Publications by authors named "Guo-Yan Yang"

23 Publications

  • Page 1 of 1

Chinese Patent Medicine as Adjuvant for Mild-to-Moderate Active Ulcerative Colitis: A Network Meta-Analysis of Randomized Controlled Trials.

Evid Based Complement Alternat Med 2021 26;2021:1075886. Epub 2021 Aug 26.

Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China.

Objective: To evaluate the effectiveness and safety of Chinese patent medicine for mild-to-moderate active ulcerative colitis (UC) using network meta-analysis (NMA).

Methods: We systematically searched PubMed, Cochrane library, Embase, Sino-Med, China National Knowledge Infrastructure (CNKI), Wanfang, and Chinese Scientific Journal Database (VIP) databases to October, 2020. We included randomized controlled trials (RCTs) on Chinese patent medicine for mild-to-moderate active UC. The main analysis was complemented by network subanalyses and standard pairwise comparisons. Statistical heterogeneity, inconsistencies, and ranking probability were also evaluated.

Results: The databases search identified 3222 citations, of which 33 RCTs involving 2971 patients met the inclusion criteria. A total of 15 Chinese patent medicines were analyzed. The overall quality of the included studies was low. Pairwise meta-analysis showed that Chinese patent medicine was superior to Mesalazine in improving disappearances of clinical symptoms, recurrence rate, and Mayo score. Based on decreases in adverse events, results from NMA showed that Xilei powder plus Mesalazine was more effective than other drugs. Other NMA results indicated that Danshen freeze-dried powder plus Mesalazine (RR: 0.13; 95% CI, 0.02-0.78) and Kangfuxin lotion plus Mesalazine (RR: 0.24; 95% CI, 0.07-0.57) were superior to Mesalazine in decreasing recurrence rate. Another NMA result indicated that Kangfuxin lotion plus Mesalazine (RR: 0.00; 95% CI, 0.00-0.02) and Zhi Kang capsule plus Mesalazine (RR: 0.00; 95% CI, 0.00-0.02) were superior to Mesalazine in increasing the disappearance of tenesmus.

Conclusion: In the probability sorting, Xilei powder combined with Mesalazine ranked first for having the fewest adverse events, Maintaining Intestines Antidiarrheal Pills combined with Mesalazine ranked first for having the lowest recurrence rate, Xilei powder combined with Mesalazine ranked first for improving disappearance rate of mucopurulent bloody stool/abdominal pain, and Kangfuxin lotion combined with Mesalazine ranked first for improving the disappearance rate of diarrhea/tenesmus. However, there is a lack of direct comparisons among Chinese patent medicines for UC. More multiarm RCTs are needed in the future to provide direct comparative evidence.
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http://dx.doi.org/10.1155/2021/1075886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413025PMC
August 2021

Adjunctive effect of compound Kushen Injection to chemotherapy for non-small cell lung cancer: An evidence map and overview of systematic reviews.

J Ethnopharmacol 2021 Aug 18;281:114538. Epub 2021 Aug 18.

Beijing University of Chinese Medicine, Beijing, 100029, China. Electronic address:

Ethnopharmacological Relevance: Extract from Kushen (Sophora flavescens Aiton) and Baituling (Heterosmilax japonica Kunth), Compound Kushen Injection has a long history for cancer treatment in China. As a common adjunctive drug in chemotherapy of non-small cell lung cancer (NSCLC), the evidence of effectiveness and safety of Compound Kushen Injection needs to be synthesized.

Aim Of The Study: The objective of this overview is to synthesize recent evidence and assess the methodological quality of systematic reviews (SRs) of Compound Kushen Injection, in treating NSCLC as an adjunctive treatment of chemotherapy.

Materials And Methods: We searched PubMed, PubMed Central, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform and VIP China Science and Technology Journal Database from inception to April 22, 2020. We included SRs of the efficacy and safety of Compound Kushen Injection combined with chemotherapy in the treatment of NSCLC. Two authors assessed eligibility and extracted data. The quality of SRs was assessed using AMSTAR-2. A meta-analysis was conducted for the original trials where good homogeneity was present. Evidence maps using bubble plots illustrated overall results. The quality of the evidence was graded by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Results: Twelve SRs were included, with 91 randomized controlled trials and 7466 participants. Overall, the quality of the included SRs was low. Only six SRs reported specific chemotherapy regimens, three using vinorelbine combined with cisplatin (NP), one using paclitaxel combined with cisplatin (TP), one using gemcitabine combined with cisplatin (GP), and one discussed the three regimens in subgroups. Meta-analysis showed that CKI used as an adjuvant to chemotherapy was superior to chemotherapy alone in promoting tumor complete response rate, tumor partial response rate, Kamofsky score, and relieving some chemotherapy related side effects. Evidence mapping showed that Kushen Injection combined with NP and GP had better effect. The evidence quality of increasing Kamofsky score and decreasing the incidence of leukopenia were moderate, others were low or very low.

Conclusions: There are some favorable effects in improving short-term effectiveness, quality of life and alleviating some side effects of chemotherapy in patients with NSCLC. Results are more promising when Compound Kushen injection is used as an adjunctive to NP and GP. Promising results are however, compromised by the poor quality overall of the clinical trials.
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http://dx.doi.org/10.1016/j.jep.2021.114538DOI Listing
August 2021

Tai Chi for health and well-being: A bibliometric analysis of published clinical studies between 2010 and 2020.

Complement Ther Med 2021 Aug 10;60:102748. Epub 2021 Jun 10.

NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia.

The objective of this bibliometric review was to identify the volume, breadth, and characteristics of clinical studies evaluating Tai Chi published between January 2010 and January 2020. Five English and four Chinese language databases were searched. Following independent screening, 1018 eligible publications representing 987 studies were identified, which was a three-fold increase from the previous decade. Most common were randomized controlled trials (548/987, 55.5 %), followed by systematic reviews (157/987, 15.9 %), non-randomized controlled clinical studies (152/987, 15.4 %), case series (127/987, 12.9 %) and case reports (3/987, 0.3 %) that were conducted in China (730/987, 74.0 %), followed by the United States of America (123/987, 12.5 %) and South Korea (20/987, 2.0 %). Study participants were mostly in the adult (55.2 %) and/or older adult (72.0 %) age groups. The top ten diseases/conditions were hypertension, chronic obstructive pulmonary disease, diabetes, knee osteoarthritis, heart failure, depression, osteoporosis/osteopenia, breast cancer, coronary heart disease and insomnia. A quarter of the studies enrolled healthy participants to evaluate the effects of Tai Chi on health promotion/preservation, balance/falls, and physiological/biomechanical outcomes. Yang style Tai Chi was the most popular, followed by Chen and Sun style. Tai Chi was mostly commonly delivered face-to-face by a Tai Chi instructor in group settings for 60 min, three times a week, for 12 weeks. Most studies (93.8 %) reported at least one outcome in favor of Tai Chi. Adverse events were underreported (7.2 %). Over half fell short of expected intervention reporting standards, signalling the need for Tai Chi extensions to existing guidelines.
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http://dx.doi.org/10.1016/j.ctim.2021.102748DOI Listing
August 2021

Effects of Different Surface Treatments on Bond Strength of Resin Cement to Machined Pure Titanium.

J Adhes Dent 2019 ;21(5):401-411

Purpose: To investigate the effects of grit blasting, acidic or alkaline/heat treatments, and metal primer application on the shear bond strength (SBS) of resin cement to machined commercially pure titanium (CP-Ti).

Materials And Methods: Titanium plates were machined and received one of the following treatments: grit-blasting (GB), or grit-blasting followed by either acidic treatment (GB/AC) or alkaline/heat treatment (GB/AH). The specimens were randomly divided into 4 groups and treated with Rely X Ceramic Primer (RCP), Z Prime Plus (ZPP), and Alloy Primer (ALP), or without primer as the control. The pairs of titanium plates were cemented together with the Rely X Unicem cement. SBS was measured before and after thermocycling between 5°C and 55°C for 5000 cycles.

Results: SEM observation showed that honeycomb-shaped pores formed on the surface of machined CP-Ti after GB/AC treatment, whereas a uniform net-like pattern formed after GB/AH treatment. In descending order, the surface roughness was GB, GB/AC, and GB/AH. The GB/AH group showed the highest SBS among all the treatments. As for primers, ALP group showed the highest SBS, while the RCP group showed the lowest. GB followed by ALP presented the highest SBS.

Conclusion: A fine, uniform network structure was formed on the surface of CP-Ti following GB/AH treatment, providing an effective micromechanical interlocking mechanism for resin bonding. At the same time, after AH treatment, the -OH formed on the surface of the machined CP-Ti triggered a chemical reaction with the acid monomers in the resin adhesives, creating a chemical bond. As a result, GB/AH treatment significantly improved the bond strength relative to GB/AC treatment. In addition, ALP treatment facilitated the formation of hydrogen bonds, which further improved the chemical bond strength. Finally, the combination of the effects mentioned above resulted in the most robust bond between machined CP-Ti and the resin adhesives.
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http://dx.doi.org/10.3290/j.jad.a43182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889805PMC
October 2019

Acupuncture for Depression: A Systematic Review and Meta-Analysis.

J Clin Med 2019 Jul 31;8(8). Epub 2019 Jul 31.

Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, NSW 2751, Australia.

Background: Depression is commonly treated with anti-depressant medication and/or psychological interventions. Patients with depression are common users of complementary therapies, such as acupuncture, either as a replacement for, or adjunct to, their conventional treatments. This systematic review and meta-analysis examined the effectiveness of acupuncture in major depressive disorder.

Methods: A search of English (Medline, PsychINFO, Google Scholar, and CINAL), Chinese (China National Knowledge Infrastructure Database (CNKI) and Wanfang Database), and Korean databases was undertaken from 1980 to November 2018 for clinical trials using manual, electro, or laser acupuncture.

Results: Twenty-nine studies including 2268 participants were eligible and included in the meta-analysis. Twenty-two trials were undertaken in China and seven outside of China. Acupuncture showed clinically significant reductions in the severity of depression compared to usual care (Hedges (g) = 0.41, 95% confidence interval (CI) 0.18 to 0.63), sham acupuncture (g = 0.55, 95% CI 0.31 to 0.79), and as an adjunct to anti-depressant medication (g = 0.84, 95% CI 0.61 to 1.07). A significant correlation between an increase in the number of acupuncture treatments delivered and reduction in the severity of depression ( = 0.015) was found.

Limitations: The majority of the included trials were at a high risk of bias for performance blinding. The applicability of findings in Chinese populations to other populations is unclear, due to the use of a higher treatment frequency and number of treatments in China. The majority of trials did not report any post-trial follow-up and safety reporting was poor.

Conclusions: Acupuncture may be a suitable adjunct to usual care and standard anti-depressant medication.
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http://dx.doi.org/10.3390/jcm8081140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722678PMC
July 2019

Acupuncture for Treatment of Erectile Dysfunction: A Systematic Review and Meta-Analysis.

World J Mens Health 2019 Sep 15;37(3):322-338. Epub 2019 Mar 15.

Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.

Purpose: To assess the effectiveness and safety of acupuncture for erectile dysfunction (ED).

Materials And Methods: We searched six major English and Chinese databases included randomized controlled trials (RCTs) testing acupuncture alone or in combination for ED. Dichotomous data were presented as risk ratio (RR) and continuous data were presented as mean difference (MD) both with 95% confidence interval (CI). The Revman (v.5.3) was used for data analyses. Quality of evidence across studies was assessed by the online GRADEpro tool.

Results: We identified 22 RCTs, fourteen of them involving psychogenic ED. Most of the included RCTs had high or unclear risk of bias. There was no difference between electro-acupuncture and sham acupuncture with electrical stimulation on the rate of satisfaction and self-assessment (RR, 1.50; 95% CI, 0.71-3.16; 1 trial). Acupuncture combined with tadalafil appeared to have better effect on increasing cure rate (RR, 1.31; 95% CI, 1.00-1.71; 2 trials), and International Index of Erectile Function-5 scores (MD, 5.38; 95% CI, 4.46-6.29; 2 trials). When acupuncture plus herbal medicine compared with herbal medicine alone, the combination therapy showed significant better improvement in erectile function (RR, 1.68; 95% CI, 1.31-2.15; 7 trials). Only two trials reported facial red and dizziness cases, and needle sticking and pruritus cases in acupuncture group.

Conclusions: Low quality evidence shows beneficial effect of acupuncture as adjunctive treatment for people mainly with psychogenic ED. Safety of acupuncture was insufficiently reported. The findings should be confirmed in large, rigorously designed and well-reported trials.
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http://dx.doi.org/10.5534/wjmh.180090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704310PMC
September 2019

Pediatric Tui Na for acute diarrhea in children under 5 years old: A systematic review and meta-analysis of randomized clinical trials.

Complement Ther Med 2018 Dec 30;41:10-22. Epub 2018 Aug 30.

Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China. Electronic address:

Objective: To evaluate the benefits and harms of pediatric Tui Na as a non-pharmaceutical Chinese medicine therapy for acute diarrhea in children under 5 years of age.

Design: Systematic review and meta-analysis of randomized clinical trials.

Methods: We searched seven major English and Chinese databases from their inception to January 2018 for randomized clinical trials (RCTs) comparing pediatric Tui Na therapy with conventional medicine (montmorillonite/diosmectite or probiotics used alone or in combination). Two authors extracted data and assessed the Cochrane risk of bias, independently. The primary outcomes are clinical cure rate and diarrhea duration from admission to the cessation of diarrhea. 'Clinical cure' is defined as the frequency, timing and character of stool back to normal status, as well as disappearance of diarrhea symptoms. We present dichotomous data as risk ratio (RR), and continuous data as mean difference (MD) with their 95% confidence interval (CI). We used the Cochrane's Revman software (v.5.3) for data analysis. Trial sequential analysis (TSA) was applied to calculate the required sample size in a meta-analysis and detect the robustness of the results. The GRADEpro was used to generate a summary of finding table.

Results: Totally 26 RCTs were included, involving 2410 children with acute diarrhea. Most of the included trials had high or unclear risk of bias in terms of random sequence generation, blinding, and incomplete outcome reporting. The pooled results demonstrated that pediatric Tui Na was superior to montmorillonite after three-session treatment (RR 1.45, 95% CI 1.29-1.62, n = 772, 10 trials), and also superior to montmorillonite combined with probiotics after three-session treatment (RR 2.04, 95% CI 1.49-2.78, n = 533, 7 trials) and after six-session treatment (RR 1.52, 95% CI 1.34-1.73, n = 631, 5 trials) in improving clinical cure rate. Pediatric Tui Na significantly decreased the duration of acute diarrhea (hrs) (MD -0.40 h, 95% CI -15.31 to -5.48 h, n = 410, 6 trials) and daily stool frequency (MD -1.71times, 95% CI -2.37 to -1.04, n = 217, 3 trials, after three-session treatment). No adverse event related to pediatric Tui Na was reported in the included trials. The quality of evidence of included trials was generally moderate to low. TSA for cure rate demonstrated that the pooled data reached a sufficient power regarding both numbers of trials and participants.

Conclusions: This review shows pediatric Tui Na appears to be effective and safe in improving clinical cure rate and shortening diarrhea duration in childhood aged less than five years of age with acute diarrhea. However, rigorously designed well-reported RCTs are warranted to confirm the findings.
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http://dx.doi.org/10.1016/j.ctim.2018.08.011DOI Listing
December 2018

(ST36) Acupoint Injection for Diabetic Peripheral Neuropathy: A Systematic Review of Randomized Controlled Trials.

J Altern Complement Med 2018 Dec 26;24(12):1138-1149. Epub 2018 Sep 26.

Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.

Acupuncture point (acupoint) injection is a common practice in China. Some trials showed that Chinese herbal extracts and/or conventional medication are injected at the (ST36) acupoint for the treatment of diabetic peripheral neuropathy (DPN). The study aimed to assess the effectiveness and safety of acupoint injection for DPN at the ST36 by systematically evaluating the evidence published to date. Six databases were searched for randomized controlled trials (RCTs) of ST36 injection for DPN with primary outcome of pain, global symptom improvement, and quality of life. Methodological quality was assessed by the Cochrane risk of bias (ROB) tool. Data were analyzed using RevMan 5.3. Fourteen RCTs involving 1,071 participants with DPN were included. All RCTs were assessed as unclear or high ROB. Few RCTs adequately reported methodology-related items and needling details according to Consolidated Standards of Reporting Trials (CONSORT) and Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) statement. Medications injected at ST36 included conventional medications (11 RCTs) and Chinese herbal extracts (3 RCTs). The authors of this study did not perform any meta-analysis due to the heterogeneity of medications used for injections. Two individual RCTs favored ST36 injection in relieving pain compared with intramuscular injection of the same medication. For global symptom measured by Toronto clinical scoring system, one RCT showed that ST36 injection of was more effective than intramuscular injection of vitamin B, two RCTs demonstrated that ST36 injection of mecobalamin or with cointervention was superior, while one RCT showed no significant differences between ST36 injection and intramuscular injection of mecobalamin. For improving nerve conduction velocity (NCV), three of four individual RCTs showed that ST36 injection was better than intramuscular or intravenous injection of the same medication, two RCTs favored ST36 injection with cointervention, and one RCT favored ST36 injection without cointervention. Four RCTs reported monitoring adverse events, all of which showed no significant difference between groups. Limited evidence suggests that ST36 injection appears to be safe, and potentially effective in reducing pain score and improving NCV compared with intramuscular injection of the same medication. However, poor methodological and reporting quality reduced confidence in the findings. Rigorously designed and well-reported RCTs evaluating the effectiveness of ST36 injection for DPN are warranted.
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http://dx.doi.org/10.1089/acm.2018.0053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987730PMC
December 2018

Total glucosides of paeony for rheumatoid arthritis: A systematic review of randomized controlled trials.

Complement Ther Med 2017 Oct 26;34:46-56. Epub 2017 Jul 26.

Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Yinghua East Road No. 2, Chaoyang District, Beijing 100029, China. Electronic address:

Background: Total glucosides of paeony (TGP) is commonly used to treat rheumatoid arthritis (RA) in China. However, clinical practice hasn't been well informed by evidence from appropriately conducted systematic reviews. This PRISMA-compliant systematic review aims at examining the effectiveness and safety of TGP for RA.

Methods: Randomized controlled trials (RCTs) comparing TGP with placebo, no treatment, or disease-modifying antirheumatic drugs (DMARDs) for patients with RA were retrieved by searching seven databases. Primary outcomes included disease improvement and disease remission. Secondary outcomes included adverse effects, pain, health-related quality of life, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Data extraction and analyses were conducted according to the Cochrane standards. We assessed risk of bias for each included studies and quality of evidence on pre-specified outcomes.

Results: Eight studies enrolling 1209 patients with active RA were included in this systematic review. On the basis of traditional DMARD(s), TGP might be beneficial for patients with RA in improvement of American College of Rheumatology (ACR) 20 response rate, ACR 50 response rate, ACR70 response rate, and in reduction of adverse effects, compared with no treatment. The overall methodological quality of included studies and the quality of evidence for each outcome were limited.

Conclusions: Current trials suggested potential benefits of TGP for RA on the basis of traditional DMARD(s). Therefore, TGP may be a good choice for RA as an adjuvant therapy. However, considering the limited methodological quality and strength of evidence, high-quality RCTs are warranted to support the use of TGP for RA.
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http://dx.doi.org/10.1016/j.ctim.2017.07.010DOI Listing
October 2017

Clinical effects of a standardized Chinese herbal remedy, Qili Qiangxin, as an adjuvant treatment in heart failure: systematic review and meta-analysis.

BMC Complement Altern Med 2016 Jul 11;16:201. Epub 2016 Jul 11.

Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.

Background: Qili Qiangxin capsule is a standardized Chinese herbal treatment that is commonly used in China for heart failure (HF) alongside conventional medical care. In 2014, Chinese guidelines for the treatment of chronic HF highlighted Qili Qiangxin capsules as a potentially effective medicine. However, there is at present no high quality review to evaluate the effects and safety of Qili Qiangxin for patients with HF.

Methods: We conducted a systematic review and meta-analysis and followed methods described in our registered protocol [PROSPERO registration: CRD42013006106]. We searched 6 electronic databases to identify randomized clinical trials (RCTs) irrespective of blinding or placebo control of Qili Qiangxin used as an adjuvant treatment for HF.

Results: We included a total of 129 RCTs published between 2005 and 2015, involving 11,547 patients, aged 18 to 98 years. Meta-analysis showed no significant difference between Qili Qiangxin plus conventional treatment and conventional treatment alone for mortality (RR 0.53, 95 % CI 0.27 to 1.07). However, compared with conventional treatment alone, Qili Qiangxin plus conventional treatment demonstrated a significant reduction in major cardiovascular events (RR 0.46, 95 % CI 0.34 to 0.64) and a significant reduction in re-hospitalization rate due to HF (RR 0.49, 95 % CI 0.38 to 0.64). Qili Qiangxin also showed significant improvement in cardiac function measured by the New York Heart Association scale (RR 1.38, 95 % CI 1.29 to 1.48) and quality of life as measured by Minnesota Living with Heart Failure Questionnaire (MD -8.48 scores, 95 % CI -9.56 to -7.39). There were no reports of serious adverse events relating to Qili Qiangxin administration. The majority of included trials were of poor methodological quality.

Conclusions: When compared with conventional treatment alone, Qili Qiangxin combined with conventional treatment demonstrated a significant effect in reducing cardiovascular events and re-hospitalization rate, though not in mortality. It appeared to significantly improve quality of life in patients with HF and data from RCTs suggested that Qili Qiangxin is likely safe. This data was drawn from low quality trials and the results of this review must therefore be interpreted with caution. Further research is warranted, ideally involving large, prospective, rigorous trials, in order to confirm these findings.
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http://dx.doi.org/10.1186/s12906-016-1174-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940829PMC
July 2016

Total glucosides of paeony for rheumatoid arthritis: a protocol for a systematic review.

BMJ Open 2016 Mar 9;6(3):e010116. Epub 2016 Mar 9.

Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing, China.

Introduction: Total glucosides of paeony (TGP) is a natural plant extract, which is widely used in China for treating rheumatoid arthritis (RA). Many relevant randomised controlled trials (RCTs) of TGP for RA are available, but they have not been systematically reviewed. This systematic review aims to examine the effectiveness and safety of TGP in patients with RA.

Methods And Analyses: We will search for RCTs of TGP in the treatment of RA, performed up until February 2016, in PubMed, Embase, Cochrane Central Register of Controlled Trials, and four Chinese databases (Chinese Biomedical Database, China National Knowledge Infrastructure, Wanfang Database and Chinese Scientific Journal Database). Trial registers and reference lists of retrieved articles will also be searched to identify potential articles. RCTs comparing TGP with placebo, no treatment, or disease-modifying antirheumatic drugs for patients with RA will be retrieved. The primary outcomes will be disease improvement and disease remission. The secondary outcomes will be surrogate outcomes, symptoms, adverse effects, and quality of life. Two reviewers will independently extract data on participants, interventions, comparisons, outcomes, etc. The methodological quality of each included study will be evaluated using the Cochrane risk of bias tool, and the strength of evidence on prespecified outcomes will be assessed in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Review Manager 5.3 software will be used for data analyses. Meta-analyses will be performed if the data are sufficiently homogeneous, both statistically and clinically. Possible publication bias will also be checked using funnel plots once the number of included studies is sufficient.

Ethics And Dissemination: Ethics approval is not required, as this study will not involve patients. The results of this study will be submitted to a peer-reviewed journal for publication, to inform both clinical practice and further research.

Trial Registration Number: CRD42015026345.
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http://dx.doi.org/10.1136/bmjopen-2015-010116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785289PMC
March 2016

Integrative treatment for low back pain: An exploratory systematic review and meta-analysis of randomized controlled trials.

Chin J Integr Med 2015 Oct 26. Epub 2015 Oct 26.

School of Health and Social Care, London South Bank University, London, UK.

Objective: Low back pain (LBP) is a common musculoskeletal condition often treated using integrative medicine (IM). Most reviews have focused on a single complementary and alternative medicine (CAM) therapy for LBP rather than evaluating wider integrative approaches. This exploratory systematic review aimed to identify randomized controlled trials (RCTs) and provide evidence on the effectiveness, cost effectiveness and adverse effects of integrative treatment for LBP.

Methods: A literature search was conducted in 12 English and Chinese databases. RCTs evaluating an integrative treatment for musculoskeletal related LBP were included. Reporting, methodological quality and relevant clinical characteristics were assessed and appraised. Metaanalyses were performed for outcomes where trials were sufficiently homogenous.

Results: Fifty-six RCTs were identified evaluating integrative treatment for LBP. Although reporting and methodological qualities were poor, meta-analysis showed a favourable effect for integrative treatment over conventional and CAM treatment for back pain and function at 3 months or less follow-up. Two trials investigated costs, reporting £ 5332 per quality adjusted life years with 6 Alexander technique lessons plus exercise at 12 months follow-up; and an increased total costs of $244 when giving an additional up to 15 sessions of CAM package of care at 12 weeks. Sixteen trials mentioned safety; no severe adverse effects were reported.

Conclusion: Integrative treatment that combines CAM with conventional therapies appeared to have beneficial effects on pain and function. However, evidence is limited due to heterogeneity, the relatively small numbers available for subgroup analyses and the low methodological quality of the included trials. Identification of studies of true IM was not possible due to lack of reporting of the intervention details (registration No. CRD42013003916).
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http://dx.doi.org/10.1007/s11655-015-2125-2DOI Listing
October 2015

Influences of Deqi on Immediate Analgesia Effect of Needling SP6 (Sanyinjiao) in Patients with Primary Dysmenorrhea in Cold and Dampness Stagnation Pattern: Study Protocol for a Randomized Controlled Trial.

Evid Based Complement Alternat Med 2015 30;2015:238790. Epub 2015 Jul 30.

School of Acupuncture Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China ; The Key Unit of State Administration of Traditional Chinese Medicine, Evaluation of Characteristic Acupuncture Therapy, Beijing 100029, China.

Deqi, according to traditional Chinese medicine, is a specific needle sensation during the retention of needles at certain acupoints and is considered to be necessary to produce therapeutic effects from acupuncture. Although some modern researches have showed that Deqi is essential for producing acupuncture analgesia and anesthesia, the data are not enough. It is a paper of a multicenter, randomized controlled study protocol, to evaluate the influences of Deqi on acupuncture SP6 in Cold and Dampness Stagnation pattern primary dysmenorrhea patients, in terms of reducing pain and anxiety, and to find out the relationship between Deqi and the temperature changes at SP6 (Sanyinjiao) and CV4 (Guanyuan). The results of this trial will be helpful to explain the role of Deqi in acupuncture analgesia and may provide a new objective index for measuring Deqi in the future study. This trial is registered with ChiCTR-TRC-13003086.
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http://dx.doi.org/10.1155/2015/238790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534612PMC
August 2015

Is traditional Chinese medicine recommended in Western medicine clinical practice guidelines in China? A systematic analysis.

BMJ Open 2015 06 3;5(6):e006572. Epub 2015 Jun 3.

Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China NAFKAM, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.

Background: Evidence-based medicine promotes and relies on the use of evidence in developing clinical practice guidelines (CPGs). The Chinese healthcare system includes both traditional Chinese medicine (TCM) and Western medicine, which are expected to be equally reflected in Chinese CPGs.

Objective: To evaluate the inclusion of TCM-related information in Western medicine CPGs developed in China and the adoption of high level evidence.

Methods: All CPGs were identified from the China Guideline Clearinghouse (CGC), which is the main Chinese organisation maintaining the guidelines issued by the Ministry of Health of China, the Chinese Medical Association and the Chinese Medical Doctors' Association.TCM-related contents were extracted from all the CPGs identified. Extracted information comprised the institution issuing the guideline, date of issue, disease, recommendations relating to TCM, evidence level of the recommended content and references supporting the recommendations.

Results: A total of 604 CPGs were identified, only a small number of which (74/604; 12%) recommended TCM therapy and only five guidelines (7%) had applied evidence grading. The 74 CPGs involved 13 disease systems according to the International Classification of Diseases 10th edition. TCM was mainly recommended in the treatment part of the guidelines (73/74, 99%), and more than half of the recommendations (43/74, 58%) were related to Chinese herbal medicine (single herbs or herbal treatment based on syndrome differentiation).

Conclusions: Few Chinese Western medicine CPGs recommend TCM therapies and very few provide evidence grading for the TCM recommendation. We suggest that future guideline development should be based on systematic searches for evidence to support CPG recommendations and involve a multidisciplinary approach including TCM expertise.
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http://dx.doi.org/10.1136/bmjopen-2014-006572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458581PMC
June 2015

Evidence base of clinical studies on Tai Chi: a bibliometric analysis.

PLoS One 2015 16;10(3):e0120655. Epub 2015 Mar 16.

Centre for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China; School of Basic Medical Sciences, Beijing University of Chinese Medicine, Beijing, China.

Background: The safety and health benefits of Tai Chi mind-body exercise has been documented in a large number of clinical studies focused on specific diseases and health conditions. The objective of this systematic review is to more comprehensively summarize the evidence base of clinical studies of Tai Chi for healthcare.

Methods And Findings: We searched for all types of clinical studies on Tai chi in PubMed, the Cochrane Library and four major Chinese electronic databases from their inception to July 2013. Data were analyzed using SPSS17.0 software. A total of 507 studies published between 1958 and 2013 were identified, including 43 (8.3%) systematic reviews of clinical studies, 255 (50.3%) randomized clinical trials, 90 (17.8%) non-randomized controlled clinical studies, 115 (22.7%) case series and 4 (0.8%) case reports. The top 10 diseases/conditions was hypertension, diabetes, osteoarthritis, osteoporosis or osteopenia, breast cancer, heart failure, chronic obstructive pulmonary disease, coronary heart disease, schizophrenia, and depression. Many healthy participants practiced Tai Chi for the purpose of health promotion or preservation. Yang style Tai Chi was the most popular, and Tai Chi was frequently practiced two to three 1-hour sessions per week for 12 weeks. Tai Chi was used alone in more than half of the studies (58.6%), while in other studies Tai Chi was applied in combination with other therapies including medications, health education and other physical therapies. The majority of studies (94.1%) reported positive effects of Tai Chi, 5.1% studies reported uncertain effects and 0.8% studies reported negative effects. No serious adverse events related to Tai Chi were reported.

Conclusions: The quantity and evidence base of clinical studies on Tai Chi is substantial. However, there is a wide variation in Tai Chi intervention studied and the reporting of Tai Chi intervention needs to be improved. Further well-designed and reported studies are recommended to confirm the effects of Tai Chi for the frequently reported diseases/conditions.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120655PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361587PMC
October 2015

[Chinese medicine clinical trial protocol design and report specifications].

Zhongguo Zhong Xi Yi Jie He Za Zhi 2014 Aug;34(8):907-10

Clinical trial protocol is the document that illustrates the background of a clinical trial, theoretic basis, objective, design, methods, and organization, as well as statistical calculating, implement, and conditions for completion. Clinical trial protocol is the basic measure for ensuring the validity of scientific results and reducing bias. In order to optimize the design of clinical trial protocol, we generalize main problems in Chinese medicine clinical trials, key points of clinical trial protocol, as well as report standards.
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August 2014

Acupoint Stimulation for Acne: A Systematic Review of Randomized Controlled Trials.

Med Acupunct 2013 06;25(3):173-194

Centre for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China .

Background: Acupoint stimulation-including acupuncture, moxibustion, cupping, acupoint injection, and acupoint catgut embedding-has shown a beneficial effect for treating acne. However, comprehensive evaluation of current clinical evidence is lacking.

Objective: The aim of this review was to assess the effectiveness and safety of all acupoint stimulation techniques used to treat acne vulgaris.

Design: A systematic review was conducted. It included only randomized controlled trials on acupoint stimulation for acne. Six electronic databases were searched for English and Chinese language studies. All searches ended in May 2012. Studies were selected for eligibility and assessed for quality. RevMan 5.1 software was used for data analysis with an effect estimate presented as risk ratios () or mean difference (MD) with a 95% confidence interval (CI).

Patients: Studies with subjects who were diagnosed with acne vulgaris, or papulopustular, inflammatory, adolescent, or polymorphic acne-regardless of gender, age, and ethnicity-were included.

Intervention: Interventions included any acupoint stimulation technique-such as acupuncture, moxibustion, cupping, acupoint injection, and acupoint catgut embedding-compared with no treatment, placebo, or conventional pharmaceutical medication.

Main Outcome Measure: Reduction of signs and symptoms and presence of adverse effects were examined.

Results: Forty-three trials involving 3453 patients with acne were included. The methodological quality of trials was generally poor in terms of randomization, blinding, and intention-to-treat analysis. Meta-analyses showed significant differences in increasing the number of cured patients between acupuncture plus herbal medicine and herbal medicine alone (: 1.60; 95% CI: 1.19-2.14; =0.002), and between acupuncture plus herbal facial mask and herbal facial mask alone (: 2.14; 95% CI: 1.29-3.55; =0.003). Cupping therapy was significantly better than pharmaceutical medications for increasing the number of cured patients (: 2.11; 95% CI: 1.45-3.07; <0.0001). Serious adverse events were not reported in all included trials.

Conclusions: Acupoint stimulation therapies combined with other treatments appears to be effective for acne. However, further large, rigorously designed trials are needed to confirm these findings.
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http://dx.doi.org/10.1089/acu.2012.0906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3689157PMC
June 2013

Songling Xuemaikang Capsule () for primary hypertension: A systematic review of randomized controlled trials.

Chin J Integr Med 2015 Apr 2;21(4):312-20. Epub 2014 Mar 2.

Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.

Objective: To evaluate the effectiveness and safety of Songling Xuemaikang Capsule (, SXC) for the treatment of primary hypertension.

Methods: An extensive search including Cochrane Library, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), KoreaMed, Japanese database, and online clinical trial registry websites was performed up to February 2013. Randomized controlled trials (RCTs) regarding SXC for the treatment of primary hypertension were searched without no language restrictions. The quality of each trial was assessed according to the Cochrane Reviewers' Handbook 5.0, and RevMan 5.0 provided by the Cochrane Collaboration.

Result: A total of 17 RCTs involving 1,778 patients were included. Meta-analysis showed that there was no significant difference between SXC and antihypertensive agents on systolic blood pressure [mean difference (MD): -0.10 [-4.83, 4.63]; P=0.97] and diastolic blood pressure (MD: 1.00 [-1.16, 3.16]; P=0.36), but SXC combined with antihypertensive drugs was more effective in lowering systolic blood pressure (MD: -6.17 [-7.86, -4.49]; P<0.00001) and diastolic blood pressure (MD: -7.24 [-8.62, -5.85]; P<0.00001) compared with the antihypertensive drugs alone.

Conclusions: SXC used alone or combined with antihypertensive drugs appear to be an effective treatment for lowering elevated blood pressure and improving symptoms in patients with primary hypertension. However, the conclusion cannot be drawn definitely due to the poor quality of the included studies. There is still an urgent need for well-designed, long-term studies to address the benefits of SXC for treating primary hypertension.
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http://dx.doi.org/10.1007/s11655-014-1709-6DOI Listing
April 2015

Chinese herbal medicine Guizhi Fuling Formula for treatment of uterine fibroids: a systematic review of randomised clinical trials.

BMC Complement Altern Med 2014 Jan 2;14. Epub 2014 Jan 2.

Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No, 11 Bei San Huan Dong Lu, Beijing, Chaoyang District, China.

Background: Guizhi Fuling Formula is widely applied for uterine fibroids in China. Many clinical trials are reported. This study assessed the efficacy and safety of Guizhi Fuling Formula for the treatment of uterine fibroids.

Methods: PubMed, Cochrane CENTRAL, EMBASE, and four Chinese databases were searched through May 2013. We included randomised controlled trials (RCTs) that tested Guizhi Fuling Formula for uterine fibroids, compared with no intervention, placebo, pharmaceutical medication, or other Chinese patent medicines approved by the State Food and Drug Administration of China. Authors extracted data and assessed the quality independently. We applied RevMan 5.2.0 software to analyse data of included randomised trials.

Results: A total of 38 RCTs involving 3816 participants were identified. The methodological quality of the included trials was generally poor. Meta-analyses demonstrated that Guizhi Fuling Formula plus mifepristone were more effective than mifepristone alone in reducing the volume of fibroids (in total volume of multiple fibroids, MD -19.41 cm(3), 95% CI -28.68 to -10.14; in average volume of multiple fibroids, MD -1.00 cm(3), 95% CI -1.23 to -0.76; in average volume of maximum fibroids, MD -3.35 cm(3), 95% CI -4.84 to -1.87, I(2) = 93%, random effects model). Guizhi Fuling Formula significantly improved symptoms of dysmenorrhea either when it was used alone (RR 2.27, 95% CI 1.04 to 4.97) or in combination with mifepristone (RR 2.35, 95% CI 1.15 to 4.82). No serious adverse events were reported.

Conclusions: Guizhi Fuling Formula appears to have additional benefit based on mifepristone treatment in reducing volume of fibroids. However, due to high risk of bias of the trials, we could not draw confirmative conclusions on its benefit. Future clinical trials should be well-designed and avoid the issues that are identified in this study.
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http://dx.doi.org/10.1186/1472-6882-14-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881498PMC
January 2014

Chinese herbal medicine for the treatment of recurrent miscarriage: a systematic review of randomized clinical trials.

BMC Complement Altern Med 2013 Nov 18;13:320. Epub 2013 Nov 18.

Center for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.

Background: Traditional Chinese medicine has been widely used for the treatment of recurrent miscarriage in China and other Asian countries for long time. We conducted this review to systematically summarize the evidences of Chinese herbal medicine (CHM) for the prevention and treatment of recurrent miscarriage in randomized trials, and evaluate the effectiveness and safety of CHM compared with placebo or conventional medicine.

Methods: We searched studies in PubMed, ClinicalTrials, the Cochrane Library, CNKI, SinoMed and VIP databases until December, 2012. Randomized trials on CHM alone or in combination with conventional medicine for recurrent miscarriage compared with placebo or conventional medicine were included. We evaluated the methodological quality of each included trials using the Cochrane risk of bias tool.

Results: A total of 41 RCTs (3660 participants) were included. The majority of trials had a high or unclear risk of bias. CHM used alone or plus progesterone-based treatment showed superior effect over progesterone-based treatment in improving live birth rate and embryonic developmental state (measured by B ultrasound). However, there is substantial heterogeneity within each subgroup analysis (I2 ranging from 35% to 71%). CHM plus progesterone and hCG-based treatment was superior to progesterone and hCG-based treatment in improving the embryonic developmental state, but not live birth rate. No severe adverse events were reported in relation to CHM.

Conclusions: Some Chinese herbal medicines or in combination with progesterone-based treatment demonstrated potentially beneficial effect in improving live birth rate and embryonic developmental state for women with recurrent miscarriage. However, due to the substantial heterogeneity among the herbal interventions and limitations of methodological quality of the included trials, it is not possible to recommend any specific CHMs for recurrent miscarriage. Further rigorous clinical trials are warranted to evaluate the efficacy and safety of CHM.
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http://dx.doi.org/10.1186/1472-6882-13-320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225605PMC
November 2013

Manual acupuncture for treatment of diabetic peripheral neuropathy: a systematic review of randomized controlled trials.

PLoS One 2013 12;8(9):e73764. Epub 2013 Sep 12.

Centre For Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.

Objective: Manual acupuncture has commonly been used in China, either alone or in combination with conventional medicine, to treat diabetic peripheral neuropathy (DPN). The objective of this study was to perform a systematic review to evaluate the potential benefits and harms of manual acupuncture for DPN to justify its clinical use.

Methods: We searched for published and unpublished randomized controlled trials of manual acupuncture for DPN till 31 March 2013. Revman 5.2 software was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI).

Results: A total of 25 trials involving 1649 participants were included. The methodological quality of included trials was generally poor. Meta-analysis showed that manual acupuncture had better effect on global symptom improvement compared with mecobalamin (RR 1.31, 95%CI 1.21 to 1.42), vitamin B1 and B12 (RR 1.55, 95%CI 1.33 to 1.80), and no treatment (RR 1.56, 95%CI 1.31 to 1.85), and that the combination of manual acupuncture and mecobalamin had better effect compared with mecobalamin alone on global symptom improvement (RR 1.56, 95%CI 1.28 to 1.90). Adverse events were not reported in any trials. The asymmetric funnel plot suggested publication bias.

Conclusions: Despite the number of trials of manual acupuncture for DPN and their uniformly positive results, no clinically relevant conclusions can be drawn from this review due to the trials' high risks of bias and the possibility of publication bias. Clearly defined and internationally acknowledged outcome measures are required for future study. There remains an urgent need for training Chinese researchers in conducting unbiased trials as well as prospectively registering all initiated Chinese trials to avoid publication bias.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0073764PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771980PMC
April 2014

Prospective registration, bias risk and outcome-reporting bias in randomised clinical trials of traditional Chinese medicine: an empirical methodological study.

BMJ Open 2013 16;3(7). Epub 2013 Jul 16.

Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.

Background: Clinical trials on Traditional Chinese Medicine (TCM) should be registered in a publicly accessible international trial register and report on all outcomes. We systematically assessed and evaluated TCM trials in registries with their subsequent publications.

Objective: To describe the characteristics of TCM trials, estimate bias risk and outcome-reporting bias in clinical trials.

Data Sources And Study Selection: Fifteen trial registries were searched from their inception to July 2012 to identify randomised trials on TCM including Chinese herbs, acupuncture and/or moxibustion, cupping, tuina, qigong, etc.

Data Extraction: We extracted data including TCM specialty and treated disease/conditions from the registries and searched for subsequent publications in PubMed and Chinese databases. We compared information in the registries of completed trials with any publications focusing on study design, sample size, randomisation, bias risk including reporting bias from the register protocol.

Results: 1096 registered randomised trials were identified evaluating TCM, of which 505 were completed studies (46.1%). The most frequent conditions were pain (13.3%), musculoskeletal (11.7%), nervous (8.7%), digestive (7.1%), circulatory (6.5%), respiratory (6.3%), mental and behavioural disorders (6.2%) and cancer (6.0%). The trial register data identified parallel, phase II/III randomised trials with sample size estimations and blinding, but limited information about randomisation (sequence generation and allocation concealment). Comparing trial registration data of 115 completed trials (22.8%) with their subsequent 136 publications, inconsistencies were identified in one or more of the following: sample size (11%), outcome assessor blinding (37.5%), primary outcomes (29%) and safety (28%) reporting.

Conclusions: Increasing numbers of clinical trials investigating a variety of TCM interventions have been registered in international trial registries. The study design of registered TCM trials has improved in estimating sample size, use of blinding and placebos. However, selective outcome reporting is widespread and similar to conventional medicine and therefore study conclusions should be interpreted with caution.
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http://dx.doi.org/10.1136/bmjopen-2013-002968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717464PMC
July 2013

Syndrome differentiation in chinese herbal medicine for irritable bowel syndrome: a literature review of randomized trials.

Evid Based Complement Alternat Med 2013 11;2013:232147. Epub 2013 Mar 11.

Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China.

Traditional Chinese medicine (TCM) has been commonly used for irritable bowel syndrome (IBS). Syndrome differentiation is one of the important characteristics of TCM. To assess the application and basic characteristics of syndrome differentiation in randomized controlled trials (RCTs) of Chinese herbal medicine for IBS, we performed this paper. We conducted electronic searches in main Chinese and English databases till March 2012. A total of 735 RCTs involving 67,784 IBS participants were included. 224 (30.5%) studies applied syndrome differentiation. The major syndromes of IBS patients were the syndrome of liver stagnation and spleen deficiency (56.8%), spleen-stomach weakness (49.4%), spleen-kidney yang deficiency (48.1%), and cold and heat in complexity (29.6%). Herbal formulas were prescribed based on syndrome differentiation in 202 studies. Chinese patent medicine was more commonly used in studies that only enrolled patients with a specific syndrome. 15 studies compared the therapeutic effect among different syndromes, of which 6 studies showed that there were significant differences among different syndromes. The low use of TCM syndrome differentiation in randomized trials of Chinese herbal medicine for IBS results in the poor pertinence of treatment. TCM syndrome differentiation should be used in further studies at the stage of recruitment, treatment, and data analyses.
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http://dx.doi.org/10.1155/2013/232147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608279PMC
April 2013
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