Holistic Integrative Medicine Research Articles

2024 Chinese guidelines for the diagnosis and treatment of rheumatoid arthritis

Rheumatoid arthritis(RA) is an autoimmune disease characterized by erosive arthritis, which is an important cause of disability in Chinese population. It is of great significance to formulate and update RA diagnosis and treatment guidelines that meet the standards of international guidelines and clinical practice in China. The update of the Chinese guidelines for the diagnosis and treatment of RA was initiated by National Clinical Research Center for Dermatologic and Immunologic Diseases, jointly with the Chinese Association of Rheumatology and Immunology Physicians, the Rheumatology and Immunology Professional Committee of Chinese Rehabilitation Medical Association, the Rheumatology and Immunology Professional Committee of Chinese Research Hospital Association, and the Rheumatology and Immunology Branch of Beijing Association of Holistic Integrative Medicine. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist were followed to update the guidelines. The guidelines provide evidence-based recommendations on 10 clinical issues which were concerned by Chinese rheumatologists. The aim is to improve the level of diagnosis and standard treatment of RA in China, and to improve the quality of life and prognosis of patients.

Holistic Integrative Medicine Declaration- Secondary publication

AbstractHolistic integrative medicine, abbreviated as HIM, has been officially proposed since 2012. Its theoretical system has been continuously improved, and its practical methods have become increasingly diverse, becoming an inevitable choice and path for the medical development in the new era. This article demonstrates ten major propositions for HIM, elaborating on the connotation and extension of HIM from the perspectives of epistemology and methodology, in order to achieve the transformation and adaptive evolution of modern medicine.

CACA guidelines for holistic integrative management of adult acute myeloid leukemia

The CACA Guidelines was summarized by Hematology Oncology Committee of China Anti- Cancer Association. This portion of the CACA Guidelines for adult acute myeloid leukemia (AML) not only focuses on diagnosis, the treatment options for younger (age < 60 years) and older (age ≥ 60 years) patients (including non-APL, APL, R/R AML), but also pay attention to the treatment of AML complications, including central nervous system leukemia (CNSL), cardiotoxicity, agranulocytosis and fever, hepatitis B virus reactivation, uric acid nephropathy, bleeding and coagulation disorders, and nursing for patients with AML from the perspective of holistic integrative medicine to enhance the quality of life and treatment effects.

Characteristics of metabolic inflammatory syndrome among inpatients with type 2 diabetes: A cross-sectional study in China.

As meta-inflammation is a common feature for obesity, type 2 diabetes (T2D), nonalcoholic fatty liver disease and atherosclerosis, we have proposed a new concept, metabolic inflammatory syndrome (MIS), to cluster such diseases. We aimed to characterize MIS and explore its association with coronary heart disease (CHD) among T2D inpatients in China. A total number of 8344 T2D participants were enrolled. Each component of MIS and metabolic syndrome (MS) was analyzed. Their association with the risk of CHD was assessed using a binary logistic analysis. Among the T2D inpatients, the detection rate of MIS was much higher than that of MS (93.6 % vs. 53.2 %). Among all the components of MIS and MS, carotid atherosclerosis (71.9 %) was most commonly detected, which increased with aging in subgroups. Surprisingly, the most common combination of MIS was with all 4 components in T2D patients, with a constituent ratio of 30.9 %. According to the odds ratios (ORs), MIS was a better predictor of CHD than MS, especially after adjustment for age, sex, smoking, and alcohol consumption (adjusted OR for MIS: 3.083; for MS: 1.515). The presence of more components of MIS was associated with a higher detection rate of CHD (P<0.001). Among all the components of MIS and MS, carotid atherosclerosis best predicted the risk of CHD (adjusted OR: 1.787). MIS is an independent risk factor for CHD, with a bigger OR value than MS. Carotid atherosclerosis, with the highest detection rate, was the best individual predictor of CHD and thus a critical component of MIS. The concept of MIS represents the understanding of metabolic diseases from the perspective of holistic integrative medicine.

A commentary on 'Prothrombin induced by vitamin K Absence-II versus alpha-fetoprotein in detection of both resectable hepatocellular carcinoma and early recurrence after curative liver resection: a retrospective cohort study' ( Int J Surg 2022;105:106843).

aDepartment of General Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Graduate School of Peking Union Medical College bSchool of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine cDepartment of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Published online ■ ■ *Corresponding author. Address: Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing 210008, China. Tel: 86-13357851195; fax: 86-25-86560946. E-mail address: [email protected] (X. Xu). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

An approach to co-medication mechanism mining of Chinese Materia Medica and western medicines based on complex networks with the multi-source heterogeneous information

The co-medication strategy of Chinese Materia Medica (CMM) and western medicines under the holistic integrative medicine (HIM) model offers the advantages of increased efficacy and reduced toxicity, particularly in clinical practice for treating complex and challenging diseases. However, due to the mutual fragmentation of basic theories and principles of medication decision-making between traditional Chinese medicine (TCM) and western medicine, research on the mechanisms for the combined use of CMM and western medicines has become a challenging problem in modern clinical medicine research. Traditional drug combination mining models encounter numerous bottlenecks when dealing with this complex decision-making problem with multi-source information characteristics. This paper aims to mine the optimal drug combination strategy from a real-life decision-making scenario of co-medication between CMM and western medicines. It abstracts this realistic problem as a class of complex network optimal overlapping community detection problem, focusing on solving key difficulties such as the inability of existing drug complex network models to handle the multi-source information of drugs and the randomness in the community detection process. We integrate co-medication prescription information with attribute information to construct the speaker-listener label propagation algorithm based on semantic attribute features (SA-SLPA) and develop a new medicine combination identification strategy based on weighted complex networks. Using 6671 clinically real prescriptions, we conclude that the detection quality of the SA-SLPA method proposed in this paper is improved by up to 78% compared to existing methods. This improvement illustrates the scientificity and effectiveness of the model in this paper and provides new ideas for the application of theoretical models and methods of interdisciplinary disciplines such as decision science, data science, and computational science in the field of modern medicine.

CACA guidelines for holistic integrative management of nasopharyngeal carcinoma

Abstract Purpose Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor originating in the nasopharynx and is particularly prevalent in southern China. Unfortunately, international guidelines, such as NCCN or ESMO, fail to adequately coincide with clinical practice in China, making it difficult to achieve precision personalized therapy in China. The aim of this guideline is to better promote a “Multidisciplinary Team to Holistic Integrative Medicine" (MDT to HIM) system for the prevention, screening, diagnosis, treatment, and rehabilitation of NPC. Methods The China Anti-Cancer Association (CACA) invited domestic multi-disciplinary experts, involving radiologists, oncologists, surgeons, pathologists, herbalists, physiatrists, and psychologists, to write, discuss, and revise the guidelines. Based on the integration of research evidence, clinical experience, and patient needs, the domestic experts have iteratively developed these guidelines to provide proper and feasible management of NPC. Results and conclusion The CACA Guidelines for Holistic Integrative Management of Nasopharyngeal Carcinoma are more suitable for China's clinical practice, highlight Chinese characteristics, and have important clinical significance.

China Anti-Cancer Association (CACA) guidelines for holistic integrative management of cancer-peritoneal tumours from gastrointestinal tract

Peritoneal tumours have a large population and a poor prognosis with limited therapeutic options available, and are common originated from gastric, colorectal, appendix and other cancers. Traditionally, peritoneal tumours have long been considered to be a terminal condition with a median survival of 3-6 months, and the palliative symptomatic treatment is recommended. Recently, the multimodal therapeutic strategy of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has resulted in more effective on the prevention and treatment of peritoneal metastasis, which can significantly improve the survival and quality of life. Under the guidance of the China Anti-Cancer Association (CACA), the "CACA Guidelines for Holistic Integrative Management of Cancer-Peritoneal Tumours" was jointly completed by experts in related fields organized by the Chinese Society of Peritoneal Oncology. This guideline is guided by the concept of integrative medicine and focuses on the domestic epidemiology, genetic background and original studies. It emphasizes the multidisciplinary team to holistic integrative medicine (MDT to HIM), and pays attention to the whole-course management of "prevention, screening, diagnosis, treatment, and rehabilitation". This guideline mainly focuses on peritoneal metastasis from gastrointestinal tumours, aiming to standardize the clinical diagnosis and treatment process, and jointly promote the management of peritoneal metastasis in China.

A Preliminary Report on the Variation of Respiratory Blood Pressure during Sleep in Normal Subjects

ObjectiveBased on the new theory of holistic integrative physiology and medicine, we hypothesize that respiration is the origin of the variability of circulatory parameters, and initially verify this view by analyzing the relationship between blood pressure variability and respiration.MethodsThis study analyzed 8 normal subjects (NS) with no disease diagnosis who performed cardiopulmonary exercise testing (CPET), polysomnography (PSG), continuous fingertip pulse wave and electrocardiogram (ECG), and analyzed the correlation between the respiratory cycle of nasal airflow and blood pressure variation cycle during sleep. The respiratory cycle included complete inhalation and subsequent exhalation. Analysis and calculation of the number of breathing cycles (B‐n), average breathing cycle time (Bn‐T) and other parameters. Blood pressure variability is calculated using two different methods: fingertip pulse wave waveform and pulse transit time (PTT). The peak of the fingertip pulse wave represents the systolic blood pressure (SBP), and the end point represents the diastolic blood pressure (DBP). The values of the peak and end points are extracted separately and sorted separately. Continuous blood pressure rises from lowest to highest at a time, then dropped from highest to lowest, as a blood pressure variation cycle, calculation of blood pressure variation cycle (BPV‐n), and other parameters. PTT can directly calculate the blood pressure value, and it calculates the blood pressure variability in the same way as the fingertip pulse wave. To compare the relationship between respiratory and blood pressure variability parameters and the similarities and differences between the two methods, independent‐sample t test and paired‐sample t test were used for statistical test.ResultsThe subject's apnea hypopnea index was 1.71±1.30 events/hour. Pulse wave waveform calculation Bn (6581.63±1411.90), SBPV‐n (6629.88±1479.84) and DBPV‐n (6628.38±1396.37) are highly consistent during sleep. Bn/SBPV‐n (1.00±0.03) and Bn/DBPV‐n (0.99±0.02) is close to 1 (P&gt;0.05); Bn‐T (4.19±0.57 s), average systolic blood pressure variation cycle time (4.17±0.63 s) and average diastolic blood pressure variation cycle time (4.16±0.60 s) basically the same (P&gt;0.05). SBPV‐n (3988.38±1701.93) and DBPV‐n (886.63±176.86) calculated by PTT during sleep were significantly lower than the calculated values of pulse wave waveform (P&lt;0.01).ConclusionNormal subjects’ blood pressure variability during sleep is very similar to respiration, and the initiating factor of blood pressure variability is respiration.

A preliminary report on the variation of respiratory heart rate during sleep in normal subjects and patients with chronic diseases without sleep apnea

Objective: The new theory of holistic integrative physiology and medicine, which describes the integrative regulation of respiratory, circulatory and metabolic systems in human body, generates the hypothesis of that breath is the origin of variability of circulatory parameters. We investigated the origin of heart rate variability by analyzing relationship between the breath and heart rate variability (HRV) during sleep. Methods: This retrospective study analyzed 8 normal subjects (NS) and 10 patients of chronic diseases without sleep apnea (CDs-no-SA). After signed the informed consent form, they performed cardiopulmonary exercise testing (CPET) in Fuwai Hospital and monitored polysomnography (PSG) and electrocardiogram (ECG) during sleep since 2014. We dominantly analyzed the correlation between the respiratory cycle during sleep and the heart rate variability cycle of the ECG R-R interval. The HRV cycle included the HR increase from the lowest to the highest and decrease from the highest to the lowest point. The number of HRV (HRV-n), average HRV time and other parameters were calculated. The breath cycle included complete inhalation and subsequent exhalation. The number of breath (B-n), average breath time and other breath parameters were analyzed and calculated. We analyzed each person's relationship between breath and HRV; and the similarities and differences between the NS and CDs-no-SA groups. Independent sample t test was used for statistical analysis, with P<0.05. Results: CPET core parameter such as Peak VO2 (83.8±8.9)% in NS were significantly higher than that (70.1±14.9)% in patients of chronic diseases without sleep apnea (P<0.05), but there was no difference between their AHI (1.7±1.3) in NS and AHI (2.9±1.2) in CDs-no-SA (P>0.05). The B-n and the HRV-n (6581.63±1411.90 vs 6638.38±1459.46), the average B time and the average HRV time (4.19±0.57)s vs (4.16±0.62)s in NS were similar without significant difference (P>0.05). The comparison of the numbers in CDs-no-SA were the number (7354.50±1443.50 vs 7291.20±1399.31) and the average times ((4.20±0.69)s vs (4.23±0.68)s) of B and HRV were similar without significant difference (P>0.05). The ratios of B-n/HRV-n in NS and CDs-no-SA were (0.993±0.027 vs 1.008±0.024) and both were close to 1 and similar without significant difference (P>0.05). The average magnitude of HRV in NS ((5.74±3.21) bpm) was significantly higher than that in CDs-no-SA ((2.88±1.44) bpm) (P<0.05). Conclusion: Regardless of the functional status of NS and CDs-no-SA, there is a similar consistency between B and HRV. The origin of initiating factors of HRV is the respiration.

The new theory CPET guides the overall plan of individualized precision exercise to effectively improve the overall functional status of "frailty"

Objective: Under the guidance of the new theory of holistic integrated physiology and medicine, the effect of individualized accurate exercise program on the overall functional state was studied according to cardiopulmonary exercise testing (CPET). Methods: Li xx, female, 31 years old, has a fast heart rate since childhood (90~100 bpm), usually feel cold, especially in autumn and winter, and general health good. CPET was performed after signing the informed consent form at Fuwai Hospital in September 2019. Peak oxygen uptake, anaerobic threshold (AT), and peak cardiac output were (69~72)% pred, respectively, and the oxygen uptake ventilation efficiency and carbon dioxide exhaust ventilation efficiency were basically normal (96~100)% pred. The resting heart rate was fast, the blood pressure was low, the blood pressure response was weak during exercise, and the heart rate was mainly increased. The holistic integrated physiology medical theory pointed out that she was in weak health and heart weakness was the main manifestation. CPET was used to guide individualized precise exercise intensity titration, combine continuous beat-by-beat blood pressure, ECG, pulse and blood glucose dynamic monitoring to formulate an holisticplan of individualized quantitative exercise .Reexamine CPET after 8 weeks' strengthening management. Results: After 8 weeks of intensive holistic management, the limbs were warm and the cold symptoms disappeared. Re-examination of CPET peak oxygen uptake, AT and peak cardiac output were (90~98)% pred, which increased by (30~36)% respectively, and the holistic weak functional status was significantly improved; basically normal oxygen uptake ventilation efficiency and carbon dioxide exhaust ventilation efficiency also increased by (10~37)% respectively; resting heart rate and blood pressure basically returned to normal, and blood pressure and heart rate response during exercise were normal. Continuous ambulatory blood glucose monitoring indicated that the average blood glucose level decreased slightly and became more stable. Repeated measurement results of continuous ECG and beat-to-beat blood pressure also indicated a decrease in heart rate and an increase in blood pressure during rest, exercise and during sleep, and radial pulse wave. The amplitude of the dicrotic wave increases and becomes more pronounced. Conclusion: The new theoretical system to guide CPET to formulate an holistic plan for individualized precision exercise can safely and effectively enhance myocardial contractility, increase stroke volume, increase blood pressure, lower heart rate, stabilize and slightly lower blood glucose, and improve holistic functional status.

The characteristics of core parameters during cardiopulmonary exercise testing in patients with hypertrophy cardiomyopathy

Objective: The patients with Hypertrophic CardioMyopathy (HCM), characterized by hypertrophy of the myocardium with a high risk of sudden death, was less clear for the exercise pathophysiology. Under the guidance of holistic integrative physiology and medicine (HIPM), the ramp protocol symptom-limited CardioPulmonary Exercise Testing (CPET) is the only method to evaluate the overall functional status of human body. We investigated the CPET pathophysiology in patients with HCM. Methods: From April 2017 to January 2020, 244 subjects were enrolled after signed the informed consent form and completing CPET in Fuwai Hospital. They 219 HCM patients and 25 healthy normal subjects as control (NS). The changes of CPET core parameters between two them were calculated, compared and did Individual analysis. Results: ①The gender of HCM was 163 maleand 56 female. The gender of NS was 11 male and 14 female. The age of HCM was (46.7±12.8, 16.0~71.0) year; NS was (43.7±10.4, 26.0~61.0) year.②The core CPET parameters of HCM: peak oxygen uptake (Peak VO2) was (65.2±13.8, 22.8~103.4) %pred; anaerobic threshold (AT) was (66.4±13.0, 33.7~103.5) %pred; Peak O2 pulse was (84.3±19.0, 90.9~126.0)%pred; oxygen uptake efficiency platform (OUEP) was (99.2±13.4, 69.1~155.5) %pred; Lowest VE/VCO2 was (108.0±13.2, 70.4~154.0)%pred; VE/VCO2 Slope was (108.5±17.9, 66.9~164.9)%pred. Compared with NS, the Peak VO2, AT, Peak O2 pulse, and OUEP were significantly decreased (P<0.01 or P<0.05), but the Lowest VE/VCO2 and VE/VCO2 Slope were significantly increased (P<0.05). For Individual analysis of the overall functional status of CPET, some were very sever but some HCM were still within the normal range.③ The Peak VO2 was positively correlated with AT, OUEP, Peak O2 pulse, and peak systolic blood pressure, but was negative correlated with Lowest VE/VCO2 and VE/VCO2 Slope. Conclusion: CPET is safe and specific characteristics for patients with HCM, which deserve further research and clinical application. Under HIPM guidance, CPET can not only be used for overall functional evaluation, disease diagnosis and differential diagnosis, risk stratification, curative effect evaluation and accurate prognostic prediction, but also be utilized in formulating the individualized training prescription and management of chronic diseases.

Ultra-fast response polymer optical fiber oxygen measurement device and its preliminary experimental report on continuous dynamic change of arterial oxygen partial pressure under mechanical ventilation in living animals

Objective: We tried to implant the ultra-fast polymer optical fiber chemical oxygen sensor （POFCOS） into arterial blood vessel,connect with photoelectric conversion measurement system to record the continuous dynamic rapid changes of arterial PO2(PaO2) in whole living animals. It should be the experimental evidence for the new theory of holistic integrative physiology and medicine(HIPM) forexplain the mechanism of respiratory control and regulation in whole circusof respiration-circulation-metabolism. Methods: ①Fabrication of ultrafast POFCOS, calibration and its measuring system: The distal part of 2 m optical fiber was heated and pulled until it became a tapered tip. After cleaning and drying, the tip of 1 mm tapered optical fiber was dip-coated into the luminophore doped polymer solution, then was slowly pumped out while solvent was quickly evaporated to form an oxygen sensing tip, which was dried at room temperature for 24 hours. ②Animal experiments: Under general anesthesia and intubation, goatwas mechanically ventilated with 40%~60% oxygen. We exposed both right and left carotid arteries and the left femoral artery by skin cutting, and inserted the POFCOS directly into the arteries via indwelling catheter. The end of POFCOS were connected to the personal computer through optical fiber, excitation and detection Y-type optical fiber coupler through photoelectric conversion, so as we can realize the continuous dynamic response of living goat carotid PaO2 under mechanical ventilation. We mainly analyzed the intra-breath wave-form alternate increase and decrease of PaO2 and their time delay between lung and carotid arteries.We completes breathing control whole loop to explain the mechanism of mutual breathing and the switching of inspiration and exhalation. Results: The POFCOS has a very fast T90 response time was set 100 ms for liquid. When the heart rate of 40%~60% oxygen mechanical ventilated living goat was ~110 bpm, the PaO2 of left and right carotid artery showed a same wave-sizeup and down following with the inspiration and expiration of ventilator, with a range of up to 15 mmHg. There weresignificant noises of PaO2 change recorded in the left femoral artery. The lung-carotid artery time delay is 1.5~1.7 s after inhalation and exhalation, PaO2 at both left and right carotid arteries starts toincrease and decrease. After two-three heartbeats after the start of lung ventilation, thealternate up-down wave-form information of the arterialized pulmonary vein blood after pulmonary capillaries waspumpedby left ventricle to the position of peripheral chemoreceptors,thus realizing the whole cycle of inhalation and exhalation. It alternately interrupted inhalation, i.e. switching inhalation to exhalation, and then interrupted exhalation,i.e. switching exhalation to inhalation. Conclusion: The ultra-fast reactive implantableoxygen sensor and its measuring system can measure the physiological waveform changes of PaO2 in living animals, which can provide experimental evidence for explaining the mechanism of switching of inspiration-expiration in HIPM.

Multidisciplinary Team to Holistic Integrative Medicine

Multidisciplinary teams (MDTs) have been widely used for the diagnosis, treatment and management of cancer patients and other patients with complex diseases and conditions. The decisions of MDTs have not always been the best options as MDTs in general may encourage overtreatment. From MDT to holistic integrative medicine (HIM), a multidisciplinary working model should be established to formulate an individualized and integrated healthcare plan to achieve an optimal effect using a holistic view and integrative thinking.

My perspective on Holistic integrative medicine

My perspective on Holistic integrative medicine

From Cardiopulmonary Resuscitation, Cardiopulmonary Exercise Test and Cardiopulmonary Coupling to NewTheory of Holistic Integrative Physiology and Medicine

The Holistic Integrative Physiology and Medicine (HIPM), which was firstly purposed by Xing-Guo Sun since 2011 at APS conference, is a brand-new concept of physiology and medicine for human being. It originated from the philosophy of traditional Chinese and Western medicine and culture. It steps upon the coupling ideas of systems, such as cardiopulmonary resuscitation (CPR) by Yuan-Chang Wang and Kouwenhoven, cardiopulmonary exercise testing (CPET) by Karlman Wasserman and cardiopulmonary coupling (CPC) and integrated physiology. HIPM’s concept is always combining not only “Holistic” but “Integrative” (rather than integrated), not only time but space, not only normal (i.e. physiology) but abnormal (i.e. pathophysiology and medicine) for human physiology and medicine: only one inseparable set in whole contenting the all functional systems and their control and regulation in human being are internally integrative altogether, rather than the integrated one-by-one system of two or more systems as integrative physiology in systemic physiology. HIPM approaches the mechanism of neurohumoral control and regulation with the integration of all systems in the human body. We described the rough constructural frame of HIPM theory and clearly explained many unique questions in physiological and medical and pathophysiological mechanism of patients with chronic diseases (CDs). With HIPM, we can widely apply the methods of CPET, CPC and continuous functional monitoring for accurate diagnosis and differential diagnosis, evaluation, training, treatment, rehabilitation, prognosis and prevention in clinical medicine. We also can accurately and quantitatively manage CDs and do initial successful practice of integration of optimized traditional therapy, rehabilitation, health care and management, eating, drinking, exercise, sleep and lifestyle modification in China. The implementation and popularization of HIPM has the excellent opportunity and prospect. HIPM is the future of human physiology and medicine.

Application of Arterial Pulse Waveform for Diagnosis and Treatment of Chronic Diseases

BackgroundPulse wave is the vibration generated by the heart pulsating ejection along the elastic duct of the artery. It is affected by many factors such as the heart itself, the elasticity of the blood vessel wall and the viscosity of the blood. The main wave of the pulse wave is composed of a rising branch and a descending branch, and the descending branch contains a dicrotic wave. The left ventricle contracts and ejects blood, the aorta dilates, the blood pressure rises, and the ascending branch is formed. Ejection velocity slows down, blood pressure drops, forming the descending branch; The left ventricle dilates, the aortic valve closes, blood flows back and rebounds after impacting aortic valve, forming a repulse. The changes of pulse wave shape can indicate many physiological and pathological phenomena.MethodsEleven patients with chronic disease (mainly with abnormalities of sugar, lipid and pressure) and 8 healthy subjects were selected. The pulse wave was measured at rest and then individualized precise exercise was developed according to the results of each person's cardiopulmonary exercise testing (CPET). The program allowed the subjects to perform a single individualized precise exercise, measured the pulse wave again, recorded the pulse wave at 5, 15, 30, and 40 minutes after exercise. Then re‐mapped, calculated the feature points. The differences of pulse wave between patients with chronic disease and healthy people at rest and after exercise were compared, and the changes of pulse wave between patients and healthy people before and after exercise was summarized respectively.ResultsUnder resting state, healthy people had obvious dicrotic waves, while patients with chronic diseases had no obvious or no dicrotic waves. After exercise, the main wave peak of healthy people became higher, the waveform became narrower, and the dicrotic waves deepened; Similarly, the main wave peak of the patients became higher, the waveform became narrower, and most importantly, the dicrotic waves occurred which not had appeared at rest, or unconspicuous dicrotic waves turned obvious.ConclusionUnder the guidance of new theory of holistic integrative physiology and medicine, the sugar, lipid or pressure abnormalities are caused by abnormal supply and demand of oxygen, energy substances and metabolites in life regulation. We treat abnormal sugar, fat and pressure as one kind of disease for the first time. A single individualized precise exercise can significantly change the pulse wave of patients with chronic diseases, suggesting that pulse waves have a certain significance in the effective diagnosis and treatment of chronic diseases. We will expand the sample size to further explore the effectiveness of individualized precision exercise in strengthening control of chronic diseases in the aspect of pulse wave.Support or Funding InformationNational Natural Science Foundation of China (81470204);Fuwai Hospital, National Cardiovascular Institute of Chinese Academy of Medical Sciences (2012‐YJR02);Research on Clinical Characteristics of the Capital (Z141107002514084);Research and Outcome Promotion of Clinical Characteristics in the Capital (Project No. Z161100000516127)

Cardiopulmonary Exercise Testing under the Guidance of New Theory of Holistic Integrative Physiology and Medicine (HIPM)

BackgroundCardiopulmonary exercise testing (CPET), is guided by holism, a comprehensive evaluation of the overall functional status of the subject's gender, age, body mass, resting lung function, daily activities, etc. It gives specific load power, makes subjects do maximum limitation movement on exercise load equipment, closely monitors the exercise ECG, blood pressure, oxygen saturation and other cycle indicators during the exercise, and measures the gas exchange index such as the oxygen uptake and carbon dioxide output, to reflect the functional status of multiple system organs such as circulation, respiration, and metabolism.METHODSHuman beings are an inseparable whole. The systems and organs such as breathing, circulation and metabolism are interrelated and mutually influential. The O2 and CO2 produced by each inhalation and exhalation are exchanged in the lungs to form the up‐down “W” waveform information, which enters the pulmonary veins, the left atrium, and the left ventricle with the blood of the pulmonary capillaries, and reaches the arterial system through non‐100% cardiac ejection. It acts on peripheral chemoreceptors to switch respiration and acts on the central chemoreceptor after about 30 seconds to maintain the stability of the breath. The regulation of respiration requires the participation of circulation. The substances in the circulating blood (nutrients, metabolites, etc.) and hemodynamic indicators affect the breathing. Similarly, the gas signal molecules generated by respiration also affect certain circulation indicators such as strokes, output, heart rate, blood pressure, autonomic variability, and thus affect circulation. On this basis, digestion and absorption, urinary excretion, neurohumoral, skin, metabolism, and even mental and psychological factors are involved in the integration of the body, so that the whole person is in a dynamic balance.RESULTSCPET is to put the subject under extreme exercise state. At this time, the whole body is in a state of stress. The whole system and organs cooperate to maintain the metabolism of the body, which is actually to meet the needs of the cells for O2 and energy substances. When there is a lesion in the heart, lungs or other organs and systems, the O2 and energy substances required for the exercise muscle cells cannot be supplied in time, and the subject exhibits a decrease in exercise endurance. According to the electrocardiogram, gas exchange, and blood flow during CPET, we can comprehensively assess the subject's overall functional status and the degree of grading function limitation, and provide a basis for clinical decision‐making.CONCLUSIONCPET is an example for a human HIPM. CPET is the only method for objective, quantitative and accurate assessment of the overall functional status of human. It has important for disease prevention, diagnosis, treatment and prognosis. Only be guidanced by HIPM, we can correctly use CPET and interpret the data.Support or Funding InformationNational Natural Science Foundation of China (81470204);Fuwai Hospital, National Cardiovascular Institute of Chinese Academy of Medical Sciences (2012‐YJR02);Research on Clinical Characteristics of the Capital (Z141107002514084);Research and Outcome Promotion of Clinical Characteristics in the Capital (Project No. Z161100000516127)

The New Theory of Holistic Integrative Physiology (HIP)

BACKGROUNDThe modern systemic physiology, based on limit‐understand functional classification, has significant limitation and one‐sidedness. Human being is organic; we approach to set new theory for mechanism of functional control and regulation of all systems.METHODSWe use new theory of holistic integrative physiology and medicine to explain the mechanism of control and regulation of respiration, circulation, metabolism and all systems together.RESULTS1. Idea for respiration: The up‐down “W” waveform information of arterial blood gas (ABG) is core signal to control and regulate breathing, in addition to the mean level of ABG participate in it. In order to control and regulate breathing, we must integrate all systems together. The new theory will help to explain some unanswered questions in physiology and medicine which based on functional classification, for example: fetal does not breathing; how first breath generates; how respiratory rhythm and frequency generates, etc. 2. Idea for circulation: The main purpose of circulation is to maintain a stable metabolism of cells, i.e. transport oxygen (from lung) and nutrients (from gastrointestinal tract) to cells, and return carbon dioxide and metabolic products back for elimination. Based on this goal, all respiration and gastrointestinal digestion, absorption, urinary excretion, etc. are integrative together for regulation to maintain the supply‐demand balance at any metabolic statuses. So that, we can explain many existing problems and questions, for example: why and how the foramen ovale closed after birth; mechanism of Cheyne‐Stokes respiration; blood flow redistribution during exercise; variability of systolic blood pressure, heart rate and autonomic tone. (see The Published Structure Graph wih permission in Chinese for the Theory of HIP. Sun, XG. CJAP,2015,31(4):289–384). 3. There are “Y” type core axes for all functions of human life: The first one is the common goal of respiration and circulation to transport oxygen and carbon dioxide for cells, and the second one is the goal of gastrointestinal tract and circulation to transport energy material and metabolic product for cells (see The Published Structure Graph in Chinese for the Theory of HIP. Sun, XG. CJAP,2015,31(4):289–384). The “Y” core axes work together to maintain stable metabolism of cells. The neurohumoral regulation is holistically integrated and unified for all functions in human body. We simplified explain the mechanism of neurohumoral control and regulation life (respiration and circulation) as the example pattern of sound system.CONCLUSIONHolistic Integrative Physiology explains the mechanism of control and regulation of life, which integrates respiration, circulation, nerves, metabolism, exercise, sleep and digestion, absorption and elimination and etc. all systems together. It is linking all life styles of sleeping, waking, resting, exercise, drinking, eating, fasting, urinating, defecating, and etc. everything altogether.Support or Funding InformationNational Natural Science Foundation of China (81470204); Fuwai Hospital, National Cardiovascular Institute of Chinese Academy of Medical Sciences (2012‐YJR02); Research on Clinical Characteristics of the Capital (Z141107002514084); Research and Outcome Promotion of Clinical Characteristics in the Capital (Project No. Z161100000516127)Figure 1

The Personalized Precise Exercise Training with Holistic Integrative Protocol (PPET‐HIP) for Effective Management in Patient with Chronic Diseases (CDs)

BACKGROUNDThe patients with chronic diseases (CDs, i.e. hypertension, hyperglycemia, hyperlipidemia, hyperuricemia and obesity etc. with or without MI or Stoke) were uncured, according to the guidelines of all each one group of exports. However, based on our new Holistic Integrative Physiology and Medicine (HIPM), we might be able to use the core personalized precise exercise training and continuous functional monitoring with holistic integrative protocol (PPET‐HIP) for effective management of CDs patients.METHODSTen CDs patients, who has more than 10–30year history and four of them had MI or Stoke, were recruited from 2014–2018.Before and after 12‐week intervention, general evaluations(blood pressure, glucose, and lipid profiles), cardiopulmonary exercise testing (CPET), echocardiogram, and the adjustment of drugs treated CDs patients were recorded respectively. Based on HIPM for CPET interpretation, we gave each patient an PPET‐HIP for adjusting of all life styles.RESULTSAll patients exercised safely with any problem. After 12w HIPM‐PPT management, the all abnormal parameters of hypertensive, hyperglycemia, hyperlipidemia, hyperuricemia and obesity were become normal; CPET parameters, left ventricular function, and QoL were improved significantly than those before (P&lt;0.05). Then we decreased drugs dosages and totally stopped drugs, the levels of blood pressure, glucose and lipid were still maintained stable. Surprisingly, the curable condition was achieved in CDs patients.CONCLUSIONSHIPM guiding CPET for the PPET‐HIP could safely and effectively control the conditions of patients with CDs.Support or Funding InformationNational Natural Science Foundation of China (81470204);Fuwai Hospital, National Cardiovascular Institute of Chinese Academy of Medical Sciences (2012‐YJR02);Research on Clinical Characteristics of the Capital (Z141107002514084);Research and Outcome Promotion of Clinical Characteristics in the Capital (Project No. Z161100000516127)