臺灣博碩士論文加值系統

中醫診斷的研究是目前十分活躍的題目，將傳統中醫的診斷流程予以
建立規格化、客觀化的模型，保留中醫原有的理論特色，引進科學化的思
路及方法期使中醫體系的現代化。

本研究以模糊推理來模擬中醫對氣喘的辨證，氣喘在中醫而言可依體質
寒熱及外邪因素分為數種證候，各類證候有相對的方劑來治療，然而在臨
床時病人所提供的症狀多為夾雜不清或不全，中醫內科學的辨證論治難以
直接用來作病證推論，一般病證多為夾雜症如氣喘病多為寒、熱夾雜型，
有經驗的中醫師多以數個基準理念為依歸再整合病情及病史來做臨床的辨
證推理，本研究以模糊理論來建立一電腦化中醫系統，以望、聞、問、切
四診資料為主，用於症狀資料或有不全，或有誤差，藉著模糊理論處理模
糊不全資料的能力，來摘取中醫氣喘症狀的實在成分並模擬中醫氣喘專家
來做氣喘辨證論治。

模糊理論已經廣泛的應用在各個領域之中，醫學方面也有很多成功的
例子。傳統邏輯為二值邏輯[0,1]，並無所謂的模糊地帶，然而中醫的推
導過程中常有模糊、不確定的部分，因此單純採用二值邏輯將會忽略掉某
些症狀，以致於影響到結果的推導。模糊邏輯的延伸，包含了從1到0之間
的所有值，因此可以完整的表現出中醫的思考邏輯，並從症狀對症狀、症
狀對證候、證候對證候，彼此之間的模糊關係矩陣來表達中醫整體性的概
念。將來累積更多的病例，除了可修改系統的參數外，亦可從事西醫、
中醫之間的對照、比對，做進一步的中、西醫的結合。

The related research of the Chinese Medical Diagnosis has
been widely studied and discussed. Many people desire to
construct a specific and objective model of traditional Chinese
Medical Diagnosis process. To modernize the Chinese Medical
System with scientific thinking and methodology and how to
reserve the original theoretical characteristic become an
important task.

In this thesis, we simulate the diagnosis of Chinese
Medicine for asthma with fuzzy set theory. Asthma present many
inherent or extrinsic symptom of human body. Each symptom is
cured with different correspondent Chinese Medicine. Because of
the symptom provided by the clinical patients is almost
indistinct or incomplete, scientific diagnosis Chinese Medicine
with these symptoms is difficult. Experienced Chinese Medical
doctors infer the disease based on some cricerions and combine
the condition and history of disease to complete the diagnosis.
In this study, we construct a computerized Chinese Medical
diagnosis system with fuzzy set theory. The source of data are
obtained via looking, listening, asking and touching. These data
may be incomplete or erroneouss but the fuzzy set theory has
the ability to deal with this kind of situation. We take use of
the property of fuzzy set theory to extract the relationship
between asthma and its symptoms. The final object is to simulate
the diagnose process of Chinese Medical doctors for asthma and
buildup the Fuzzy Expert Chinese Medical diagnose System. We
merge the fuzzy set theory and Chinese Medical Diagnose to
construct a computerized Chinese Medical Diagnose System with
capability of incomplete and erroneous symptom data.
The fuzzy set theory has been widely evolved in many
applications include the medical use. The traditional logic
theory is binary with true value ?" and false value ?". There
is no so called "fuzzy zone". But the uncertainty often
encountered and can not be completely described with traditional
logic set theory. The fuzzy set logic which is exceeded from
the traditional set logic include arbitrary value between *0*
and *1*. It represent the logic of human beens and Chinese
Medical Diagnosis. It extract the relationship of symptom-to-
symptom, symptom-to-syndrom and syndrom-to- syndrom with fuzzy
relation matrix. This will fully represent the global concept of
Chinese Medical Diagnosis. In the future, the system parameter
can be adjust to be utilized in diagnosis of other symptom with
more clinical data. If support the property diagnosis and alert
of possible diseases.

第一章簡介------------------------------------------1
第二章原理------------------------------------------4
2-1專家系統-----------------------------------4
2-1-1專家系統的介紹-------------------4
2-1-2專家系統的架構-------------------5
2-1-3專家系統的特色-------------------6
2-2模糊理論-----------------------------------8
2-2-1傳統明確集合---------------------8
2-2-2模糊集合------------------------10
2-2-3廣義的模糊集合運算--------------10
2-2-4模糊關係------------------------11
2-2-5模糊關係矩陣--------------------12
2-2-6模糊統合運算--------------------12
2-2-7彈性模糊邏輯--------------------14
2-2-8幾何平均值----------------------14
2-2-9彈性幾何平均值------------------15
2-3模糊理論和專家系統的結合------------------16
第三章氣喘病---------------------------------------17
3-1氣喘病的介紹------------------------------17
3-2西醫的觀點--------------------------------18
3-2-1西醫氣喘的定義------------------18
3-2-2哮喘的致病轉機與病態生理學------19
3-3中醫的觀點--------------------------------20
3-3-1中醫哮證的定義------------------21
3-3-2哮證的病因病機------------------21
3-3-3中醫喘證的定義------------------24
3-3-4喘證的病因病機------------------24
第四章西醫診斷系統的分析---------------------------27
4-1西醫診斷系統的介紹--------------------------------27
4-2西醫診斷系統的架構--------------------------------30
4-3西醫診斷系統的分析--------------------------------31
第五章中醫診斷系統分析-----------------------------36
5-1中醫診斷系統的介紹------------------------36
5-2中醫診斷系統的流程--------------------------------37
5-3中醫診斷系統的數理架構----------------------------38
5-4中醫診斷系統的分析------------------------42
第六章中醫診斷系統臨床應用與結果-------------------48
6-1臨床應用----------------------------------48
6-1-1病患來源----------------------------------------48
6-1-2病患記錄----------------------------------------48
6-1-3實驗室檢查--------------------------------------48
6-1-4評估方式----------------------------------------48
6-2結果--------------------------------------49
第七章結論與建議-----------------------------------50
參考文獻---------------------------------------------52
附錄-------------------------------------------------54
附錄A：系統開發所用的軟硬體配備--------------54
附錄B：收集病例的問卷------------------------55
附錄C：發作期的證候與病狀--------------------64
附錄D：緩解期的證候與病狀--------------------70

〔1〕 張伯臾，董建華，周仲瑛，1996年2月，“中醫內科學”，
人民衛生出版社。
〔2〕 許濟群，王綿之，1995年12月，“方劑學”，人民衛生出版社。
〔3〕 程紹恩，夏洪生，1995年7月，“中醫證候診斷治療學”，
北京科學技術出版社。
〔4〕 晁恩祥，楊民均，李迪臣，張天，王永炎，1993年12月，
“臨床中醫內科學（上）”。
〔5〕 翁清松，何俊弦，1995年6月，“模糊理論在中醫診斷上的應用”
，中原大學醫學工程研究所碩士學位論文。
〔6〕 葉怡成，郭耀煌，1993年6月，"專家系統方法應用與實作"。
〔7〕 孫宗瀛，楊英魁，1995年9月，"Fuzzy控制理論、實作與應用"。
〔8〕 Abraham Kandel, 1992, " Fuzzy Expert Systems", CRC Press,
Inc.
〔9〕 Shortliffe, E. H., 1976, "Computer-Based Medical
Consultation, MYCIN, Elsevier/North-Holland, New York.
〔10〕 Hudson, D. L. and Cohen M. E., 1991, "The role of
approximate reasoning in a medical expert system", Fuzzy
Expert System ,11 ,CRC, Florida.
〔11〕 Zadeh, L. A., 1965, "Fuzzy Sets", Inf. Control, 8, 338.
〔12〕 Adlassnig, K. P., 1980, "A fuzzy logical model of
computer-assisted medical diagnosis", Math. Inform.
Med., 1993,144.
〔13〕 Esogbue, A. O. and Elder, R. C., 1983, "Management and
valuation of a fuzzy mathematical model for medical
diagnosis", in Fuzzy Sets Syst., 10, 223,
Elsevier/North-Holland, Amsterdam.
〔14〕 Vila, M. A. and Delgado, M., 1983, "On medical diagnosis
using possibility measures", in Fuzzy Sets Syst., 10,
211, Elsevier/North-Holland, Amsterdam.
〔15〕 Anderson, J., Bandler, W., Kohout, L. J., and Trayner,
C., 1985 "The design of a fuzzy medical expert system",
in Approximate Reasoning in Expert Systems, Gupta, M. M.,
Kandel, A.,Bandler, W., and Kiszka, J. B.,
Elservier/North-Holland, Amsterdam, 689.
〔16〕 Adlassnig, K. P., 1982, "A survey on medical diagnosis
and fuzzy subsets", in Approximate Reasoning in Decision
Analysis, Gupta, M. M. and Sanchez, E. Eds., 203,
Elservier/ North-Holland, Amsterdam.
〔17〕 Adlassnig, K. P., Kolarz, G., Scheithauer, W. and
Grabner, H., 1986, "Approach to a hospital-based
application of a medical expert system", Med. Inform.,
Vol 11.
〔18〕 Adlassnig, K. P., 1986, "Fuzzy Set Theory in Medical
Diagnosis", IEEE trans. Syst. Man, Cybern., SMC 16(2),
263.
〔19〕 Klir G. J. and Folger T. A., Fuzzy sets, uncertainty and
information, 247-254, Prentice Hall, New Jersey.
〔20〕 H. Chris Tseng and Dennis W. Teo, 1994, "Uncertainty
Management and Medical Diagnosis with Elastic Fuzzy
Logic", Department of Electrical Engineering, Duke
University.