The model of western integrative medicine: The role of Chinese medicine

The basic concept of integrative medicine(IM) is that by combining mainstream(biomedicine) with complementary and alternative medicine(CAM), synergistic therapeutic effects can be attained.When the methods of mind/body medicine(MBM) are added to this combination,as in Western countries,a new concept emerges that drastically changes the approach toward illness. It is interesting to note that the joining of traditional Chinese medicine and Western medicine in the early days of the Peoples’ Republic of China preceded the Western model of IM by almost 50 years.Several elements that make up the key components of IM as practiced today in the West were already present in the Chinese version of IM,and Chinese medicine has played and continues to play an important role in advancing IM.However,one of the major differences between the Chinese and the Western models of IM today,besides MBM and some other treatment options,is that Western integrative medicine(WIM) strictly requires its CAM methods to be supported by scientific evidence. The therapeutic methods of IM and their applications are many and varied.However,they are most frequently employed to treat chronic medical conditions,e.g.,bronchial asthma,rheumatic disease, chronic inflammatory bowel disorder and chronic pain.Other fields in which IM may be applied are internal medicine(inflammatory bowel diseases and cardiovascular diseases),musculoskeletal disorders,oncology (chemotherapy-induced side effects),obstetrics and gynecology(dysmenorrhea,endometriosis,infertility and menopausal complaints),pediatrics,geriatrics,neurology(migraine and chronic headache),and psychiatry (anxiety and depression). The concept of WIM is discussed here in detail by reviewing its scope and implications for the practice of medicine and focusing on the role of Chinese medicine in WIM.     

中医药在康复医学中的循证实践

Chinese medicine is among other traditional medical systems practiced either as a coadjutant intervention to Greek medicine or as the unique therapeutic intervention for illness prevention,treatment or rehabilitation.The complete spectrum from that traditional system includes acupuncture and moxibustion,herbal and food therapy,massage therapy(tuina),physical exercises(taijiquan),and breathing exercises(qigong).In this article,it is presented several randomized controlled trials and systematic reviews on the application of all therapeutic modalities from Chinese medicine in the physical rehabilitation scenario.The discussed studies encompasses both "positive" and "negative" results of Chinese medicine intervention for disabilities due to illnesses of the nervous,musculoskeletal or cardiovascular systems.Additionally,the importance of the personalized approach for Chinese medicineand rehabilitation is emphasized together with the need for reproducible methods for pattern differentiation and intervention selection.Chinese medicine resources are recognized as promising methods for therapeutic rehabilitation and can be incorporated into the rehabilitation science.The wide variety of therapeutic resources explains why Chinese medicine is currently a multidisciplinary practice for health protection and promotion,early diagnosis and treatment as well as rehabilitation with roles in the public health care system.     

The new strategy for modulating dyslipidemia: Consideration from updated understanding on high-density lipoprotein

With further researches on blood lipids and atherosclerosis,especially after the conception of"residual cardiovascular risk",high-density lipoprotein cholesterol(HDL-C) becomes a new therapeutic target against atherosclerosis.However,the failure of ILLUMINATE study that was targeted at raising HDL-C level disappointed cardiologists all over the world,which indicates the limitation of HDL-C concentration in representing HDL function.The updated understanding of HDL from"quantity"to"quality"brings a new cut-in point for integrative Chinese and Western medicine in preventing and treating dyslipidemia and atherosclerosis. In addition to highlighting statins in directly intervening low-density lipoprotein cholesterol,we should make full use of the superiority of Chinese medicine in overall regulation and individualized treatment to promote the self-healing capacity of the patients,which further regulates abnormity of both concentration and function of the whole blood lipid family to equilibrium.This new strategy for modulating dyslipidemia with mutual complement of advantages from Western and Chinese medicines will no doubt play an important role in future therapies.     

Meta-analysis of the effectiveness of Chinese and Western integrative medicine on medium and advanced lung cancer

<正>Objective:To summarize the effectiveness of Chinese and Western integrative medicine in treating medium and advanced lung cancer,and to provide guidelines for clinical application.Methods:For this metaanalysis, a comparative search of Chinese medicine data in Chinese National Knowledge Infrastructure(CNKI) and Chinese BioMedical Literature Database(CBM) was undertaken to identify articles related to randomized comparative research of Chinese and Western integrative medicine in treating medium and advanced lung cancer between 1996 to 2006.Quality of life(QOL) was estimated using RevMan 4.2 software for data processing, adopting the odd ratio(OR) and the 95%confidence interval(CI).Results:Through meta-analysis of 10 qualified articles,the results were as follows:the merging effectiveness of QOL[OR=3.80,95%CI(2.65,5.47)];the rate of survival[OR=3.44,95%CI(2.04,5.80)];the tumor response rate[OR=1.88,95%CI(1.37,2.58)];the tumor developing rate[OR=0.33,95%CI(0.23,0.48)].Significant differences existed between the Chinese and Western integrative medicine treatment group and the Western treatment group(P0.01).Conclusions:Chinese and Western integrative medicine treatment of medium and advanced lung cancer has shown to improve patients' QOL and survival rate;it also can control tumor development in the short term.     

AN OBSERVATION ON COMBINED USE OF CHEMOTHERAPY AND TRADITIONAL CHINESE MEDICINE TO RELIEVE CANCER PAIN

We have treated 50 patients with stage Ⅲ, Ⅵmalignant tumors confirmed by pathology. The patients were divided into two groups. One group was treated by combination of chemotherapy and traditional Chinese medicine (treatment group); the other only by chemotherapy (control group). The effect of cancer treatment was evaluated according to the criteria of WHO. The results showed that the effective rate was 80% in treatment group and 52% in control group. The pain relieving rate was 68% in treatment group and 40% in control group (P< 0.01). This fact demonstrates that the application of traditional Chinese medicine can invigorate blood circulation, eliminate blood stasis, soften hardness and dissolve the mass, nourish blood and increase vigor. This kind of application can not only enhance the effect of cancer treatment but also increase the cancer pain relieving rate.     

Use of Traditional Chinese Medicine in Chinese Patients with Coronary Heart Disease

Objective To study the use of traditional Chinese medicine(TCM)or both TCM and guideline-recommended Western medicine(WM)in Chinese patients with coronary heart disease(CHD).Methods A cross-sectional nationwide survey of 2803 CHD outpatients was completed by collecting information,including general demographic data,disease history,and use of drugs(including TCM and WM).Results Of the 2712 CHD outpatients with complete drug treatment data,only 3.1% received TCM without any WM for CHD,30.0% received both TCM and WM recommended by current CHD guidelines,and 66.9% received only WM.Patients with a longer history of CHD or with a history of stroke,were more likely to use TCM.However,90.6% of CHD patients who used TCM also used certain WM.Furthermore,patients who used more types of TCM tended to use much less WM recommended by current guidelines.Conclusion A substantial proportion of Chinese CHD outpatients use both TCM and WM for secondary prevention of CHD.It is important to assess the effect of combined TCM and WM on major clinical outcomes in Chinese CHD patients.     

Which Research Is Needed to Support Clinical Decision-Making on Integrative Medicine?——Can Comparative Effectiveness Research Close the Gap?

<正>In clinical research on complementary and integrative medicine, experts and scientists have often pursued a research agenda in spite of an incomplete understanding of the needs of end users.Consequently,the majority of previous clinical trials have mainly assessed the efficacy of interventions.Scant data is available on their effectiveness.Comparative effectiveness research(CER) promises to support decision makers by generating evidence that compares the benefits and harms of the best care options.This evidence,more generalizable than the evidence generated by traditional randomized controlled trials(RCTs),is better suited to inform real-world care decisions.An emphasis on CER supports the development of the evidence base for clinical and policy decision-making.Whereas in most areas of complementary and integrative medicine data on comparative effectiveness is scarce,available acupuncture research already contributes to CER evidence.This paper will introduce CER and make suggestions for future research.     

Identifying the targets for treatment of liver fibrosis and hepatocellular carcinoma from both Western medicine and Chinese medicine

<正>Liver fibrosis and hepatocellular carcinoma(HCC) are emerging health problems worldwide.Number of death due to HCC was steadily increased during the last decade.Although liver fibrosis and HCC have been investigated extensively,there are no successful and/or satisfactory therapies especially for patients with HCC.From our understanding of both Western medicine and Chinese medicine,it could identify the targets in liver fibrosis and HCC for intervention with Chinese medicine such as bone morphogenetic protein 4(BMP-4).BMP-4 expression was significantly increased in both liver fibrosis and HCC and saponin class of certain Chinese herbs could regulate its expression.Therefore,BMP-4 could be one of the targets for treatment of liver fibrosis and HCC from integrative medicine.     

Chinese medicine approach in clinical practice for breast cancer survivors

A Chinese medicine(CM) approach,designed based on the clinical experiences of the West Los Angeles Center for Traditional Chinese Medicine,is a practical path for assessing and treating breast cancer survivors.The approach consists of balancing the body with deciphering the cause of the patient’s chief complaints by assessing and recognizing the six physiological dysfunctions that include gastrointestinal problems,sleeps problems,emotional imbalance,low body energy,menstrual change and pain.Muitifaceted interventions are used for eliminating various CM pathologies based on identifying the basic CM patterns (syndromes) differentiation.Watching to assess the above two situations dynamically is used for outcome evaluation and predicting prognosis.Therefore this approach is called BMW.It can serve as a reference for CM clinical practice and integrative clinical care.It also can be used to simplify the clinical interpretation of CM and provide an easier way for CM doctors to communicate with Western medical doctors and patients. Additionally,it can be used as a guide for patients to assess their own symptoms for self-monitoring and self-care.     

中医药教育在美国发展现状及挑战

Over the past 4 decades Chinese medicine （CM） has comeincreasingly into the spotlight in the United States as the clinical effectiveness ofCM has been not only empirically well-tested over a long period of time but alsoproven by recent scientific research. It has proven cost effectiveness, safety, andis authorized for natural and holistic approaches. In consideration, CM is one of theunderutilized health care professions in the United States with a promising future.However, CM faces many challenges in its education and system, its niche in thehealth care system as an independent profession, legal and ethical issues. This paperdiscusses the confronting issues in the United States： present education, standardsof CM education with shifting first professional degree level, new delivery systemsof CM education. Development of new research models, training of evidence-basedpractice, and implementation of integrative medicine into CM education also are the key issues in the currentCM profession. This paper also discusses opportunities for the CM profession going beyond the current status,especially with a focus on fusion medicine.     

Review on efficacy and health services research studies of complementary and alternative medicine in inflammatory bowel disease

Objective:To assess the evidence of the use and efficacy for complementary and alternative medicine(CAM) in inflammatory bowel disease(IBD). Methods:A systematic literature search in MEDLINE was performed for randomized controlled trials(RCTs) in Crohn’s disease and ulcerative colitis.Moreover,a selective literature search for health services research studies on the use of CAM in patients with IBD was performed.Results:Health services research studies showed a high use of CAM in adult and pediatric patients with IBD worldwide.In contrast to the high use among IBD patients,there was a lack of high-quality data for many of the used CAM methods.Although most of the studies showed positive results,the methodological quality of most studies was rather low;therefore,the results had to be interpreted with caution.While there were many studies for probiotics and fish oil,RCTs for the highly used method homeopathy, for most herbal products,and for traditional Chinese medicine methods apart from acupuncture RCTs were completely lacking.Conclusions:The lack of high-quality studies might be the consequence of the problems associated with the funding of clinical trials involving CAM.However,having the high user rates in mind,high-quality studies assessing efficacy and safety of those methods are urgently needed.Furthermore,there is a need for better representation of CAM in undergraduate and postgraduate medical education.     

Complementary and Alternative Medicine Therapies for Chronic Pain

Pain afflicts over 50 million people in the US, with 30.7% US adults suffering with chronic pain. Despite advances in therapies, many patients will continue to deal with ongoing symptoms that are not fully addressed by the best conventional medicine has to offer them. The patients frequently turn to therapies outside the usual purview of conventional medicine(herbs, acupuncture, meditation, etc.) called complementary and alternative medicine(CAM). Academic and governmental groups are also starting to incorporate CAM recommendations into chronic pain management strategies. Thus, for any physician who care for patients with chronic pain, having some familiarity with these therapies—including risks and benefits—will be key to helping guide patients in making evidence-based, well informed decisions about whether or not to use such therapies. On the other hand, if a CAM therapy has evidence of both safety and efficacy then not making it available to a patientwho is suffering does not meet the need of the patient. We summarize the current evidence of a wide variety of CAM modalities that have potential for helping patients with chronic pain in this article. The triad of chronic pain symptoms, ready access to information on the internet, and growing patient empowerment suggest that CAM therapies will remain a consistent part of the healthcare of patients dealing with chronic pain.     

Herbal Medicine in the Treatment of Alzheimer’s Disease

Associated with the aging of our world population is a sharp increase in the incidence of Alzheimer’s disease,which not only poses a significant health issue but also presents a serious social problem.Although pharmacological treatments were developed based on existing hypotheses,the disease pathogenesis remains to be fully elucidated.Given the complexity of Alzheimer’s disease,Chinese herbal medicine appears to have therapeutic potential for Alzheimer’s disease through multi-target and multi-pathway approach at cellular and molecular levels and holistic adjustment of the body at organ system levels.Recently,a significant breakthrough has been made in the research of Chinese medicine for Alzheimer’s disease.In this article,we review the experimental research progress in understanding how Chinese medicine could be used for the treatment of Alzheimer’s disease.     

Effect and prognostic analysis of treatment for acute myeloid leukemia using Chinese drugs combined with chemotherapy

Objective:To observe the clinical efficacy of Chinese drugs combined with chemotherapy in the treatment of acute myeloid leukemia(AML) and to investigate the prognostic relevance of the main parameters in AML treated with integrative medicine.Methods:Forty AML patients hospitalized at the authors' hospital were treated with Chinese drugs and chemotherapy.The routine examination,immunophenotype and karyotype analyses were carried out.The clinical efficacy was observed and the prognostic factors were analy...     

A survey of complementary and alternative medicine in Iran

Objective:To survey the use,capability and satisfaction of complementary and alternative medicine(CAM)in comparison with conventional medicine in Iran.Methods:In this national survey,a cross-sectional study was designed,5,000 people were surveyed to identify predictors of Iranian traditional medicine(ITM)use compared with conventional medicine.Data were collected through a questionnaire that covered three different predictor categories: demographic information,patient’s viewpoint,and patients’ experiences.Results: Most of the participants preferred government owned hospitals rather than other places.Praying for one’s own health was the most frequent and favorable ITM domain(P=0.017)based on patients’ interests,both in low-(P=0.08)and highlevel (P=0.011)educated subjects.Among the participants,97.8%had previous conventional medicine history due to their chronic diseases Conclusions:Iranian patients resort to ITM as a choice at the late stage of the disease.Current deficiency in integration of CAM and conventional medicine is in contrast to the increasing demand on patients’ side.Health care organizers should be facilitating the CAM services by tuition of CAM practitioners and supporting eligible CAM centers for diagnosis and treatment of patients.     

Chinese Medicine for Treating Diabetic Nephropathy

Diabetic nephropathy is one of the main causes of renal end-stage disease.The pathogenesis of diabetic nephropathy is complex.The current treatment is only for a particular cause without multi-target therapeutic drugs.Chinese medicine is a great treasure with multi-component complex drugs interacting with multiple targets and functions.This paper reviewed the protective effect of Chinese medicine for treating diabetic nephropathy in clinical studies,in vivo studies,and in vitro studies.The possible mechanisms,the major compounds and active crude drugs were also summarized.It was shown that Chinese medicine could not only relieve several symptoms and improve the quality of life,but also reduce the levels of proteinuria and kidney damage,and further improve renal function via multiple pathways based on the whole human system.Moreover, there were no reports of severe adverse reactions during the treatment.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

Colon May Provide New Therapeutic Targets for Treatment of Chronic Kidney Disease with Chinese Medicine

Chronic kidney disease(CKD) has become a worldwide health and social problem.Retarding its progression to end-stage renal disease is beneficial both to the patients and the healthcare system.Plenty of clinical trials have indicated that enema with Chinese medicine could effectively prevent chronic renal failure,and was widely used in the clinical practice.However,studies on mechanism were still nearly blank,which may prevent further improvement of therapeutic efficacy.Recent studies had discovered that colon was an important organ where uremic toxins were generated.The uremic toxins involved could not only promote CKD progression,but also was closely correlated with CKD mortality.Reducing production and promoting excretion of toxins were confirmed to reduce renal tubule interstitial fibrosis and delay renal progression.On the basis of the theory of gut-kidney axis above,we had conducted pilot clinical researches to evaluate the effect of enema with Chinese medicine on the intestinal flora,gut barrier,enterogenous uremic toxins and renal protection.The preliminary results revealed that rheum enema through colon could accelerate intestinal dynamics,improve intestinal barrier function,regulate intestinal flora and reduce production and absorption of intestine-derived uremic toxins such as indoxyl sulfate,which may reduce renal fibrosis and delay renal progression.Further studies could provide more evidence for colon as a new therapeutic target for the treatment of CKD with Chinese medicine.     

The Therapeutic Effects of the Radiotherapy Plus TCM Treatment Observed in Senile Non-Parvicellular Lung Cancer Patients at the Late Stage

47 senile non-parvicellular lung cancer patients at stage Ⅲ or Ⅳ were randomly divided into a treatmentgroup (26 cases) treated by radiotherapy plus traditional Chinese medicine (TCM) and a control group (21cases) treated only by radiotherapy for observation of the therapeutic effects.The patients in the treatmentgroup orally took Chinese medicine during and after the radiotherapy.There was no obvious difference inshort-term therapeutic effects between the two groups,but the long-term curative effects in the treatmentgroup was obviously superior to that in the control group (P<0.05 or P<0.01).Conclusion:radiotherapy plusTCM can prolong the survival period for senile non-parvicellular lung cancer patients.