Under the narrative medicine theory to establish the evidence-based medical record written by doctors and patients through integrated therapy of traditional Chinese and western on digestive system diseases

Objective:The aim of this article was to discuss the theory of doctor-patient co-operated evidence-based medical record and set up the preliminary frame of the doctor-patient co-operated evidence-based medical record following the concept of narrative evidence-based medicine.Methods:The information was searched from Pubmed,Embase,CBMdisc,CNKI.A preliminary agreement was reached by referring to the principles of narrative medicine and advises given by experts of digestive system and evidence-based medicine in both Traditional Chinese Medicine and Western Medicine.Result:This research is a useful attempt to discuss the establishment of doctor-patient co-operated evidence-based medical record guided by the direction of narrative evidence-based medicine.Reflection and outlook:Doctor-patient co-operated medical record can be a key factor of the curative effect evaluation methodology system of integrated therapy of Tradition Chinese Medicine and Western Medicine on spleen and stomach diseases.

Clinical practice guideline on traditional Chinese medicine in the treatment of influenza (2021)

Influenza is a serious public health problem that endangers the health of the global human population.Traditional Chinese medicine(TCM)is rich in theory and practical experience regarding the treatment of influenza,and TCM treatments have shown good curative effects,but there is a dearth of standardized clinical guidance.It is necessary to formulate a clinical practice guide based on evidence-based medicine.To this end,the Specialty Committee of Emergency,China Association of Chinese Medicine(Beijing,China)organized a team of clinical experts,methodological experts,and other multidisciplinary experts to develop a guideline with integrated research methods in the first place of TCM.This guide includes 23 recommendations.The prescription section contains 16 recommendations,including 5 recommendations for mild cases,5 recommendations for severe cases,3 recommendations for critical cases,and 4 recommendations for the recovery period;the portion covering proprietary Chinese medicines forms a total of 7 recommendations.This guide aims to provide the best evidence for clinicians and related practitioners to make decisions about influenza diagnosis and treatment in Chinese medicine.

Letters for "Prospects for the future of clinical efficacy evaluation of traditional Chinese Medicine—Emphasis on original theory and clinical practice"

Editorial Note:On January 1,2020,we published an online comment,titled“Prospects for the future of clinical efficacy evaluation of traditional Chinese medicine——Emphasis on original theory and clinical practice”,which focuses on the evaluation of traditional Chinese medicine.After the article was published,it attracted the attention of some scholars,who discussed with the editorial department by letters.The relevant letters are organized as follows for further communication and discussion by readers.

CLINICAL APPLICATION OF CHINESE HERBS REMEDIES AS IMMUNOMODULATORS IN THE TREATMENT OF CANCER

IMMUNITY AND TUMOR Immune system has closely relation to the growth and development of tumor. One of its immune functions is to constantly recognize and kill malignant cells which develop from normal cells. The occurance of tumor indicates to some extent the failure of this "immune serveillance" function. Many studies have shown that the tumor cells of body have some tumor interrelative antigen that dose not exist in normal tissues. Tests in vitro

COMPUTERIZED DIGITAL DESCRIPTION AND CLASSIFICATION OF THE TONGUE AND ITS COATING

In recent years there were various scientif creports on the tongue pictures in physiological,biochemical,pathomorphological,bacteriological,immunological and microcirculatory respects.Inaddition,a large-sized atlas of tongue pictureswas published in China.The Chinese Associa-tion of Traditional and Western Medicine andthe Traditional Diagnosis Group of Chinese Anti-Cancer Association first tried to investigatethe tongue picture in 19654 cases by using colorplates.Although the check on color plates mayreduce the errors of observation,it still

Research Advance in the Efficacy and Mechanism of Qing Fei Xiao Yan Wan for the Treatment of Respiratory Diseases

Qing Fei Xiao Yan Wan had been incorporated into the existing “Chinese Pharmacopoeia”, protected by patents. The manufacturing process of it was scientific and its compatibility was reasonable. It was also shown by clinical trials that the efficacy is exact. Clinical trials and experiment studies had confirmed the efficacy and some mechanism for the treatment of respiratory diseases, which were summaried in this paper. Combined with the experimental results (published in another paper), the other prospect application was further discussed.

Professor Xudong Tang's experience in the treatment of gastroesophageal reflux

Professor Xudong Tang believes that definite diagnosis is the key to gastroesophageal reflux disease treatment,and the treatment of refluxesophagitis should be combined with PH monitoring and clinical symptoms differentiation.Generally,according to the degree of acid regurgitation,it can be divided into different traditional Chinese medical syndromes:the liver-stomach depressionheat syndrome differentiation is the main type of acid regurgitation,while the liver-qi stagnation is the main type of acid regurgitation.In addition,attention should be paid to the step-down therapy of combination of traditional Chinese and Western medicine in the process of discontinuation.The lower efficacy of Western medicine should be used successively,together with traditional Chinese medicine Decoction,which can often achieve the effect of stopping recurrence.In addition,the traditional Chinese medicine prescription imitates Jianhua Dong's well-known old Chinese medicine thought,believing that the pathogenesis of gastroesophageal reflux disease is mainly Qi stagnation,the location of the disease is in the stomach,involving the liver and spleen.On the basis of Dr Dong Ganwei Baihe Decoction,the experience of treating gastroesophageal reflux disease with Lianzhu Liuyi Pill combined with Huagan Decoction was summarized.

Treatment of refractory H.pylori by Chai Ping Decoction:two case reports

Objectives:Helicobacter pylori(H.pylori)infection is one of the most common infections,for which wellestablished medical treatments have been widely used,such as quadruple therapy and sequential therapy.However,some patients still suffer from the infection after multiple treatment.Traditional Chinese medicine(TCM)has been widely used to treat the H.pylori infection.Whether the combination of TCM therapy and antibiotic treatment is effective for these patients with repeated infection with H.pylori needs clinical observation.Methods:In this study,we reported two cases with refractory H.pylori infection.One is a 60-yearold Chinese woman with diagnoses of chronic atrophic gastritis and H.pylori infection,who has an uncomfortable feeling in her stomach with a poor appetite,depression and irregular defecations.The other is a Vietnamese woman aged 46,who had abdominal pain for 11 years.We treated the two patients with Chai Ping Decoction,combined with sequential therapy.Results:Both patients had pain relieved and H.pylori infection eradicated after treatment.Conclusion:TCM therapy may eliminate H.pylori infection well with sequential therapy.Based on the TCM theory,the patients who were diagnosed as spleen deficiency and dampness with abdominal uncomfortable symptoms could be well treated.

The progress of treatment of children＇s psoriasis

Psoriasis is a chronic recurrent inflammatory skin disease, with erythema based on silver-white scales as the main clinical features. The incidence of psoriasis in children has gradually increased, and the clinical manifestations are not typical. Moreover, the drug sensitivity and tolerance of children are different with that of adults. This article reviews the treatment of children's psoriasis in China and abroad.

PnMYB4 negatively modulates saponin biosynthesis in Panax notoginseng through interplay with PnMYB1

Saponins are the main triterpenoid ingredients from Panax notoginseng,a well-known Chinese medicine,and are important sources for producing drugs to prevent and treat cerebrovascular and cardiovascular diseases.However,the transcriptional regulatory network of saponin biosynthesis in P.notoginseng is largely unknown.In the present study we demonstrated that one R2R3-MYB transcription factor,designated PnMYB4,acts as a repressor of saponin accumulation.Suppression of PnMYB4 in P.notoginseng calli significantly increased the saponin content and the expression level of saponin biosynthetic genes.PnMYB4 directly bound to the promoters of key saponin biosynthetic genes,including PnSS,PnSE,and PnDS,to repress saponin accumulation.PnMYB4 and the activator PnMYB1 could inter-acted with PnbHLH,which is a positive regulator of saponin biosynthesis,to modulate the biosynthesis of saponin.PnMYB4 competed with PnMYB1 for binding to PnbHLH,repressing activation of the promoters of saponin structural genes induced by the PnMYB1-PnbHLH complex.Our study reveals that a complex regulatory module of saponin biosynthesis is associated with positive and negative MYB transcriptional regulators and provides a theoretical basis for improving the content of saponins and efficacy of P.notoginseng.

Complementary and alternative medicine on cognitive defects and neuroinflammation after sepsis

Sepsis-associated encephalopathy(SAE)is a common manifestation of sepsis,ranging from mild confusion and delirium to severe cognitive impairment and deep coma.SAE is associated with higher mortality and long-term outcomes,particularly substantial declines in cognitive function.The mechanisms of SAE probably include neuroinflammation that is mediated by systemic inflammation and ischemic lesions in the brain,a disrupted blood–brain barrier,oxidative stress,neurotransmitter dysfunction,and severe microglial activation.Increasing evidence suggests that complementary and alternative medicine,especially Traditional Chinese Medicine(TCM),is favorable in alleviating cognitive decline after sepsis.Here,we summarized the studies of traditional herbal remedies,TCM formulas and acupuncture therapy in animal models of neurological dysfunctions after sepsis in recent decades and reviewed their potential mechanisms.

Bloodletting puncture in the treatment of acute ischemic stroke:protocol for a mixed-method study of a multi-center randomized controlled trial and focus group

This study is to investigate the effectiveness and safety of bloodletting puncture(BP)for acute ischemic stroke(AIS)when used in combination with standard treatment,as well as the patients'feelings and attitudes toward the treatment.This is a mixed method research which includes a multi-center,superiority,randomized controlled clinical trial,and focus group interview.A total of 360 AIS participants will be enrolled.They will be randomized into one of the following two groups for 7 d:(a)BP with standard treatment group(n=180);(b)standard treatment group(n=180).The primary outcome will be National Institute of Health stroke scale(NIHSS)score at day 7 after treatment.Secondary outcomes will be changes of Glasgow Coma Scale score,NIHSS score,mRS and Traditional Chinese Medicine syndrome score from baseline to 7,14,and 30 d after treatment,recurrence rate and all-cause mortality rate within 30 d,and the safety assessments.The focus group will be conducted with a purposive sample of 1-2 acupuncturists and 1-2 patients respectively at each center at 7 and 30 d after treatment.We designed a mixed method study to evaluate the effect of BP,an acupuncture therapy for patients with AIS.If the findings of this study confirm the effectiveness of BP to reduce the NIHSS score and other related outcomes and patients are willing to accept the therapy,we believe this study will help the implementation of this therapy in clinical practice,and provide new evidence for the treatment of AIS.

Efficacy and safety of the Qiguiyin formula in severe pneumonia: study protocol for a randomized, double-blind, placebo-controlled clinical trial

OBJECTIVE: To evaluate the clinical efficacy and safety of Qiguiyin(QGY) formula in patients with severe pneumonia in China compared with a placebo.METHODS: This is a multicenter double-blind, placebo-controlled, randomized clinical trial with two parallel arms. There will be 530 patients enrolled and randomized into either the experimental group(QGY formula) or the control group(placebo). Therapies for patients in the two groups above will be based on the conventional therapy. The primary outcome is 28-day mortality. Secondary outcomes include:(a) duration of hospital stay;(b) duration of time in the intensive care unit(ICU) stays;(c) duration of mechanical ventilation;(d) antibiotic DDD value(which means the doses of antibotics during the treatment period);(e) serum procalcitonin(PCT) level;(f) serum C-reactive protein(CRP)level;(g) Pneumonia severity index(PSI) score;(h)Sequential Organ Failure Assessment(SOFA) score;(i) sputum culture results;(j) blood routine examination results;(k) routine urine test results;(l) stool routine examination results;(m) electrocardiogram results;(n) alanine aminotransferase levels;(o) aspartate amino transferase levels;(p) total bilirubin;(q) creatinine levels;(r) urea nitrogen levels;and(s)adverse events.ETHICS AND DISSEMINATION: The protocol has been approved by the Research Ethics Committee of Beijing Hospital of Traditional Chinese Medicine,Affiliated with Capital Medical University(2018 BL-053-02). This trial aims to provide evidence for QGY formula combined with conventional therapy in treating patients with severe bacterial pneumonia,and to verify the clinical effectiveness and safety of QGY formula in China compared with placebo. Additionally, this trial will reveal the effect of QGY formula on delaying/reversing the characteristics of drug-resistant bacteria.Trial registration number: Chi CTR1800019785.

Distribution and Development of the TCM Syndromes in Psoriasis Vulgaris

Objective: To study the distribution and development rules of the TCM syndromes in psoriasis vulgaris. Methods: Based on the clinical epidemiologic mass survey, the study was carried out by means of a status survey, multi-center and large-sample research. The data base was set up by EPIINFO6.0. The SPSS was used to do the statistical analyses in 2651 cases of psoriasis vulgaris to study the correlations among the distribution and development of the TCM syndromes, the stages of the disease, nationality, psoriasis history, family history, smoking history, alcohol drinking history, and severity of the disease. Results: The TCM syndromes in psoriasis vulgaris mainly include the blood-heat syndrome (53.8%), blood-dryness syndrome (27.4%), and blood-stasis syndrome (18.1%). Other syndromes were rarely seen, covering 0.6%. The concurrent syndromes mainly involve dampness, heat, blood stasis and toxin. The distribution differences of the main syndromes at different stages of the disease had statistical significance (P<0.01). The syndrome distribution is not related with nationality and family history (P>0.05), but it was closely related with the psoriasis history, smoking history, alcohol drinking history, and severity of the disease (P<0.01). Conclusion: At the initial stage, psoriasis vulgaris usually manifests itself as the blood-heat syndrome, and later it may be improved or turn into the blood-dryness or blood-stasis syndrome. Smoking, alcohol consumption, and severity of the disease may play a role in the syndrome's transformation.

Effectiveness of flesh-moistening paste in psoriasis vulgaris patients with symptom pattern of blood stasis:a randomized and parallel-controlled trial

OBJECTIVE:To evaluate the efficacy and safety of flesh-moistening paste for treating psoriasis vulgaris in patients with blood stasis pattern in terms of Traditional Chinese Medicine(TCM).METHODS:Eudipleural rashes on both the left and right side of the same patients with psoriasis vulgaris,diagnosed via TCM as blood stasis pattern,were selected as the targeted skin lesions.A randomized,double-blind,parallel-controlled,multicenter controlled trial was conducted.The targeted skin lesions were categorized into either the treatment or control group.The treatment group used the flesh-moistening paste;the control group used a placebo.Both the paste and the placebo were topically applied twice daily for eight weeks.The patients were examined biweekly to evaluate the effects.The two groups were compared in terms of the psoriasis area and severity index(PASI)of the targeted skin lesions,which is scored according to erythema,desquamation,infiltration,area,pruritus,and improvement of skin barrier function.Adverse events were recorded during the study period.SPSS 21.0 was used to analyze the data.RESULTS:Fifty-six patients were enrolled between February 2016 and October 2017.Two were complicated by cardio-cerebrovascular disease and were excluded;thus,54 outpatients were finally enrolled in the study.Four dropped out during the study period:three failed to complete their follow-up visits for unknown reasons,and one exited due to an adverse event.The final trial comprised 50 of the 56 originally selected patients,with a 92.6%completion rate.After 8 weeks of treatment,the targeted skin lesion scores differed significantly(P<0.05).The PASI scores of the targeted skin lesions differed significantly beginning at week 6(P<0.05).The treatment group presented better results than those of the control group.Only one patient had an adverse reaction associated with the treatment.Improvements in skin barrier function differed significantly(P<0.05).CONCLUSION:The flesh-moistening paste demonstrated a reliable curative effect and safety for treating psoriasis vulgaris in patients with blood stasis patterns.The topical paste improved the barrier function of the skin lesions.

Tanreqing Injection(痰热清注射液) for Patients with Influenza: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objective:To systematically evaluate the efficacy and safety of Tanreqing Injection(痰热清注射液,TRQI)combined with conventional treatment on clinical outcomes in the treatment of patients with influenza.Methods:The electronic databases searched were Cochrane Central Register of Controlled Trials(CENTRAL,The Cochrane Library),MEDLINE(PubMed),EMbase(OvidSP),Chinese Bio-medical Literature and Retrieval System(Sinomed),China National Knowledge Infrastructure Database(CNKI),China Science and Technology Journal Database(VIP)and WanFang Data Knowledge Service Platform,and we checked the reference sections of the retrieved articles as well.The search was performed in October 2018,and we used the randomized controlled trials(RCTs)that corresponded to the new diagnostic criteria for influenza.Two review authors independently screened the internalized articles in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis(PRISMA)statement checklist.We evaluated the quality of the articles and extracted the data from the studies using the Revmen5.3 software.Results:We included 12 RCTs of over 882 cases in this meta-analysis.Compared to conventional treatment,TRQI combined with conventional treatment could increase the total effective rate[9 RCTs,n=648,odds ratio(OR):4.92,95%confidence interval(CI):2.94,8.24,P<0.0001,random effects model],decrease the average time for fever clearance[7 RCTs,n=564,mean difference(MD):–1.08,95%CI:–1.68,–0.48,P=0.0004,random effects model]and decrease the time for resolution of cough(5 RCTs,n=362,MD:–1.76,95%CI:–2.63,–0.90,P<0.0001,random effects model).Conclusion:Based on this meta-analysis of RCTs,TRQI combined with conventional treatment had a statistically significant benefit in increasing the total effective treatment rate and reducing the time for fever clearance as well as time for resolution of cough.

Effects of Modified Sanhuang Decoction (加味三黄汤) Enemaon Serum Tumor Necrosis Factor-α and Colonic Mucosa Interleukin-1β,Interleukin-6 Levels in Ulcerative Colitis Rats

Objective：To investigate the effects of Modified Sanhuang Decoction（加味三黄汤,MSD）enema on the serum tumor necrosis factor alpha（TNF-α）and colonic mucosa interleukin-1β（IL-1β）,interleukin-6（IL-6）levels in experimental ulcerative colitis（UC）rats.Methods：Forty-five male Wistar rats were randomly divided into 4 groups：normal group（n=12）,model group（n=11）,salazosulfapyridine（SASP）group（n=11）and MSD group（n=11）.The UC model was induced by 2,4,6-trinitrobenzene sulfonic acid（TNBS）/ethanol solution.Rats in the normal group and model group were clystered with 0.9%normal saline,while in the SASP group and MSD group were clystered with SASP and MSD enema,respectively.After drug administration（10 mL/kg body weight,for 7 days）,colonic gross changes and colonic mucosa histology were observed,serum TNF-αand colonic mucosa IL-1β,IL-6 levels were tested by enzyme linked immunosorbent assay and radioimmunoassay,respectively.Results：As compared with the normal group,the experimental UC rats,the colonic mucosal damage index scores（CMDIs）,histopathological scores（HS）and the serum TNF-a and colonic mucosa IL-1β,IL-6 levels significantly increased（P〈0.05 or P〈0.01）.In the MSD and SASP groups,the ulcer area significantly reduced,and edema disappeared.The CMDIs,HS,the serum TNF-a and colonic mucosa IL-1β,IL-6 levels in the MSD and SASP groups significantly decreased（P〈0.05 or P〈0.01）compared with the model group.The CMDIs in the MSD group were lower than that in the SASP group（P〈0.05）,but there were no significant differences in HS,serum TNF-αor colonic mucosa IL-1β,IL-6 levels between the MSD and SASP groups.Conclusion：MSD enema can improve colonic mucosa impairment and decrease serum TNF-αand colonic mucosa IL-1β,IL-6 levels in experimental UC.

Preparation and physicochemical characterization of T-OA PLGA microspheres

As the carrier of water-insoluble drugs, microspheres can play a role in increasing solubility and delaying releasing essence. The objective of this study was to improve the solubility and to delay the release of a newly discovered antitumor compound 3β-hydroxyolea-12-en-28-oic acid-3, 5, 6-trimethylpyrazin-2-methyl ester(T-OA). Early-stage preparation discovery concept(EPDC) was employed in the present study. The preparation, physicochemical characterization, and drug release properties of PLGA microspheres were evaluated. T-OA-loaded PLGA microspheres were prepared by an oil-in-water(O/W) emulsification solvent evaporation method. Characterization and release behaviors of the T-OA PLGA microspheres were evaluated by X-ray diffract(XRD), differential scanning calorimetry(DSC), Fourier transform infrared spectroscopy(FTIR), scanning electron microscopy(SEM), and high performance liquid chromatography(HPLC). The results demonstrated that T-OA-loaded PLGA microspheres could be successfully obtained through solvent evaporation method with appropriate morphologic characteristics and high encapsulation efficiency. The XRD analysis showed that T-OA would be either molecularly dispersed in the polymer or distributed in an amorphous form. The DSC and FTIR analysis proved that there were interactions between T-OA and PLGA polymer. SEM observations displayed the morphology of the microspheres was homogeneous and the majority of the spheres ranged between 50 and 150 μm. The drug release behavior of the microspheres in the phosphate buffered saline medium exhibited a sustained release and the duration of the release lasted for more than 23 days, which was fit with zero-order release pattern with r^2 = 0.994 7. In conclusion, TOA-loaded PLGA microspheres might hold great promise for using as a drug-delivery system in biomedical applications.

Conventional Acupuncture for Cardiac Arrhythmia：A Systematic Review of Randomized Controlled Trials

Objective：To exam the effect and safety of conventional acupuncture（CA） on cardiac arrhythmia.Methods：Nine medical databases were searched until February 2016 for randomized controlled trials.Heterogeneity was measured by Cochran Q test.Meta-analysis was conducted if I2 was less than 85% and the characteristics of included trials were similar.Results：Nine qualified studies involving 638 patients were included.Only 1 study had definitely low risk of bias,while 7 trials were rated as unclear and 1 as high.Meta-analysis of CA alone did not have a significant benefit on response rate compared to amiodarone in patients with atrial fibrillation（Af） and atrial flutter（AF） [relative risk（RR）：1.09;95% confidence interval（CI）：0.79–1.49;P=0.61;I2=61%,P=0.11].However,1 study with higher methodological quality detected a lower recurrence rate of Af in CA alone as compared with sham acupuncture plus no treatment,and benefits on ventricular rate and time of conversion to normal sinus rhythm were found in CA alone group by 1 study,as well as the response rate in CA plus deslanoside group by another study.Meta-analysis of CA plus anti-arrhythmia drug（AAD） was associated with a significant benefit on the response rate when compared with AAD alone in ventricular premature beat（VPB） patients（RR,1.19,95% CI：1.05–1.34;P=0.005;I2=13%,P=0.32）,and an improvement in quality-of-life score（QOLS） of VPB also showed in 1 individual study.Besides,a lower heart rate was detected in the CA alone group by 1 individual study when compared with no treatment in sinus tachycardia patients（MD –21.84 [–27.21,–16.47]） and lower adverse events of CA alone were reported than amiodarone.Conclusions：CA may be a useful and safe alternative or additive approach to AADs for cardiac arrhythmia,especially in VPB and Af patients,which mainly based on a pooled estimate and result from 1 study with higher methodological quality.However,we could not reach a robust conclusion due to low quality of overall evidence.

Mixed methods research in complementary and alternative medicine:a scoping review

OBJECTIVE:To update the current characteristics about the scope and quality of mixed methods research(MMR)in complementary and alternative medicine(CAM)after nearly 10 years.METHODS:A 5-stage approach for conducting a scoping review was adopted.Articles published on the top 10 journals in CAM with the highest impact factor in 2020 were screened for MMR.Information of included articles were extracted,and then synthesized to illustrate the current state.Methodological quality was evaluated according to the Mixed Method Appraisal Tool(MMAT)2018 version.RESULTS:A total of 55(55/2991,2%)articles using mixed methods were retrieved,including 17 medical studies and 38 ethnobotanical studies.We performed an in-depth analysis on the 17 medical studies,which studied cancer,stress,pain,fatigue,exercises,mindfulness intervention,herbal medicine use,art and acupuncture.Thirteen pilot studies applied MMR to evaluate the feasibility of interventions or programs(13/17,76%);phenomenology was inferred as the most common philosophical assumptions(13/17,76%);the most applied type of MMR was convergent design(16/17,94%);integration often took place at integration(12/17,71%).Among the 16 eligible studies for quality appraisal,majority were rated as good(14/16,88%),whereas two studies were rated as poorly described.Primarily,a poor rating was due to incomplete reporting of data analysis and citations in qualitative components;lack of confounder controlling and the sampling strategy in quantitative components;poor description of integration and justification for mixed methods.Comparing with the previous review,fewer MMR were published in 2020 in CAM,but the proportion of studies that clearly reported MMR has increased by 4 times(4%→15%).CONCLUSION:CAM researchers need to realize the benefits that MMR can have on conducting further health care research.Our findings highlight that applying MMR will be helpful to understand the complex dynamics and interdisciplinary nature of complex intervention.In addition,addressing a standardized reporting criteria for MMR is recommended.