Variability in the Traditional Chinese Medicine (TCM) Diagnoses and Herbal Prescriptions Provided by Three TCM Practitioners for 40 Patients with Rheumatoid Arthritis

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Abstract
Objective: To ascertain if previous findings of low levels of agreement of Traditional Chinese Medicine (TCM) pattern diagnoses made by TCM practitioners in patients with rheumatoid arthritis (RA) were a function of practitioner differences or would be replicated with a different sample of clinicians, and to examine the relationship between TCM diagnosis and herbal treatment plans. Design: A prospective survey. Setting: General clinical research center, University of Maryland Hospital System, Baltimore, MD. Subjects: Forty (40) patients with RA. Practitioners: Licensed acupuncturists with at least 5 years’ experience and education in Chinese herbs. Methods: Three (3) TCM practitioners examined the same 40 RA patients separately, following the traditional Four Diagnostic Methods. Patients filled out questionnaires and physical examinations, including observations of the tongue and palpation of radial pulse, were conducted by the 3 practitioners. Each practitioner then provided both a TCM diagnosis and an herbal prescription. These diagnoses/prescriptions were examined with respect to the rate of agreement among the 3 practitioners. Results: The average agreement with respect to the TCM diagnoses among the 3 TCM practitioners was 31.7 % (range, 27.5–35%). The degree to which the herbal prescriptions agreed with textbook recommended practice for each TCM diagnosis was 91.7% (range, 85–100%). The most commonly used TCM assessments in arriving at these diagnoses were inquiry about factors affecting pain and pulse diagnosis. No statistically significant differences were found between this study and our previous study regarding the level of agreement on TCM diagnosis. Conclusion: The average agreement of the diagnoses provided by 3 TCM practitioners was at the same low level as previously reported. No association was found between the diagnostic methods used and the consistency of diagnosis. Both studies, however, found a high degree of consistency between the TCM pattern diagnoses provided and the herbal treatment plans made as a result of those diagnoses.