Sydrome Differentiation questionnaire

[Guest guest]

The following contains the information sheet, consent form and

questionnaire assessing syndrome differentiation among TCM

practitioners. I have just cut and pasted from a word file so the

resulting posting is pretty clunky. You can send your response to

me as an attachment (sh463) or post it c/o Flat 4 Dean

House, 193 High Street, EN3 4DZ. If you would like a word file,

then email me and I can send you the file.

 

Thanks for your responses

 

yours sue

 

PARTICIPANT INFORMATION SHEET

 

 

1. Study title

An assessment of syndrome differentiation among traditional Chinese

medicine (TCM) practitioners following the presentation of a case-

study and questionnaire.

 

2. Invitation paragraph

You are being invited to take part in a research study. Before you

decide whether to participate, it is important for you to understand

why the research is being done and what it involves. Please take

the time to read the following information carefully and discuss it

with others if you wish. Please ask if there is anything that is

not clear or if you would like more information or clarification.

Take time to decide whether or not you wish to take part.

 

3. What is the purpose of the study?

TCM is currently being re-formulated in order to integrate current

scientific medical research with ancient models and philosophical

concepts. There appears to be very little research into the

possible differences in approach to diagnosis and syndrome

differentiation in contemporary TCM.

Because of the complexity of current TCM practice, this research

will focus on a single case study. Analyses of the responses to the

case study, using questionnaires will be made, in order to determine

potential trends and divergences among contemporary TCM

practitioners. The study will be carried out over a 3 month period

from March – May 2005.

 

4. Why have I been chosen?

You have been chosen as a practitioner of Traditional Chinese

Medicine with valuable experience in syndrome differentiation.

 

5. Do I have to take part?

It is up to you to decide whether or not to take part. If you do

decide to take part you will be given this information sheet and a

signed consent form to keep. If you decide to take part you are

free to withdraw at any time without giving a reason.

 

6. What will happen to me if I take part?

If you decide to participate, you will be asked to read a case-study

which has been taken from the literature. For ethical reasons it is

not based upon a known or identifiable patient. Following this, you

will be asked to respond to a series of questions related to the

case-study. The questionnaire should not take longer than 20-25

minutes to complete. All participants will receive the same case-

study and related questionnaire.

 

The study being carried out will take the form of a survey. In a

survey, the aim is to collect information to answer the research

question through the use of a self completion questionnaire.

 

7. What do I have to do?

You are asked to read a case-study and answer a questionnaire. Your

participation is only necessary for the time it takes you to read

and answer the questions.

 

8. What are the possible disadvantages and risks of taking part?

I do not know of any risks arising from being in this study (see

also point 10)

 

9. What are the possible benefits of taking part?

TCM, as it is being developed, is attempting to integrate

contemporary scientific medical research with ancient models and

philosophical concepts. This research is investigating an area

which is under studied. You will be providing an evidence-base upon

which future research can be made.

 

10. Will my taking part in this study be kept confidential?

All information that is collected about you during the course of the

research will be kept strictly anonymous in the final report. Any

personal information, such as your name and address, shall not

appear in the report so that your comments and opinions will be

anonymous.

 

11. What will happen to the results of the research study?

This study will form part of an undergraduate dissertation for

Middlesex University's BSc Traditional

programme.

The resulting thesis will be available on request from the

researcher after it has been assessed by the University.

 

12. Who has reviewed the study?

This study has been reviewed by the Middlesex University Health

Studies Ethics Sub-Committee (HSESC).

 

13. Contact for Further Information

 

Principal Researcher: Suzette Humphreys

Undergraduate BSc Traditional

Middlesex University

Phone: 078 1463 7346

Email: sh463

Supervisor: Catherine Kerr

Programme Co-ordinator, BSc Health Sciences/Studies

School of Health and Social Sciences

Middlesex University

Phone: 020 8411 4595

Email: c.kerr

 

Thank you for participating in this study.

 

You will be given a copy of this information sheet and a signed

consent form to keep.

 

 

CONSENT FORM

 

 

Title of Project: An assessment of syndrome-differentiation among

traditional Chinese medicine (TCM) practitioners, following the

presentation of a case-study and questionnaire.

 

 

 

Name of Researcher: Suzette Humphreys

 

 

 

Please initial next to statement

 

___ I confirm that I have read and understood the information sheet

dated ....................... for the above study and have had the

opportunity to ask questions.

 

___ I understand that my participation is voluntary and that I am

free to withdraw at any time, without giving any reason.

 

___ I agree to take part in the above study.

 

 

 

________________________ ____________ ________________

Name of Participant Date Signature

 

 

_________________________ ____________ ________________

Name of Person taking consent Date Signature

(if different from researcher)

 

 

_________________________ _____________ ________________

Researcher Date Signature

 

 

1 copy for participant; 1 copy for researcher

 

 

QUESTIONNAIRE

 

A: About you (Please tick the relevant box)

Sex: ___ Female ___ Male

 

Age: ___<35 ___ 36–45 ___ 46–55 ___56–65 ___>66

 

Number of years TCM experience: ___0-1 ___1-5 ___5–10

___10–15

___>15

 

Case- study

A 35 year old female suffering from a red, itchy and raised patch of

eczema on the left side of anus for 20 years. It first appeared

when she was 15 and escalated in her mid-twenties, when she had a

difficult pregnancy termination, and has been a constant problem

since then. It occasionally oozes and at other times was extremely

dry, it worsens under stress.

Accompanying symptoms: recurrent sore throat, accompanied by yellow

sticky phlegm and red, swollen tonsils. She suffers from black

floaters and, on a few occasions, extreme stress brought on a white

light in the right visual field which disappeared when she relaxed.

She often suffered from severe distending abdominal pain with

flatulence if she did not eat on time. Sleep, appetite, bowels,

urination and sweat were all normal. Menstrual cycle is 26 days

long, she suffers from PMT (breast and abdominal distension, mood

swings, increased hunger and mood swings).

Tongue: pale with teeth marks, wet, sticky, thin and white coating

with red spots at the front.

Pulse: Right–thin; Left–choppy

 

[taken from Zeffert and Desser 1998, p41]

 

B: Diagnosis according to the Eight Principles (Please tick the

relevant box. Use the spaces provided to add details)

Is the pattern predominately:

___ Yin ___ Yang ___ Combination

 

Is the disorder located in:

___ Interior ___ Exterior ___ Combination

 

Is the nature of the disorder:

___ Hot ___ Cold ___ Combination

 

Is the disorder:

___Full ___ Empty ___ Combination

 

C: Diagnosis according to Qi, Blood, Yin, Yang and Body Fluids

(circle Yes or No and then use key to provide details) S = Stasis;

D = Deficiency; R = Rebellious; H = Heat; C = Cold; O = Other

(please specify)

Which substance(s), if any, is principally affected by the pattern

and how:

Key(s) Comments

Qi Yes / No ______ ________________________________

Blood Yes / No ______ ________________________________

Yin Yes / No ______ ________________________________

Yang Yes / No ______ ________________________________

Body fluids Yes / No ______ ________________________________

 

D: Diagnosis according to the Zang Fu organ system (please number 1

or more organ in the order most appropriate)

Which organ(s), if any, is principally affected by the pattern.

___ Liver ___ Gallbladder

___ Spleen ___ Stomach

___ Kidney ___ Bladder

___ Heart ___ Small Intestine

___ Lung ___ Large Intestine

___ Pericardium ___ San Jiao

 

E: Diagnosis according to the meridian (jing luo) system

(instructions as in D above).

Which meridian(s), if any, is principally affected

___ Liver ___ Gallbladder

___ Spleen ___ Stomach

___ Kidney ___ Bladder

___ Heart ___ Small Intestine

___ Lung ___ Large Intestine

___ Pericardium ___ San Jiao

___ Extra Meridian(s)

 

F: Diagnosis according to pathogenic factors (instructions as in D

above)

Which pathogenic factor(s), if any, is involved

___ Wind ___ Cold

___ Damp ___ Dry

___ Summer Heat ___ Fire

 

G: Diagnosis according to the 4 Levels (circle Yes or No. If Yes

add details in space)

Which level, if any, is involved

Defensive Qi Level Yes / No Pathological mechanism

 

Qi Level Yes / No Pathological mechanism

 

Nutritive Qi Level Yes / No Pathological mechanism

 

Blood Level Yes / No Pathological mechanism

 

 

H: Comments

Please comment on any other diagnostic point that may not have been

covered above

 

 

 

 

 

I: Your Opinion (please tick the appropriate box)

Would you expect wide variations in diagnosis in the above case-

study among practitioners?

___ Yes ___ No

If yes what is your opinion on the variation (tick the box

you most agree with)

___ Too much variation among practitioners raises questions

of objectivity and validity of TCM diagnosis

___ Some variation is inevitable among medical practitioners

of all medical traditions

___ Variation and plurality are integral to TCM and is one

of its strengths

___ Other please specify

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Note: This questionnaire is CONFIDENTIAL and will only be used for

research purposes. Your answers will not be shown to anyone else,

so feel free to say what you really think. If you do not wish to

answer a question or if it is not relevant to you, please leave it

blank. Please do not write your name. Thank you for your help!