Universidade Federal do Ceará
Grupo de Atenção Integral e Pesquisa em Acupuntura e Medicina Tradicional Chinesa – GAIPA UFC

Estudos Metodológicos (methodological research)

Este tipo de estudo visa avaliar a validade de teorias e instrumentos de medida bem como a sua confiabilidade para mensurar desfechos em populações específicas. Validade pode ser entendida como a capacidade de um instrumento em medir exatamente o que se propõe a medir (Ex.: fita métrica para medir altura ou o cronômetro para medir o tempo). Confiabilidade é a capacidade de um instrumento reproduzir um resultado de forma consistente no tempo e no espaço ou a partir de avaliadores diferentes (Ex.: a exatidão do peso de um objeto avaliado por uma balança em diferentes momentos, ou da temperatura avaliada por diferentes termômetros). No caso do paradigma da MTC, estudos metodológicos são realizados a fim de avaliar a validade de suas teorias e a confiabilidade dos seus exames clínicos. Apresentamos alguns destes estudos abaixo.

Para acessar o capítulo suplementar da CID-11 com as categorias de diagnóstico da MTC <Clique aqui>.

Unitermos: TCM pattern OR TCM syndrome (zhèng 证), TCM disease (bìng 病), Treatment based on pattern differentiation (biàn zhèng lùn zhì 辨证论治), Pattern differentiation (biàn zhèng 辨证), Disease differentiation (biàn bìng 辨病)

Diagnóstico pela Diferenciação do Padrão Sindrômico

• Maeda-Minami A et  al. Discrimination of prediction models between cold-heat and deficiency-excess patterns. Complement Ther Med. 2020 Mar;49:102353. <https://pubmed.ncbi.nlm.nih.gov/32147085/>.
• Schnyer RN et al. Can Reliability of the Chinese Medicine Diagnostic Process Be Improved? Results of a Prospective Randomized Controlled Trial. J Altern Complement Med. 2019 Nov;25(11):1103-1108. <https://www.ncbi.nlm.nih.gov/pubmed/31730401>.
• Zhou X et al. Assessment of Intermingled Phlegm and Blood Stasis Syndrome in Coronary Heart Disease: Development of a Diagnostic Scale. Evid Based Complement Alternat Med. 2018 Oct 24; 2018: 4683431. <https://www.ncbi.nlm.nih.gov/pubmed/30473717>.
• Wong YC, Pang MC. Initial validation of the Yin-Yang Assessment Questionnaire for persons with diabetes mellitus. World J Diabetes. 2015 Sep 10; 6(11): 1198-206. <https://www.ncbi.nlm.nih.gov/pubmed/26380063>.
• Lee JA et al. Interobserver reliability of four diagnostic methods using traditional korean medicine for stroke patients. Evid Based Complement Alternat Med. 2014;2014:465471.<https://pubmed.ncbi.nlm.nih.gov/25574181/>.
• Wong W et al. Measuring body constitution: validation of the Body Constitution Questionnaire (BCQ) in Hong Kong. Complement Ther Med. 2014 Aug; 22(4): 670-82. <https://www.ncbi.nlm.nih.gov/pubmed/25146072>.
• Park YJ et al. Development and validation of the Yin deficiency scale. J Altern Complement Med. 2013 Jan; 19(1): 50-6. <https://www.ncbi.nlm.nih.gov/pubmed/22950657>.
• Hua B et al. Reliability of the Eight Guiding Principles and Syndrome Diagnosis in Chinese Medicine Diagnosis of Patients with Knee Osteoarthritis. J Altern Complement Med. 2012 Aug 21. <https://pubmed.ncbi.nlm.nih.gov/22909254/>.
• Okitsu R et al. Development of a questionnaire for the diagnosis of Qi stagnation. Complement Ther Med. 2012 Aug;20(4):207-17. <https://pubmed.ncbi.nlm.nih.gov/22579432/>.
• Hua B et al. Reliability of Chinese medicine diagnostic variables in the examination of patients with osteoarthritis of the knee. J Altern Complement Med. 2012 Nov;18(11):1028-37. <https://pubmed.ncbi.nlm.nih.gov/22897413/>.
• Ryu H et al. Reliability and validity of a cold-heat pattern questionnaire for traditional Chinese medicine. J Altern Complement Med. 2010 Jun; 16(6): 663-7. <https://www.ncbi.nlm.nih.gov/pubmed/20569034>.
• Mist S et al. Effects of questionnaire-based diagnosis and training on inter-rater reliability among practitioners of traditional Chinese medicine. J Altern Complement Med. 2009 Jul;15(7):703-9. <https://pubmed.ncbi.nlm.nih.gov/19538100/>.
• O’Brien KA et al. Understanding the reliability of diagnostic variables in a Chinese Medicine examination. J Altern Complement Med. 2009 Jul;15(7):727-34. <https://pubmed.ncbi.nlm.nih.gov/19552599/>.
• O’Brien KA, Birch S. A review of the reliability of traditional East Asian medicine diagnoses. J Altern Complement Med. 2009 Apr;15(4):353-66. <https://pubmed.ncbi.nlm.nih.gov/19388857/>.
• O’Brien KA et al. An investigation into the reliability of Chinese medicine diagnosis according to Eight Guiding Principles and Zang-Fu Theory in Australians with hypercholesterolemia. J Altern Complement Med. 2009 Mar;15(3):259-66. <https://pubmed.ncbi.nlm.nih.gov/19249997/>.
• Zhang GG et al. Improvement of agreement in TCM diagnosis among TCM practitioners for persons with the conventional diagnosis of rheumatoid arthritis: effect of training. J Altern Complement Med. 2008 May; 14(4): 381-6. <https://www.ncbi.nlm.nih.gov/pubmed/18576921>.
• MacPherson H et al. Acupuncture for low back pain: traditional diagnosis and treatment of 148 patients in a clinical trial. Complement Ther Med. 2004 Mar; 12(1): 38-44. <https://www.ncbi.nlm.nih.gov/pubmed/15130570>.
• Langevin HM et al. Yin scores and yang scores: A new method for quantitative diagnostic evaluation in traditional Chinese medicine research. J Altern Complement Med. 2004 Apr;10(2):389-95; discussion 387. <https://pubmed.ncbi.nlm.nih.gov/15165421/>.

Diagnóstico Auricular

• Oleson TD et al. An experimental evaluation of auricular diagnosis: the somatotopic mapping or musculoskeletal pain at ear acupuncture points. Pain. 1980 Apr;8(2):217-29. <https://www.ncbi.nlm.nih.gov/pubmed/7402685>.
• Usichenko TI et al. Detection of ear acupuncture points by measuring the electrical skin resistance in patients before, during and after orthopedic surgery performed under general anesthesia. Acupunct Electrother Res. 2003;28(3-4):167-73. <https://pubmed.ncbi.nlm.nih.gov/14998054/>.
• Andersson E et al. Are auricular maps reliable for chronic musculoskeletal pain disorders? A double-blind evaluation. Acupunct Med. 2007 Sep;25(3):72-9. <https://pubmed.ncbi.nlm.nih.gov/17906600/>.
• Romoli M, Mazzoni R. The Validation of Auricular Diagnosis. Dtsch Z Akupunkt. 2009; 52(2): 10–16. <https://www.sciencedirect.com/science/article/abs/pii/S0415641209000733>.
• Romoli M et al. Auricular acupuncture diagnosis in patients with lumbar hernia. Complement Ther Med. 2016 Jun;26:61-5. <https://www.ncbi.nlm.nih.gov/pubmed/27261983>.
• Suen LKP et al. Predictive value of auricular diagnosis on coronary heart disease. Evid Based Complement Alternat Med. 2012; 2012: 706249. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544543/>.
• Suen LK et al. Association of Auricular Reflective Points and Status of Type 2 Diabetes Mellitus: A Matched Case-Control Study. Evid Based Complement Alternat Med. 2015; 2015: 981563. <https://www.ncbi.nlm.nih.gov/pubmed/26089953>.
• Suen LKP et al. Association between Auricular Signals and the Risk Factors of Metabolic Syndrome. Medicines (Basel). 2017 Sep; 4(3): 45. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622380/>.
• Suen LKP et al. Association of auricular reflective points and the status of lower urinary tract symptoms in aging males. Aging Male. 2015;18(3):149-56.  <https://pubmed.ncbi.nlm.nih.gov/26030348/>.
• Romoli M et al. Ear Acupoint Detection before and after Hysteroscopy: Is it Possible to Clarify the Representation of the Uterus on the Outer Ear? Acupunct Med. 2010; 28: 169-73. <https://pubmed.ncbi.nlm.nih.gov/20923940/>.
• Wang AM et al. Is commercially available point finder accurate and reliable in detecting active auricular acupuncture points? J Altern Complement Med. 2012 Sep;18(9):860-3. <https://pubmed.ncbi.nlm.nih.gov/22834870/>.
• Szopinski JZ et al. Estimation of the diagnostic accuracy of organ electrodermal diagnostics. S Afr Med J. 2004 Jul;94(7):547-51. <https://pubmed.ncbi.nlm.nih.gov/15285457/>.
• Szopinski JZ, Rayne S. Usefulness of Organ Electrodermal Diagnostics in Detection of Breast Pathology: A Multicenter, Randomized, Double-Blinded Clinical Study. Med Acupunct . 2017 Dec 1;29(6):390-396. <https://pubmed.ncbi.nlm.nih.gov/29279734/>.
• Usichenko TI et al. Auricular Acupoints with Reduced Skin Resistance: Detection in Patients Scheduled for Hip Arthroplasty. Med Acupunct. 2018 Dec 1;30(6):308-312. <https://pubmed.ncbi.nlm.nih.gov/30671150/>.
• Lee EJ. Correlations Between Auricular Tenderness and Symptoms in Korean Adults. Holist Nurs Pract. 2020 May/Jun;34(3):180-186. <https://pubmed.ncbi.nlm.nih.gov/32282494/>.
• Borlack RE et al. Electrodermal Activity of Auricular Acupoints in Pediatric Patients With Functional Abdominal Pain Disorders. J Pediatr Gastroenterol Nutr. 2021 Aug 1;73(2):184-191. <https://pubmed.ncbi.nlm.nih.gov/33853109/>.

Diagnóstico pela Língua

• Segawa Met al. Construction of a Standardized Tongue Image Database for Diagnostic Education: Development of a Tongue Diagnosis e-Learning System. Front Med Technol. 2021 Dec 22;3:760542. <https://pubmed.ncbi.nlm.nih.gov/35047962/>.
• Wang ZC et al. Intra-Rater and Inter-Rater Reliability of Tongue Coating Diagnosis in Traditional Chinese Medicine Using Smartphones: Quasi-Delphi Study. JMIR Mhealth Uhealth. 2020 Jul 9;8(7):e16018. <https://pubmed.ncbi.nlm.nih.gov/32459647/>.
• Jiao W. Tongue color clustering and visual application based on 2D information. Int J Comput Assist Radiol Surg. 2020 Feb;15(2):203-212.  <https://pubmed.ncbi.nlm.nih.gov/31713089/>.
• Qi Z et al. The Classification of Tongue Colors with Standardized Acquisition and ICC Profile Correction in Traditional Chinese Medicine. Biomed Res Int. 2016; 2016: 3510807. <https://www.ncbi.nlm.nih.gov/pubmed/28050555>.
• Gareus I et al. Introducing a computer-assisted, digital tongue-imaging device for standardization of traditional tongue diagnosis. Forsch Komplementmed. 2014; 21(3): 190-6. <https://www.ncbi.nlm.nih.gov/pubmed/25060159>.
• Tomura T et al. Validity of a diagnostic scale for acupuncture: application of the item response theory to the five viscera score. Evid Based Complement Alternat Med. 2013; 2013: 928089. <https://www.ncbi.nlm.nih.gov/pubmed/23690864>.
• Kim M et al. Traditional Chinese medicine tongue inspection: an examination of the inter- and intrapractitioner reliability for specific tongue characteristics. J Altern Complement Med. 2008 Jun; 14(5): 527-36. <https://www.ncbi.nlm.nih.gov/pubmed/18564955>.

Diagnóstico pelo pulso

• Lan KC et al. Traditional Chinese Medicine Pulse Diagnosis on a Smartphone Using Skin Impedance at Acupoints: A Feasibility Study. Sensors (Basel). 2020 Aug 17;20(16):4618. <https://pubmed.ncbi.nlm.nih.gov/32824477/>.
• Bilton K, Zaslawski C. Reliability of Manual Pulse Diagnosis Methods in Traditional East Asian Medicine: A Systematic Narrative Literature Review. J Altern Complement Med. 2016 Aug; 22(8): 599-609. <https://www.ncbi.nlm.nih.gov/pubmed/27314975>.
• Huang PY et al. Regression analysis of radial artery pulse palpation as a potential tool for traditional Chinese medicine training education. Complement Ther Med. 2013 Dec; 21(6): 649-59. <https://www.ncbi.nlm.nih.gov/pubmed/24280474>.
• Bilton K et al. Contemporary Chinese pulse diagnosis: a modern interpretation of an ancient and traditional method. J Acupunct Meridian Stud. 2013 Oct;6(5):227-33. <https://pubmed.ncbi.nlm.nih.gov/24139459/>.
• Tyan CC et al. How to standardize 3 finger positions of examiner for palpating radial pulses at wrist in traditional Chinese medicine. Acupunct Electrother Res. 2007; 32(1-2): 87-96. <https://www.ncbi.nlm.nih.gov/pubmed/18077940>.
• King E et al. The testing of classical pulse concepts in Chinese medicine: left- and right-hand pulse strength discrepancy between males and females and its clinical implications. J Altern Complement Med. 2006 Jun; 12(5): 445-50. <https://www.ncbi.nlm.nih.gov/pubmed/16813508>.
• King E et al. The reliable measurement of radial pulse characteristics. Acupunct Med. 2002 Dec; 20(4): 150-9. <https://www.ncbi.nlm.nih.gov/pubmed/12512788>.
• King E et al. The reliable measurement of radial pulse: gender differences in pulse profiles. Acupunct Med. 2002 Dec;20(4):160-7. <https://www.ncbi.nlm.nih.gov/pubmed/12512789>.

Palpação abdominal

• O’Brien KA et al. Investigating the reliability of Japanese toyohari meridian therapy diagnosis. J Altern Complement Med. 2009 Oct; 15(10): 1099-105. <https://www.ncbi.nlm.nih.gov/pubmed/19785529>.

Palpação do acuponto local

• Yang E, Lu W, Muñoz-Vergara D, Goldfinger E, Kaptchuk TJ, Napadow V, Ahn AC, Wayne PM. Acupoint Sensitivity in Health and Disease: A Systematic Review. J Integr Complement Med. 2024 May 16. <https://pubmed.ncbi.nlm.nih.gov/38748400/>.
• Tan H et al. Acupoints sensitization in people with and without chronic low back pain:A matched-sample cross-sectional study. J Back Musculoskelet Rehabil. 2023;36(1):137-146. <https://pubmed.ncbi.nlm.nih.gov/35871318/>.

COMENTÁRIOS

•  Standardising the evaluation process could improve reliability. Development and testing of instruments and structured approaches to improve reliability in evaluation of disability are urgently needed. (PMID: 28122727)
• Reddy B, Fan AY. Incorporation of complementary and traditional medicine in ICD-11. BMC Med Inform Decis Mak. 2022 Jun 30;21(Suppl 6):381. <https://pubmed.ncbi.nlm.nih.gov/35773641/>.
• Matos LC, Machado JP, Monteiro FJ, Greten HJ. Can Traditional Chinese Medicine Diagnosis Be Parameterized and Standardized? A Narrative Review. Healthcare (Basel). 2021 Feb 7;9(2):177.<https://pubmed.ncbi.nlm.nih.gov/33562368/>.
• Alraek T. Designing clinical studies that take into account traditional East Asian medicine’s systems and methods – with focus on pattern identification. Chin J Integr Med. 2014 May;20(5):332-5. <https://pubmed.ncbi.nlm.nih.gov/24788085/>.
• Birch S, Alraek T. Traditional East Asian medicine: how to understand and approach diagnostic findings and patterns in a modern scientific framework? Chin J Integr Med. 2014 May;20(5):336-40. <https://pubmed.ncbi.nlm.nih.gov/24788086/>.