The model of Western integrative medicine: the role of Chinese medicine

The Western model of integrative oncology: the contribution of Chinese medicine

Western integrative oncology (IO) combines conventional mainstream medicine with complementary and alternative medicine (CAM) for the care of cancer patients. Since it includes patient orientation and the holistic approach of many CAM options, IO offers not only preventive measures, but also a wide spectrum of treatment modalities for all stages of illness, from the acute phases through the rehabilitation period. Many therapeutic methods of IO are supported by scientific evidence, for example, dietary and nutritional counseling, exercise, and mind-body medicine, among others. IO also includes therapeutic interventions of traditional Chinese medicine (TCM). At present acupuncture, qigong, and foot massage play an important role in the Western care of cancer patients. However, unlike in China, in Western countries herbal remedies are usually only used during those periods in which chemotherapy is not applied in order to avoid herb-drug interactions. Instead, acupuncture is widely used to manage the side-effects that often accompany chemotherapy. This paper focuses on the role of Chinese medicine in Western IO and reviews the scope and limitations of IO in the care of cancer patients today. The future challenges of IO will also be discussed in this paper.

Analysis on outcome of 5284 patients with coronary artery disease: the role of integrative medicine

ETHNOPHARMACOLOGICAL RELEVANCE

Traditional Chinese Medicine (TCM) has a history of thousands of years and has made great contributions to the health and well-being of the people. Integrative medicine (IM) treatment, combing TCM and conventional medicine, has been the most representative characteristic for coronary artery disease (CAD) patients in China, especially those in IM hospitals. However, the secondary prevention status of CAD and the potential benefit of IM therapy in improving CAD prognosis remains unclear.

MATERIALS AND METHODS

By means of a unified clinical and research information platform, we collected clinical information of hospitalized patients with CAD in cardiovascular department of 9 IM hospitals in Beijing and Tianjin from January 2003 to September 2006. The primary endpoints were major adverse cardiac events (MACEs) which include all-cause death in hospital and during one-year follow-up, acute myocardial infarction (AMI), percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). The diagnostic and therapeutic status of CAD patients was evaluated based on the latest available clinical guidelines. Meanwhile, a logistic stepwise regression analysis was also used to identify independent prognostic factors.

RESULTS

5284 hospitalized patients with CAD were registered. The top five TCM patterns were in turn blood stasis 79.3%, Qi deficiency 56.5%, phlegm-turbidness 41.1%, Yin deficiency 24.8%, Yang deficiency 11.3%. The standard-reaching rate of CAD patients with hyperlipidemia was 85.6% for total cholesterol, 31.2% for triglyceride, 21.4% for low-density lipoprotein cholesterol, 52.5% for high-density lipoprotein cholesterol, while it was 61.9% and 80.9% in systolic and diastolic blood pressure of CAD with hypertension respectively. The top five commonly used herbs by functions were Qi-tonifying agents 89.25%, blood-activating agents 86.04%, Qi-regulating agents 77.60%, heat-clearing agents 67.50%, dampness-draining agents 65.95%. The herbs commonly used were Salvia miltiorrhiza Bunge 63.10%, Poria 59.99%, Raidx Astragali 49.67%, Radix Paeoniae Rubra 48.71%, peach seed 47.32%, angelica 46.82%, Radix Ligustici Chuanxiong 46.36%, safflower 45.40%, Pinellia 45.30%, glycyrrhiza 41.36%. 90 patients (1.7%) died in hospital, and the overall incidence of endpoints was 6.1% (322/5284). The logistic stepwise regress analysis showed that AMI (OR, 5.62, 95% CI=2.56-12.33), heart failure (OR, 2.68, 95% CI=1.67-4.29), age≥60 years (OR, 2.01, 95% CI=1.22-3.30), and medication of phosphodiesterase inhibitors (OR, 1.67, 95% CI=1.15-2.42) were independent risk factors for in-hospital mortality and one-year follow-up MACEs, while statins (OR, 0.23, 95% CI=0.06-0.91) and IM therapy (OR, 0.69, 95% CI=0.49-0.97) were protective factors.

CONCLUSION

There was still certain gap between the usage of conventional medicine and clinical guideline in IM hospitals of China. Integrative Medicine might have potential benefit for CAD patients in reducing MACEs. However, the scheme of IM intervention and the mechanism of action are still needed to be further determined.

Outcome measures of chinese herbal medicine for coronary heart disease: an overview of systematic reviews

Objective. The aim of this overview was to summarize the outcome measures of Chinese herbal medicine (CHM) as the treatment of coronary heart disease (CHD) based on available systematic reviews (SRs), so as to display the current situation and evaluate the potential benefits and advantages of CHM on CHD. Methods. An extensive search included the Cochrane Database of Systematic Reviews, MEDLINE, and 4 databases in Chinese. SRs of CHM for CHD were included. Besides evaluating and summarizing the outcome measures, we also estimated the quality of the included reviews by PRISMA (preferred reporting items for systematic reviews and meta-analyses). Data were extracted according to predefined inclusion criteria by two independent reviewers. Results. 46 articles were included. 20 kinds of CHM were reviewed. 7 SRs were concerned with myocardial infarction (MI), 38 SRs were related to angina pectoris. 11 SRs had primary endpoints, while others focused on secondary endpoints to evaluate CHM for CHD such as angina pectoris and electrocardiogram (ECG). One SR reported more adverse effects of CHM for CHD and of the SRs analyzed quality of life. Many CHM appeared to have significant effect on improving symptoms, ECG, biomarkers and so on. However, most SRs failed to make a definite conclusion for the effectiveness of CHM in CHD patients due specifically to the poor evidence. And according to PRISMA we found most of the trials in the SRs were of low quality. Conclusion. Primary endpoints were not used widely. The benefits of CHM for CHD need to be confirmed in the future with RCTs of more persuasive primary endpoints and high-quality SRs.

Traditional Chinese medicine research in the post-genomic era: good practice, priorities, challenges and opportunities

BACKGROUND AND AIMS

GP-TCM is the 1st EU-funded Coordination Action consortium dedicated to traditional Chinese medicine (TCM) research. This paper aims to summarise the objectives, structure and activities of the consortium and introduces the position of the consortium regarding good practice, priorities, challenges and opportunities in TCM research. Serving as the introductory paper for the GP-TCM Journal of Ethnopharmacology special issue, this paper describes the roadmap of this special issue and reports how the main outputs of the ten GP-TCM work packages are integrated, and have led to consortium-wide conclusions.

MATERIALS AND METHODS

Literature studies, opinion polls and discussions among consortium members and stakeholders.

RESULTS

By January 2012, through 3 years of team building, the GP-TCM consortium had grown into a large collaborative network involving ∼200 scientists from 24 countries and 107 institutions. Consortium members had worked closely to address good practice issues related to various aspects of Chinese herbal medicine (CHM) and acupuncture research, the focus of this Journal of Ethnopharmacology special issue, leading to state-of-the-art reports, guidelines and consensus on the application of omics technologies in TCM research. In addition, through an online survey open to GP-TCM members and non-members, we polled opinions on grand priorities, challenges and opportunities in TCM research. Based on the poll, although consortium members and non-members had diverse opinions on the major challenges in the field, both groups agreed that high-quality efficacy/effectiveness and mechanistic studies are grand priorities and that the TCM legacy in general and its management of chronic diseases in particular represent grand opportunities. Consortium members cast their votes of confidence in omics and systems biology approaches to TCM research and believed that quality and pharmacovigilance of TCM products are not only grand priorities, but also grand challenges. Non-members, however, gave priority to integrative medicine, concerned on the impact of regulation of TCM practitioners and emphasised intersectoral collaborations in funding TCM research, especially clinical trials.

CONCLUSIONS

The GP-TCM consortium made great efforts to address some fundamental issues in TCM research, including developing guidelines, as well as identifying priorities, challenges and opportunities. These consortium guidelines and consensus will need dissemination, validation and further development through continued interregional, interdisciplinary and intersectoral collaborations. To promote this, a new consortium, known as the GP-TCM Research Association, is being established to succeed the 3-year fixed term FP7 GP-TCM consortium and will be officially launched at the Final GP-TCM Congress in Leiden, the Netherlands, in April 2012.

Atherosclerosis: an integrative East-west medicine perspective

Recent understanding of atherosclerosis and coronary heart disease has shifted the focus from lumen stenosis to vulnerable plaque, from lipid deposit to inflammatory reaction, and from vulnerable plaque to vulnerable patient. This has led to a new direction of treatment consisting of intervening the inflammatory reaction, stabilizing the vulnerable plaque, inhibiting thrombosis after plaque rupture, and treating the vulnerable patient instead of treating lumen stenosis. This seems to mirror the traditional Chinese medicine (TCM) focus on prevention and on the vulnerable patient with treatment matched to the pattern dysfunction and dysregulation using the Chinese herbal medicine multitargeted approach. Given the convergence of both the East and the West conceptualization of atherosclerosis, it is hopeful that the integrative East-West approach will facilitate early detection and more effective treatment of the vulnerable patients with coronary heart disease.

Effects and mechanisms of actions of Chinese herbal medicines for asthma

Asthma is a chronic inflammatory disorder of airways that affects approximately 300 million adults and children worldwide. Most therapy currently uses bronchodilators and corticosteroids. Systemic side effects from chronic use of these drugs are concern. Chinese medicine (CM) has a long history of human use in China and other Asian countries and well received by the patients. But as one component of Western integrative medicine (WIM), it is required that CM use is supported by scientific evidence. On the other hand, there are also suggestions that Western standardized medicine should consider personalized practice. In recent years there have been an increasing studies to narrow the gap between CM, the personalized medicine and Western medicine, evidence based medicine. This communication reviews several CM studies published in the English language in details by reviewing the effects and mechanisms of actions on asthma from clinic and experimental studies.Chinese herbal medicines exhibit broad actions on multiple asthma pathologic mechanisms. These mechanisms may involve antiinflammatory and immunomodulatory effects, inhibiting airway remodeling and normalization of hypothalamus, pituitary and adrenal (HPA)-axis disturbances. However, the mechanisms of actions of Chinese herbal medicines for asthma are not fully understood. More controlled clinical studies are warranted and some anti-asthma CM may be proved to be effective when used as monotherapy or complementary asthma therapies.