Development and validation of a quality appraisal tool for case reports in traditional Chinese medicine using the Delphi method

Development and evaluation of an inquiry scale for diagnosis of heart system syndromes in traditional Chinese medicine

See related article, pages 1973–1979. The lack of effective and widely applicable pharmacological treatments for ischemic stroke patients may explain a growing interest in traditional medicines, for which extensive observational and anecdotal experience has accumulated over the past thousand years. The World Health Organization (WHO) defines traditional medicine as “health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being”.1 Unlike Western medicine, which focuses on disease, traditional medicine takes the approach that the body provides external clues to an internal imbalance that can be addressed by interventions such as herbs and acupuncture (holistic treatment approach).2 According to a 2003 WHO report,1 traditional medicine is very popular in all developing countries, and its use is rapidly increasing in industrialized countries. For example, traditional herbal preparations account for 30% to 50% of the total medicinal consumption in China. In Europe, North America and other industrialized regions, over 50% of the population have used traditional medicine at least once. The global market for herbal medicines currently stands at over US $60 billion annually and is growing steadily.1 In recent years, several reviews have been published on the effect and potential benefits of traditional Eastern medicine in stroke.3–7 It has been suggested that some herbal medicines, or their products, may improve microcirculation in the brain,4,8 protect against ischemic reperfusion injury,8,9 possess neuroprotective properties3,4 and inhibit apoptosis,10 thus justifying their use in ischemic stroke patients. However, unlike industrially manufactured pharmacological drugs used in Western medicine, the active (potent) components of herbal medicines often have not been specified and measured precisely, although there have been recent attempts to regulate dosages and use of …

Objective This study aimed to assess the clinical efficacy and safety of the treatment of refractory nephrotic syndrome with integrated traditional Chinese and western medicine. Methods The study was a prospective, randomized, double-blind, 2∶1 basic-control, multi-center clinical trial, with 120 patients recruited from 7 hospitals in China. The test group was administered with traditional Chinese medicine (TCM) particles on the base of prednisone and cyclophosphamide treatment for 3 months, while the control group was administered with placebo using the same method. The 24-hour urinary protein, serum albumin, serum creatinine, TCM syndrome score and adverse reactions were monitored timely. SPSS 20.0 software was used for data analysis. Results At 3 months, the total effective rate was 89.39% and 63.64% for the test and the control, respectively, the difference of which was of statistical significance (χ2=7.824, P=0.005). The total effective rate of TCM syndromes was 93.94% and 72.73% for the test and the control, respectively, the difference of which was also of statistical significance (χ2=6.918, P=0.009). The incidence of Cushing′s syndrome, digestive tract reactions, and infections in the test group were lower than in the control group, the difference of which was of statistical significance (χ2=7.666, P=0.006; χ2=5.088, P=0.024; χ2=5.227, P=0.022). Conclusion Treatment with integrated traditional Chinese and western medicine effectively improved the clinical efficacy of refractory nephrotic syndrome, improved the clinical symptoms, and reduced the side effects of immunosuppressive agents. Key words: Treatment with integrated traditional Chinese and western medicine; Refractory nephrotic syndrom; Clinical trial

Expert symposium on severe acute hepatitis of unknown cause in children, a paradigm of exchanges and sharing between Chinese and Western medicine professionals.

Clinical practice guidelines for the diagnosis and treatment of atopic dermatitis with integrative traditional Chinese and Western medicine.

: In China, allergic rhinitis patients are looking not only for western therapy in Chinese traditional medicine but also for treatment in Western and Chinese mixed medicine. Several studies have compared traditional Chinese medicine, Western and Western combined. Such three forms of treatment were not analyzed simultaneously. Aim: The research examines the differences between populations and medical applications of allergic rhinitis patients who received all three treatments to determine the use of different drugs. Methods: The inventory for patients diagnosed with allergic rhinitis (International Disease Classification). The Chi-square test and Tukey test were performed for the region of interest to check the disparity between these three treatments (a significant difference still exists). Results: The interview rate for women with allergic rhinitis is higher than for men regardless of whether it is treatment with traditional Chinese medicine, Western or combined traditional Chinese and Western medicine. Persons 0-19 years of age was first in the proportion of allergic rhinitis diagnosis and care. Traditional Chinese medicine includes medical measures with maximum hours per person, the daily cost per hour of medicines and minimum overall hourly expenditure. Western medicine, by comparison, costs the lowest daily drug per hour, and the highest total drug costs per hour per person. Between traditional Chinese and western medicine, the total cost per capita of integrated traditional Chinese and Western Medicine as well as drug costs per capita and the total cost per capita. Conclusion: Although only 6.82% of allergic rhinitis patients opt for combined traditional Chinese medicines and western medicine, their rate of receipt is higher each year. Moreover, mixed medications are used more frequently compared to single-component medicines

Discussion on definition of "traditional Chinese medicine and western medicine integration" and "integrated traditional Chinese and western medicine"

Study on the therapeutic effect of combined traditional Chinese and western medicine on gouty arthritis

Ovarian cancer (OC) has the highest mortality rate among gynecologic malignant tumors and is clinically difficult to cure. Traditional Chinese medicine (TCM) has shown unique advantages in the treatment of OC. However, there is currently a lack of normative guidance documents for the treatment of OC with integrated traditional Chinese and western medicine. The guidelines are the first comprehensive approach to diagnosing and treating OC by integrating TCM with western medicine. Adhering to evidence-based principles, the guidelines draw on the most recent advancements in OC treatment from both domestic and international researches. The guidelines formulate a variety of therapeutic methods, including oral Chinese herbal medicine, acupuncture, and external treatments, providing a treatment strategy for the combined use of TCM and western medicine in OC. Furthermore, the guidelines establish a diagnostic and treatment pathway for the holistic management of OC with TCM throughout the disease’s progression. The guidelines were officially published in the China Association of Chinese Medicine in January 2023, which provided a scientific basis for the formulation of clinical diagnosis and treatment strategies and promoted integration with international academic standards. This paper interpreted the features of the guidelines and the 7 PICO issues (Population, Intervention, Comparison, Outcome) in the whole TCM management of OC, aiming to help TCM and western medicine practitioners better understand and apply the guidelines, and provide better medical services for patients with OC.

To evaluate the clinical efficacy and safety of combination of traditional Chinese and Western medicine in the treatment of coronavirus disease 2019 (COVID-19) by Meta analysis. The clinical randomized controlled trials (RCT) and cohort studies on the treatment of COVID-19 with combination of Chinese traditional and Western medicine published on CNKI, Wanfang database, VIP database and PubMed were searched by computer from January 2020 to June 2020. Patients in the simple Western medicine treatment group were treated with routine treatment of Western medicine, and the patients in integrated traditional Chinese and Western medicine treatment group were treated with traditional Chinese medicine on the basis of routine treatment of Western medicine. The main outcome was the total effective rate of treatment. The secondary outcome were the antipyretic rate, chest CT recovery rate, lymphocyte count (LYM), C-reactive protein (CRP) level and safety. The Cochrane manual and the Newcastle Ottawa Scale (NOS) were used to evaluate the quality of the literature; the RevMan5.3 software was used to analyze the articles that meets the quality standards, and a funnel chart was drawn to evaluate the total effective publication bias. Thirteen articles were analyzed, including 1 039 COVID-19 patients, 559 in integrated traditional Chinese and Western medicine treatment group and 480 in simple Western medicine treatment group. The results of Meta- analysis showed that compared with the simple Western medicine treatment group, the combination of routine treatment of Western medicine and traditional Chinese medicine Qingfei Paidu decoction, Lianhua Qingwen granule, Shufeng jiedu capsule, Xuebijing injection or Reyanning mixture could significantly improve the total effective rate, antipyretic rate and chest CT recovery rate [total effective rate: odds ratio (OR) = 2.95, 95% confidence interval (95%CI) was 2.10-4.14, P < 0.000 01; antipyretic rate: OR =3.01, 95%CI was 1.64-5.53, P = 0.000 4; chest CT recovery rate: OR = 2.53, 95%CI was 1.83-3.51, P = 0.000 1], increase LYM levels [mean difference (MD) = 0.26, 95%CI was 0.02-0.50, P = 0.03], and reduce of CRP content (MD = -17.68, 95%CI was -33.14 to -2.22, P = 0.02). Based on the funnel chart analysis of 12 articles with total efficiency, the result showed that the funnel chart distribution was not completely symmetrical, indicating that there might be publication bias. On the basis of routine treatment with Western medicine, combined with traditional Chinese medicine can significantly improve the total effective rate of COVID-19 and improve the laboratory results and clinical symptoms of patients. Compared with the routine treatment of Western medicine alone, the combination of traditional Chinese and Western medicine has better clinical efficacy and safety.

Considerations about treatment programs of elderly patients with hypertension

Recurrent spontaneous abortion is one of the most common pregnancy complications in obstetrics and gynecology. The normative diagnosis and treatment of recurrent spontaneous abortion has become an important problem to be solved urgently in the field of reproductive health. The integrated traditional Chinese and western medicine provides a safe and effective treatment method for recurrent spontaneous abortion, but there is no guideline for diagnosis and treatment of recurrent spontaneous abortion with integrated traditional Chinese and western medicine. The guideline is based on the requirements of World Health Organization(WHO) handbook for guideline development and follows the principles of evidence-based medicine. Through literature pre-search, expert interviews, clinical research, and conference consensus, 16 clinical problems are identified in this guideline. PICO principles are used for evidence retrieval, screening, and synthesis. The evidence quality is evaluated for the included evidence bodies. Recommendation opinions and consensus suggestions are formed through three rounds of the Delphi expert questionnaire survey. An expert meeting is held to finalize the draft. The opinions of experts in traditional Chinese medicine, western medicine, integrated traditional Chinese and western medicine, methodology and pharmacy are widely solicited. The guideline contains five parts: scope, term and definition, diagnosis, treatment, and diagnosis and treatment flow chart of integrated traditional Chinese and western medicine. There are corresponding recommendations and summaries of evidence for clinical problems related to the diagnosis and treatment of integrated traditional Chinese and western medicine. This guideline is guided by clinical problems, combining disease differentiation and syndrome differentiation and integrating pre-pregnancy regulation and treatment and post-pregnancy preservation, highlighting the therapeutic advantages of integrated traditional Chinese and western medicine, so as to further standardize the clinical diagnosis and treatment of recurrent spontaneous abortion and promote the diagnosis and treatment level of integrated traditional Chinese and western medicine for recurrent spontaneous abortion.

Objective: The objective of this study is to establish a nursing standard of integrated traditional Chinese and Western medicine for patients with COVID-19 (mild and common) in Beijing, to provide reference for clinical nursing of patients with COVID-19 (mild and common).Methods: Through online communication meeting with nurses who are in the frontline of anti-epidemic, clinical investigation, literature research, and expert demonstration meeting are carried out to prepare the draft of the standard, and the Delphi method is applied to determine the standard of integrated traditional Chinese and Western medicine care for patients with COVID-19 (mild and common) in Beijing.Results: The nursing standard of integrated traditional Chinese and Western medicine for patients with COVID-19 (mild and common) was established, which included 5 first-level indicators, 14 second-level indicators and 60 third-level indicators. After two rounds of Delphi method, the positive coefficients of experts were 96% and 83%, the authoritative coefficients of experts were 0.89 and 0.91, and the Kendall's coefficient of concordance (W) of experts were 0.12, 0.09, 0.10, 0.13 (P < 0.05) and 0.44, 0.43, 0.37, 0.39 (P < 0.05).Conclusion: The standard of integrated traditional Chinese and Western medicine nursing for patients with COVID-19 (mild and common) in Beijing constructed by the Delphi method is scientific and practical, which provides a reference for clinical application of integrated traditional Chinese and Western medicine nursing to fight against COVID-19 infection.

Objective To explore the curative effect of combination of traditional Chinese and western medicine in the treatment of senile vasovagal syncope. Methods Eighty one elderly patients with vasovagal syncope outpatients and inpatients who were admitted from January 2016 to September 2017 in Xixi Hospital of Hangzhou were included. Among them, 38 were Western medicine group (metoprolol sustained-release tablets + tilt training), and 43 were combination of traditional Chinese and Western medicine group (radix bupleuri liver scattered flavored party + Metoprolol sustained-release tablets + tilt training). Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), depression and anxiety scores were observed before and after treatment in both groups, as well as tilt test after treatment and clinical efficacy. The patients were followed up by telephone for half a year after treatment and the recurrence was recorded. Results Heart rate, SBP, DBP and depression anxiety score were significantly reduced in both Western medicine group and combination of traditional Chinese and western medicine group after treatment, and the differences were statistically significant (t=3.55, 18.68, 13.57, 18.68, 7.74, 19.83, 10.08, 19.83; P<0.05 or P<0.01). Heart rate, SBP, DBP and depression anxiety scores of patients after treatment in the combination of traditional Chinese and western medicine group were significantly lower than those in the western medicine group, with statistically significant differences (t=4.17, 1.77, 2.89, 6.79; all P<0.05).There were 19 effective cases in the western medicine group (76.32%, 10 cases cured, 19 cases effective), and 36 effective cases in the combination of traditional Chinese and western medicine group (93.02%, 17 cases cured, 19 cases effective). The difference was statistically significant (χ2=4.462, P<0.05). Twenty-nine patients with positive tilt test and 6 patients with relapse within 6 months after treatment were in Western medicine group. Twenty-two cases with positive tilt test and 1 case with recurrence within six months after treatment were in combination of traditional Chinese medicine and Western medicine group. The differences were statistically significant (χ2=2.147, 3.083; P<0.05). Conclusion Metoprolol sustained-release tablets + tilt training are effective in the treatment of senile vasovagal syncope. Western medicine combined radix bupleuri liver flavored party is better, with improved the patient's heart rate, blood pressure levels and depression anxiety symptoms, reducing the patients with recent recurrent syncope. Key words: Chaihu liver dispersing flavor side; Metopolol sustained-release tablet; Aged; Tilt-table test; Syncope, vasovagal

Renal involvement of systemic small-vessel vasculitis is clinically a critical illness. Although many novel immunosuppressants, such as biological agents, have improved the clinical remission rate of the disease, the efficacy is still not satisfactory due to high recurrence rate, high infection rate, and high rate of progressing to end-stage renal failure. So many scholars explore the treatment with integrative traditional Chinese and western medicine in order to improve its clinical efficacy. By means of the literature review and their own clinical experience, the authors advocated the application of collateral disease theory of traditional Chinese medicine (TCM) into the syndrome-differentiation treatment of this disease. The disease position is at the blood collaterals, and its basic pathological feature is block of collaterals. The pathogenesis is characterized by the deficiency in origin and excess in evil, and blood stasis is through the whole course of disease. The treatment should be carried out according to the different stages of disease, grasping the dialectical relationship between the unblocking therapy and reinforcing therapy. Key words: Systemic small-vessel vasculitis; Renal damage; Integrative traditional Chinese and western medicine; Etiology and pathogenesis; Treatment