Evidence-based Clinical Chinese Medicine:What Has Changed Over the Past 20 Years

Chinese medicine has been used for centuries to treat a range of health conditions.This history has produced a wealth of classical literature,case studies and clinical research data detailing its use and effectiveness.However,high-quality and conclusive evidence that meets modern requirements for clinical decision support is lacking.This evidence gap limits the integration of Chinese medicine with contemporary medicine,which in turn limits global access and acceptance of Chinese medicine as a form of safe and effective health care.Over the past 20 years,researchers and organisations around the world,including the World Health Organization(WHO)and United Nations,have worked to support the integration of traditional medicines,such as Chinese medicine,with conventional medicines to improve global health care.This paper provides an overview of Chinese medicine studies published in the top four general medical journals(BMJ,JAMA,Lancet and New England Journal of Medicine)from February 2005 to February 2024 in the past 20 years to highlight the progress in the development of this evidence base.It also highlights key actions taken to promote evidence-based clinical Chinese medicine,including product and practitioner regulation,formalising education standards,and international collaborations.Research conducted at the China-Australia International Research Centre for Chinese Medicine demonstrates the benefits of such a collaboration.Through development of its unique and inclusive‘whole-evidence’approach,plus clinical studies and systematic reviews,the Centre has significantly contributed to the evidence base for clinical Chinese medicine.In addition,its high-impact papers and groundbreaking monographs have been cited in international conventional medicine guidelines.While progress has certainly been made during the past 20 years to build a stronger evidence base for clinical Chinese medicine,there is still a considerable gap that limits its integration with conventional medicine.Future funding and research are needed to continue this work and achieve to safe,effective and accessible traditional medicine as part of the WHO’s Universal Health Coverage strategy.

基于循证医学原则的中医干预类临床证据分级系统的构建

基于证据推荐等级的评估、制订与评价(GRADE)系统构建符合中医药临床实践特点的中医干预类临床证据分级系统。通过文献调研和核心小组讨论,中医干预类临床证据包括中医古籍、名医经验及现代临床研究证据,采用德尔菲法专家调查,确定该证据分级系统的范围、评价条目及具体的分级水平。其中,中医古籍干预类证据评价因素包括古籍医案的来源、诊疗内容完整性及古籍的传承性三方面;名医经验证据的评价因素包括名医资质、内容完整性、经验传承性三方面;评价条目采用权重赋分,将古籍及名医经验的证据均分为高、中、低3个等级。中医干预类临床证据分级水平与现代临床研究的GRADE分级一致,分为高、中、低、极低4个水平,旨在为中医临床实践和未来的研究提供参考。构建的中医干预类临床证据分级系统既遵从循证医学原则,又体现中医药临床证据特点,期望能更加全面、客观地评估支撑中医药临床实践的多来源证据。