Chinese medicine pattern diagnosis could lead to innovation in medical sciences

Chinese medicine(CM) pattern diagnosis(Bianzheng or syndrome differentiation),as another patient classification approach,has been incorporated with biomedicine diagnosis in clinical practice in China,and the clinical experience has proven that the integration of biomedicine and CM is better in the treatment of many diseases.CM pattern diagnosis is completely different from the diagnosis in biomedicine,and it must take an active role in innovation for medical sciences.This paper is trying to discuss how CM pattern diagnosis lead to innovations in basic research,clinical research and new drug discovery.Scientific basis of CM pattern in innovation of basic research,clinical efficacy and safety,CM pattern based clinical trial design,CM pattern and clinical practice guideline in innovation of clinical study, CM pattern based indication finding,and CM pattern based network pharmacology in innovation of new drug discovery have been discussed.     

Improving the Level and Quality of Ethics Review in Chinese Medicine and Integrative Medicine

Three features of ethics review in Chinese medicine (CM) and integrative medicine (IM) were put forward in this paper. It is consistent with the principles of ethical review in Western medicine; it has to be compliant with the laws of CM and IM; emphasis should be laid on the review of clinical practice facts and experience. Three problems were pointed out. The characteristics of CM and IM are not distinctive enough, operation procedures need to be refined and effectiveness remains to be improved. Based on the mentioned above, seven measures were proposed to improve the level and quality of ethics review in CM and IM, including better brand awareness, considerable tolerance, treatment based on disease differentiation and syndrome differentiation, scientific review and toxicity and side effects of CM, perfection of the ethics review system, reasonable procedures of ethics review and more specialized ethics review workers.     

New Developments in the Pharmacodynamics and Pharmacokinetics of Combination of Chinese Medicine and Western Medicine

It is very common to use Chinese medicine (CM) combined with Western medicine (WM) in clinical practice. The appropriate combination of CM with WM can reduce toxicity and enhance effects in order to make the best use of advantages and bypass the disadvantages. However, an inappropriate combination can not only affect the curative effect but even cause death. Therefore, strengthening the complementary advantages of the CM and WM to improve the therapeutic efficacy and reduce side effects has become an important research topic of clinical medicine and pharmacy. Many researchers try to clarify the effects of combining CM with WM on therapeutic efficacy and absorption, distribution, metabolism and excretion by pharmacodynamics and pharmacokinetics studies, providing evidence for clinical application. This review focuses on the new developments in the pharmacodynamics and pharmacokinetics of the combination of CM with WM in order to give references for clinical treatment.     

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.     

A New Perspective for Chinese Medicine Intervention for Coronary Artery Disease: Targeting Inflammation

Inflammation, which plays a critical role in atherosclerosis and the occurrence of acute cardiovascular events, may be a new target for treatment of coronary artery disease(CAD) to reduce residual cardiovascular risk. Recently, Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease(CANTOS), the largest scale clinical trial that targeted inflammation but not lipids, has affirmed for the first time the inflammatory hypothesis of artherosclerosis and marked the advent of an exciting era of targeting inflammation for the prevention and treatment of cardiovascular diseases. Chinese medicine(CM) is a promising adjuvant therapy for CAD in light of its safety and pleiotropic effect of anti-inflammation, anti-platelet, lipid-regulating, endothelium-protection, microcirculation-improving, etc. In recent years, exploration of anti-inflammatory treatment of CAD with CM has been going on from theory to practice. Taking CANTOS as an example, the design strategy to combine CM and Western medicine to inhibit inflammation were discussed in this paper, which might provide a new perspective for CM intervention on CAD.     

Toward Evidence-Based Chinese Medicine: Status Quo, Opportunities and Challenges

How to test the treatments of Chinese medicine(CM) and make them more widely accepted by practitioners of Western medicine and the international healthcare community is a major concern for practitioners and researchers of CM.For centuries,various approaches have been used to identify and measure the efficacy and safety of CM.However,the high-quality evidence related to CM that produced in China is still rare.Over the recent years,evidence-based medicine(EBM) has been increasingly applied to CM,strengthening its theoretical basis.This paper reviews the past and present state of CM,analyzes the status quo,challenges and opportunities of basic research,clinical trials,systematic reviews,clinical practice guidelines and clinical pathways and evidence-based education developed or conducted in China,pointing out how EBM can help to make CM more widely used and recognized worldwide.     

Evidence-based practice method of integrative Chinese and Western medicine based on literature retrieval through PICO question and complementary and alternative medicine topics

An evidence-based practice method according to literature retrieval through PICO （Patients,Intervention,Comparison,Outcome） questions and complementary and alternative medicine （CAM） topics,which can obtain helpful evidence for guiding clinical practice,was introduced with a practical example in this paper.The knowledge of diseases and Western medicine treatment can be acquired by literature retrieval through PICO question,while searching by CAM topics may provide evidence for Chinese medicine （CM）.Thus the author held that literature retrieval through both PICO question and CAM topics was an ideal evidencebased practice method for integrative Chinese and Western medicine （ICWM）.However,since the standard in CM evidence hierarchy is still under study,the value of the CAM thematic retrieval method remains very limited.In the future,studies on the definition and hierarchy of CM evidences and the herb-drug interaction between Western and Chinese medicine during a combination therapy should be strengthened to improve the status of ICWM evidence-based practice.     

Integrative medicine: A characteristic china model for cancer treatment

Integrative medicine(IM) has attracted increasing attention of the experts and patients around the world.Chinese medicine(CM),as the important part of IM,has played an important role in the treatment of cancer.CM is practiced side by side with Western medicine in many of China’s hospitals and clinics.On the basis of the review of the clinical practices and basic researches these years,we introduce the current situation and progress in integrative oncology in China,and show the main feature of CM approach in the cancer treatment.Furthermore,we also discuss the main problems limiting the progress of CM,and point out international collaboration will provide new opportunity to promote the development of IM in China.     

中药参附黄蒲汤治疗脾胃虚寒证胃痛临床观察

目的探讨中药参附黄蒲汤的临床治疗效果。方法将确诊为脾胃虚寒证胃痛的患者随机分为两组,治疗组给予中药参附黄蒲汤口服治疗,对照组给予黄芪建中汤口服,治疗1个月后观察其临床治疗效果。结果治疗组治愈率为60．59％,总有效率为98．56％;对照组治愈率为51．82％,总有效率为83．94％,两组比较,在治愈率：总有效率上治疗组明显高于对照组,差异有统计学意义（P〈0．05）。治疗过程中未发生不良反应。结论中药参附黄蒲汤治疗脾胃虚寒证胃痛疗效确切、安全可靠,值得临床推广应用。     

中药口服、敷脐联合静脉补液治疗肝胃不和型妊娠剧吐32例

目的探讨清肝和胃中药口服、敷脐联合静脉补液治疗肝胃不和型妊娠剧吐的临床疗效。方法将2008年9月-2010年6月就诊于消化科及妇科门诊、住院部的66例肝胃不和型妊娠剧吐患者随机分为两组。对照组34例,单纯采用静脉补液治疗;观察组32例,采用清肝和胃中药口服、敷脐,并联合静脉补液治疗。结果治疗组32例中,痊愈13例,显效12例,有效5例,无效2例,总有效率93．75％;对照组34例中,痊愈10例,显效11例,有效7例,无效6例,总有效率82．35％。经统计学处理,两组总有效率比较,差异有统计学意义（P〈0．05）,治疗组疗效优于对照组。结论清肝和胃中药口服、敷脐联合静脉补液治疗肝胃不和型妊娠剧吐疗效显著,是一种实用的中西医结合疗法,值得在临床上推广使用。     

Chinese medicine pattern differentiation and its implications for clinical practice

Chinese medicine practitioners apply the differentiation reasoning for decision-making. The wide scope of Chinese medicine intervention provides coverage of methods and techniques with applications to primary, secondary and tertiary levels of prevention. The rapid evolution of mathematical and computational techniques allowed the implementation of several models for pattern differentiation that were tested for several physiologic systems. Concurrently, it is argued that pattern differentiation might improve the efficacy of either traditional or conventional medical interventions. This article reviewed the influence of pattern differentiation into clinical practice organized by medical field: general pattern differentiation; genitourinary (recurrent cystitis); cardiovascular (coronary heart disease; arterial hypertension; angina pectoris); neurology (stroke); surgery; metabolic (diabetes mellitus); hepatic (cirrhosis); gastrointestinal (chronic superficial gastritis); orthopedic (low back pain; rheumatoid arthritis; cervical spondylosis; elbow arthritis); oncology (gastric mucosal dysplasia; lung cancer); gynecologic and obstetric manifestations (nausea and vomiting). The reviewed studies presented achievements that have contributed to the integration of Chinese medicine and evidence-based medicine in the treatment of many mild and severe diseases. Target diseases considered as major public health problems were also investigated and the results are promising regarding the possibility to treat guided by pattern differentiation.     

Chinese medicine for menopausal syndrome: Current status, problems and strategies

The use of Chinese medicine(CM) for the management of menopausal syndrome is considered effective both at home and abroad,and more and more clinical studies are confirming its efficacy.However,many problems still exit in current studies,such as the standard of CM syndrome differentiation,the design methodology and criteria to assess the quality of clinical trials and the efficacy of interventions.In this paper,the authors present the CM research and treatment strategies for menopausal syndrome with concepts explaining the CM understanding of the mechanism of the disorder.It is concluded that CM is effective for menopausal syndrome,but improvement in both study methodology and treatment strategy is needed.In detail,it is firstly necessary to conduct clinical studies to evaluate the difference of various CM treatments for menopausal syndrome manifesting different symptoms,so as to establish a comprehensive treatment protocol of CM.Secondly, an acknowledged evaluation system needs to be founded,which embodies the characteristics of CM,and covers appropriate endpoint indices and parameters to objectively evaluate the effect and study quality of CM.Finally, an epidemiological survey with large sample size should be implemented with robust statistical design and CM expertise to collect data for establishing diagnostic criteria for menopause in different stages and with different symptoms.     

Effects and mechanisms of actions of Chinese herbal medicines for asthma

Asthma is a chronic inflammatory disorder of airways that affects approximately 300 million adults and children worldwide.Most therapy currently uses bronchodilators and corticosteroids.Systemic side effects from chronic use of these drugs are concern.Chinese medicine(CM)has a long history of human use in China and other Asian countries and well received by the patients.But as one component of Western integrative medicine(WIM),it is required that CM use is supported by scientific evidence.On the other hand,there are also suggestions that Western standardized medicine should consider personalized practice.In recent years there have been an increasing studies to narrow the gap between CM,the personalized medicine and Western medicine,evidence based medicine.This communication reviews several CM studies published in the English language in details by reviewing the effects and mechanisms of actions on asthma from clinic and experimental studies. Chinese herbal medicines exhibit broad actions on multiple asthma pathologic mechanisms.These mechanisms may involve antiinflammatory and immunomodulatory effects,inhibiting airway remodeling and normalization of hypothalamus,pituitary and adrenal(HPA)-axis disturbances.However,the mechanisms of actions of Chinese herbal medicines for asthma are not fully understood.More controlled clinical studies are warranted and some anti-asthma CM may be proved to be effective when used as monotherapy or complementary asthma therapies.     

中医在临床肿瘤学中的角色

Chinese Medicine（CM）has been used for several thousand years,playing an important role in the prevention and treatment of diseases including cancer.In the recent four decades,a number of CM herbs have aroused extreme interest in the world-isolating anticancer components from medicinal herbs,using them as biological response modifiers,and most recently as angiogenesis inhibitors.The present review reports both the experimental and clinical results obtained in the field of clinical oncology,especially conducted by our group.The review also presents the possible future of integration of CM and modern medicine in basic research and clinical practice,especially when CM used as adjuvant and maintenance therapy.     

The mobilization of autologous bone marrow stem cells in the treatment of heart failure with Chinese medicine

Heart failure(HF) is a severe heart disease.The use of autologous bone marrow stem cells (BMCs) mobilization in the treatment of HF has been a hot topic to research both in Western medicine and Chinese medicine(CM).There are many clinical trials and experiments on study of BMCs mobilization for HF therapy,including integrative medicine.The effect of BMCs mobilization is favorable for cardiac repair,while some advantages of CM support the advanced study of its application in BMCs mobilization to treat HF.In addition,with mechanisms of autologous BMCs mobilization for the treatment of HF that will be revealed in the future,especially stem cells niches,integrative medicine would play an important role in this clinical thought of therapy model gradually.Simultaneously,CM should adapt the new approaches of stem cells progresses on HF treatment as holding characteristics of itself.     

An innovative method to accommodate chinese medicine pattern diagnosis within the framework of evidence-based medical research

Pattern diagnosis is an integral aspect of Chinese medicine (CM). CM differentiates biomedical diseases into patterns, based upon the patient’s symptoms and signs. Pattern identification (PI) is used to diagnose, direct the treatment principle and determine the treatment protocol. Most CM research has used fixed formula treatments for Western-defined diseases with outcomes measured using objective biomedical markers. This article presents an innovative method used in a randomised controlled pilot study using acupuncture for participants with hepatitis C virus. Each participant’s CM patterns were identified and quantified at baseline which directed the treatment protocol for the treatment group. Data identified that while each participant expressed different patterns at baseline all participants displayed multiple patterns. Six patterns showed some expression by all 16 participants; Liver (Gan) yin vacuity expressing a group aggregate mean percentage of 47.2, binding depression of Liver qi 46.9, and Liver Kidney (Shen) yin vacuity 45.1. Further sub category gender grouping revealed that pattern ranking changed with gender; Liver yin vacuity (male 53.4%, female 51.93%), binding depression of Liver qi (male 50.0%, female 42.86%) and Liver Kidney yin vacuity (male 42.9%, female 47.96%). The quantification of CM patterns described in this article permitted statistical evaluation of presenting CM patterns. Although this methodology is in its infancy it may have potential use in the integration of PI with rigorous evidence based clinical research. Biomedical markers often do not relate to symptom/signs and therefore this innovative measure may offer an additional CM evaluation methodology and further CM PI understanding.     

中医和中西医结合临床指南制定的现状与问题

随着临床循证指南的广泛应用及中医药规范化工作的开展,各类中医或中西医临床指南也在逐渐增多。借助指南质量评估工具对2008年10月前公开发表的11个中医和中西医结合临床指南进行初步评价,大部分指南未描述证据收集和综合证据的方法,仅1篇说明推荐意见的证据分级标准,存在指南制作不够规范,编写人员专业背景单一,缺乏高级别的证据等问题。建议成立多学科组成的指南制定小组,注重证据并严格遵循循证指南制订的原则和流程,建立符合中医文献自身特点的证据评价和分级方法,注重中医指南的适用性与指导性,并加强对指南质量的评估。     

中药单味药及其膏剂镇痛的研究进展

中医药治疗痛证已有几千年的历史,早在《黄帝内经》中,就已对痛证的病因、病机、病位、证候、预后等方面进行了系统的论述。治疗各种疼痛的中药及中药复方在中医临床中应用广泛,中药镇痛作用明确,且毒副作用极小,在人类医学史上发挥着不可替代的作用。本文将中药单味药及中药膏剂镇痛作用的研究进展做简要叙述。     

Chinese Medicine as Complementary Therapy for Female Infertility

Chinese medicine (CM) has been used in clinical treatment for thousands of years in China, Japan, Korea, and other countries. CM is at present attracting many attentions around the world for reproductive health care and disease prevention, including treatment of female infertility. This review focuses on the CM treatment for female infertility patients, and supplies a summary on the efficacy, safety, and mechanism of some Chinese herbal medicines, herbal medicine-derived active compounds, and acupuncture. A large number of researches have reported that CM could alleviate or even cure female infertility by regulating hormone, improving reproductive outcome of in vivo fertilization, affecting embryonic implantation, curing polycystic ovarian syndrome, endometriosis, pelvic inflammatory disease, relieving mental stress, and regulating immune system. Meanwhile, a few studies claimed that there was little adverse reaction of CM in randomized controlled trials. However, up to present there is a lack of adequate evidences with molecular mechanistic researches and randomized controlled trials to prove the CM as an effective and safe treatment for infertility. Thus, utility of CM as a complementary medicine will be a feasible method to improve the outcome of female infertility treatment.