Efficacy and safety of activating blood circulation and removing blood stasis of Traditional Chinese Medicine for managing renal fibrosis in patients with chronic kidney disease: a systematic review and Meta-analysis

OBJECTIVE

To evaluate the efficacy and safety of activating blood circulation and removing blood stasis in terms of Traditional Chinese Medicine (TCM) for managing renal fibrosis (RF) in patients with chronic kidney disease (CKD).

METHODS

We searched randomized controlled trials (RCTs) from eight databases.

RESULTS

Sixteen eligible studies with 1,356 participants were included in this study. Compared to treatment with Western Medicine (WM) alone, the combined treatment with activating blood circulation and removing blood stasis in terms of TCM (ARTCM) and WM to manage RF in patients with CKD significantly ameliorated type Ⅳ collagen (CⅣ) (: 2.17, 95% : 3.01 to 1.34), type Ⅲ procollagen (PCⅢ) (: 1.08, 95% : 1.64 to 0.53), laminin (LN) (: 1.28, 95% : 1.65 to 0.90), transforming growth factor β 1 (TGFβ1) (: 0.65, 95% : 1.18 to 0.12), serum creatinine (Scr) (: 1.36, 95% : 1.85 to 0.87), blood urea nitrogen (BUN) (: 1.51, 95% : 2.59 to 0.43), and 24 h urine protein (24hUpro) (: 1.23; 95% : 1.96 to 0.50). The level of hyaluronic acid (HA) was similar in both types of treatment (: 0.74, 95% : 1.91 to 0.44). The subgroup analysis showed that the duration of 8 weeks might affect the concentration of C-Ⅳ, PC-Ⅲ, and LN (<0.05). The effectiveness of the longer duration to C-Ⅳ, PC-Ⅲ, and LN was not certain. However, the result should be interpreted in care. The safety of the treatment using ARTCM and WM could not be evaluated because a few studies had reported adverse effects. The results of the Metaanalysis were not stable enough. There was publication bias for the reports on Scr ( 0.001), C-Ⅳ ( 0.001), PC-Ⅲ ( 0.026), and LN ( 0.030) and no publication bias for the reports on BUN ( 0.293). The quality of evidence varied from low to very low.

CONCLUSIONS

The combined treatment using ARTCM and WM to manage RF in patients with CKD has some advantages over treatment with WM alone. Highquality RCTs need to be conducted for the strong support.

Methodological quality of systematic reviews on Chinese herbal medicine: a methodological survey

BACKGROUND

Systematic reviews (SRs) synthesise the best evidence of effectiveness and safety on Chinese herbal medicine (CHM). Decision-making should be supported by the high-quality evidence of prudently conducted SRs, but the trustworthiness of conclusions may be limited by poor methodological rigour.

METHODS

This survey aimed to examine the methodological quality of a representative sample of SRs on CHM published during January 2018 to March 2020. We conducted literature search in Cochrane Database of Systematic Reviews, MEDLINE via Ovid, and EMBASE via Ovid. Eligible SRs must be in Chinese or English with at least one meta-analysis on the treatment effect of any CHM documented in the 2015 Chinese Pharmacopoeia. Two reviewers extracted the bibliographical characteristics of SRs and appraised their methodological quality using AMSTAR 2 (Assessing the Methodological Quality of Systematic Reviews 2). The associations between bibliographical characteristics and methodological quality were investigated using Kruskal-Wallis tests and Spearman's rank correlation coefficients.

RESULTS

We sampled and appraised one hundred forty-eight SRs. Overall, one (0.7%) was of high methodological quality; zero (0%), four (2.7%), and one-hundred forty-three (96.6%) SRs were of moderate, low, and critically-low quality. Only thirteen SRs (8.8%) provided a pre-defined protocol; none (0%) provided justifications for including particular primary study designs; six (4.1%) conducted a comprehensive literature search; two (1.4%) provided a list of excluded studies; nine (6.1%) undertook meta-analysis with appropriate methods; and seven (4.7%) reported funding sources of included primary studies. Cochrane reviews had higher overall quality than non-Cochrane reviews (P < 0.001). SRs with European funding support were less likely to have critically-low quality when compared with their counterparts (P = 0.020). SRs conducted by more authors (r_s = 0.23; P = 0.006) and published in higher impact factor journals (r_s = 0.20; P = 0.044) were associated with higher methodological quality.

CONCLUSIONS

Our results indicated that the methodological quality of SRs on CHM is low. Future authors should enhance the methodological quality through registering a priori protocols, justifying selection of study designs, conducting comprehensive literature search, providing a list of excluded studies with rationales, using appropriate method for meta-analyses, and reporting funding sources among primary studies.

Registration of intervention trials of Traditional Chinese Medicine for four neurological diseases on Chinese Clinical Trial Registry and ClinicalTrials.gov: a narrative review

OBJECTIVE

To analyze the current status of clinical trial registration of Traditional Chinese Medicine (TCM) for the treatment of neurological diseases.

METHODS

Interventional clinical trials of TCM treatment for ischemic stroke, hemorrhagic stroke, vascular cognitive impairment, tension-type headache before September 22, 2020 on the platform of Chinese Clinical Trial Registry (ChiCTR), and ClinicalTrials.gov were searched. Two researchers independently selected the literature and extracted data.

RESULTS

A total of 180 interventional clinical trials were included for analysis. Out of 180 trials, 127 were from ChiCTR and 53 from ClinicalTrials.gov. The countries primary sponsoring the included trials were China (176, 97.8%), and the common categories of primary sponsors were hospital (131, 72.8%). Among the study design, the largest proportion of allocation was randomized (172, 95.6%), interventional model assignment was parallel (163, 90.6%), masking was double blind 49 (27.2%), and the sample size was ≤ 400 (144, 80.0%). The trials were most carried out at a single center (102, 56.7%). Among the included studies, 112 (62.2%) registered on ChiCTR attached the ethical approval documents. In terms of trial stages, 50 (27.7%) studies were in phase IV. The mostly used intervention was Chinese herbal medicines (99, 55%), acupuncture (68, 37.8%) was the second. By searching the registration number on China National Knowledge Infrastructure Database and PubMed, 38 (21.1%) registered trials were published, including 25 protocol studies and 14 research results with one (NCT02275949) published both the protocol and the results.

CONCLUSIONS

Irregular and inadequate reporting, untimely update and publication, insufficient information on traditional medicine unique characteristics, and lack of international collaborations are the problems existing in the interventional clinical registration trials of traditional medicine treatment on neurological diseases. More efforts need to be made from the above aspects to standardize and improve the registration of traditional medicine trials.

Protocol to study the effects of Traditional Chinese Medicine on patients with coronary heart disease showing phlegm-heat-stasis symptom pattern

OBJECTIVE

To describe a protocol to assess the effects of Traditional Chinese Medicine (TCM) on patients with coronary heart disease (CHD) showing symptoms of phlegm-heat-stasis symptom pattern.

METHODS

This is a single-blind randomized controlled trial that will be conducted in the First Teaching Hospital of Tianjin University of TCM and 60 patients with CHD showing phlegm-heat-stasis symptom pattern will be included. Patients will be randomly divided into either a treatment group (Qingre Huatan formulae + Western Medicine) or to a control group (conventional Western Medicine only) for 7-14 d. Primary patient outcomes will be vascular endothelial function and quality of life. Measurement data will be expressed as mean ± standard deviation using t-test analysis or repeated-measure variance analysis. Enumeration data will be expressed by cases and percentages, using χ2 analysis, and rank sum test will be used for ranked data.

RESULTS

This study further verified the effectiveness and safety of Qingre Huatan formulae for the phlegm-heat-stasis syndrome pattern of CHD on the basis of previous studies on the characteristics of syndromes and medication rules.

DISCUSSION

Phlegm-heat-stasis symptom pattern has become a common manifestation in CHD. Standardized Western medications together with TCM have been extensively used in China and have developed into a comprehensive treatment model. Our trial will help formulate recommendations for symptom maintenance and provide clinical evidence for the application of TCM for patients with CHD showing phlegm-heat-stasis symptom pattern.

State-target strategy: a bridge for the integration of Chinese and Western Medicine

The methods ofTraditional Chinese Medicine(TCM)'s diagnosis and treatment have undergone several changes. It is crucial to build a proper model which is capable to modernize TCM into a both standardized and individualized treatment. Tong xiao-lin proposed the state-target strategy to build a bridge for the integration of Chinese and Western medicine. It is a model based on modern medical disease concepts and using the method of TCM to balance the pathological states and adopting the achievements of pharmacology of Chinese medicine to focus on the disease targets, symptom targets, and biochemical indicator targets. The reconstruction of TCM diagnosis and treatment system for diabetes is a good example to demonstrate this theory. It could improve the clinical efficacy, support the scientific research, and reinforce the standardization of TCM.

Traditional Chinese Medicine guidelines for coronavirus disease 2019

OBJECTIVE

To summarize the evidence from Traditional Chinese Medicine (TCM) practice in the treatment of coronavirus disease 2019 (COVID-19) and provide timely clinical practice guidance.

METHODS

The guidelines were developed in accordance with the World Health Organization rapid guideline process. The evidence on TCM for COVID-19 from published guidelines, direct and indirect published clinical evidence, first hand clinical data, and expert experience and consensus were collected. The grading of recommendations assessment, development and evaluation (GRADE) method was used to grade the evidence and make the recommendations.

RESULTS

Based on the available evidence, the guidelines recommended 17 Chinese medicines for COVID-19: 2 Chinese herbal granules, 7 Chinese patent medicines, and 8 Chinese herbal injections.

CONCLUSION

As the literature search was conducted on March, any subsequent versions of these guidelines require an up-to-date literature review. We hope that the evidence summary in these will be helpful in global efforts to address COVID-19.

Therapeutic efficacy of traditional Chinese exercises and massage treatment on lumbar instability: a randomized controlled trial

OBJECTIVE

To determine the effect of traditional Chinese exercises combined with traditional Chinese massage on lumbar instability.

METHODS

Seventy patients with lumbar instability were randomly divided into experimental group and control group. The experimental group was treated with traditional Chinese exercises combined with traditional Chinese massage, while the control group was only treated with traditional Chinese exercises. The Japanese Orthopaedic Association (JOA) scores, Oswestry Disability Index (ODI) and dynamic imaging indexes were used to assess treatment outcomes.

RESULTS

After 8 weeks of treatment, the JOA scores of both groups were significantly higher than those before treatment (P < 0.05), while ODI was significantly lower (P < 0.05). In addition, compared with the control group, the JOA score of the experimental group was significantly increased (P < 0.05), and the ODI was significantly decreased (P < 0.05). Besides, the dynamic imaging indexes of patients with lumbar instability significantly changed after treatment. The lumbar vertebral laxity was significantly decreased (P < 0.05) than those before treatment.

CONCLUSION

The traditional Chinese exercises and massage may improve the symptoms of lumbar instability, and traditional Chinese exercises combined with massage treatment may be better than exercises alone.

Chinese herbal medicines for prevention and treatment of colorectal cancer: From molecular mechanisms to potential clinical applications

Worldwide, colorectal cancer (CRC) is one of the most common malignant tumors, leading to immense social and economic burdens. Currently, the main treatments for CRC include surgery, chemotherapy, radiotherapy and immunotherapy. Despite advances in the diagnosis and treatment of CRC, the prognosis for CRC patients remains poor. Furthermore, the occurrence of side effects and toxicities severely limits the clinical use of these therapies. Therefore, alternative medications with high efficacy but few side effects are needed. An increasing number of modern pharmacological studies and clinical trials have supported the effectiveness of Chinese herbal medicines (CHMs) for the prevention and treatment of CRC. CHMs may be able to effectively reduce the risk of CRC, alleviate the adverse reactions caused by chemotherapy, and prolong the survival time of patients with advanced CRC. Studies of molecular mechanisms have provided deeper insight into the roles of molecules from CHMs in treating CRC. This paper summarizes the current understanding of the use of CHMs for the prevention and treatment of CRC, the main molecular mechanisms involved in these processes, the role of CHMs in modulating chemotherapy-induced adverse reactions, and CHM's potential role in epigenetic regulation of CRC. The current study provides beneficial information on the use of CHMs for the prevention and treatment of CRC in the clinic, and suggests novel directions for new drug discovery against CRC.

Interpretation of the Traditional Chinese Medicine portion of the diagnosis and treatment protocol for corona virus disease 2019 (Trial Version 7)

The TCM protocol in the Diagnosis and Treatment Protocol for corona virus disease 2019 (COVID-19) (Trial Version 7) has been updated from previous versions. The protocol was formulated under the direct leadership of the National Administration of Traditional Chinese Medicine, based on the experience of a panel of experts, supported by evidence from fever clinics and from the outcomes of emergency (EM) observation rooms and inpatients throughout China (especially in Wuhan, Hubei Province) in combination with the latest scientific research results and data. The present interpretation of the TCM protocol is based on an overall understanding of the revised content, and aims to guide and standardize its clinical application to provide a reference for clinicians.

Effect of Ginkgo biloba extract on pacemaker channels encoded by HCN gene

BACKGROUND

In the present study, the electropharmacological activity of traditional Chinese medicine, Ginkgo biloba extract (GBE), on human hyperpolarization-activated nucleotide-gated (HCN) channels and the underlying "funny" currents was investigated.

METHODS

Standard two-electrode voltage-clamp recordings were employed to examine the properties of cloned HCN subunit currents expressed in Xenopus oocytes under controlled conditions and GBE administration.

RESULTS

We found that GBE irreversibly inhibited the HCN2 and HCN4 channel currents in a concentration-dependent fashion and that the HCN4 current was more sensitive to GBE compared with HCN2. In addition, GBE inhibition of the current amplitudes of HCN2 and HCN4 currents was accompanied by a decrease in the activation and deactivation kinetics.

CONCLUSION

The results of this study contribute toward illustrating the antiarrhythmic mechanism of GBE, which might be useful for the treatment of arrhythmia.

Guidelines for diagnosis and treatment of hepatic fibrosis with integrated traditional Chinese and Western medicine (2019 edition)

In 2006, the Hepatology Committee of Chinese Association of Integrative Medicine issued the "Guidelines for the Prevention and Treatment of Liver Fibrosis with Integrated Traditional Chinese and Western Medicine." In recent years, the fields of Chinese medicine, Western medicine, and integrative medicine have made rapid advances in basic and clinical research into chronic liver disease, and accumulated new evidence for the prevention and treatment of hepatic fibrosis. Therefore, in order to meet clinical needs, liver disease experts of integrated traditional Chinese and Western medicine were united to revise the previous guidelines in order to help physicians make correct and reasonable decisions in the diagnosis and treatment of hepatic fibrosis.

Effect of Chinese Herbal Medicines on Helicobacter pylori-associated gastroduodenal ulcers: a systematic review and Meta-analysis

OBJECTIVE

To evaluate the effect and safety of Chinese herbal medicines on Helicobacter pylori (HP)-associated gastroduodenal ulcers.

METHODS

All randomized controlled trials (RCTs) listed in the PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure Database, WanFang, China Science and Technology Journal Database and SinoMed databases that were published in English or Chinese were searched, and the retrieval time range was from database inception to December 31, 2018. A comprehensive Meta-analysis of all publications was performed with RevMan 5.3 software, and the quality of the evidence reported in the results of Meta-analysis was analyzed with GRADE profiler software (version 3.6.1). Dichotomous data were analyzed by calculating odds ratios and 95% confidence intervals (CIs). Outcome measures included the HP clearance rate and percentage of adverse effects.

RESULTS

Eight trials with 919 participants were included in this Meta-analysis. Compared with the effects of single drug therapy on HP-associated gastroduodenal ulcers, according to the statistical analysis, odds ratios for the HP clearance rate and percentage of adverse effects of Chinese herbal medicines administered as complementary medicines combined with drugs were 3.10 [95% CI (2.21, 4.36), P < 0.01] and 0.28 [95% CI (0.15, 0.52), P < 0.01], respectively, and the differences were statistically significant. According to the GRADE analysis, the quality of evidence for the HP clearance rate and percentage of adverse effects were both very low.

CONCLUSION

Compared with using the drug therapy only, the combination of Chinese herbal medicines with the drug therapy more effectively eliminates HP and alleviates adverse reactions. However, the available studies were of low quality, and therefore more well-designed studies are required to further confirm the findings.

Efficacy and safety of external application of Traditional Chinese Medicine for the treatment of acute gouty arthritis: a systematic review and Meta-analysis

OBJECTIVE

To evaluate the clinical efficacy and safety of external application of Traditional Chinese Medicine (EATCM) on acute gouty arthritis (AGA).

METHODS

Six electronic data bases were retrieved from their inception to march 2017. 15 randomized controlled clinical trials (RCTs) were included. The quality of the literatures was assessed according to Cochrane review criteria by using RevMan5.3 software; and related data was counted using Stata14.0 software.

RESULTS

There was no significant difference in C-reactiveprotein (CRP) between experimental intervention group and control group [(WMD = 1.093, 95% CI (－2.514, 4.701); P = 0.553)]. In terms of overall efficacy, the EATCM's treatment group was significantly superior to control group [(OR = 3.692; 95% CI (2.408, 5.661); P < 0.001)]. The EATCM was better than western medicine treatments or other interventions in reducing the adverse reactions [(OR = 0.135; 95% CI (0.067, 0.274); P < 0.001)]. All these funnel plots showed unlikelihood of publishing bias. But due to excessive heterogeneity, the statistical results of serum uric acid and visual analogue scale and CRP between the two groups became uncertain.

CONCLUSION

The results indicate that EATCM may have greater overall efficacy with fewer adverse drug reactions, although the evidence is weak owing to the low methodological quality and the small number of the included trials.

Traditional Chinese Medicine-facilitated switch from methadone to buprenorphine-naloxone for treatment of heroin dependence: a case report

The switch from methadone to buprenorphine-naloxone for individuals with heroin dependence is associated with several obstacles and challenges. Such patients may experience discomfort from discontinuing methadone, precipitated withdrawal symptoms induced by buprenorphine-naloxone, and poor psychosocial adjustments such as anticipatory anxiety regarding severe opioid withdrawal. We herein describe a 46-year-old man with a history of heroin dependence who underwent Traditional Chinese Medicine (TCM)-facilitated switching from methadone to buprenorphine-naloxone. No precipitated withdrawal was induced by buprenorphine-naloxone. The drug-switching process was successful and smooth. He maintained abstinence from heroin for the following year. In this case, we applied TCM for enhancement of methadone metabolism and detoxification, analgesic effects, and anxiolytic and hypnotic effects during the drug switch. We observed that TCM effectively facilitated the switch from methadone to buprenorphine-naloxone in our case. Further studies regarding TCM-facilitated treatment for heroin dependence should be conducted.

Different meridian tropism in three Chinese medicines: Tinglizi (Semen Lepidii Apetali), Yiyiren (Semen Coicis), Cheqianzi (Semen Plantaginis)

OBJECTIVE

To study the meridian tropism (MT) for three Chinese medicines: Tinglizi (Semen Lepidii Apetali, TLZ), Yiyiren (Semen Coicis, YYR), Cheqianzi (Semen Plantaginis, CQZ) in vivo experiments.

METHODS

The extracts of TLZ, YYR, CQZ were orally administered to rats at a dose 234, 700 and 350 mg/kg, respectively. The urinary excretion rate, loss in weight of rats and the electrolyte levels in the plasma were measured, in order to assess the mechanisms of the three traditional Chinese diuretic medicines.

RESULTS

TLZ, YYR and CQZ exhibited obvious diuretic effect and reduced the weight of saline-loaded animals. All the three diuretic medicines differentially reduced various serum, urinary, lung, stomach, kidney and hormonal markers, thus indicating the different mechanisms of action and a close resemblance with their different meridian as per the MT theory.

CONCLUSION

Our findings suggest that the three Traditional Chinese Medicine (TCM) medicines-TLZ, YYR and CQZ- possess different Shamisen meridian. This can support the regimen of treating the same disease with different therapies in TCM theory.

Prevalence of liver injury among patients with acquired immunodeficiency syndrome treated with highly active antiretroviral therapy in China

OBJECTIVE

To estimate the prevalence of liver injury among patients with acquired immunodeficiency syndrome (AIDS) who received highly active antiretroviral therapy (HAART) in rural Henan Province in China, and to explore whether Traditional Chinese Medicine (TCM) treatment based on HAART would increase this risk.

METHODS

This was a retrospective cross-sectional study. We collected medical information on patients with AIDS from two treatment databases in 2014. Criteria established by the AIDS Clinical Trials Group in 1996 were used for grading liver injury, classified based on the limit of normal (ULN) for alanine transaminase and aspartate aminotransferase: grade 1 (1.25-2.5 × ULN); grade 2 (2.6-5 × ULN); grade 3 (5.1-10 × ULN); and grade 4 (> 10 × ULN). Factors associated with liver injury were evaluated using a logistic regression model.

RESULTS

A total 6953 patients with AIDS (3324 male and 3629 female patients) were enrolled into this study. The prevalence of liver injury was 22.0% (18.0% grade 1, 3.1% grade 2, 0.9% grade 3). In multivariate analysis, patients aged 34-45 years were more likely to have liver injury than patients in other age groups [adjusted odds ratio (AOR), 1.39; 95% CI, 1.01-1.91)]. Other factors associated with liver injury included male sex (AOR, 1.64; 95% CI, 1.46-1.85), HIV infection via blood (AOR, 1.47; 95% CI, 1.19-1.82), hepatitis B virus antibody positive (AOR, 1.07; 95% CI, 0.85-1.36), and hepatitis C virus (HCV) antibody positive (AOR, 2.76; 95% CI, 2.28-3.34).

CONCLUSION

The prevalence of liver injury was relatively high among HAART-experienced patients. Several factors associated with liver injury included male sex, age 35-45 years old, HIV infection through blood, and concurrent HCV infection. TCM had no relationship with liver injury in patients receiving HAART.

Prevalence trend and risk factors for anemia among patients with human immunodeficiency virus infection receiving antiretroviral therapy in rural China

OBJECTIVE

To estimate the prevalence trend and risk factors for anemia in patients with human immunodeficiency virus (HIV) infection receiving antiretroviral therapy (ART) in rural China.

METHODS

We conducted cross-sectional studies among the same population in 2010, 2012, and 2014, based on data from standard medical record registers. Factors associated with anemia were evaluated using a logistic regression model.

RESULTS

The number of patients with HIV infection included in each cross-sectional study was 1456 in 2010, 1531 in 2012, and 1567 in 2014, and the prevalence of anemia was 44.3%, 34.7%, and 27.6%, respectively. The prevalence of anemia was lower in female patients in 2010 [odds ratio (OR) 0.68; 95% confidence interval (CI) 0.55-0.85]; however, there was no difference by sex in 2012 (OR 0.90; 95% CI 0.72-1.11) and 2014 (OR 1.05; 95% CI 0.84-1.32). Patients with a higher level of education had a lower risk of anemia in 2014 (OR 0.72; 95% CI 0.56-0.92), but there was no difference in 2010 (OR 1.00; 95% CI 0.79-1.25) and 2012 (OR 0.99; 95% CI 0.79-1.24). Patients who had received a longer duration of ART had a higher risk of anemia in 2014 (OR 1.74; 95% CI 1.15-2.64), but there was no difference in 2010 and 2012 (P > 0.05). Patients receiving Traditional Chinese Medicine (TCM) therapy had a lower risk of anemia.

CONCLUSION

The prevalence of anemia among patients with HIV infection receiving ART decreased between 2010 and 2014 in Henan Province but was still higher than the prevalence in the general population of China. TCM therapy can potentially decrease the risk of anemia among patients with HIV infection.

Traditional Chinese Medicine as a Remedy for Male Infertility: A Review

Male infertility (MI) is a complex multifactorial disease, and idiopathic infertility accounts for 30% of cases of MI. At present, the evidence for the effectiveness of empirical drugs is limited, and in vitro fertilization is costly and may increase the risk of birth defects and childhood cancers. Therefore, affected individuals may feel obliged to pursue natural remedies. Traditional Chinese medicine (TCM) may represent a useful option for infertile men. It has been demonstrated that TCM can regulate the hypothalamic-pituitary-testicular axis and boost the function of Sertoli cells and Leydig cells. TCM can also alleviate inflammation, prevent oxidative stress, reduce the DNA fragmentation index, and modulate the proliferation and apoptosis of germ cells. Furthermore, TCM can supply trace elements and vitamins, ameliorate the microcirculation of the testis, decrease the levels of serum anti-sperm antibody, and modify epigenetic markers. However, the evidence in favor of TCM is not compelling, which has hindered the development of TCM. This review attempts to elucidate the underlying therapeutic mechanisms of TCM. We also explore the advantages of TCM, differences between TCM and Western medicine, and problems in existing studies. Subsequently, we propose solutions to these problems and present perspectives for the future development of TCM.

Risk assessment model for endpoints of ischemic stroke: A study protocol for a registry study

OBJECTIVE

To evaluate the risk of ischemic stroke endpoints by establishing risk assessment models that combine Traditional Chinese Medicine (TCM) and modern medicine indicators.

METHODS/DESIGN

The proposed study is a registry-based participant survey conducted in seven hospitals nationwide in China. After obtaining informed consent, 3000 patients diagnosed with ischemic stroke will be recruited. One-year follow-ups will be performed on-site in hospitals and by telephone to track endpoint events. Comparative analysis of the prevalence of endpoint events and other TCM or modern medicine features in different groups will be conducted using frequency analysis and X2 tests, and the results will be expressed as composition ratios. Comparative analysis of quantitative scores and related patterns or symptoms will be conducted using a rank-sum test. Correlation analysis of endpoint events and TCM or modern medicine factors will be performed using a multivariate Cox proportional hazard model.

DISCUSSION

Previous reports have described modern medicine indicator-based risk assessment models for ischemic stroke endpoint events, but no such studies have included TCM features. Our new risk assessment model combines TCM and modern medicine indicators and thus has the potential to facilitate early warning, early intervention, and early control of ischemic stroke endpoint events.

Application of Traditional Chinese Medicine Four-diagnostic auxiliary apparatus in evaluation of health status and clinical treatment

OBJECTIVE

To evaluate the application of Traditional Chinese Medicine (TCM) Four-diagnostic Auxiliary Apparatus in disease diagnosis.

METHODS

The liver cancer patients and healthy controls were recruited from Shanghai Integrated Chinese and Western Medicine Hospital and Beijing University of Traditional Chinese Medicine, respectively. Then, the included subjects were diagnosed by the Four-diagnostic auxiliary apparatus.

RESULTS

Thirty liver cancer patients and 30 paired healthy controls were enrolled in this study. Based on the apparatus, the pulse wave velocity was significantly higher in patients compared with controls (P < 0.05). The number of patients with purple tongue and ecchymosis were more than controls (P < 0.05). The number of patients (10%) with yellow tongue coating were higher than the controls (0%). Patients were inclined to be with water type and fire type constitution.

CONCLUSION

TCM Four-diagnostic auxiliary apparatus can be applied in clinical diagnosis of body constitution and health status of subjects. It promotes the accuracy and speed for disease diagnosis and TCM standardization.

Efficacy of Traditional Chinese Medicine in patients with acute myocardial infarction suffering from diabetes mellitus

OBJECTIVE

To investigate the ""real world"" effectiveness of Traditional Chinese Medicine (TCM) in patients with acute myocardial infarction suffering from diabetes mellitus (AMI+DM patients).

METHODS

This was a retrospective cohort study. During hospitalization, the ""exposure group"" was defined as patients who had a TCM injection for ≥ 7 d. During follow-up, the definition of the exposure group was application of a Chinese patent medicine or decoction of Chinese medicine for ≥ 28 d. General information (age, sex, contact details), TCM use and endpoint events of AMI+DM patients during hospitalization and follow-up were collected. The correlation between TCM and the end-point events of AMI + DM patients was analyzed using a multiple logistic regression method.

RESULTS

A total of 479 AMI + DM patients were enrolled and 345 cases were followed up. During hospitalization, TCM, age, hypertension and use of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) were associated with cardiac death. During follow-up, TCM was associated with cardiac death. TCM was a relevant factor for a composite endpoint of re-infarction and stroke. TCM, anti-thrombotic therapy and lipid-lowering therapy were related to acute heart failure. TCM, anti-thrombotic therapy, anti-MI therapy and ACEI/ARB use exhibited a strong correlation with re-hospitalization due to cardiovascular disease.

CONCLUSION

TCM reduced the prevalence of cardiac death during hospitalization, and cardiac death, a composite endpoint of re-infarction and stroke, acute heart failure and re-hospitalization due to cardiovascular disease during follow-up.

Western medication plus Traditional Chinese Medicine preparations in patients with chronic heart failure: a prospective, single-blind, randomized, controlled, and multicenter clinical trial

OBJECTIVE

To assess the efficacy and safety in patients with chronic heart failure (CHF) of Western medication plus Traditional Chinese Medicine (TCM) preparations.

METHODS

This prospective, single-blind, randomized, controlled, and multicenter clinical trial began on September 17, 2008, and was completed on June 25, 2011. A total of 340 inpatients, aged 40-79 years, with exacerbating CHF from 10 hospitals were enrolled and randomly allocated within 24 h of admission. The trial included three intervention periods. During hospitalization, the control group received western medication for CHF and the treatment group received Danhong injection with Shenfu injection or Shenmai injection. After discharge, all patients were treated with Qiliqiangxin capsules and Buyiqiangxin tablets or a placebo for 6 months. After the 6-month intervention, both groups received only continuous western medication. The primary endpoint was all-cause mortality. The efficacy assessments were as follows: B-type natriuretic peptide (BNP), Lee's HF score, the 6-minute walking test (6MWT), left ventricular ejection fraction (LVEF), and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The safety assessments were as follows: blood and urine routine examination, hepatic and renal function, electrolytes in blood and adverse events.

RESULTS

Compared with the control group, the treatment group showed a 30.99% reduction in all-cause mortality and an improved survival rate. The treatment group showed greater improvement in 6MWT (P = 0.02) than the control group on discharge, after 12-month follow-up, there was a time-group interaction for MLHFQ (P = 0.03). Incidence rate of adverse events and other relevant safety indexes were not statistically significant between the two groups.

CONCLUSION

Western medication plus TCM treatment can increase 6-minute walking distance (improve exercise tolerance) and quality of life with heart failure patients.

Diabetic kidney disease treated with a modified Shenzhuo formula derived from Traditional Chinese Medicine: a case report

INTRODUCTION

Diabetic kidney disease (DKD) is one of the most common microvascular complications of diabetes mellitus and is the leading cause of end-stage renal disease. DKD seriously affects the quality of life of patients and brings heavy economic burden to the country. At present, the pathogenesis of DKD is not entirely clear, and clinical treatment is mainly to control blood glucose and lower blood pressure and urine protein. However, the clinical effect is not satisfactory.

CASE PRESENTATION

A female patient, aged 72 years, first visited our hospital endocrinology clinic, and was diagnosed with DKD. She suffered from fatigue, cold sensation in the lower extremities, convulsion of the lower limbs and frequent urination at night. She had a dark purple tongue with white and yellow fur and sublingual varices. Accessory examinations showed that her fasting blood glucose was 5.7 mmol/L, serum creatinine 159 μmol/L, blood urea nitrogen 13.6 μmol/L, blood uric acid 493 μmol/L, and blood pressure 138/65 mm Hg. The patient received Traditional Chinese Medicine treatment of the modified Shenzhuo formula [Huangqi (Radix Astragali Mongolici), Dahuang (Radix Et Rhizoma Rhei Palmati), Shuizhi (Hirudo) and Danshen (Radix Salviae Miltiorrhizae)] for 7 years and achieved good results.

CONCLUSION

This case provides a specific treatment plan and an effective reference for clinical application of Traditional Chinese Medicine for treating DKD. This may be an alternative treatment for DKD.

[Burning mouth syndrome in the views of modern stomatology and traditional Chinese medicine]

Burning mouth syndrome (BMS) is a common clinical disorder characterized by burning of the mouth or other discomfort, which significantly affects the quality of life of patients. The present article introduces and makes comparison of the mechanisms and clinical treatments of BMS in modern stomatology and traditional Chinese medicine. Modern stomatology studies have shown that BMS is related to the factors of neuropathy, psychology, endocrine or metabolic disorders, drug effects and local adverse stimuli. Traditional Chinese medicine suggests that BMS is mainly caused by diet, fatigue, bad emotion, poor health, oldness, etc. Individualized therapy is advocated in the treatment of BMS. Modern stomatology pays attention to comprehensive treatment for psychological disorder, systematic and oral local diseases. The thoughts of dialectical therapy and health keeping in traditional Chinese medicine also have clinical value.

Clinical characteristics of 96 patients with drug-induced acute liver failure: a comparison between Traditional Chinese and Western Medicine

OBJECTIVE

To compare the causes, clinical symptoms, laboratory test results, and prognosis in patients with acute liver failure (ALF) induced by traditional Chinese medicines (TCM) and by Western Medicines (WM).

METHODS

The medical histories of patients who were diagnosed with drug-induced ALF (DALF) (n = 96) after hospitalization in the 302 Military Hospital between January 2010 and December 2015 were retrospectively examined.

RESULTS

Fifty-eight of the 96 DALF patients (60.4%) had a hepatocellular pattern of DALF, 16 patients (16.7%) had a cholestatic pattern, and 22 patients (22.9%) had a mixed pattern. DALF resolved in 24 patients (25.0%). Twenty-five patients (26.0%) developed chronic liver injury, 43 patients (44.8%) died, and 4 patients (4.2%) underwent liver transplantation. There were 42 ALF patients (43.8%) who received WM, and 32 ALF patients (33.3%) who received TCM. TCM-induced ALF patients had a higher average age [42.4 ± 18.4) vs (33.5 ± 17.9) years, P = 0.04] and higher creatinine and urine nitrogen levels [(155.2 ± 108.8) vs (97.5 ± 130.4) mmol/L, P = 0.047; (9.1 ± 7.7) vs (4.3 ± 5.0) mmol/L, P = 0.002, respectively]. Patients with TCM-induced ALF exhibited an increased risk of renal injury [odds ratio (OR), 3.75; 95% confidence interval (CI), 1.330-10.577]. The 14 patients with TCM-induced ALF who died exhibited higher creatinine levels than the 18 patients with TCM-induced ALF patients who survived [(218.7 ± 111.6) vs (105.8 ± 78.4) mmol/L, P = 0.002]. They were also more likely to exhibit ascites (85.7% vs 44.4%, P = 0.017) and hepatorenal syndrome (78.6% vs 22.2%, P = 0.002).

CONCLUSION

TCM-induced ALF was more likely to be accompanied by renal injury than was WM-induced ALF, especially in TCM-induced ALF patients who died.

Colon hydrotherapy plus Traditional Chinese Medicine to treat non-alcoholic fatty liver disease: a pilot study

OBJECTIVE

To demonstrate the potential to treat non-alcoholic fatty liver disease (NAFLD) with colon hydrotherapy (CHT) plus Traditional Chinese Medicine (TCM).

METHODS

A total of 20 patients were enrolled into the study and received CHT with TCM for 2 weeks. Body mass index (BMI) and levels of serum triglycerides (TG) and total cholesterol (TC) were compared between pre-treatment and post-treatment.

RESULTS

Two-week treatment with CHT plus TCM significantly lowered BMI and reduced blood lipids. BMI decreased from 29.5 4.3 to 25.4 1.0, while mean TG levels decreased by 0.70 mmol/L on average from baseline and mean TC levels decreased by 0.37 mmol/L. Forty-five percent of patients exhibited TC decreasing by more than 10% from baseline and 25% of patients exhibited TC decreasing by more than 20%. Sixty percent of patients exhibited TG decreasing by more than 20% and 20% of patients exhibited TG decreasing by more than 40%. However, high-density and low-density lipoprotein cholesterol levels did not change significantly after intervention. No serious adverse events were reported.

CONCLUSION

Our findings suggest that CHT plus TCM to treat NAFLD is promising and it might be a new treatment strategy for management of NAFLD.

Corticosteroid adulteration in proprietary Chinese medicines: a recurring problem

OBJECTIVES

To investigate adulteration of proprietary Chinese medicines with corticosteroids in Hong Kong.

DESIGN

Case series with cross-sectional analysis.

SETTING

A tertiary clinical toxicology laboratory in Hong Kong.

PATIENTS

All patients using proprietary Chinese medicines adulterated with corticosteroids and referred to the authors' centre from 1 January 2008 to 31 December 2012.

MAIN OUTCOME MEASURES

Patients' demographic data, clinical presentation, medical history, drug history, laboratory investigations, and analytical findings of the proprietary Chinese medicines were analysed.

RESULTS

The records of 61 patients who consumed corticosteroid-adulterated proprietary Chinese medicines were reviewed. The most common corticosteroid implicated was dexamethasone. Co-adulterants such as non-steroidal anti-inflammatory drugs and histamine H1-receptor antagonists were detected in the proprietary Chinese medicine specimens. Among the patients, seven (11.5%) required intensive care, two (3.3%) died within 30 days of presentation, and 38 (62.3%) had one or more complications that were potentially attributable to exogenous corticosteroids. Of 22 (36.1%) patients who had provocative adrenal function testing performed, 17 (77.3% of those tested) had adrenal insufficiency.

CONCLUSION

The present case series is the largest series of patients taking proprietary Chinese medicines adulterated with corticosteroids. Patients taking these illicit products are at risk of severe adverse effects, including potentially fatal complications. Adrenal insufficiency was very common in this series of patients. Assessment of adrenal function in these patients, however, has been inadequate and routine rather than discretionary testing of adrenal function is indicated in this group of patients. The continuing emergence of proprietary Chinese medicines adulterated with western medication indicates a persistent threat to public health.