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Background Treatment of patients according to individual pattern diagnoses is an important feature of acupuncture rooted in traditional Chinese medicine (TCM). Little is known about the reliability of TCM pattern diagnoses. Objective To examine in a cross-sectional study the inter-rater reliability of TCM diagnoses and acupuncture point selection.Methods 30 infertile and 24 previously pregnant women were examined for TCM patterns by two acupuncturists. An operational interview guide related to gynaecology was used. The acupuncturists independently decided on the TCM patterns (categorised as excess, defi ciency and merged patterns) and the prescription of acupuncture points. Kappa Statistics were used in the analyses. Results 39 different TCM patterns and 36 different acupuncture points were used. For the choice of acupuncture points, poor to no agreement was found. Moderate to fair agreement was seen in excess/defi ciency and merged patterns. Perfect match to moderate agreement on treatment was obtained when choosing meridians given certain TCM patterns. Conclusions The low agreement on diagnoses indicates that acupuncturists follow individual pattern differentiation processes. The selection of acupuncture points seem to be closely related to the choice of TCM pattern diagnoses. The results indicate that the poor reliability in the diagnoses and thus treatment received by a patient will vary individually, which in turn is a challenge for clinical trials of acupuncture. INTRODUCTION Acupuncture is commonly used as an adjunct to in vitro fertilisation (IVF).1 Although IVF and acupuncture is an active area of research, 1 2 the results of studies are diffi cult to interpret and compare because of a large variation in diagnostic criteria for patient inclusion and in the choice of acupuncture points.1 This has been emphasised as a major obstacle for systematic reviews in this area. 3 4 Individualised pattern diagnoses (based on signs and symptoms) and treatment according to their individual patterns are important features of acupuncture rooted in traditional Chinese medicine (TCM). [5][6][7][8] To ensure consistent and optimal treatment the pattern diagnoses must be reliable, but only a few studies have assessed the reliability of diagnostic data collected during a TCM examination. 9O'Brien and Birch reviewed studies of the reliability of traditional East Asian medicine diagnoses and concluded that reliability of pattern diagnoses and treatment was low. 10 Reliability has been studied for different patient groups using a wide range of research designs. Some studies have examined how several clinicians diagnose and suggest treatment for one or only a few patients, 11 12 whereas others have compared pairs of clinicians examining a number of patients. 13 The results of these studies show no consistent pattern. A relatively good agreement has been reported for TCM diagnoses while suggestions for acupuncture points have shown greater variation. 12 Most of the studies report percentage agreement and sometimes the...

The results showed extensive variation and poor inter-rater reliability in TCM diagnoses. Demographic variables influenced the frequency of diagnoses and symptoms were used inconsistently to set a diagnosis. The variability shown could impede individually tailored treatment.

Background Acupuncture is rooted in traditional Chinese medicine (TCM) and emphasises individualised treatment according to TCM patterns. Eight TCM patterns are regarded as typical for female infertility. There are no empirical data comparing these patterns in fertile and infertile women. Objective To identify and compare the TCM patterns and recommended acupuncture points in infertile and fertile women. The hypothesis that infertile and fertile women should differ in occurrence of TCM patterns described as typical for infertility was examined. Methods A cross-sectional study examined the distribution of TCM patterns and acupuncture points among 24 infertile and 24 fertile women. TCM patterns and points proposed by two acupuncturists were analysed. The odds ratio was used as the effect measure. Results Three patterns were found in more than 92% of the women. Five patterns occurred more frequently among infertile (p≤0.03), and four among fertile (p≤0.02) women. Only three of the eight patterns assumed typical for infertile women were more common among infertile women. Two of the eight patterns were more common among fertile women. Acupuncture points KI3, LI3 and SP6 were chosen for almost all women, whereas CV4, CV3 and ST29 were chosen more often for infertile women (p<0.03), and SP3 more often for fertile women (p<0.001). Conclusion The data indicate that the presence of some, and the absence of other, TCM patterns are associated with infertility. These results are not consistent with the assumed associations between eight specifi c patterns and infertility, as maintained by TCM textbooks. INTRODUCTIONAcupuncture is rooted in traditional Chinese medicine (TCM) and emphasises individualised treatment. It is based on the selection of appropriate acupuncture points according to the TCM pattern diagnosis. [1][2][3][4] This approach is regarded as a key concept of TCM and one of its main distinguishing features.5 6 Pattern identifi cation is thus an important basis for treatment. Relevant TCM patterns for infertility are described in TCM textbooks. [7][8][9][10][11] The books are used as manuals for diagnostics and constitute the main framework for clinical practice and research. 8 10 12 Maciocia described eight TCM patterns as causes of female infertility; Kidney-'Yang defi ciency', Kidney-'Yin deficiency', 'Blood defi ciency', 'Cold in Uterus', 'Dampness in the Lower Burner', 'Blood Heat', 'Qi stagnation' and 'Stasis of Blood'. 10Hence, we should expect to fi nd these TCM patterns in infertile women. Furthermore, Maciocia also recommended appropriate acupuncture points to treat patients with these TCM patterns, 10 suggesting that these points should be commonly recommended for infertile women when examined by acupuncturists.Coyle and Smith explored the prevalence of the eight TCM patterns described by Maciocia 10 as relevant for infertility. 13 About half of the women were diagnosed with Kidney-Yang defi ciency and Kidney-Yin defi ciency. The other fi ve diagnoses were present in about onethird or less of ...

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