Research on the development methodology for clinical practice guidelines for organic integration of traditional Chinese medicine and Western medicine

Integrated traditional Chinese medicine(TCM)and Western medicine(WM)is a new medical science grounded in the knowledge bases of both TCM and WM,which then forms a unique modern medical system in China.Integrated TCM and WM has a long history in China,and has made important achievements in the process of clinical diagnosis and treatment.However,the methodological defects in currently published clinical practice guidelines(CPGs)limit its development.The organic integration of TCM and WM is a deeper integration of TCM and WM.To realize the progression of"integration"to"organic integration",a targeted and standardized guideline development methodology is needed.Therefore,the purpose of this study is to establish a standardized development procedure for clinical practice guidelines for the organic integration of TCM and WM to promote the systematic integration of TCM and WM research results into clinical practice guidelines in order to achieve optimal results as the whole is greater than the sum of the parts.

Therapeutic Evaluation on Advanced Pancreatic Cancer Treated by Integrative Chinese and Western Medicine──Clinical Analysis of 56 Cases

Objective: In comparison with chemotherapy, to evaluate therapeutic effects on advanced pancreatic cancer treated by integrative Chinese and western medicine (ICWM) therapies. Methods: Based on the retrospective study of 56 patients with advanced pancreatic cancer, life table was applied to the analysis of patients' survival rate and Xz test to the comparison of therapeutic response between ICWM and chemotherapy groups. Results: The results showed that 1-year survival rate in the ICWM group was 55. 37%±3.24%; 2-year survival rate 34. 61%±16. 31%; 3-year survival rate 25. 96%±24. 64%; 5-year survival rate 25. 96%±24.64%; and median survival period 16. 3 months. However 1-year survival rate in the chemotherapy group was 21. 95%±27. 54% ; 2-year survival rate 7. 31%±27. 54% ; 3-year survival rate 0 % ; and median survival period 7. 5 months. The therapeutic effects between two groups were significantly different (P=0. 004). Further analysis suggested that the reduction of cancer mass in the ICWM group was more than that in chemotherapy group (P=0.049) and the improvement of advanced pancreatic cancer related-symptoms better than that of chemotherapy group (P = 0. 002). Conclusion: The ICWM comprehensive therapy is of important value in the treatment of advanced pancreatic cancer.

Clinical Controlled Study of Integrative Chinese and Western Medicine in Treating 49 Cases of SARS

Objective: To evaluate the efficacy of integrative Chinese and western medicine (ICWM) in treating severe acute respiratory syndrome (SARS) patients. Methods: Through parallel control design, 49 SARS patients were observed. Used as control, there were in the western medicine (WM) group 29 patients, who were treated with Ribavirin, Levofloxacin, Thymopentin, Azithromycin, methylprednisolone, etc. , on the basis of 'Recommended Protocol for Infectious Atypical Pneumonia' (abbreviated as 'Recommended Protocol') issueed by Ministry of Health. As the treated group, there were in the ICWM 20 cases. The protocol for treatment of SARS in 'Special Science and Technological Action to Prevent and Treat SARS' (abbreviated as 'Special S-T Action'), issued by Ministry of Science and Technology, together with the same WM as those for the control group. Results: (1) Time from the disease onset to the symptom improvement were 5.10±2. 83 days and 7. 62±2. 27 days in ICWM and WM group respectively, P<0.05; (2) As to corticosteroid (CS) amount and days before reducing dosage, 2 groups showed no significant difference, P>0. 05;(3) There was no significant difference in the time from disease onset to the body temperature normalization and the total amount of CS and the duration of using CS before reducing it to 80 mg between the ICWM group and the WM group; (4) The days and amounts for use CS after reducing between the ICWM group and the WM group were significantly different (P<0. 05). Conclusion: There were obvious advantages in ICWM to treat SARS, compared with that of WM alone, especially in improving the clinical symptoms, promoting the recovery of immune function, promoting the absorption of pulmonary inflammation and reducing the dosage and duration of CS treatment.

China Association of Chinese Medicine Paper notice for seminar on clinical application of new technology of integrated Chinese and western medicine in treating sequelae of cerebrovascular diseases

Hosted by ChinaAssociation of Chinese Medicine,and organized by World Journal of Integrated traditional and western Medicine,seminar on clinical application of new technology of integrated Chinese and western medicine in treating sequelae of cerebrovascular diseases is planned to be held in Nanning,Guangxi in August.

Clinical Effect of Integrated Traditional Chinese and Western Medicine on Diabetic Peripheral Neuropathy

Objective:Patients with diabetic peripheral neuropathy were treated with integrated traditional Chinese and western medicine,and the final results were observed.Methods:70 patients with such symptoms were randomly divided into two groups.The number of people is the same,and the treatment methods are different.The control group uses western medicine,while the observation group uses traditional Chinese medicine to evaluate the treatment effect.Results:After treatment,the effective rate of the observation group was(P<0.05),indicating that the treatment effect was significantly better.Conclusion:Patients with clinical diabetic peripheral neuropathy treated with routine nutrition and nerve repair,and with Chinese medicine,the effect is more satisfactory,and the effect is positive,so as to promote the optimization of their health.

Organic Integration of Traditional Chinese and Western Medicines—Future of Clinical Practice Guidelines of Integrated Traditional Chinese and Western Medicines

The transformation and implementation of clinical practice guidelines for integrated traditional Chinese medicine(TCM)and Western medicine(WM)is crucial to the adoption of medical science and technological findings and is an important way for TCM to be made available to the world.First,clinical practice guidelines(CPGs)of TCM and WM integration in recent years was analyzed to clarify the current situation and problems in the existing guidelines according to the following four perspectives:(1)perspective of TCM and WM integration in guidelines,(2)diagnosis Using integrated TCM and WM,(3)integration of TCM and WM treatment,(4)promoting TCM and WM integration.Secondly,the information and quality evaluation of CPGs for integrated Chinese and Western medicine in 2020–2022 were analyzed to explore the degree and methods of integration of Chinese and Western medicine guidelines.And last this study aimed to lay a foundation for the further establishment of Chinese characteristic,repeatable,and calculable clinical practice guidelines of TCM and WM integration.

Multi-centric Study on Clinical Epidemiology Is the Key Link in Treating Hypertension with Integrative Chinese and Western Medicine

General survey ofhypertension has beencarried out in our coun—try for three times.Thelast time was in 1999,with the result showingthat in our country theincidence of hyperten-sion among people over15 years old was11.26％.The incidencehas been raised by 25％

Meta-analysis of Integrated Traditional Chinese and Western Medicine in Treating H Type Hypertension

Objective: The aim of this study was to compare the clinical emcacy of integration of traditional Chinese medicine (TCM) and we stern medicine, and the western medicine therapy for H type hypertension. Methods: The randomized contmlled trials were collected via searching the internet. The literatures were screened according to inclusion and exclusion criteria. All the assignments were performed by two researchers. If there was disagreement between the two researchers, we would ask evidence based medicine expert for advice, to get an optimal result. The database included the ChianInfo (1978—2015), the Superstar database (1955—2017), the CBM(1985—2017), CNKI(1984—2017), PubMed(1966—2017). Accordingto Meta analysis, the RevMan 5.2 software was used to recover and analyze the literatures, and make the assessment of the integration of TCM and westem medicine in treating H Type Hypertension. Results: In the study, 12 trials were included. The total number of cases is 1139. The Meta analysis results showed that: Compared with western medicine the integration of TCM and western medicine would improve the antihypertensive efficacy [OR=0.39, 95%CI (0.25, 0.59), Z=4.38(P< 0.0001)],lower Hcy levels [WMD=-1.93, 95%CI (-2.27, 0.21), Z=4.38 (P< 0.0001)]. Conclusion: The combination therapy can effectively reduce Hcy levels, control blood pressure, better than Western medicine.

Clinical features and TCM syndromes of infectious AECOPD caused by influenza virus

Objective:To observe the clinical characteristics of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)caused by influenza virus,and to explore the distribution of Chinese medical syndromes.Methods:A retrospective study method was used to collect 66 patients with infectious AECOPD who were hospitalized in the Department of Respiratory Medicine of Wangjing Hospital from January 2016 to December 2020.They were divided into the infected group and the negative group according to whether they were infected with influenza virus.The patients were collected for general clinical practice Data(sex,age,course of disease,whether fever this time),inflammation index levels(procalcitonin PCT,C-reactive protein CRP,white blood cell count WBC,neutrophil percentage NEUT%,monocyte percentage MONO%,lymphocytes Percent LYM%),lung function(vital capacity VC,forced vital capacity FVC,forced expiratory volume FEV1 in 1 second,FEV1/FVC in 1 second),arterial blood gas analysis(arterial blood oxygen partial pressure PaO_(2),arterial blood carbon dioxide partial pressure PaCO_(2))And so on.Spearman correlation analysis was used to analyze the clinical characteristics of infectious AECOPD caused by influenza virus.Summarize the distribution law of TCM syndromes.Results:Patients in the infected and negative group were at age[77(69,80)vs 67(62,78)years],the proportion of patients with fever[14(38.89%)vs 4(13.33%)],PCT[0.059(0.041,0.085)ng/ml vs 0.040(0.028,0.068)ng/ml],CRP[20.42(2.61,60.99)mg/L vs 5.01(1.51,16.55)mg/L],LYM%(17.10±6.81)vs (20.96±8.68),PaO_(2)[71.75(62.85,77.90)mmHg vs 75.15(68.18,80.23)mmHg]and other indicators,there are significant differences,and the difference is statistically significant(P<0.05).Spearman correlation analysis showed that compared with the negative group,patients with infectious AECOPD caused by influenza virus were older,often had fever,and had higher levels of PCT and CRP.Conclusion:If AECOPD patients are elderly,have fever symptoms,and the levels of inflammation indicators PCT and CRP are high,influenza virus infection can be considered.TCM syndromes are mainly based on phlegm-heat stagnation in the lung,often combined with yin deficiency,qi deficiency,qi and yin deficiency and blood stasis;the viscera often involves lung,spleen,and kidney。

Effect of Western medicine therapy assisted by Ginkgo biloba tablet on vascular cognitive impairment of none dementia

Objective:To discuss the clinical effects of Western medicine therapy assisted by Ginkgo biloba tablet(GBT) on patients with vascular cognitive impairment of none dementia(VCIND).Methods: A total of 80 patients with VCIND were divided into two groups randomly:Conventional treatment group(control group) and combined treatment group.Conventional treatment group was given conventional treatment with anti-platelet aggregation.In this group,75 mg aspirin was given three times a day for 3 months.While in combined treatment group,19.2 mg CRT was given three times a day for 3 months together with conventional treatment(anti-platelet aggregation drugs). Montreal cognitive assessment(MoCA) and transcranial Doppler(TCD) were used to observe changes of cognitive ability and cerebral blood flow in VCIND patients before and after treatment in both groups.Then the clinical data were analyzed so as to compare the efficacy in two groups. Results:After 3 month-treatment in combined treatment group,the scores of executive ability, attention,abstract,delayed memory,orientation in the MoCA were significantly increased compared with those before treatment and those in control group after treatment.Besides,blood flow velocity of anterior cerebral artery increased significandy than that before treatment and that in control group after treatment.Conclusions:CBT tablet can improve the therapeutic efficacy as well improve cognitive ability and cerebral blood flow supply of patients with VCIND.

Clinical Practice Guideline of Integrative Chinese and Western Medicine for Acute Myocardial Infarction

With increasing morbidity and mortality,acute myocardial infarction(AMI)has become one of the major causes of human death,leading to heavy burdens to individuals,families and society.Previous researches have found that though large amount of resources and great effort were devoted,no significant improvements were achieved in reducing the in-hospital mortality of AMI patients.Meanwhile,extensive studies about Chinese medicine(CM)have found that CM has special advantages in treating AMI patients.However,there is no standardized and unified clinical practice guideline(CPG)of CM for AMI.Therefore,a CPG with strict standard and generally acknowledgement is urgent to be established.This guideline was developed following the methodological process established by the World Health Organization Handbook for Guideline Development.Extensive search on clinical evidences including systematic review(SR),randomized controlled trial(RCT),observational study and case reports was launched,covering evidence of CM for AMI on several aspects,such as diagnosis,CM patterns,CM interventions on AMI and complications,cardiac rehabilitation and clinical pathway management.Besides,the application of Grading of Recommendations Assessment,Development and Evaluation(GRADE)approach enabled the evaluation of evidence and formulation of grade of recommendation(GOR)and level of evidence(LOE).With the help of GOR and LOE,this CPG recommends the integrative CM and WM treatment method in AMI patients and provides useful information on medical decision for clinical physicians.

Clinical features and the traditional Chinese medicine therapeutic characteristics of 293 COVID-19 inpatient cases

Coronavirus disease 2019 (COVID-19) is now pandemic worldwide and has heavily overloaded hospitals in Wuhan City, China during the time between late January and February. We reported the clinical features and therapeutic characteristics of moderate COVID-19 cases in Wuhan that were treated via the integration of traditional Chinese medicine (TCM) and Western medicine. We collected electronic medical record (EMR) data, which included the full clinical profiles of patients, from a designated TCM hospital in Wuhan. The structured data of symptoms and drugs from admission notes were obtained through an information extraction process. Other key clinical entities were also confirmed and normalized to obtain information on the diagnosis, clinical treatments, laboratory tests, and outcomes of the patients. A total of 293 COVID-19 inpatient cases, including 207 moderate and 86 (29.3%) severe cases, were included in our research. Among these cases, 238 were discharged, 31 were transferred, and 24 (all severe cases) died in the hospital. Our COVID-19 cases involved elderly patients with advanced ages (57 years on average) and high comorbidity rates (61%). Our results reconfirmed several well-recognized risk factors, such as age, gender (male), and comorbidities, as well as provided novel laboratory indications (e.g., cholesterol) and TCM-specific phenotype markers (e.g., dull tongue) that were relevant to COVID-19 infections and prognosis. In addition to antiviral/antibiotics and standard supportive therapies, TCM herbal prescriptions incorporating 290 distinct herbs were used in 273 (93%) cases. The cases that received TCM treatment had lower death rates than those that did not receive TCM treatment (17/273= 6.2% vs. 7/20= 35%, P = 0.0004 for all cases;17/77= 22% vs. 7/9= 77.7%, P = 0.002 for severe cases). The TCM herbal prescriptions used for the treatment of COVID-19 infections mainly consisted of Pericarpium Citri Reticulatae, Radix Scutellariae, Rhizoma Pinellia, and their combinations, which reflected the practical TCM principles (e.g., clearing heat and dampening phlegm). Lastly, 59% of the patients received treatment, including antiviral, antibiotics, and Chinese patent medicine, before admission. This situation might have some effects on symptoms, such as fever and dry cough. By using EMR data, we described the clinical features and therapeutic characteristics of 293 COVID-19 cases treated via the integration of TCM herbal prescriptions and Western medicine. Clinical manifestations and treatments before admission and in the hospital were investigated. Our results preliminarily showed the potential effectiveness of TCM herbal prescriptions and their regularities in COVID-19 treatment.

Diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia and acute exacerbation of chronic obstructive pulmonary disease in Gansu Province:A case report

BACKGROUND In December 2019,the first patient with 2019-novel coronavirus(2019-nCoV)was reported in Wuhan,China,and the disease spread rapidly across the country and surrounding countries within 2 mo.As of February 29,2020,a total of 91 confirmed cases had been reported in Gansu Province.This case report of the diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia complicated by acute exacerbation of chronic obstructive pulmonary disease in Gansu Province aims to provide a better reference for the treatment of patients in the future.CASE SUMMARY The patient,a 94-year-old female,lived in Maiji District of Tianshui,Gansu Province,China.On January 30,2020,she was admitted to the Fourth People’s Hospital of Tianshui after 9 d of close contact with a patient with 2019-nCoV pneumonia.She was subsequently admitted to Gansu Provincial Hospital of Traditional Chinese Medicine for isolation and transferred to Tianshui Gansu Provincial Hospital of Infectious Diseases on February 3,2020 for treatment.Upon initial examination,her body temperature was 36.7°C,pulse was 80,breathing was 20,and blood pressure was 130/80 mmHg.She was conscious with normal development and normal nutrition.The pharynx was not red,and bilateral tonsils were not red and swollen.The lungs sounded slightly coarse with no dry or wet rales.The first symptoms were cough and fatigue on 2 February.The patient was hospitalized for 12 d.After active treatment,she was discharged on February 14 with a good prognosis.CONCLUSION A history of exposure to the affected area or patient is a major cause of 2019-nCoV infection,and population clustering is a high risk factor for transmission.Patients may not necessarily have respiratory system symptoms as the only clinical manifestation but may also have concomitant or first onset digestive symptoms.Attention should be paid to the prevention and treatment of multiple organ dysfunction syndrome.Nucleic acid testing is extremely important and needs to be repeated several times.Laboratory and auxiliary examination indicators during the first week of admission are extremely important.It is feasible to carry out dynamic and continuous index monitoring,which can predict and guide the prevention and treatment of multiple organ dysfunction and the prognosis of the disease.

Improving Clinical Practice Guideline Development in Integration of Traditional Chinese Medicine and Western Medicine

Integration of traditional Chinese medicine （TCM） and Western medicine （WM）, or called as integrative medicine （IM） in China, came into being in 1950s as a new form of medicine. IM emphasizes the combination of both conventional WM and TCM alternative approaches to address all aspects of health and illness.（1） The major practice in IM includes the integration of disease diagnosis in WM and pattern classification （or syndrome differentiation） in TCM, and the integration of WM interventions and TCM interventions.

Practice and principle of traditional Chinese medicine for the prevention and treatment of COVID-19

Traditional Chinese medicine(TCM)has played an important role in the prevention and treatment of Coronavirus disease 2019(COVID-19)epidemic in China.The integration of Chinese and Western medicine is an important feature of Chinese COVID-19 prevention and treatment.According to a series of evidence-based studies,TCM can reduce the infection rate of severe acute respiratory syndrome coronavirus 2 in high-risk groups.For patients with mild and moderate forms of COVID-19,TCM can relieve the related signs and symptoms,shorten the period of nucleic-acid negative conversion,and reduce conversion rate to the severe form of the disease.For COVID-19 patients with severe and critical illnesses,TCM can improve inflammatory indicators and blood oxygen saturation,shorten the hospital stay,and reduce the mortality rate.During recovery,TCM can improve patients’symptoms,promote organ function recovery,boost the quality of patients’life,and reduce the nucleic-acid repositive conversion rate.A series of mechanism research studies revealed that capability of TCM to treat COVID-19 through antiviral and anti-inflammatory effects,immune regulation,and protection of organ function via a multicomponent,multitarget,and multipathway approach.

Clinical Study of Sudden Desfness Treated with IntegratedTraditional Chinese and Western Medicine

Objective: To explore the mechanisms of integrated traditional Chinese and western medicine (TCM-WM) in treating sudden deafness. Methods: One hundred and forty-six patients suffered from sudden deafness were divided into two groups, 64 cases in the treated group were treated with TCM-WM therapy and the other 82 cases treated with western medicine alone for control. Results: The total effective rate of the treated group was 92. 19 %, that of the control group was 75. 61 %. The difference between the two groups was significant, P < 0. 01. Conclusion: The TCM-WM therapy is very effective in treating sudden deafness. Its mechanism might be: (1) Decrease of the blood viscosity and increase of the red blood cell's tenacity, so that the blood stream could pass through unimpededly. (2) Decrease of the plasma TXA2 level and increase of the PGI2 level,to benefit the blood supply for inner ear. (3) Increase of the activity of SOD and clearing away the free radicals so as to reduce the damage to the inner ear.

Analysis of Clinical Effect of Wumen Qingyi Decoction on Acute Pancreatitis

[Objectives]To examine the effects of Wumen Qingyi Decoction on inflammatory responses in patients with acute pancreatitis(AP).[Methods]Eighty patients with mild or severe AP were randomly allocated to a treatment group(Wumen Qingyi Decoction+baseline treated)or a control group(baseline treated).All patients were managed conservatively.In addition,the Group A received Wumen Qingyi Decoction for 400 mL/d for 7 d.Laboratory parameters,condition of disease and therapeutic effect indexes,and so on,between the two groups were compared.[Results]The recovery of serum levels of amylase(AMS),C reaction protein(CRP),and tumor necrosis factor(TNF-α),interleukin1(IL-1),IL-6,IL-10,as well as the scores of Balthazar and BISAP in Treatment group were quicker than those in Control group(P<0.05).In addition,the improvement of organic dysfunction in Treatment group was better than that in Control group.[Conclusions]The course of combined Wumen Qingyi Decoction and basic treatment of western medicine could effectively adjust the body's inflammatory response to promote the recovery process of acute pancreatitis.

Clinical Characteristics of Prostate Cancer in Advanced Stage and Its Treatment by Chinese and Western Medicine

Prostate cancer is a common malignant tumor in male seniors,with the higher rates in the Europe and America.There has been obvious increase in the incidence of prostate cancer in China recently.It has been reported that the incidence of prostate cancer was only