Shared names, different diseases: concordance of Thai traditional Tor diagnoses with biomedical eye conditions and back skin lesions.

BACKGROUND: In Thailand, many eye diseases are described under the umbrella term tor, originating from Thai Traditional Medicine (TTM), including pinguecula, pterygium, cataract, and glaucoma (torlom, tornuea, torkrajok, and torhin). Ophthalmologists often use these terms as labels for biomedical diagnoses, whereas TTM practitioners use them within a traditional framework that includes characteristic back skin lesions. Apparent disagreement between diagnoses may therefore reflect nosologic mismatch rather than simple error. This study aimed to compare TTM tor diagnoses with ophthalmic diagnoses and to examine the association between tor categories and back skin lesion types. METHODS: We conducted a double-blind study in adults attending a university ophthalmology clinic and an affiliated TTM clinic. All participants underwent ophthalmic examination and independent assessment by an ophthalmologist and a TTM practitioner. Back skin lesions identified as tor-related were photographed with dermoscopy and classified by a dermatologist. Agreement between TTM and ophthalmic diagnoses was evaluated using Cohen's kappa, and the association between TTM diagnosis and lesion type was tested with Fisher's exact test. RESULTS: Of 140 enrolled participants, 128 were included in the ophthalmic analysis. Tornuea showed moderate agreement with pterygium (κ = 0.598) and torhin with glaucoma (κ = 0.407), whereas torlom and torkrajok showed no agreement with pinguecula or cataract. Among 186 skin lesions, there was no significant association between TTM diagnosis and dermatologic lesion type. CONCLUSION: TTM tor diagnoses therefore only partly overlap with biomedical eye disease categories, and tor-related back lesions appear to be benign rather than disease-specific markers.