Abstract
Objectives This study aimed to propose biomarkers for diagnosing Chuna manual therapy (CMT) based on X-ray images in the thoracic and lumbar spines.
 Methods Through a literature review and expert consensus process, diagnostic bio- markers for CMT were selected based on the listing system in thoracic and lumbar ra- diograph anterior-posterior (AP) and lateral views.
 Results 1. Diagnostic biomarkers were derived from four points on the outer contour of the vertebral body in the thoracic and lumbar spine radiograph lateral view, en- abling the diagnosis of flexion and extension malposition. 2. Additional diagnostic bi- omarkers were identified in the thoracic and lumbar radiographAP view, utilizing points on the outer contour of the vertebral body. These biomarkers facilitate the di- agnosis of lateral bending. Moreover, biomarkers derived from the innermost point of the pedicle contour allow for the diagnosis of rotation malposition. 3. Furthermore, through the biomarkers proposed in this study, all malpositions of the thoracolumbar spines and complex Type I and II malpositions can be diagnosed in CMT.
 Conclusions The biomarkers reported in this study consist of minimal points to de- termine the position of the vertebral body, providing the advantage of simplicity while minimizing potential errors during the CMT diagnostic process. Further clinical re- search and the development of related programs should be pursued to expand the evidence for CMT.
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