Traditional Chinese Medicine
Objective: To establish Caco-2 (a human colon adenocarcinoma cell line) cell monolayer model and the standard operation procedure for studying and assessing intestinal absorption of chemical components of traditional Chinese medicine.Methods: Caco-2 cell monolayer model was established and evaluated by morphology feature using scanning electron microscope, inverted microscope and transepithelial electrical resistance (TEER) assay. Additionally, the model was further tested for the activity of alkaline phosphatase and the apparent permeability (Papp) of standard compounds, i.e. propranolol and atenolol, which were the control substances for high and poor transcellular transport marker, respectively.Results: The integrality of cell monolayer, cell differentiation (reflected by expression of alkaline phosphatase and cell monolayer morphology), and the Papp value of standard compounds in the established Caco-2 cell model were satisfactory. All parameters tested were in good agreement with those reported in the literature.Conclusion: The established Caco-2 cell model can be used to study the intestinal absorption of orally administrated chemical components of traditional Chinese medicine and their absorption mechanism.
Progressive loss of retinal ganglion cells (RGCs) and their axons is the main pathogenesis of glaucoma. The cause of glaucoma is not fully understood, but the neurodegeneration of glaucoma involves many mechanisms such as oxidative stress, glutamate toxicity and ischemia/reperfusion insult. In order to target these mechanisms, multiple neuroprotective interventions have been investigated to prevent the death of RGCs. Of note are some tonic herbs from the traditional Chinese medicine (TCM) pharmacopeia that have shown neuroprotective effects in glaucoma. TCM differs from Western medicine in that TCM exhibits complicated bioactive components, triggering many signaling pathways and extensive actions on vital organs. Modern scientific approaches have demonstrated some of their underlying mechanisms. In this review, we used Lycium barbarum and Ginkgo biloba as examples to elaborate the characteristics of TCM and their potential applications in neuroprotection in glaucoma.
Objective
To explore and identify the therapeutic components of traditional Chinese medicine (TCM) as a complex intervention through grounded theory, and the correlation and interaction within this model and the possible effects that they may have on the therapeutic effects of TCM. Methods
Data were collected through 41 half-day participant observations and 7 in-depth interviews, and the study design and data analysis were based on the grounded theory. Results
The components of TCM practice that emerged were: prescribed Chinese medicinal herbs, doctor’s medical advice, psychological intervention, doctor-patient relationship, and patient adherence. There were some overlaps in the TCM diagnosis and treatment process, and there were underlying therapeutic effects associated with diagnosis. TCM herbal intervention was considered as a main therapeutic component which might dominate patients’ outcome. We summarized this process as a process of problem finding and solving from macroscopic and microcosmic perspectives, which embodies the concept of a holistic approach and highly individualized pattern through syndrome differentiation and treatment. Conclusion
TCM is a complex whole system, and all therapeutic components of TCM may contribute to global treatment effect. In the future, we need more participants to test and improve the model of grounded theory through qualitative and quantitative methods such as randomized controlled trials so as to identify and explore the relevance of each therapeutic component of TCM with the treatment effect.
Biological, psychological and sociological model of medicine substantializes the old model lacking the social humane attributes. The new medical model makes people take medical anthropology into research and highly evaluate traditional medical system. Cultural anthropology of traditional Chinese medicine (TCM) is part of medical anthropology with three major characteristics: wide research scope, specificity, and integration. It has developed its own research methods, such as field investigation, comprehensive inspection and comparison study. Cultural anthropology provides an efficient research method for TCM, and its application would further develop TCM theory and form comprehensive evaluation on TCM effects.
Traditional Chinese medicine (TCM) is regarded as an important treatment for gastric cancer patients, especially for those in advanced stage. To evaluate the effects of TCM treatment on gastric cancer patients, the authors performed a retrospective study to report the result of the integrated treatment of TCM with chemotherapy for stage IV non-surgical gastric cancer.
Methods
In this study, 182 patients with stage IV and non-surgical gastric cancer were retrospectively analyzed to evaluate the effects of TCM integrated with chemotherapy. Among the 182 cases, 88 cases received integrated therapy consisting of TCM and chemotherapy, while 94 cases received chemotherapy alone. The overall survival and Karnofsky performance status (KPS) score were measured as the main outcome.
Results
The median overall survival of the integrated therapy group and chemotherapy group were 16.9 and 10.5 months, respectively. The 1-, 3- and 5-year survival rates of integrated therapy group vs. chemotherapy group were 70% vs. 32%, 18% vs. 4%, and 11% vs. 0%, respectively. There was a significant difference between the two groups (χ2 = 42.244, P < 0.001). After six-month treatment, KPS scores of the integrated therapy group and the chemotherapy group were 75.00 ± 14.78 and 60.64 ± 21.39, respectively (P < 0.001). The Cox regression analysis showed that TCM treatment is a protective factor for patients' overall survival.
Conclusion
This study demonstrated that TCM integrated with chemotherapy may prolong overall survival and improve survival rate and life quality of patients with stage IV non-surgical gastric cancer.
The field of gene therapy has been increasingly studied in the last four decades, and its clinical application has become a reality in the last 15 years. Traditional Chinese medicine (TCM), an important component of complementary and alternative medicine, has evolved over thousands of years with its own unique system of theories, diagnostics and therapies. TCM is well-known for its various roles in preventing and treating infectious and chronic diseases, and its usage in other modern clinical practice. However, whether TCM can be applied alongside gene therapy is a topic that has not been systematically examined. Here we provide an overview of TCM theories in relation to gene therapy. We believe that TCM theories are congruent with some principles of gene therapy. TCM-derived drugs may also act as gene therapy vehicles, therapeutic genes, synergistic therapeutic treatments, and as co-administrated drugs to reduce side effects. We also discuss in this review some possible approaches to combine TCM and gene therapy.
In this paper, factors contributing to the formation of pulse wave were analyzed based on hemodynamic principles. It is considered that formation of pulse wave was related to its propagation and reflection characteristics. Propagation of the pulse wave was characterized by pulse wave velocity, and reflection of the pulse wave was characterized by reflection coefficient. Pulse wave velocity and reflection coefficient were proposed as the eigenvectors of pulse wave in pulse diagnosis of traditional Chinese medicine, and support vector machine (SVM) was used to recognize slippery pulse, stringy pulse and plain pulse. Pulse wave velocity and reflection coefficient of the slippery, stringy and plain pulses in healthy people were calculated in this study, and SVM with Gaussian radial basis function was used for classifying. Results showed that pulse wave velocity and reflection coefficient with physiological and pathological significance had advantages in distinguishing slippery pulse, stringy pulse and plain pulse, which offered a new idea for recognizing pulse condition.
Background
Chinese and contemporary Western medical practices evolved on different cultures and historical contexts and, therefore, their medical knowledge represents this cultural divergence. Computerization of traditional Chinese medicine (TCM) is being used to promote the integrative medicine to manage, process and integrate the knowledge related to TCM anatomy, physiology, semiology, pathophysiology, and therapy.
We proposed the development of the SuiteTCM software, a collection of integrated computational models mainly derived from epidemiology and statistical sciences for computerization of Chinese medicine scientific research and clinical practice in all levels of prevention. The software includes components for data management (DataTCM), simulation of cases (SimTCM), analyses and validation of datasets (SciTCM), clinical examination and pattern differentiation (DiagTCM, TongueTCM, and PulseTCM), intervention selection (AcuTCM, HerbsTCM, and DietTCM), management of medical records (ProntTCM), epidemiologic investigation of sampled data (ResearchTCM), and medical education, training, and assessment (StudentTCM).
Discussion
The SuiteTCM project is expected to contribute to the ongoing development of integrative medicine and the applicability of TCM in worldwide scientific research and health care. The SuiteTCM 1.0 runs on Windows XP or later and is freely available for download as an executable application.
The central nervous system (CNS) plays a key regulatory role in glucose homeostasis. In particular, the brain is important in initiating and coordinating protective counterregulatory responses when blood glucose levels fall. This may due to the metabolic dependency of the CNS on glucose, and protection of food supply to the brain. In healthy subjects, blood glucose is normally maintained within a relatively narrow range. Hypoglycemia in diabetic patients can increase the risk of complications, such as heart disease and diabetic peripheral neuropathy. The clinical research finds that the use of traditional Chinese medicine (TCM) has a positive effect on the treatment of hypoglycemia. Here the authors reviewed the current understanding of sensing and counterregulatory responses to hypoglycemia, and discuss combining traditional Chinese and Western medicine and the theory of iatrogenic hypoglycemia in diabetes treatment. Furthermore, the authors clarify the feasibility of treating hypoglycemia on the basis of TCM theory and CNS and have an insight on its clinical practice.
Objective: Traditional Chinese medicine stagnation syndrome is a prevalent syndrome characterized by mind-body obsession-like symptoms. To standardize the evaluation of this syndrome, previous studies have developed and validated a 3-factor, 16-item Stagnation Scale with good psychometric properties. The current study aimed to survey stagnation syndrome among adults in community. Methods: A cross-sectional questionnaire survey was conducted among 755 adults recruited by cluster sampling in Hong Kong. Results: Using self-appraisal of symptom severity as reference, receiver operating characteristics (ROC) analysis suggested an optimized cut-off point of 50 on the Stagnation Scale, with false positive and negative rates at 25.8% and 23.3%, respectively. Prevalence of stagnation syndrome was revealed at 6.2%. It is more prevalent in women, with a male to female ratio of 1∶2.8 (P=0.02). Stagnation showed significant negative correlation with age (r=–0.22, P<0.01). It showed non-significant correlation with marital status and education level. Among people with stagnation syndrome, 30.4% showed substantial intention to seek treatment (male: 25.0%; female: 32.4%). Conclusion: Stagnation syndrome seems to be prevalent among adults and shows a fairly high rate of motivation for people to seek treatment. The construct can be a useful entry point for healthcare interventions and warrants further in-depth studies. Limitations of using a structured questionnaire for epidemiological studies and corresponding remedies are discussed.
Pulse wave analysis (PWA) quantifies the phenomenon of pulse waveform propagation in patients with cardiovascular diseases, whereas pulse image analysis (PIA) is a subjective examination in traditional Chinese medicine.
This study evaluated the association of PIA with PWA and hemodynamics in patients with hypertension.Design, setting, participants and interventions This observational, cross-sectional study enrolled 45 patients (26 men, (55.2 ± 10.3) years, systolic blood pressure (155 ± 28) mmHg, diastolic blood pressure (93 ± 17) mmHg) for assessment of clinical and laboratorial data.
Main outcome measures
Primary outcomes comprised: pattern differentiation based on an automated method; PIA at the radial artery using the ‘simultaneous pressing’ method for identification of factors such as strength (strong/weak), depth (superficial/deep), and speed (fast/moderate/slow); and PWA at the same artery using a noninvasive system.
Significant multivariate main effects were observed for depth (λ=0.648, F5,29 =3.149, P=0.022, η2 =0.352), strength (λ=0.608, F5,29 =3.736, P=0.010, η2 =0.392), and speed (λ=0.535, F5,29 =5.302, P=0.002, η2 =0.465). General effects comprised high values of PWA and blood pressure for superficial, strong, and fast pulse images. A strong pulse was found for pulse pressure ≥ 62.5 mmHg and systolic blood pressure ≥ 149.5 mmHg, whereas a superficial pulse was found for heart rate ≥ 58.25 beats/min; a fast pulse was found for heart rate ≥ 69.6 beats/min and pulse wave velocity ≥ 9.185 m/s.
Associations were explained by LaPlace's law, arterial remodeling in hypertension, alongside the traditional criterion for classifying speed in pulse images. PIA is associated with PWA and hemodynamics in patients with hypertension. Systolic and pulse pressures, heart rate, and pulse wave velocity are quantitative variables that have information to describe the qualitative pulse images such as strength, depth and speed.
Objective: To study the mechanism of herbal application along meridians for treatment and prevention of asthma by using serum pharmacological test to observe the effects of serum containing herbs against the constriction of tracheal spiral strips induced by acetylcholine chloride (Ach).
Methods: Guinea pigs were randomly divided into normal control group, normal saline (NS) application group, aminophylline application group, aminophylline injection group, 1-day herb application group, 7-day herb application group and 14-day herb application group. Asthma was induced by Hutson's method in guinea pigs except the normal control group. Guinea pigs in herb application groups were treated by external application of a compound herbal medicine 60 min once every day. Guinea pigs in NS application group were treated by external application of NS. Guinea pigs in the two aminophylline-treated groups were treated by external application and intraperitoneal injection of aminophylline at a dose of 400 mg/kg, respectively. The guinea pigs were killed and the sera were obtained after 1-day, 7-day and 14-day treatment in the three herb application groups, 7-day treatment in the NS application group, the aminophylline application and injection groups, respectively. Serum pharmacological method was used to do the experiment, the effects of different sera on the constriction of tracheal strips were observed, and the constriction rates were calculated.
Result: The serum containing herbs had an effect in reducing the constriction of tracheal spiral strips induced by Ach, and the effect was similar to that of the serum obtained from the aminophylline injection group. The constriction rate of the tracheal spiral strips was decreased when herbal application treatment was prolonged within a period of time, and it became stable when herbal application treatment was between 7-14 days. The constriction of tracheal spiral strips induced by Ach could be reduced remarkably when it was previously treated by serum containing herbs.
Conclusion: The anti-acetylcholine function with a time-dependent effect is one of the mechanisms of herbal application treatment along meridians for asthma, and furthermore, herbal application treatment along meridians might be useful for preventing asthma.
Polycystic ovary syndrome (PCOS) is an endocrine disease that affects gynecological health. Treatment of PCOS remains a big challenge for clinicians.
This meta-analysis was developed to compare the efficacy of co-treatment with traditional Chinese medicine (TCM) and letrozole against letrozole monotherapy in the treatment of PCOS.
Search strategy
Randomized controlled trials (RCTs) were electronically retrieved from PubMed, Cochrane Library, China Biomedical Literature Database, China National Knowledge Infrastructure and Wanfang Data; related papers that were not available electronically were manually checked. All papers were assessed according to the Cochrane Handbook for Systematic Reviews of Interventions and the valid data were analyzed using Revman software (The Cochrane Collaboration, Copenhagen, Denmark).
Inclusion criteria
We included RCTs that compared co-treatment with TCM and letrozole against letrozole monotherapy in women with PCOS, which was defined by anovulation, biochemical or clinical hyperandrogenemia and polycystic ovaries. We included trials from all sources.
Data extraction and analysis
Two independent reviewers extracted data, and evaluated study quality according to the Cochrane Handbook for Systematic Reviews of Interventions criteria for RCT, including issues of patient randomization, blinding and bias.
Eight RCTs, involving a total of 537 patients, were included in the present study. The meta-analysis showed that the cycle ovulation rate, the pregnancy rate and the total effective rate of symptom treatment were higher in treatments combining TCM with letrozole, compared with letrozole monotherapy. Although the rate of luteinizing hormone (LH)/follicle-stimulating hormone (FSH) and the body mass index of the group receiving combined therapy were lower than in letrozole monotherapy, no statistical difference was found in the LH and FSH level between the two groups.
Available evidence showed that co-treatment with TCM and letrozole was more effective than letrozole monotherapy in the treatment of PCOS.
To analyze and compare the curriculum and delivery of a Chinese and Australian university-level Chinese medicine program.
A review of PubMed and the Chinese National Knowledge Infrastructure for relevant educational papers was undertaken. Online and paper documents available at the University of Technology Sydney (UTS) and the Chengdu University of Traditional Chinese Medicine (CDUTCM) were read and analyzed. In addition, in-depth interviews with academics from the two universities were conducted during 2014 to 2015.
The two Chinese medicine programs share the common goal of providing health services to the local community, but differ in some aspects when the curricula are compared. Areas such as student profile, curriculum structure, teaching approaches and education quality assurance were found to be different. The UTS program adopts a “flipped learning” approach with the use of educational technology aiming at improving learning outcomes. On the other hand, the CDUTCM has better clinical facilities and specialist physician resources.
A better understanding of the different curricula and approaches to Chinese medicine education will facilitate student learning and educational outcomes.
To observe hypoglycemic effects of Yunu Decoction, Zuogui Pill and Shenqi Pill, three compound traditional Chinese herbal medicines, in treatment of diabetes mellitus induced by alloxan in rats, and to compare the therapeutic effects among the three recipes for nourishing yin, clearing away heat, and nourishing yin and warming yang. Methods
Diabetes mellitus was induced in rats with alloxan at a dose of 60 mg/kg via tail vain injection. The diabetic rats were randomly divided into four groups: alloxan model group, Yunu Decoction-treated group, Zuogui Pill-treated group and Shenqi Pill-treated group. Rats in the three recipe groups were administered intragastrically with water extraction of Yunu Decoction, Zuogui Pill, and Shenqi Pill accordingly for 10 days. Then the level of blood glucose was measured by glucose oxidase method and the glucose tolerance was determined. Results
Compared with the normal rats, blood glucose level in the alloxan model group was obviously increased (P<0.05). Glucose levels in the three recipe groups were obviously decreased as compared with the alloxan model group (P<0.05), and glucose level in the Yunu Decoction-treated group after treatment was significant lower than before treatment (P<0.05). The glucose tolerance test indicated that rats in the alloxan model and three recipe groups revealed impaired glucose tolerance as compared with the normal rats, and there were no significant differences between the alloxan model group and the three recipe groups. Conclusion
Yunu Decoction, Zuogui Pill and Shenqi Pill can effectively decrease the glucose level of the rats with diabetes mellitus induced by alloxan, and Yunu Decoction showed the best therapeutic effects. The glucose tolerance test shows that the three recipes cannot correct the abnormal metabolism of glucose.
Objective: A method based on dubious condition of information entropy was introduced and applied to discuss a complexity problem in the analysis of correlation between traditional Chinese medicine (TCM) syndrome and season.Methods: Eight hundred and seventy one cases of chronic virus hepatitis B (hepatitis B) with TCM clinical data were analyzed by information entropy method.Results: It was found that hepatitis B with Yin deficiency of liver and kidney happened more often in summer than in other seasons.Conclusion: It is inferred that the difference of seasons may influence the variation of TCM syndromes.
Background: Coronary artery disease (CAD), a common disease with high incidence and mortality rate, has seriously threatened the health and life of the public. Traditional Chinese medicine (TCM) has an important role in the prevention and treatment of this disease. Through clinical epidemiological survey, a deeper understanding of TCM etiology and syndrome characteristics in CAD would further improve clinical efficacy in the treatment of this disease. Methods/design: The preliminary clinical questionnaire for TCM etiology and syndrome differentiation in CAD was designed after literature reviews and analysis. Through a series of clinical pre-surveys, expert consultation and demonstration, the formal TCM clinical epidemiology questionnaire on the etiology and syndrome differentiation in CAD was finalized, after which, the study protocol, inclusive and exclusive criteria and related quality control measures were prepared. The multiregional clinical epidemiological survey with more than 5 000 participants with CAD will be carried out in 41 TCM hospitals of China for investigating the TCM etiology and syndrome differentiation of CAD. Discussion: Multiregion large sample size clinical epidemiology survey on TCM etiology and syndrome differentiation in CAD will provide further evidence in preventing CAD and improving the standardization process of syndrome research.
Objective: Due to the differences between Chinese and Western cultures, Chinese version of foreign research instruments may not be totally applicable for use in evaluating the therapeutic effect of traditional Chinese medicine (TCM). Great efforts have been made by Chinese researchers to develop scales for evaluation of the therapeutic effects of TCM. This study aims to understand the current situation of research in the development of evaluation instrument in TCM. Methods: Database searches of Chinese Biomedical Literature Database, China Academic Journal Network Publishing Database and Chinese Scientific Journals Database were undertaken to identify published studies with the purpose of developing instruments in assessing the effectiveness of TCM, including papers regarding the construction of conceptual framework of instrument, item generation and selection and the evaluation of measurement properties. Results: A total of 60 pieces of literature involving 36 instruments were included. The first article on the development of each of the instruments was published between 2005 and 2011 and the instruments were used in many kinds of medical conditions, including cardiocerebrovascular, respiratory, digestive and infectious diseases. The number of items ranged from 10 to 52. Of the 36 instruments, 13 (36.1%) defined the hypothesized concepts measured by the instrument, 30 (83.3%) reported the domains of the questionnaires before measurement property testing and all of them were multidomain. Of 32 studies regarding item selection and the instrument’s property evaluation, 14 (43.8%) articles reported the administration mode, 24 (75%) reported response option types, and 10 (31.5%) provided scoring algorithm for the scale, but none of these 32 studies specified the recall period. In 29 studies aiming at testing instrument’s measurement property, 28 articles tested the Cronbach’s α coefficient of the full scale and/or subscales, and retest reliability was also detected in 15 studies. Twenty-seven studies evaluated the construct validity by exploratory factor analysis and among them there were two studies applying confirmatory factor analysis. Content validity, responsiveness and feasibility of instruments were assessed in 11, 16 and 16 studies, respectively. Conclusion: This study shows that in recent years many instruments have been developed in an attempt to evaluate the therapeutic effects of TCM, but some problems still exist in their practical implementation, including negligence in outlining the hypothesized concepts of the TCM instruments and in the reporting of instrument’s content validity such as administration mode, scoring and recall period. Some instrument attributes and testing methods were misunderstood and/or misused. Revision of instruments is rarely carried out, though the development of an instrument is an iterative process. Researchers should have a thorough understanding of the general procedure and steps before starting to develop an instrument.
Some conclusions drawn from explanatory randomized controlled trial (ERCT) lack practical value in application under real-world clinical settings, and there are also some limitations on the generalization of pragmatic randomized controlled trial (PRCT) results. In some countries, real-world studies (RWSs) have been conducted to explore the effectiveness and safety of clinical interventions or postmarketing drugs, which is a new tendency in clinical researches. By reviewing some RWSs carried out in Western countries, we sum up the basic characteristics of the research design, and discuss the differences and connections between PRCT and RWS. The design ideas of RWS are different from PRCT. Researchers in RWS tend to perform long-term evaluation based on large quantities of subjects and quite large sample and focus on outcome measures which are clinically meaningful. Strict control on data collection, management and analysis are very important to RWS and PRCT. Owing to the complexity of clinical interventions and evaluation, PRCT is not completely suitable for clinical researches in traditional Chinese medicine (TCM). It is an inevitable tendency to apply RWS in clinical trials of TCM. We can explore the efficacy of TCM interventions through PRCT, and better understand the effectiveness through RWS. RWS will become a powerful approach to TCM clinical trials and postmarketing evaluation of Chinese medicines.
Study of traditional Chinese medicine (TCM) syndromes is a key to the research of TCM modernization, and the core is the classification and diagnostic criteria of syndromes. The purpose of this article is to review the usage of classification algorithms of data mining in TCM syndrome researches, and comprehensively analyze the main features of algorithms and their applications. The appropriate classification algorithm should be chosen according to different research purposes. Rough sets and cluster analysis are suitable for exploratory research without requiring a prior knowledge. Fuzzy sets theory, neural networks and decision tree are suitable for syndrome diagnostic criteria research when the classification goal is clear, because they require a prior knowledge. Among them, fuzzy sets theory could be used in combination with other classification algorithms. Thus, some new methods such as fuzzy clustering, fuzzy rough sets or fuzzy decision tree might be more suitable for TCM algorithm classification research. It is suggested that some novel classification algorithms need to be developed to fit the condition of TCM syndrome, based on the interdisciplinary theories and technologies.
There lack scientific methods for evaluating the treatment of cancer pain with external therapies of traditional Chinese medicine (TCM). The level of clinical study in this field needs to be improved. The authors assert that when external therapies of TCM are applied to treat cancer pain, different types of cancer pain should be distinguished and treatment should be applied according to such a differentiation. Under this framework scientific evaluation can be conducted. The authors also assert that the findings of randomized, blinded and controlled trials should be given particular attention, and it is necessary to include titration of morphine into clinical trails of external therapies for the treatment of cancer pain, not only complying with the three-ladder principle for treating cancer pain suggested by the World Health Organization, but also not influencing the effect evaluation of external therapies of TCM on cancer pain. Patient diaries recording pain were revised as observation indexes. The primary indicator of efficacy was the pain intensity score and the secondary indicators were the equivalent of morphine and the remission rate of pain. The time to onset, remission duration and comparison of assessment of pain influence can mirror the characteristics of external therapies of TCM on cancer pain.
Objective: To explore microcosmic information in chronic gastritis dampness syndrome by using serum proteomics of patients with chronic gastritis dampness syndrome.Methods: Serum proteomics of 18 dampness syndrome cases, 17 non-dampness syndrome cases in chronic gastritis patients and 8 normal controls were analyzed by surface enhanced laser desorption/ionization-time of flight (SELDI-TOF) protein-chip. Results: There was a high expression trend in three ratios of charge (of an electron) to mass (M/S) of 3.2 kD, 6.4 kD and 8.1 kD of protein expression spectrum from patients with chronic gastritis dampness syndrome, and the wave peak value was over 10 units. There was a low expression trend in above-mentioned sites of protein expression spectrum from patients with chronic gastritis non-dampness syndrome and normal group. The wave peak value of patients with chronic gastritis non-dampness syndrome was about or below 10 units, and the wave peak value in normal group was below 5 units. Conclusion: There exists a certain significance to explore biologic theory basis of chronic gastritis dampness syndrome by analyzing the serum proteomics.
Objective: The research is aimed at investigating the developing rule and the relationship between syndrome differentiation in traditional Chinese Medicine (TCM) and clinical factors of gastric cancer so as to guide clinical work and indicate prognosis.Methods: We collected the medical records and the information of four diagnostic methods of 325 cases of gastric cancer sufferers in the way of clinical epidemiological survey, and divided them into 6 syndromes including dysfunction of spleen, disharmony of liver and stomach, blood stagnation in stomach, yin deficiency of stomach, phlegm dampness stagnation and deficiency of both qi and blood. Then we used logistic regression analysis to analyze the relationship between syndrome differentiation and clinical-related factors such as age, gender, Karnofsky score and clinical stage, etc.Results: The syndrome spleen dysfunction is a dominant one among the syndromes of stomach cancer. Disharmony of liver and stomach always happens in early stage of stomach cancer and is frequently seen in women. Patients with syndrome of phlegm dampness stagnation or deficiency of both qi and blood have lower Karnofsky score and poorer living quality. Syndromes of blood stagnation in stomach and yin deficiency of stomach show no relationship with the clinical factors in this research.Conclusion: >Syndrome differentiation in TCM of gastric cancer is related to some clinical factors to a certain extent.
This paper is devoted to discussing two research patterns of biological basis of traditional Chinese medicine syndrome and presenting a research strategy for data mining methods. It points out that data mining methods which are based on feature selection are better fit for investigating biological basis of traditional Chinese medicine syndrome. Based on such a discussion, the concept of “characteristic pattern” is proposed to bridge the gap between “golden index” and biological basis of traditional Chinese medicine syndrome. This paper presents a novel research avenue for investigating biological basis of traditional Chinese medicine syndrome.
Great progress has been made in the study of fatty liver with integrated traditional Chinese and western medicine in aspects of diagnosis, treatment and experimental study, etc. Most researches were designed to utilize diagnostic or model replicating method of western medicine to observe the effects or investigate the action mechanism of compound recipe, single Chinese herb or effective ingredients of Chinese herbs on fatty liver. According to the pathological mechanism of traditional Chinese medicine (TCM), fatty liver is characterized by deficiency in nature and repletion in appearance, which involves three Zang viscera such as liver, spleen and kidney and manifests as spleen Qi deficiency, liver and kidney deficiency, phlegm and dampness heaping internally, and Qi stagnation and blood stasis. This facilitates us to use specific recipe or modified recipe to treat fatty liver from the points of integrated traditional Chinese and western medicine and combining syndrome differentiation with disease differentiation. With gratifying achievement, this kind of approach has been the mainstream of the research on fatty liver and many researchers have reached an agreement on this point domestically. Spleen Fortifying and Blood Invigorating Recipe (SFBVER in brief, invented by our institute) can significantly improve the B ultrasound outcome of the liver in patients with fatty liver, with significant difference in B ultrasound scoring between pre-and post-treatment. It can alleviate the patients' symptoms, improve or regain liver function, decrease waist/buttocks ratio and the content of triglyceride and cholesterol in blood. SFBVER is superior to Dongbao Gantai Recipe in general effective rate. Experimental study also reveals that SFBVER can alleviate CCl4 induced liver cell fatty degeneration and the inflammatory cell infiltration in rats, decrease the activities of ALT and AST, lower the content of triglyceride in liver, recover SOD activity in liver to normal level. The overall efficacy of SFBVER is superior to that of Dongbao Gantai Recipe. Further correlated study should be focused on inventing new preparation of traditional Chinese medicine and investigating its action mechanism with the guiding of the theory of TCM and referring to the latest discovery in fatty liver research in modern medicine.
Objective: To explore the analysis methods for composite traditional Chinese medicine (TCM) constitutions.
Methods: The epidemiological data of TCM constitutions were collected from 974 volunteers via a cross-sectional survey. The samples were classified into 9 constitution types according to the maximal standardized scores of imbalanced constitutions. The correlation matrix of 9 constitutions was computed. The standardized scores of 9 constitutions of all the volunteers were ranked respectively, and the composite status of every two constitutions was observed using cross tabulation. The constitution types of all the volunteers were transformed into ternary code of 9 digits, and the composite status of 3 or more than 3 kinds of constitution types was analyzed.
Results: According to the maximal standardized scores of imbalanced constitutions, of 974 volunteers, 227, 148, 218, 102, 31, 81, 44, 97 and 26 volunteers had balanced constitution, qi-deficiency constitution, yang-deficiency constitution, yin-deficiency constitution, phlegm-dampness constitution, heat-dampness constitution, blood stasis constitution, qi-stagnation constitution, and inherited special constitution, respectively. The standardized scores of balanced constitution were negatively correlated with those of imbalanced constitutions, while there was a positive correlation between the standardized scores of every two imbalanced constitutions. Among the 8 imbalanced constitutions, one kind of imbalanced constitutions was usually complicated with another kind of imbalanced constitutions. The number of qi-deficiency constitution complicated with yang-deficiency constitution, qi-deficiency constitution complicated with yin-deficiency constitution, and yin-deficiency constitution complicated with yang-deficiency constitution ranked the top three. The constitution types of 974 volunteers were transformed into a total of 465 ternary codes, showing a total of 465 kinds of constitution types; the simplex constitution, the approximately simplex constitution, and the composite constitution of two or more than two types were found in 259, 130, and 585 volunteers, respectively.
Conclusion: Cross tabulation can show the composite status of every two constitutions, while the ternary code can show the composite status of three or more than three constitutions.
Breast cancer is called ''Ruyan'' in literature of traditional Chinese medicine. We synthesized the ancient and contemporary discussions and raised the theory that ''Duxie'' (poisonous pathogenic factor) is the etiological factor and pathologic product through the whole course of breast cancer. ''Liuyin Fudu'' (latent poison of six exogenous pathogenic factors) and ''Qiqing Yudu'' (stagnant poison of seven emotions) are the main etiological factors affecting the breast cancer occurrence. ''Aidu Neisheng'' (internal product of cancer poison) is the essential change in breast cancer occurrence. ''Tandu Yujie'' (stagnation of phlegm, poison and blood stasis) is the essential pathogenesis of the breast cancer's development. ''Yudu Weiqing'' (vestigial poison) is the main pathogenesis of breast cancer after operation. ''Yudu Pangcuan'' (vestigial poison invasion elsewhere) is the key pathogenesis of recurrence and metastasis after operation. ''Sanjie Jiedu'' (dispersing accumulation and detoxification) is an important therapeutic principle in breast cancer's treatment after operation. The ''Tandu-Yujie'' pathogenesis theory and ''Sanjie Jiedu'' therapeutic principle developed the theory about breast cancer in traditional Chinese medicine, and have some clinical application value.
To provide more objective basis for traditional Chinese medicine (TCM) syndrome differentiation of deficiency and excess by collecting and analyzing voice signals and extracting characteristic parameters. Methods
All of 308 samples including 150 samples of qi-deficiency, 52 yin-deficiency, 55 excess and 51 normal were collected by “Voice Collecting System of TCM” and analyzed by wavelet packet transform (WPT) combined with approximate entropy (ApEn). The characteristic parameters with remarkable differences were chosen as input vectors for support vector machine (SVM) classifier to obtain classification results. Results
Comparison between the normal and non-healthy showed that ApEn values of several nodes in 2 to 3 kHz, 3.5 to 4 kHz and 5 to 8 kHz frequencies were significantly different (P≤0.05); comparison between the deficiency and excess showed that ApEn values of several nodes in 0 to 2.5 kHz and 6 to 6.5 kHz frequencies were significantly different (P≤0.05); comparison between the qi-deficiency and yin-deficiency showed that ApEn values of node in 2 to 4 kHz frequency were significantly different(P≤0.05). The outputs of SVM showed that accuracies of samples in each group had good classification results by analyzing the ApEn values in different frequencies through WPT. Conclusion
The methods of voice collection and analysis used in the auscultation of TCM can provide objective basis for syndrome differentiation of deficiency and excess.
Objective: To investigate the relationship between visceral syndrome differentiation in traditional Chinese medicine (TCM) and the changes of nutrition status or blood gas analysis in patients with chronic obstructive pulmonary disease (COPD).Methods: Sixty patients with COPD in stable phase were divided into dysfunction of lung (DL, n=20) group, dysfunction of lung and spleen (DLS, n=16) group and dysfunction of lung, spleen and kidney (DLSK, n=24) group according to syndrome differentiation of TCM. Moreover, the basic electric rhythm, percentage of bradygastria in electrogastrogram (EGG), ratio of actual body weight (ABW) to ideal body weight (IBW) and serum albumin level were determined to evaluate the nutrition status of the patients with COPD. Blood gas analysis was made too.Results: The basic electric rhythm values in the DL, DLS and DLSK groups were (56.20±13.24)%, (47.38±10.24)% and (41.35±10.01)%, respectively. Compared with the DL group, the basic electric rhythm values in the DLS and DLSK groups decreased obviously (P＜0.05). The percentages of bradygastria in the DL, DLS and DLSK groups were (45.18±18.13)%, (46.31±15.83)% and (49.90±17.54)%, respectively, and there were no differences among the three groups (P＞0.05). The incidence rates of ABW/IBW＜90% in the DL, DLS and DLSK groups were 50%, 75% and 54.17%, respectively, and there were no differences among the three groups (P＞0.05). The incidence rates of serum albumin less than 35 g/L were 20%, 37.5% and 54.17%, respectively, and there were no differences among the three groups (P>0.05). PO2 in the DLS group [(63.56±15.06) mmHg] and DLSK group [(63.17±19.05) mmHg] were decreased as compared with the DL group [(78.15±16.63) mmHg] (P＜0.05). PCO2 in the DL, DLS and DLSK groups were (42.25±12.46) mmHg, (48.60±17.60) mmHg and (49.97±13.43) mmHg respectively, and there were no differences among the three groups (P＞0.05).Conclusion: Several dysfunction organs described in TCM were involved in COPD followed by the increased severity, hypoxemia and PCO2. Dysfunction of gastrointestinal tract and malnourishment took place accordingly.
Objective: This study explores the applicability of a multi-attribute decision-making method in assessing Guizhi Decoction (GZD) and its varieties as noted in the Shanghanlun. Methods: A known multi-attribute decision-making method, the analytic hierarchy process (AHP), was adopted to transform the clinical challenge of selecting optional decoction for a given combination of symptoms or signs into multiple criteria decision-making problem. Results: A normative model based on the AHP was realized for indications of GZD and its varieties. The indications of sub-family GZD-f (indications of GZD itself) were exterior illness; the indications of GZD-vf1 (indications of GZD’s variants which consist of fine adjustments to the ingredients or content on the basis of GZD) were exterior illness with interior excess, suggesting that GZD-vf1 consisted of most conservative variants of GZD; the indications of both GZD-vf2 (indications of Guizhi Qu Shaoyao Decoction and its derivative variants) and GZD-vf3 (indications of Guizhi Gancao Decoction and its derivative variants) showed evolution from exterior illness to interior deficiency in 2 directions. As to efficacy evaluation of the decoction, GZD and its varieties (restricted to those comparable ones) were of equal efficacy on 3 popular signs or symptoms indicating exterior illness: floating pulse, aversion to wind and spontaneous sweating, which were the common ground of indications for the GZD family. Conclusion: Modeling of diagnostic procedure based on the AHP is proved practicable to analyze the clinical judgment system of traditional Chinese medicine. Quantification research on syndrome differentiation and decoction evaluation system focused on signs and symptoms is suggested as a feasible and reliable model.
This paper proposes a new idea of the theory of Ju (aggregation) syndrome complex based on succeeding to traditional Chinese medicine. It presumes that the etiological factors of Ju are both heritage deficiency and postnatal viscerae damage, which cause the disturbance of qi-transformation, and thus, the evil heat, turbid damp and stagnated blood take the chance of retention in the body, to block up the production and distribution of the essence and energy. Ju is a mixed symptom complex of asthenia and sthenia, and should be simultaneously applied to purging-tonifying therapy and aggregation-dissipating method. Under the guidance of Ju theory, patients with metabolic syndrome were treated with Chinese medicine. The symptoms were relieved, and the insulin resistance, hyperglycemia, hyperlipidemia, body weight, waist circumference, and the inflammatory cytokines were improved, which confirmed the theoretical significance of the practical value of Ju theory.
To investigate the characteristics of traditional Chinese medicine (TCM) syndromes and their elements in people with subhealth fatigue. Methods
The TCM symptoms in line with the diagnostic criteria of subhealth fatigue status were collected by clinical investigations and using information collection form based on TCM four diagnostic methods. Referred to Clinical Guidelines of Chinese Medicine on Subhealth and other related standards, the syndrome type was identified in accordance with clinical symptoms of each patient with subhealth fatigue by two physicians. The data of syndrome differentiation were analyzed by descriptive statistical analysis. Results
There were 81 syndrome types from 495 cases of subhealth fatigue. There were 24 syndrome types after separation, and the top ten were liver stagnation and spleen deficiency, stagnation of liver qi, hyperactivity of liver fire, disharmony between liver and stomach, damp obstruction due to spleen deficiency, deficiency of both heart and spleen, yin deficiency of liver and kidney, yang deficiency of spleen and kidney, stagnation of gallbladder and disturbance of phlegm, and internal disturbance of phlegm-heat. There were 17 syndrome elements, including seven disease location elements and ten disease nature elements. The disease location elements were liver, spleen, kidney, stomach, heart, gallbladder and lung. The disease nature elements were qi stagnation, qi deficiency, exuberance of fire (heat), damp obstruction, phlegm obstruction, yin deficiency, adverse flow of qi, yang deficiency, blood deficiency, and blood stasis. Conclusion
Syndrome types of subhealth fatigue involve in deficiency syndrome, excess syndrome, and mixture of deficiency and excess syndromes. The syndrome elements of disease location involve five zang organs and two fu organs, and the liver and spleen were the most frequently involved organs. The syndrome elements of disease nature involve deficiency and excess. Qi stagnation is most frequently involved in the excess syndrome, and qi deficiency is most frequently involved in the deficiency syndrome.
：Objective: To investigate the relationship between syndrome differentiation of traditional Chinese medicine (TCM) and characteristic changes of vascular endothelial function in patients with diabetic arterial occlusion (DAO) of lower extremities.Methods: Forty patients with DAO were selected as trial group. Twenty patients among them were attributed to blood stasis syndrome (group A1), and the others were attributed to syndrome of pathogenic dampness-heat attacking the lower limb (group A2) according to syndrome differentiation type of TCM. Patients with diabetes (group B), arteriosclerosis obliterans (group C) and healthy people (group D) were observed as the control groups, respectively. There were 20 cases in each group. Endothelium-dependent dilation (EDD) and endothelium-independent dilation (EID) were measured by high resolution ultrasound in the 100 subjects and the changes of vascular tension factors were also studied. Results: The results showed that EDD in group A was reduced significantly as compared with that in the groups B, C and D. The levels of vascular contractile factors such as endothelin-1 (ET-1) and thromboxane B2 (TXB2) in group A were higher than those in the groups B, C and D, while the levels of vascular dilatory factors such as nitric oxide (NO) and 6-keto-prostaglandin F1α (6-Keto-PGF1α) were declined significantly as compared with those in the groups B and D. Linear correlation analysis showed that EDD was correlated positively with the levels of NO and 6-Keto-PGF1α, while the levels of ET-1 and TXB2 had negative correlation with EDD. EDD and EID in group A2 were declined significantly as compared with those in group A1.Conclusion: Our findings indicate that endothelial dysfunction may play an important role in the pathogenesis of DAO and may be associated with syndrome differentiation of TCM.
On the basis of medical literature review and clinical research experience, the authors analyzed the reasons for low recognition rate of depression and poor progress of traditional Chinese medicine (TCM) differentiation of depression in this paper and put forward that depressive episode symptoms and the corresponding common terminology classification of Chinese and Western medicine should be the breakthrough points. Through symptom stratification and combination, as well as distinguishing between primary and secondary symptoms, the comprehensive integrative medicine clinical assessment of depression was explored so as to further obtain expert consensus and provide a methodology reference for the TCM differentiation of depression and the research of etiology and pathogenesis.
To treat patients with vascular mild cognitive impairment (VMCI) using traditional Chinese medicine (TCM), it is necessary to classify the patients into TCM syndrome types and to apply different treatments to different types. In this paper, we investigate how to properly carry out the classification for patients with VMCI aged 50 or above using a novel data-driven method known as latent tree analysis (LTA).
Method
A cross-sectional survey on VMCI was carried out in several regions in Northern China between February 2008 and February 2012 which resulted in a data set that involves 803 patients and 93 symptoms. LTA was performed on the data to reveal symptom co-occurrence patterns, and the patients were partitioned into clusters in multiple ways based on the patterns. The patient clusters were matched up with syndrome types, and population statistics of the clusters are used to quantify the syndrome types and to establish classification rules.
Eight syndrome types are identified: Qi deficiency, Qi stagnation, Blood deficiency, Blood stasis, Phlegm-dampness, Fire-heat, Yang deficiency, and Yin deficiency. The prevalence and symptom occurrence characteristics of each syndrome type are determined. Quantitative classification rules are established for determining whether a patient belongs to each of the syndrome types.
A solution for the TCM syndrome classification problem for patients with VMCI and aged 50 or above is established based on the LTA of unlabeled symptom survey data. The results can be used as a reference in clinic practice to improve the quality of syndrome differentiation and to reduce diagnosis variances across physicians. They can also be used for patient selection in research projects aimed at finding biomarkers for the syndrome types and in randomized control trials aimed at determining the efficacy of TCM treatments of VMCI.
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