Chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and mortality, and is predicted to become the third leading cause of death worldwide by 2020.¹ x 1 Chapman, K.R., Mannino, D.M., Soriano, J.B. et al. Epidemiology and costs of chronic obstructive pulmonary disease. Eur Respir J. 2006; 27: 188–207 Crossref | PubMed | Scopus (476) | Google Scholar See all References ^{, 2} x 2 Murray, C.J. and Lopez, A.D. Alternative projections of mortality and disability by cause 1990-2020: global burden of disease study. Lancet. 1997; 349: 1498–1504 Abstract | Full Text | Full Text PDF | PubMed | Scopus (4917) | Google Scholar See all References Over 10% of the global population (age 40 or older) suffers from stage II or higher COPD with the figure being 14.3% for the United States.³ x 3 Buist, A.S., McBurnie, M.A., Vollmer, W.M. et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007; 370: 741–750 Abstract | Full Text | Full Text PDF | PubMed | Scopus (1254) | Google Scholar See all References In China, COPD affects 8.2% of individuals who are over 40 years old.⁴ x 4 Zhong, N., Wang, C., Yao, W. et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med. 2007; 176: 753–760 Crossref | PubMed | Scopus (389) | Google Scholar See all References COPD is characterized by progressive, non-reversible airflow limitation.⁵ x 5 The Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for diagnosis management and prevention of COPD. ; 2008 http://www.goldcopd.org. Google Scholar See all References As there is no cure, symptom management, quality of life (Qol) improvement and reducing exacerbations become the primary treatment objectives.⁶ x 6 Abramson, M., Crockett, A.J., Frith, P.A. et al. The COPD-X Plan: Australian and New Zealand guidelines for the management of chronic obstructive pulmonary disease 2009. ; 2009 http://www.copdx.org.au/guidelines. Google Scholar See all References It is generally understood that current pharmacotherapy does not prevent progression of COPD nor improve lung function.⁵ x 5 The Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for diagnosis management and prevention of COPD. ; 2008 http://www.goldcopd.org. Google Scholar See all References Moreover, they have been associated with significant adverse events such as oropharyngeal candidiasis, bruising and risk of pneumonia.⁶ x 6 Abramson, M., Crockett, A.J., Frith, P.A. et al. The COPD-X Plan: Australian and New Zealand guidelines for the management of chronic obstructive pulmonary disease 2009. ; 2009 http://www.copdx.org.au/guidelines. Google Scholar See all References Complementary and alternative medicines are increasingly being used by patients with chronic disease.⁷ x 7 Saydah, S.H. and Eberhardt, M.S. Use of complementary and alternative medicine among adults with chronic diseases. J Altern Complement Med. 2002; 2006: 805–812 (United States) Google Scholar See all References Herbal medicines are used by 14% of adults with chronic pulmonary conditions and specifically, Ginseng is used by 23% of herbal medicine consumers in the US⁸ x 8 Mehta, D.H., Gardiner, P.M., Phillips, R.S. et al. Herbal and dietary supplement disclosure to health care providers by individuals with chronic conditions. J Altern Complement Med. 2008; 14: 1263–1269 Crossref | PubMed | Scopus (66) | Google Scholar See all References and 6% of the Victorian (Australia) herb users.⁹ x 9 Zhang, A.L., Story, D.F., Lin, V. et al. A population survey on the use of 24 common medicinal herbs in Australia. Pharmacoepidemiol Drug Saf. 2008; 17: 1006–1013 Crossref | PubMed | Scopus (41) | Google Scholar See all References

Background: The coronavirus disease 2019 (COVID‐19) has turned into a pandemic and resulted in huge death tolls and burdens. Integrating Chinese and western medicine has played an important role in the fight against the COVID‐19 pandemic.Purpose: We aimed to develop a living evidence‐based guideline of integrating Chinese and western medicine for COVID‐19.Study design: Living evidence‐based guideline.Methods: This living guideline was developed using internationally recognized and accepted guideline standards, dynamically monitoring the release of new clinical evidence, and quickly updating the linked living systematic review, evidence summary tables, and recommendations. Modified Delphi method was used to reach consensus for all recommendations. The certainty of the evidence, resources, and other factors were fully considered, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the certainty of evidence and the strength of recommendations.Results: The first version of this living guidance focuses on patients who are mild or moderate COVID‐19. A multidisciplinary guideline development panel was established. Ten clinical questions were identified based on the status of evidence and a face‐to‐face experts’ consensus. Finally, nine recommendations were reached consensus, and were formulated from systematic reviews of the benefits and harms, certainty of evidence, public accessibility, policy supports, feedback on proposed recommendations from multidisciplinary experts, and consensus meetings.Conclusion: This guideline panel made nine recommendations, which covered five traditional Chinese medicine (TCM) prescription granules/decoction (MXXFJD, QFPD, XFBD, TJQW, and JWDY), three Chinese patent medicines (LHQW granules/capsule, JHQG granules, and LHQK granules), and one Chinese herbal injection (XBJ injection). Of them, two were strongly recommended (LHQW granules/capsule and QFPD decoction), and five were weakly recommended (MXXFJD decoction, XFBD decoction, JHQG granules, TJQW granules, and JWDY decoction) for the treatment of mild and moderate COVID‐19; two were weakly recommended against (XBJ injection and LHQK granules) the treatment of mild and moderate COVID‐19. The users of this living guideline are most likely to be clinicians, patients, governments, ministries, and health administrators.

Background: Body constitution is a fundamental concept in traditional Chinese medicine (TCM) for clinical diagnosis, treatment of illness, and community-based health promotion. Clinical assessment of patients’ body constitutions, however, has never been easy and consistent, even by well-trained clinicians and TCM practitioners. Therefore, questionnaires such as the popular Constitution in Chinese Medicine Questionnaire (CCMQ) can be an appealing and convenient assessment alternative. The present research borrowed advanced methodologies for questionnaire development in psychology and other social sciences to examine the performance of the CCMQ in terms of (i) the strength of relations of each item with its designated constitution, (ii) the reliabilities of each constitution, and (iii) the overall 9-constitution structure. This research provided empirical evidence to support the use of the CCMQ and proposed directions for refinement in future revisions of the CCMQ or similar measures. Methods: A total of 1571 volunteers from three villages in southern China participated in the CCMQ survey. The item characteristics, reliabilities, interconstitution correlations, and confirmatory factor analysis of the 9-body-constitution structure were examined. Results: The results generally supported the appropriateness of the clinical observations (the questionnaire items) and the CCMQ 9-constitution classification structure. Nevertheless, some relatively weaker items, item pairs with similar meanings, and highly overlapping constitutions were identified for future CCMQ revisions. Conclusion: The CCMQ measured the 9 constitutions efficiently and with reasonably good reliability and construct validity. Given the various challenges to assessing TCM body constitutions even by experienced clinicians, the CCMQ provides an appealing alternative to measure the Chinese body constitutions of healthy participants in large-scale research or community health promotion programs. The present study also demonstrated how advanced methodologies in social sciences can help validate and refine the CCMQ and similar complementary medicine measures.

Integrated traditional Chinese medicine (TCM) and Western medicine (WM) is a new medical science grounded in the knowledge bases of both TCM and WM, which then forms a unique modern medical system in China. Integrated TCM and WM has a long history in China, and has made important achievements in the process of clinical diagnosis and treatment. However, the methodological defects in currently published clinical practice guidelines limit its development. The organic integration of TCM and WM is a deeper integration of TCM and WM. To realize the progression of "integration" to "organic integration", a targeted and standardized guideline development methodology is needed. Therefore, the purpose of this study is to establish a standardized development procedure for clinical practice guidelines for the organic integration of TCM and WM to promote the systematic integration of TCM and WM research results into clinical practice guidelines in order to achieve optimal results as the whole is greater than the sum of the parts.

Background: Pediatric Tuina has been widely used in children with acute diarrhea in China. However, due to the lack of high-quality clinical evidence, the benefit of Tuina as a therapy is not clear. We aimed to assess the effect of pediatric Tuina compared with sham Tuina as an add-on therapy in addition to usual care for 0–6-year-old children with acute diarrhea. Methods: Eighty-six participants aged 0–6 years with acute diarrhea were randomized to receive pediatric Tuina plus usual care (n = 43) or sham Tuina plus usual care (n = 43). The primary outcomes were days of diarrhea from baseline and times of diarrhea on day 3. Secondary outcomes included a global change rating (GCR) and the number of days when the stool characteristics returned to normal. Adverse events were assessed. Results: Pediatric Tuina was associated with a reduction in times of diarrhea on day 3 compared with sham Tuina in both ITT (crude RR, 0.73 [95% CI, 0.59–0.91]) and PP analyses (crude RR, 0.66 [95% CI, 0.53–0.83]). However, the results were not significant when we adjusted for social demographic and clinical characteristics. No significant difference was found between groups in days of diarrhea, global change rating, or number of days when the stool characteristics returned to normal. Conclusions: In children aged 0–6 years with acute diarrhea, pediatric Tuina showed significant effects in terms of reducing times of diarrhea compared with sham Tuina. Studies with larger sample sizes and adjusted trial designs are warranted to further evaluate the effect of pediatric Tuina therapy. Trial registration: Clinicaltrials.gov, Identifier: NCT03005821, Data of registration: 2016-12-29.

Pattern diagnosis-guided treatments in Traditional Chinese Medicine (TCM) has been recognised by the eleventh revision of the International Classification of Diseases (ICD-11). Accurate pattern diagnosis requires reliable and valid diagnostic instruments that guide the collection of TCM clinical data without bias. This study synthesised the existing TCM diagnostic instruments for functional dyspepsia (FD) and appraised their quality regarding their development process and measurement properties. Seven electronic databases were searched for validation studies on TCM diagnostic instruments for FD. Synthesis and appraisal of the included studies were performed following the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) Initiative guidelines adapted for TCM diagnostic instruments. Risk of bias assessment was conducted using the COSMIN Risk of Bias Checklist. Five studies were included, with five unique TCM diagnostic instruments for FD identified. All five diagnostic instruments were of inadequate quality in terms of their development process, implying a shortcoming in their relevance, comprehensibility, and comprehensiveness. Only the criterion validity of Stomach Qi Deficiency Pattern Assessment Scale was of sufficient quality and had no risk of bias in its validation. The quality of TCM diagnostic instruments for FD warrants urgent improvements. None of them was considered reliable or valid for guiding TCM pattern diagnosis. To support the evidence base of the standardization of TCM patterns in ICD-11, TCM diagnostic instruments should be developed and validated rigorously under the COSMIN guidelines. Amendments should be made on the guidelines to accommodate the features and uniqueness of TCM diagnostic process.