Despite of the progress in the treatment of severe acute pancreatitis (SAP), there are still factors that hinder the improvement of the efficacy of treatment: there is a lack of an accurate and easy-to-use system for early severity prediction; the multidisciplinary collaboration mechanism needs to be further optimized; there is no clinical efficacy evaluation system for traditional Chinese medicine (TCM); the therapeutic targets of TCM are unclear; the effector substances are unknown; and the research and development of new medicines is still difficult. In order to further reduce the mortality of SAP and realize the goal of improving the efficacy, we should strengthen the integration of Chinese and Western medicine, multidisciplinary collaboration, and improve the treatment levels; as well as carry out basic and clinical research oriented to clinical value. We will also promote the innovative development of combined Chinese and Western medicine in the treatment of SAP by elucidating the mechanism, validating the efficacy and commercializing the achievements. In view of SAP, a major and difficult disease, we should insist on the principle of integrity and innovation, the synergy of Chinese and Western medicines and the complementarity of advantages, and promote the innovation and development of combined Chinese and Western medicines in the treatment of SAP, so as to further reduce the morbidity and mortality and to alleviate the burden of the disease.
We described our understanding of EBM, the ‘three principles＇ and ‘five steps＇ to practice it. EBM is an embodiment of human moral rule and axiom in clinical medicine; it is an advanced clinical model and medical practical methodology; it results from a basis of developed and perfected clinical research methodology, best evidence database, information technology. We also discussed the relationship between EBM and traditional Chinese medicine （TCM） modernization. The definition of modernization of TCM was suggested as scientifical standardization and internationalization. TCM theory in fact is not a basic but a clinical practice theory. EBM model should become the standard model of TCM practice to accelarate the standardization of TCM diagnostic technique and therapy. The key is not try to explain TCM theories with modern medical theroies, but work out common effectiveness evaluation criteria. Only when the effectiveness is intemationally acknowledged, can TCM be internationalized.
The two factors that affect enrollment of participants and the process of intervention in randomizedcontrolled pragmatic trials are similar to the situation of clinical practice, thus its effects are similar to the situation ofclinical practice. Therefore, when one estimates an intervention’s effect on a patient, it will be more similar to a real clinicalsituation than results taken from an explanatory trial. Due to the introduction of interventions and process variables usedin a pragmatic trial that conform to traditional Chinese medicine and acupuncture practices, more and more interest isgrowing among researchers in the traditional Chinese medicine field. This article introduces the principles and conceptsof the pragmatic trial, and the key points of design via some samples.
Objective To explore the correlation between traditional Chinese medicine (TCM) blood stasis pattern of coronary heart disease (CHD) and coronary angiography result, so as to screen dangerous patterns and provide evidence for the objectification of TCM pattern differentiation. Methods Literature on correlation between blood stasis pattern and coronary angiography results from January 1992 to May 2012 were searched in the following databases: China Academic Journal Network Publishing Database (CAJD), Chinese Biomedical Literature Database (CBM), China Doctor Dissertation Full-text Database (CDFD), Chinese Selected Master’s Theses Full-Text Databases (CMFD), PubMed and MEDLINE. According to the inclusion and exclusion criteria, literature screening, data extraction and methodological quality assessment of the included studies were conducted. Then meta-analysis was performed using RevMan 5.1 software. Results A total of 28 studies involving 4 901 patients were included. The results of meta-analysis showed that, there is a significant significance between blood stasis pattern and the following coronary angiography result, namely, number of culprit vessels (OR=1.38, 95%CI 1.08 to 1.77, Plt;0.05), severity of stenosis (OR=1.79, 95%CI 1.04 to 3.08, Plt;0.05), and Gensini score (OR=7.74, 95%CI 3.99 to 11.49, Plt;0.05). Conclusion Compared with other TCM patterns, CHD with blood stasis pattern easily tends to present multi-vessels lesions, more than 75% stenosis and higher Gensini score, indicating the condition of CHD with blood stasis pattern is more severe than with other patterns. Due to the discrepancy of pattern differentiation and the limited quality of original studies, this conclusion is insufficient to be fully applied into clinical practice, and more large scale and high quality clinical trials are required.
Evidence-based research is the essential method for the modernization of traditional medicine. China and Japan have made great progress in traditional Chinese medicine and Japanese Kampo medicine after years of evidence-based research, but there are also shortcomings. This paper compares the current situation of evidence-based research in traditional medicine from the aspects of the system of clinical evidence production and evaluation, standardization of clinical research report, standardization of traditional medicine in China and Japan, evaluation of the totality of clinical evidence via systematic review, application of clinical evidence via clinical practice guideline and development of research methodology. The purpose of this paper is to seek mutually complementary fields, and to provide enlightenment for future Chinese medicine and Japanese Kampo medicine evidence-based cooperation research.
ObjectiveTo assess effect of the self-made traditional Chinese medicine iontophoresis in treatment of acute lactation mastitis. MethodsTwo hundred cases of acute lactation mastitis who were treated in Langfang Maternal and Child Health-Care Hospital from Apr.to Nov.in 2012 were divided into traditional Chinese medicine group and control group by number of cases, each group enrolled 100 cases.The cases of traditional Chinese medicine group were treated with traditional Chinese medicine iontophoresis by using photoelectric ion therapeutic apparatus, and cases of control group were treated with 0.9% saline iontophoresis by using the same device.All of the 200 cases were treated with 1-3 courses (5 days per course), 2 times per day, and every time needed 30 minutes.At the same time, cases were educated the breast-feeding knowledge.Effect evaluation was performed after 1 course and 3 courses of treatment.The cases who were not cured after 3 courses needed to weaning, and needed to receive abscess incision drainage surgery.In 3 months after stopping therapy, telephone interview was performed to investigate the situation of recurrence. ResultsAfter 1 course of treatment, the effect was as follows:recovery in 89 cases, effective in 6 cases, invalid in 5 cases, and the total effective rate was 89%(89/100) in traditional Chinese medicine group; recovery in 71 cases, effective in 16 cases, invalid in 13 cases, and the total effective rate was 87%(87/100) in control group.After 3 courses of treatment, the effect was as follows:recovery in 97 cases, invalid in 3 cases, and the total effective rate was 97%(97/100) in traditional Chinese medicine group; recovery in 86 cases, invalid in 14 cases, and the total effective rate was 86%(86/100) in control group.There were 3 cases and 14 cases underwent abscess incision drainage surgery in Chinese medicine group and control group respectively.The clinical effect of Chinese medicine group were better than that of control group in 1 course (χ2=3.96, P < 0.05) and 3 courses (χ2=7.78, P < 0.01) of treatment.The recurrence rate of Chinese medicine group and control group were 5%(5/100) and 35%(35/100) respectively, and the rate of control group was higher (χ2=28.13, P < 0.01). ConclusionsCom-pared with 0.9% saline iontophoresis, the effect of traditional Chinese medicine iontophoresis in the treatment of acute lactation mastitis is better, which contribute to the breastfeeding.In addition, it is worth popularizing for that it can reduce the operation rate and recurrence rate effectively.
Currently, there is a lack of clarity and standardization regarding the implementation details of interventions in traditional Chinese medicine clinical practice guidelines (CPGs). This in methodological guidance for standardizing the implementation prescription adversely impacts the quality of implementation and hinders the clinical application rate of recommendations. Through in-depth analysis of implementation prescription of evidence-based CPGs in traditional Chinese medicine, we identified the challenges associated with standardization. In response, we propose enhancing the technical specifications of implementation prescriptions, advocating for improved formulation processes, diverse reporting approaches, and standardizedological guidelines. These recommendations aim to serve as a methodological reference and guidance for clinical practice guideline developers.
The method of evaluating clinical efficacy of traditional Chinese medicine is one of the hotspots in the field of traditional Chinese medicine in recent years. How to dynamically evaluate individual efficacy is one of the key scientific problems to explain the clinical efficacy of traditional Chinese medicine. At present, there are no recognized methods of evaluating individual efficacy of traditional Chinese medicine. In this study, we provided a method of dynamically evaluating individual efficacy of traditional Chinese medicine based on Bayesian N-of-1 trials after analyzing the current status of researches on methods of evaluating individual efficacy of traditional Chinese medicine. This method has the advantages of both N-of-1 trials and Bayesian multilevel models. It is feasible to evaluate individual efficacy of traditional Chinese medicine from the perspective of the design and analysis method. This study can provide an important basis for enriching and improving the methodology of evaluating individual efficacy of traditional Chinese medicine.
Acute pancreatitis (AP) is a common clinical emergency of the abdomen with increasing incidence and lack of effective treatment. Traditional Chinese medicine, as a treasure of the Chinese people, has been used in the treatment of AP for decades with favorable therapeutic effects. Currently, clinical trials and experimental studies have shown that traditional Chinese medicine has the effects of inhibiting pancreatic enzyme activity, anti-inflammation, promoting gastrointestinal dynamics, as well as delaying the progress of AP, improving clinical symptoms, reducing related complications, and reducing the mortality rate. Therefore, traditional Chinese medicine has considerable clinic value in treating AP. Based on the related research progress and clinical practice of our team, the authors summarized the targets and mechanism of traditional Chinese medicine in treating AP.