For macro photography sometimes you simply have to bite the bullet and use f/32 or even f/48 - Diffraction is an issue, yes. But sometimes getting the shot is more important. TS-E lenses reduce the need of small f stops due to the scheimpflug effect - but for SLR cameras these are expensive lenses, and there isn't much variation in terms of focal length or aperture speeds with TS-E lenses.
With large format you can exploit the scheimpflug effect with practically any lens*. With a medium format digital back sensor which is typically smaller than a 4X5 negative you can get away with some pretty insane camera movements - this is why large format will always have an edge over smaller formats the inherent flexibility delivered through simplicity.
Bear in mind these are 100% crops from a Pentax K5IIs
As the actor Michael Caine once said " you eventually get to the point where you have to say f*ck it, I don't care! and just get the job done"
*though the Imaging circle projected by the lens does restrain the use of tilts/shifts.