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Chen L, Zhang Q, Huang Z, Da W, Liu S, Xue C, Ding C, Chen D, Fan T, Shi Q, Li X. Efficacy of Combining Traditional Chinese Manual Therapy (Tuina) and Specific Therapeutic Neck Exercise in Young Adults with Non-Specific Chronic Neck Pain: Study Protocol for a Randomized Controlled Trial. J Pain Res 2023; 16:3119-3131. [PMID: 37724170 PMCID: PMC10505386 DOI: 10.2147/jpr.s424812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
Purpose Non-specific chronic neck pain (NSCNP) is an increasingly common musculoskeletal disease and an important issue in the global healthcare system. Some studies have shown that the combination of manual therapy and exercise is effective in treating NSCNP but still with several limitations. Traditional Chinese manual therapy (tuina) is a Chinese manual therapy that consists of soft tissue manipulation and spinal manipulation. This study aims to design a randomized controlled trial to assess the effect of a tuina combined with specific therapeutic neck exercise modified protocol for NSCNP patients. Patients and Methods This is a study protocol for a randomized, participant-, assessor- and analyst-blinded controlled trial. Eighty-eight eligible NSCNP patients will be randomly allocated into tuina combined with specific therapeutic neck exercise group (TSTE group) and tuina combined with sham therapeutic neck exercise group (TS group) in a ratio of 1:1. All participants will receive 8 treatment sessions applied in 4 weeks and then be followed up for another 12 weeks. Clinical data will be collected at baseline, during treatment phase (at the 2- and 4-week) and at the 8-, 12-, 16-week follow-ups. The primary outcome is the changes in neck pain intensity (visual analogue scale). The secondary outcomes include neck disability (Neck Disability Index), cervical range of motion (ROM), neck muscle endurance, cervical muscle cross-sectional area, cervical curvature and analgesic consumption. Adverse events will be collected and recorded throughout the study. Conclusion We will discuss whether our tuina combined with specific therapeutic neck exercise modified protocol is more effective at improving pericervical muscle endurance, ROM, cervical muscle cross-sectional area and cervical curvature than tuina alone, thereby decreases neck pain and disability in individuals with NSCNP more effectively. Trial Registration Chinese Clinical Trials Registry, ChiCTR2300067903. Registered on 31 January 2023.
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Affiliation(s)
- Lin Chen
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Qi Zhang
- Department of Traditional Chinese Medicine, Xuhui District Tianping Street Community Health Center, Shanghai, People’s Republic of China
| | - Zheng Huang
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Weiwei Da
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Shuang Liu
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Chunchun Xue
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Chao Ding
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Deta Chen
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Tianyou Fan
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Qi Shi
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Xiaofeng Li
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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HUANG H, WANG B, CHEN S, FANG J, WANG X, CHEN L, JIANG Y, ZHANG H, CHEN J, LIN Z. Chinese Tuina remodels the synaptic structure in neuropathic pain rats by downregulating the expression of N-methyl D-aspartate receptor subtype 2B and postsynaptic density protein-95 in the spinal cord dorsal horn. J TRADIT CHIN MED 2023; 43:715-724. [PMID: 37454256 PMCID: PMC10626369 DOI: 10.19852/j.cnki.jtcm.20221214.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/08/2022] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To investigate whether the Chinese massage system, Tuina, exerts analgesic effects in a rat model of chronic constriction injury (CCI) by remodeling the synaptic structure in the spinal cord dorsal horn (SCDH). METHODS Sixty-nine male Sprague-Dawley rats were randomly and evenly divided into the normal group, sham group, CCI group, CCI + Tuina group, CCI + MK-801 [an -methyl D-aspartate receptor subtype 2B (NR2B) antagonist] group, and CCI + MK-801 + Tuina group. The neuropathic pain model was established using CCI with right sciatic nerve ligation. Tuina was administered 4 d after CCI surgery, using pressing manipulation for 10 min, once daily. Motor function was observed with the inclined plate test, and pain behaviors were observed by the Von Frey test and acetone spray test. At 19 d after surgery, the L3-L5 spinal cord segments were removed. Glutamate, interleukin 1β (IL-1β), and tumor necrosis factor-α (TNF-α) levels were detected by enzyme-linked immunosorbent assay. The protein expression levels of NR2B and postsynaptic density protein-95 (PSD-95) were detected by Western blot, and the synaptic structure was observed by transmission electron microscopy (TEM). RESULTS CCI reduced motor function and caused mechanical and cold allodynia in rats, increased glutamate concentration and TNF-α and IL-1β levels, and increased expression of synapse-related proteins NR2B and PSD-95 in the SCDH. TEM revealed that the synaptic structure of SCDH neurons was altered. Most of these disease-induced changes were reversed by Tuina and intrathecal injection of MK-801 ( < 0.05 or < 0.01). For the majority of experiments, no significant differences were found between the CCI + MK-801 and CCI + MK-801 + Tuina groups. CONCLUSIONS Chinese Tuina can alleviate pain by remodeling the synaptic structure, and NR2B and PSD-95 receptors in the SCDH may be among its targets.
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Affiliation(s)
- Hongye HUANG
- 1 College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Bingqian WANG
- 4 Peking University International Hospital, Beijing 102206, China
| | - Shuijin CHEN
- 2 Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital, Fuzhou 350003, China
- 3 Fujian Provincial Key Laboratory of Rehabilitation Technology, Fuzhou 350003, China
| | - Jiayu FANG
- 1 College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Xiaohua WANG
- 1 College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Lechun CHEN
- 2 Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital, Fuzhou 350003, China
- 3 Fujian Provincial Key Laboratory of Rehabilitation Technology, Fuzhou 350003, China
| | - Yu JIANG
- 2 Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital, Fuzhou 350003, China
- 3 Fujian Provincial Key Laboratory of Rehabilitation Technology, Fuzhou 350003, China
| | - Huanzhen ZHANG
- 2 Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital, Fuzhou 350003, China
- 3 Fujian Provincial Key Laboratory of Rehabilitation Technology, Fuzhou 350003, China
| | - Jincheng CHEN
- 2 Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital, Fuzhou 350003, China
- 3 Fujian Provincial Key Laboratory of Rehabilitation Technology, Fuzhou 350003, China
| | - Zhigang LIN
- 2 Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital, Fuzhou 350003, China
- 3 Fujian Provincial Key Laboratory of Rehabilitation Technology, Fuzhou 350003, China
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Wu W, Xie J, Liu T, Chen J, Li S, Xu G. Analysis of biomechanical characterization of the thumb rubbing method. Technol Health Care 2023; 31:505-513. [PMID: 37066946 DOI: 10.3233/thc-236044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Thumb rubbing is one of the widely accepted massage techniques, owing to its simple and effective operation. Exploring the biomechanical characteristics of the thumb rubbing method can assist the understanding of the operating characteristics of manipulation, thereby improvising the therapeutic role of manipulation. OBJECTIVE To study the kinematic and kinetic characteristics of the thumb kneading method from the biomechanical point of view, and to quantitatively analyze the key points of thumb kneading operation. METHODS We explored the biomechanical characteristics of the thumb kneading operation by an analysis of the parameters scored by the experts and students using the "thumb kneading data glove and data collection system". RESULTS (1) Force trajectory: The expert group showed a regular force trajectory compared to the student group, with a stable thumb suction position, small drift and concentrated force. (2) Force value: The average force value of the expert group was concentrated in the range 0.614 ± 0.041 kg, while the average force value of the student group was concentrated in the range 0.650 ± 0.146 kg and the difference was not statistically significant. (3) Frequency: The frequency of the expert group was mainly concentrated in the range 134.280 ± 39.106 times/min, while that of the student group was 66.04 ± 23.651 times/min, (P< 0.05). (4) Period: The operation cycle during the thumb kneading of the expert and student groups was mainly concentrated in the range of 0.476 ± 0.117 s and (0.990 ± 0.259) s, respectively, and the difference was statistically significant (P< 0.05). CONCLUSION The present study revealed that the technical operation of the expert group was more stable and standardized than that of the student group. It was found that the force value was inversely proportional to the frequency of the operation. In the "circular rotation" operation of the thumb rubbing method, the force value conversion degree of different parts of the thumb reflected the motion trajectory. Furthermore, the "circular rotation" operation performed by the expert group was better than the student group. The study of the parameters, including the angle of frequency, period and force value can reflect the biomechanical characteristics of thumb rubbing method to a significant extent.
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Affiliation(s)
- Wenjie Wu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Juncheng Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tangyi Liu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Chen
- Xiangya Boai Renabilitation Hospital, Changsha, Hunan, China
| | - Shaoxiong Li
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gang Xu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Cheng ZJ, Zhang SP, Gu YJ, Chen ZY, Xie FF, Guan C, Fang M, Yao F. Effectiveness of Tuina Therapy Combined With Yijinjing Exercise in the Treatment of Nonspecific Chronic Neck Pain: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2246538. [PMID: 36512354 PMCID: PMC9856335 DOI: 10.1001/jamanetworkopen.2022.46538] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Both tuina therapy and yijinjing exercise were beneficial to patients with nonspecific chronic neck pain, but the evidence for this combination is limited. OBJECTIVE To investigate the effectiveness of tuina therapy combined with yijinjing exercise compared with tuina therapy alone for patients with nonspecific chronic neck pain. DESIGN, SETTING, AND PARTICIPANTS A 12-week, open-label, analyst-blinded randomized clinical trial (8-week intervention plus 4-week observational follow-up) was conducted from September 7, 2020, to October 25, 2021. A total of 102 participants with nonspecific chronic neck pain were recruited, and data were analyzed from December 10, 2021, to March 26, 2022. INTERVENTIONS Participants in the tuina group or tuina combined with yijinjing group received 3 sessions of tuina therapy per week for 8 weeks, for a total of 24 sessions. Participants in the tuina combined with yijinjing group practiced yijinjing 3 times a week for 8 weeks, including an instructor-guided exercise at the hospital and 2 self-practice exercises at home. MAIN OUTCOMES AND MEASURES The primary outcome was change in visual analog scale (VAS) score from baseline to week 8. Secondary outcomes included Neck Disability Index scores, Self-rating Anxiety Scale scores, tissue hardness, and active range of motion. RESULTS This randomized clinical trial recruited 102 patients (mean [SD] age, 36.5 [4.9] years; 69 [67.6%] female) who were randomized to 2 groups. All 102 patients (100%) completed all the outcome measurements. The mean difference in VAS scores from baseline at week 8 for the tuina combined with yijinjing group was -5.4 (95% CI, -5.8 to -5.1). At week 8, the difference in VAS score was -1.2 (95% CI, -1.6 to -0.8; P < .001) between the tuina group and the tuina combined with yijinjing group. The effectiveness of tuina combined with yijinjing in treating nonspecific chronic neck pain remained at the 12-week follow-up. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, for patients with nonspecific chronic neck pain, tuina combined with yijinjing was more effective than tuina therapy alone in terms of pain, functional recovery, and anxiety at week 8, and effectiveness remained at week 12. A combination of tuina and yijinjing should be considered in the management of nonspecific chronic neck pain. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2000036805.
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Affiliation(s)
- Zi-ji Cheng
- Tuina Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuai-pan Zhang
- Tuina Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuan-jia Gu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zi-ying Chen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fang-fang Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chong Guan
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Fang
- Tuina Department, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fei Yao
- Tuina Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Liu Z, Qin X, Sun K, Yin H, Chen X, Yang B, Wang X, Wei X, Zhu L. Manipulation for degenerative lumbar spondylolisthesis: A systematic review of randomized controlled trials. JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2022. [DOI: 10.1016/j.jtcms.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Cheng Z, Chen Z, Xie F, Guan C, Gu Y, Wang R, You Y, Yao F. Efficacy of Yijinjing combined with Tuina for patients with non-specific chronic neck pain: study protocol for a randomized controlled trial. Trials 2021; 22:586. [PMID: 34479613 PMCID: PMC8414714 DOI: 10.1186/s13063-021-05557-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-specific chronic neck pain (NCNP) is a common musculoskeletal disorder which has caused a huge economic burden due to its expensive health costs and high re-occurrence rate. Yijinjing and Tuina are widely used for non-specific chronic neck pain in China. But there is little scientific evidence to evaluate their efficacy for NCNP. The aim of this research is to compare the efficacy of Yijinjng combined with Tuina versus Tuina for patients with NCNP. METHODS/DESIGN A randomized controlled trial in which 102 patients with non-specific chronic neck pain will be recruited and randomly allocated to either the Tuina group or the Yijinjng combined with Tuina group in a 1:1 ratio. The interventions for both groups will be carried out three times a week for 8 weeks. The patients in the two groups will receive follow-up 1 month after the intervention. The primary outcome will be the changes in the visual analog scale (VAS). Secondary outcomes will be measured by the Neck Disability Index (NDI), Self-Rating Anxiety Scale (SAS), and Tissue Hardness and Active Range of Motion (AROM). The data will be analyzed at the baseline, 4 weeks during the intervention, at the end of the intervention, and 1 month after the intervention. The significance level sets as 5%. The safety of interventions will be evaluated after each treatment session. DISCUSSION The purpose of this trial is to determine whether Yijinjing combined with Tuina is not inferior to Tuina for patients with NCNP. This study will provide clinicians and stakeholders much-needed knowledge for a complementary and alternative therapy for patients with non-specific chronic neck pain. TRIAL REGISTRATION ChiCTR registry (ChiCTR) 2000036805 . Registered on August 25, 2020.
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Affiliation(s)
- Ziji Cheng
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ziying Chen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fangfang Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chong Guan
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuanjia Gu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ruiping Wang
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
| | - Yanli You
- Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Fei Yao
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Niu K, Li Y, Guan H, Zhang S, Yang F, Zhang G, Zhao L, Yuan Y, Zhang H. Optimization of traditional Chinese medicine rolling manipulation and pressure attenuation. Am J Transl Res 2021; 13:7654-7666. [PMID: 34377242 PMCID: PMC8340264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Traditional Chinese Medicine (TCM) massage utilizes mechanical force stimulation, and the amount of mechanical force influences therapeutic outcome. This amount is determined by pressure, frequency, and duration; however, there are no standard definitions for these measures. METHODS An orthogonal design was used to evaluate massage efficacy using muscle tension as an index. Pressure (2, 4, 6 kg), duration (5, 10, 15 min), frequency (60, 120, 180 repetitions/min), pain (mild, medium, severe), weight (<60, 60-75, >75 kg), and sex (male, female) were evaluated. Additionally, a porcine model of muscle tension was used to construct pressure-time curves for muscle tissues under static and dynamic pressure. RESULTS We identified an interaction among the six massage measures (P<0.05). Of these measures, only two were individually significant: manipulation frequency and patient pain level (P<0.05). Specifically, 120 repetitions/min improved muscle tension significantly more than 60 or 180 repetitions/min (P<0.05), and patients with severe pain had significantly improved muscle tension compared to those with medium or mild pain (P<0.05). In the porcine muscle model, both static and dynamic pressure were attenuated by approximately 12.5% per cm. This attenuation dropped to 10% per cm when the pressure sensor was placed below tissues with different thicknesses instead of being inserted into tissues at different levels. CONCLUSION Manipulation frequency and patient pain level were primarily responsible for the therapeutic effects of TCM massage. Mechanistically, pressure was attenuated by nearly 75% at a depth of 2 cm from the muscle surface during TCM massage.
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Affiliation(s)
- Kun Niu
- College of Traditional Chinese Medicine, Hainan Medical UniversityHainan 571199, China
| | - Yafang Li
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghai 200437, China
| | - Huazong Guan
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghai 200437, China
| | - Shuyu Zhang
- School of Traditional Chinese Medicine, Beijing University of Traditional Chinese MedicineBeijing 100029, China
| | - Fan Yang
- College of Traditional Chinese Medicine, Hainan Medical UniversityHainan 571199, China
| | - Guohui Zhang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghai 200437, China
| | - Lijuan Zhao
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghai 200437, China
| | - Yuan Yuan
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghai 200437, China
| | - Hong Zhang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghai 200437, China
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