQ is a fundamental tool for standardizing KDP differentiation, serving both to screen patients with KDP and to track their long-term prognosis. This questionnaire will next be used in a prospective observational study to determine cut-off values.

Key words: Kidney deficiency, pattern differentiation, Delphi technique, systematic review

Hyungsun Jun, Nahyun Cho, Wonbae Ha, Junghan Lee, Mi Mi Ko, Young-Eun Kim, Jeeyoun Jung, Jungtae Leem. Key elements for screening kidney deficiency pattern in Traditional Chinese and Korean Medicine: a systematic review and Delphi study[J]. Journal of Traditional Chinese Medicine, 2025, 45(6): 1169-1177.

Figures/Tables 3

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Category	No.	Symptom	KDP (n = 18)	KDP-Yin (n = 14)	KDP-Yang (n = 19)
Systemic symptoms	1	Edema	5 (27.8)	0	9 (47.4)^c
	2	Lassitude	5 (27.8)	0	9 (47.4)^c
	3	Aversion to cold, cold intolerance	4 (22.2)	0	10 (52.6)^c
	4	Insomnia^a	4 (22.2)	7 (50)^c	0
	5	Night sweats	2 (11.1)	8 (57.1)^c	0
	6	Tidal fever in the afternoon^a	1 (5.6)	7 (50)^c	0
Symptoms in the trunk and limbs	7	Pain and soreness in the lumbar region or knee joints	14 (77.8)^b	7 (50)	11 (57.9)
	8	Weakness in the lumbar region or knee joints	8 (44.4)^b	5 (35.7)	8 (42.1)
	9	Cold limbs	4 (22.2)	1 (7.1)	15 (78.9)^c
	10	Heat sensations in the palms, feet, and chest	4 (22.2)	6 (42.9)^c	0
Urinary and bowel issues	11	Urinary incontinence	12 (66.7)^b	4 (28.6)	10 (52.6)
	12	Early morning (Cock’s crow) diarrhea, loose stools	4 (22.2)	0	9 (47.4)^c
	13	Clear urine, increased urine volume^a	1 (5.6)	0	7 (36.8)^c
Sexual dysfunction	14	Impotence	6 (33.3)^c	0	4 (21.1)
	15	Reduced libido	5 (27.8)	3 (21.4)	9 (47.4)^c
Symptoms in the head and face	16	Tinnitus, deafness	12 (66.7)^c	5 (35.7)	6 (31.6)
	17	Dizziness^a	7 (38.9)^b	8 (57.1)	5 (26.3)
	18	Forgetfulness	7 (38.9)^b	4 (28.6)	4 (21.1)
	19	Loose teeth, weak gums, and bleeding	6 (33.3)^c	1 (7.1)	0
	20	Loss of hair, hair thinning, white hair	5 (27.8)^c	1 (7.1)	0
	21	Dry mouth, thirst	3 (16.7)	9 (64.3)^c	2 (10.5)
	22	Red facial complexion, hot flush^a	2 (11.1)	6 (42.9)^c	0

Category	No.	Symptom	KDP (n = 18)	KDP-Yin (n = 14)	KDP-Yang (n = 19)
Systemic symptoms	1	Edema	5 (27.8)	0	9 (47.4)^c
	2	Lassitude	5 (27.8)	0	9 (47.4)^c
	3	Aversion to cold, cold intolerance	4 (22.2)	0	10 (52.6)^c
	4	Insomnia^a	4 (22.2)	7 (50)^c	0
	5	Night sweats	2 (11.1)	8 (57.1)^c	0
	6	Tidal fever in the afternoon^a	1 (5.6)	7 (50)^c	0
Symptoms in the trunk and limbs	7	Pain and soreness in the lumbar region or knee joints	14 (77.8)^b	7 (50)	11 (57.9)
	8	Weakness in the lumbar region or knee joints	8 (44.4)^b	5 (35.7)	8 (42.1)
	9	Cold limbs	4 (22.2)	1 (7.1)	15 (78.9)^c
	10	Heat sensations in the palms, feet, and chest	4 (22.2)	6 (42.9)^c	0
Urinary and bowel issues	11	Urinary incontinence	12 (66.7)^b	4 (28.6)	10 (52.6)
	12	Early morning (Cock’s crow) diarrhea, loose stools	4 (22.2)	0	9 (47.4)^c
	13	Clear urine, increased urine volume^a	1 (5.6)	0	7 (36.8)^c
Sexual dysfunction	14	Impotence	6 (33.3)^c	0	4 (21.1)
	15	Reduced libido	5 (27.8)	3 (21.4)	9 (47.4)^c
Symptoms in the head and face	16	Tinnitus, deafness	12 (66.7)^c	5 (35.7)	6 (31.6)
	17	Dizziness^a	7 (38.9)^b	8 (57.1)	5 (26.3)
	18	Forgetfulness	7 (38.9)^b	4 (28.6)	4 (21.1)
	19	Loose teeth, weak gums, and bleeding	6 (33.3)^c	1 (7.1)	0
	20	Loss of hair, hair thinning, white hair	5 (27.8)^c	1 (7.1)	0
	21	Dry mouth, thirst	3 (16.7)	9 (64.3)^c	2 (10.5)
	22	Red facial complexion, hot flush^a	2 (11.1)	6 (42.9)^c	0

Pattern	Q	Questionnaire item
KDP	1	Easily experiences physical weakness and mental listlessness
	2	Weakness in the legs, making it difficult to walk
	3	Numbness and soreness in the lumbar region or knee joints
	4	Persistent pain in the lumbar region or knee joints
	5	Dull pain and sluggish movement in the lumbar region or knee joints
	6	Reduced libido or issues with male and female reproductive functions (such as ejaculation and erectile dysfunction, menstrual irregularities, vaginal dryness, abnormal vaginal discharge, etc.)
	7	Tinnitus or impaired hearing
	8	Frequent urge to urinate during activity and involuntary leakage of urine
	9	Nocturia that affects sleep more than three times a night
	10	Thinning of hair and excessive hair loss
	11	Frequent forgetfulness that affects daily life
	12	Teeth feeling wobbly due to weak gums and loose teeth
KDP-Yin	13	Heat sensation in the palms and feet
	14	Heat sensation and tightness above the chest in the afternoon
	15	Excessive night sweats
	16	Frequent thirst and dry mouth, with an urge to drink
KDP-Yang	17	Aversion to cold and sensitivity to cold
	18	Edema, especially of the legs and ankles
	19	Tendency to have loose stools
	20	Frequent abdominal pain or diarrhea at dawn

Pattern	Q	Questionnaire item
KDP	1	Easily experiences physical weakness and mental listlessness
	2	Weakness in the legs, making it difficult to walk
	3	Numbness and soreness in the lumbar region or knee joints
	4	Persistent pain in the lumbar region or knee joints
	5	Dull pain and sluggish movement in the lumbar region or knee joints
	6	Reduced libido or issues with male and female reproductive functions (such as ejaculation and erectile dysfunction, menstrual irregularities, vaginal dryness, abnormal vaginal discharge, etc.)
	7	Tinnitus or impaired hearing
	8	Frequent urge to urinate during activity and involuntary leakage of urine
	9	Nocturia that affects sleep more than three times a night
	10	Thinning of hair and excessive hair loss
	11	Frequent forgetfulness that affects daily life
	12	Teeth feeling wobbly due to weak gums and loose teeth
KDP-Yin	13	Heat sensation in the palms and feet
	14	Heat sensation and tightness above the chest in the afternoon
	15	Excessive night sweats
	16	Frequent thirst and dry mouth, with an urge to drink
KDP-Yang	17	Aversion to cold and sensitivity to cold
	18	Edema, especially of the legs and ankles
	19	Tendency to have loose stools
	20	Frequent abdominal pain or diarrhea at dawn

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Key elements for screening kidney deficiency pattern in Traditional Chinese and Korean Medicine: a systematic review and Delphi study

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