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This study aims to investigate the etiology， pathogenic properties and pathogenic characteristics of corona virus disease-2019 （COVID-19） in traditional Chinese medicine（TCM）， so as to provide ideas for clinical treatment based on syndrome differentiation. Efforts were made to retrive relevant literature concerning clinical studies， theoretical discussions and TCM diagnosis and treatment schemes issued by the state and various provinces， municipalities， autonomous regions and municipalities directly under the central government in relation to TCM from China Knowledge Network（CNKI） and Wanfang Database， and to analyze and summarize the etiology， pathology， theoretical viewpoints， clinical symptoms and signs， syndrome differentiation and medication rules. Currently， the common understanding of the etiology of COVID-19 in the field of TCM is the infection of "pestilential pathogen". However， there is a dispute over cold and heat or mixed understanding of cold and heat in terms of pathogenic attributes. The pathogenic factors are different from each other in dampness， toxin， dryness， fire （heat）， wind， filth， depression， etc. There are various understandings on the pathogenesis including dampness， cold， heat， toxin， stasis， phlegm， stagnation， knot， dryness， filth， deficiency， blocking， collapse and asthma， etc. The etiology and pathogenesis are often mixed up. Integration of cold and heat， dryness and dampness， and other contradictory pathogens or pathogenesis is widely seen， which lacks the logicality of theoretical systems， and does not in line with the thinking characteristics of TCM on the etiology， pathogenesis， and syndrome differentiation of exogenous diseases. The main idea of medication in treatment is to diffuse the lung， clear away heat， eliminate dampness， resolve phlegm and repel foulness with aromatics. Maxing Shigantang is used as the core prescription. Chosen warm acrid drugs are mainly the ones with the effect of fragrance， removing dampness， resolving phlegm， and invigorating spleen. They are not the ones with the effects of warming yang and dissipating cold， but the combination of cold and heat， suggesting the complexity of etiology and pathogenesis. COVID-19 is categorized as plaque in TCM， and its etiology is "pestilential pathogen". This pestilential pathogen possesses not only the basic properties of toxin and filth， but also the characteristics of dampness， heat and wind. Throughout the course of the disease， phlegm， stasis， stagnation and other secondary pathogenic factors also occur. The evolution of pathogenesis is characterized by depression， blocking， and deficiency. There are more evidences that the pestilential pathogen of COVID-19 belongs to heat property no matter in the aspects of clinical manifestation， transmission law （syndrome differentiation at different stages）， or in compatibility of medication.
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To clarify the clinical application of the group standard (T/CACM 1035-2017) of the Chinese Society of Traditional Chinese Medicine (TCM), the clinical practice guideline on traditional chinese medicine therapy alone or combined with community acquired pneumonia, and to understand the clinical applicability of the Guideline. The clinical workers trained in terms of the Guideline in hospitals at all levels in China were selected as the research objects. A total of 494 questionnaires on application evaluation and 511 questionnaires on applicability evaluation were collected to construct the database of the post-effect evaluation of the Guideline. Excel software was used for statistical analysis. The overall evaluation of the Guideline was 92.31%, 91.06%, 87.45% respectively in efficacy, safety and economy. The Guideline was well used in clinical application, and 99.41% of the patients were willing to follow the recommended scheme. The agreed ratio in rationality evaluation was 97.98%, 92.37%, 94.53% and 92.71% in treatment rules, syndrome differentiation and classification, prevention of complications, and rehabilitation method. The effective rate of the prescriptions recommended in the Guideline was all above 65%. More than 80% of the prescriptions were Tanreqing Injection, Yinqiao Powder, Qingjin Huatan Decoction, Maxing Shigan Decoction, Shengmai San and Shashen Maidong Decoction. Adverse reactions, unknown active components and economy of Chinese patent medicines were the important factors affecting drug use and efficacy, providing a clinical basis for updating and revising the standard.
Subject(s)
Humans , Anti-Bacterial Agents , China , Community-Acquired Infections , Drug Therapy , Drugs, Chinese Herbal , Medicine, Chinese Traditional , PneumoniaABSTRACT
Objective To investigate the MR features of different clinical staging of scapulohumeral periarthritis and provide relevant support data for the clinical staging of scapulohumeral periarthritis, so as to guide clinical treatment. Methods 30 patients with scapulohumeral periar-thritis received in the hospital from June 2015 to February 2017 were selected to form the observation group and 8 same-sex and same-aged volunteers without such disease were selected to form the control group. MR imaging was used to observe and measure the structure of shoulder joint of the people in the two groups and statistical analysis was performed to analyze the changes in the structure of the shoulder around dif-ferent clinical stages. Results The thickness of joint capsule and coracohumeral ligament ( CHL) , the ratio of subcoracoid fat triangle re-placed were significantly greater in patients with scapulohumeral periarthritis than those in the control group, and the difference was statisti-cally significant (P<0. 05). Comparing the thickness of joint capsule in the third stage of the scapulohumeral periarthritis group compare with those in the first and second stages, the difference was statistically significant (P<0. 05). There was no statistically significant differ-ence (P>0. 05) in the thickness of the coracohumeral ligament and the ratio of subcoracoid fat triangle replaced in the scapulohumeral peri-arthritis group between the 1st, 2nd and 3rd stages. Conclusion Patients with different stages have different structures around the shoulder joints. The thickness of joint capsule can be used as an important reference for diagnosing scapulohumeral periarthritis and can guide the clin-ical staging. The thickness of coracohumeral ligament and the ratio of subcoracoid fat triangle replaced can be used as a basis for diagnosing scapulohumeral periarthritis, but it cannot be used as a guideline for clinical staging.
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Objective: To compare the clinical features between very late stent thrombosis (VLST) and very late in-stent restenosis, to discuss the potential risk factors for VLST occurrence. Methods: Our research included in 2 groups: VLST group, 21 ACS patients with coronary angiography (CAG) confirmed VLST admitted in our hospital and Control group, 38 ACS patients with CAG confirmed very late in-stent restenosis at same period of time. Basic clinical data, laboratory tests and relevant examinations were compared between 2 groups; potential risk factors for VLST occurrence were studied by Logistic regression analysis. Results: ① There were 8 (38.1%) patients discontinued anti-platelet therapy in a month by themselves in VLST group and 5 (13.2%) in Control group, P=0.03. ② 13 (61.9%) patients presented as ST-segment elevation myocardial infarction (STEMI) in VLST group, while all (100%) patients presented as Non-ST-segment elevation ACS (NST-ACS) in Control group, P<0.001. ③ The age, gender, previous histories of hypertension, diabetes, MI, smoking and interventional therapy were similar between 2 groups, P>0.05. ④ Compared with Control group, VLST group had decreased LVEF, P=0.001, increased peak values of TnI and NT-pro BNP, elevated WBC and hs-CRP, all P<0.001. ⑤ The index of echocardiography, blood lipid profiles, glucose and creatinine were similar between 2 groups, P>0.05. ⑥ Logistic regression analysis showed that discontinued anti-platelet therapy, elevated NT-pro BNP and hs-CRP were the independent risk factors for VLST occurrence, P<0.05. Conclusion: VLST may have life-threatening clinical features, insisted anti-platelet therapy and improved cardiac function could reduce VLST occurrence.
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Among the literatures of the prevention and treatment of community-acquired pneumonia (CAP) published in recent years, there were 16 kinds of classic prescription, including 52 RCTs about Maxingshigan Decoction, 21Chinese patent medicines. There are eight kinds of indications for the drug specification, among which the literatures of Tan Reqing injection accounted for the most about 136 RCTs; There were literatures about non-drug treatment, including： acupuncture, Chinese medicine paste, enema, Chinese medicine ionization, Chinese medicine fumigation, bamboo cans and so on. In this study, author has analysed the classic prescription, Chinese patent medicine and non-drug therapy referring to advantages and disadvantages of CAP, which could be used to treat virus infection instead of antibiotic therapy. Based on antibiotic therapy, Chinese medicine treatment could increase synergistic interaction while decrease the antibiotic side-effects. In addition, Chinese medicine could perform synergistic interaction in CAP every period, which resulted from classified analysis of basic studies about Chinese medicine treatment in CPA. This study is aimed to provides an important basis for clarifying the direction of scientific research.
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This study is aimed to identify and assess the methodological quality of community-acquired pneumonia (CAP) clinical practice guidelines (CPG) in China by using AGREE Ⅱ tool. CNKI, SinoMed, Wanfang, and VIP Chinese databases from database establishment to March 2017 were searched by manual retrieval to collect all the clinical practice guidelines prepared by various associations or organizations, then AGREE Ⅱtool was used to assess them. Data in each CPG were analyzed in terms of six domains, including scope and purpose, participants, rigor, clarity and readability, applicability and editorial independence. A total of 4 CPGs were included. The results showed that the scope and purpose scored 45.8%; the clarity of expression scored 44.75%; the participants scored 31.9%; the rigor scored 18.98%; the applicability scored 7%; and finally the editorial independence scored 1%. It is concluded that the quality of applicability and the editorial independence should attained paid more attention in future development or updating of the guidelines. In addition to strengthening the compliance with international general principles, we should also pay attention to the characteristics of traditional Chinese medicine treatment, especially the related evidences as complementary and alternative treatment for western intervention measures.
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<p><b>OBJECTIVE</b>To observe effect of Shufeng Xuanfei Recipe (SXR) and Jiebiao Qingli Recipe (JQR) on mRNA and protein expressions of Toll-like receptor 7 (TLR7), myeloid differentiation factor 88 (MyD88), and nuclear factor-kappaB (NF-kappaB) in mice infected with influenza virus FM1.</p><p><b>METHODS</b>One hundred and eight mice were randomly divided into nine groups, i.e., the normal control group, the model group, the Oseltamivir group (at the daily dose of 2.5 g/mL), the high dose SXR group (at the daily dose of 3.762 g/kg), the middle dose SXR group (at the daily dose of 1.881 g/kg), the low dose SXR group (at the daily dose of 0.941 g/kg), the high dose JQR group (at the daily dose of 4.368 g/kg), the middle dose JQR group (at the daily dose of 2.184 g/kg), and the low dose JQR group (at the daily dose of 1.092 g/kg), 12 in each group. All mice were mildly anesthetized by ether. Mice in the normal control group were treated by nasal drop of 0.05 mL normal saline, while mice in the rest groups were infected by nasal drop of 0.05 mL influenza virus strain FM1 (LD50). The successful modeling rate was 100%. All medication was performed by gastrogavage 2 h after infection. Distilled water was given by gastrogavage to mice in the normal control group and the model group at the daily dose of 0.2 mL, each time per day for 4 successive days. mRNA expressions of TLR7, MyD88, and NF-kappaB in the lung tissue were determined by Western blot.</p><p><b>RESULTS</b>Compared with the normal control group, mRNA expressions of TLR7, MyD88, and NF-kappaB increased in the model group (P < 0.01). Compared with the model group, mRNA and protein expressions of TLR7, MyD88, and NF-kappaB decreased in the Oseltamivir group, the high, middle, and low dose SXR groups (P < 0.05, P < 0.01); mRNA and protein expressions of TLR7 and NF-kappaB decreased in the high and middle dose JQR groups (P < 0.05, P < 0.01); mRNA expressions of MyD88 decreased in the high and middle dose JQR groups (P < 0.05); protein expressions of MyD88 decreased in the middle dose JQR group (P < 0.05); protein expressions of TLR7 and NF-kappaB decreased in the low dose JQR group (P < 0.05). Compared with the Oseltamivir group, protein expressions of MyD88 decreased in the low dose SXR group (P < 0.05); protein expressions of NF-kappaB decreased in the middle and low dose SXR groups (P < 0.01); mRNA and protein expressions of TLR7 (P < 0.05, P < 0.01), and protein expressions of MyD88 (P < 0.01) decreased in the high, middle, and low dose JQR groups; mRNA and protein expressions of NF-kappaB decreased in the low dose JQR group (P < 0.05, P < 0.01).</p><p><b>CONCLUSIONS</b>Each dose SXR and middle dose JQR could down-regulating the activity of NF-kappaB through adjusting MyD88 dependent TLR signal pathway, thus fighting against influenza virus. SXR was more effective than JQR.</p>