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.     

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.     

Research on frequency of application with modern Chinese herbal medicine

Objective:To study the relationship between 500 kinds of commonly used Chinese herbal medicine and the classification of their efficacies in Chinese Materia Medica in relation to the common diseases listed in Internal Medicine.Methods:Database retrieval frequency of the quantitative statistical method was adopted.First,the 8 980 kinds of Chinese herbal medicine recorded in Chinese Materia Medica were used as the original search objects,and 4 493 kinds which were cited in more than five articles were picked out and then rechecked for further title citations.Second,as judged based on the Criterion,the numbers of articles which included the medicines in the line of standards were examined.As a result,500 species of Chinese herbal medicine were singled out based on their retrieval frequency and were then used for compilation of the classification statistics according to their efficacy and the common diseases in Internal Medicine.Results:From the classification of Chinese medicines,herbs with wide efficiency and a meek nature had higher frequencies, but those which were not appropriate as decoctions had relatively lower frequencies.However,according to the average frequency,the Chinese herbal medicine for nourishing qi and tonifying blood,at 36 346 times and 34 544 times,respectively,were the most commonly used.Analyzed from the frequency of application of the Chinese medicine in the treatment of common diseases,most of the top 10 kinds of Chinese herbal medicine with the highest frequencies generally coincided with the 500 selected medicines.In addition,the Chinese medicines with clear pharmacological efficiency were easily isolated and purified to be made into injections, although other forms are more commonly used.Conclusion:The results of the research objectively reflected the current applications of Chinese herbal medicine,and could be used as references in teaching,research,clinical applications,and in compiling and increasing the drugs in textbooks and Pharmacopoeia.     

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.     

Therapeutic effect of Chinese herbal medicine for strengthening qi, nourishing yin, and removing stasis on serum osteopontin and quality of life of patients with primary Sjogren's syndrome

Objective:To observe the therapeutic effect of Chinese herbal medicine for strengthening qi, nourishing yin,and removing stasis on serum osteopontin(OPN) and quality of life(QOL) in patients with primary Sjogren’s syndrome(pSS) and to study the correlation between OPN level and the disease.Methods:Sixtyeight pSS patients were randomly assigned to two groups:the treatment group(35 cases) treated by Chinese herbal medicine for strengthening qi,nourishing yin,and removing stasis combined with hydroxychloroquine sulfate tablet(HCQ) and the control group(33 cases) treated by HCQ only.Both were treated for 3 months. Before and after treatment,immunoglobulin G(IgG) level,erythrocyte sedimentation rate(ESR),and OPN level were measured.The QOL in patients was evaluated using the Short Form-36 Health Survey(SF-36) before and after treatment.Thirty healthy females were taken as the normal control.Results:Before treatment,levels of IgG,ESR,and OPN in patients were higher than those in the normal control.After 3 months of treatment, those in both treatment groups decreased but were lower in the treatment group than those in the control group (P<0.05).The scores of 8 dimensions of SF-36 were lower in the pSS patients than those in the normal control (P<0.05) and higher in the treatment group than in the control group after treatment(P<0.05).Furthermore, there was a positive correlation between the levels of OPN and the levels of IgG and ESR,and a negative correlation between OPN levels and the overall score of SF-36(P<0.05).Conclusions:Chinese herbal medicine for strengthening qi,nourishing yin,and removing stasis could alleviate pSS disease and improve the QOL.In addition,the OPN level might be used as an evaluating index for pSS disease.     

设计适合传统东亚医学系统和方法的临床研究-聚焦模式辨识

ABSTRACT This article is based on two presentations held at Chinese medicine conference in Rothenburg （2013）, Germany and at the 19th Anniversary of Korean Institute of Oriental Medicine （KIOM） International Symposium of Current Research Trends in Traditional Medicine - Pattern of Identification （2013）. In designing clinical studies, it is a research question that leads to appropriate study design. However, they are mostly diagnostic procedures and techniques that are the key points to reflect the application of systems and methods in all forms of medicine - traditional East Asian medicine （TEAM） is no exception. The challenges within TEAM based on research reflect in different systems of medicine/theories such as traditional Japanese acupuncture, traditional Korean acupuncture and traditional Chinese acupuncture. This diversitv of medical svstems and methods applied in East Asia seems to have beenfruitful within the different countries and traditional medicines have found their places within the respective countries health systems. The existing diversity, from a clinician＇s point of view, may be viewed as a treasure when dealing with patients in the ＇real world＇. On the other hand, this diversity seems to challenge the scientific mind worldwide, esoeciallv when it comes to research. Hence. there is a and between clinical practice and research.     

Current situation and progress in integrative medicine in China

In the past 50 years, integration of traditional Chinese medicine and Western medicine, known as the Chinese version of integrative medicine （IM）, has achieved significant developments. In this article, the present situation and progress in IM development in China are summarized from the aspects of IM application, policy making, scientific research, education, academic exchanges, and its future development. With continuous support from the Chinese government and successful scientific achievements in the past 50 years, the authors believe that IM will be moving forwards to a full globalization.     

Principles of ethics review on traditional medicine and the practice of institute review board in China

As one of the significant parts of medical science research in China,the research on Chinese medicine(CM) reflects the essence of healthcare tradition in the country both theoretically and clinically, and embodies the values of Chinese culture.Therefore,in the practice of ethics review on CM research protocols,besides abiding by the contemporary prevalent international principles and guidelines on bioethics, which emphasizes the scientific and bioethical value of the study,we should also stress the CM theoretical background and relevant clinical experience in the framework of Chinese culture and values.In this paper, we went over the traits of CM clinical research and the experience from the practice of ethics review by the institution review board for bioethics,and then attempted to summarize the key points for the bioethics review to CM researches in China,so as to serve as reference for the bioethics review to traditional and alternative medicine researches.     

Parallel Subgroup Design of a Randomized Controlled Clinical Trial——Comparing the Approaches of Chinese Medicine and Western Medicine

A new method for the comparison of the treatment efficacy for specific diseases or conditions between Chinese medicine and Western medicine, which serve the same medical aim but are based on substantially different theoretical systems, was identified. Abiding by the principle of parallel subgroup design of a randomized controlled trial （PSD-RCT）, participants were recruited following identical inclusion and exclusion criteria and were randomly allocated into two groups to receive treatment using the respective approaches of Chinese medicine and Western medicine. The Chinese medicine group was divided into subgroups according to the theory of Chinese medicine and the Western medicine group was also divided into subgroups according to the theory of Western medicine. The treatment for each subgroup was well defined in the protocol, including major formulae and principles for individualized modifications. The primary outcome measure was ascertained to be directly related to the patients＇ status but independent from both theories of Chinese medicine and Western medicine, while the secondary outcomes were represented by the patient-reported outcomes and some laboratory tests commonly accepted by Chinese medicine and Western medicine. Then, taking functional dyspepsia as an example, the authors explain the framework of the PSD-RCT for efficacy comparisons between Chinese medicine and Western medicine, and recommend that the PSD-RCT can be used to compare treatment efficacy for a specific disease or condition between Chinese medicine and Western medicine, and the comparison among subgroups can provide valuable clues for further studies.     

Evidence-based Chinese Medicine for Rheumatoid Arthritis

Chinese medicine (CM) has long been adopted for treatment of rheumatoid arthritis (RA). CM approaches RA as it does for other diseases by holistic treatment, focusing on the whole body condition, and giving a variety of applications in accordance with the stage and symptoms of the disease. For seeking the best evidence of CM in making decisions for the care of RA individual patients, a number of clinical studies have been conducted in China to gain credibility with the researchers’ unremitting efforts. But the heterogeneity in many of these clinical trials and the low quality of design in some previous studies present an obstacle to the meaningful systematic reviews (SR) and meta-analysis. Some favorable results in improvement of response to biomedicine and reduction of severe adverse reactions of conventional RA therapy should be carefully interpreted and need further research. Fortunately, more appropriate quality assurance and control of CM researches are raised for the implementation of CM in RA therapy to pave the evidence-based way. Guidelines for the diagnosis and treatment of RA recommend evidence to the clinicians. In future, randomized controlled trials (RCT) with smart and flexible design as a good approach to evaluate the effectiveness will be widely used in CM for RA clinical study, with better research methods suitable for certain CM clinical researches. The development of evidence-based CM for RA will be full of challenge and opportunity, but we have full confidence.     

中医药调整脑内微环境改善阿尔兹海默病引发认知损伤作用效果及生物学机制研究进展

阿尔茨海默病病因复杂，目前其发病病因、病机尚未得到完全阐明，尚无特别有效的治疗药物。西医学认为该病的发生可能与遗传、自身免疫、环境、衰老等因素导致的脑内微环境异常有关，是其进行性加重的重要原因，脑内物质淋巴引流是改善脑内微环境防治阿尔茨海默病的重要手段。随着传统中医“毒损脑络”病机及西医学对阿尔茨海默病发病过程中脑内微环境、淋巴引流等组织形态学以及功能学认识的不断深化，系统阐明中医药调整脑内微环境改善阿尔兹海默病引发认知损伤作用效果及生物学机制已成为可能，并且对进一步指导临床应用具有重要意义。     

阿尔茨海默病中医康复方案临床研究探微

阿尔茨海默病（AD）是老年痴呆症最常见的一种,患者早期认知功能受损,记忆力减退;晚期则智能衰退,生活不能自理,严重影响患者生活质量并给家庭与社会带来巨大负担,且发病率只增不减。现代医学深入微观机制研究,治疗以改善胆碱系统功能药物、抗氧化剂、抗炎药物等为主。虽长期用于临床,但西药大多针对单一环节或单一靶点,覆盖面较窄,而且老年患者一般多病缠身、需联合用药,这既加重了药物的毒副作用,也降低了患者服药的依从性。如何在用药之外探寻毒副作用小、刺激人体机能促进自我恢复的康复方案,以缓解AD症状和促进疾病良性发展迫在眉睫。     

阿尔茨海默病转基因模型Tg2576小鼠血清的代谢组学研究

目的 Tg2576转基因小鼠与阿尔茨海默病（Alzheimer''s disease,AD）患者的病理改变相近,本文动态研究了Tg2576小鼠在AD发病不同阶段的血清代谢物特征,为临床AD的早期诊断提供代谢依据。方法 收集Tg2576小鼠在AD发病初期（6个月）和末期（12个月）时的血清样本,采集样本的¹HNMR谱并运用多变量分析方法进行代谢特征的分析。结果 结果显示Tg2576与C57小鼠分别在6和12个月时的血清代谢特征有明显差异,且不同AD发病阶段的Tg2576小鼠具有明显的代谢差异。与C57小鼠相比,在AD出现的初期阶段,Tg2576小鼠血清中乳酸、肌醇和氨基酸（如亮氨酸、异亮氨酸、丙氨酸）的含量升高,而脂质、胆碱、磷脂酰胆碱/甘油磷脂酰胆碱、甜菜碱、甘氨酸和葡萄糖含量降低;在AD发病的末期,血清中乳酸、肌醇和丙氨酸的含量继续上升,脂质、胆碱、磷脂酰胆碱/甘油磷脂酰胆碱、甜菜碱和甘氨酸含量持续降低,同时谷氨酸和肌酸含量初步显示出下降趋势。通过比较AD的初期和末期血清代谢物,我们能够发现疾病末期血清中乳酸、肌醇和丙氨酸含量升高,脂质、胆碱、磷脂酰胆碱、甘油磷脂酰胆碱含量降低。在这些代谢物中,乳酸、脂质、胆碱、磷脂酰胆碱和甘油磷脂酰胆碱在AD发生初期已具有显著性变化,且与AD发生的严重程度密切相关。结论 结果表明Tg2576小鼠中乳酸与阿尔茨海默病程度的加重呈正相关变化,而脂质、胆碱、磷脂酰胆碱和甘油磷脂酰胆碱呈负相关改变,且这些代谢物随着疾病的发展呈动态进行性变化,可能是AD早期诊断的重要代谢标志物。     

潘智敏教授治疗阿尔茨海默病的用药规律挖掘分析

阿尔茨海默病,又称老年性痴呆,是一种中枢神经系统变性疾病,以不可逆的认知功能衰退、日常生活能力减退、精神行为异常为主要特征。潘智敏教授是浙江中医药大学博士生导师,浙江省国医名师,第四、六批全国名老中医专家学术经验继承指导老师、全国首批中国中医科学院中医药传承博士后导师。长期从事老年病的临床、科研、教学工作,对阿尔茨海默病有丰富的临证经验。本文通过中医传承辅助系统平台对潘教授治疗AD的用药规律进行数据挖掘分析。     

老年性痴呆合并精神症状的中医论治

[目的] 探讨老年性痴呆合并精神症状的中医治疗思路及方法,以期寻求中医药治疗减轻患者认知减退合并精神症状的方法。[方法] 系统查询历代古籍及近期（主要为最近10年）文献,收集中医治疗老年性痴呆合并精神症状的相关文献资料,从释义、病因、病机、治法等方面分析老年性痴呆合并精神症状的辨治方法。[结果] 老年性痴呆合并精神症状的病理基础是肾亏肝郁而发呆、痰瘀气结而致狂,中医可通过补肾调肝益神智、豁痰祛瘀开清窍、开通鬼门降浊气等方法治疗老年性痴呆合并精神症状,改善其认知并减轻精神症状。[结论] 可以通过中医理论及方法来综合治疗老年性痴呆合并精神症状,从而改善患者认知减退及减轻患者精神症状。     

珠海市社区护理人员阿尔茨海默症知信行的调查研究

目的 了解珠海市社区护理人员阿尔茨海默症知信行的现状,分析其影响因素.方法 2019年9月至2020年1月,采用问卷对珠海市区20家社区卫生服务中心的护理人员进行调查.问卷内容包括一般基本资料和阿尔茨海默症知识、态度及行为.结果 问卷回收283份.知识、态度、行为得分分别为(19.87±3.11)分、(4.79±1.8...     

移动医疗技术支持下早期诊断老年痴呆症系统研究

介绍移动医疗和早期老年痴呆症的定义以及国内外相关研究现状,从所需技术、设计原则、实施方法和步骤、应用效果几方面阐述基于移动医疗技术的早期诊断老年痴呆症系统设计,为进一步实现老年痴呆症早期干预奠定基础。     

桥本病中医命名探讨

基于"浊"特性和致病特点,以及对中医古今文献中"浊"的研究,通过对桥本病病因病机、临床表现、中西医对本病的认识及特效治疗等方面进行分析,探讨桥本病对应较确切的中医命名,进一步探索中医对桥本病的精确治疗。     

桥本病中医命名探讨

基于"浊"特性和致病特点，以及对中医古今文献中"浊"的研究，通过对桥本病病因病机、临床表现、中西医对本病的认识及特效治疗等方面进行分析，探讨桥本病对应较确切的中医命名，进一步探索中医对桥本病的精确治疗。     

中医药防治阿尔茨海默病与Wnt/β-catenin信号通路作用研究述评

阿尔茨海默病(Alzheimer's disease,AD)是一种中枢神经系统退行性疾病,以记忆力减退和认知障碍为主要表现。经典Wnt信号通路是重要的信号转导通路之一,调节多种靶基因的转录、翻译,参与中枢神经系统发育的过程。Wnt/β-catenin信号通路参与多种神经系统发育过程的调节,包括突触发生及功能形态变化,神经细胞的增值分化等。Wnt/β-catenin信号通路在AD发生机制中起到非常重要的作用。近年来研究发现,中医药对Wnt/β-catenin信号通路具有调节作用,中医药具有多成分、多靶点的优势,多种中药及复方、单体具有保护神经血管单元的作用,主要是通过调节Wnt/β-catenin信号通路中的关键信号分子Wnt3a、Axin2、GSK-3β、Wnt7b、β-catenin、TCF4、Fiz9等蛋白的表达发挥作用。这对探讨AD的发病机制及中医药防治的作用机制提供理论基础。