Year : 2014 | Volume
: 1 | Issue : 2 | Page : 58--59
Evidence-Based Differential Diagnosis and Treatment of Syndromes in Traditional Chinese Medicine
Yunman Wang, Hao Wang, Yujun Liu, Wen Peng
Department of Nephrology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
Department of Nephrology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai - 200062
Evidence-based medicine has become increasingly important to medicine, how to deal with evidence-based medicine traditional Chinese medicine (TCM) syndrome diagnostic criteria and treatment of the relationship between the experiences will be a hot topic currently. TCM syndrome diagnostic criteria derived from the accumulated experience of the ancient physicians in medical practice, but the diagnostic criteria specified in medicine needs to be improved; experience in the treatment of evidence-based medicine as an important component is unlikely to be replaced, for evidence-based medicine TCM specificity, only through the practice of TCM syndrome diagnosis based on standard combination treatment experience, from simple to complex, TCM evidence-based medicine in order to have a new development.
|How to cite this article:|
Wang Y, Wang H, Liu Y, Peng W. Evidence-Based Differential Diagnosis and Treatment of Syndromes in Traditional Chinese Medicine.J Integr Nephrol Androl 2014;1:58-59
|How to cite this URL:|
Wang Y, Wang H, Liu Y, Peng W. Evidence-Based Differential Diagnosis and Treatment of Syndromes in Traditional Chinese Medicine. J Integr Nephrol Androl [serial online] 2014 [cited 2021 Feb 28 ];1:58-59
Available from: http://www.journal-ina.com/text.asp?2014/1/2/58/143377
Evidence-based medicine refers to the clinical practice based on the scientific evidence. It is defined by the eminent clinical epidemiologist Dr. David Sackert as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.  The core of this proposal is that any health plan or decision should be based on the best clinical evidence provided by the objective clinical scientific study. Therefore, all the policies and plans can achieve the purpose of disease prevention, health promotion and life quality improvement. Clinical evidence mainly comes from randomized controlled trial (RCT) involving large sample size, systematic review and meta-analysis.
Relationship between evidence-based medicine and Traditional Chinese Medicine
The purpose of evidence-based medicine is to solve the problems in clinical practice as follows:
Seeking solutions to different clinical problems in diagnosis and treatment; Acquiring the best evidence in the most effective way; Evaluating the accuracy, reliability and feasibility of the evidence objectively; Integrating the evidence with individual clinical expertise and professional advice to direct the clinical practice; Assessing the effects of the above-mentioned evidence-based clinical practice.
Fundamentally speaking, TCM is an evidence-based medicine. With the history of thousands of years, TCM has summarized different clinical problems into groups of syndromes (the position, etiology, characteristics and immune ability against the disease). During the diagnosis and treatment, TCM exemplifies the idea of "referring to authoritative works" and "examining the source." To verify the ancient practice is to seek the evidence. In most cases, the treatment is based on previous effective treatment, personal experience and the real situation. To combine TCM and evidence-based medicine is a road leading to the international arena.
Characteristics of evidence-based TCM
Currently, there are three evidence sources for TCM. The first is the four classics, especially the "Yellow Emperor Internal Medicine" and "Treatise on Febrile and Miscellaneous Disease," the fundamental and most important evidence in TCM. The second is other classic works including innumerable amount of evidence with different accuracy and reliability. The third is the clinical evidence obtained from the modern science. All the evidence reported in the literature has guided the TCM practice from the past to present.
Emphasizing syndrome grouping
TCM emphasizes treatment based on syndrome differentiation. All the problems are distinguished by different syndromes, based on which the treatment is formulated. Therefore, syndrome differentiation study is a characteristic of TCM. Although diseases are innumerable, they can be treated with limited similar treatments when distinguished into different syndrome groups.
Development of evidence-based TCM
Problems in evidence-based TCM
Early studies in which the diagnostic criteria for common diseases syndromes are not uniform have been restricting the scientific research and the new drug development in TCM. Different criteria lead to poor reproducibility and low confidence, significantly hindering the development of TCM. The diagnosis and treatment criteria are mainly based on personal experience. For example, Kong et al. studied the syndrome of chronic renal failure with TCM differential view, which showed that although the syndrome and the criteria of chronic renal failure in TCM were established at national conferences 1983 and 1987, many later studies did not follow the guidelines.
TCM studies still lack good experimental design and enough sample size. And the measurement methods for observed indicators are not clear. Either syndromes or therapeutic evaluation indicators are difficult to be standardized. The therapeutic indicators are less scientific and lack long-term follow-up endpoints, such as mortality and morbidity and so on. These issues directly affect the authenticity of the findings and reduce the scientific value of the study. Li et al. evaluated 32,939 papers out of 13 journals, in which 3312 papers were RCT, accounting for 10.1%, a quite low proportion. By the standards of evidence-based medicine, the researches of TCM are at the low level.
Progress of TCM evidence-based medicine
In classification of TCM syndromes, the establishment of Guidelines for New Traditional Chinese Medicine Drug Research and Therapeutic Standards for Traditional Chinese Medicine Diagnosis and Treatment is playing a positive role in unifying diagnostic criteria. , Meanwhile, TCM has been included in WHO/ICD-11, which offers an independent description of disease classification. Diagnosis and Treatment Guidelines for Common Diseases in TCM by Traditional Chinese Medicine Internal Medicine Association and TCM Evidence-Based Clinical Practice Guidelines by China Academy of Traditional Chinese Medicine sponsored by WTO are all established through systematic evaluation of clinical evidence based on international guidance principles.
In the process of TCM evidence-based medicine development, we have been exploring the ways from simple to complex while correcting the mistakes all the way around. We are sticking to differentiation and studying the current evidence, such as the four classics and previous medical practice, raising the levels of the current evidence and continuously innovating along the road. We will absolutely make new progress in TCM evidence-based medicine.
|1||Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence-based Medicine: What it is and What it isn′t. BMJ 1996;312:71-2.|
|2||Shea JL, Shi CX. Application of Evidence-based Medicine in Chinese Medicine: Debate and strategy. Zhongguo Zhong Xi Yi Jie He Za Zhi 2010;30:233-6.|
|3||Li TQ, Mao B, Chang J, Yang XN, Wang L, Zhang Y, et al. An Evaluation of Clinical Research Literatures in Core Journals of Traditional Chinese Medicine Integrated with Western Medicine or Traditional Chinese Medicine. West China Med J 2000;15:266-9.|
|4||Liu JP. Evidence-based medicine and evaluation of TCM efficacy. J Tradit Chin Med 2007;48:27-8.|
|5||Liu JP, Wang SC, Wu DR. Establishment and implementation of evidence-based clinical pathway of Chinese medicine. Zhongguo Zhong Xi Yi Jie He Za Zhi 2011;31:115-9.|