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.

A systematic review of the efficacy of traditional Chinese medicine retention enema in the treatment of ulcerative colitis

The objective of this study is to summarize the efficacy and safety of traditional Chinese medicine(TCM)enema in the treatment of ulcerative colitis(UC).The randomized controlled trials on TCM enema intervention in the treatment of UC were searched in seven databases:PubMed,Embase,Web of Science,CBM,CNKI,Wanfang Database,and VIP Database from January 1,2013 to June 6,2022,and the data were analyzed using RevMan 5.3 software.A total of 18 studies involving 1514 UC patients were included.Meta analysis results showed that compared with conventional Western medicine,Chinese medicine enema had a significant effect on UC,and the clinical effective rate of the experimental group using Chinese medicine enema was 4.45 times that of the control group using conventional Western medicine(odds ratio=4.45,95%confidence interval[3.27,6.06]).Therefore,Chinese medicine enema is effective in the treatment of UC,and can significantly reduce related symptoms.

Literature study on traditional Chinese medicine syndromes after renal transplantation

BACKGROUND Kidney transplantation is the most effective means to treat patients with renal failure,but its postoperative problems such as rejection reactions,immunosuppressant poisoning,chronic transplant kidney nephropathy,etc.still have not been effectively solved.This study searched for literature on traditional Chinese medicine(TCM)syndromes after kidney transplantation in China,conducted statistical analysis of the results,and sought to identify the underlying patterns.AIM To understand the TCM syndromes after renal transplantation and associated rules and provide a theoretical basis for further clinical research.METHODS The literature pertaining to TCM syndromes in renal transplantation,published in the China National Knowledge Infrastructure,Wanfang database,and WIP database from 1970 to 2021,was meticulously searched and comprehensively and statistically analyzed.RESULTS Following the established inclusion and exclusion criteria,13 studies were selected for analysis.Post-renal transplantation,no significant discrepancy was noted among the groups based on the location of TCM viscera.However,when categorized according to TCM pathogenic factors,the groups with spleen and kidney yang deficiency,as well as liver and kidney yin deficiency,exhibited a statistically significant difference in the frequency.CONCLUSION Currently,the research on TCM syndromes pertaining to renal transplantation is in its nascent phase.It is imperative to conduct a multicentric,large-scale survey of TCM syndromes subsequent to renal transplantation in the ensuing years.

A Review of Knowledge Graph in Traditional Chinese Medicine:Analysis,Construction,Application and Prospects

As an advanced data science technology,the knowledge graph systematically integrates and displays the knowledge framework within the field of traditional Chinese medicine(TCM).This not only contributes to a deeper comprehension of traditional Chinese medical theories but also provides robust support for the intelligent decision systems and medical applications of TCM.Against this backdrop,this paper aims to systematically review the current status and development trends of TCM knowledge graphs,offering theoretical and technical foundations to facilitate the inheritance,innovation,and integrated development of TCM.Firstly,we introduce the relevant concepts and research status of TCM knowledge graphs.Secondly,we conduct an in-depth analysis of the challenges and trends faced by key technologies in TCM knowledge graph construction,such as knowledge representation,extraction,fusion,and reasoning,and classifies typical knowledge graphs in various subfields of TCM.Next,we comprehensively outline the current medical applications of TCM knowledge graphs in areas such as information retrieval,diagnosis,question answering,recommendation,and knowledge mining.Finally,the current research status and future directions of TCM knowledge graphs are concluded and discussed.We believe this paper contributes to a deeper understanding of the research dynamics in TCM knowledge graphs and provides essential references for scholars in related fields.

Effectiveness and safety of traditional Chinese medicine for diabetic retinopathy:A systematic review and network meta-analysis of randomized clinical trials

BACKGROUND Diabetic retinopathy(DR)is currently recognized as one of the most serious diabetic microangiopathies and a major cause of adult blindness.Commonly used clinical approaches include etiological control,microvascular improvement,and surgical intervention,but they are ineffective and have many side effects.Oral Chinese medicine(OCM)has been used for thousands of years to treat DR and is still widely used today,but it is unclear which OCM is more effective for DR.AIM To estimate relative effectiveness and safety profiles for different classes of OCMs for DR,and provide rankings of the available OCMs.METHODS The search time frame was from the creation of the database to January 2023.RevMan 5.3 and Stata 14.0 software were used to perform the systematic review and Network meta-analyses(NMA).RESULTS A total of 107 studies and 9710 patients were included,including 4767 cases in the test group and 4973 cases in the control group.Based on previous studies and clinical reports,and combined with the recommendations of Chinese guidelines for the prevention and treatment of DR,9 OCMs were finally included in this study,namely Compound Xueshuantong Capsules,Qiming Granules,Compound Danshen Dripping Pills,Hexue Mingmu Tablets(HXMM),Qiju Dihuang Pills(QJDH),Shuangdan Mingmu Capsules(SDMM),Danggui Buxue Decoction(DGBX),Xuefu Zhuyu Decoction and Buyang Huanwu Decoction.When these nine OCMs were analyzed in combination with conventional western medicine treatment(CT)compared with CT alone,the NMA results showed that HXMM+CT has better intervention effect on the overall efficacy of DR patients,HXMM+CT has better effect on improving patients'visual acuity,SDMM+CT has better effect on inhibiting vascular endothelial growth factor,DGBX+CT has better effect on reducing fundus hemorrhage area,HXMM+CT has better effect on reducing fasting blood glucose,and QJDH+CT has better effect on reducing glycated hemoglobin.When there are not enough clinical indicators for reference,SDMM+CT or HXMM+CT treatments can be chosen because they are effective for more indicators and demonstrate multidimensional efficacy.CONCLUSION This study provides evidence that combining OCMs with CT leads to better outcomes in all aspects of DR compared to using CT alone.Based on the findings,we highly recommend the use of SDMM or HXMM for the treatment of DR.These two OCMs have demonstrated outstanding efficacy across multiple indicators.

Efficacy and safety of traditional Chinese medicine kidney-nourishing formula for Alzheimer's disease in comparison with donepezil:a systematic review and meta-analysis

Objective:Finding an effective therapy against Alzheimer’s disease(AD)has been associate increasingly pressing issue and traditional Chinese medicine(TCM)is widespread in the prevention and treatment of AD in China.The aim of this study was to judge the efficaciousness and safety of TCM kidney-nourishing(the changes of pathological state of kidney deficiency by means of TCM treatment and so on)formula(TKNF)for AD in comparison with donepezil.Methods:The retrieval period of seven databases was from the establishment of each database to April 2019.Two authors independently identified randomized controlled trials(RCTs),fetched data and assessed bias risk.Comprehensive analysis process was conducted with review manager for eligible and appropriate RCTs.Results:A complete of 981 AD patients from 13 studies were enclosed.Meta-analysis of RCTs showed that there was no significant difference in the improvement of Alzheimer's disease assessment scale-cognitive subscale score between 2 groups in short term,but the effect of long-term treatment may exceed donepezil;there was a significant difference in the improvement of activities of daily living score between 2 groups;there was a significant difference in TCM curative efficacy between 2 groups with long-term treatment.There was no significant difference in the incidence of adverse events between 2 groups.The quality of the evidence was high or moderate.Conclusion:Compared with donepezil,TKNF was an effective drug for AD patients and the clinical application of TKNF was safe.TKNF's long-term benefits need more evidence to verify.

Traditional Chinese medicine for acute mountain sickness prevention: A systematic review and meta-analysis of randomized controlled trials

Objective: To evaluate the efficacy of traditional Chinese medicine(TCM) for preventing acute mountain sickness(AMS).Methods: We included randomized controlled trials(RCTs) which evalueded the effect of TCM for preventing AMS, compared with a placebo, no treatment or acetazolamide. The literature was searched in 6major databases. RevMan 5.4 software was used for the meta-analysis. The relative risk for discrete variables and the mean difference for continuous variables with 95% confidence intervals(CIs) were applied to express the effect size. The risk of bias in the included studies was evaluated using the Cochrane risk assessment tool 2.0(RoB 2.0), and the evidence certainty was assessed using the Grading of Recommendations Assessment and the Development and Evaluation(GRADE) approach.Results: Twenty RCTs involving 3015 participants and 16 TCM patent drugs were included. The overall risk of bias in the majority of studies(15/20) was of some concerns. In terms of the AMS incidence,Rhodiola rosea(R. rosea, Hong Jing Tian) and Ginkgo biloba(G. biloba, Yin Xing Ye) were equivalent to the placebo/no treatment [RR(95% CI): 0.66(0.43-1.01), 0.82(0.63-1.06), respectively]. The AMS incidence in the G. biloba group was higher than that in the acetazolamide group [RR(95% CI): 2.92(1.69-5.06)]. In terms of improving the AMS symptom score on days 1 and 3 in the plateau, R. rosea and G. biloba were superior to the placebo or no treatment [MD(95% CI):-0.98(-1.71,-0.25),-2.05(-3.14,-0.95), respectively]. The other 14 Chinese patent medicines were evaluated in a single trial, and the majority of the results were negative. The subgroup analysis showed that the effect of R. rosea was related to the intervention time, way of ascending, and altitude.Conclusion: R. rosea and G. biloba were effective in improving AMS symptoms but had no effect in reducing the AMS incidence. There was insufficient evidence to support the use of other TCM patent drugs to prevent AMS. More randomized double-blind placebo-controlled trials are warranted to evaluate and screen effective Chinese patent medicines for AMS prevention.

Systematic evaluation of traditional Chinese medicine for treating Parkinson's disease

BACKGROUND：To evaluate the quality of the literature addressing traditional Chinese medicine for treating Parkinson＇s disease.DATA SOURCE：A computer-based online search of Chinese publications from January 2001 to July 2008 was conducted in Chinese Biology Medical Disc Database and China National Knowledge Infrastructure. Search key words were Parkinson＇s disease, integrated traditional Chinese and Western medicine, traditional Chinese medicine therapy, and Chinese herb therapy.DATA SELECTION：Articles describing randomized, controlled trials and quasi-randomized, controlled trials were included. Literature quality was assessed using the criteria-Systematic evaluation of clinical literature related to treatment of Parkinson＇s disease with traditional Chinese medicine. This included methodology, interventions in the treatment/control group, evaluation criterion of outcomes, and frequency.MAIN OUTCOME MEASURES：Evaluation criterion of outcomes （various score methods and evaluation scales）, methodological quality, and frequency distribution were all measured.RESULTS：A total of 33 articles with randomized, controlled trials were included. Of these, six described a random method, and the remaining did not describe random allocation methods or random sequence generation methods. None of the studies estimated sample size. Case descriptions of withdrawal and loss to follow-up were unclear. Both the Unified Parkinson＇s Disease Rating Scale and Webster scale were used in the eligible studies as evaluation criteria.CONCLUSION：There are no high-quality studies that address traditional Chinese medicine therapy and integrated traditional Chinese and Western medicine for treating Parkinson＇s disease in China. Eligible studies were not performed in accordance with Consolidated Standards of Reporting Trials statement or Standards for Reporting Interventions in Controlled Trials of Acupuncture criteria, and the literature quality was low. The presently used criteria for evaluating therapeutic effects do not completely assess outcomes of traditional Chinese medicine for treating Parkinson＇s disease. The identification of precise outcomes should be verified using randomized, controlled studies with adequate controls and proper designs.

Effect of traditional Chinese medicine on anthracycline-induced cardiotoxicity in animal models:A systematic review and metaanalysis

Objective:To evaluate the effect of traditional Chinese medicine(TCM)on anthracycline-induced cardiotoxicity(AIC)in animal models.Methods:Separate systematic searches for preclinical studies were performed in the PubMed,EMBASE,Web of Science,Chinese National Knowledge Infrastructure,Chinese Biomedical Database,Chinese Scientific Journal Database,and Wanfang Data from inception to August 2019.The primary outcomes were echocardiography,serum assays for myocardial enzymograms,histological assessments,and electrocardiograms.The secondary outcomes mainly included body weight and safety evaluations.The protocol is registered on PROSPERO(CRD42019145819).RevMan(V.5.3)was used for meta-analysis.Results:We identified 10 studies from 9 international scientific publications describing the efficacy of TCM on AIC animal models.All the included studies reported that,compared with animal model without any intervention,TCM significantly improved ventricular function,cardiac biomarkers,electrocardiograph results,and cardiac fibrosis.Improved survival rates and body mass indices were also observed with TCM.We further pooled the available data from four studies(63 animals)for the meta-analysis and the results showed that,compared with models without any intervention,TCM significantly increased the ejection fraction by 14.13%(95%CI,9.96e18.29)and fraction shortening by 8.66%(95%CI,6.05 e11.26).Creatine kinase-MB(SMD=2.49,95%CI:-3.12 to-1.85)and lactate dehydrogenase(SMD=-2.78,95%CI:-3.45 to-2.12)were also significantly decreased by TCM.Conclusions:TCM is effective in improving AIC in animal models and has tremendous potential to be translated to treat AIC in clinical practice.Additionally,the systematic review and meta-analysis of animal experiments may be valuable in enhancing and guiding animal experiments and promoting the transformation of the results.

The clinical efficacy of traditional Chinese medicine in the auxiliary treatment of grade 1 hypertension: A systematic review and metaanalysis

Objective:To systematically evaluate the clinical efficacy of traditional Chinese medicine(TCM)in auxiliary treatment of grade 1 hypertension.Methods:The China National Knowledge Infrastructure,Wan Fang Data,VIP,PubMed were searched to screen the literature of randomized controlled trials of TCM or non-drug therapies assisting conventional medicine to treat grade 1 hypertension.The search time was from the establishment of the database to October 1,2020.Revman5.3 was used for meta-analysis.Results:8 Chinese literatures were included.The results of the study showed that 24h diastolic blood pressure(DBP),24h systolic blood pressure(SBP),DBP lowering effect and TCM syndrome curative efficacy of the experimental group using TCM was better than that of the control group.However,TCM combined conventional medicine did not show an advantage on SBP lowering effect,antihypertensive efficacy rate and total clinical efficacy rate.Conclusion:TCM has a significant effect on lowering blood pressure for adjuvant treatment of grade 1 hypertension and can significantly improve clinical symptoms.

Chinese medicine formulas for nonalcoholic fatty liver disease: Overview of systematic reviews

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)affects more than one-quarter of the global population.Due to the lack of approved chemical agents,many patients seek treatment from traditional Chinese medicine(TCM)formulas.A variety of systematic reviews have been published regarding the effectiveness and safety of TCM formulas for NAFLD.AIM To critically appraise available systematic reviews and sort out the high-quality evidence on TCM formulas for the management of NAFLD.METHODS Seven databases were systematically searched from their inception to 28 February 2020.The search terms included“non-alcoholic fatty liver disease,”“Chinese medicines,”“systematic review,”and their synonyms.Systematic reviews involving TCM formulas alone or in combination with conventional medications were included.The methodological quality and risk of bias of eligible systematic reviews were evaluated by using A Measure Tool to Assess Systematic Reviews 2(AMSTAR 2)and Risk of Bias in Systematic Review(ROBIS).The quality of outcomes was assessed by the Grading of Recommendations Assessment,Development and Evaluation(GRADE)system.RESULTS Seven systematic reviews were ultimately included.All systematic reviews were conducted based on randomized controlled trials and published in the last decade.According to the AMSTAR 2 tool,one systematic review was judged as having a moderate confidence level,whereas the other studies were rated as having a low or extremely low level of confidence.The ROBIS tool showed that the included systematic reviews all had a high risk of bias due to insufficient consideration of identified concerns.According to the GRADE system,only two outcomes were determined as high quality;namely,TCM formulas with the HuoXueHuaYu principle were better than conventional medications in ultrasound improvement,and TCM formulas were superior to antioxidants in alanine aminotransferase normalization.Other outcomes were downgraded to lower levels,mainly because of heterogeneity among studies,not meeting optimal information sample size,and inclusion of excessive numbers of small sample studies.Nevertheless,the evidence quality of extracted outcomes should be further downgraded when applying to clinical practice due to indirectness.CONCLUSION The quality of available systematic reviews was not satisfactory.Researchers should avoid repeatedly conducting systematic reviews in this area and focus on designing rigorous randomized controlled trials to support TCM formula applications.

Property theory of Chinese materia medica: Clinical pharmacodynamics of traditional Chinese medicine

The property theory of Chinese materia medica is one of the foundations of traditional Chinese medicine.The property of Chinese materia medica(PCMM)is a multi-dimensional expression of the effect of Chinese materia medica(CMM),and it is related to the clinical prescription that fully reflects the clinical effect evaluation of CMM in a holistic,systematic,and scientific way.This paper discusses the source,development,and application of the PCMM by considering not only the five dimensions that constitute the PCMM but also the recognition of the human body and disease as given in traditional Chinese medicine.This paper aims to provide theoretical guidance for the rational use and development of CMM.

Traditional Chinese Medicine for Bladder Cancer:a Systematic Review and Meta-Analysis

Objective:To evaluate the efficacy and safety of traditional Chinese medicine in the treatment of bladder cancer.Methods:The databases of CNKI(1989-2018.10),Wan fang Data(1989-2018.10),VIP(1989-2018.10),PubMed(1966-2018.10),EMbase(1986-2018.10)and Cochrane Library(3rd issue,2018)were searched..Evidence quality and rating recommendations were scored using the GRADE system.Results:Thirty-six eligible studies were included with 3,109 patients.The meta-analysis showed that the total effective rate OR combination=2.85[OR=2.85,95%CI(1.98,4.09),P<0.00001].Recurrence OR merge=0.33[OR=0.33,95%CI(0.26,0.42),P<0.00001];Adverse reaction rate OR combination=0.37[OR=0.37,95%CI(0.32,0.43),P<0.00001];Incidence of adverse reactions OR combination=0.41[OR=0.41,95%CI(0.30,0.55),P<0.00001];Survival rate OR combination=1.78[OR=1.78,95%CI(0.55,5.77),P=0.34];Quality of life improvement rate OR consolidation=12.42[OR=12.42 95%CI(3.21,48.11),P=0.0003].The GRADE system evaluation results show that the evidence level is B and the recommendation level is weak.The traditional Chinese medicine group was superior to the control group in the efficiency rate,postoperative recurrence rate,incidence rate of adverse reactions,survival rate,quality of life improvement rate and incidence rate of toxic and side effects in the treatment of bladder cancer.Conclusion:Traditional Chinese Medicine has a good effect on treating bladder cancer and controlling recurrence of bladder cancer.Due to the impact of the original study on the results of meta-analysis,larger sample and high-quality clinical trials are still needed to verify.

Chinese herbal medicine combined with nucleotide analogues for compensated HBV-related cirrhosis: a systematic review of randomized controlled trials

Objective:To systematically evaluate the effectiveness and safety of Chinese herbal medicine (CHM) plus nucleotide analogues (NAs) for treating compensated HBV-related cirrhosis,the early stage of cirrhosis.Methods:PubMed,Cochrane library,China Network Knowledge Infrastructure Database (CNKI),Chinese Scientific Journals Database (VIP),Wan Fang Database and Sino-Med Database were searched.Randomized controlled trials (RCTs) and quasi-RCTs comparing NAs and NAs plus CHM therapy on patients with compensated HBV-related cirrhosis were included.Two reviewers independently extracted information and assessed the methodological quality of the trials.Different CHM herbal formulas used in the trials were considered.Primary metaanalysis was conducted when there were at least two trials comparing the same CHM formula.Results:Forty-five trials comprising 3497 participants were included.The quality of most of the trials was moderate or low.Twenty-six herbal formulations were identified.A meta analysis was conducted for compound Biejia Ruangan (FFBJ),Dahuang Zhechong (DHZC),and Fuzheng Huayu (FZHY).The results of the subgroup analysis showed a beneficial effect of FFBJ plus entecavir (ETV),and DHZC plus adefovir dipivoxil (ADV) on hyaluronic acid (HA);FFBJ plus ADV on laminin (LN);and FZHY plus ADV on HA,LN,and precollagen type Ⅲ (PC-Ⅲ).The results from other studies suggested significant benefits of CHM plus NAs compared with NAs alone,except those on albumin (ALB).None of the trials evaluated the quality of life or reported severe adverse events.Conclusions:A positive effect was found for FFBJ plus ETV,DHZC plus ADV,and FZHY plus ADV on HA;FZHY plus ADV and FFBJ plus ADV on LN;and FZHY plus ADV on PCⅢ compared with the effects of NAs used alone.

Clinical practice guidelines for traditional Chinese medicine and integrated traditional Chinese and western medicine:a cross-sectional study of data analysis from 2010 to 2020

Objective With the increasing publication of clinical practice guidelines(CPG)for Traditional Chinese Medicine(TCM)and Integrated Traditional Chinese and Western Medicine(IM),the standardization and scientifiction of its formulation have gradually attracted many people’s attention.To offer an overview of TCM and IM CPGs published over the past decade and analyze their general characteristics and methodological quality.Methods The China National Knowledge Infrastructure(CNKI)and WANFANG databases were searched for clinical practice guidelines and expert consensus papers from January 2010 to June 2021.Two researchers independently completed the literature screening and cross-checking according to the inclusion and exclusion criteria of CPGs and extracted information on general characteristics and methodological quality of CPGs.Results According to the selection criteria,231 CPGs(EB-CPGs=119,CBCPGs=112)were selected and the number of CPGs published in the 11 years showed an overall upward trend.The vast majority of CPGs used the Western naming system for the diseases,and only 11 CPGs were named of TCM diseases or symptoms.TCM treatments were recommended in 223 CPGs.There were 156 ancient Chinese Medicine literature sources cited in 231 CPGs and opinions and experiences of 62 TCM experts cited in 37 CPGs.The methodological quality of EB-CPGs for TCM and IM were significantly better than CB-CPGs in 11 items.Only 60 EB-CPGs and 7 CB-CPGs designated clear criteria for grading quality of evidence and strength of the recommendations and 74 CPGs presented both the level of evidence and the strength of recommendations.We classified all CPGs according to whether or not they used GRADE,and the results showed that the CPGs using GRADE had higher methodological quality and more standardized reports.Conclusion This research has shown that the quantity and quality of CPGs in both TCM and IM have improved over the time span,but the methodological quality,especially evidence citation,and the use of criteria for grading quality of evidence and strength of the recommendations,still needs to further improvement in the future.

Meta-analysis of traditional Chinese medicine Jiedu therapy in the treatment of psoriasis vulgaris

Objective:To evaluate the clinical efficacy of traditional Chinese medicine Jiedu therapy in treatment of psoriasis.Methods: CNKI, Wanfang knowledge service platform, VIP journal database, Chinese biomedical literature database ( CBM), PubMed, the Cochrane Library and EMbase database from the establishment of the database to March 2020 were searched for the randomized controlled trials (Rcts) on traditional Chinese medicine Jiedu therapy in treatment of psoriasis. Literature selection and information extraction was completed and screened by two independent reviewers, and then the Cochrane recommended bias risk assessment method was used to evaluate the bias risk, and Review Manager5.3 was used for the data analysis. Totally 17clinical Rcts were included in this study, involving 1376 patients.Results:Analysis results showed that traditional Chinese medicine Jiedu therapy had higher clinical effective rate, with statistically significant difference ( OR= 4.53, 95% CI[3.17,6.46], Z =8.32, P<0. 00001);the improvement of score was more evident, PASI score (WMD =-2.21, 95%CI[-2.77, -1.64], Z = 7.60, P<0. 00001);and trial-related adverse events were reported in 6RCTs. Conclusion: Studies have shown that traditional Chinese medicine Jiedu therapy had higher clinical efficacy.

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.

Unsatisfied methodological qualities assessment of systematic reviews/Meta-analyses on Chinese medicine for stroke and their risk factors

Background:Stroke is not only high in morbidity and mortality but also poses a great burden of disease and it is also the most reported disease in Chinese medicine systematic reviews.Therefore,the quality of such evidence couldn’t be ignored.This study aims to use a measurement tool to assess systematic reviews(AMSTAR)to assess the methodological qualities of SR/Meta-analyses of Chinese medicine on stroke.Methods:Systematic searching of seven electronic databases and PROSPERO registration platform was carried out.Two researchers separately selected studies,extracted bibliographical characteristics and scored every included study independently after training.Total score and the proportion of each item completion were explored in different subgroup comparisons.Spearman rank correlation and multivariable logistic regression were used to measure the association between bibliographical characteristics and total score or each item.Results:Total average score of AMSTAR 1.0 checklists of 234 systematic reviews/Meta-analyses was 4.47(95%CI 4.27–4.68)and the qualities were unsatisfied especially in terms of priori setting(2.14%),grey literature inclusion(5.13%),providing a list of excluded studies(2.14%)and conflict of interest(0.00%).No improvement was found in 3 years even after the publication of AMSTAR.Chinese or nonregistered systematic reviews/Meta-analyses showed even worse methodological qualities(P<0.01).Positive correlation was found between individual items and number of pages,number of authors,research questions,languages or Meta-analyse separately(P<0.05).Conclusion:The methodological qualities of systematic reviews/Meta-analyses of Chinese medicine on stroke are poor especially Chinese studies,non-registered studies,brief studies and studies without Meta-analyse or cooperation.There is no obvious improvement over these years even after the publication of AMSTAR tool,so it is urgent to promote the use of AMSTAR or develop other efficient methods to control the quantity and monitor the quality in future.

Traditional Chinese Medicine in the treatment of recurrent respiratory tract infections in children:an overview of systematic reviews and Meta-analyses

OBJECTIVE:To evaluate and summarise the evidence from published Meta-analyses/systematic reviews(MAs/SRs)of Traditional Chinese Medicine(TCM)in the treatment of recurrent respiratory tract infections(RRTIs)and to provide a scientific basis for the clinical treatment of RRTIs with TCM.METHODS:Studies were retrieved from Chinese and English databases including the China National Knowledge Infrastructure,Wanfang database,China Science and Technology Journal Database,SinoM ed,PubM ed,Web of Science,the Cochrane Library and EMbase from their establishment date to March 2023.Involved studies were screened,extracted,and evaluated for quality by two researchers independently.The a measurement tool to assess systematic reviews(AMSTAR)2 scale was used for methodological quality evaluation,as well as the preferred reporting items for systematic reviews and Meta-analyses(PRISMA)2020 statement for report quality evaluation,the risk of bias in systematic reviews(ROBIS)tool for risk of bias,and the grading of recommendations,assessment,development and evaluation(GRADE)quality assessment tool for evidence quality.RESULTS:Twenty MAs/SRs studies were included,including analyses of 274 original studies involving 38335 patients with RRTIs.The AMSTAR 2 scale evaluation results showed that 19 studies were of very low quality and one of moderate quality.The ROBIS evaluation results showed that 11 MAs/SRs were at high risk and nine at low risk of bias.The PRISMA 2020 report quality showed the included studies had scores between 23.5 and 35.5,among them one with high quality,17 with moderate quality and two with low quality.The GRADE system results showed that among 126 outcome indicators,only 17 had moderate quality of evidence,27 had low quality,82 had very low quality,and none had high quality.CONCLUSIONS:The MAs/SRs methodological quality of using TCM for treatment RRTIs is generally poor,the quality of reports as well as of evidence is generally low,and the risk of bias is high;therefore we should treat these results with caution.

Efficacy of Xianglian pill for antibiotic-associated diarrhea: a protocol for systematic review and meta-analysis

Background:Antibiotic-associated diarrhea is a clinical common symptom of antibiotics overuse and occurs in 5%-70%of adults.Xianglian pill has been traditionally considered as an efficient treatment of diarrhea and gastrointestinal diseases for thousands of years.However,no systematic review and meta-analyses have focused on its positive effects.Hence,this protocol for systematic review and meta-analysis was developed to evaluate the effect and clinical safety of Xianglian pill on treating antibiotic-associated diarrhea.Methods:All randomized controlled trials published in Chinese and English and assessed use of Xianglian pill for antibiotic-associated diarrhea will be included.Databases of PubMed,EMBASE,Cochrane Library,China National Knowledge Infrastructure,Chinese Biomedical Literature,Wanfang,and Chinese Science and Technology Periodical Database will be searched for randomized controlled trials from their inception until November 16,2020.Primary outcomes will be the incidence of diarrhea and adverse events,and secondary outcomes will be bowel movements and microbiome characteristics.Two authors will extract data and assess the risk of bias independently.Risk ratio will be used to evaluate the results,and meta-analyses will be conducted using STATA 15.0 software.The review aims to demonstrate the effectiveness of Xianglian pill in the prevention and treatment of antibiotic-associated diarrhea.