Tongue diagnosis in practice: evaluating concordance between practitioners
By Ray Littlewood - MSc in Acupuncture
Abstract
The primary aim of the research was to evaluate concordance between traditional Chinese medicine practitioners when diagnosing and assessing tongue body and coat colours. The secondary aim was to develop a tongue protocol diagnostic document and tongue topographic diagnostic chart that could be used by professional acupuncturists. The research question was: “How consistent are traditional Chinese medicine practitioners in tongue evaluation?”
A telephone survey based on a questionnaire was developed for the 94 Yorkshire based qualified practitioners, representing 6% of the total number of 1614 British Acupuncture Council practitioners in England. Yorkshire was chosen as a prime target area and research base for the study.
67 (71.3%) of the 94 practitioners responded to the telephone survey. From these, 6 practitioners were selected for case studies. Selection criteria was based on consent to interview, a high score on a survey question asking how useful they found tongue diagnosis, their geographical distance from Leeds, plus purposive sampling based on gender and training institution. An in-depth case study interview incorporating a structured questionnaire was used to explore their approach to tongue diagnosis.
To assess concordance, the 6 practitioners were asked to diagnose 2 sets of tongue colour photographs (one set of 12 body colour, and another set of 12 coat colour). Diagnostic concordance or “agreement over and above chance” known as “kappa,” between each pair of practitioners was calculated. A kappa of zero meant there was no agreement above chance, whereas a kappa of 1.00 meant there was 100% agreement above chance.
Body colour concordance results showed 4 out of the 15 kappa values as negative or “Agreement worse than chance” and one as “Very Good.” The rest were almost equally divided into “Poor,” “Fair,” or “Moderate” classifications. Coat colour concordance showed one “Poor” kappa. Other values were mixed, and almost one third were spread across the “Fair” and “Moderate” ranges.
A ”tongue protocol diagnostic document” and “tongue topographic diagnostic chart” were proposed to enable a more comprehensive tongue examination. Further research is suggested to investigate whether such a diagnostic protocol and chart have the potential to improve concordance.
