舌診是傳統中醫學的獨特診斷方法，也是辨證論治與護理之重要依據，臨床上舌診完全依中醫師個人知識與經驗，缺乏客觀與定量，因此發展出自動化舌診系統，提供科學化數據輔助中醫師進行診斷，為證實其於臨床應用之可行性，本研究以20位病人間隔十分鐘拍攝之20組舌頭影像和兩階段舌診問卷探討自動化舌診系統於光照強度、拍攝之頭部角度、伸舌長度等不同環境變因影響下之自身一致性與有共識中醫師團隊和無共識中醫師團隊對舌頭特徵判斷之自身一致性，及自動化舌診系統與有共識中醫師團隊和無共識中醫師團隊對舌頭特徵判斷之外部一致性，和有共識中醫師團隊和無共識中醫師團隊醫師與醫師之間對舌頭特徵判斷之外部一致性，並針對無共識中醫師團隊進行以自動化舌診系統為標準所設計之再教育訓練，審視其訓練後自身一致性、與自動化舌診系統之外部一致性，及團隊醫師與醫師間之外部一致性是否提升。

Tongue diagnosis is a unique method of diagnosis practiced in traditional Chinese medicine and an important tool in diagnosing diseases before determining proper methods of cures and treatment. In the traditional clinical practice, tongue diagnosis depends solely on the personal knowledge and experience of the practitioner, thereby lacking in objectivity and quantification. Consequently, an automatic tongue diagnosis system (ATDS) has been developed to provide practitioners with objective data and assist them in reaching diagnoses. To prove the system’s stability in clinical application, this study employs 20 sets of tongue images, taken 10 minutes apart from 20 patients with possible variations in lighting, and the length, shape and angle of extruding tongue. The features extracted by the ATDS for each set of tongue images are compared to investigate the intra-agreement of ATDS, and two sessions of tongue diagnosis questionnaires to investigate the intra-agreement of doctors with consensus (DC) and doctors without consensus(DWC),and the inter-agreement between ATDS, DC and DWC, and the inter- agreement among DC and DWC.
And this study also investigate the improvement of agreement by DWC after a training process.

論文審定書 i
中文摘要 ii
英文摘要 iii
第一章 簡介 1
1.1 自動化舌診系統之一致性檢定 2
1.2 自動化舌診系統 2
1.2.1 取像環境 3
1.2.2 舌頭影像自動分析 8
第二章 相關研究 9
2.1 中醫師舌診之一致性 9
2.2 特殊疾病中醫師診斷之一致性 10
第三章 統計方法 12
3.1 Cohen’s Kappa 12
3.2 Weighted Kappa 14
3.3 Fleiss’ Kappa 15
第四章 研究方法 16
4.1 研究架構 16
4.1.1 參予醫師與研究對象 17
4.1.2 問卷 17
4.1.3 實驗環境 18
4.2 實驗流程 18
4.2.1 自動化舌診系統自身一致性檢定 18
4.2.2 有共識之中醫師團隊自身一致性檢定 21
4.2.3 無共識之中醫師團隊自身一致性檢定 23
4.2.4 檢驗三者對各項特徵判斷的一致性是否有顯著差異 25
4.2.5 舌診系統與有共識中醫師團隊、舌診系統與無共識中醫師團隊之外部一致性檢定 26
4.2.6 有共識中醫師團隊醫師間之外部一致性檢定、無共識中醫師團隊醫師間之外部一致性檢定 31
4.2.7 再教育後無共識中醫師團隊之自身一致性檢定 36
4.2.8 再教育後無共識中醫師團隊醫師間之外部一致性檢定流程 40
4.2.9 自動化舌診系統與再教育後無共識中醫師團隊外部一致性 43
第五章 實驗結果 45
5.1 自身一致性 45
5.2 外部一致性 45
5.3 再教育 48
第六章 結論 50
參考文獻 51
附錄 54

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