Development of a standardized, Oriental medical diagnosis form

Terry Oleson, Emperor’s College of Traditional Oriental Medicine, Los Angeles, CA

While there have been numerous research studies examining the clinical effectiveness of acupuncture and Chinese herbs, there have been few investigations of another prominent feature of Oriental Medicine, the unique qualities used for diagnostic assessment. Previous controlled studies have demonstrated the statistical verification of auricular diagnosis for musculoskeletal pain and for coronary disorders, but other aspects of Oriental Medical diagnosis have only been noted in anecdotal studies. The two most prominent features of traditional Chinese clinical assessment, pulse diagnosis and tongue diagnosis, remain hypothetical constructs with little scientific corroboration. Consultations with several, experienced, acupuncture practitioners led to the development of an initial, structured, assessment form to conduct systematic evaluation of such qualities as pulse, tongue, and facial diagnosis. A pilot study of 16 patients examined with this questionnaire was used to develop a revised Oriental Medical Diagnosis Form (OMDX) prepared for the present study. Inter-rater reliability will be determined by having the same set of patients independently evaluated by three licensed acupuncturists. Specific qualities rated by the OMDX include such aspects of pulse diagnosis as superficial / floating versus deep / sinking and surging / flooding as contrasted with rolling / slippery. The tip of, center; back, and sides of the tongue will be rated for specific characters as moisture of tongue, quality of coating, color of coating, color of body, and form of body. The facial color and complexion of a patient will be examined for features such as bright versus dull or dry versus moist. The practitioners conducting the clinical assessment will also be asked to designate the presence or absence of the syndromes of zang – fu organs, such as heart blood stagnation, lung phlegm damp, lung yin deficiency, spleen qi deficiency, liver qi stagnation, or kidney yang deficiency. Patterns of disharmony, such as deficiency versus excess, exterior versus interior, heat versus cold, dry versus damp, and fire versus wind will also be analyzed.

Use of acupressure beads in the treatment of ADHD

Michael O. Smith, Lincoln Hospital, Bronx, NY

We have used a type of acupressure bead (called "ear magnet seeds" in Chinese), to treat Attention Deficit Hyperactivity Disorder (ADHD) in children (Clin Acu Orient Med 1:31-2, 2000). The bead, a round metallic object coated with gold, is taped to the posterior surface of the ear just opposite the Shenmen location on the anterior surface. There is often a clear sensation of Qi when this bead is applied. One can frequently observe distended veins, moderate erythemia, and poor skin tone at this location, suggesting a need for tonification treatment. The beads do not need to be pressed or manipulated. Treatment is more-or-less continuous for the duration of the patient’s problem. Most ADHD patients come to us when they are taking medication but continue to have very significant symptoms. We never suggest that medication should be changed when the beads are applied. Medication should only be changed by the primary prescribing physician on the basis of clear changes in the clinical picture.

The Child Psychiatry clinics at Lincoln Hospital and nearby Morrisania NFCC have conducted a 6-week clinical trial of this method. Project staff were Sandra Runes, PhD, director; Cecily Dell, PhD; Rene Valentin, MSW; Michael Smith,MD; and Lauren Kittel MS, a psychology intern, who is coordinating the analysis.

Sixty subjects, between the ages of 6 and 12 (from 2 psychiatric outpatient clinics in the South Bronx) were recruited to receive 2 consecutive treatment conditions of auricular acupressure, each lasting 3 weeks. All subjects had been diagnosed with more severe than average ADHD, had not experienced a successful response to medication and were referred by a treating professional. Subjects were matched for age, medication, and gender. They were then randomly assigned to Group 1, to receive the experimental condition first and the placebo condition second, or Group 2, to receive the same treatments in reverse order. Both conditions involved the placement of a small adhesive patch, at approximately the shenmen point, on the back of each ear. The experimental patches contained a magnetized acupressure bead, approximately the size of a sesame seed; a plain adhesive patch with no bead attached was used as placebo. Parents were trained by an expert in acupressure to administer the treatment and apply replacement patches as needed. Parents completed the Connors’ Parent Rating Scale (CPRS) and teachers completed the Connors’ Teacher Rating Scale (CTRS) pre and post treatments 1 and 2. At the conclusion of both treatments, subjects completed a symptom self-report questionnaire while parents completed a brief questionnaire about treatment compliance and behavior.

Preliminary analysis of the results indicates that parents could not be adequately blinded and the CPRS was difficult to complete appropriately. The teachers rating scale could be used for outcome evaluations. 32 of the 48 teacher participants had CTRS completed at baseline and subsequent to the first half of the crossover design. Very few teachers completed the final CTRS. Therefore the study was evaluated only as a comparison between 17 subjects in Group 1 and 15 in Group 2. Using an outcome measure of seven or more points (³ 10%) drop in the teachers’ and in the parents’ scores to indicate a beneficial effect, the preliminary findings were that 6 of 17 subjects had a beneficial effect with the bead, while 1 of 15 had a beneficial effect with the placebo patch. The mean differences in the bead group were 12 in CTRS and 16 in CPRS. The single subject responding well to the placebo patch had a 17-point difference in CTRS and a 20-point difference in CPRS. These findings show a significant treatment effect.