A Novel Approach to Evaluate Traditional Chinese Medicine Treatment Outcomes Using Pattern Identification

Efficacy and safety of the herbal formula Naesohwajung-tang for functional dyspepsia: a randomized, double-blind, placebo-controlled, multi-center trial

Background: Current treatment and management options for functional dyspepsia (FD) often fail to alleviate symptoms. Naesohwajung-tang (NHT) is a herbal formula frequently used to treat functional dyspepsia in traditional Korean medicine. However, few animal and case reports on the use of Naesohwajung-tang for functional dyspepsia treatment exist, and the clinical evidence remains deficient. Objectives: This study aimed to evaluate the efficacy of Naesohwajung-tang in patients with functional dyspepsia. Methods: We enrolled 116 patients with functional dyspepsia at two study sites in this 4 weeks, randomized, double-blind, placebo-controlled trial and randomly assigned them to either the Naesohwajung-tang or placebo group. To evaluate the efficacy of Naesohwajung-tang, the primary endpoint was a score on the total dyspepsia symptom (TDS) scale after treatment. The overall treatment effect (OTE), single dyspepsia symptom (SDS) scale, food retention questionnaire (FRQ), Damum questionnaire (DQ), functional dyspepsia-related quality of life (FD-QoL) questionnaire, and gastric myoelectrical activity measured using electrogastrography were evaluated as secondary outcomes. Laboratory tests were performed to confirm the safety of the intervention. Results: The 4 weeks administration of Naesohwajung-tang granules demonstrated a significantly higher reduction in the total dyspepsia symptom (p < 0.05) and a higher degree of improvement in the total dyspepsia symptom (p < 0.01) than the placebo group. Patients who underwent Naesohwajung-tang had a significantly higher overall treatment effect and a greater increase in the degree of improvement in scores such as epigastric burning, postprandial fullness, early satiation, functional dyspepsia-related quality of life, and Damum questionnaire (p < 0.05). Additionally, the Naesohwajung-tang group showed a greater effect in preventing a decrease in the percentage of normal gastric slow waves after meals than the placebo group. As a result of subgroup analyses using the degree of improvement in total dyspepsia symptom, Naesohwajung-tang was found to be more effective than placebo in female, younger patients (<65 years), with a high body-mass index (≥22), overlap type, food retention type, and Dampness and heat in the spleen and stomach systems pattern. There was no significant difference in the incidence of adverse events between the two groups. Conclusion: This is the first randomized clinical trial to verify that Naesohwajung-tang leads on symptom relief in patients with functional dyspepsia. Clinical Trial Registration: https://cris.nih.go.kr/cris/search/detailSearch.do/17613, identifier KCT0003405.

A Novel Framework for Understanding the Pattern Identification of Traditional Asian Medicine From the Machine Learning Perspective

Pattern identification (PI), a unique diagnostic system of traditional Asian medicine, is the process of inferring the pathological nature or location of lesions based on observed symptoms. Despite its critical role in theory and practice, the information processing principles underlying PI systems are generally unclear. We present a novel framework for comprehending the PI system from a machine learning perspective. After a brief introduction to the dimensionality of the data, we propose that the PI system can be modeled as a dimensionality reduction process and discuss analytical issues that can be addressed using our framework. Our framework promotes a new approach in understanding the underlying mechanisms of the PI process with strong mathematical tools, thereby enriching the explanatory theories of traditional Asian medicine.

Efficacy of a Traditional Herbal Formula, Banha-Sasim-Tang in Functional Dyspepsia Classified as Excess Pattern

This study evaluated the efficacy and safety of Banha-sasim-tang (BST) in patients with functional dyspepsia (FD). BST (Banxia-xiexin-tang in traditional Chinese medicine and Hange-shashin-to in Kampo medicine) is traditionally prescribed for the treatment of dyspepsia with epigastric stiffness and gastric fullness in China, Japan, and Korea. Patients with FD were randomly administered an oral dose (10 g) of BST syrup or placebo, twice a day for 4 weeks. The primary outcome was the symptom checklist part of the Nepean dyspepsia index (NDI). The secondary outcomes were the quality of life (QoL) part of the NDI, functional dyspepsia-related QoL (FD-QoL), and visual analog scale (VAS). A total of 60 patients with FD were screened, and 50 were randomized into BST group (n = 25) and placebo group (n = 25). Two patients in the placebo group withdrew before the start of the treatment. Administration of BST syrup resulted in improvement in the symptom-related NDI score in the BST group compared with that in the control group; however, the difference was not significant. BST syrup significantly improved "fullness after eating" index of NDI at follow-up time point (2.88 ± 2.65 vs 4.78 ± 2.69, p = 0.0081). In the total score of the QoL section of the NDI and FD-QoL scales, there was no significant improvement in the BST group compared to that in the placebo group. With regard to improvement in overall FD symptoms, the VAS scale showed improvement in both groups, but the difference was not significant. Interestingly, follow-up investigation showed a significantly beneficial effect of BST on FD symptoms, when compared to placebo. Significant improvement observed in VAS score (39.60 ± 22.29 vs 52.17 ± 20.55, p = 0.048). This indicated that the effect of BST lasted even after the completion of the medication regimen. Overall, our data suggest that while BST showed no significant improvement in the symptom-related NDI score and the QoL related scores in NDI and FD-QoL after 4 weeks of treatment, it effectively improved the VAS score and fullness after eating-related symptoms in the follow-up visit. Clinical Trial Registration:https://cris.nih.go.kr; Identifier KCT 0002013.

Constitutions of Deficiency and Stasis of Traditional Chinese Medicine and Related Factors among Middle-Aged Women in Taiwan

Background

Traditional Chinese medicine (TCM) appears to be the common therapy in middle-aged women. The constitution serves as a guide for TCM treatment. However, little is known about the constitution and related factors in middle-aged women. The objectives of this study were to describe the yang-deficiency, yin-deficiency, and stasis constitutions in middle-aged women. Demographic and health factors related to yang deficiency, yin deficiency, and stasis were also examined.

Methods

A total of 1,000 women aged 40–65 years were selected from 2009 through 2018 using random sampling from the Taiwan Biobank Research Database in Taiwan. Yang-deficiency, yin-deficiency, and stasis were assessed using the body constitution questionnaire. Multiple logistic regression analysis was used to identify factors associated with constitution in deficiency or stasis.

Results

The proportions of middle-aged women who had the constitution in yang-deficiency, yin-deficiency, and stasis were 29.7%, 21.7%, and 17.7%, respectively. The result of binary logistic regression showed that current menstruation, abnormal spirometry, and education level were predictive factors of yang deficiency. Women with younger age, abnormal spirometry, or a vegetarian diet had a significantly associated yin deficiency. Younger age, abnormal spirometry, and coffee habit were predictors of stasis.

Conclusions

Middle-aged women in Taiwan with abnormal spirometry had a higher risk for deficiency or stasis constitutions, especially for those younger than 56 years. Healthcare providers should learn patients' constitutions and provide appropriate advice, referring them to safe providers of their desired method.

PRISMA extension for moxibustion 2020: recommendations, explanation, and elaboration

BACKGROUND

Moxibustion is a common intervention of Chinese medicine (CM). Systematic reviews (SRs) on moxibustion are increasing. Although the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement provides guidelines for SRs, the quality of moxibustion-related SRs is still not satisfactory. In particular, descriptions of the interventions and the rationale for using moxibustion are insufficient. To address these inadequacies, the working group developed this PRISMA extension for reporting SRs of moxibustion (PRISMA-M 2020).

METHODS

A group of CM clinical professionals, methodologists of SRs, reporting guideline developers, and journal editors developed this PRISMA-M 2020 through a comprehensive process that includes registration, literature review, consensus meetings, Delphi exercises for soliciting comments, and revision, resulting in this final draft.

RESULTS

Seven of the 27 PRISMA checklist items, namely title (1), rationale (3), eligibility criteria (6), data item (11), additional analyses (16), study characteristics (18), and additional analysis (23), were extended, with specific reference to the application of moxibustion. Illustrative examples and explanations for each item are provided.

CONCLUSION

The PRISMA-M 2020 will help improve the reporting quality of SRs with moxibustion.

SYSTEMATIC REVIEW REGISTRATION

We have registered it on the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) network, particularly under the item of PRISMA-TCM: http://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-systematic-reviews/#65 .

WHO Trial Registration Data Set (TRDS) extension for traditional Chinese medicine 2020: recommendations, explanation, and elaboration

Background

Although the WHO Trial Registration Data Set (TRDS) has been published for many years, the quality of clinical trial registrations with traditional Chinese medicine (TCM) is still not satisfactory, especially about the inadequate reporting on TCM interventions. The development of the WHO TRDS for TCM Extension 2020 (WHO TRDS-TCM 2020) aims to address this inadequacy.

Methods

A group of clinical experts, methodologists, epidemiologists, and editors has developed this WHO TRDS-TCM 2020 through a comprehensive process, including the baseline survey, draft of the initial items, three-round of Delphi survey, solicitation of comments, revision, and finalization.

Results

The WHO TRDS-TCM 2020 statement extends the latest version (V.1.3.1) of TRDS published in November 2017. The checklist includes 11 extended items (including subitems), namely Source(s) of Monetary or Material Support (Item 4), Scientific Title (Item 10a and 10b), Countries of Recruitment (Item 11), Health Condition(s) or Problem(s) Studied (Item 12), Intervention(s) (Item 13a, 13b and 13c), Key Inclusion and Exclusion Criteria (Item 14), Primary and Key Secondary Outcomes (Item 19 to 20), and Lay Summary (Item B1). For Item 13 (Interventions), three common TCM interventions--i.e., Chinese herbal medicine formulas, acupuncture and moxibustion—are elaborated.

Conclusions

The group hopes that the WHO TRDS-TCM 2020 can improve the reporting quality and transparency of TCM trial registrations, assist registries in assessing the registration quality of TCM trials, and help readers understand TCM trial design.

Inhibitory effects of Cheongsangbangpoong-tang on both inflammatory acne lesion and facial heat in patients with acne vulgaris: A double-blinded randomized controlled trial

OBJECTIVES

To investigate the inhibitory effects of an herbal formulation of Cheongsangbangpoong-tang (CBT) on inflammatory acne lesions as the control of the 'Heat' pattern.

DESIGN

A single center study. Randomized, placebo-controlled, parallel group, double-blind trial SETTING: Fifty-six subjects, who had more than 10 acne inflammatory lesions each, were randomly allocated into the CBT or placebo groups and took 5 g CBT extract (CBT group) or 5 g placebo extract (control group), respectively, three times a day for 8 weeks. Pattern identification, change of the inflammatory and non-inflammatory acne lesions, temperature of the facial points, serum cortisol level, serum dehydroepiandrosterone-sulfate level, number rating scale, investigator global assessment (IGA), and severity score on the Korean acne grading system were measured.

MAIN OUTCOME MEASURE

mean change of the inflammatory acne lesions.

RESULTS

After CBT/placebo administration, the percentage count of inflammatory lesions in subjects was significantly reduced in the CBT group when compared with the control group. The other outcomes showed no significant difference between the two groups. On pattern identification, subjects with the Wind-Heat pattern (, WHP) and Disharmony of the thoroughfare and conception vessels pattern (, DTCVP) tended show better effect than those with other patterns.

CONCLUSIONS

CBT is a potential therapeutic agent for the treatment of acne vulgaris, linked to inhibition of inflammatory lesions and facial heat.

TRIAL REGISTRATION

CRiS (Clinical Research Information Service, Republic of Korea), KCT0001468. Registered 06 May 2015.

Characterization of hidden rules linking symptoms and selection of acupoint using an artificial neural network model

Comprehension of the medical diagnoses of doctors and treatment of diseases is important to understand the underlying principle in selecting appropriate acupoints. The pattern recognition process that pertains to symptoms and diseases and informs acupuncture treatment in a clinical setting was explored. A total of 232 clinical records were collected using a Charting Language program. The relationship between symptom information and selected acupoints was trained using an artificial neural network (ANN). A total of 11 hidden nodes with the highest average precision score were selected through a tenfold cross-validation. Our ANN model could predict the selected acupoints based on symptom and disease information with an average precision score of 0.865 (precision, 0.911; recall, 0.811). This model is a useful tool for diagnostic classification or pattern recognition and for the prediction and modeling of acupuncture treatment based on clinical data obtained in a real-world setting. The relationship between symptoms and selected acupoints could be systematically characterized through knowledge discovery processes, such as pattern identification.

The Association of Quantitative Facial Color Features with Cold Pattern in Traditional East Asian Medicine

Introduction

Facial diagnosis is a major component of the diagnostic method in traditional East Asian medicine. We investigated the association of quantitative facial color features with cold pattern using a fully automated facial color parameterization system.

Methods

The facial color parameters of 64 participants were obtained from digital photographs using an automatic color correction and color parameter calculation system. Cold pattern severity was evaluated using a questionnaire.

Results

The a^⁎ values of the whole face, lower cheek, and chin were negatively associated with cold pattern score (CPS) (whole face: B = -1.048, P = 0.021; lower cheek: B = -0.494, P = 0.007; chin: B = -0.640, P = 0.031), while b^⁎ value of the lower cheek was positively associated with CPS (B = 0.234, P = 0.019). The a^⁎ values of the whole face were significantly correlated with specific cold pattern symptoms including cold abdomen (partial ρ = -0.354, P < 0.01) and cold sensation in the body (partial ρ = -0.255, P < 0.05).

Conclusions

a^⁎ values of the whole face were negatively associated with CPS, indicating that individuals with increased levels of cold pattern had paler faces. These findings suggest that objective facial diagnosis has utility for pattern identification.

Efficacy of Banha-sasim-tang on functional dyspepsia classified as excess pattern: study protocol for a randomized controlled trial

Background

Functional dyspepsia (FD) refers to the presence of one or more gastrointestinal symptoms including postprandial fullness, epigastric pain, burning, and early satiety without an organic explanation for chronic symptoms. FD causes considerable discomfort in patients and affects their everyday activity and productivity. Because most conventional treatments have limited efficacy, numerous patients seek alternatives such as herbal medicines. In this proposed study, we will conduct a clinical trial of an herbal drug, Banha-sasim-tang (BST). Furthermore, participants will be limited to those classified as having an excess pattern by using an instrument of pattern identification for FD to determine the efficacy of BST in a specific subset of patients.

Methods

This randomized, blinded, parallel-group clinical trial of BST versus placebo will consist of 4 weeks of oral administration of BST or placebo and a 4-week follow-up period. The Korean version of the symptom-based questionnaire of the Nepean Dyspepsia Index (NDI-K) will be used as the primary outcome measure. Secondary outcome measures will include the quality-of-life (QoL) evaluation from the NDI-K, the FD-related QoL (FD-QoL) scale, assessment of gastric myoelectrical dysrhythmias (GMA), and a Visual Analog Scale (VAS) analysis.

Discussion

The results of this trial are expected to provide relevant evidence demonstrating that BST can be used as an effective treatment in a specific subset of FD subjects.

Trial registration

KCT 0002013. Registered at Clinical Research Information Service in the Republic of Korea on 18 August 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2282-z) contains supplementary material, which is available to authorized users.

Development of a Novel Questionnaire for the Traditional Chinese Medicine Pattern Diagnosis of Stress

Currently, there is no definitive diagnosis or list of signs and symptoms for "stress" in either modern biomedicine or Chinese medicine (CM). While modern theories on stress relate to the neurological interaction of a stressor or stimuli on the autonomic nervous system, it is generally regarded as subjective in nature and as such each individual will likely present varying somatic or cognitive signs and symptoms. A questionnaire was therefore developed, based on textual research, that incorporated both general as well as gender specific signs and symptom responses to determine the most common CM patterns associated with individuals who report as feeling stressed. For the 45 females who completed the questionnaire, the mean percentage of symptoms per CM pattern showed that the pattern with the highest average percentage was heart qi deficiency (61.88%) followed by liver blood deficiency (60.23%) and then heart blood deficiency (60.12%). For males (n = 16), heart qi deficiency was also the highest scoring CM pattern with a scoring percentage of 54.81%. In males, however, heart blood deficiency was second with 53.29% followed by liver blood deficiency with 51.10%. Of the general non gender-specific symptoms collected (n = 65 symptoms), the symptom most commonly reported by both men and women was "anxious or racing thoughts", followed by "constant worrying" and "inability to concentrate". The CM diagnostic pattern results may prove useful for clinicians as the change in diagnostic understanding will also modify the treatment principle and subsequent treatment with acupuncture or herbal medicine. Future CM research studies should consider including the questionnaire either as a diagnostic aid or as an outcome measure for acupuncture or herbal medicine studies related to stress.

Cold and Spleen-Qi Deficiency Patterns in Korean Medicine Are Associated with Low Resting Metabolic Rate

Background. Korean medicine (KM) patterns such as cold, heat, deficiency, and excess patterns have been associated with alterations of resting metabolic rate (RMR). However, the association of KM patterns with accurately measured body metabolic rate has not been investigated. Methods. Data on cold (CP), heat (HP), spleen-qi deficiency (SQDP), and kidney deficiency (KDP) patterns were extracted by a factor analysis of symptoms experienced by 954 participants. A multiple regression analysis was conducted to determine the association between KM patterns and RMR measured by an indirect calorimeter. Results. The CP and SQDP scores were higher and the HP score was lower in women. The HP and SQDP scores decreased with age, while KDP scores increased with age. A multiple regression analysis revealed that CP and SQDP scores were negatively associated with RMR independently of gender and age, and the CP remained significantly and negatively associated with RMR even after adjustment for fat-free mass. Conclusions. The underlying pathology of CP and SQDP might be associated with the body's metabolic rate. Further studies are needed to investigate the usefulness of RMR measurement in pattern identification and the association of CP and SQDP with metabolic disorders.

Relationship of the Cold-Heat Sensation of the Limbs and Abdomen with Physiological Biomarkers

The present study explored the relationship between the regional Cold-Heat sensation, the key indicator of the Cold-Heat patterns in traditional East Asian medicine (TEAM), and various biomarkers in Korean population. 734 apparently healthy volunteers aged 20 years and older were enrolled. Three scale self-report questions on the general thermal feel in hands, legs, and abdomen were examined. We found that 65% of women tended to perceive their body, particularly their hands and legs, to be cold, versus 25% of men. Energy expenditure and temperature load at resting state were lower in women, independently of body mass index (BMI). Those with warm hands and warm legs had a 0.74 and 0.52 kg/m² higher BMI than those with cold hands and cold legs, respectively, regardless of age, gender, and body weight. Norepinephrine was higher, whereas the dynamic changes in glucose and insulin during an oral glucose tolerance test were lower in those with cold extremities, particularly hands. No consistent differences in biomarkers were found for the abdominal dimension. These results suggest that gender, BMI, the sympathetic nervous system, and glucose metabolism are potential determinants of the Cold-Heat sensation in the hands and legs, but not the abdomen.

[Changes in symptom patterns and health-related quality of life of cancer patients before and after chemotherapy]

OBJECTIVE

Symptom patterns are an important diagnostic concept in terms of Traditional Chinese Medicine. Although symptom patterns and health related quality of life (HRQOL) are common diagnostic measures for cancer patients, the association between them has not been studied. This study aimed to describe the changes in the pattern of symptoms of Yang-deficiency, Yin-deficiency, blood stasis, and HRQOL before and after chemotherapy, and to examine the association between the patterns and the cancer patients' HRQOL.

METHODS

A panel study was undertaken with 123 cancer patients who were about to begin their first course of chemotherapy at four teaching hospitals in Taiwan. A structured questionnaire was used before and after chemotherapy. HRQOL was assessed using the Medical Outcomes Survey Short-Form 36. The Traditional Chinese Medical Constitutional Scale was used to measure Yang-deficiency, Yin-deficiency, and blood stasis patterns, with higher scores indicating a larger deficiency.

RESULTS

The patients had significantly worse scores for Yang-deficient pattern, Yin-deficiency pattern, blood stasis pattern, and the physical components of HRQOL after chemotherapy compared with before chemotherapy. The HRQOL scores correlated significantly with Yang-deficiency, Yin-deficiency, and the blood stasis pattern scores. A generalized estimating equation model showed that the HRQOL scores were significantly worse after chemotherapy compared with before chemotherapy for the physical component, but not for the mental component. Blood stasis pattern was significantly associated with a decreased HRQOL in both the physical and mental components. A hemoglobin level < 12 g/dL was associated with a worse physical component of HRQOL.

CONCLUSION

The Yang-deficiency, Yin-deficiency, and blood stasis patterns were all associated with lower HRQOL in cancer patients after chemotherapy.

Acupuncture for Symptomatic Treatment of Fatigue in Parkinson's Disease: Trial Design and Implementation

Background: Acupuncture use is increasing worldwide for many conditions, including movement disorders. Clinical research in acupuncture has also increased to test anecdotal reports of clinical benefits empirically and investigate potential mechanisms. Method: This article describes considerations for designing a double-blinded, randomized, placebo-controlled clinical trial of acupuncture for fatigue in Parkinson's disease (PD) and describes the current authors' experience in the implementation and early conduct of this trial. Relevant literature is also reviewed to provide guidance for other researchers seeking to perform clinical research relevant to PD and related disorders. Results: Trial design should be driven by a well-defined research question and sufficient detail to meet Standards for Reporting Interventions in Clinical Trials of Acupuncture criteria when a trial is complete. Important items for review include: randomization and blinding; recruitment and participant selection; sham methodology choice; staff training; and practical implementation of study procedures. Sample forms used for the current authors' trial are shared. Conclusions: High-quality clinical trials of acupuncture can provide valuable information for clinicians, patients, and policymakers. Acupuncture trials differ in critical ways from pharmaceutical trials and might require additional considerations regarding design and implementation. Adequate preparation for the unique challenges of acupuncture studies can improve trial implementation, design, efficiency, and impact.

Validation of the qi blood yin yang deficiency questionnaire on chronic fatigue

Background

Chronic fatigue (CF) reflects an imbalance of inter-organ functions or of the four essential physiological components qi, blood (xue), yin, and yang. CF can be subdivided into different patterns. However, there are no diagnostic methods for CF. This study aimed to clinically validate a pattern identification method by identifying correlations between CF and responses to the qi blood yin yang deficiency questionnaire (QBYY-Q).

Methods

Participants were recruited between May and June 2014 through the Kyung Hee University Korean Medicine hospital website and via posters and comprised 129 CF patients diagnosed with the United States Centers for Disease Control and Prevention (1994) criteria. Participants who had organic diseases that explained the CF were excluded. A total of 159 participants were asked to complete the QBYY-Q, the fatigue severity scale, and the Chalder fatigue scale. The latter two questionnaires were used to assess convergent validity with the QBYY-Q. Among the 129 CF participants, 70 and 59 had chronic fatigue syndrome and idiopathic chronic fatigue, respectively. Two Korean medical doctors independently assessed participants’ qi, blood, yin, and yang deficiency patterns using QBYY deficiency pattern identification guidelines. Based on the results of a preliminary study of the QBYY-Q, we selected 32 reliable items for symptoms corresponding to each deficiency pattern. The items were used to estimate internal consistency and construct validity. Multinomial logistic regression analysis was performed for scores on each deficiency pattern.

Results

The data were means and standard deviations or numbers of participants and proportions for continuous and categorical variables, respectively. A statistical significance level of P < 0.05 was assumed. The QBYY-Q showed satisfactory internal consistency. Explanatory factor analysis extracted two factors for each deficiency pattern. The percentages of explained variance for qi, blood, yin, and yang deficiency were 45.1, 58.0, 52.2, and 63.4 %, respectively. Each QBYY-Q deficiency score was positively associated with each corresponding deficiency pattern. Qi deficiency was used as a reference category. Odds ratios of blood, yin, and yang deficiency were 10.97, 10.69, and 14.64, respectively.

Conclusion

The QBYY-Q was suitable for estimating the influences of qi, blood, yin, and yang deficiencies in CF.

Trial registration This trial was registered with the Korean Clinical Trial Register (KCT0001199)

Electronic supplementary material

The online version of this article (doi:10.1186/s13020-016-0092-y) contains supplementary material, which is available to authorized users.

Confirmatory and Exploratory Factor Analysis for Validating the Phlegm Pattern Questionnaire for Healthy Subjects

Background. Phlegm pattern questionnaire (PPQ) was developed to evaluate and diagnose phlegm pattern in Korean Medicine and Traditional Chinese Medicine, but it was based on a dataset from patients who visited the hospital to consult with a clinician regarding their health without any strict exclusion or inclusion. In this study, we reinvestigated the construct validity of PPQ with a new dataset and confirmed the feasibility of applying it to a healthy population. Methods. 286 healthy subjects were finally included and their responses to PPQ were acquired. Confirmatory factor analysis (CFA) was conducted and the model fit was discussed. We extracted a new factor structure by exploratory factor analysis (EFA) and compared the two factor structures. Results. In CFA results, the model fit indices are acceptable (RMSEA = 0.074) or slightly less than the good fit values (CFI = 0.839, TLI = 0.860). Many average variances extracted were smaller than the correlation coefficients of the factors, which shows the somewhat insufficient discriminant validity. Conclusions. Through the results from CFA and EFA, this study shows clinically acceptable model fits and suggests the feasibility of applying PPQ to a healthy population with relatively good construct validity and internal consistency.

Inhibitory effects of Cheongsangbangpoong-tang on both inflammatory acne lesions and facial heat in patients with acne vulgaris: A randomized controlled trial protocol

BACKGROUND

Due to increasing interest from acne patients concerned about the side effects associated with conventional therapies, complementary and alternative medicine (CAM) has been suggested as a new therapeutic modality for acne vulgaris. Herbal medicine is one of these CAM treatments. Cheongsangbangpoong-tang (CBT) is a common herbal formula used in patients with acne vulgaris in the clinical practice of Korean Medicine (KM). However, despite the common use of CBT in clinical practice, the current level of evidence is insufficient to support an inhibitory effect of CBT on inflammatory acne lesions and facial heat. Therefore, this study was designed to assess the inhibitory effect of CBT on both inflammatory acne lesions and facial heat.

METHODS/DESIGN

A randomized, double-blind, parallel-group, and placebo-controlled trial will be conducted. Fifty-six participants with acne vulgaris will be randomized into one of two groups: the CBT or placebo groups. After randomization, participants will be prescribed either CBT or placebo three times a day at a dose of 5 g after meals for 8 weeks. The following outcome measurements will be used in the examination of subjects: the mean percentage change and the count change of the inflammatory and non-inflammatory acne lesions, the temperature of facial points on digital infrared thermal imaging (DITI), serum cortisol, serum dehydroepiandrosterone-sulfate (DHEA-S), visual analogue scale (VAS), investigator global assessment (IGA), and severity score on the Korean Acne Grading System (KAGS) from baseline to the end of the trial.

DISCUSSION

This trial will provide evidence regarding the inhibitory effect of CBT on inflammatory acne lesions and facial heat. The findings of this trial may have important implications for the more widespread use of CBT for the treatment of acne vulgaris.

TRIAL REGISTRATION

The trial is registered with the Clinical Research Information Service (CRiS), Republic of Korea: KCT0001468 .

The correlation of lab data, hormone peptides, quality of life, and different traditional chinese medicine syndrome groups in type 2 diabetes patients

The aim of this study is to explore the correlation of laboratory data, hormone peptides, and quality of life with different traditional Chinese medicine (TCM) syndrome groups in type 2 diabetes patients. Of 513 registered patients, 179 subjects aged between 20 and 65 years and having type 2 diabetes mellitus (T2DM) for more than 1 year were enrolled in the study. All the participants were asked to fill out a questionnaire on diabetic TCM syndrome groups, which was designed by professional TCM doctors, and two questionnaires on the quality of life (QOL), WHOQOL-BREF Taiwan version and Medical Outcomes Study (MOS) Short Form-12 (SF-12). The biochemical characteristics and hormone peptide levels were collected at the same time. The patients in any one of the six TCM syndrome groups had the trend to have worse QOL. Especially, patients with qi deficiency had worse life quality on every aspect compared to those without qi deficiency and were fatter than others. We also found that the subjects who had qi deficiency, qi stagnation, and yin deficiency at the same time had worsened condition. We consider that patients with qi deficiency may also be at a higher risk of developing other complications. They need more advanced health care than others. This self-reported questionnaire will be a reference for health care workers screening those T2DM patients who have a higher possibility of developing other complications. Especially in remote areas, where there is a lack of medical resources, an easy-to-use tool such as the one in the present study for detecting and evaluating disease conditions is needed.

A mathematical model for the deficiency-excess mechanism of yin-yang in five viscera

To raise traditional medicine to a higher level of scientific research, a mathematical model has been proposed using symbolic notations and operators to describe several disease symptoms generally recognized in traditional medicine. Even though this model to a certain degree offers a mathematical approach to identify the relationships between yin-yang and the five viscera, it is not an efficient means of explaining the pathology in traditional medicine due to its use of superfluous notations and definitions. In this paper, we introduce two concise operators, a self-development operator and an action operator: the former describes the effect of a viscus in the unbalanced state on other viscera: the latter explains the engendering and restraining relationships between the two viscera. These tools are useful to elucidate the interactions among the states of the five viscera based on yin-yang and the five elements theory. Our mathematical model with these two operators facilitates description for the scheme of deficiency-excess of yin-yang in the five viscera. Accordingly, we have mathematically refined the existing results and shown clinical applications as well.

Relationships between Pathological Patterns and Quality of Life: Pathway Analysis

Purpose. The purpose of our study was to examine the relationships between pathological patterns and self-rated quality of life (QoL). Methods. A total of 426 Korean subjects participated in this study (male : female = 154 : 272). The subjects were asked to complete Yin Deficiency (YD), Qi Deficiency (QD), Food Stagnation (FS), Blood Stasis (BS), Phlegm, and Seven Emotions Impairment (SEI) pattern Questionnaires and the General Health Questionnaire (GHQ). We formed a pathway model consisting of pathological patterns and QoL questionnaire scores and examined which pathological patterns resulted in decreased QoL using path analysis. Results. Our pathway model had satisfactory fitness levels (GFI = 0.975, NFI = 0.984, and CFI = 0.984) and showed that Phlegm and SEI patterns directly resulted in decreased QoL, whereas QD, YD, FD, and BS indirectly resulted in decreased QoL. The pathway model suggested that the severity or stage of decreased QoL may be estimated by pathological patterns: QD and YD patterns are associated with the early stage; FS and BS patterns are associated with the middle stage; Phlegm and SEI are associated with the later stage of decreased QoL. Conclusion. Our results suggest that pathological patterns directly or indirectly affect decreases in QoL.

A current update on the rule of alternative and complementary medicine in the treatment of liver diseases

There is a vast body of knowledge which is ever-increasing about the treatment of liver disease with alternative and complementary medicine for which hundreds of thousands of literatures have been documented. Liver disease is a general term. This term covers all the potential problems that cause the liver to fail to perform its specified operations. Liver disease has a variety of presentations and causes a great public health problem worldwide which threatens the wellness of billions of people. Incidences of many types of liver disease are currently rising. Although there is still a debate about the entity of alternative and complementary medicine, it is now widely used and it is improving. And it covers the shortages and compensates for the weaknesses of conventional methods in the treatment of liver diseases. Alternative and complementary medicine for liver diseases provides benefits by regulating immunity, controlling disease progression, improving quality of life, and prolonging survival. This paper reviews the increasing interest and growing research into alternative and complementary medicine for liver diseases, with a look at the rough classification, principle of management, evidence-based applications, and issues for prescription and perspectives.

Development of a valid and reliable blood stasis questionnaire and its relationship to heart rate variability

OBJECTIVES

The present study was conducted to develop a valid and reliable Blood stasis questionnaire (BSQ), to define its optimum cut-off score, and to examine whether the BSQ score affected cardiovascular autonomic function.

METHODS

Three hundred and thirty-eight outpatients (group A) and 61 inpatients (group B) were asked to complete the BSQ. In addition to the BSQ, heart rate variability parameters were recorded for group A. We estimated the internal consistency and construct validity for the BSQ data from group A. Three clinicians determined whether 61 inpatients (group B) exhibited blood stasis (BS), and we defined the optimum cut-off point for the BSQ using the clinicians' diagnoses and BSQ scores for group B. Finally, the differences in the HRV parameters between the BS and non-BS groups (group A) were examined.

RESULTS

The 12-item BSQ exhibited a satisfactory internal consistency (α=0.813). In the test of construct validity, a total of three factors (pain-lump, dark blue signs, and trauma) were extracted (total percentage of variance=54.8%). ROC curve analyses showed that the BSQ had a high discriminative ability for BS (AUC=0.948, 95% confidence interval 0.895-1.001). The optimum cut-off score for the BSQ was defined as three points. SDNN, TP, LF, and HF were lower in the BS group than in the non-BS group, indicating that the BS pattern partially caused a decrease in sympathetic and parasympathetic activities.

CONCLUSIONS

Our results suggest that the BSQ is a valid and reliable instrument for evaluating BS and BS may partially cause a decrease in cardiovascular autonomic function.

Xiaoxuming decoction for acute ischemic stroke: a systematic review and meta-analysis

ETHNOPHARMACOLOGICAL RELEVANCE

Xiaoxuming decoction (XXMD) is a well-known traditional Chinese herbal prescription in treatment of patients with stroke. The objective of this study is to assess the efficacy and safety of XXMD for acute ischemic stroke.

MATERIALS AND METHODS

A systematic literature search was conducted in 6 databases until June 2012 to identify randomized controlled trials (RCTs) of XXMD for acute ischemic stroke compared with western conventional medicine (WCM). The primary outcome measures were National Institutes of Health Stroke Scale (NIHSS) scores and modified Rankin Scale (mRS) scores. The secondary outcome measures were the clinical effective rate and adverse events at the end of treatment course. The methodological quality of RCTs was assessed independently using 12-item criteria according to the Cochrane Back Review Group. All data were analyzed using Review Manager 5.0 software.

RESULTS

Eight RCTs with 601 individuals published from 1992 to 2012 were identified. The studies were deemed to have a high risk of bias. Compared with WCM, 1 RCT showed significant effects of XXMD for improving mRS after stroke (p<0.05); 3 RCTs for improving NIHSS scores [n=186, weighted mean difference (WMD): -1.86, 95% CI: -3.25 to -0.48, z=2.63, p<0.01]; 7 RCTs for improving the clinical effective rate [n=531, risk ratio (RR)=1.17, 95% CI, 1.09 to 1.26, z=4.38, p<0.01]. Five trials contained safety assessments and stated that no adverse event was found, whereas the other 3 trials did not provide the information about adverse events.

CONCLUSIONS

This systematic review showed positive but weak evidence of XXMD for acute ischemic stroke because of the poor methodological quality and the small quantity of the included trials. The difficulties of fitting Chinese herbal medicine (CHM) into the double blinded RCTs have raised as follows: (A) traditional Chinese medicine (TCM) as whole systems of healthcare offers unique methodological and theoretical challenges for RCTs; (B) suspicions against the placebo and unwillingness to stop taking other CHMs make recruitment more difficulty, time-consumption, and cost; (C) the shortcomings of the TCM diagnostic process includes the lack of standardization in terminology, disagreement of pattern differentiation (Bianzheng), and neglect of formula corresponding to syndrome (TCM Zheng); (D) It is difficult to design credible herbal placebos with similar appearance, smells and tastes to the experimental CHM and at the same time is absent of any pharmacological activity; (E) the achieving efficacy of CHM complex interventions is often nonspecific and the outcome measures is subjective using Chinese quantitative instrument.

Increases in Xu Zheng and Yu Zheng among Patients with Breast Cancer Receiving Different Anticancer Drug Therapies

Aim. The objectives of this study were to compare yang-xu, yin-xu, and yu among patients with breast cancer right before, one month after, and three months after receiving target, chemo, or combined therapy. Method. After recruiting 126 patients from 4 hospitals in northern Taiwan, a longitudinal study was carried out with 61 patients receiving chemotherapy, 30 receiving target therapy, and 35 receiving combined therapy. Yang-xu, yin-xu, and yu were assessed using the Traditional Chinese Medical Constitutional Scale (TCMCS), with higher scores indicating more xu and yu. Results. There were significant increases in yang-xu, yin-xu, and yu at 1 month and 3 months after than before the start of the chemotherapy, target, or combined therapy. Patients receiving combined therapy had significantly higher scores in yang-xu and yin-xu than patients receiving chemo or target therapy. A history of coronary heart disease was associated with more yin-xu. Those patients who had undergone a mastectomy were associated with less yu zheng than those patients who had not. Conclusion and Implications. TCM doctors should focus their treatment on dealing with xu and yu in order to support their patients, as they complete their modern anticancer treatments.

Syndrome pattern and its application in parallel randomized controlled trials

Syndrome pattern (SP) is a core concept of Chinese medicine (CM) and is used to diagnose and treat patients based on an overall analysis of symptoms and signs. This study aimed to systematically review randomized controlled trials (RCTs) using the SP concept and to demonstrate how the SP concept could be applied to the study design of parallel RCTs, considering a gold standard of clinical research. After conducting a brief systematic review by way of a PubMed search, we analyzed how the SP concept was applied to the design of RCT in a CM herbal medicine trial. We then formulated possible research questions, applied the SP concept to answer the research questions, and suggested possible RCT designs to be used for conducting future trials. Fourteen RCTs were included in our systematic review, and three key points of the SP concept were formulated for the design of parallel RCTs: the time point of SP diagnosis between before and after randomization; the relationship between the international classification of diseases (ICD) and SP for the inclusion of target population; and the proper diagnostic method of SP. In this study, we formulated three possible research questions and then suggested perspectives for five possible RCT models arrived at using SP concepts. Future trials applying SP concept to RCTs should overcome the shortcomings of past SP trials, moving CM forward from experience-based to evidence-based medicine.

The effect of TJ-15 plus TJ-17 on atopic dermatitis: a pilot study based on the principle of pattern identification

AIM

Hwang-Yeon-Hae-Dok-San (TJ-15) and Ou-Ryung-San (TJ-17) are two common herbal formulas that have been used to treat atopic dermatitis (AD), especially the Dampness-Heat pattern of AD. The aim of this study was to determine the safety and efficacy of TJ-15 plus TJ-17 for patients with the Dampness-Heat pattern of AD based on pattern identification.

METHODS

This study was a parallel, randomized, active-controlled, double-blind trial. A total of 24 patients were enrolled. Either a combination of TJ-15 plus TJ-17, or TJ-15 alone was orally administered 3 times daily for 4 weeks. Of the patients enrolled, 19 patients completed the 4-week treatment course (TJ-15 plus TJ-17: n=8, TJ-15: n=11). Efficacy was assessed using the scoring atopic dermatitis (SCORAD) index; area of eczema and severity index (EASI); as well as the symptoms related to the Dampness-Heat by pattern identification. Efficacy measures were evaluated at the baseline and at 4 weeks. Safety was assessed throughout the study using ongoing laboratory tests.

RESULTS

Both the SCORAD and EASI showed more improvement in the TJ-15 plus TJ-17 group than in the TJ-15 group; however, the differences were not statistically significant. The symptoms related to the Dampness-Heat pattern were reduced in both groups, and the changes were similar. There were no reported adverse events during this study, or abnormalities observed on aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, and creatinine testing.

CONCLUSIONS

The results of this study suggest that both the TJ-15 plus TJ-17 and the TJ-15 provided safe and effective treatment for patients with the Dampness-Heat pattern type of AD.

Development and validation of the Yin deficiency scale

OBJECTIVES

Yin Deficiency (YD) is a pathophysiologic pattern that manifests with emaciation, dry mouth, tidal fever, Five Center Heat, night sweats, and malar flushing. The purpose of the present study was to develop and validate a new YD metric, the Yin Deficiency Scale (YDS), to define an optimum cutoff point for the YDS, and to examine the relationships between YD and Cold-Heat patterns.

METHODS

A total of 169 outpatients and 83 college students were asked to complete the YDS. The college students were also asked to complete the Yin Deficiency Questionnaire (YDQ) and Cold-Heat Questionnaire (CHQ). Twelve clinicians determined whether or not the 169 outpatients had YD. YDS and YDQ data were used to estimate the internal consistency, construct validity, and concurrent validity of the YDS. CHQ data were used to examine the relationships between YDS and CHQ subscale scores. Total YDS scores and the clinicians' diagnoses of the outpatients were used to define an optimum cutoff score for the YDS.

RESULTS

The 27-item YDS had satisfactory internal consistency (α=0.885) and concurrent validity, with correlations between the YDS and YDQ subscale scores. A total of eight factors were extracted in the test of construct validity, using principal component analysis, and the overall variance explained by all factors was 63.1%. Among the eight factors, cough, fever, and skin-related factors were associated only with Heat pattern, whereas pain, urine, and fatigue-related factors were associated with both Cold and Heat patterns. In the receiver operating characteristic curve analysis, the sensitivity, specificity, and area under the curve of the YDS were 73.7%, 84.8%, and 0.875, respectively. The optimum cutoff score was defined as 10 points.

CONCLUSIONS

The results of this study suggest that the YDS is a reliable and valid instrument for evaluating YD.

Construction of a traditional Chinese medicine syndrome-specific outcome measure: the Kidney Deficiency Syndrome Questionnaire (KDSQ)

Background

Development of Traditional Chinese Medicine (TCM) syndrome-specific outcome measures is needed for the evaluation of TCM syndrome-specific therapies. We constructed a Kidney Deficiency Syndrome Questionnaire (KDSQ) for the evaluation of the common TCM syndromes Kidney-Yin Deficiency Syndrome (KDS-Yin) and Kidney-Yang Deficiency Syndrome (KDS-Yang) in middle-aged women with menopausal symptoms.

Methods

KDS-Yin and KDS-Yang were traditionally defined by expert opinion were validated by exploratory factor analysis (EFA) and structural equation modeling (SEM). Content validity was tested by EFA on a sample of 236 women from a seminar and SEM on another sample of 321 women from a postal survey. Other psychometric properties were tested on 292 women from the seminar at baseline and two systematically selected sub-samples: 54 who reported no changes in discomforts 11–12 days after the baseline and 31 who reported changes in discomforts 67–74 days after the baseline. All participants completed the KDSQ, the Greene Climacteric Scale and the standard 12-item Short Form Health Survey.

Results

The EFA and SEM established the measurement models of KDS-Yin and KDS-Yang supporting content validity of the KDSQ. Internal consistency was good (Cronbach’s Alpha >0.70). Construct validity was supported by theoretically-derived levels of correlation with the established external measures. Test–retest reliability was strong (ICC_agreement: KDS-Yin, 0.94; KDS-Yang, 0.93). The KDSQ was responsive to changes over time as tested by effect size and longitudinal validity.

Conclusions

The KDSQ was a valid and reliable measure for KDS-Yin and KDS-Yang in Hong Kong Chinese middle-aged women with menopausal symptoms.

An integrative approach of linking traditional Chinese medicine pattern classification and biomedicine diagnosis

Traditional Chinese medicine (TCM) is a medical system with over 3000 years of continuous practice experience and refinement through treatment observations. The TCM pattern classification (also defined as Syndrome or Zheng differentiation) and treatment of ill health is the basis and the key concept of the TCM theory. All diagnostic and therapeutic methods in TCM are based on the differentiation of TCM pattern. TCM pattern can be considered as the TCM theoretical interpretation of the symptom profiles. Pattern classification is often used as a guideline in disease classification in TCM practice and has been recently incorporated with biomedical diagnosis, resulting in the increasing research interest of TCM pattern among various disciplines of integrative medicine. This paper describes the historical evolution on the integration of the TCM pattern classification and disease diagnosis in biomedicine, the methodology of pattern classification for diseases, efficacy of TCM practice with integration of TCM pattern classification and biomedical disease diagnosis, and the biological basis of TCM pattern. TCM pattern classification, which may lead to new findings in biological sciences, was also discussed.

An innovative method to accommodate Chinese medicine pattern diagnosis within the framework of evidence-based medical research

Pattern diagnosis is an integral aspect of Chinese medicine (CM). CM differentiates biomedical diseases into patterns, based upon the patient's symptoms and signs. Pattern identification (PI) is used to diagnose, direct the treatment principle and determine the treatment protocol. Most CM research has used fixed formula treatments for Western-defined diseases with outcomes measured using objective biomedical markers. This article presents an innovative method used in a randomised controlled pilot study using acupuncture for participants with hepatitis C virus. Each participant's CM patterns were identified and quantified at baseline which directed the treatment protocol for the treatment group. Data identified that while each participant expressed different patterns at baseline all participants displayed multiple patterns. Six patterns showed some expression by all 16 participants; Liver (Gan) yin vacuity expressing a group aggregate mean percentage of 47.2, binding depression of Liver qi 46.9, and Liver Kidney (Shen) yin vacuity 45.1. Further sub category gender grouping revealed that pattern ranking changed with gender; Liver yin vacuity (male 53.4%, female 51.93%), binding depression of Liver qi (male 50.0%, female 42.86%) and Liver Kidney yin vacuity (male 42.9%, female 47.96%). The quantification of CM patterns described in this article permitted statistical evaluation of presenting CM patterns. Although this methodology is in its infancy it may have potential use in the integration of PI with rigorous evidence based clinical research. Biomedical markers often do not relate to symptom/signs and therefore this innovative measure may offer an additional CM evaluation methodology and further CM PI understanding.

Hemadsorption and fusion inhibition activities of hemagglutinin analyzed by vaccinia virus mutants

Vaccinia virus IHD-J strain induces hemagglutinin (HA) on the surface membrane of infected cells and does not elicit cell-cell fusion (F-). We isolated 21 independent hemadsorption-negative (HAD-) mutant viruses from IHD-J and five HAD+ revertants from one of these mutants. Of the 21 mutants, 19 that synthesized either no or little HA at the cell surface caused cell-cell fusion (F+), whereas none of the five revertants that synthesized HA at the cell surface induced cell-cell fusion. Furthermore, anti-HA monoclonal antibody B2D10 induced extensive polykaryocytosis of IHD-J-infected cells and suppressed the ability of the IHD-J-infected cell extract to inhibit the polykaryocytosis induced by IHD-W. The other 2 of the 21 HAD- mutants, B1 and A2, which induced HAs at the cell surface, showed F- and F+ phenotype, respectively. The HA molecule of mutant B1 had a single amino acid substitution of Lys for Glu-121 in its extracellular domain, whereas that of mutant A2 had a single substitution mutation of Tyr for Cys-103. We conclude that the vaccinia HA is a fusion inhibition protein, that the active sites for the two activities reside separately in its extracellular domain, and that cysteine-103 is important in forming the proper tertiary structure of the protein to exert both activities.