An index of open-access traditional Chinese medicine content relevant to primary care
Advantages，Key Issues and Research Strategies of Traditional Chinese Medicine in the Prevention and Treatment of Bone and Joint Degenerative Diseases
WEI Xu，HAN Tao，SUN Kai，CHEN Xin，YIN He，ZHU Liguo
Chinese General Practice 2021, 24 (35): 4421-4426. DOI: 10.12114/j.issn.1007-9572.2021.01.032
Abstract
The treatment of bone and joint degenerative diseases represented by cervical spondylosis，lumbar degenerative diseases，and knee osteoarthritis is mainly non-surgical treatment，which aredominant diseases of Traditional Chinese Medicine orthopedics. Traditional Chinese Medicine，manipulation，acupuncture，and traditional functional exercises are characteristic therapies commonly used in Chinese Medicine，which can significantly improve the clinical symptoms and signs of patients and prevent disease recurrence. At present，the prevention and treatment of bone and joint degenerative diseases with traditional Chinese Medicine still have many problems such as insufficient clinical efficacy evaluation，insufficient application of clinical Biobanks，insufficient research and development of key traditional Chinese Medicine technology and equipment，lack of multidisciplinary collaborative innovation. In order to solve these problems，it is suggested that traditional Chinese Medicine should follow the principle of “evidence-oriented，Chinese and Western medicine consensus” to carry out clinical research，standardize the collection of Chinese Medicine diagnosis and treatment information，build a clinical biological sample library，integrate modern science and technology to develop key Chinese Medicine technical equipment，integrate advantageous resources to achieve a collaborative research organization model，improve the research evidence of traditional Chinese Medicine in the prevention and treatment of bone and joint degenerative diseases，and further improve the level of clinical diagnosis and treatment.
Advances in the Mechanism of Chinese Medicine Targeting NF-κB Signaling Pathway in the Prevention and Treatment of Cognitive Impairment
LUO Meng，GAO Jing，DUAN Zhaoyuan，LIU Chengmei，LI Ruiqing，SU Kaiqi，CHEN Zhuo，FENG Xiaodong
Chinese General Practice 2021, 24 (36): 4640-4647. DOI: 10.12114/j.issn.1007-9572.2021.02.062
Abstract
Cognitive impairment （CI） refers to impaired attentiveness，learning and memory ability，executive function，language ability，perceptual and motor functions，or social cognition. There is no effective pharmaceutical treatment for CI although it will be prevalent worldwide as the global aging accelerates. The nuclear factor-κB （NF-κB） signaling pathway can regulate inflammation，apoptosis，oxidative stress and other processes，and has been widely present and activated in the development of CI. Many experiments are underway to try to explore a new molecular biology approach to the prevention and treatment of CI based on regulating the NF-κB signaling pathway. We reviewed the use of single，compound preparations of Chinese medicine，and Chinese herbal extracts to prevent and treat CI via regulating NF-κB signaling pathway，providing evidence for studies regarding the use of Chinese medicine for CI with this pathway as a treatment target.
Rules of Prescribing Chinese Medicines for Pulmonary Heart Disease from 2000 to 2020
TIAN Wangwang，WANG Zhiwan
Chinese General Practice 2021, 24 (36): 4633-4639. DOI: 10.12114/j.issn.1007-9572.2021.02.033
Abstract
Background Chronic pulmonary heart disease（PHD） is a common respiratory disease，which is the final stage of some chronic lung diseases. Chinese medicines have proved to be effective in treating PHD. However，due to complexity of PHD，the TCM syndrome differentiation for it is not unified，and the prescriptions are various，so it is of great significance to explore the characteristics of prescribing Chinese medicines and the rules of combination use of Chinese medicines for treating PHD. Objective To explore the rules of prescribing Chinese medicines and the rules of combination use of these medicines for PHD using data mining technique. Methods Studies about PHD treated with Chinese medicines published during 2000—2020 were searched in databases of CNKI，Wanfang Data，VIP，and SinoMed，and screened according to the inclusion and exclusion criteria. Data were extracted and input into a standardized database created from an Excel spreadsheet. Data mining technique was used to statistically analyze the use frequency，properties，taste，channel tropism，and effectiveness of Chinese medicines，rules of combination use and cluster analysis of core combinations for complex conditions. Results A total of 166 articles were included，involving 197 prescriptions，and 202 herbs，with cumulative frequency of drug use of 2 944 times. The most frequently used medicines were Poria cocos （60.41%），Glycyrrhiza uralensis （59.39%），Astragalus membranaceus （58.84%），Salvia miltiorrhiza （49.23%），Lepidium seed （44.67%），Pinellia ternata （41.12%），and Atractylodes macrocephala Koidz （40.10%）. The commonly used categories classified by physiologic effect were tonifying deficiency （25.79%），antitussive and antiasthmatic （15.35%），promoting blood circulation and removing blood stasis （13.71%），expectorant （9.28%），and promoting diuresis for eliminating dampness （8.23%）. The drug properties were mainly warm （38.40%） and mild （22.73%）. The three primary tastes were bitter （31.84%），sweet （30.13%） and pungent （28.11%）. The three primary meridian tropisms of drugs were lung meridian（27.47%），spleen meridian（18.52%） and heart meridian（16.15%）. Nineteen dual combination therapies，227 triple combination therapies，and 160 quadruple combination therapies for pulmonary heart disease were identified，which mainly belong to the combination use of tonifying qi drugs，antitussive，antiasthmatic and expectorant drugs，and qi-regulating and spleen-strengthening drugs. Seven core prescriptions were excavated by cluster analysis. Conclusion The mechanism of Chinese medicines treating PHD is mainly based on tonifying lung functions，strengthening spleen and cardiac functions，supplemented with antitussive，antiasthmatic，expectorant，blood stasis removing，and eliminating the pathogenic qi according to syndrome differentiation analysis. The commonly used drugs and rules of drug combinations for PHD obtained by data mining may contribute to clinical treatment of PHD using Chinese medicines，the development of new preparations，and drug combinations for PHD.
Development of Traditional Chinese Medicine Clinical Practice Guidelines Using Mixed Methods and Example Interpretation
ZHAO Guozhen，CHEN Tengfei，GUO Yuhong，FENG Xue，SU Xiangfei，HU Jing，FENG Shuo，ZHANG Huina，DU Yuan，YAN Yumeng，WANG Yafan，LI Bo，LIU Qingquan
Chinese General Practice 2021, 24 (32): 4155-4159. DOI: 10.12114/j.issn.1007-9572.2021.01.215
Abstract
The development of Traditional Chinese Medicine（TCM）clinical practice guidelines is a key measure to achieve the standardization of TCM. The TCM guidelines greatly contribute to the guidance of clinical practice，but the phenomenon of inadequate use of them exists，which may be related to the contents of the guidelines. As there is a small number of high-quality TCM clinical studies，guidelines developed based on evidence-based medical data derived from them，namely，guidelines mainly based on quantitative research results，have showed limitations in their recommendations. In contrast，the evidence（quantitative and qualitative research results）from mixed methods studies may be more practical，which may better benefit the development of TCM guidelines. This paper preliminarily discussed the idea and function of mixed method research in the process of guidelines formulation，and took the Clinical practice guide in the treatment of influenza by TCM as an example. This paper discussed the problems encountered in the guideline formulation led by quantitative research and the specific application of mixed method research in the guideline formulation. It was found that mixed method research can make up for the lack of relying solely on quantitative or qualitative research results，and may become one of the main methods for future guideline formulation，but there are still certain limitations and further research is needed.
Distribution of TCM Constitution and Associated Factors of the Severity of Clinical Symptoms in Patients with Chronic Prostatitis
MAO Dandan，ZHAO Yan，LIU Qinghua，ZHOU Jianping，ZHENG Junzhuang
Chinese General Practice 2021, 24 (24): 3054-3059. DOI: 10.12114/j.issn.1007-9572.2021.00.532
Abstract
Background The risk factors for the degree of clinical symptoms of chronic prostatitis （CP） are unclear. TCM constitution has been found to be strongly associated with the development，progression，outcome and prognosis of many diseases，but whether it also affects the development of CP is unknown. Objective To investigate the distribution of TCM constitution and associated factors of the severity of clinical symptoms in CP patients. Methods Convenience sampling was used to select 357 first-visit patients with CP from Andrology Clinic，Ningbo Municipal Hospital of TCM from October 2018 to December 2019. They were invited to attend a survey using two self-administered questionnaires，the TCM Constitution Classification and Determination Table for assessing TCM constitution，and Chinese version of NIH-CPSI for evaluating the severity of CP clinical symptoms. The questionnaires were returned immediately after being completed. Multivariate Logistic regression analysis was used to explore the factors associated with the severity of CP clinical symptoms. Results In all，357 cases（100.0%）who returned responsive questionnaires were included for final analysis. The distribution of TCM constitution was as follows：66 （18.5%） with damp-heat constitution，65（18.2%） with qi-stagnation constitution，44（12.3%） with phlegm-dampness constitution，41（11.5%） with qi-deficiency constitution，37 （10.4%） with balanced constitution，37（10.4%） with yang-deficiency constitution，35 （9.8%） with yin-deficiency constitution，26（7.3%） with blood stasis constitution，and 6（1.6%） with special constitution. The severity of clinical symptoms：142 were mild （39.8%，Chinese version of NIH-CPSI score of 4 to 14），199 were moderate（55.7%，Chinese version of NIH-CPSI score of 15 to 29），and 16 were severe（4.5%，Chinese version of NIH-CPSI score of 30 to 43）. The severity of clinical symptoms differed significantly by monthly income，work stress，sexual satisfaction，sleep time，number of hours of cycling per week，and TCM constitution（P<0.05）. Multivariate Logistic regression analysis showed that monthly income〔<10 000 yuan：OR=0.629，95%CI（0.503，0.785）〕，sleep time 〔OR=0.686，95%CI（0.484，0.971）〕 and TCM constitution 〔damp-heat constitution：OR=3.177，95%CI（1.310，7.702）；qi-stagnation constitution：OR=4.902，95%CI（1.897，12.666）〕 were associated with the severity of clinical symptoms of CP（P<0.05）. Conclusion Damp-heat constitution and qi-stagnation constitution were the two most common abnormal TCM constitution in CP patients. Low monthly income，insufficient sleep，qi-stagnation constitution and damp-heat constitution were risk factors for the exacerbation of clinical symptoms.
Association of Frailty with Sleep Quality and TCM-based Constitution among Elderly People
CUI Guanghui，LI Shaojie，YIN Yongtian，CHEN Lijun，LIU Xinyao，YU Peilin
Chinese General Practice 2021, 24 (9): 1082-1087. DOI: 10.12114/j.issn.1007-9572.2020.00.620
Abstract
Background According to body disease-related theories，TCM-based constitution is closely associated with the initiation，progression，and outcome of diseases，suggesting that TCM-based constitution may play an important role in the development of frailty in the elderly，but there are no relevant studies.Objective To investigate the effects of sleep quality，body constitution，and their interactions on frailty in the elderly.Methods In December 2019，by use of random stratified sampling，six communities and 10 administrative villages in Jinan City，China were selected，from which a cluster sample of eligible 1 130 elderly individuals were enrolled，and were invited to attend a questionnaire survey using the General Demographic Questionnaire（developed by our research team），Constitution in Chinese Medicine Questionnaire（CCMQ），Pittsburgh Sleep Quality Index（PSQI）and the Chinese version of Tilburg Frailty Indicator（TFI）.Multivariate Logistic regression analysis was performed to investigate the strength of association of frailty with sleep quality，TCM-based constitution，as well as the interaction between sleep quality and TCM-based constitution.Results In all，1 091 cases（96.5%） who returned responsive questionnaires were included for final analysis.Among the respondents，186 （17.0%） had sleep disorders and other 905 （83.0%） did not；448 （41.1%） had balanced TCM-based constitution while 643 （58.9%） had unbalanced；373 （34.2%） were frail and 718 （65.8%） were non-frail.Multivariate Logistic regression analysis showed that the presence of sleep disorders〔OR=2.718，95%CI（1.891，3.905）〕and unbalanced TCM-based constitution〔OR=4.782，95%CI（3.410，6.704）〕were factors associated with frailty in the elderly（P<0.05）.Multivariate Logistic regression model-based additive interaction analysis demonstrated that the risk of frailty in elderly individuals with sleep disorders and unbalanced TCM-based constitution was 12.960 times higher than in those without sleep disorders and with balanced TCM-based constitution〔95%CI（8.207，20.465）〕，RERI=6.101〔95%CI（0.579，11.623）〕，AP=0.471〔95%CI（0.181，0.761）〕，S=2.041〔95%CI（1.092，3.817）〕，indicating that sleep quality and TCM-based constitution had additive interaction on frailty.Conclusion Sleep disorders and unbalanced TCM-based constitution were risk factors for frailty in the elderly，and they also had an additive interactive effect on frailty.
Status of and Solutions to the Problems during the Implementation of the Special Scheme for Recruiting TCM General Practitioners to Work in Remote Areas with Harsh Conditions
DENG Guoxing1，ZENG Xingshui，CHEN Lingxuan，HAN Yunpeng，CHEN Zhiquan，WANG Chaonan
Chinese General Practice 2021, 24 (7): 881-885. DOI: 10.12114/j.issn.1007-9572.2021.00.011
Abstract
Background To gradually solve the shortage of general practitioners（GPs） and licensed physicians in primary care，China has implemented the special scheme of recruiting GPs to work in remote areas with harsh conditions since 2013 to guide and encourage highly qualified medical and health professionals to deliver general care in primary care. At present，there are few investigations on the implementation of this kind of special schemes of recruiting TCM GPs. Objective To investigate the implementation of the special scheme for recruiting TCM GPs to work in remote areas with harsh conditions，to promote the development of TCM workforce in primary care. Methods From July 1 to 20，2019，participants were recruited from 14 provinces of China in which the special scheme for recruiting GPs to work in remote areas with harsh conditions has been implemented as a pilot project. Of them，administrators（n=970） of 970 township hospitals （one administrator from each township hospital） attended an online questionnaire survey，and specially recruited TCM GPs（n=258） working at township hospitals attended another online questionnaire survey，and other 32 informants （4 leaders from county-level administrative institutions of Chinese medicine，4 leaders of county-level TCM hospitals，8 directors of township hospitals and 16 representative TCM GPs） attended group interviews. Results According to the survey，793（81.8%）of the responded administrators thought there was a shortage of TCM medical professionals，and 915（94.3%）thought that the special recruitment scheme was an appropriate project for their hospital，and 851（87.7%） thought the total specially recruited TCM GPs should be increased.Among the 258 TCM GPs，173（67.0%）had junior college degree or below，112（43.4%） had an annual salary of less than 50 000 yuan. Their main difficulties and demands were as follows：access to continuing medical education and training （94.2%，243/258），access to an officially budgeted post（91.1%，235/358），improving the salary （73.6%，190/258），access to the guidance from highly qualified physicians from higher level hospitals during practice（64.3%，166/258）. 255（98.8%） of them considered it was necessary to carry out the special recruitment scheme in township hospitals，and 249（96.5%） thought it was necessary to increase the number of special recruited TCM GPs. All the group interviewees were in support of increasing the number of special recruited TCM GPs. Conclusion The specially recruited TCM GPs in township hospitals had solved the shortage of GPs to some extent，and their services had obtained favorable comment from concerned primary care departments and patients. However，on the whole，they were not well-paid，had relatively low education level，limited career development and less training opportunities. To address the needs of TCM GPs in primary care，a set of actions are required such as promoting the pilot implementation of this special recruitment scheme，increasing the number of recruited cases，strengthening continuing medical education for recruited TCM GPs and safeguarding their vital interests via increasing financial investment.
Traditional Chinese Medicine for the Prevention and Treatment of Bone Marrow Suppression after Chemotherapy Based on AMSTAR 2 and GRADE：an Overview of Systematic Reviews and Meta-Analyses
XUE Mengting，YANG Min，PAN Yalan，TAN Jiani，HUANG Anle，BU Zihan，WANG Qing，XU Guihua
Chinese General Practice 2021, 24 (6): 718-726. DOI: 10.12114/j.issn.1007-9572.2020.00.568
Abstract
Background Bone marrow suppression is one of the common dose-limiting toxic and side effects of chemotherapy.There have been many systematic reviews and Meta-analyses about traditional Chinese medicine（TCM）for preventing and treating bone marrow suppression after chemotherapy，but their quality is uneven，with a lack of systematic evaluation.Objective To evaluate the methodological quality and outcome indicators quality of systematic reviews and Meta-analyses about TCM in preventing and treating post-chemotherapy bone marrow suppression by AMSTAR 2 and GRADE.Methods The databases such as the Cochrane Library，PubMed，Web of Science，OVID，EBSCO，CBM，CNKI，Wanfang Data and VIP were searched for systematic reviews and Meta-analyses on the topic of TCM in preventing and treating bone marrow suppression after chemotherapy from inception to February，2020.AMSTAR 2 was used to assess the methodological quality，and the evidence quality of the outcome indicators was graded according to the GRADE system.Results A total of 23 systematic reviews and Meta-analyses were enrolled，AMSTAR 2 evaluation results showed that，1 had moderate reliability，2 had low reliability，and the other 20 had extremely low reliability.The GRADE evaluation results showed that，among the totaled 62 outcome indicators from meta-analyses，2 were high-quality，11 were intermediate-quality，13 were low-quality and 36 were critically low-quality，with the main degradation factors of limitation，followed by inconsistency，imprecision and publication bias.Conclusion Methodological quality and quality of evidence of outcome indicators of available systematic reviews and Meta-analyses about TCM in preventing and treating post-chemotherapy bone marrow suppression are both low，with general reliability of relevant conclusions，thus it is uncertain that TCM can effectively prevent and treat bone marrow suppression after chemotherapy.And more high-quality systematic reviews and Meta-analyses with rigorous design are needed in the future.
Strategies of TCM Syndrome Differentiation to Encounter Asymptomatic Cases Infected with Coronavirus，Even if without Symptoms Macrocosmically
DING Jianwen，LIU Baohou
Chinese General Practice 2021, 24 (3): 259-266. DOI: 10.12114/j.issn.1007-9572.2020.00.575
Abstract
Against the backdrop of COVID-19 pandemic tending to be basically contained in China but continuously spreading in many other countries，increasing studies have found that there is a certain amount of asymptomatic cases infected with coronavirus，and they are contagious，whose diagnoses have posed great challenges both to COVID-19 containment and TCM syndrome differentiation and treatment due to lack of obvious clinical symptoms and signs.We analyzed the syndrome classification，pathogenesis，perspectives and principles of TCM syndrome differentiation for asymptomatic cases infected with coronavirus，and proposed that such cases could be diagnosed and treated by micro syndrome differentiation，disease identification，constitutional differentiation，and “preventive treatment of disease”and so forth，even if without symptoms macrocosmically.
Reflections on Methodological Approaches to Telephone Follow-ups in Clinical Trials of Traditional Chinese Medicine
WANG Tianyuan，SUN Xing，HU Jing，FENG Shuo，ZHANG Huina，WANG Hong，LI Bo
Chinese General Practice 2021, 24 (2): 248-252. DOI: 10.12114/j.issn.1007-9572.2020.00.633
Abstract
Outcome evaluation is very important for clinical trials of traditional Chinese medicine（TCM）.As a way for obtaining outcome information，the process of telephone follow-up needs to be standardized using methodological approaches due to many problems.To address these problems，we put forward the following practical methodological approaches summarized from real investigation results of TCM clinical trials：（1）Rationally designing the telephone follow-up of a TCM clinical trial；（2）Developing and improving a telephone follow-up investigation responsibility system；（3）Improving the pre-job training system for a telephone follow-up investigator；（4）Improving patients' awareness of disease and follow-up；（5）Optimizing the follow-up mechanism；（6）Hiring a professional follow-up team for regular follow-up.We could probably explore and establish a follow-up data platform，sharing the resource rapidly and comprehensively in the future.