Understanding the Reliability of Diagnostic Variables in a Chinese Medicine Examination

Abstract

The question of the objectivity of the clinical examination has been raised in relation to Western and non-Western medical systems. Western practitioners are often skeptical about Traditional Chinese Medicine (TCM), on the basis that its diagnostic variables and subcategories of disease appear subjective and not repeatable. We conducted a study investigating the reproducibility of individual diagnostic observations within three of the four diagnostic methods used in a TCM examination: inspection, palpation, and auscultation. Three TCM practitioners participated in the study, and examined 45 adults who had mild-to-moderate hypercholesterolemia but were otherwise healthy. Results indicated that while there are certain features of the TCM system that are highly objective and repeatable, such as detection of the presence of shen, character of breath sounds, and pulse speed, there are other features that are subjective and unreliable, such as color under the eyes and tongue body color. This poses a challenge for TCM practitioners to improve their clinical practice and demonstrates to Western medical practitioners that TCM does in part rest on a rigorous and objective empirical basis.

Interobserver Reliability of Pulse Diagnosis Using Traditional Korean Medicine for Stroke Patients

“…The j value is typically used to measure the level of agreement beyond that which would be expected by chance and provides a measure of interobserver reliability. 11 In general, definitive j interpretations have been proposed. [22][23][24][25][26][27] However, for most purposes, a value £ 0.40 represents ''poor'' agreement, a value between 0.40 and 0.75 represents ''moderate'' to ''good'' agreement, and a value ‡ 0.75 indicates ''excellent'' agreement.…”

“…The subjects in the studies regarding interobserver reliability of pulse diagnosis that were reviewed included hypercholesterolemia and cystic fibrosis patients and primarily normal groups. 11,31 However, few studies have investigated the reliability of pulse diagnosis in patients with stroke.…”

“…This lack of evidence is because the clinical competence of performing a pulse diagnosis is dependent on the experience and knowledge of the clinician; moreover, the pulse diagnosis can be affected by a variety of factors such as emotion, activity, diet, biorhythm, and season. 7 Thus, although many experimental studies have detected the pulse using mechanic tools in an attempt to obtain an accurate pulse diagnosis, and although studies have attempted to assess the reliability in order to standardize and objectify the pulse diagnosis, [8][9][10][11] the majority of these studies cannot be considered scientifically and/or quantitatively reliable.…”

Inspección de la lengua, preferencias y pulsos en corredores chilenos desde la medicina tradicional China

“…A su vez, se podría incorporar otros tipos de análisis estadísticos tales como la estratificación por sexo, diferencias por grupos de edad o la categorización por cantidad de kilómetros a competir, alcanzando el control de la mayor cantidad de variables posibles, minimizando de esta manera cualquier tipo de escepticismo acerca de la práctica de la MTC (29) .…”

Advances in Chinese Medicine Diagnosis: From Traditional Methods to Computational Models

“…Reports of errors for Chinese medicine practitioners are available from ancient literature (Yang & Li, 1993;Luo, 1995;Yang, 2003;Flaws, 2004;Yang & Chase, 2004) including non-skilled practice, misdiagnosis and mistreatment; however, little contemporary literature is available on this subject. Evidence shows that subjectivity of manifestations or limited detection of clinical features is the major causes of unreliable pattern differentiation made by Chinese medicine practitioners (Kim et al, 2008;O'Brien et al, 2009). While diagnostic errors can never be eliminated, they can be minimised through understanding factors related to the pattern differentiation process.…”