Traditional Chinese Medicine Tongue Inspection: An Examination of the Inter- and Intrapractitioner Reliability for Specific Tongue Characteristics

Kim, Minah; Cobbin, Deirdre M.; Zaslawski, Chris

doi:10.1089/acm.2007.0079

Cited by 69 publications

(46 citation statements)

References 5 publications

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“…The difficulty within TCM is that the existing studies have shown poor reproducibility between practitioners. [15][16][17] This should not be used to cast doubt about the validity and=or role of diagnosis within TCM. Biomedical diagnoses suffer from similar difficulties, [18][19][20] as do psychological diagnoses.…”

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confidence: 99%

Effects of Questionnaire-Based Diagnosis and Training on Inter-Rater Reliability Among Practitioners of Traditional Chinese Medicine

Mist

Ritenbaugh

Aickin

2009

The Journal of Alternative and Complementary Medicine

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Objective: To investigate whether a training process that focused on a questionnaire-based diagnosis in Traditional Chinese Medicine (TCM), and developing diagnostic consensus, would improve the agreement of TCM diagnoses among 10 TCM practitioners evaluating patients with temporomandibular joint disorder (TMJD). Design and setting: Evaluation of a diagnostic training program at the Department of Family and Community Medicine, University of Arizona, Tucson Arizona, and the Oregon College of Oriental Medicine, Portland, Oregon. Subjects: Screened participants for a study of TCM for TMJD. Practitioners: Ten (10) licensed acupuncturists with a minimum of 5 years licensure and education in Chinese herbs. Methods: A training session using a questionnaire-based diagnostic form was conducted, followed by waves of diagnostic sessions. Between sessions, practitioners discussed the results of the previous round of participants with a focus on reducing variability in primary diagnosis and severity rating of each diagnosis: 3 waves of 5 patients were assessed by 4 practitioner pairs for a total of 120 diagnoses. At 18 months, practitioners completed a recalibration exercise with a similar format with a total of 32 diagnoses. These diagnoses were then examined with respect to the rate of agreement among the 10 practitioners using inter-rater correlations and kappas. Results: The inter-rater correlation with respect to the TCM diagnoses among the 10 practitioners increased from 0.112 to 0.618 with training. Statistically significant improvements were found between the baseline and 18 month exercises ( p < 0.01). Conclusions: Inter-rater reliability of TCM diagnosis may be improved through a training process and a questionnaire-based diagnosis process. The improvements varied by diagnosis, with the greatest congruence among primary and more severe diagnoses. Future TCM studies should consider including calibration training to improve the validity of results.

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confidence: 99%

Effects of Questionnaire-Based Diagnosis and Training on Inter-Rater Reliability Among Practitioners of Traditional Chinese Medicine

Mist

Ritenbaugh

Aickin

2009

The Journal of Alternative and Complementary Medicine

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“…They concluded that in Ayurveda, the low level of reliability could be due to a lack of standardized tongue examination procedure. They suggested that standardization of diagnostic methods may improve the level of reliability 16 . Similar type of study was conducted by Minah Kim et al In their study they reported that the TCM tongue inspection was not a reliable diagnostic method 17 .…”

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confidence: 69%

Jivha Pariksha - One of the Diagnostic Tools in Ayurveda: A Review

Sadhana¹

2017

Int. J. Res. Ayurveda Pharm.

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“…Mist et al [33], using interrater correlations and kappa values, assessed whether a training process that focused on a questionnaire-based diagnosis would improve agreement in traditional Chinese medicine TCM diagnosis. Finally, Kim et al [34] examined the reliability of TCM tongue inspection by evaluating inter-and intrapractitioner agreement levels for specific tongue characteristics.…”

Section: Discussionmentioning

confidence: 99%

A Review of Studies of Tongue Deviations in Korean Stroke Patients

박¹,

임²,

조³

et al. 2017

J Int Korean Med

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Observation of the tongue, also known as tongue diagnosis, is an important procedure in diagnosis by inspection in Traditional Korean medicine (TKM). We investigated the reliability of TKM tongue diagnosis in stroke patients by evaluating interobserver reliability regarding tongue indicators as part of the project named the Fundamental Study for the Standardization and Objectification of Pattern Identification in TKM for Stroke (SOPI-Stroke). A total of 658 patients with stroke admitted to 9 oriental medical university hospitals participated. Each patient was independently seen by two experts from the same department for an examination of the status of the tongue. Interobserver agreement about subjects regarding pattern identification with the same opinion between the raters (n = 451) was generally high, ranging from "moderate" to "excellent". Interobserver agreement was nearly perfect for certain signs of special tongue appearance (mirror, spotted, and bluish purple), poor for one of the tongue colors (pale) and moderate for others. Clinicians displayed measurable agreement regarding tongue indicators via both observation and pattern identification consistency. However, interobserver reliability regarding tongue color and fur quality was relatively low. Therefore, it is necessary to improve objectivity and reproducibility of tongue diagnosis through the development of detail-oriented criteria and enhanced training of clinicians.

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Traditional Chinese Medicine Tongue Inspection: An Examination of the Inter- and Intrapractitioner Reliability for Specific Tongue Characteristics

Abstract: The findings suggest that a major contribution to the low levels of inter- and intrapractitioner agreements stems from inadequate operational definitions of both the tongue characteristics studied and of the inspection regions of the tongue.

Cited by 69 publications

References 5 publications

Effects of Questionnaire-Based Diagnosis and Training on Inter-Rater Reliability Among Practitioners of Traditional Chinese Medicine

Effects of Questionnaire-Based Diagnosis and Training on Inter-Rater Reliability Among Practitioners of Traditional Chinese Medicine

Jivha Pariksha - One of the Diagnostic Tools in Ayurveda: A Review

A Review of Studies of Tongue Deviations in Korean Stroke Patients

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