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Journal of Traditional Chinese Medicine >

2025 , Vol. 45 >Issue 6: 1169 - 1177

DOI: https://doi.org/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

  • Jun Hyungsun ,
  • Cho Nahyun ,
  • Ha Wonbae ,
  • Lee Junghan ,
  • Mi Ko Mi ,
  • Kim Young-Eun ,
  • Jung Jeeyoun ,
  • Leem Jungtae
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  • 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 date: 2024-05-12

  Accepted date: 2025-03-26

  Online published: 2025-11-24

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

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

Cite this article

Jun Hyungsun , Cho Nahyun , Ha Wonbae , Lee Junghan , Mi Ko Mi , Kim Young-Eun , Jung Jeeyoun , Leem Jungtae . 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 . DOI: 10.19852/j.cnki.jtcm.2025.06.001

References

1. Miettinen OS. Reflections on preventive medicine. Prev Med 2014; 67: 313-5.
2. Kaeberlein M, Rabinovitch PS, Martin GM. Healthy aging: the ultimate preventative medicine. Science 2015; 350: 1191-3.
3. Xu J, Li Y, Zhao J, Li Y, Zhang L, Zhang G. Theoretical origin and practical thinking of the theory of Chinese Medicine preventive treatment of disease. J Tradit Chin Med 2016; 57: 1351-4.
4. World Health Organization. WHO international standard terminologies on Traditional Chinese Medicine. World Health Organization, 2022-03-21, cited 2023-09-27; 155-7. Available from URL: https://www.who.int/publications-detail-redirect/9789240042322.
5. Zhang NL, Yuan S, Chen T, Wang Y. Latent tree models and diagnosis in Traditional Chinese Medicine. Artif Intell Med 2008; 42: 229-45.
6. Cha WS, Oh JH, Park HJ, Ahn SW, Hong SY, Kim NI. Historical difference between traditional Korean medicine and Traditional Chinese Medicine. Neurol Res 2007; 29 Suppl 1: S5-9.
7. Zhang Y, Liu Y, Li X, et al. Age-related changes in prevalence and symptom characteristics in kidney deficiency syndrome with varied health status: a cross-sectional observational study. J Tradit Chin Med Sci 2014; 1: 20-7.
8. Wang SJ, Yue W, Rahman K, et al. Mechanism of treatment of kidney deficiency and osteoporosis is similar by Traditional Chinese Medicine. Curr Pharm Des 2016; 22: 312-20.
9. Qiu J, Zhu Y, Xing J, Wang L, Zhang J, Yin H. Comparative pharmacokinetic study of 5 active ingredients after oral administration of Zuogui Pill in osteoporotic rats with different syndrome types. Int J Anal Chem 2023; 2023: e1473878.
10. Wang Y, Zhang J, Wang L, Yin H. Twelve-component pharmacokinetic study of rat plasma after oral administration of You-Gui-Wan in osteoporosis rats with kidney-Yin deficiency and kidney-Yang deficiency. Biomed Chromatogr 2023; 37: e5619.
11. Min Y, Yao H, Wang Z, et al. Efficacy of suspended moxibustion stimulating Shenshu (BL23) and Guanyuan (CV4) on the amygdala-HPA axis in rats with kidney-deficiency symptom pattern induced by hydrocortisone. J Tradit Chin Med 2023; 43: 113-23.
12. Zhang T, Xun YQ, Liu HL, et al. Observation on clinical effect of fire needling for mild to moderate benign prostatic hyperplasia with kidney Yang deficiency. Zhong Guo Zhen Jiu 2023; 43: 45-50.
13. Jin X, Ding L, Xia D, Chen P. Effects of acupoint catgut embedding combined with auricular point pressure on menopausal syndrome of liver-kidney deficiency type and estradiol. Zhong Guo Zhen Jiu 2017; 37: 836-9.
14. Wan X. Formulate development and assessment of Yang deficiency syndrome patient reported outcome scale. Fuzhou: Fujian University of Traditional Chinese Medicine, 2016: 1-98.
15. Xiong L. Development and evaluation of the patient-reported outcomes of Yin-deficiency syndrome. Fuzhou: Fujian University of Traditional Chinese Medicine, 2016: 1-118.
16. Zhao Z, Gong W, Dong J, et al. Kidney-Qi deficiency diagnosed by Deng’s diagnosis standard was not correlated with aging based on clinical observation of 90 participants. J Tradit Chin Med 2019; 39: 267-74.
17. Zhang GG, Singh B, Lee W, Handwerger B, Lao L, Berman B. 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 2008; 14: 381-6.
18. Okoli C, Pawlowski SD. The Delphi method as a research tool: an example, design considerations and applications. Inf Manage 2004; 42: 15-29.
19. Hopper J. Why you need 4-point scales. Versta research serial online, 2016-11-23, cited 2024-06-12; 4 screens. Available from URL: https://verstaresearch.com/blog/why-you-need-4-point-scales/.
20. Lynn MR. Determination and quantification of content validity. Nurs Res 1986; 35: 382-5.
21. Polit DF, Beck CT. The content validity index: are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health 2006; 29: 489-97.
22. Zell B, Hirata J, Marcus A, Ettinger B, Pressman A, Ettinger KM. Diagnosis of symptomatic postmenopausal women by Traditional Chinese Medicine practitioners. Menopause 2000; 7: 129-34.
23. Park KS. The factors of kidney vacuity syndrome and life style related to BMD decrease. Iksan: Wonkwang University, 2003: 1-41.
24. Yun Y.Objectification and industrialization of Oriental Medical prescription, part Ⅱ. Korea Institute of Oriental Medicine, 2004-12-01, cited 2023-09-27;1-155. Available from URL: http://www.riss.kr/search/detail/DetailView.do?p_mat_type=1a0202e37d52c72d&control_no=25c9a2c516a1a19dc85d2949c297615a
25. Ding H, Tan C, Feng W, Wang M. Analyse of differentially expressed genes associated with signal transduction of patients who suffered from osteoarthritis of the deficiency of Kidney-Yang. Liaoning Zhong Yi Za Zhi 2006; 33: 1220-2.
26. Kim SM. Clinical characteristics of kidney deficiency in patients with low back pain. Pocheon: Pochon CHA University, 2006: 1-59.
27. Shi YQ, Zhou ZH, Liu JH, Wang K, Ou MH. Sort and diagnostic standard of kidney deficiency syndrome of Traditional Chinese Medicine in exercise-induced fatigue. Zhong Guo Lin Chuang Kang Fu 2006; 10: 28-30.
28. Moon J, Park K, Choi S. Study on the development of a questionnaire software for health examination in Oriental Medicine. Korean J Orient Med 2007; 13: 135-42.
29. Chen RQ, Cao KJ, Lam TH, Wong CM. Symptom characteristics of Kidney-Yin deficiency and Kidney-Yang deficiency in Hong Kong Chinese midlife women. J Altern Complement Med 2008; 14: 457-60.
30. Zhang M. A research on the diagnosis and treatment characteristic of Shen diagnosis and treatment based on the database of Chinese Medical Records. Jinan: Shandong University of Traditional Chinese Medicine 2009: 1-56.
31. Chen RQ, Wong CM, Cao KJ, Lam TH. An evidence-based validation of Traditional Chinese Medicine syndromes. Complement Ther Med 2010; 18: 199-205.
32. Zhang J, Zhang T, Cheng Z. Discussion on the basic method of syndrome differentiation based on principal symptoms. Lin Chuang He Shi Yan Yi Xue Za Zhi 2011; 10: 1634-5.
33. Luiz AB, Cordovil I, Filho JB, Ferreira AS. Zangfu zheng (patterns) are associated with clinical manifestations of zang shang (target-organ damage) in arterial hypertension. Chin Med 2011; 6: 23.
34. Xiong G, Virasakdi C, Geater A, Zhang Y, Li M, Lerkiatbundit S. Factor analysis on symptoms and signs of chronic low-back pain based on Traditional Chinese Medicine theory. J Altern Complement Med 2011; 17: 51-5.
35. Chen RQ, Wong CM, Lam TH. Construction of a Traditional Chinese Medicine syndrome-specific outcome measure: the Kidney Deficiency Syndrome Questionnaire (KDSQ). BMC Complement Altern Med 2012; 12: 73.
36. Tian F, Xie Y, Yi D, et al. Reliability and validity analysis on risk factor and syndrome questionnaire of postmenopausal osteoporosis in 40-65 years' old women. Zhong Guo Zhong Yi Ji Chu Yi Xue Za Zhi 2012; 18: 609-11.
37. Ahn MY, Song YK, Ko SG, Lim HH. Development of questionnaire for pattern identification of chronic low back pain by Delphi method. J Korean Med Rehabil 2013; 23: 143-58.
38. Wang H, Li X, Zhao T, Yu C, Meng J. Development and evaluation of questionnaire for clinical epidemiological investigation of kidney essence deficiency syndrome. Tianjin Zhong Yi Yao 2013; 30: 711-3.
39. Kim MY, Ahn JY, Hwang DS, et al. A Study on the relationship of climacteric women’s vasomotor symptoms and body temperature, kidney deficiency pattern. J Korean Obstet Gynecol 2014; 27: 66-78.
40. Kim Y, Kang J, Kwak K, Lee H. Observation of correlation between deficiency syndrome of kidney and bone mineral density in osteoporosis patients. Korean J Acupunct 2014; 31: 99-107.
41. Xue JG, Fan Q, Zhou YC, Ning KQ, Wang JS, Bian TS. Distribution, combination, and evolution of syndromic etiologies of erectile dysfunction. Zhong Hua Nan Ke Xue 2014; 20: 830-3.
42. Zheng D, Dai Z, Wang H. Objectifying research on special region corresponding to five internal organs in colour inspections of Chinese medicine. Chin J Integr Med 2014; 20: 737-42.
43. Lee JC, Lee S, Jin HJ. Development of decision-making rules for pattern identification. Eur J Integr Med 2015; 7: 348-53.
44. Huang LW, Chen IJ, Hsu CH. Influence of Traditional Chinese Medicine syndrome groups on quality of life in women with metabolic syndrome. J Tradit Complement Med 2016; 6: 404-8.
45. Zhao T, Wang H, Yu C, et al. Classification and differentiation between kidney Yang and Yin decficiency syndromes in TCM based on decision tree analysis method. Int J Clin Exp Med 2016; 9: 21888-99.
46. Jang E, Kim Y, Park Y, Jeon J, Jung IC. The development of instrument of Korean Medical pattern identification and functional evaluation for five organ. J Physiol Pathol Korean Med 2017; 31: 173-81.
47. Mun S, Kim S, Bae KH, Lee S. Cold and Spleen-Qi deficiency patterns in Korean Medicine are associated with low resting metabolic rate. Evid Based Complement Alternat Med 2017; 2017: e9532073.
48. Sun Y. The establishment of macroscopic diagnostic scale for Yang-xu Syndrome. Guangzhou: Guangzhou University of Chinese Medicine, 2018: 1-153.
49. Zhang Z, Yang J, Kong T, et al. Traditional Chinese Medicine syndrome elements of male infertility revealed by latent tree model analysis. J Tradit Chin Med 2018; 38: 926-35.
50. Zhao W, Xu FS. Essentials of the differentiation and standardization of syndromes for male impotence in Xu Fu-song’s clinical experience. Zhong Hua Nan Ke Xue 2018; 24: 911-5.
51. World Health Organization. World report on ageing and health. World Health Organization, 2015-09-30, cited 2023-10-05; 1-246. Available from URL: https://www.who.int/publications-detail-redirect/9789241565042/
52. World Health Organization. Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity. World Health Organization; 2017-01-01, cited 2023-10-05; 1-15. Available from URL: https://www.who.int/publications-detail-redirect/9789241550109.
53. Vespa J, Medina L, Armstrong DM. Demographic turning points for the United States: population projections for 2020 to 2060. U.S. Census Bureau, 2020-03-01, cited 2023-10-05; 25-1144: 1-15. Available from URL: https://www.census.gov/library/publications/2020/demo/p25-1144.html.
54. Wang X, Zhang L, Huang R, et al. Regulatory mechanism of hormones of the pituitary-target gland axes in kidney-Yang deficiency based on a support vector machine model. J Tradit Chin Med 2015; 35: 238-43.
55. Chen CB, Ma J, Jia J, Li YQ, Liu AQ, Dong HJ. Reproduction-related proteins differentially expressed in the testes of the mice with kidney-Yang or kidney-Yin deficiency. Zhong Hua Nan Ke Xue 2019; 25: 248-56.
56. Fang G, Zhang LL, Ren Q, et al. Development of a diagnostic questionnaire for Damp Phlegm Pattern and Blood Stasis Pattern in coronary heart disease patients (CHD-DPBSPQ). Evid Based Complement Alternat Med 2019; 2019: 6856085.
57. Maeda-Minami A, Yoshino T, Katayama K, et al. Discrimination of prediction models between cold-heat and deficiency-excess patterns. Complement Ther Med 2020; 49: 102353.
58. He Y, He J, Xu X, et al. Consensus on diagnostic criteria for Yin deficiency syndrome in hypertension: a modified Delphi study. J Tradit Chin Med 2023; 43: 181-7.
59. Hsu CC, Sandford B. The Delphi technique: making sense of consensus. Pract Assess Res Eval 2007; 12: 10.
60. Kim S, Lee JH, Yook TH, Park J, Leem J, Lee H. Development and validation of a survey form for adverse events associated with acu-puncture and moxibustion. Korean J Acupunct 2015; 32: 177-89.
61. Lee IS, Kim DI, Yoo JE, Kang CW. Development of a guideline for the application of a diagnostic tool for menopausal syndromes based on the use of systemic review and Delphi method. J Korean Obstet Gynecol 2017; 30: 175-202.
62. Colbert GB, Venegas-Vera AV, Lerma EV. Utility of telemedicine in the COVID-19 era. Rev Cardiovasc Med 2020; 21: 583-7.
63. Jünger S, Payne SA, Brine J, Radbruch L, Brearley SG. Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review. Palliat Med 2017; 31: 684-706.
64. Yeo MK, Dong SO, Lee YS, Jang ES. Review on reliability and validity of questionnaire of pattern identification in Traditional Chinese Medicine -using China National Knowledge Infrastructure. J Physiol Pathol Korean Med 2015; 29: 246-55.
65. Ko MM, Lee MS, Birch S, Lee JA. The reliability and validity of instruments measuring pattern identification in Korean Medicine: systematic review. Eur J Integr Med 2017; 15: 47-63.
66. Zamanzadeh V, Ghahramanian A, Rassouli M, Abbaszadeh A, Alavi-Majd H, Nikanfar AR. Design and implementation content validity study: development of an instrument for measuring patient-centered communication. J Caring Sci 2015; 4: 165-78.
67. Tinsley HE, Weiss DJ. Interrater reliability and agreement of subjective judgments. J Couns Psychol 1975; 22: 358-76.
68. Wynd CA, Schmidt B, Schaefer MA. Two quantitative approaches for estimating content validity. West J Nurs Res 2003; 25: 508-18.
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