Making Evidence-based Decisions in the Clinical Practice of Integrative Medicine

In 1948, the first clinical paper adopting the protocol of randomized and controlled design was published in British Medical Journal by Bradford Hill,a noted British biostatistician, who introduced rigorous theory of mathematical statistics into clinical design the first time and successfully evaluated the therapeutic effect of streptomycin on tuberculosis.

Integrating Traditional Medicine with Biomedicine Towards a Patient-Centered Healthcare System

In this new age of scientific developments, biomedicine makes it possible for us to draw precise pictures of the internal workings of the human body, measure tiny metabolic reactions,exchange organs from one person to another,and even grow babies in test tubes.These accomplishments have enabled us to alter successfully and dramatically the natural history of many diseases.Nobody can detract from these achievements, and it is a matter of course for biomedicine to be regarded as conventional medicine or mainstream medicine.However,biomedicine is at its limits nowadays

Therapeutic Evaluation on Complex Interventions of Integrative Medicine and the Potential Role of Data Mining

It is a common view that the integration of Chinese medicine （CM） and modern Western medicine is an efficient way to facilitate the development of CM. Integrative medicine is a kind of complex interventions. Scientific therapeutic evaluation plays a crucial role in making integrative medicine universally acknowledged. However, the modern method of clinical study, which is based on the concept of evidence-based medicine, mostly focuses on the population characteristics and single interventional factor. As a result, it is difficult for this method to totally adapt to the clinical features of CM and integrative medicine as complex interventions. One possible way to solve this issue is to improve and integrate with the existing method and to utilize the evaluation model on complex interventions from abroad. As an interdisciplinary technique, data mining involves database technology, artificial intelligence, machine learning, statistics, neural network and some other latest technologies, and has been widely used in the field of CM. Therefore, the application of data mining in the therapeutic evaluation of integrative medicine has broad prospects.

Herb-drug Interaction:An Emerging Issue of Integrative Medicine

With the increasing enhancement of people＇s awareness of self-care,the voice for humans to return to nature is growing louder and louder.Drugs with natural plants as raw materials are increasingly favored by people all over the world for their unique advantages in preventing and curing diseases, rehabilitation and health care,especially in Europe,

Evidence-based Practice Method of Integrative Chinese and Western Medicine Based on Literature Retrieval through PICO Question and Complementary and Alternative Medicine Topics

An evidence-based practice method according to literature retrieval through PICO （Patients,Intervention,Comparison,Outcome） questions and complementary and alternative medicine （CAM） topics,which can obtain helpful evidence for guiding clinical practice,was introduced with a practical example in this paper.The knowledge of diseases and Western medicine treatment can be acquired by literature retrieval through PICO question,while searching by CAM topics may provide evidence for Chinese medicine （CM）.Thus the author held that literature retrieval through both PICO question and CAM topics was an ideal evidencebased practice method for integrative Chinese and Western medicine （ICWM）.However,since the standard in CM evidence hierarchy is still under study,the value of the CAM thematic retrieval method remains very limited.In the future,studies on the definition and hierarchy of CM evidences and the herb-drug interaction between Western and Chinese medicine during a combination therapy should be strengthened to improve the status of ICWM evidence-based practice.

A Multi-Center Randomized Double-Blind Placebo-Controlled Trial of Xiongshao Capsule(芎芍胶囊)in Preventing Restenosis after Percutaneous Coronary Intervention:A Subgroup Analysis of Senile Patients

Objective：To evaluate the safety and efficacy of Xiongshao Capsule（芎芍胶囊,XS）,consisting of Chuangxiongol and paeoniflorin,in preventing restenosis after percutaneous coronary intervention（PCI） in senile coronary heart disease（CHD） patients.Methods：A multi-center,randomized,double-blind,placebo-controlled trial was conducted.A total of 335 CHD patients were randomly assigned to treatment with oral administration of XS,or a placebo for 6 months after successful PCI.A clinical follow-up was performed at 1, 3 and 6 months after PCI and an angiographic follow-up was scheduled at 6 months.The primary endpoint was angiographic restenosis defined as a luminal stenosis≥50%in follow-up.The secondary endpoints were combined incidence of death,target lesion nonfatal myocardial infarction,repeat target-vessel angioplasty,and coronary artery bypass graft surgery（CABG）.The follow-up for the above clinical endpoint events was continued to 1 year after PCI.Results：The subgroup analysis of 152 senile patients（68 cases angiographic follow-up） showed that the restenosis rates tended to reduce in the XS group as compared with that in the placebo group （24.32%vs.38.71%,P0.05）,and the minimum lumen diameter（MLD） significantly increased in the follow-up （2.15±0.84 for XS vs.1.73±0.91 for placebo,P0.05）.The incidence of recurrent angina at 3 and 6 months after PCI was also significantly reduced in the XS group（4.11%and 12.33%） as compared with those in the placebo group（17.72%and 43.04%）,but there was no significant difference in the combined incidence of clinical outcomes（6.85%in the XS group vs.11.39%in the placebo group,P0.05）.No significant adverse reactions occurred within the 6-month follow-up period in the XS group.Conclusion：Administration of XS in addition to standardized Western medication for 6 months is demonstrated to be safe and effective in reducing post-PCI recurrent angina and inhibiting luminal restenosis after PCI in senile CHD patients.

The New Strategy for Modulating Dyslipidemia:Consideration from Updated Understanding on High-Density Lipoprotein

With further researches on blood lipids and atherosclerosis,especially after the conception of＂residual cardiovascular risk＂,high-density lipoprotein cholesterol（HDL-C） becomes a new therapeutic target against atherosclerosis.However,the failure of ILLUMINATE study that was targeted at raising HDL-C level disappointed cardiologists all over the world,which indicates the limitation of HDL-C concentration in representing HDL function.The updated understanding of HDL from＂quantity＂to＂quality＂brings a new cut-in point for integrative Chinese and Western medicine in preventing and treating dyslipidemia and atherosclerosis. In addition to highlighting statins in directly intervening low-density lipoprotein cholesterol,we should make full use of the superiority of Chinese medicine in overall regulation and individualized treatment to promote the self-healing capacity of the patients,which further regulates abnormity of both concentration and function of the whole blood lipid family to equilibrium.This new strategy for modulating dyslipidemia with mutual complement of advantages from Western and Chinese medicines will no doubt play an important role in future therapies.

Study on the Tongue Manifestations for the Blood-Stasis and Toxin Syndrome in the Stable Patients of Coronary Heart Disease

Objective： To explore the tongue manifestations for the blood-stasis and toxin syndrome in the stable patients of coronary heart disease （CHD） according to the acute cardiovascular events （ACEs） in one-year follow-up which based on the pathogenesis hypothesis of ＂blood-stasis and toxin causing catastrophe＂. Methods： Totally 254 stable CHD cases were enrolled after diagnosed by coronary angiography, their tongue appearances were recorded by the digital camera of uniform type, 29 cases with ACEs during one-year follow-up were assigned in ACEs group. The non-ACEs were matched in proportion of 2：1 according to the gender, age （± 2.5 years）, diabetes mellitus history and previous acute coronary syndrome hospitalization history in the non-ACEs group, and 54 cases were eligibly included. The differences of tongue appearance between the ACEs and non-ACEs group were compared. Results： Fifteen cases manifested with bluish tongue （including bluish-grounding or bluish purple tongue）, among which 11 cases （37.9%） in the ACEs group and four cases （7.4%） in the non-ACEs group, and there was significant difference （P〈0.002）. Twenty six cases showed yellow tongue coating in the non-ACEs group, which was significantly higher than that in the ACEs group （48.1 vs. 10.3%, P=0.001）. The tongue of sticky greasy coating was more frequently occurred in the non-ACEs group than that in the ACEs group （66.7% vs. 41.4%, P=0.026）. The proportion of purplish-red sublingual vessel was higher in the ACEs group than that in the non-ACEs group （41.4% vs. 20.4%, P=0.041）. Odd ratio （OR） analysis showed that the patients with bluish tongue, purplish-red sublingual vessel, dry-greasy or dirty greasy coating were more likely to experience ACEs during one- year follow-up （OR： 11.67, 95%CI： 3.34-40.81, P〈0.001; OR： 2.76, 95%CI： 1.02-7.44, P〈0.05; OR： 3.12, 95%, CI： 0.89-10.92, P=0.066）. Conclusions： The bluish tongue （including bluish-grounding or bluish purple tongue） and purplish-red sublingual vessel were potential tongue manifestations of blood-stasis and toxin. The tongue coating changing from sticky greasy to dry greasy or dirty greasy was also probably a tongue manifestation of ＂transforming toxin＂, which need demonstration by further study.

Thinking on Treatment of Post-reperfusion Events in Patients with Coronary Heart Disease by Integrated Traditional Chinese and Western Medicine

In the 1970＇s, promoting blood circulation to remove blood stasis （PCRS） was the main method in integrative traditional Chinese and Western medicine （ICWM） in treating acute myocardial infarction （AMI）. It decreased the case fatality rate of AMI from 30% to 13%-16% as compared with that treated by simple Western internal medical conservative treatment. Later in the 1980＇s, such therapeutic approaches as infarction related arterial revascularization, thrombolysis and percutaneous coronary intervention （PCI） became the most effective means in treating AMI, which could re-canalize the obstructed coronary vessels, recover the blood perfusion of myocardium, and thus to save the ischemic myocardium, diminute the infarcted size, preserve the ventricular function and improve the patient＇s near and long-term prognosis, with the fatality rate reduced by 5%-7%. Hence, the some-time superiority of ICWM in treating AMI was overshadowed with no more luster left.

Reflections on the Research Status of Kampo Medicine:A Most Rewarding Visit to Japan

Traditional medicine in Japan originated from Chinese medicine （CM）, on the basis of which the abdominal diagnosis and treatment by differentiation of diseases were developed. It was also called Kampo medicine （KM）, natural medicine or oriental medicine. KM had been on the verge of extinction by suffering from serious loss during the Meiji Restoration, and only started to revive in the beginning of the 1950s, and has had considerable progress up to now.

Alprostadil liposome microsphere preparation stabilizes vascular plaques and inhibits intra-plaque inflammation

Background Vulnerable plaques play an important role in the onset of sudden cardiac events and strokes. How to stabilize vulnerable plaques is still a challenge to medical science. Alprostadil is a biologically active substance with strong activity on vessel. Our study assessed the stabilizing effects of an alprostadil liposome microsphere preparation （ALMP） on vulnerable plaques in the brachiocephalic artery of apolipoprotein E （Apo E） knockout mice. Methods Seventy-two male Apo E-knockout mice were fed a high-fat diet beginning at eight weeks of age. At week 17, they were divided randomly into groups for treatment with a high dose （3.6 μg, kg-1. d-1） or low dose （1.8 μg. kg-1 . d-1） of an ALMP, or 0.2 ml/d normal saline （control group）, The drug was administered using a micro-capsule pump. Twenty weeks after drug administration, pathological changes in the vulnerable plaques within the brachiocephalic artery were assessed, and levels of anti-mouse monocyte/macrophage monoclonal antibody （MOMA-2） and superoxide anions in the plaques were detected using immunofluorescence. The soluble intercellular adhesion molecule-1 （ICAM-1） expression was measured by ELISA, and the expression of matrix metalloproteinase-9 （MMP-9） and CD40 mRNA was measured using RT-PCR. Thrombospindin-1 （TSP-1） expression was detected using Western blotting. Results Compared with the control group, ALMP treatment significantly reduced the plaque area in the brachiocephalic artery （P 〈0.01）, significantly lowered the contents of the lipid core （P 〈0.01 ）, significantly reduced the number of ruptured fibrous caps （P 〈0.05）, and increased the thickness of the fibrous cap and significantly reduced the incidence of intra-plaque hemorrhage （P 〈0.05）. ALMP treatment significantly reduced the expression of MOMA-2, superoxide anion, MMP-9, ICAM-1 and CD40 in the plaques （P 〈0.01）, decreased plasma ICAM-1 expression （P 〈0.01 ）, and increased the expression of TSP-1. Conclusions Treatment with ALMP can stabilize vulnerable plaques by inhibiting inflammation.

Clinical Study on Effect of Garlicin in Stabilizing the Carotid Artery Atherosclerotic Plaque in Patients with Primary Hypertension and Coronary Artery Disease

Objective： To investigate the effect of garlicin in treating carotid artery atherosclerotic plaque （OAAP） in patients with primary hypertension and coronary heart disease （PHT-OHD）. Methods： Seventynine patients with PHT-OHD were randomly divided into the treated group （39 patients） treated with garlicin and fosinopril and the control group （40 patients） treated with fosinopril alone. The change of OAAP was evaluated by high frequency ultrasonic examination every six months, and the changes of intercellular adhesion molecule-1 （IOAM-1） and high sensitive O-reactive protein （hs-ORP） were measured by ELISA, with the observation proceeding for 52 weeks totally. Results： By the end of the experiment, the number of complex plaques, Orouse integrals, intima-media thickness, serum IOAM-1 and hs-ORP were significantly lower in the treated group than those in the control group with significant difference （P〈0.05）. Conclusion： Garlicin could stabilize CAAP to a certain extent and shows a definite vascular protective effect in patients with PHT-CHD.

Characteristics of Lymphocyte Nuclear Factor-κB Signal Transduction Kinase Expression in Aging Process and Regulatory Effect of Epimedium Flavonoids

Objective：To study the characteristics of lymphocyte nuclear factor kappa B（NF-κB） signal transduction kinase-related molecular mRNA differential expressions at various month age segments in aging process and the intervening effect of Epimedium flavonoids（EF） on it.Methods：Sixty SD rats were divided into six groups,according to animals＇ age,i.e.,the 3 days（d） group,the 4 months（m） group,the 10 m group,the 18 m group,the 27 m group,and the 27 m＋EF group.RNA was extracted from separated splenic lymphocytes. Adopting NF-κB signal path functional genome oligonucleotide gene-chip（128 related genes）,the integral characteristics and differences of NF-κB signal transduction kinase-related mRNA expressions were determined, and the intervening effect of EF was examined.Results：The mean level of the NF-κB signal transduction kinase-related mRNA expressions in rats＇ splenic lymphocytes lowered with aging;the highest expression was presented at 3 d after birth,and then,it lowered gradually,with the lowest level at 18 m or 27 m.After EF intervention,the expression level was raised to the 10-18 m level in the aged rats.Conclusion：The changing rules of lymphocyte NF-κB-signal-transduction-kinase-related mRNA expressions in various stages of aging are helpful for selecting the well time for preventing and intervening aging,and will also give a hint to the molecular index for assessment of senility retarding researches.

Qingre Quyu Granule(清热祛瘀颗粒)Stabilizes Plaques through Inhibiting the Expression of Tenascin-C in Patients with Severe Carotid Stenosis

Objective： To investigate the therapeutic effects of Qingre Quyu Granule （请热祛瘀颗粒, QQG） on the patients with severe carotid stenosis, and to explore the mechanism of it. Methods： Ninety-six patients with severe carotid stenosis were enrolled in the study and were classified into a QQG group （n=48） and a control group （n=48） randomly using consecutively numbered envelopes. The patients in the QQG group were given QQG and Western medicine, those in the control group were given Western medicine merely, the course of treatment was 16 weeks. All patients went through endarterectomy after treatment. Plaques were subjected to the analysis of CD3, CD68, soluble intercellular adhesion molecule 1 （ICAM-1）, matrix metalloprotease-9 （MMP-9）, CD40L, tenascin-C, and collagen content lipid content by immunohistochemistry or polarized light analysis. Results： By the end of experiment, the expressions of CD3, CD68, ICAM-1, MMP9, CD40L and tenascin-C on the plaques were statistically significant lower in the QQG group compared with the control group （P〈0.01）, The lipid content of the plaque was also significantly lower in the QQG group compared with the control group （P〈O.01）, The interstitial collagen in the tissue sections of the plaques was also significantly higher in the QQG group in comparison with the control group （P〈0.01）. Conclusion： QQG could stabilize carotid artery plaques through inhibiting pro-inflammation factors and restraining the tenascin-C and MMP9 pathway.

Effect of Qingre Quyu Granule (清热祛瘀颗粒) on Stabilizing Plaques in the Brachiocephalic Artery of Apolipoprotein E Defficient Mice

Objective： To investigate the effect of Qingre Quyu Granule （清热祛瘀颗粒, QRQYG） on stabilizing vulnerable plaques in apolipoprotein E （ApoE） defficient mice. Methods： Seventy-two male ApoE defficient mice were given a high-fat diet from 6 weeks of age. At the 16th week, all the mice were randomized into 3 groups： the QRQYG group, the simvastatin group, and the control group. Sixteen weeks after administration of 0.9 g/kg QRQYG, 3 mg/kg simvastatin or 10 mg/kg sodium chloride per day to the respective groups, the animals were euthanized. The pathological morphologic changes in the vulnerable plaques were evaluated, the matrix metalloprotease-9 （MMP-9） expression was measured by immunohistofluorescence, the soluble intercellular adhesion molecule 1 （ICAM-1） was determined by ELISA, the nuclear factor kappaB （NF-κB） subunit p65 was measured by quantitative RT-PCR, and, finally, thrombospondin-1 （TSP-1） was determined by the immunohistochemical method. Results： The plaque cross-sectional area in the brachiocephalic artery （23.7%, P0.01）, the lipid core of the plaque （43.1%±3.1%）, and the number of buried ？brotic caps of the plaque were significantly decreased in the QRQYG group compared to the control group （both P0.01）; furthermore, the thickness of the ？brotic cap of the plaque increased and the intra-plaque hemorrhage of the plaque decreased. The serum soluble ICAM-1 （27.1±5.1 μg/mL）, the protein expression of MMP-9 and TSP-1 and the p65 mRNA expression increased in the QRQYG group in comparison with the control group （P0.05 or P0.01）. Conclusion： QRQYG could stabilize the vulnerable plaque through inhibition of the inflammatory response.

Acupuncture:A Paradigm of Worldwide Cross-Cultural Communication

On 16 November 2010, an exciting news inspired all traditional Chinese medicine （TCM） practitioners, especially acupuncturists in China. Acupuncture and moxibustion of TCM along with Peking Opera were both inscribed on the Representative List of the Intangible Cultural Heritage of Humanity during the 5th session of the United Nations Educational, Scientific and Cultural Organization （UNESCO） Intergovernmental Committee for the Safeguarding of the Intangible Cultural Heritage meeting in Nairobi.