[Potential of using pattern diagnosis of traditional Chinese medicine to improve the clinical use of antihypertensive agents]

Trends in the treatment of hypertension from the perspective of traditional chinese medicine

Hypertension is a major public-health issue. Much consensus has been reached in the treatment, and considerable progress has been made in the field of antihypertensive drugs. However, the standard-reaching rate of blood pressure is far from satisfaction. Considering these data and the seriousness of the effects of hypertension on the individual and society as a whole, both economically and socially, physicians must look for more effective and alternative ways to achieve the target blood pressure. Could treatment of hypertension be improved by insights from traditional Chinese medicine? As one of the most important parts in complementary and alternative therapies, TCM is regularly advocated for lowering elevated blood pressure. Due to the different understanding of the pathogenesis of hypertension between ancient and modern times, new understanding and treatment of hypertension need to be reexplored. Aiming to improve the efficacy of Chinese herbal medicine in treating hypertension, the basis of treatment is explored through systematically analyzing the literature available in both English and Chinese search engines. This paper systematically reviews the trends in emerging therapeutic strategies for hypertension from the perspective of traditional Chinese medicine.

BCQ-: A Body Constitution Questionnaire to assess Yin-Xu. Part II: evaluation of reliability and validity

BACKGROUND

Based on the Traditional Chinese Medicine (TCM) theory and guided by the principles of modern medicine (MM), we aimed to develop an effective and reliable diagnostic tool using self-reported data in order to assess the Yin-Xu body constitution. In this study, we further evaluated a provisional 22-item version of the Yin-Xu Body Constitution Questionnaire (BCQ-) previously derived from the Delphi process.

METHODS

A total of 1,272 eligible participants aged between 20 and 60 years was recruited. The participants had received health examination in teaching hospitals and had not shown any disease onset in the prior month. The factor structure of the BCQ- was explored, and the reliability and validity of each derived factor (scale) were evaluated.

RESULTS

Exploratory factor analysis revealed 5 factors corresponding to the manifestations of the diminishing Yin-Xu level in 5 different body areas: head, 4 limbs, gastrointestinal tract, body surface, and abdominal cavity. 3 items with low factor loading (<0.4) were dropped, resulting in a 19-item BCQ-. Cronbach's α ranged from 0.57 to 0.85, and the intra-class correlation coefficients were greater than 0.7 for most items. The diagnoses of Yin-Xu by both the BCQ- and experienced TCM doctors were consistent. The concurrent validity showed that higher Yin-Xu scores were associated with lower hemoglobin.

CONCLUSIONS

The final BCQ- measures the Yin-Xu constitution of 5 different body areas. The questionnaire is a reliable, valid, and potentially useful instrument for evaluating the Yin-Xu constitution in clinical research and practice.

Urine metabolomics combined with the personalized diagnosis guided by Chinese medicine reveals subtypes of pre-diabetes

The prevalence of type 2 diabetes continuously increases globally. A personalized strategy applied in the pre-diabetic stage is vital for diabetic prevention and management. The personalized diagnosis of Chinese Medicine (CM) may help to stratify the diabetics. Metabolomics is regarded as a potential platform to provide biomarkers for disease-subtypes. We designed an explorative study of 50 pre-diabetic males, combining GC-MS urine metabolomics with CM diagnosis in order to identify diagnostic biomarkers for pre-diabetic subtypes. Three CM physicians reached 85% diagnosis consistency resulting in the classification of 3 pre-diabetic groups. The urine metabolic patterns of groups 1 'Qi-Yin deficiency' and 2 'Qi-Yin deficiency with dampness' (subtype A) and group 3 'Qi-Yin deficiency with stagnation' (subtype B) were clearly discriminated. The majority of metabolites (51%), mainly sugars and amino acids, showed higher urine levels in subtype B compared with subtype A. This indicated more disturbances of carbohydrate metabolism and renal function in subtype B compared with subtype A. No differences were found for hematological and biochemical parameters except for levels of glucose and γ-glutamyltransferase that were significantly higher in subtype B compared with subtype A. This study proved that combining metabolomics with CM diagnosis can reveal metabolic signatures for pre-diabetic subtypes. The identified urinary metabolites may be of special clinical relevance for non-invasive screening for subtypes of pre-diabetes, which could lead to an improvement in personalized interventions for diabetics.

Chinese medicine pattern differentiation and its implications for clinical practice

Chinese medicine practitioners apply the differentiation reasoning for decision-making. The wide scope of Chinese medicine intervention provides coverage of methods and techniques with applications to primary, secondary and tertiary levels of prevention. The rapid evolution of mathematical and computational techniques allowed the implementation of several models for pattern differentiation that were tested for several physiologic systems. Concurrently, it is argued that pattern differentiation might improve the efficacy of either traditional or conventional medical interventions. This article reviewed the influence of pattern differentiation into clinical practice organized by medical field: general pattern differentiation; genitourinary (recurrent cystitis); cardiovascular (coronary heart disease; arterial hypertension; angina pectoris); neurology (stroke); surgery; metabolic (diabetes mellitus); hepatic (cirrhosis); gastrointestinal (chronic superficial gastritis); orthopedic (low back pain; rheumatoid arthritis; cervical spondylosis; elbow arthritis); oncology (gastric mucosal dysplasia; lung cancer); gynecologic and obstetric manifestations (nausea and vomiting). The reviewed studies presented achievements that have contributed to the integration of Chinese medicine and evidence-based medicine in the treatment of many mild and severe diseases. Target diseases considered as major public health problems were also investigated and the results are promising regarding the possibility to treat guided by pattern differentiation.

FBAT-SNP-PC: an approach for multiple markers and single trait in family-based association tests

OBJECTIVE

Develop a new test for family-based association studies and continuous traits that incorporates power- enhancing techniques from two existing testing strategies.

METHODS

The new procedure initiates with an extraction of the relevant information from the variability of the genotypes and an assessment of the approximate individual markers effects and their directions. This information is incorporated in the construction of the actual test statistic through a selection of a data-determined number of optimal linear combinations of the offspring genotypes which, in a power enhancing step, are consequently combined into a single degree of freedom test. We conduct a comparison simulation study in which the performance of the new test is contrasted with the test that is currently known to offer the highest overall power, FBAT-LC.

RESULTS

The new test has an overall performance very similar to that of FBAT-LC but attains higher power in candidate genes with lower average pairwise correlations and moderate to high allele frequencies with large gains (up to 80%) for some of the analyzed genes possessing the above-mentioned characteristics.

CONCLUSION

The new test is a promising tool for candidate gene studies with substantial power gains for genes that are characterized by SNPs with low mean pairwise correlation.