The Chinese Medical Diagnostic Descriptor
The Chinese Medical Diagnostic Descriptor (CMDD) was developed by Michael Popplewell as part of his PhD at the University of Technology, Sydney. The CMDD is designed to enable a true opinion of a patient’s constitution to be recorded by a practitioner, while using a minimal number of variables. As there are only 15 diagnostic descriptors in the CMDD, non-selection or a low scoring of a variable is as important as scoring it highly. All descriptor scores made as part of a diagnosis go towards the calculation of agreement between practitioners who would have diagnosed the same patient. Agreement between practitioners diagnosing patients from an open population using the CMDD is about to be reported in a research paper by Michael Popplewell etal. This format provides a solid foundation examining the treatments recorded by different practitioners from a Chinese medical perspective.

This is in contrast with the contemporary approach of choosing one, two or more of over 100 Chinese Medical (CM) patterns, where precise agreement is virtually impossible to obtain, as is also about to be published in a research paper by Michael Popplewell etal.

A schematic of the CMDD is presented in figure 1, with the descriptors arranged in three columns; the first pathogenic issues, the second Chinese medical factors and the last the elements/organs. The colours in figure 1 conform to the representations of the descriptors in the earliest classics .

Figure 1. The Chinese Medical Diagnostic Descriptor (CMDD)

The fifteen descriptors of the CMDD conform to the definitions of CM terms as set out the ‘WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region’ . In contemporary diagnosis, over one hundred patterns are utilised. In the contemporary diagnostic approach, non-selection of many patterns occurs in every diagnosis due to the large number of options available. In an effort to reduce the number of descriptors in the CMDD, Yang organs are attributed to their Yin counterparts, Jing Xu is seen as a kind of Yin Xu, and Phlegm is accepted as an expression of Damp. Bi Syndromes are described where appropriate as combinations of the descriptors.

Each descriptor is scored with a 0-5 scale, where 0 represents the absence and 5 represents the maximum expression of the pathology in this descriptor. This use of a Likert scale is an important innovation over the current approach of CM diagnosis practice of stating primary, secondary and even tertiary patterns. The use of a linear scale also enables the utilization of weighted versions of chance removed agreement statistics to determine the level of change of patient’s symptoms. In contemporary CM a pattern is recorded with shades of severity not clearly expressed, except possibly by the descriptive wording of pattern severity such as mild or strong, which are vulnerable to semantic interpretation.

A feature of the CMDD is that any diagnosis that can be expressed in the CM terminology, either a combination of many patterns or simple, single pattern diagnosis, can be recorded in the CMDD format.

An example of the CMDD format that is used in the True Results program will now be given in Figure 2. In this example a patient with back pain is shown. He was diagnosed as a complex case; with liver blood deficiency, kidney deficiency, qi and blood stasis with cold and damp. All are recorded in the one CMDD profile.

Figure 2. An example of the constitution of a patient with back pain using the CMDD.

Total Pathogenic Score
Additionally, descriptor scoring within the CMDD enables a Total Pathogenic Score (TPS) to be calculated. The TPS is the sum of scores from all descriptors, and can be used as a generalized wellness measure of a patient within CM terms. In the example shown in Figure 2, the TPS value is 15. The TPS can also be used to reliably track changes in the overall health of a patient, where lower a TPS indicates an improvement in health and vice-versa. Score changes in a subject’s health status recorded by the same practitioner should be more useful for the determination of health changes than absolute descriptor scores, due to possible practitioner scoring biases.

Creating and Updating Client Records
During the initial consultation, you may want to use the paper paper forms we provide, but soon you may find that it is much faster to record even the initial session on your PC or iPad during the interview.

Please Note: It is important to record all treatment interventions with as much detail as possible. For instance don’t add groups of acupuncture points to your treatments, add each point separately. Adding groups of points as a single treatment prevents future analysis across many clinics to determine the points are associated with the best effect.

Updating a patient’s record after the first session with a patient is simple. Just adjust scores of or add/remove the previous Key Symptoms, import and update the previous CMDD profile and update Other Influences section. Then import and adjust a previous treatment to quickly record your treatment and patient’s progress.

Completed Treatment Units
Apart from the CMDD, another key attribute of the True Results program is the concept of Completed Treatment Units (CTUs). CTUs consist of the combination of a record of a patient’s symptoms, their CMDD constitutional diagnosis, a detailed information of treatment interventions applied, other influences (such as Western medication, other therapies, relationship stress etc) AND the updating of their CMDD, symptoms and other influences within two weeks of the treatment, to capture the effects of treatment interventions. A visualisation of the CTU concept is presented below.

Figure 3 A visualisation of a Completed Treatment Unit

Practitioners using the True Results program are encouraged to complete as many CTUs as possible by following up on patients who have not attended a session within two weeks and recording any changes in their symptom, OM constitution and other influences. It is planned in later versions of our software to provide a reminder system that prompt practitioners to follow up on incomplete CTUs and give feedback on the percentage of occasions CTUs were not completely recorded. This strategy of minimising CTU losses, also has an advantage of potentially improving client retention in participating clinics, as the follow-up is an opportunity to make a further treatment appointment if necessary.

CTUs are critical to work out what treatments are the most effective. We are currently working to include a new feature within the True Results program that enables you to search your clinic and the True Results Communities’ participating clinics de-identified treatment data. Difference(s) after treatments in patient’s Key Symptoms, CMDD descriptors and Other Factors after one or more treatments will be able to be analysed to find out what is associated with improvements. You will be able to look for interventions which are associated with the most improvements and those that seem to make no difference.

The collection of a large number of CTUs is a critical component of our strategy to provide you, the participating members of the True Results Community with reliable data of what is really working in clinics just like yours. We encourage you to follow up on patients who have not returned after a session to record the effects of your treatment. This can be done in the True Results program by creating another treatment session, editing the observations section and not recording any treatments.

Not only will you be completing more CTUs, but you will probably get better patient retention. You will also learn if your treatment was either so effective that they didn’t need to come (fantastic!), or made them worse and they were discouraged (not so fantastic, but useful and an opportunity to try to convince them to come again and make amends).