Traditional Chinese Medicine Consultation Research Articles

Large Language Models in Traditional Chinese Medicine: A Scoping Review.

The application of large language models (LLMs) in medicine has received increasing attention, showing significant potential in teaching, research, and clinical practice, especially in knowledge extraction, management, and understanding. However, the use of LLMs in Traditional Chinese Medicine (TCM) has not been thoroughly studied. This study aims to provide a comprehensive overview of the status and challenges of LLM applications in TCM. A systematic search of five electronic databases and Google Scholar was conducted between November 2022 and April 2024, using the Arksey and O'Malley five-stage framework to identify relevant studies. Data from eligible studies were comprehensively extracted and organized to describe LLM applications in TCM and assess their performance accuracy. A total of 29 studies were identified: 24 peer-reviewed articles, 1 review, and 4 preprints. Two core application areas were found: the extraction, management, and understanding of TCM knowledge, and assisted diagnosis and treatment. LLMs developed specifically for TCM achieved 70% accuracy in the TCM Practitioner Exam, while general-purpose Chinese LLMs achieved 60% accuracy. Common international LLMs did not pass the exam. Models like EpidemicCHAT and MedChatZH, trained on customized TCM corpora, outperformed general LLMs in TCM consultation. Despite their potential, LLMs in TCM face challenges such as data quality and security issues, the specificity and complexity of TCM data, and the nonquantitative nature of TCM diagnosis and treatment. Future efforts should focus on interdisciplinary talent cultivation, enhanced data standardization and protection, and exploring LLM potential in multimodal interaction and intelligent diagnosis and treatment.

Feasibility and Challenges of Interactive AI for Traditional Chinese Medicine: An Example of ChatGPT

Abstract As a complementary and alternative medicine (CAM), traditional Chinese medicine (TCM) represents an established medical system with a rich history and abundant clinical experience. TCM is an empirical medicine, the process of which is analogous to ChatGPT’s learning and development model. In TCM, inquiry is a relatively objective way of traditional syndrome differentiation. Although various artificial intelligence systems related to TCM consultation exist, their interactive abilities remain limited. The study standardized the primary complaint and instructed ChatGPT to simulate a TCM practitioner, conducting three comprehensive inquiry tests. The results yielded unexpected conclusions, revealing that ChatGPT could simulate a TCM practitioner’s inquiry with patients, confirming its potential in the field of TCM inquiry. However, current applications still pose certain limitations and risks. Hence, to integrate ChatGPT-like language models with traditional TCM AI to establish an associative mode that can facilitate TCM diagnosis and treatment with more convenience and standardization is crucial, yet at the same time, it should be treated very carefully.

Personalized Intelligent Syndrome Differentiation Guided By TCM Consultation Philosophy.

Traditional Chinese Medicine (TCM) is one of the oldest medical systems in the world, and inquiry is an essential part of TCM diagnosis. The development of artificial intelligence has led to the proposal of several computational TCM diagnostic methods. However, there are few research studies among them, and they have the following flaws: (1) insufficient engagement with the patient, (2) barren TCM consultation philosophy, and (3) inadequate validation of the method. As TCM inquiry knowledge is abstract and there are few relevant datasets, we devise a novel knowledge representation technique. The mapping of symptoms and syndromes is constructed based on the diagnostics of traditional Chinese medicine. As a guide, the inquiry knowledge base is constructed utilizing the "Ten Brief Inquiries," TCM's domain knowledge. Subsequently, a corresponding assessment approach is proposed for an intelligent consultation model for syndrome differentiation. We establish three criteria: the quality of the generated question-answer pairs, the accuracy of model identification, and the average number of questions. Three TCM specialists are asked to undertake a manual evaluation of the model separately. The results reveal that our approach is capable of pretty accurate syndrome differentiation. Furthermore, the model's question and answer pairs for simulated consultations are relevant, accurate, and efficient.

Realizing Holism in Traditional Chinese Medicine (TCM) Consultations through the Voice of TCM (VOTCM): An Interactional Analytical Approach

ABSTRACT In recent years, doctor-patient communication in the context of traditional Chinese medicine (TCM) has attracted increasing attention. Highly influenced by ancient Chinese philosophy, TCM is unique in its exemplification of Chinese wisdom, particularly with respect to how the idea of zhěngtǐguān (整体观) (lit. whole body concept), realized as “the idea of the whole” or simply “holism,” is valued and realized in TCM consultations. Adopting an interactional analytical approach, our study aims to illustrate how TCM doctors and patients co-construct a medical consultation that can exemplify the idea of holism. Based on a spoken corpus of Mandarin Chinese totaling 443 minutes in length, this paper identifies instances of what can be labeled as the voice of TCM (VOTCM) in a typical TCM consultation that reflect the idea of holism and describes and analyzes the communicative routines that are specific to these TCM consultations. It is observed that the steps and strategies involved in the consultation not only illustrate the collaborative co-construction of holism but also point to the holistic aspect of TCM philosophy, particularly topics related to the different body parts and the lifeworld. The diagnostic explanations provided by doctors and the co-topical talks between doctors and patients at various stages of the consultation also play an important role in the co-construction and realization of holism.

Understanding the Traditional Chinese Medicine (TCM) consultation: Why do patients adhere to treatment?

Backgroundand purpose: Adherence is an issue that affects Complementary and Alternative Medicine (CAM) and conventional medicine practitioners, whereby approximately half of the patients do not take their medicines or remedies as prescribed. The consultation is an opportune area where practitioners can have an impact on patient adherence to treatment. As such, research was undertaken to explore this in depth within one CAM. The aim of the study was to understand the Traditional Chinese Medicine (TCM) consultation process that occurs in relation to adherence and develop a consultation model health professionals can use. Materials and methodsA classical grounded theory approach was employed to semi-structured interviews of TCM practitioners and patients along with observations of their consultations. Sampling was theoretical and by snowball in the United Kingdom. NVivo 11 was used to assist with analysis of the transcribed interviews and observations. ResultsSeven TCM practitioners and twenty-eight patients were recruited. TCM practitioners built a therapeutic relationship through the consultation by enabling patients to feel comfortable, valued as individuals which incorporated feeling understood and known, as well as supported in the management of their health. Fundamentally, patients needed to feel cared for and have trust in their TCM practitioner for the therapeutic relationship to be established. This motivated patients to continue with treatment. ConclusionThe TCM Consultation Model for Adherence was developed to conceptualise the consultation process that occurs in relation to adherence. It can be used to encourage patient persistence with treatment by TCM practitioners and potentially other health professionals.

Testing the Traditional Chinese Medicine Consultation Model for Adherence in Complementary and Alternative Medicine.

The Traditional Chinese Medicine (TCM) Consultation Model for Adherence conceptualises the consultation process specific to patient adherence. It can be used to improve patient persistence with treatment by TCM practitioners and possibly other health professionals. The aim of this research was to determine the applicability of the TCM Consultation Model for Adherence in the wider complementary and alternative medicine (CAM) setting. A survey containing validated questionnaires and items developed specifically to test the model was administered online in the United Kingdom. SPSS 25 was used to perform Spearman's correlations and Mann–Whitney U tests on the data. In total, 101 patients completed the survey. The results showed that patients having a therapeutic relationship and trusting in their practitioner was associated with overall adherence to CAM, while patients feeling supported was associated with all types of adherence to CAM. Specific behaviours of the TCM Consultation Model for Adherence that were positively correlated with adherence to CAM were identified. They could potentially be used by CAM practitioners to improve their patients' adherence with treatment.

Public attitudes toward traditional Chinese medicine and how they affect medical treatment choices in Hong Kong

PurposeThis study aims to test a conceptual model using public attitudes toward biomedicine and traditional Chinese medicine (TCM) to predict respondents’ medical treatment choice.Design/methodology/approachA quantitative online survey was conducted using quota sampling. Altogether 1,321 questionnaires from Hong Kong residents of age 15 years or above were collected.FindingsAttitudes toward biomedicine in relation to TCM and perceived cost of TCM consultation were found to be significant variables in predicting respondents’ medical treatment choice of treatment. Perceived efficacy of TCM, however, was not a significant predictor. Older respondents, as well as respondents with higher education, were less likely to consult biomedicine first when ill. They were also less likely to consult biomedicine exclusively.Research limitations/implicationsThis study uses a convenience sample recruited through personal networks. The findings cannot be generalized to the rest of the population.Practical implicationsRespondents in the study generally perceived TCM’s efficacy to be high, but not high enough to make it the medical treatment of choice. To promote TCM in Hong Kong, there is a need to enhance trust in it. This can be achieved through strengthening scientific research and development of TCM, enhancing professional standards of TCM practitioners and educating the public about the qualifications of TCM practitioners. Strategic channel planning to reach potential target and reducing the time cost of TCM medication should be examined.Originality/valueThe study is the first to relate attitudes to and perceptions of TCM with medical treatment choices in Hong Kong.

Utilization of Western medicine and traditional Chinese medicine among patients with Alzheimer's disease in Taiwan: a nationwide population-based study.

Large-scale studies of utilization of medical services among patients with Alzheimer's disease (AD) are lacking. We aimed to investigate the usage of Western medicine and traditional Chinese medicine (TCM) among these patients in Taiwan. We analyzed one million samples from the National Health Insurance Research Database in Taiwan. Patients (n=1814) newly diagnosed with AD in 2001-2010 were divided into TCM users (n=528) and non-TCM users (n=1286). Compared with non-TCM users, TCM users were younger, had a higher female:male ratio and higher utilization rate of Western medicine. The median interval between diagnosis and the first TCM consultation was 7.92months. Donepezil and rivastigmine were commonly prescribed medications. Chinese herbal medicine was the most popular treatment among TCM users. This study revealed the specific usage patterns of TCM and non-TCM medical services among patients with AD. The information could be used for improving the healthcare of patients with AD.

Use of Complementary Traditional Chinese Medicines by Adult Cancer Patients in Taiwan: A Nationwide Population-Based Study.

Background. Many patients with cancer seek complementary and alternative medicine treatments. We investigated the use of traditional Chinese medicine (TCM) by adult cancer patients in Taiwan. Methods. We reviewed the Registry for Catastrophic Illness Patients Database of Taiwan, and included all adult patients diagnosed cancer, based on the International Classification of Diseases (ninth revision), from 2001 to 2009 and followed until 2011. This database allowed categorization of patients as TCM users (n = 74 620) or non-TCM users (n = 508 179). All demographic and clinical claims data were analyzed. Results. Compared with non-TCM users, TCM users were younger and more likely to be female, white-collar workers, and reside in highly urbanized areas. The average interval between cancer diagnosis and TCM consultation was 15.3 months. The most common cancer type was breast cancer in TCM users (19.4%), and intrahepatic bile duct cancer in non-TCM users (13.6%). The major condition for which TCM users visited clinics were endocrine, nutritional and metabolic diseases, and immunity disorders (23.2%). A total of 33.1% of TCM users visited TCM clinics more than 9 times per year and their time from diagnosis to first TCM consultation was 5.14 months. The most common TCM treatment was Chinese herbal medicine. The common diseases for which cancer patients sought TCM treatment were insomnia, malaise and fatigue, dizziness and headache, gastrointestinal disorders, myalgia and fasciitis, anxiety, and depression. Overall, TCM users had a lower adjusted hazard ratio (aHR) for mortality (aHR = 0.69, 95% CI = 0.68-0.70) after adjustment for age, sex, urbanization of residence, occupation, annual medical center visits, and annual non–medical center visits. Conclusions. This study provides an overview of TCM usage among adult cancer patients in Taiwan. TCM use varied among patients with different types of cancer. Physicians caring for cancer patients should pay more attention to their patients’ use of complementary TCM.

Characteristics of traditional Chinese medicine usage in patients with stroke in Taiwan: A nationwide population-based study

Ethnopharmacological relevanceStroke has been the leading causes of death worldwide. Traditional Chinese medicine (TCM) has been used for stoke patients for thousands of years. This study aimed to investigate TCM usage and prescription patterns in stroke patients in Taiwan. Materials and methodsWe analyzed a random sample of one million individuals representing the 23 million enrollees selected from the National Health Insurance Research Database in Taiwan. Demographic characteristics, TCM usage, prescription patterns and mortality rate among stroke patients were analyzed. ResultsWe identified 23,816 patients who were newly diagnosed with stroke between 2001 and 2009 by their diagnostic codes (ICD-9-CM 430–438). Among them, 4302 patients had hemorrhagic stroke while 19,514 patients had ischemic stroke. Overall, 12% of the stroke patients (n=2862) were TCM users. The median interval between stroke onset to the first TCM consultation is 12.2 months. Among the TCM users, more than half (52.7%) of the patients received both Chinese herbal remedies and acupuncture/traumatology treatment. Bu-yang-huan-wu-tang and Dan-shen (Radix Salviae Miltiorrhizae; Salvia miltiorrhiza Bunge) was the most commonly prescribed Chinese herbal formula and single herb, respectively. TCM users had a higher incidence rate ratio in myalgia, myositis, fasciitis and insomnia than non-TCM users. Mental disorders such as anxiety and depression are common in both TCM and non-TCM users. Comparing with the non-TCM users, the TCM users had a lower mortality rate (adjusted hazard ratios were 0.44 in overall stroke, 0.50 in ischemic stroke and 0.25 in hemorrhagic stroke). ConclusionAdjunctive TCM use may reduce the risk of mortality rate among stroke patients. Bu-yang-huan-wu-tang and Dan-shen are the most common prescribed Chinese herbal formula and single herb for stroke patients, respectively. Future study investigating the anti-inflammatory and neuroprotective efficacy of Bu-yang-huan-wu-tang and Dan-shen in stroke is warranted.

Traditional Chinese Medicine Use among Patients with Psoriasis in Taiwan: A Nationwide Population-Based Study.

Traditional Chinese medicine (TCM) has long been used for patients with psoriasis. This study aimed to investigate TCM usage in patients with psoriasis. We analyzed a cohort of one million individuals representing the 23 million enrollees randomly selected from the National Health Insurance Research Database in Taiwan. We identified 28,510 patients newly diagnosed with psoriasis between 2000 and 2010. Among them, 20,084 (70.4%) patients were TCM users. Patients who were female, younger, white-collar workers and lived in urbanized area tended to be TCM users. The median interval between the initial diagnosis of psoriasis to the first TCM consultation was 12 months. More than half (N = 11,609; 57.8%) of the TCM users received only Chinese herbal medicine. Win-qing-yin and Bai-xian-pi were the most commonly prescribed Chinese herbal formula and single herb, respectively. The core prescription pattern comprised Mu-dan-pi, Wen-qing-yin, Zi-cao, Bai-xian-pi, and Di-fu-zi. Patients preferred TCM than Western medicine consultations when they had metabolic syndrome, hepatitis, rheumatoid arthritis, alopecia areata, Crohn's disease, cancer, depression, fatty liver, chronic airway obstruction, sleep disorder, and allergic rhinitis. In conclusion, TCM use is popular among patients with psoriasis in Taiwan. Future clinical trials to investigate its efficacy are warranted.

Consumers’ attitudes toward advertising by traditional Chinese medicine practitioners

This study investigated consumers’ attitudes toward advertising by traditional Chinese medicine (TCM) practitioners, and how attitudes varied among different demographic groups and user experiences in TCM. A survey using quota sampling was conducted. Altogether 1,039 adults aged 20 or above in Hong Kong filled in an online questionnaire in March 2014. Factor analysis found that attitudes toward TCM advertising consisted of four underlying dimensions: information value of TCM advertising; benefits of TCM advertising; confidence in financial aspects of TCM; and doubts about TCM advertising. Consumers’ attitudes toward TCM practitioners were in general favorable. Respondents appreciated information value of TCM advertising, but held some skepticism and worries about it. Respondents perceived strongly that advertising by medical professionals would lead to increase in the cost of services. Respondents with TCM consultation experience demonstrated a more positive attitude toward TCM advertising than respondents without TCM experience. Practical implications and limitations were discussed. (149 words)

An Expert System for Supporting Traditional Chinese Medicine Diagnosis and Treatment

Abstract Portugal has recently become one the few European countries to fully acknowledge Traditional Chinese Medicine (TCM); this substantial paradigm shift calls for novel tools for TCM practitioners, students and patients alike. This paper describes an Expert System for supporting the TCM consultation process – both in terms of gathering and managing the patients’ personal and symptomatic data, and of obtaining accurate diagnoses and treatments under regulated and reviewed protocols. The proposed tool was designed and is being developed with the support of two TCM therapists, which act as experts and provide aid to the processes of building the knowledge base and the automatic diagnosis system. In terms of architecture, the current version of the framework includes a mobile client application for the Android platform, integrated with an online spreadsheet. A survey was conducted in order to assess some of the needs of the community of TCM practitioners, and allowed gathering information on their needs.

Evaluation of services of the integrative health clinic in Hong Kong

(i) To provide a profile of the clients who have used the Integrative Health Clinic's services, (ii) to determine the clients' extent of satisfaction with the services received and (iii) to assess whether integrative therapies can/should be recommended to other clinics. Based on the integration of various health paradigms and the use of health promotion strategies, our Integrative Health Clinic in Hong Kong provides a range of different therapies for integrated symptom management. The integrative therapies are derived from conventional, complementary and alternative medicine. Design. Postal survey, followed by routine data analysis. Hong Kong Chinese clients attending a residential community health clinic were surveyed about health status and satisfaction towards the services received. A total of 489 clients (30.8% were male and 69.2% female) were registered with the clinic during the study period. The mean age (SD) was 47.8 (15.4) years. The customer satisfaction survey found that traditional Chinese medicine consultation was the most frequently used modality of the Integrative Health Clinic, followed by pain management. Out of the 489 clients, those who attended the Integrative Health Clinic only once in the study period for an annual health assessment and those who died during the period were excluded from the survey, giving a total of 276 eligible clients. Out of the 276 clients, 52.5% (128) responded to the survey that asked them to evaluate their satisfaction with the services received at the clinic and the performance of the clinic's practitioners who interacted with them. For practitioner performance, the percentage of respondents who gave a rating of satisfaction was found to range between 86.3-64.3%, while the percentage of respondents who gave a rating of dissatisfaction ranged from 13.7-35.7%. Overall, the survey found that most aspects of the Integrative Health Clinic's services were rated as satisfactory. The overwhelming satisfaction of clients with the services they received at the Integrative Health Clinic suggests that this integrative health services model could be considered for adoption in other clinics in Hong Kong and perhaps the region. It is necessary to review the use of integrative therapies so as to provide more data for the evaluation of this increasingly popular modality of health services.