Standards for pattern discrimination

[Guest guest]

Heads up:

 

The lead article in issue #3, 2007 of Xin Zhong Yi (New Chinese

Medicine) by Wu Xiu-yan and Wang Tian-fang, both of the Chinese

Medical Diagnostics Faculty of the Bejing Univeristy of Chinese

Medicine & Pharmacology, states that lack of accepted standard

criteria for CM pattern discrimination has impeded the development of

scientific research into, the clinical practice of, and the

modernization of CM. Therefore, the establishment of such diagnostic

standards is of prime importance. Such a lead article in such an

important journal suggests that this issue is of growing importance in

the PRC.

 

Basically what Wu and Wang are talking about is a lack of inter-rater

reliability, and I agree that this is a huge impediment to the growth

and development of CM worldwide. A couple of weeks ago, I was teaching

in the DAOM program at OCOM, and Rosa Schnyer, one of the students

(but someone who has been involved with research for 10 years or

more), said that, in research she was recently involved with, American

CM inter-rater reliability was extremely low, so low as to be a

serious professional issue. If I remember correctly, it was less than 30%.

 

The more I practice, study, and teach this medicine, the more I

believe we could achieve significant inter-rater reliability if we

wanted to without any damage to the medicine itself.

 

Bob

[Guest guest]

Bob,

Some time ago on CHA, you and Todd discussed a list of standard

patterns from mainland China that could be translated and used as a

de facto standard blueprint. Did you ever follow up on this?

 

 

On May 4, 2007, at 1:46 PM, Bob Flaws wrote:

 

> Heads up:

>

> The lead article in issue #3, 2007 of Xin Zhong Yi (New Chinese

> Medicine) by Wu Xiu-yan and Wang Tian-fang, both of the Chinese

> Medical Diagnostics Faculty of the Bejing Univeristy of Chinese

> Medicine & Pharmacology, states that lack of accepted standard

> criteria for CM pattern discrimination has impeded the development of

> scientific research into, the clinical practice of, and the

> modernization of CM. Therefore, the establishment of such diagnostic

> standards is of prime importance. Such a lead article in such an

> important journal suggests that this issue is of growing importance in

> the PRC.

>

> Basically what Wu and Wang are talking about is a lack of inter-rater

> reliability, and I agree that this is a huge impediment to the growth

> and development of CM worldwide. A couple of weeks ago, I was teaching

> in the DAOM program at OCOM, and Rosa Schnyer, one of the students

> (but someone who has been involved with research for 10 years or

> more), said that, in research she was recently involved with, American

> CM inter-rater reliability was extremely low, so low as to be a

> serious professional issue. If I remember correctly, it was less

> than 30%.

>

> The more I practice, study, and teach this medicine, the more I

> believe we could achieve significant inter-rater reliability if we

> wanted to without any damage to the medicine itself.

>

> Bob

>

>

>

 

 

 

 

[Guest guest]

inter-rater reliability could be achieved within certain schools of thought by

focusing on strictly TCM-style tongue and pulse analysis, the latter emphasizing

qualities over nuanced positional information, plus s/s standards. problem is I

would wager that well more than half the practitioners use methods of diagnosis

that fall outside these parameters from more obscure (dong han) to the highly

specialized (nanjing) to the pseudoscientific (NAET, electronic meridian

analysis, etc.). Inter-rater reliability may be 30% amongst TCMers, but across

the profession as whole, more like 5-10%. OTOH, within certain schools of

thought amongst japanese style practitioners who all have had the same or very

similar training, such as so-called jingei diagnosis (where the carotid and

radial pulses are compared), I have seen very high reliability within certain

cohorts. I don't much hope of any rectification of this problem now that the

AAOM has caved on its futile demand for standards and accepte

d the defacto standardless eclecticism of the alliance in the re-formation of

the AAAOM.

 

-------------- Original message ----------------------

" Bob Flaws " <pemachophel2001

> Heads up:

>

> The lead article in issue #3, 2007 of Xin Zhong Yi (New Chinese

> Medicine) by Wu Xiu-yan and Wang Tian-fang, both of the Chinese

> Medical Diagnostics Faculty of the Bejing Univeristy of Chinese

> Medicine & Pharmacology, states that lack of accepted standard

> criteria for CM pattern discrimination has impeded the development of

> scientific research into, the clinical practice of, and the

> modernization of CM. Therefore, the establishment of such diagnostic

> standards is of prime importance. Such a lead article in such an

> important journal suggests that this issue is of growing importance in

> the PRC.

>

> Basically what Wu and Wang are talking about is a lack of inter-rater

> reliability, and I agree that this is a huge impediment to the growth

> and development of CM worldwide. A couple of weeks ago, I was teaching

> in the DAOM program at OCOM, and Rosa Schnyer, one of the students

> (but someone who has been involved with research for 10 years or

> more), said that, in research she was recently involved with, American

> CM inter-rater reliability was extremely low, so low as to be a

> serious professional issue. If I remember correctly, it was less than 30%.

>

> The more I practice, study, and teach this medicine, the more I

> believe we could achieve significant inter-rater reliability if we

> wanted to without any damage to the medicine itself.

>

> Bob

>

>

 

 

 

 

 

[Guest guest]

I my study we had several mainland Chinese trained Dr none of which had any

interrater reliability on tongue or pulse at all (almost 0% if all aspects are

taken into account, ie if both fur and body color had to be right for agreement

on tongue). I think one can get inter-rater numbers to go up when participant

are calibrated before the study but i am also willing to bet that when these

same practitioners are evaluated 4 weeks later without recalibration the

reliability will be very poor again. At the same time we need to realize that

most physical assessments in WM, osteopathy and other western methods have poor

inter-reliability as well. On top of that just look at the real world, for

example your instructors at school, how much agreement is there?

 

 

 

 

 

 

 

 

-

Friday, May 04, 2007 2:19 PM

Re: Standards for pattern discrimination

 

 

inter-rater reliability could be achieved within certain schools of thought by

focusing on strictly TCM-style tongue and pulse analysis, the latter emphasizing

qualities over nuanced positional information, plus s/s standards. problem is I

would wager that well more than half the practitioners use methods of diagnosis

that fall outside these parameters from more obscure (dong han) to the highly

specialized (nanjing) to the pseudoscientific (NAET, electronic meridian

analysis, etc.). Inter-rater reliability may be 30% amongst TCMers, but across

the profession as whole, more like 5-10%. OTOH, within certain schools of

thought amongst japanese style practitioners who all have had the same or very

similar training, such as so-called jingei diagnosis (where the carotid and

radial pulses are compared), I have seen very high reliability within certain

cohorts. I don't much hope of any rectification of this problem now that the

AAOM has caved on its futile demand for standards and accepte

d the defacto standardless eclecticism of the alliance in the re-formation of

the AAAOM.

 

-------------- Original message ----------------------

" Bob Flaws " <pemachophel2001

> Heads up:

>

> The lead article in issue #3, 2007 of Xin Zhong Yi (New Chinese

> Medicine) by Wu Xiu-yan and Wang Tian-fang, both of the Chinese

> Medical Diagnostics Faculty of the Bejing Univeristy of Chinese

> Medicine & Pharmacology, states that lack of accepted standard

> criteria for CM pattern discrimination has impeded the development of

> scientific research into, the clinical practice of, and the

> modernization of CM. Therefore, the establishment of such diagnostic

> standards is of prime importance. Such a lead article in such an

> important journal suggests that this issue is of growing importance in

> the PRC.

>

> Basically what Wu and Wang are talking about is a lack of inter-rater

> reliability, and I agree that this is a huge impediment to the growth

> and development of CM worldwide. A couple of weeks ago, I was teaching

> in the DAOM program at OCOM, and Rosa Schnyer, one of the students

> (but someone who has been involved with research for 10 years or

> more), said that, in research she was recently involved with, American

> CM inter-rater reliability was extremely low, so low as to be a

> serious professional issue. If I remember correctly, it was less than 30%.

>

> The more I practice, study, and teach this medicine, the more I

> believe we could achieve significant inter-rater reliability if we

> wanted to without any damage to the medicine itself.

>

> Bob

>

>

 

[Guest guest]

Bob,

I think you speak to a crucial issue, and I agree with you that we could and

should achieve much greater inter-rater reliability without significant damage

to the medicine--and hopefully with actual improvement to it. During research,

those involved should agree to certain standards, such as to only take pulse

diagnosis as far as it goes with general consensus. For example, everyone agrees

about the yin organ/channel resonances with five of the positions, and I think

it would not kill anyone if we all agreed to call the sixth one Kidney Yang, for

the sake of a trial at least. I remember learning (I think from you) that TCM

itself was created by communist fiat--they called a bunch of senior

practitioners together, shut them in a big room and wouldn't let them out until

they came to basic consensus on TCM standards and teaching. Now this may have

caused some loss of subtleties and nuance, but we're talking about research

here.

 

There should be a very much standardized way of approaching pattern diagnosis,

so that everyone knows what it is. This doesn't really limit anyone from

treating it any way they see fit--it's mainly a matter of semantics, I think. As

long as we use the same words for the same things, outside observers will think

we are agreeing. Of course we'll know that inside each of us we are meaning our

own brand of pattern diagnosis understanding, and of course all the other

practitioners are koo-koo and inferior, but we look like a united front to the

observers. We need to just pick a translation system and go with it, and it

needs to be simple enough, broad enough, and specific enough to satisfy the

majority of us. I appreciate Wiseman's attempt to do this and his devotion to

the field, but I don't like the esoteric-sounding nature of his stuff. I don't

want to create another professional arcane language that separates one set of

people from another. Don't we have enough of those

already? Isn't that why the language of Chinese medicine has stayed with words

about nature that we all recognize?

 

Anyway, surely (I hope) there is enough standardization of teaching about

pattern diagnosis recognition that what we have is mainly a semantics problem.

Nigel, I'm sorry, but your very specific yet too-esoteric system is probably not

going to fly in the long run. Simple is best. So, Bob, what do you think is the

answer?

Joseph

 

Bob Flaws <pemachophel2001 wrote:

Heads up:

 

The lead article in issue #3, 2007 of Xin Zhong Yi (New Chinese

Medicine) by Wu Xiu-yan and Wang Tian-fang, both of the Chinese

Medical Diagnostics Faculty of the Bejing Univeristy of Chinese

Medicine & Pharmacology, states that lack of accepted standard

criteria for CM pattern discrimination has impeded the development of

scientific research into, the clinical practice of, and the

modernization of CM. Therefore, the establishment of such diagnostic

standards is of prime importance. Such a lead article in such an

important journal suggests that this issue is of growing importance in

the PRC.

 

Basically what Wu and Wang are talking about is a lack of inter-rater

reliability, and I agree that this is a huge impediment to the growth

and development of CM worldwide. A couple of weeks ago, I was teaching

in the DAOM program at OCOM, and Rosa Schnyer, one of the students

(but someone who has been involved with research for 10 years or

more), said that, in research she was recently involved with, American

CM inter-rater reliability was extremely low, so low as to be a

serious professional issue. If I remember correctly, it was less than 30%.

 

The more I practice, study, and teach this medicine, the more I

believe we could achieve significant inter-rater reliability if we

wanted to without any damage to the medicine itself.

 

Bob

 

 

 

 

 

 

 

Ahhh...imagining that irresistible " new car " smell?

Check outnew cars at Autos.

 

 

[Guest guest]

 

I think I get all you have to say, but didn't we all learn to speak TCM in

school? Didn't we all learn to do TCM-style diagnosis? Is that not the only glue

holding all this together? Can we not for research sake just do TCM-style, and

then after the research go back to our peculiar brands of diagnosis/treatment?

There will always be wildness in this field, and that is what makes it alive and

truly representative of nature, but when the so-called scientific world looks at

us, we need to pretend to be scientific. We don't have to agree about anything

(God forbid), but we do have to look as though we do if we are ever to get

credibility for our medicine from the " scientific " world. That is of course if

we care about getting said credibility.

 

There's an old saying that you can be right, or you can be married. As far as

I can tell, most people in Chinese medicine would rather be right than married.

As long as that is the case, we will be second-class medical citizens at best.

However, what you say about the AAAOM is a case of getting married rather than

being right, and I believe I am agreeing with you that that is one instance

where there needs to be a shotgun wedding with standards on the menu. It's all

for show anyway. I know people are probably concerned that they'll someday be

held to some mainstream medicine-like standard of care that is beneath them. I

say let's cross that bridge when we come to it, if we ever come to it.

Joseph

 

wrote:

inter-rater reliability could be achieved within certain schools of

thought by focusing on strictly TCM-style tongue and pulse analysis, the latter

emphasizing qualities over nuanced positional information, plus s/s standards.

problem is I would wager that well more than half the practitioners use methods

of diagnosis that fall outside these parameters from more obscure (dong han) to

the highly specialized (nanjing) to the pseudoscientific (NAET, electronic

meridian analysis, etc.). Inter-rater reliability may be 30% amongst TCMers, but

across the profession as whole, more like 5-10%. OTOH, within certain schools of

thought amongst japanese style practitioners who all have had the same or very

similar training, such as so-called jingei diagnosis (where the carotid and

radial pulses are compared), I have seen very high reliability within certain

cohorts. I don't much hope of any rectification of this problem now that the

AAOM has caved on its futile demand for

standards and accepte

d the defacto standardless eclecticism of the alliance in the re-formation of

the AAAOM.

 

-------------- Original message ----------------------

" Bob Flaws " <pemachophel2001

> Heads up:

>

> The lead article in issue #3, 2007 of Xin Zhong Yi (New Chinese

> Medicine) by Wu Xiu-yan and Wang Tian-fang, both of the Chinese

> Medical Diagnostics Faculty of the Bejing Univeristy of Chinese

> Medicine & Pharmacology, states that lack of accepted standard

> criteria for CM pattern discrimination has impeded the development of

> scientific research into, the clinical practice of, and the

> modernization of CM. Therefore, the establishment of such diagnostic

> standards is of prime importance. Such a lead article in such an

> important journal suggests that this issue is of growing importance in

> the PRC.

>

> Basically what Wu and Wang are talking about is a lack of inter-rater

> reliability, and I agree that this is a huge impediment to the growth

> and development of CM worldwide. A couple of weeks ago, I was teaching

> in the DAOM program at OCOM, and Rosa Schnyer, one of the students

> (but someone who has been involved with research for 10 years or

> more), said that, in research she was recently involved with, American

> CM inter-rater reliability was extremely low, so low as to be a

> serious professional issue. If I remember correctly, it was less than 30%.

>

> The more I practice, study, and teach this medicine, the more I

> believe we could achieve significant inter-rater reliability if we

> wanted to without any damage to the medicine itself.

>

> Bob

>

>

 

 

[Guest guest]

Z'ev,

 

You're talking about the PRC National Standards published by the

Nanjing College of CM Press. The problem is that the work is

copyrighten. It'd be easy to translate, but then it could not be

legally desseminated unless someone bought the English language rights

from the Chinese. My previous experience trying to do that has not

been very positive. As soon as they hear " America, " they tend to think

in unrealistic $ terms.

 

Bob

 

, " "

<zrosenbe wrote:

>

> Bob,

> Some time ago on CHA, you and Todd discussed a list of standard

> patterns from mainland China that could be translated and used as a

> de facto standard blueprint. Did you ever follow up on this?

>

>

> On May 4, 2007, at 1:46 PM, Bob Flaws wrote:

>

> > Heads up:

> >

> > The lead article in issue #3, 2007 of Xin Zhong Yi (New Chinese

> > Medicine) by Wu Xiu-yan and Wang Tian-fang, both of the Chinese

> > Medical Diagnostics Faculty of the Bejing Univeristy of Chinese

> > Medicine & Pharmacology, states that lack of accepted standard

> > criteria for CM pattern discrimination has impeded the development of

> > scientific research into, the clinical practice of, and the

> > modernization of CM. Therefore, the establishment of such diagnostic

> > standards is of prime importance. Such a lead article in such an

> > important journal suggests that this issue is of growing importance in

> > the PRC.

> >

> > Basically what Wu and Wang are talking about is a lack of inter-rater

> > reliability, and I agree that this is a huge impediment to the growth

> > and development of CM worldwide. A couple of weeks ago, I was teaching

> > in the DAOM program at OCOM, and Rosa Schnyer, one of the students

> > (but someone who has been involved with research for 10 years or

> > more), said that, in research she was recently involved with, American

> > CM inter-rater reliability was extremely low, so low as to be a

> > serious professional issue. If I remember correctly, it was less

> > than 30%.

> >

> > The more I practice, study, and teach this medicine, the more I

> > believe we could achieve significant inter-rater reliability if we

> > wanted to without any damage to the medicine itself.

> >

> > Bob

> >

> >

> >

>

>

>

>

[Guest guest]

Hi Bob could you send me the Chinese Tittle and

publisher, I would like to take a look at it.

thanks

Gabe Fuentes

--- Bob Flaws <pemachophel2001 wrote:

 

> Z'ev,

>

> You're talking about the PRC National Standards

> published by the

> Nanjing College of CM Press. The problem is that the

> work is

> copyrighten. It'd be easy to translate, but then it

> could not be

> legally desseminated unless someone bought the

> English language rights

> from the Chinese. My previous experience trying to

> do that has not

> been very positive. As soon as they hear " America, "

> they tend to think

> in unrealistic $ terms.

>

> Bob

>

> , " Z'ev

> Rosenberg "

> <zrosenbe wrote:

> >

> > Bob,

> > Some time ago on CHA, you and Todd discussed a

> list of standard

> > patterns from mainland China that could be

> translated and used as a

> > de facto standard blueprint. Did you ever follow

> up on this?

> >

> >

> > On May 4, 2007, at 1:46 PM, Bob Flaws wrote:

> >

> > > Heads up:

> > >

> > > The lead article in issue #3, 2007 of Xin Zhong

> Yi (New Chinese

> > > Medicine) by Wu Xiu-yan and Wang Tian-fang, both

> of the Chinese

> > > Medical Diagnostics Faculty of the Bejing

> Univeristy of Chinese

> > > Medicine & Pharmacology, states that lack of

> accepted standard

> > > criteria for CM pattern discrimination has

> impeded the development of

> > > scientific research into, the clinical practice

> of, and the

> > > modernization of CM. Therefore, the

> establishment of such diagnostic

> > > standards is of prime importance. Such a lead

> article in such an

> > > important journal suggests that this issue is of

> growing importance in

> > > the PRC.

> > >

> > > Basically what Wu and Wang are talking about is

> a lack of inter-rater

> > > reliability, and I agree that this is a huge

> impediment to the growth

> > > and development of CM worldwide. A couple of

> weeks ago, I was teaching

> > > in the DAOM program at OCOM, and Rosa Schnyer,

> one of the students

> > > (but someone who has been involved with research

> for 10 years or

> > > more), said that, in research she was recently

> involved with, American

> > > CM inter-rater reliability was extremely low, so

> low as to be a

> > > serious professional issue. If I remember

> correctly, it was less

> > > than 30%.

> > >

> > > The more I practice, study, and teach this

> medicine, the more I

> > > believe we could achieve significant inter-rater

> reliability if we

> > > wanted to without any damage to the medicine

> itself.

> > >

> > > Bob

> > >

> > >

> > >

> >

> >

> >

> > [Non-text portions of this message have been

> removed]

> >

>

>

>

 

 

 

 

 

 

[Guest guest]

Ditto.

 

 

 

-Jason

 

 

 

_____

 

 

On Behalf Of gabe gabe

Saturday, May 05, 2007 5:17 PM

 

Re: Standards for pattern discrimination

 

 

 

Hi Bob could you send me the Chinese Tittle and

publisher, I would like to take a look at it.

thanks

Gabe Fuentes

--- Bob Flaws <pemachophel2001@ <pemachophel2001%40>

> wrote:

 

> Z'ev,

>

> You're talking about the PRC National Standards

> published by the

> Nanjing College of CM Press. The problem is that the

> work is

> copyrighten. It'd be easy to translate, but then it

> could not be

> legally desseminated unless someone bought the

> English language rights

> from the Chinese. My previous experience trying to

> do that has not

> been very positive. As soon as they hear " America, "

> they tend to think

> in unrealistic $ terms.

>

> Bob

>

> @ <%40>

, " Z'ev

> Rosenberg "

> <zrosenbe wrote:

> >

> > Bob,

> > Some time ago on CHA, you and Todd discussed a

> list of standard

> > patterns from mainland China that could be

> translated and used as a

> > de facto standard blueprint. Did you ever follow

> up on this?

> >

> >

> > On May 4, 2007, at 1:46 PM, Bob Flaws wrote:

> >

> > > Heads up:

> > >

> > > The lead article in issue #3, 2007 of Xin Zhong

> Yi (New Chinese

> > > Medicine) by Wu Xiu-yan and Wang Tian-fang, both

> of the Chinese

> > > Medical Diagnostics Faculty of the Bejing

> Univeristy of Chinese

> > > Medicine & Pharmacology, states that lack of

> accepted standard

> > > criteria for CM pattern discrimination has

> impeded the development of

> > > scientific research into, the clinical practice

> of, and the

> > > modernization of CM. Therefore, the

> establishment of such diagnostic

> > > standards is of prime importance. Such a lead

> article in such an

> > > important journal suggests that this issue is of

> growing importance in

> > > the PRC.

> > >

> > > Basically what Wu and Wang are talking about is

> a lack of inter-rater

> > > reliability, and I agree that this is a huge

> impediment to the growth

> > > and development of CM worldwide. A couple of

> weeks ago, I was teaching

> > > in the DAOM program at OCOM, and Rosa Schnyer,

> one of the students

> > > (but someone who has been involved with research

> for 10 years or

> > > more), said that, in research she was recently

> involved with, American

> > > CM inter-rater reliability was extremely low, so

> low as to be a

> > > serious professional issue. If I remember

> correctly, it was less

> > > than 30%.

> > >

> > > The more I practice, study, and teach this

> medicine, the more I

> > > believe we could achieve significant inter-rater

> reliability if we

> > > wanted to without any damage to the medicine

> itself.

> > >

> > > Bob

> > >

> > >

> > >

> >

> >

> >

> > [Non-text portions of this message have been

> removed]

> >

>

>

>

 

 

 

 

http://mail. <>

 

 

 

 

 

 

[Guest guest]

, " Bob Flaws "

> Basically what Wu and Wang are talking about is a lack of inter-rater

> reliability, and I agree that this is a huge impediment to the growth

> and development of CM worldwide.

 

This is a major issue in Asian research. It is widely recognized that

different practitioners vary in their analysis of a case, and

establishing diagnostic standards is essential for Chinese medical

research. The major developments I've seen in response to this issue are:

 

1) Use of the point-based rating scale that Bob is referring to.

Although the rating scale is from the PRC, I've seen it in use in

clinical research in Taiwan as well. It is widely agreed that

grouping the cohorts based on pattern identification is best done with

the same diagnostic standards.

 

2) While the rating scale handles many elements of the diagnosis

effectively, tongue and pulse remain a major source of disagreement

between practitioners. The trend here is to invent digital tools that

can be used in research.

 

Most practitioners believe that the computers will never ultimately

surpass a highly-skilled human in terms of tongue and pulse, but they

are very promising in terms of reducing inter-rater variability in

research.

 

One of the doctors that I studied with at Chang Gung Memorial Hospital

was Dr. Chang Hen-Hong. Dr. Chang is involved in research with one

of the pulse machines, and I've seen presentations of doctors using

other machines. Currently, the pulse machine is capable of extremely

fine measurements in terms of width, strength, rhythm, and depth. I

believe it calculates something like 16 or 32 depths. It also has

some overall calculating abilities for pulses like the wiry pulse. In

terms of numbers, the machine is far more detailed than a human can

be. However, the clinical community as a whole will probably never

switch from the human art over to a machine reading- people will use a

machine when they need to agree with others in a research setting, but

they will use their own perception in their private office visits.

 

One of the other machines in use analyzes the tongue. Again, it has a

staggering number of pixels that it can analyze, and clever minds are

constantly getting the machines to handle tricky issues like coating,

color, lighting, moisture, etc. There are a lot of issues for them

left to work out, but the work is progressing very quickly. Once

machines for both tongue and pulse are fully created and accepted by

the community, they will nearly certainly be integrated into the

research. The rating scale is already there.

 

We are working in a field that we are just scratching the surface of.

There is an incredible amount of effort going into these problems

worldwide. However, even if Westerners caught up to our colleagues

and formed a consensus on how to diagnose a given pattern clinically,

we are still too fragmented as a community to even call the patterns

by the same names. Nigel's terminology is too concerned with

linguistic accuracy to appeal to the masses, but no one else will step

up to the plate to lay down a workable alternative. Our community is

very divided, arriving at the same diagnostic standards is going to

take some time.

 

Eric

[Guest guest]

Eric and Group,

 

 

 

I also acknowledge the divide in our field in the West, but this also exists

in China. Although there is a push for standardization from some there is

also resistance from others (in China just as here). It is not that doctors

just call the pulse and tongue differently, they use different words to name

patterns and diseases (present and past). They also diagnosis patterns

according to different criteria. This is just a fact of life, and one

primary reason many people see standardizations of terms in the west a

problem.

 

 

 

The more I read and study the more I see the vastness of perspectives that

CM offers, hence one of its major strengths. For example one may have

Disease X. Through out time there may be any number of possible ways to

define that disease. Agreeing on one word/phrase to name this is English is

one thing, but the diagnostic criteria for the Disease may be immensely

varied depending on what tradition one aligns oneself with. One doctor might

follow a more SHL approach, another a modern TCM, and yet another a meng he

lineage. IS there really just one right way? IMO, all will have a different

and useful slant. Modern dictionaries in Chinese usually only scratch the

surface when sifting through these issues.

 

 

 

Of course one alternative is to not acknowledge anything that has not made

it into the modern " TCM " approach, but IMO this is precisely why part of the

medicine is a bit weak. The rigor of teaching students how to think and

examine the past literature is declining and being replaced by cookbook

protocols for given and predefined diseases. Granted I agree that this

method is helpful for western style research, it is also draining the life

and flexibility of a potentially strong medicine. I am fully convinced that

the distillation process that we commonly see in our modern textbooks, may

work for many cases, also completely misses the boat in others. But that is

a whole other topic.

 

 

 

Finally I recently came across one of those definitive diagnosis lists,

where basically it lays out what you need to diagnosis a given pattern.

Although I found myself reminiscing at a time (1-2nd year school) where

everything was black and white, it became quickly apparent how flawed it

was. Clearly if one practiced in this manner one could help people, but one

would not be a superior doctor, and miss many patterns. It is a great tool

for beginners to grasp the concepts but for almost every pattern I could

think of obvious exceptions that I encounter in the clinic daily. I am just

not convinced how realistic something like this is for the modern clinic /

difficult to treat conditions. Comments?

 

 

 

The further examine the difficulty of standardization of terms, one often

cites Western medicine as an example. Meaning it is fairly uniform (in

consensus) compared to CM. Yet in Chinese one will find multiple Chinese

words for one western medical term. I am not saying this latter occurrence

is good, but clearly a fact of life.

 

 

 

Comments?

 

 

 

 

 

-

 

 

 

_____

 

 

On Behalf Of Eric Brand

Monday, May 07, 2007 1:33 AM

 

Re: Standards for pattern discrimination

 

 

 

 

 

We are working in a field that we are just scratching the surface of.

There is an incredible amount of effort going into these problems

worldwide. However, even if Westerners caught up to our colleagues

and formed a consensus on how to diagnose a given pattern clinically,

we are still too fragmented as a community to even call the patterns

by the same names. Nigel's terminology is too concerned with

linguistic accuracy to appeal to the masses, but no one else will step

up to the plate to lay down a workable alternative. Our community is

very divided, arriving at the same diagnostic standards is going to

take some time.

 

Eric

 

 

 

 

[Guest guest]

Title: Zhong Yi Bing Zheng Zhen Duan Liao Xiao Biao Zhun (Criteria for

Diagnosis & Therapeutic Effect of Diseases & Syndromes in Traditional

). (The English title is their translation on the cover.)

 

Created: 1994/06/28

Published: 1995/01/01

 

Nanjing University Publishing Company

ISBN: 7-305-02723-5/R-105

Price: 23.00 Yuan

 

 

 

 

 

 

 

, gabe gabe <fuentes120

wrote:

>

> Hi Bob could you send me the Chinese Tittle and

> publisher, I would like to take a look at it.

> thanks

> Gabe Fuentes

> --- Bob Flaws <pemachophel2001 wrote:

>

> > Z'ev,

> >

> > You're talking about the PRC National Standards

> > published by the

> > Nanjing College of CM Press. The problem is that the

> > work is

> > copyrighten. It'd be easy to translate, but then it

> > could not be

> > legally desseminated unless someone bought the

> > English language rights

> > from the Chinese. My previous experience trying to

> > do that has not

> > been very positive. As soon as they hear " America, "

> > they tend to think

> > in unrealistic $ terms.

> >

> > Bob

> >

> > , " Z'ev

> > Rosenberg "

> > <zrosenbe@> wrote:

> > >

> > > Bob,

> > > Some time ago on CHA, you and Todd discussed a

> > list of standard

> > > patterns from mainland China that could be

> > translated and used as a

> > > de facto standard blueprint. Did you ever follow

> > up on this?

> > >

> > >

> > > On May 4, 2007, at 1:46 PM, Bob Flaws wrote:

> > >

> > > > Heads up:

> > > >

> > > > The lead article in issue #3, 2007 of Xin Zhong

> > Yi (New Chinese

> > > > Medicine) by Wu Xiu-yan and Wang Tian-fang, both

> > of the Chinese

> > > > Medical Diagnostics Faculty of the Bejing

> > Univeristy of Chinese

> > > > Medicine & Pharmacology, states that lack of

> > accepted standard

> > > > criteria for CM pattern discrimination has

> > impeded the development of

> > > > scientific research into, the clinical practice

> > of, and the

> > > > modernization of CM. Therefore, the

> > establishment of such diagnostic

> > > > standards is of prime importance. Such a lead

> > article in such an

> > > > important journal suggests that this issue is of

> > growing importance in

> > > > the PRC.

> > > >

> > > > Basically what Wu and Wang are talking about is

> > a lack of inter-rater

> > > > reliability, and I agree that this is a huge

> > impediment to the growth

> > > > and development of CM worldwide. A couple of

> > weeks ago, I was teaching

> > > > in the DAOM program at OCOM, and Rosa Schnyer,

> > one of the students

> > > > (but someone who has been involved with research

> > for 10 years or

> > > > more), said that, in research she was recently

> > involved with, American

> > > > CM inter-rater reliability was extremely low, so

> > low as to be a

> > > > serious professional issue. If I remember

> > correctly, it was less

> > > > than 30%.

> > > >

> > > > The more I practice, study, and teach this

> > medicine, the more I

> > > > believe we could achieve significant inter-rater

> > reliability if we

> > > > wanted to without any damage to the medicine

> > itself.

> > > >

> > > > Bob

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > [Non-text portions of this message have been

> > removed]

> > >

> >

> >

> >

>

>

>

>

>

>

>

[Guest guest]

Jason,

Standards, specifically patterns in this case, are a double-edged

sword. I personally think having a list of patterns, based on the

zhong yi da ci dian/Great Dictionary of , would be a

good thing because it would be much wider than the patterns listed in

extant English language textbooks, and would enable us to develop a

coherent platform in terms of diagnosis. Remember, the Chinese

couldn't develop a national health care system without standards of

some kind, and we will also find it hard. On the other hand, such

standards tend to lead to short-cuts in education, which, as you

point out, lead to students who are unable to 'think' Chinese

medicine out in their own heads, leading to the cookbook practice we

both dislike. It is not too different to the present scenario,

however, which is governed by memorizing what is going to be on state

and national boards. Even though students can learn to pass these

exams, it doesn't prepare them to face the real world of their

clinics, real people with real problems.

One of my ideas I hope to work on some day are 'expert systems'

of the algorithms and thinking processes of some of the great Chinese

physicians. Still an idea, but a possible road into the great depth

and complexity of the work of the various schools of thought in our

rich heritage.

Somehow we need to get ourselves and our colleagues under the

surface of the great ocean of knowledge we've inherited.

 

 

On May 7, 2007, at 6:45 AM, wrote:

 

> Of course one alternative is to not acknowledge anything that has

> not made

> it into the modern " TCM " approach, but IMO this is precisely why

> part of the

> medicine is a bit weak. The rigor of teaching students how to think

> and

> examine the past literature is declining and being replaced by

> cookbook

> protocols for given and predefined diseases. Granted I agree that this

> method is helpful for western style research, it is also draining

> the life

> and flexibility of a potentially strong medicine. I am fully

> convinced that

> the distillation process that we commonly see in our modern

> textbooks, may

> work for many cases, also completely misses the boat in others. But

> that is

> a whole other topic.

>

> Finally I recently came across one of those definitive diagnosis

> lists,

> where basically it lays out what you need to diagnosis a given

> pattern.

> Although I found myself reminiscing at a time (1-2nd year school)

> where

> everything was black and white, it became quickly apparent how

> flawed it

> was. Clearly if one practiced in this manner one could help people,

> but one

> would not be a superior doctor, and miss many patterns. It is a

> great tool

> for beginners to grasp the concepts but for almost every pattern I

> could

> think of obvious exceptions that I encounter in the clinic daily. I

> am just

> not convinced how realistic something like this is for the modern

> clinic /

> difficult to treat conditions. Comments?

 

 

 

 

[Guest guest]

The problem is not just one of having agreed upon criteria with which

to diagnose. In a study a colleague of mine, Rich Blitstein, and I

designed and completed after we graduated looked at the inter-observer

reliability of tongue observation. This was a study looking at not how

practitioners use information to make a diagnosis, but on whether they

were even seeing the same things. It involved using three

practitioners of 5 yrs experience each, tongue slides from Barb

Kirschbaum, and a data recording form. Each practitioner had as much

time as they needed for each slide. If I remember correctly, the data

showed that agreement was poor to fair using Cohen's kappa coefficient.

It certainly makes it tough to diagnose people the same way if you

cannot even agree upon what you are seeing in the clinic.

 

-Steve

 

On May 7, 2007, at 2:33 AM, Eric Brand wrote:

 

 

> , " Bob Flaws "

> > Basically what Wu and Wang are talking about is a lack of

> inter-rater

> > reliability, and I agree that this is a huge impediment to the

> growth

> > and development of CM worldwide.

>

> This is a major issue in Asian research. It is widely recognized that

> different practitioners vary in their analysis of a case, and

> establishing diagnostic standards is essential for Chinese medical

> research. The major developments I've seen in response to this issue

> are:

>

> 1) Use of the point-based rating scale that Bob is referring to.

> Although the rating scale is from the PRC, I've seen it in use in

> clinical research in Taiwan as well. It is widely agreed that

> grouping the cohorts based on pattern identification is best done with

> the same diagnostic standards.

>

> 2) While the rating scale handles many elements of the diagnosis

> effectively, tongue and pulse remain a major source of disagreement

> between practitioners. The trend here is to invent digital tools that

> can be used in research.

 

Stephen Bonzak, L.Ac., Dipl. C.H.

sbonzak

773-470-6994

 

 

 

[Guest guest]

Stephen

As i said in our study which had 9 dr and 30 pt the kappa was to low to report,

and that was only body color and fur color and quality.

 

 

 

 

 

 

 

 

-

Stephen Bonzak

Monday, May 07, 2007 11:32 AM

Re: Re: Standards for pattern discrimination

 

 

 

The problem is not just one of having agreed upon criteria with which

to diagnose. In a study a colleague of mine, Rich Blitstein, and I

designed and completed after we graduated looked at the inter-observer

reliability of tongue observation. This was a study looking at not how

practitioners use information to make a diagnosis, but on whether they

were even seeing the same things. It involved using three

practitioners of 5 yrs experience each, tongue slides from Barb

Kirschbaum, and a data recording form. Each practitioner had as much

time as they needed for each slide. If I remember correctly, the data

showed that agreement was poor to fair using Cohen's kappa coefficient.

It certainly makes it tough to diagnose people the same way if you

cannot even agree upon what you are seeing in the clinic.

 

-Steve

 

On May 7, 2007, at 2:33 AM, Eric Brand wrote:

 

> , " Bob Flaws "

> > Basically what Wu and Wang are talking about is a lack of

> inter-rater

> > reliability, and I agree that this is a huge impediment to the

> growth

> > and development of CM worldwide.

>

> This is a major issue in Asian research. It is widely recognized that

> different practitioners vary in their analysis of a case, and

> establishing diagnostic standards is essential for Chinese medical

> research. The major developments I've seen in response to this issue

> are:

>

> 1) Use of the point-based rating scale that Bob is referring to.

> Although the rating scale is from the PRC, I've seen it in use in

> clinical research in Taiwan as well. It is widely agreed that

> grouping the cohorts based on pattern identification is best done with

> the same diagnostic standards.

>

> 2) While the rating scale handles many elements of the diagnosis

> effectively, tongue and pulse remain a major source of disagreement

> between practitioners. The trend here is to invent digital tools that

> can be used in research.

 

Stephen Bonzak, L.Ac., Dipl. C.H.

sbonzak

773-470-6994

 

[Guest guest]

On 5/7/07, Stephen Bonzak <stephenbonzak wrote:

>

>

> The problem is not just one of having agreed upon criteria with which

> to diagnose. In a study a colleague of mine, Rich Blitstein, and I

> designed and completed after we graduated looked at the inter-observer

> reliability of tongue observation. This was a study looking at not how

> practitioners use information to make a diagnosis, but on whether they

> were even seeing the same things. It involved using three

> practitioners of 5 yrs experience each, tongue slides from Barb

> Kirschbaum, and a data recording form. Each practitioner had as much

> time as they needed for each slide. If I remember correctly, the data

> showed that agreement was poor to fair using Cohen's kappa coefficient.

> It certainly makes it tough to diagnose people the same way if you

> cannot even agree upon what you are seeing in the clinic.

>

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I agree that inter-rater reliability is a problem in terms of research,

however it was my observation that those who favored the same style had a

much greater agreement than those who operate out of different styles or

schools of thought.

 

While my pulse skills weren't that great when i was in China, I still found

a great deal of agreement regarding the basics. As for tongue appearances,

I'm reminded of a study that was attempted a few years back in which there

was something like five of us being tested. Two of us had attended the same

school and worked with a similar treatment style (TCM). Our agreement was

far greater than those who came from other schools and styles.

 

One thing that I believe that would be of benefit though perhaps a slightly

different research topic is providing a calibration exercise for those being

tested. For instance, show the testees examples the different tongue colors,

shapes, and other criteria. THEN show them unlabeled images and have them

rate them based on a finite list of appearance options that were presented

during the calibration portion of the study. That would provide us some data

as to whether or not our eyes are even seeing the same thing.

 

Without that calibration portion of the research, we may continue to trip

over inter-rater reliability issues.

 

-al.

 

 

--

 

Pain is inevitable, suffering is optional.

 

 

 

[Guest guest]

Al-

 

All of the practitioners in our study had the same training (two were

from the same school if I remember). They agreed a majority of the

time, but when you corrected it for chance (a la kappa), the results

were much poorer than we expected. Calibration is something that I

also think is extremely important for designing research that uses

tongue as part of pattern differentiation. There is so much basic work

to be done, IMO, that the idea of designing research studies that

differentiate according to pattern seems dubious. We need to work out

the kinks on how to separate according to pattern so as not to

introduce bias first.

 

-Steve

 

 

On May 7, 2007, at 1:53 PM, Al Stone wrote:

 

> I agree that inter-rater reliability is a problem in terms of

> research,

> however it was my observation that those who favored the same style

> had a

> much greater agreement than those who operate out of different styles

> or

> schools of thought.

>

> While my pulse skills weren't that great when i was in China, I still

> found

> a great deal of agreement regarding the basics. As for tongue

> appearances,

> I'm reminded of a study that was attempted a few years back in which

> there

> was something like five of us being tested. Two of us had attended

> the same

> school and worked with a similar treatment style (TCM). Our agreement

> was

> far greater than those who came from other schools and styles.

>

> One thing that I believe that would be of benefit though perhaps a

> slightly

> different research topic is providing a calibration exercise for

> those being

> tested. For instance, show the testees examples the different tongue

> colors,

> shapes, and other criteria. THEN show them unlabeled images and have

> them

> rate them based on a finite list of appearance options that were

> presented

> during the calibration portion of the study. That would provide us

> some data

> as to whether or not our eyes are even seeing the same thing.

>

> Without that calibration portion of the research, we may continue to

> trip

> over inter-rater reliability issues.

>

> -al.

>

> --

>

> Pain is inevitable, suffering is optional.

>

>

[Guest guest]

Thanks! Bob

 

--- Bob Flaws <pemachophel2001 wrote:

 

> Title: Zhong Yi Bing Zheng Zhen Duan Liao Xiao Biao

> Zhun (Criteria for

> Diagnosis & Therapeutic Effect of Diseases &

> Syndromes in Traditional

> ). (The English title is their

> translation on the cover.)

>

> Created: 1994/06/28

> Published: 1995/01/01

>

> Nanjing University Publishing Company

> ISBN: 7-305-02723-5/R-105

> Price: 23.00 Yuan

>

>

>

>

[Guest guest]

Hi Jason,

 

Since the definitive diagnosis lists are of my own creation I thought

it best I should reply!

 

First, these lists are not published for the general public and are

used as a teaching tool for my own students. They are not meant to

be taken out of context of the entire course on definitive diagnosis.

One of the main purposes of the lists is to help practitioners avoid

jumping to faulty conclusions in their diagnosis. This means that

what is NOT in the list is as important as what is on the list. For

example - hot flashes are not listed under Yin vacuity. Fatigue is

not listed under Spleen Qi deficiency etc. The conclusion that when

there are hot flashes there is Yin deficiency and when there is

fatigue there is Spleen Qi deficiency is such common ones for

practitioners to jump to that it is ubiquitous. Of course there are

many many others.

 

I'd love to hear what daily cases you have that contradict them

nonetheless. My guess is that, in this case, the lists are taken out

of context but I wonder.

 

You know what would be fun is to get together a few experienced

practitioners to diagnose a few patients and discuss our conclusions

and methods. I'll be in Boulder most likely this autumn teaching the

Integrative Mandala Acupuncture program - Maybe You, Chip and I could

do this and write up some or our insights? I'll ask Chip if he's

interested.

 

warm regards,

 

Sharon

 

 

 

writes

 

Finally I recently came across one of those definitive diagnosis lists,

where basically it lays out what you need to diagnosis a given pattern.

Although I found myself reminiscing at a time (1-2nd year school) where

everything was black and white, it became quickly apparent how flawed it

was. Clearly if one practiced in this manner one could help people,

but one

would not be a superior doctor, and miss many patterns. It is a great

tool

for beginners to grasp the concepts but for almost every pattern I could

think of obvious exceptions that I encounter in the clinic daily. I

am just

not convinced how realistic something like this is for the modern

clinic /

difficult to treat conditions. Comments?

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com