Chinese Medical Practitioners Research Articles

Regulating effect of Qifu Yin on intestinal microbiota in mice with memory impairment induced by scopolamine hydrobromide

Ethnopharmacological relevanceQifu Yin (QFY) originates from “Jingyue Quanshu · Volume 51 · New Fang Bazhen · Buzhen” a work by Zhang Jingyue, a distinguished Chinese medical practitioner from the Ming Dynasty. QFY is composed of Ginseng Radix et Rhizoma, Rehmanniae Radix Praeparata, Angelicae Sinensis Radix, Atractylodis Macrocephalae Rhizoma, Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle, Ziziphi Spinosae Semen, and Polygalae Radix. QFY is frequently employed to address memory loss and cognitive impairment stemming from vascular dementia, Alzheimer's disease (AD), and related conditions. Our findings indicate that QFY can mitigate nerve cell damage. Moreover, the study explores the impact of QFY on the calcium ion pathway and sphingolipid metabolism in mice with myocardial infarction, presenting a novel perspective on QFY's mechanism in ameliorating myocardial infarction through lipidomics. While this research provides an experimental foundation for the clinical application of QFY, a comprehensive and in-depth analysis of its improvement mechanism remains imperative. Aim of the studyTo clarify the regulatory mechanism of QFY on intestinal microecology in mice with memory impairment (MI). Material and methodsThe memory impairment mouse model was established by intraperitoneal injection of scopolamine hydrobromide. Kunming (KM) mice were randomly divided into blank group, Ginkgo tablet group (0.276 g/kg), QFY high, medium and low dose groups (17.2 g/kg, 8.6 g/kg, 4.3 g/kg). The effect on memory ability was evaluated by open field and step-down behavioral experiments. The morphological changes of nerve cells in the hippocampus of mice were observed by pathological method. The contents of superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT) and glutathione peroxidase (GSH-Px) in the brain tissue of mice were detected. The expression levels of CREB, Brain-Derived Neurotrophic Factor (BDNF) and Recombinant Amyloid Precursor Protein (APP) in the hippocampus of mice were determined using immunohistochemistry. The expression of N-methyl-D-aspartate receptor (NMDAR) and cAMP response element binding protein (CREB) related factors in the serum of mice was analyzed by ELISA. The levels of apoptosis signal-regulating kinase-1 (ASK1) and c-Jun N-terminal kinase (JNK) mRNA in the hippocampus were detected by quantitative real-time fluorescence polymerase chain reaction (qPCR). The intestinal feces of mice were collected, and the 16 S rDNA technology was used to detect the changes in intestinal microbiota microecological structure of feces in each group. ResultsBehavioral experiments showed that the high-dose QFY group exhibited a significant increase in exercise time (P<0.05) and a decrease in diagonal time (P<0.05) compared to the model group. The medium-dose group of QFY showed a reduction in diagonal time (P<0.05). Additionally, the latency time significantly increased in the medium and high-dose groups of QFY (P<0.01). The number of errors in the low, medium and high dose groups was significantly decreased (P<0.05, P<0.01, P<0.01). The nerve cells in the CA1 and CA3 regions of QFY-treated mice demonstrated close arrangement and clear structure. Furthermore, the content of SOD significantly increased (P<0.01) and the content of MDA significantly decreased (P<0.05) in the low and high-dose QFY groups. The content of CAT in the medium-dose group significantly increased (P < 0.05). Immunohistochemical analysis showed a significant reduction in the number of APP expression particles in the CA1 and CA3 regions of all QFY groups. Moreover, BDNF expression significantly increased in the medium and high-dose groups, while CREB expression significantly increased in the low and medium-dose groups of QFY within the CA1 and CA3 regions. Serum analysis revealed significant increases in CREB content in the low, medium, and high dose groups of QFY (P<0.01, P<0.05, P<0.05), and decreases in NMDAR content across all QFY dose groups (P<0.01). PCR analysis showed a significant decrease in the contents of ASK1 and JNK in the medium-dose group (P<0.01). Microecological analysis of intestinal microbiota demonstrated a significant restoration trend in the relative abundance of Fusobacteria, Planctomycetes, and Verrucomicrobia (P<0.01 or P<0.05) at the phylum level in the QFY groups. At the genus level, Akkermansia, Paramuribaculum, Herminiimonas, Erysipelatoclostridium and other genera in the QFY groups showed a significant trend of relative abundance restoration (P<0.01 or P<0.05). ConclusionQFY can improve the memory of MI animals induced by scopolamine hydrobromide by restoring the homeostasis of intestinal microbiota and regulating related indexes in serum and brain tissue.

Revisiting Traditional Chinese Medicine in Hong Kong during the Influenza Epidemics in the 1950s and 1960s.

This paper examines the supply and utilization of traditional Chinese medicine (TCM) in Hong Kong during the influenza epidemics of the 1950s and 1960s. Existing narratives of TCM in Hong Kong have predominantly framed with within the dichotomy of Western medicine "Xiyi" and Chinese medicine "Zhongyi," portraying TCM as marginalized and nearly wiped out by colonial power. Departing from this binary opposition, this study views TCM as an autonomous space that had never been subjugated by the colonial power which opted for minimal interventionist approach toward TCM. By adopting diachronic and synchronic perspectives on Hong Kong's unique environment shaped by its colonial history and the geopolitics of the Cold War in East Asia, particularly its relationships with "China," this research seeks to reassess the role and status of TCM in post-World War II Hong Kong. In Hong Kong, along with other countries in East Asia, traditional medicine has ceded its position as mainstream medicine to Western medicine. Faced with the crisis of "extinction," Chinese medical professionals, including medical practitioners and merchant groups, persistently sought solidarity and "self-renewal." In the 1950s and 1960s, the colonial authorities heavily relied on private entities, including charity hospitals and clinics; furthermore, there was a lack of provision of public healthcare and official prevention measures against the epidemic influenza. As such, it is not surprising that the Chinese utilized TCM, along with Western medicine, to contain the epidemics which brought about an explosive surge in the number of patients from novel influenza viruses. TCM was significantly consumed during these explosive outbreaks of influenza in 1957 and 1968. In making this argument, this paper firstly provides an overview of the associations of Chinese medical practitioners and merchants who were crucial to the development of TCM in Hong Kong. Secondly, it analyzes one level of active provision and consumption of Chinese medicine during the two flu epidemics, focusing on the medical practices of TCM practitioners in the 1957 epidemic. While recognizing the etiologic agent or agents of the disease as influenza viruses, the group of Chinese medical practitioners of the Chinese Medical Society in Hong Kong adopted the basic principles of traditional medicine regarding influenza, such as Shanghanlun and Wenbingxue, to distinguish the disease status among patients and prescribe medicine according to correct diagnoses, which were effective. Thirdly, this paper examines the level of folk culture among the people, who utilized famous prescriptions of Chinese herbal medicine and alimentotherapy, in addition to Chinese patent medicines imported from mainland China. In the context of regional commercial network, this section also demonstrates how Hong Kong served as a sole exporting port of medicinal materials (e.g., Chinese herbs) and Chinese patent medicines from the People's Republic of China to capitalist markets, including Hong Kong, under the socialist planned or controlled economy in the 1950s and 1960s. It was not only the efficacy of TCM in restoring immunity and alleviating symptoms of the human body, but also the voluntary efforts of these Chinese medical practitioners who sought to defend national medicine "Guoyi," positioning it as complementary and alternative medicine to scientific medicine. Additionally, merchants who imported and distributed Chinese medicinal materials and national "Guochan" Chinese patent medicine played a crucial role, as did the people who utilized Chinese medicine, all of which contributed to making TCM thrive in colonial Hong Kong.

Boundaries and classification: the cultural logic of treating foreign medicine

From the 16th to the 19th centuries, Western medicine emerged in China and was considered dangerous by Chinese residents. Relatedly, Chinese medical practitioners have attempted to use knowledge based on traditional Chinese medicine to explain the principles of Western medicine. From the 19th to 20th centuries, traditional Chinese medicine (TCM) was introduced to the United States, and American residents also described it as dangerous; they believed that TCM could only be accepted after scientific verification and explanation. This article uses the method of historical anthropology to explain these phenomena using boundaries as an analytical concept. This article finds that when foreign medicine crosses borders, it causes the disorganization of local classification systems. When a local classification system cannot provide a suitable location for foreign medicine, such medicine is easily regarded as dangerous by residents. The key to solving this problem is to use local classification systems to reinterpret foreign medicine. Reinterpreted by these local classification systems, foreign medicine can gain legitimacy within local societies. Based on this, the current article attempts to illustrate not only that science is a classification method but also that the boundary between science and nonscience is cultural in a sense, thereby undertaking corresponding cultural functions in daily life.

A Chinese interpretation for the "ACGS Best Practice Guidelines for Variant Classification in Rare Disease 2020"

ACGS Best Practice Guidelines for Variant Classification in Rare Disease 2020, a supplementary practical guidelines, is based on the Standards and Guidelines for the Interpretation of Sequence Variations issued by the American Society for Medical Genetics and Genomics (ACMG) and the Association of Molecular Pathology (AMP) in 2015 by the British Medical Genetics Society under the Clinical Genomics Society (ACGS), and has integrated the detailed rules of standards developed by the ClinGen Sequence Variant Interpretation (SVI) Working Group by 2020. The further development of the ACMG/AMP guidelines is currently undertaken by the ClinGen SVI working group in the United States, which focuses on the classification of high penetrance and protein coding variants. ClinGen has established many expert panels on variants for specific diseases which required various evidence thresholds and is currently developing disease/gene specific guidelines. The British Medical Genetics Society has collected and integrated information on the guidelines for sequence variation classification and their extended rules, forming its own "2020 ACGS Best Practice Guidelines for Rare Disease Variation Classification" and is regularly updating it. The author has translated and summarized it for the reference of Chinese Medical Genetics Practitioners.

Performance and exploration of ChatGPT in medical examination, records and education in Chinese: Pave the way for medical AI

BackgroundAlthough chat generative pre-trained transformer (ChatGPT) has made several successful attempts in the medical field, most notably in answering medical questions in English, no studies have evaluated ChatGPT's performance in a Chinese context for a medical task. ObjectiveThe aim of this study was to evaluate ChatGPT’s ability to understand medical knowledge in Chinese, as well as its potential to serve as an electronic health infrastructure for medical development, by evaluating its performance in medical examinations, records, and education. MethodThe Chinese (CNMLE) and English (ENMLE) datasets of the China National Medical Licensing Examination and the Chinese dataset (NEEPM) of the China National Entrance Examination for Postgraduate Clinical Medicine Comprehensive Ability were used to evaluate the performance of ChatGPT (GPT-3.5 and GPT-4). We assessed answer accuracy, verbal fluency, and the classification of incorrect responses owing to hallucinations on multiple occasions. In addition, we tested ChatGPT's performance on discharge summaries and group learning in a Chinese context on a small scale. ResultsThe accuracy of GPT-3.5 in CNMLE, ENMLE, and NEEPM was 56% (56/100), 76% (76/100), and 62% (62/100), respectively, compared to that of GPT-4, which was of 84% (84/100), 86% (86/100), and 82% (82/100). The verbal fluency of all the ChatGPT responses exceeded 95%. Among the GPT-3.5 incorrect responses, the proportions of open-domain hallucinations were 66 % (29/44), 54 % (14/24), and 63 % (24/38), whereas close-domain hallucinations accounted for 34 % (15/44), 46 % (14/24), and 37 % (14/38), respectively. By contrast, GPT-4 open-domain hallucinations accounted for 56% (9/16), 43% (6/14), and 83% (15/18), while close-domain hallucinations accounted for 44% (7/16), 57% (8/14), and 17% (3/18), respectively. In the discharge summary, ChatGPT demonstrated logical coherence, however GPT-3.5 could not fulfill the quality requirements, while GPT-4 met the qualification of 60% (6/10). In group learning, the verbal fluency and interaction satisfaction with ChatGPT were 100% (10/10). ConclusionChatGPT based on GPT-4 is at par with Chinese medical practitioners who passed the CNMLE and at the standard required for admission to clinical medical graduate programs in China. The GPT-4 shows promising potential for discharge summarization and group learning. Additionally, it shows high verbal fluency, resulting in a positive human–computer interaction experience. GPT-4 significantly improves multiple capabilities and reduces hallucinations compared to the previous GPT-3.5 model, with a particular leap forward in the Chinese comprehension capability of medical tasks. Artificial intelligence (AI) systems face the challenges of hallucinations, legal risks, and ethical issues. However, we discovered ChatGPT's potential to promote medical development as an electronic health infrastructure, paving the way for Medical AI to become necessary.

The future of acupuncture education: 3D Augmented Reality (AR) acupuncture model for Chinese Medicine

Acupuncture is a therapeutic modality in Traditional Chinese Medicine which aims to improve the flow of Qi (chi) or energy around the body by applying needles to specific points on the skin. Traditional Chinese Medicine teaches that Qi must flow freely through the body’s meridians, or channels, to ensure health and well-being. Traditionally, Chinese Medicine practitioners used a wooden, copper or bronze acupuncture model to show the points where needles should be applied to the skin and the meridians through which Qi flows around the body. However, as traditional models depict acupuncture points which are too rigid for teaching purposes, understanding the descriptions of acupuncture points from textbooks in 2D is also another hurdle for beginners to apply them to the human body in 3D. With modern computing and 3D-printing technologies, this article introduces a realistic human model in the form of a 6-foot copper acupuncture sculpture with over 370 virtual acupuncture points using state-of-the-art Augmented Reality (AR) and metal 3D-printing techniques for enhanced teaching, learning, and demonstration of acupuncture principles. It will be a new training model for Western and Chinese medical practitioners as well as for the public to gain interactive acupuncture experience that is beneficial to their own health.

Explore the Problem behind Dispenser Error and Improper Use - “Aconitine” Poisoning in Chinese Medicine

Consumption of Chinese herbal or seeking medical treatment from a Chinese medicine practitioner (CMP) is quite common in Hong Kong. According to the statistics published by the Census and Statistics Department, there are 22% consulted with a healthcare professional, and 15% of these consultations involved Chinese medical practitioners. Generally, Chinese medicines are safe under proper use and supervision. Chinese herbal medicine such as “Aconitine” in the aconitum species dispense error or improper use causing the risk of poisoning. This commentary discusses the context of an incident, dispense error, or improper use of “Aconitine” and its difficulties, or concerns in some case studies, as well as the management for decisions taken and improvement of “Aconitine” dispense error.

Thinking differently with Chinese medicine: 'Explanations' and case studies for a postcolonial STS.

In Mandarin, the English word ‘nature’ translates as ‘ziran’ (自然zìrán) in science, biomedicine and everyday life. At the same time, ziran indexes a second older set of meanings that make little immediate sense in English. Current in many Chinese medical practices as well as in classical Chinese philosophy, these include ‘what is spontaneously so’ or ‘let the character of the self unfold’. In this article we explore how these two families of meaning are related by particular Taiwanese Chinese medical practitioners as they describe how they negotiate the relations between biomedicine and Chinese medicine in daily professional practice. At the same time, inspired by related logic-shifting writing in anthropology, postcolonial studies and postcolonial STS, we draw on the ‘art of patterning’ (辨證 biàn zhèng) to understand how ziran-nature relations are specified in those accounts. Patterning is the art of specifying the shifting arrangements and misalignments that lead to ill health. Treating this as a way of thinking about ziran-related overlaps between biomedicine and Chinese medicine, we show that patterning attends not to objects ‘out there’ but to appearances (象xiang, xiàng). Put into use as an STS term of art it therefore shifts the epistemological basis of inquiry because case-stories no longer reveal underlying mechanisms, but instead narrate patterned appearances. One implication of this is that any particular pattern diagnosis lies alongside a galaxy of alternatives that might be equally good to think with. Within the limits set by referential academic conventions, we thus attempt a postcolonial shi (勢)-inflected STS in this paper by resisting the use of a single analytical framework, instead setting different forms of patterning alongside one another.

Herbs and Roots: A History of Chinese Doctors in the American Medical Marketplace

In Herbs and Roots, Tamara Venit Shelton provides a sophisticated account of Chinese medicine in the United States from the late nineteenth century to the present. Drawing creatively from memoirs, interviews, archival documents, census information, newspaper articles, and advertisements, Venit Shelton compellingly analyzes how Chinese doctors navigated an increasingly hostile legal, medical, and political environment to promote their therapies, knowledge, and materia medica in the United States. Often assisted by patrons, politicians, and patients, Chinese herbalists tenaciously fought opposition to their presence. Many Chinese medical practitioners flourished, despite facing periodic imprisonment, fines, license revocation, and outright discrimination. Their dispensing of herbal medicine persisted until the end of World War II, when herbs from China became too difficult to obtain owing to Cold War restrictions. Chinese herbalists' experiences of challenging legal restrictions and promoting their medical therapies in late nineteenth- and early twentieth-century America left critical legacies for the post-1970s period. In the early 1970s, white American visitors to China experienced medical treatment, and newly interested audiences back home reinterpreted the visitors' experiences for eager clients in the United States. Together with Chinese medical doctors, they elevated acupuncture to a viable therapy across the United States while maintaining long-standing tropes of “orientalism” in promoting classical Chinese medical practices.Chapters 1 and 2 trace how Chinese herbalist immigrants expanded their medical care beyond fellow immigrants to the broader population, who were already sensitized to herbal treatment prior to the arrival of Chinese medicine. Chapter 3 shows how Chinese American herbalists challenged opposition to their practices by promising noninvasive medical treatments and minimal interaction with female patients to promote their approaches as an alternative to mainstream medicine. Chapters 4 and 5 show how Chinese American herbalists worked with sympathetic advisors, patrons, politicians, and patients to subvert legal and cultural attempts to end their practice. Chapter 6 shows that, while opponents of Chinese medicine failed to diminish the herbalists' popularity, both the generational shift among Chinese Americans toward rejecting traditional medicine in favor of biomedicine and the paucity of imported herbal supplies from China during the Cold War led to the demise of the herbalists by the late 1940s. US-China rapprochement by the early 1970s, as chapter 7 shows, led white Americans to visit China; after experiencing acupuncture treatment firsthand on their travels, proponents touted its efficacy, and demand for the treatment back home increased.A key strength of Venit Shelton's account is how she demonstrates that the post-1970s struggles for legal, cultural, and political legitimacy in the United States drew from similar struggles in earlier periods. Like their predecessors, acupuncturists had to appeal to white America in their marketing and leverage sympathetic patrons and patients to evade enormous legal and biomedical scrutiny. Moreover, her rich account of many Chinese American doctors who were central to transforming and promoting Chinese medicine—including the transcultural Fong Wan, reformist Chang Gee Wo, and transpacific Ka-Kit Hui—provides biographies so needed in the global history of medicine as well as the history of medicine in the United States.Venit Shelton's focus on the nineteenth and early and mid-twentieth centuries raises important research questions for the more recent history of Chinese medicine in the United States. In addition to Venit Shelton's excellent account of how Americans' visits to China in the early 1970s popularized acupuncture therapy, additional consideration of immigrants from Taiwan and Hong Kong could also shed light on Chinese medicine in the United States from 1950 to the late 1970s. During this period, practitioners and their clients from Taiwan and Hong Kong (who made up the bulk of “ethnic Chinese” immigrants between 1960 and 1980) engaged with Chinese herbal medicine and acupuncture in alternative spaces such as Asian grocery stores, bookstores, travel agencies, and trading companies. Their experiences suggest that the configuration of Chinese medicine during the Cold War became partly refracted through diasporic experiences in Taiwan and Hong Kong, in addition to long-standing medical practices in the United States and China. Similarly, the presence of some African American activists promoting acupuncture as an alternative to discriminatory mainstream biomedical systems in post-1970s New York also complicates the narrative of Chinese medicine as an encounter only between white and Chinese Americans.In sum, Venit Shelton provides a much-needed narrative on the history of Chinese medicine in the United States. Her deft weaving of stories of expertise, serendipity, courage, self-representation, and the tumultuous migrant experience of Chinese doctors and their collaborators should be reflected in future histories of medicine in the United States. Herbs and Roots deserves to be widely read by scholars interested in the globalization of Chinese medicine, Asian American experiences, and the intersection of knowledge and practice in transcultural contexts.

Hyocholic acid and glycemic regulation: comments on ‘Hyocholic acid species improve glucose homeostasis through a distinct TGR5 and FXR signaling mechanism’

Hyocholic acid species (HCA, hyodeoxycholic acid, and their glycine and taurine conjugated forms) comprise 80% of the composition of pig bile (Haslewood, 1956). An interesting fact about pigs is that they do not get diabetes even though they eat almost anything and in abundant amounts, a diabetes-promoting diet. The first use of pig bile for treatment of 'xiao-ke', a condition known today as diabetes, was recorded ∼400 years ago by the Chinese medical practitioners in the Compendium of Materia Medica (Li, 1573‒1593). Recently, we found HCA species as novel biomarkers for metabolic diseases (Zheng et al., 2021b) and also identified the role of HCA species in the prevention of diabetes as well as their mechanism of action (Zheng et al., 2021a). Although bile acids (BAs) are mostly associated with their aid in food digestion, they have also been shown to act as signaling molecules by binding to two particular receptors, farnesoid X receptor (FXR) and the G-protein-coupled receptor, TGR5. Experiments were thus directed to the effect of HCA binding to these two BA receptors on glycemic regulation in both in vivo and in vitro models.

Review: The Chile Pepper in China: A Cultural Biography, by Brian R. Dott

Review: <i>The Chile Pepper in China: A Cultural Biography</i>, by Brian R. Dott

Directness of advice giving in traditional Chinese medicine consultations

Many studies of doctor–patient interaction have identified ways healthcare practitioners use various discourse strategies to mitigate the directness of their advice in medical consultations; however, precisely how healthcare practitioners express directness has been overlooked. Traditional Chinese medicine (TCM), one of the most popular therapeutic approaches to medicine, is of increasing importance in medical discourse research despite a relative lack of studies. To contribute to an understanding of modern Chinese medicine practice and doctor–patient communication in the TCM context, this study identifies categories of direct advice occurring in TCM consultations and explores how the directness of Chinese medical practitioners' advice is discursively constructed, negotiated, and perceived by consultation participants. Findings show that Chinese medical practitioners frequently use direct advice to express directness. Direct advice is often phrased in the imperative without mitigations. Occasionally, patients participate in the construction of directness by specifying practitioners' direct advice. Directness is also sometimes mitigated in direct advice via practitioners' medical explanations. Drawing upon the framework of relational work (Watts, 2003), this study argues that participants view advice directness in TCM consultations as judicious and appropriate. Chinese medical practitioners’ directness when offering advice in consultations can be attributed to the medical theory of TCM.

Poverty affects access to regular source of primary care among the general population in Hong Kong

AbstractA territory‐wide two‐stage stratified random sample of 2,282 community‐dwelling Hong Kong adults were surveyed between 2014 and 2015 to investigate the association between poverty and regular source of primary care utilization. Poverty was operationalized by income‐poverty and deprivation. About 94% of our sample reported having regular source of primary care (Western and/or Chinese medical practitioner) and about 69% among them were in private sector. Multivariable logistic regression showed that people who were income‐poor and deprived were less likely to have regular source of primary care (income‐poor: OR = 0.523, p = .027; deprived: OR = 0.488, p = .007) and visit private primary care doctors (income‐poor: OR = 0.445, deprived: OR = 0.222, both p &lt; .0001). Those who had chronic diseases were more likely to have regular source of primary care (multimorbid: OR = 10.709, p &lt; .0001), but less likely to access care in the private sector (one chronic disease: OR = 0.690, p = .019; multimorbid: OR = 0.374, p &lt; .0001) than those without. Further, being older and less skilled were significantly associated with less likelihood of visiting a private doctor. Path analysis showed that the number of chronic diseases had significant indirect effect on having regular source of primary care with being income‐poor and deprived as the mediators (β = −.0183, p = .0016). Therefore, despite a public health‐care system that aims to deny no one from adequate health care for lack of means, regular source of primary care in Hong Kong is found to be pro‐rich. Future policies should tackle the problem of health‐care inequalities to meet the needs of the underprivileged.

Analysis on the origin and development of elements of reinforcing and reducing needling techniques

Reinforcing and reducing needling manipulations are important factors affecting clinical therapeutic effect. In the present paper, the relevant elements of the reinforcing and reducing techniques of acupuncture needle including the left- and right-ward twirling, gender, needling at the left and right, front and back parts of the body, needling along or against the running course of the meridian, and their origin and development recorded in ancient Chinese medical books were collected and sorted out, followed by analysis on the understandings of Chinese ancient medical practitioners about them. Results show that the right- or left-ward twirling of needles, gender, and needling at the right or left part, the front or the back part of the body of patients are not the core components of the reinforcing and reducing techniques. Of the three stimulus parameters of needling, named amplitude, frequency and duration which are frequently researched at present, only the duration of single twirling (frequency) was highly noted in GAO Wu's book Zhenjiu Juying (A Collection of Gems in Acupuncture and Moxibustion). It is worthy of being studied in the further. Regarding the stimulation intensity of acupuncture involving the identification of reinforcing or reducing manipulations, the factors influencing the patients' feelings of needling intensity of acupuncture should be studied at the same time.

Delivery of patient-centered care in complementary medicine: Insights and evidence from the Chinese medical practitioners and patients in primary care consultations in Hong Kong

IntroductionTraditional Chinese Medicine (TCM) has become increasingly popular around the world, and has been accepted by people not only in China and Southeast Asia, but also in Western countries. Despite its historic role in the Chinese society, there has been limited research on exploring the nature of TCM practitioner-patient interactions in the Chinese context. As indicated by a major study regarding the Hong Kong context1, there is a need to investigate the role of TCM practitioner and promote interdisciplinary research to ensure safety and synergy of TCM and Western medicine in primary care. This study aims to address this gap by investigating the nature of TCM consultations and their communication patterns in Hong Kong. MethodsBased on 10 h of conversations (in Cantonese) between TCM practitioners and their patients in the diagnostic interviews, the study explored how the doctor-patient relationship was negotiated in the course of the consultation, while both the TCM practitioners and the patients were constantly trying to manage and maintain common ground. Particular attention had been paid to the identification of specific linguistic and discourse strategies that TCM practitioners had employed to establish doctor-patient rapport, so that a better understanding of patient-centred care in the TCM context could be obtained. The participants were recruited from a local university operated clinic which shared the characteristic of TCM practitioners in Hong Kong. ResultsA range of linguistic strategies that TCM practitioners used to deliver patient-centred care have been identified. These strategies are also helpful in shaping a joint decision-making process that will lead to better patient understanding and compliance with the doctors’ treatments. ConclusionsThis study demonstrates empirically how TCM practitioners utilize a range of linguistic resources and communication strategies to shape the ongoing discourse so that their patients can have a better understanding of their illnesses. For an example, it is found that TCM practitioners and their patients were constantly trying to manage and maintain common ground by using a range of grammatical markers, including sentence-final particles (SFPs) and discourse markers (DMs), to negotiate the epistemic commitment so that the patient would have good compliance with the practitioner’s suggested treatment. It is also observed that various types of interrogatives have been used by the TCM practitioners to elicit information from the patients as well as to encourage them to talk and make a response. Furthermore, it is found that TCM practitioners would deliberately enquire about the patients’ everyday experiences because what they eat, do, and encounter all have an important impact on their body conditions. By exploring into the patients’ daily routines in the social talk, the practitioner can help maintain and promote the overall balance of the patient’s body, and help them monitor and enhance their health conditions by modifying their daily habits and behaviours. With the adoption of these linguistic and communication strategies, the TCM practitioners are shown to have placed the patients’ needs as their top priority. Previous studies in the field have already proved that co-construction of the treatment plan between the doctor and the patient is extremely important, and that a patient-centred approach can largely reduce adverse events leading to avoidable patient harm. The specific strategies identified in the current study can enhance the TCM practitioners’ communication with patients, creating an environment that will surely optimise safety for both patients and clinicians.

Phenomenological Mechanism of Inspection in Traditional Chinese Medicine

Inspection is the crucial process to gain the physical condition of a patient before diagnosis and treatment in Traditional Chinese Medicine (TCM). Unlike the completely objective description of a patient in Western Medicine, the subjective thinking of the medical practitioners is comprised of TCM inspection. What’s more, Master of Chinese medical practitioner (CMP) could make a diagnosis only with inspection and without self-ratiocinate and demonstrate the process. This article revealed how the knowledge and experiences instantly appear in a CMP’s mind when he/she makes an inspection with the methods and conclusions of phenomenological philosophy. When a CMP sees a patient, he/she can “see” the symptoms of a patient with the help of intentional intuition, which is synthesized of retention. On this basis, pathogenesis knowledge will be given by the way of passive association. This conclusion drawn from phenomenological philosophy offers a new road for many problems remained pendent in TCM diagnosis and treatment.

Appropriate Statistics for Determining Chance-Removed Interpractitioner Agreement.

Objectives: Fleiss' Kappa (FK) has been commonly, but incorrectly, employed as the "standard" for evaluating chance-removed inter-rater agreement with ordinal data. This practice may lead to misleading conclusions in inter-rater agreement research. An example is presented that demonstrates the conditions where FK produces inappropriate results, compared with Gwet's AC2, which is proposed as a more appropriate statistic. A novel format for recording a Chinese Medical (CM) diagnoses, called the Diagnostic System of Oriental Medicine (DSOM), was used to record and compare patient diagnostic data, which, unlike the contemporary CM diagnostic format, allows agreement by chance to be considered when evaluating patient data obtained with unrestricted diagnostic options available to diagnosticians. Design: Five CM practitioners diagnosed 42 subjects drawn from an open population. Subjects' diagnoses were recorded using the DSOM format. All the available data were initially used to evaluate agreement. Then, the subjects were sorted into three groups to demonstrate the effects of differing data marginality on the calculated chance-removed agreement. Outcome measures: Agreement between the practitioners for each subject was evaluated with linearly weighted simple agreement, FK and Gwet's AC2. Results and Conclusions: In all cases, overall agreement was much lower with FK than Gwet's AC2. Larger differences occurred when the data were more free marginal. Inter-rater agreement determined with FK statistics is unlikely to be correct unless it can be shown that the data from which agreement is determined are, in fact, fixed marginal. It follows that results obtained on agreement between practitioners with FK are probably incorrect. It is shown that inter-rater agreement evaluated with AC2 statistic is an appropriate measure when fixed marginal data are neither expected nor guaranteed. The AC2 statistic should be used as the standard statistical approach for determining agreement between practitioners.

Guava Leaf Extract Diminishes Hyperglycemia and Oxidative Stress, Prevents β-Cell Death, Inhibits Inflammation, and Regulates NF-kB Signaling Pathway in STZ Induced Diabetic Rats.

Traditional Chinese medication has been utilized by Chinese medical practitioners to treat the varied symptoms of diabetes mellitus (DM). Notably, guava leaf has been used to treat diabetes in Asia. Our present study has been designed to analyze the action of guava leaf extract (GLE) at the molecular level in treating DM. A low dose of streptozotocin (STZ) was used to induce experimental diabetes in animals. Rats were treated with GLE at different concentrations (100, 200, and 400 mg/kg b.w.). The standard drug glibenclamide (GB) (600 μg/kg b.w.) was used for comparison. The diabetic rats showed a reduced level of insulin, accompanied by exaggerated levels of blood glucose, lipid peroxidation product, and augmented expressions of inflammatory cytokines, and showed reduced levels of antioxidants compared to the control rats. Supplementation with GLE counteracted the consequences of STZ. It suppresses the oxidative stress and inhibits the state of inflammation and the results are almost similar to that of standard drug group (GB group 5). Our present research, therefore, provides useful data concerning guava leaf extract by a thorough assessment in diabetes management. Being a natural product, additional analysis on GLE can shed light on finding effective phytochemicals within the field of diabetes mellitus.

An introduction of the treatment of uterine prolapse and urinary fistula from 1966 to 1976

During the period 1966 to 1976, a large number of retained patients of uterine prolapse and urinary fistula became a problem around the maternal and child health aspects not to be ignored. All traditional Chinese and Western medical practitioners under difficult condition had been trying their best to continue to carry out the treatment. For uterine prolapse, Chinese medicine therapy included decoction therapy, acupuncture therapy, comprehensive therapy, para-uterine injection of traditional Chinese medicine preparations; whereas Western medicine treatment included hysterophore and surgery. Guangxi and other places treated urinary fistula in an organized scale, and summed up the treatment experience continuously.

The first national general investigation and treatment of uterine prolapse: 1959-1966

The first national general investigationon uterine prolapse is an important measure of strengthening the protection of working women. Under the guidance of the Ministry of Health, local governments are extensively carried out all rescuing works, including the adjustment of labor time by organizing traditional and western medicine practitioners to carry on the comprehensive survey and concentrated treatment, with certain effects. Across the full application of traditional Chinese medical therapies with its recipes and medicines, traditional Chinese medical practitioners were actively involved in rescuing. Restricted by the medical conditions with non-popular surgical treatment, medical practitioners continuously explored the surgical treatment suitable for rural areas, offering valuable experiences for the future treatment.