Influenza is a major public health problem worldwide. Mutations and resistance development make the use of antiviral therapy challenging. Chinese patent medicines are often used to treat influenza in China and well tolerable. However, the misuse of Chinese patent medicines is common. We therefore aimed to develop an evidence-based guideline on treating influenza with Chinese patent medicines in adults to guide clinical practice. We formed a steering committee, a consensus panel, a consultants' group and an evidence synthesis team to guide the development of the guideline. We formulated the clinical questions through two rounds of survey, and finally selected five questions. We then systematically searched the related evidence and conducted meta-analyses, evidence summaries and GRADE decision tables to draft the recommendations, which the consensus panel then voted on using the Delphi method. Finally, we formulated six recommendations based on the evidence synthesis and experts' consensus. For treating mild influenza, we suggest either Lianhua Qingwen capsule, Jinhua Qinggan granule, Banlangen granule, Shufeng Jiedu capsule, or Jinfang Baidu pill, depending on the manifestations. For severe influenza, or mild influenza in patients at high risk of developing severe influenza, we suggest Lianhua Qingwen capsule in combination with antiviral medications and supportive therapy. The strength of all recommendations was weak. Traditional Chinese medicine has great potential to help in the fight against influenza worldwide, but more high-quality studies are still needed to strengthen the evidence.

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

Gastric cancer is recognized as one of the most common cancer. In-depth research of gastric precancerous lesions (GPL) plays an important role in preventing the occurrence of gastric cancer. Meanwhile, traditional treatment provides a novel sight in the prevention of occurrence and development of gastric cancer. The current study was designed to assess the effects of therapy with Weipixiao (WPX) decoction on N-methyl-N'-nitro-N-nitrosoguanidine (MNNG)-induced GPL rats and the underlying molecular mechanisms. After 10-weeks treatment, all rats were sacrificed. Histopathological changes of gastric tissue were assessed via hematoxylin-eosin (HE) and High-iron diamine-Alcian blue-Periodic acid-Schiff (HID-AB-PAS) staining. To be fully evidenced, RT-qPCR, Western blot and immunohistochemistry were used to detect the expressions of LDHA, CD147, HIF-1α, MCT4, PI3K, AKT, mTOR and miRNA-34a, which were crucial factors for evaluating GPL in the aspect of glycolysis pathogenesis. According to the results of HE and HID-AB-PAS staining, it could be confirmed that MNNG-induced GPL rats were obviously reversed by WPX decoction. Additionally, the increased gene levels of LDHA, CD147, MCT4, PI3K, AKT, mTOR and HIF-1α in model group were down-regulated by WPX decoction, while miRNA-34a expression was decreased and up-regulated by WPX decoction. The significantly increased protein levels of LDHA, CD147, MCT4, PI3K, AKT, mTOR and HIF-1α induced by MNNG were attenuated in rats treated with WPX decoction. In brief, the findings of this study imply that abnormal glycolysis in MNNG-induced GPL rats was relieved by WPX decoction via regulation of the expressions of LDHA, CD147, HIF-1α, MCT4, PI3K, AKT, mTOR and miRNA-34a.

This systematic review evaluated the effects of Chinese herbal medicine (CHM) plus routine pharmacotherapy (RP) on the objective outcome measures BODE index, 6-minute walk test (6MWT), and 6-minute walk distance (6MWD) in individuals with stable chronic obstructive pulmonary disease (COPD). Searches were conducted of six English and Chinese databases (PubMed, EMBASE, CENTRAL, CINAHL, CNKI and CQVIP) from their inceptions until 18th November 2013 for randomized controlled trials involving oral administration of CHM plus RP compared to the same RP, with BODE Index and/or 6MWT/D as outcomes. Twenty-five studies were identified. BODE Index was used in nine studies and 6MWT/D was used in 22 studies. Methodological quality was assessed using the Cochrane Risk of Bias tool. Weaknesses were identified in most studies. Six studies were judged as ‘low’ risk of bias for randomisation sequence generation. Twenty-two studies involving 1,834 participants were included in the meta-analyses. The main meta-analysis results showed relative benefits for BODE Index in nine studies (mean difference [MD] −0.71, 95% confidence interval [CI] −0.94, −0.47) and 6MWT/D in 17 studies (MD 54.61 meters, 95%CI 33.30, 75.92) in favour of the CHM plus RP groups. The principal plants used were Astragalus membranaceus, Panax ginseng and Cordyceps sinensis. A. membranaceus was used in combination with other herbs in 18 formulae in 16 studies. Detailed sub-group and sensitivity analyses were conducted. Clinically meaningful benefits for BODE Index and 6MWT were found in multiple studies. These therapeutic effects were promising but need to be interpreted with caution due to variations in the CHMs and RPs used and methodological weakness in the studies. These issues should be addressed in future trials.