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Background The timing of administration of agents and use of combination treatments in COVID-19 remain unclear. We assessed the effectiveness of therapeutics in cohorts in Hong Kong SAR and Anhui, China. Methods We conducted propensity-score analysis of 4771 symptomatic patients from Hong Kong between 21st January and 6th December 2020, and 648 symptomatic patients from Anhui between 1st January and 27th February 2020. We censored all observations as at 13st December 2020. Time from hospital admission to discharge, and composite outcome of death, invasive mechanical ventilation or intensive care unit admission across 1) all therapeutic options including lopinavir-ritonavir, ribavirin, umifenovir, interferon-alpha-2b, interferon-beta-1b, corticosteroids, antibiotics, and Chinese medicines, and 2) four interferon-beta-1b combination treatment groups were investigated. Findings Interferon-beta-1b was associated with an improved composite outcome (OR=0.55, 95%CI 0.38, 0.80) and earlier discharge (−8.8 days, 95%CI −9.7, −7.9) compared to those not administered interferon-beta-1b. Oral ribavirin initiated within 7 days from onset was associated with lower risk of the composite outcome in Hong Kong (OR=0.51, 95%CI 0.29, 0.90). Lopinavir-ritonavir, intravenous ribavirin, umifenovir, corticosteroids, interferon-alpha-2b, antibiotics or Chinese medicines failed to show consistent clinical benefit. Interferon-beta-1b co-administered with ribavirin was associated with improved composite outcome (OR=0.50, 95%CI 0.32, 0.78) and earlier discharge (−2.35 days, 95%CI −3.65, −1.06) compared to interferon-beta-1b monotherapy. Interpretation Our findings support the early administration of interferon-beta-1b alone or in combination with oral ribavirin for COVID-19 patients. Funding Hong Kong Health and Medical Research Fund; Hong Kong Innovation and Technology Commission; Chinese Fundamental Research Funds for the Central Universities.

Ehlers-Danlos syndrome (EDS) is a group of disorders caused by abnormalities in the extracellular matrix (ECM). Transforming growth factor-β (TGF-β) plays a crucial role in formation of the ECM by the SMAD (Sma-and Mad-related protein, mothers against decapentaplegic homolog) pathway. It has been reported that loss of function of zinc transporter ZRT/IRT-like protein 13 (ZIP13) is the cause of the spondylocheiro dysplastic form of EDS (SCD-EDS: OMIM 612350). Our previous study suggested that TGF-β1 has a relationship with the skin pathological condition in the Zip13-Knockout (KO) mouse, which is a model of SCD-EDS. Thus far, effective treatment based on modern medicine for this syndrome has not yet been established. According to an approach of traditional Chinese medicine, the present study investigates the medicinal effects of Makomo (Zizania latifolia) on certain aspects of SCD-EDS, such as skin morphology and plasma TGF-β1, in Zip13-KO mice. Increases in densities of collagen fibers and fibrils without a significant change in thickness of the dermal layer were observed in the group of mice fed a Makomo-containing diet. No change in the amount of collagen suggests that Makomo feed does not elevate collagen synthesis, but changes the length of glycosaminoglycan chains and decreases the distance between collagen fibrils. In conclusion, the changes of the skin structure suggest that Makomo can increase the mechanical strength of skin.

// Yeshu Wang 1, * , Qingfeng Xie 2, * , Chun-Ling Liang 3, * , Qiaohuang Zeng 1 and Zhenhua Dai 3 1 Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China 2 Center for Regenerative and Translational Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P.R. China 3 Section of Immunology, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, P.R. China * These authors have contributed equally to this work Correspondence to: Zhenhua Dai, email: zdai2009@outlook.com Keywords: autoimmunity, type 1 diabetes, regulatory T cells, Chinese medicine Abbreviations: CsA, cyclosporine; GAG, ginseng and astragalus granule; T1DM, type 1 diabetes mellitus; Treg, regulatory T cell Received: March 21, 2017 Accepted: April 27, 2017 Published: June 27, 2017 ABSTRACT Type 1 diabetes mellitus (T1DM) is an autoimmune disease mainly mediated by effector T cells that are activated by autoantigen, thereby resulting in the destruction of pancreatic islets and deficiency of insulin. Cyclosporine is widely used as an immunosuppressant that suppresses autoimmunity in clinic. However, continuous treatments with conventional immunosuppressive drugs may cause severe side effects. Therefore it is important to seek alternative medicine. Chinese medicine Ginseng and Astragalus granule (GAG) was used to successfully treat type 2 diabetes mellitus in clinic in China. Here we found that GAG ameliorated T1DM in autoimmune NOD mice by increasing the level of insulin and reducing the level of blood glucose. Treatments with both GAG and CsA further decreased the blood glucose level. Moreover, GAG increased both CD4+FoxP3+ and CD8+CD122+PD-1+ Treg numbers in both spleens and lymph nodes of NOD mice. In particular, GAG could reverse a decline in CD4+FoxP3+ Tregs resulted from CsA treatments. The percentage of effector/memory CD8+ T cells (CD44 high CD62L low ) was significantly reduced by GAG, especially in the presence of low-doses of CsA. Histopathology also showed that GAG attenuated cellular infiltration and lowered CD3+ T cell numbers around and in islets. Thus, we demonstrated that GAG ameliorated autoimmune T1DM by upregulating both CD4+FoxP3+ and CD8+CD122+PD-1+ Tregs while GAG synergized with CsA to further suppress autoimmunity and T1DM by reversing the decline in CD4+FoxP3+ Tregs resulted from CsA treatments. This study may have important clinical implications for the treatment of T1DM using traditional Chinese medicine.

Elevated adipogenesis of bone marrow stromal cells (BMSCs) is closely associated with non-traumatic osteonecrosis of femoral head (ONFH). Our previous studies have shown that Huogu (HG) formula was effective both in clinic experience and experimental ONFH. How HG impacts the differentiation of BMSCs and what is the underlying molecular mechanism remain largely unknown. Our results showed that ethyl acetate extract of HG (HGE) significantly decreased the adipocyte differentiation as determined by oil red staining, while slightly increased the ALP activity. Investigation of the molecular mechanism revealed that HGE could inhibit the mRNA and protein expression of peroxisome proliferators-activated receptor (PPAR)γ, lipoprotein lipase (LPL) and adipocyteprotein2 (AP2). Interestingly, the inhibition of adipogenic differentiation in BMSCs by HGE could be restored by DKK-1, an inhibitor of Wnts. However, Noggin (an inhibitor of BMPs) displayed an additive role with HGE in suppressing the expression of PPARγ, LPL, and AP2. Furthermore, the bone marrow fat formation, as well as the expression of Wnt3a and PPARγ, was effectively regulated by HGE in the steroid-induced ONFH rats. Our results demonstrated that HGE treatment significantly inhibited adipogenesis and slightly promoted osteogenesis of BMSCs through regulating the BMP and Wnt pathways. The findings shed lights on the molecular mechanism of HGE in the inhibition of adipogenesis and provide scientific rationale for its clinical application of HGE in the treatment of ONFH.

// Lei Liang 1, 2, * , Xue Yang 1, * , Yang Yu 1, 3, * , Xiaoyong Li 1, 2 , Yechen Wu 1, 2 , Rongyu Shi 1 , Jinghua Jiang 1 , Lu Gao 1 , Fei Ye 1 , Qiudong Zhao 1 , Rong Li 1 , Lixin Wei 1 , Zhipeng Han 1 1 Tumor Immunology and Gene Therapy Center, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai, China 2 Medical College of Soochow University, Suzhou, China 3 Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200065, China * These authors contributed equally to this work Correspondence to: Zhipeng Han, email: hanzhipeng0311@126.com Lixin Wei, email: weilixin_smmu@163.com Keywords: hepatic fibrosis, hepatic stellate cells, chinese medicine, Babao Dan, toll-like receptor 4 Received: August 01, 2016 Accepted: October 12, 2016 Published: October 20, 2016 ABSTRACT Babao Dan (BBD), a traditional Chinese medicine, has been widely used as a complementary and alternative medicine to treat chronic liver diseases. In this study, we aimed to observe the protective effect of BBD on rat hepatic fibrosis induced by diethylnitrosamine (DEN) and explore it possible mechanism. BBD was administrated while DEN was given. After eight weeks, values of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) indicated that BBD significantly protected liver from damaging by DEN and had no obvious side effect on normal rat livers. Meanwhile, BBD attenuated hepatic inflammation and fibrosis in DEN-induced rat livers through histopathological examination and hepatic hydroxyproline content. Furthermore, we found that BBD inhibited hepatic stellate cells activation and proliferation without altering the concentration of lipopolysaccharide (LPS) in portal vein. In vitro study, serum from BBD treated rats (BBD-serum) could also significantly suppress LPS-induced HSCs activation through TLR4/NF-κB pathway. In addition, BBD-serum also inhibited the proliferation of HSCs by regulating TLR4/ERK pathway. Our study demonstrated that BBD may provide a new therapy strategy of hepatic injury and hepatic fibrosis.

// Zhijun Wang 1 , Ranadheer Ravula 2 , Leming Shi 3 , Yunjie Song 3 , Steven Yeung 1 , Mandy Liu 2 , Bernard Lau 1 , Jijun Hao 4 , Jeffrey Wang 2 , Christopher Wai Kei Lam 5 , Moses Sing Sum Chow 1 , Ying Huang 2 1 Center for Advancement of Drug Research and Evaluation, College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA 2 Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA 3 Center for Pharmacogenomics, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Schools of Life Sciences and Pharmacy, Fudan University, Shanghai, China 4 College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, USA 5 State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa, Macau Correspondence to: Moses Sing Sum Chow, email: mchow@westernu.edu Ying Huang, email: yhuang@westernu.edu Keywords: chemotherapy, resistance, Chinese medicine, Tripterygium wilfordii, prostate cancer Received: September 24, 2015 Accepted: July 06, 2016 Published: July 28, 2016 ABSTRACT A leading cause of cancer chemotherapy failure is chemoresistance, which often involves multiple mechanisms. Chinese medicines (CM) usually contain multiple components which could potentially target many mechanisms simultaneously and may offer an advantage over single compounds that target one mechanism at a time. The purpose of this study was to investigate the chemosensitizing effect (CE) of a specific CM, Tripterygium wilfordii (TW), on prostate cancer cells resistant to docetaxel (Dtx) and identify the potential mechanisms. The CE of TW (in combination with Dtx) was evaluated in two Dtx resistant prostate cancer cell lines (PC3-TxR and DU145-TxR) and the efficacy of the combination for resistant PC3-TxR tumor was investigated using a xenograft mouse model. For mechanistic study, the inhibitory effect of TW on P-glycoprotein activity was assessed. In addition, novel gene targets of TW were identified using DNA microarray and quantitative PCR. Results showed that TW induced a CE of 8 and >38 folds in PC3-TxR and DU145-TxR cells, respectively with Dtx IC 50 reversed back to that of the sensitive parent cells. An optimum dose of TW+Dtx significantly retarded tumor growth in mice compared to TW or Dtx alone. TW inhibited P-glycoprotein activity and induced a significant gene expression changes in genes related to angiogenesis, cell cycle regulation and differentiation. Our in vitro and in vivo studies demonstrate that TW in combination with Dtx was able to overcome the chemoresistance and suppress resistant prostate tumor growth via multi-mechanisms.

Background China has introduced a series of polices and practice to manage the market access of Chinese patent medicine (CPM) products into its healthcare security system, which is less analyzed and reported in current literature. Therefore, this paper aimed to investigate the mechanisms managing market access of CPM products into healthcare security system in China, expecting to provide implications for international integration of traditional medicine products into health systems. Method This paper used a documentary analysis approach as a qualitative research method. Data were collected from four sources and analyzed in a thematic way. Results Four mechanisms to manage entry, price adjustment, and exit of innovative brand and generic CPM products are identified, including: (1) price negotiation, mechanism of new entry of innovative brand CPM products into the national reimbursement list; (2) price re-negotiation, mechanism of price adjustment of innovative brand CPM products within the national reimbursement list; (3) mass procurement, mechanism of generic CPM products to healthcare security system; and (4) direct removal, mechanism of removal from the national reimbursement list. Conclusions China has established market access framework of CPM products by focusing on price negotiation for innovative brand CPM products and mass procurement for generic CPM products. Further studies of CPM products based real-world data are needed to provide clinical and pharmacoeconomic evidence to support market access of CPM products into healthcare security systems.

Andrew Schonebaum. Novel Medicine: Healing, Literature, and Popular Knowledge in Early Modern China. Seattle: University of Washington Press, 2016. 296 pp. $50 (cloth); $30 (paper). Hilary A. Smith. Forgotten Disease: Illnesses Transformed in Chinese Medicine. Stanford, CA: Stanford University Press, 2017. 248 pp. $85 (cloth); $25 (paper/e-book). The past ten years have seen the publication of more than seventy English-language monographs, edited books, translations, dictionaries, and even a three-volume catalogue, related to the history of medicine in China. Such substantive, varied, and often ground-breaking scholarship is finally starting to do justice to the complexity of the subject and the richness of the sources vis-à-vis the better known, and thus more widely taught, history of European and Anglo-American medicine from antiquity to the modern world. Collectively bringing the field of the history of medicine in China to a new level of synthesis, these works not only demonstrate how integral the history of medicine and public health is to Chinese history but also should help facilitate the integration of East Asian medical history into more broadly conceived global histories of medicine and public health. This major boon in publications on the medical history of China over the past decade also reveals the wide-ranging methods and diverse approaches scholars have chosen to frame, and thereby exert heuristic control over, what arguably has become newly visible as the contours of a vast, complex, and essential subject of not just Chinese but human history....

Based on 67 in-depth interviews of Chinese medicine (CM) Practitioners in Hong Kong, this paper reviews the ongoing debate within Hong Kong's CM community between the two pathways of professionalization: revival of the Chinese traditional knowledge or innovate by incorporating biomedical principles. Following earlier efforts to apply social movement perspectives onto the study of professionalization, we examine how segments of CM practitioners strive to forge divergent collective identities in their quest for professional status along three analytical dimensions: consciousness, boundary and strategies. This paper deepens our understanding of the professionalization of complementary and alternative medicines by documenting the construction of distinctive sub-identities not just over how the modality should interact with the mainstream biomedicine but also how to interpret the essence of their own practice. It shall also account for the emergence of the schism of professional identities in Hong Kong as distinctive results of the institutional configuration of the Hong Kong medical system under the One Country Two Systems, shaped by the twin forces of biomedical dominance locally as well as the thrust towards integrative medicines in Mainland China.

Traditional Chinese medicine (TCM) is today practiced worldwide, rivaling biomedicine in terms of its globalization. One of the most common TCM diagnoses is “Liver qi constraint,” which, in turn, is commonly treated by an herbal formula dating back to the 10th century. In everyday TCM practice, biomedical disease categories such as depression or anxiety and popular disease categories such as stress are often conflated with the Chinese medical notion of constraint. Medical anthropologists, meanwhile, argue that constraint reveals to us a distinctive aesthetics of constructing body/persons in Chinese culture, while psychologists seek to define constraint as a distinctive psychiatric disorder distinctive from depression and anxiety. All of these actors agree in defining constraint as a concept dating back two thousand years to the very origins of Chinese medicine. This article disassembles the articulations by means of which these different facts about constraint are constructed. It shows how ideas about constraint as a disorder caused by the penetration of external pathogens into the body were gradually transformed from the eleventh century onward into constraint as an emotion-related disorder, while treatment strategies were adjusted to match perceptions about body/self that developed among the gentry elite of southeast China in late imperial China.

The Ilizarov technology was honored as a "milestone" in the history of orthopedics in the 20th century, benefiting tens of thousands of patients around the world, including Chinese patients. The paper presents an analysis of the integration of the method into Chinese medicine, taking into account national traditions, culture and clinical thinking. Ilizarov technology has revolutionized the orthopaedic surgery and clinical limb regeneration medicine in China. Ilizarov's methodology arose suddenly and brought about revolutionary changes in terms of theoretical guidance, methods of thinking, tools used and medical procedures. For the first time, Ilizarov's discovery made people realize that the human body, natural selection in biology and joint symbiotic evolutionary characteristics are common, namely, as long as the levers activate the tissue regeneration switch and changes in regulation, any tissue at any age and to any degree can complete the self-healing process in according to the requirements of doctors and the expectations of patients, similar to the growth of children. The process of working with an external Ilizarov fixator is like playing chess and changing a kaleidoscope, and the countless number of free combinations of stress configurations can be changed in accordance with the needs of the treatment. In China, Qin Xihe integrated the Chinese culture into the Ilizarov technology, thus forming the Chinese Ilizarov technology. He proposed new concepts such as the concept of natural reconstruction, evolutionary orthopedics, interpretation of body language, one walk, two lines, the principle of three balances, happy orthopedics, etc., which were introduced into clinical practice in the field of limb deformity correction and functional reconstruction. As of December 31, 2018, 35,075 cases of various deformities and disorders of the limbs were entered into the Qinsihe orthopedic database, of which 8113 cases were treated with external fixation (Ilizarov technology). The statistics of a large number of cases showed striking results: diseases treated with this technique covered almost all sections of orthopedic pathology and more than 10 sections of non-orthopedic and traumatological pathology, including vascular, nervous, genetic, metabolic, and skin diseases. In addition to orthopedic, there are more than 170 diseases in total. When Ilizarov's technology is applied, it can magically transform the old into the young. Therefore it is known as a "lifeboat". Conclusion Over the past 70 years, Ilizarov's ideas and technologies have been preserved, updated and augmented. Ilizarov's technology serves as an evolutionary phenomenon that transcends bone science. If you understand this technique, you will understand the direction of modern orthopedic surgery and regenerative medicine. Professor Ilizarov's morale and the spirit of fighting to alleviate the suffering of patients were transferred to the Chinese medical community. This awakened many Chinese doctors who followed the norms of the old and stereotyped medicine. After celebrating the centenary of the birth of Professor Ilizarov, ASAMI China will also prepare for the “Sixth ASAMI & ILLRS-BR World Conference (Beijing – 2023)”. We believe that orthopedics and allied disciplines around the world have a bright future.

Objective To establish that the Hong Kong Special Administrative Region (HKSAR) government is actively promoting Chinese medicine (CM) and to examine turnover rate of Chinese medicine practitioners (CMPs) in Hong Kong, China in light of this governmental push. Methods This study covered two major areas: reviewing CM development in Hong Kong, and assessing the turnover rate of CMPs in Hong Kong. The first part of the paper is a historical review. The investigation of turnover rate had two sections. Section 1, quantitative method, involved online questionnaires; Section 2, qualitative method comprised interviews with CMPs from different types of CM clinics to ascertain the reasons for the turnover among CMPs. Results A total of 123 online questionnaires were received in Section 1 (55 from male CMPs; 66 from female CMPs; 2 respondents were unwilling to disclose their sex). The proportion of CMPs who had resigned in 2018–19 was 22.8% (28), of whom 5.7% (7) had resigned twice in one year. The rates of resignation in 3 years and 5 years were up to 40.7% (50) and 56.9% (70), respectively. Six CMPs were interviewed in Section 2. Young CMPs were more likely to resign than seniors. The large gap between actual salary and expectations appeared to be the main reason for the high rate of resignation. Conclusion HKSAR government keenly desires to promote CM in Hong Kong, however, high turnover rate of CMPs was detected even under this positive governmental support. There is an urgent need to conduct a more representative study of the reasons for the inclination of CMPs in Hong Kong. The study highlights an important issue in CM development, and these results should remind different stakeholders in the CM industry and the government that CMPs need better career prospects and support in various areas.

Bing Yuan HK Modern Chinese Medicine R&D Center, Hong KongCorrespondence: Bing YuanHK Modern Chinese Medicine R&D Center, Room 2, 7/F Kiu Kin Mansion, 566-568 Nathan Road, Kowloon, Hong KongEmail greenisland@vip.163.comAbstract: The rise of precision medicine (PM) has initiated the transition of mainstream medicine from disease-based medicine to personalized medicine, alongside which the US FDA has begun to establish a clinical trial and efficacy evaluation (CTEE) system compatible with personalized medicine based on biological markers. Outside of modern medicine, however, there has always existed a personalized medical system, traditional Chinese medicine (TCM), that is, a personalized medical system built at the organism level with a similar concept and method to today’s complexity science. However, under the current CTEE system, TCM has not usually been shown to be effective. The CTEE system of modern medicine has now begun to embrace personalized medicine at the microlevel. Therefore, there is no reason to continue to reject TCM, which is a type of personalized medicine at the organism level. This paper analyzes and compares the commonality and differences between a personalized medical system based on biomarkers established by PM and a personalized medical system based on syndromes in TCM; the results clearly reveal structural relationships between the two medical systems. On this basis, through rigorous logical reasoning, the feasibility of applying the CTEE method which is used in PM to evaluate the efficacy of TCM treatments is demonstrated. The relationship among biomarkers by which PM describes personalized states and modern medical diseases and the relationship among TCM syndromes and diseases are completely consistent. Because of this consistency, the new CTEE system established by the US FDA to promote the development of PM is fully applicable to the clinical trial and efficacy evaluation of TCM treatment methods. Clinical trials and efficacy evaluations based on this system can scientifically prove the effectiveness of TCM, and TCM is expected to be incorporated into the modern medical system based on scientific norms.Keywords: clinical trials, personalized medicine, precision medicine, efficacy evaluation, holistic medicine, basket trial, umbrella trial, Chinese medicine, TCM

The rise of precision medicine (PM) has initiated the transition of mainstream medicine from disease-based medicine to personalized medicine, alongside which the US FDA has begun to establish a clinical trial and efficacy evaluation (CTEE) system compatible with personalized medicine based on biological markers. Outside of modern medicine, however, there has always existed a personalized medical system, traditional Chinese medicine (TCM), that is, a personalized medical system built at the organism level with a similar concept and method to today’s complexity science. However, under the current CTEE system, TCM has not usually been shown to be effective. The CTEE system of modern medicine has now begun to embrace personalized medicine at the microlevel. Therefore, there is no reason to continue to reject TCM, which is a type of personalized medicine at the organism level. This paper analyzes and compares the commonality and differences between a personalized medical system based on biomarkers established by PM and a personalized medical system based on syndromes in TCM; the results clearly reveal structural relationships between the two medical systems. On this basis, through rigorous logical reasoning, the feasibility of applying the CTEE method which is used in PM to evaluate the efficacy of TCM treatments is demonstrated. The relationship among biomarkers by which PM describes personalized states and modern medical diseases and the relationship among TCM syndromes and diseases are completely consistent. Because of this consistency, the new CTEE system established by the US FDA to promote the development of PM is fully applicable to the clinical trial and efficacy evaluation of TCM treatment methods. Clinical trials and efficacy evaluations based on this system can scientifically prove the effectiveness of TCM, and TCM is expected to be incorporated into the modern medical system based on scientific norms., Video Abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/wPcmNzYBI2c

Medically unexplained symptoms (MUS) are persistent bodily symptoms without known pathology. An unofficial term has recently emerged in Taiwan to accommodate MUS: autonomic imbalance (AI). AI literally refers to disturbances of the autonomic nervous system (ANS) that innervates vital organs. However, AI is variously conceptualised by different parties. This study intends to investigate what is in the name of AI. It draws on available databases and in‐depth interviews with AI sufferers and Western and Chinese medicine physicians. Some physicians research ANS functions through heart rate variability measurements. Research findings show that physicians regard AI as a convenient term for clinical communication and a euphemistic substitute for MUS or even psychiatric diagnoses. It is not a ‘real thing’. However, AI sufferers treat AI as a bona fide disease, only that it has not been officially classified. AI is therefore an unfaithful translation, or an uncontrolled equivocation, of MUS. The paper concludes by discussing the implications of treating AI as an equivocation. These implications include the limitations of the current diagnostic criteria, the necessity to rethink the dichotomy of mind and body, and the underlying realities exposed or masked by ‘diagnosis’.

Traditional Chinese Medicine (TCM) is a complete medical system that has evolved over millennia to include practices and procedures such as acupuncture, herbal medicine, manual therapies, nutrition, and mind–body therapies such as qi gong. In modern-day China and other Asian countries, TCM is a medical subspecialty utilized alongside western biomedicine. During the current Coronavirus Disease 19 (COVID-19) pandemic, TCM and TCM herbal medicine is being used and a number of single herbs and combination formulas have significant bioactivity and therapeutic potential. The purpose of this paper is to highlight the use of TCM in the treatment of COVID-19. This commentary provides the reader with a concise background on COVID-19 and summarizes TCM concepts including identification, pattern diagnosis, and treatment principles commonly used for the treatment of viral influenza-like diseases. It also highlights some of the challenges and potential for using TCM in an integrated medical setting.

This paper discusses the historical exchanges, communications, and circumstances that initially enabled the opening of trade routes between China and the Hellenistic and Greco-Roman world. In addition, it explains how ancient Greeks first became aware of China, and the original premise of trading silk for horses. Historical Chinese texts are analyzed to identify references to the Hellenistic and Greco-Roman world in an attempt to elucidate the extent of official interactions between the two cultures. Historical and archaeological sources confirm that trade existed for millennia before Western Europeans traveled to China during the Age of Exploration. The thesis describes how silk and disease traveled from east to west and explains the historical conditions that allowed the exchange of ideas, practices, beliefs, and culture.

Objective To select potential molecules that can target viral spike proteins, which may potentially interrupt the interaction between the human angiotension-converting enzyme 2 (ACE2) receptor and viral spike protein by virtual screening. Methods The three-dimensional (3D)-coordinate file of the receptor-binding domain (RBD)-ACE2 complex for searching a suitable docking pocket was firstly downloaded and prepared. Secondly, approximately 15,000 molecular candidates were prepared, including US Food and Drug Administration (FDA)-approved drugs from DrugBank and natural compounds from Traditional Chinese Medicine Systems Pharmacology (TCMSP), for the docking process. Then, virtual screening was performed and the binding energy in Autodock Vina was calculated. Finally, the top 20 molecules with high binding energy and their Chinese medicine (CM) herb sources were listed in this paper. Results It was found that digitoxin, a cardiac glycoside in DrugBank and bisindigotin in TCMSP had the highest docking scores. Interestingly, two of the CM herbs containing the natural compounds that had relatively high binding scores, Forsythiae fructus and Isatidis radix, are components of Lianhua Qingwen (莲花清瘟), a CM formula reportedly exerting activity against severe acute respiratory syndrome (SARS)-Cov-2. Moreover, raltegravir, an HIV integrase inhibitor, was found to have a relatively high binding score. Conclusions A class of compounds, which are from FDA-approved drugs and CM natural compounds, that had high binding energy with RBD of the viral spike protein. Our work provides potential candidates for other researchers to identify inhibitors to prevent SARS-CoV-2 infection, and highlights the importance of CM and integrative application of CM and Western medicine on treating COVID-19.

Tongue diagnosis plays a key role in TCM (Traditional Chinese Medicine) diagnosis. Tongue image segmentation lays a solid foundation for quantitative tongue analysis and diagnosis. However, the segmentation of tongue body is challenging due to the factors such as large personal variation of tongue body on color, texture and shape, as well as weak edges caused by similar color between tongue body and neighboring tissues, especially the lip. Existing segmentation methods usually use only single color component and simple prior knowledge, thus leading to inaccuracy and instability. To alleviate these issues, a patch-driven segmentation method with sparse representation is proposed in this paper. Specifically, each patch in the testing image is sparsely represented by patches in the spatially varying dictionary, which is constructed by the local patches of training images. The derived sparse coefficients are then employed to estimate the tongue probability. Finally, the hard segmentation is obtained by applying the maximum a posteriori (MAP) rule on the tongue probability map and further polished with morphological operations. The proposed method has been extensively evaluated on a tongue image dataset including 290 subjects using 10-fold cross-validation, as well as additional 10 unseen testing subjects. The proposed method has achieved more accurate segmentation results, compared with the state-of-the-art methods.

The global trade in wildlife affects ~24% of terrestrial vertebrates, and demand for traditional medicinal materials, especially for traditional Chinese medicine, is a high profile driver. At present the relative extent to which demand for wild-animal-origin medicinal materials arises from different markets (OTCM, zhongyi and CMP, see companion paper) within "TCM" is unknown. We wished to populate the above categories, revealing the numbers and types of species involved, to provide the first consolidated description of the diversity of animal species potentially able to be used for different facets of "TCM”, an overview of their conservation status, and an initial estimate of the degree to which existing trade feeds into these different facets of "TCM”. We found that the number and diversity of wild-animal-origin medicinal materials listed as available for use in "TCM" differ markedly between the Pharmacopoeia of the People’s Republic of China (representing OTCM) - which currently lists 70 wild species - and the Medical Fauna of China, representing zhongyi - which lists 2275 animal species. Our findings indicated a substantial trade - both imports to, and exports from China - of "TCM" medicinal materials from wild animal taxa listed in the Medical Fauna of China but not listed in the Pharmacopoeia, and also of species for which there is no prior textual support, including species potentially being traded as substitutes for listed species. We recommend working with TCM practitioners to enact the targeted substitution of sustainably sourced plant-based medicinal materials for the currently-used animal-origin materials. We suggest that this should initially target the 70 OTCM species, as well as inferred OTCM species and selected genera likely to be imported as substitutes, to strike a balance between keeping the focus of the required research narrow, while targeting the taxa most likely to be traded.

This paper discusses the role of the classical texts (Neijing and Nanjing) in the transmission of Chinese medicine – in particular acupuncture – to the West. This is presented in the following sections: A short historical overview of acupuncture practice in the UK; Philosophy of health and nourishing life (Yang sheng养生); The body as a complex system; Mind-body connections and the future of medicine and the problem of qi (气).

Systems biology is an academic field that attempts to integrate different levels of information to understand how biological systems function. It is the study of the composition of all components of a biological system and their interactions under specific conditions. The core of systems biology is holistic and systematic research, which is different from the manner of thinking and research of all other branches of biology to date. Chinese herbal formulae (CHF) are the main form of Chinese medicine and are composed of single Chinese herbal medicines (CHMs) with pharmacological and pharmacodynamic compatibility. When single CHMs are combined into CHF, the result is different from the original effect of a single drug and can be better adapted to more diseases with complex symptoms. CHF represent a complex system with multiple components, targets and effects. Therefore, the use of systems biology is conducive to revealing the complex characteristics of CHF. With the rapid development of omics technologies, systems biology has been widely and increasingly applied to the study of the basis of the pharmacological substances, action targets and mechanisms of CHF. To meet the challenges of multiomics synthesis-intensive studies and system dynamics research in CHF, this paper reviews the common techniques of genomics, transcriptomics, proteomics, metabolomics, and metagenomics and their applications in research on CHF.

© 2016 Informa UK Limited, trading as Taylor & Francis Group. There is increasing pressure on complementary and alternative medicine (CAM) to follow the evidence-based approach promoted in allied health and medicine, in which the randomised control trial represents the evidence gold standard. However, many CAM advocates see these methods as undermining the holism of CAM practice. This paper explores how such tensions are managed in CAM university departments – settings in which particular forms of knowledge and evidence are given ‘official’ imprimatur by CAM educators and researchers. By comparing two types of CAM, the paper also unpacks differences within this broad category, asking whether CAM academic disciplines comprise different ‘epistemic cultures’ (Knorr-Cetina, K. (1999). Epistemic cultures: How the sciences make knowledge. Cambridge, MA: Harvard University Press). Interviews were conducted with 20 lecturers in Chinese medicine and osteopathy, across five Australian universities, and augmented with observation in two degree programs. Findings reveal contrasting ontological and epistemological perspectives between the two academic fields. Chinese medicine lecturers had largely adopted bioscientific models of research, typically conducting laboratory work and trials, although teaching included traditional theories. Osteopathy academics were more critical of dominant approaches and were focused on reframing notions of evidence to account for experiences, with some advocating qualitative research. The study illustrates CAM’s ‘epistemic disunity’ while also highlighting the particular challenges facing academic CAM.

TCM (Traditional Chinese Medicine) features the Bianzheng Lunzhi (pattern identification and treatment) system, a term referring to diagnosis and treatment based on a general analysis of symptoms and signs. Manase Dosan (1507-1594) accepted this set of theories, which came to be called Satsusho Benchi in Japan. This paper considers the Satsusho Benchi of headaches by taking a concrete look at medical books associated with Dosan's school (Dosan, Dosan's teachers, and disciples). The books quote many classics of Chinese medicine, for example, Yixuezhengzhuan, Danxixinfa, Yujiweiyi and others and emphasized various diagnoses of symptoms. Satsusho Benchi theories of headache are common to the current Bingxie Bianzheng (pathogen pattern identification), Bingxing Bianzheng (nature of disease pattern identification), Qixue Bianzheng (qi-blood pattern identification), Jingluo Bianzheng (meridian pattern identification), Liujing Bianzheng (six-meridian pattern identification) and others.

Meridians systems are the pathways of qi and blood of TCM (Tradition Chinese Medicine). These systems include twelve regular meridians and eight extra meridians. The five Shu-points, namely the Well, Spring, Stream, River, and Sea, are an important grouping of acupuncture points of the twelve regular meridians. Five Shu-points on each Meridian located below the elbow and the knees are therapeutically pivotal in most styles of acupuncture needling. The Sea points of both the Yin and Yang meridians are among the most important acupuncture points for treating disorders. In order to explain the mechanism of meridian theory, infrared imaging (or thermal imaging) is one of techniques to investigate the phenomena of sensation transmission along channel in channel vessel theory. Assumed the qi can be shown by the thermal imager, based on the thermal graphic data the thermal imager was used to detect the temperature variation by needling the Sea points of a pair of Yin and Yang meridians named Large Intestine meridian of Hand Yangming and Lung meridian of Hand Taiyin. In this paper, it will show the temperature variations of Stream points of the chosen meridians are different by needling the Sea points of their corresponding meridians. And we can see the needling the Sea point of Yang meridian induced a temperature rising of its correlated Stream point. But needling the Sea point of Yin meridian deduced a temperature falling of its correlated Stream one.

The history of Chinese medicine is still widely imagined in terms dictated by the discourse of modernity, that is as ‘traditional’ and ‘Chinese.’ And yet, so as to be intelligible to us moderns, it must simultaneously be framed through categories that make it comparable somehow to the ‘West’ and the ‘modern’ from which it is said to be essentially different. This is accomplished, for instance, by viewing Chinese medicine as fundamentally shaped by cosmological thinking, as focusing on process rather than matter, and as forever hampered by attachments to the past even when it tries to innovate. At the same time, it is described as pursuing its objectives in ways that make sense in ‘our’ terms, too, such as the goal of creating physiological homeostasis through methods of supplementation and drainage. In this paper, I seek to move beyond this kind of analysis through a two-pronged approach. First, by focusing on the concept of tong 通 - a character that calls forth images of free flow, connectivity, relatedness and understanding - I foreground an important aspect of Chinese medical thinking and practice that has virtually been ignored by Western historians of medicine and science. Second, by exploring how the influential physician Ye Tianshi 葉天士 (1664–1746) employed tong to advance medical thinking and practice at a crucial moment of change in the history of Chinese medicine, I demonstrate that physicians in early modern China moved towards new understandings of the body readily intelligible by modern biomedical anatomy. I argue that this mode of analysis allows us to transcend the limitations inherent in the current historiography of Chinese medicine: because it allows for comparison to emerge from our subject matter rather than imposing our imaginaries onto it in advance.

The objective of the study described in this paper was to define Chinese medicine formula patterns for the treatment of menopausal women in London. These formula patterns are intended to become best practice guidelines for a future pragmatic randomised controlled trial with the ultimate goal of evaluating the possibility of integrating Chinese medicine treatment strategies for menopausal symptoms into the UK National Health Service. Data from a clinical study that had demonstrated the effectiveness and safety of Chinese medicine in treating 117 perimenopausal women at the Westminster University Polyclinic in London was analysed for symptom occurrence and herb use. The frequency of occurrence of different presenting symptoms and the frequency of use of individual herbs is described, and the patterns of combined herb use and the correlations between these patterns and the presenting symptoms is analysed by means of factor analysis. Treating these use patterns as Chinese herbal medicine formulas, five distinctive formula patterns emerged in the course of this study. While there is some overlap between these formulas and their associated symptom patterns and those described in Chinese medicine textbooks, some formula patterns appear to be unique to London women. This indicates that best practice guidelines for the Chinese medicine treatment of menopausal symptoms, which have been shown to vary cross-culturally, need to be derived from local clinical practice. We discuss the advantages and limitations of the methods – action based clinical study plus factor analysis – we employed to this end.

TCM (Traditional Chinese Medicine) features the bianzheng lunzhi system, a term that refers to diagnosis and treatment based on a general analysis of symptoms and signs. Manase Dosan (1507-1594) accepted this set of theories, which came to be called satsusho benchi in Japan. This paper considers the satsusho benchi of lumbago by taking a concrete look at medical books associated with Dosan's school (Dosan, Dosan's teachers, and disciples). The books quote Yuji Weiyi and others, emphasizing differential diagnosis, pulse examination, prescription drugs by Bianzheng (identifying cause of disease), and the Jingluo (meridians)

The gap between Western medicine and traditional Chinese medicine (CM) is closely related to the diversity in culture, philosophy, and scientific developments. Although numerous studies have evaluated the efficacy of acupuncture, the gap in explanatory disease models has not been bridged so far. Developments in research of ultraweak photon emission (UPE) and organized dynamics of metabolism and its relationship with technological advances in metabolomics have created the conditions to bring the basics of the medicines of the West and East together which might open the avenue for a scientific dialogue. The paper discusses (1) the UPE in relation to Qi energy, meridians and acupuncture points in CM, (2) the biochemical explanation of photon emission of living systems in Western biomedicine, and (3) the progress in research on the large-scale organization and dynamics of the metabolic network including photon metabolism.

The application of surgery, chemoradiotherapy, and endocrine treatment successfully increases survival rates of breast cancer patients. However, perimenopausal symptoms, the main side effects of these treatments, often afflict patients and reduce their quality of life. Perimenopausal symptoms include vasomotor symptoms, sleep problems, arthromuscular symptoms, and osteoporosis. Currently, there are no satisfactory treatments for perimenopausal symptoms that result from these treatments. Therefore, alternative and complementary therapies including herbal medicines represented by Chinese medicines (CMs), acupuncture, massage, and psychotherapy are increasingly being expected and explored. In this paper, we review the effects and potentials of several CM formulae, along with some active ingredients or fractions from CMs, Chinese herbal extracts, and other herbal medicines, which have drawn attention for improving perimenopausal symptoms in breast cancer patients. We also elaborate their possible mechanisms. Moreover, further studies for evaluation of standardized clinical efficacy should be scientifically well-designed and continuously performed to investigate the efficacy and mechanisms of CMs for perimenopausal symptoms due to breast cancer therapy. The safety and value of estrogen-containing CMs for breast cancer should also be clarified.

Hyperlipidemia, defined as elevated lipid levels, is the primary and major risk factor for atherosclerotic cardiovascular disease. Several studies have evaluated the effects of Chinese medicine (CM) on hyperlipidemia. However, due to the varied designs and methods of these studies, data synthesis has been difficult, restricting the practical value of the findings. Developing a core outcome set (COS) could solve these methodological concerns. In this paper, we report a protocol to develop a COS for CM clinical trials for hyperlipidemia (COS-CM-Hyperlipidemia). The development of COS-CM-Hyperlipidemia will include four stages: (1) a systematic review to identify potential important outcomes—a study advisory group, composed of core stakeholders of hyperlipidemia, will be set up afterwards to evaluate the identified outcomes and a candidate outcome set will be developed accordingly; (2) a panel of experts will be invited to conduct a three-round Delphi survey, so that the experts’ opinions on the importance of outcomes for treating hyperlipidemia with CM will be collected; (3) a consensus meeting with clinicians, patients, and other key stakeholders will be conducted to finalize the items and definitions; and (4) COS-CM-Hyperlipidemia will be promoted and updated. The development of this COS will improve the design and operation of CM trials on hyperlipidemia, keeping them in compliance with international standards, as well as the comparability and utility of their results. The Core Outcome Measures in Effectiveness Trials Initiative (COMET): http://www.comet-initiative.org/studies/details/983 . Registered on 25 April 2017.

The paper explores some of the issues concerning the transmission of Chinese medicine in Australia, its practitioner training and the future of Chinese medicine as a distinct medical discipline in the Australian context. In China over the last century Chinese medicine was overhauled in order to align it with the biomedical perspective prevalent in the West. These changes, in turn, had important consequences for the transmission of CM in Australia and the West. But while the biomedicalisation of CM has offered the path of least resistance, it has also lead to unworkable simplifications and methodological failures. The paper thus argues for a renewed access to the tradition’s primary sources in order to ally the distinctive features and methods of traditional practice with biomedicine, as an alternative to an outright integration into biomedical practice.

International audience; After a long eclipse in the European academic world that favored other forms of narrative and other sources, biographies have resurfaced in historical research over the last three decades. Renewed interest in biographies for research inthe humanities in general has, in turn, launched a reevaluation among historians, sociologists, and demographists of biography and the biographical method. Benefiting from this reflection that mainly focuses on the European biographicaltradition, this paper analyzes biographical enterprise within the Chinese tradition by relying on a broad collection of official biographies of people who were locally renowned for their skills in medicine during the Qing dynasty (1644–1911). Byusing an approach that combines a quantitative and qualitative analysis of a series of 422 biographies briefly described in this paper, it first sheds light on the features and function of these narratives. Then, it demonstrates how, in spite of their limitations,biases, and heterogeneity, these biographies of medical experts can provide crucial material for reconstructing the medical landscape at a specific time and place without limiting it to the handful of men whose writings have survived.

Objective To uncover and identify the hot topic and frontier of Chinese medicines treatment of type 2 diabetes mellitus (T2DM). Methods Web of Science TM was searched for published articles for Chinese medicines treatment of T2DM ranging from January 1st, 2002 to July 6th, 2016. Knowledge maps of the international Chinese medicines treatment of T2DM are visualized by using document co-occurrence analysis and word frequency analysis (Institution and Journal), co-citation clustering analysis (Co-reference), keyword co-occurrence clustering analysis with CiteSpac III, a tool of scientometrics. Results Universidad Nacional Autonoma de Mexico is the institution with the highest number of published papers that had been cited in this field, while China has four institutions among the top 10. The journal of the highest frequency of co-cited journal was Diabetes Care, a core one in the field. Keywords co-occurrence network was composed of 185 nodes, 541 lines, and divided into 10 clusters. Co-citation network of co-reference was composed of 407 nodes, 1199 lines, and divided into 20 clusters. Using Chinese medicine to improve insulin resistance and Chinese medicine research on blood glucose control are the hot topics. The frontier contains two aspects: new drugs development and application of intestinal insulin treatment and development and use of traditional Chinese medicine antidiabetic plants. Conclusion Institutions from China still plays a major role in TCM-focused T2DM studies. The effect of TCM herbs on insulin resistance is the hot topic of the domain. Developing new TCM herbal medicine that regulates incretin effect is the domain frontier. Research on the Chinese medicines treatment of T2DM needs more high-quality evidence to support, and its mechanism requires further exploration.

In this project, Bidens biternata (Lour.) Merr.& Sherff collected in Guangxi, China, and Austrobuxus swanii (Beuzev. & C.T.White) Airy Shaw from Queensland, Australia were chosen for NMR and MTS assay-guided chemical investigation. B. biternata, a traditional Chinese medicine (TCM), has been used to treat appendicitis, sore throat, diarrhea, dysentery, and stomach ache for hundreds of years. However, there are few of studies on the chemical constituents. Previous biological activity study indicated that the ethanol extract of B. biternata inhibited cell growth against several cancer cell lines. This warranted further research into the bioactive compounds from the TCM. The plant genus Austrobuxus belongs to one of the endemic taxa in Australia. A. swanii is a rare subtropical rainforest tree. There is also insufficient information of this species reported. A recent paper from our group reported four new picrotoxane terpenoids from A. swanii; the LC-MS analysis showed potential new picrotoxane terpenoids in the crude extract, which led to further chemical investigation of the plant species. Three phenyltriynes were isolated from the first biota, B. biternata, by using C18 flash column chromatography, diol silica gel chromatography and semi-preparative HPLC with the guidance of LC-MS and NMR data. One new picrotoxane terpenoid, austrabuxusin E, along with four know austrabuxusins (A-D) were isolated from the second biota, A. swanii by using solvent partitioning and several HPLC purification with the guidance of LC-MS and NMR data. The chemical structures of the pure compounds were elucidated by 1D and 2D NMR (COSY, HMBC, HSQC, ROSEY) and MS spectroscopic data. The anti-proliferative activity of the extracts and pure compounds were evaluated against Caco-2 and SKOV3 cell lines by the MTS assay.

Chinese history annals recorded cultural interchange between China and the Roman Empire during the Han dynasty. The first medical missionaries were Nestorian Christians from the Middle East who arrived in China in AD 635. They introduced Western medical practice into China. This paper compares the first comprehensive Chinese treatise on bone and joint injuries by a hermit monk named Lin and the Hippocratic Corpus. Based on external knowledge from the author's background as well as textural comparison the text of Hippocrates, a remarkable similarity is noted. Although these similarities could have arisen by chance, it is reasonable to hypothesize that traditional bone setting in China originated from the Hippocratic tradition and was later integrated with indigenous herbal medicine.

Breviscapine is a crude extract of several flavonoids of Erigeron breviscapus (Vant.) Hand.-Mazz., containing more than 85% of scutellarin, which has been traditionally used in China as an activating blood circulation medicine to improve cerebral blood supply. Accumulating evidence from various in vivo and in vitro studies has shown that breviscapine exerts a broad range of cardiovascular pharmacological effects, including vasodilation, protection against ischaemia/reperfusion (I/R), anti-inflammation, anticoagulation, antithrombosis, endothelial protection, myocardial protection, reduction of smooth muscle cell migration and proliferation, anticardiac remodeling, antiarrhythmia, blood lipid reduction, and improvement of erectile dysfunction. In addition, several clinical studies have reported that breviscapine could be used in conjunction with Western medicine for cardiovascular diseases (CVDs) including coronary heart disease, myocardial infarction, hypertension, atrial fibrillation, hyperlipidaemia, viral myocarditis, chronic heart failure, and pulmonary heart disease. However, the protective effects of breviscapine on CVDs based on experimental studies along with its underlying mechanisms have not been reviewed systematically. This paper reviewed the underlying pharmacological mechanisms in the cardioprotective effects of breviscapine and elucidated its clinical applications.

This paper explores how doctors of Chinese medicine have borrowed from a long history of scholarship on the problem of "constraint" to develop treatments for modern emotion-related disorders, such as depression. I argue that this combining of medical practices was made possible by a complex sequence of events. First, doctors in the 1920 and 1930s were engaged in a critical reexamination of the entire corpus of Chinese medical knowledge. Spurred by the encounter with European imperialism, the sudden rise of Japan as a new power in East Asia, and the political struggles to establish a Chinese nation state, these scholars were among the first to speculate on the possible relationship between Chinese medicine and Western medicine. Second, in the 1950 and 1960s, doctors like other intellectuals were focused on national reunification and institution building. They rejected some of the experimental claims of their predecessors to focus on identifying the key characteristics of Chinese medicine, such as the methodology of "pattern recognition and treatment determination bianzheng lunzhi." The flexibility of the new bianzheng lunzhi paradigm allowed doctors to quietly adopt innovations from their early twentieth century counterparts that they ostensibly rejected, ultimately paving the way for contemporary treatments of depression.

Chinese Herbal Medicine (CHM), as the most common form of traditional Chinese medicine (TCM), has been playing an important role in the treatment of elderly cardiovascular diseases (CVDs) in China. In this paper, we briefly discuss on the potential benefits of CHM for elderly patients with CVDs. Initially, we summarize the characteristics of CVDs in the elderly, the present treatment of CVDs in the elderly, and the clinical applications of CHM for CVDs. Secondly, in addition to introducing the features of CHM, we discuss the differences between CHM and Western medicine. Lastly, the potential benefits of CHM are presented. We came to a conclusion that as mutual complementary, Western medicine and TCM together shall benefit the elderly patients with CVDs.

Background Psoriasis vulgaris (PV) has been causing increasing concern due to its highly prevalent, harmful and therapy-resistant characteristics. The YXBCM01 (Chinese herbal medicine) for PV trial evaluates the effects of YXBCM01 on relapse rate in patients suffering from PV. As an update to the published design and method for the trial, this paper presents the statistical plan for the main publication to avoid the risk of outcome reporting bias, selective reporting, and data-driven results. Methods/design This trial is a multicenter, randomized, double-blind, placebo-controlled, parallel-group clinical trial. A total of 600 PV patients (300 in each group) will be randomized to one of two arms: participants in the experimental group will receive the YXBCM01 granule 5.5 g twice daily for 12 weeks. Placebo granules are given to patients in the control group at a dose of 5.5 g twice daily for 12 weeks. The sequential topical therapy is administrated simultaneously to all eligible patients by using calcipotriol betamethasone ointment once daily (a treatment area of up to 30 % body surface area (BSA), fingertip unit is recommended) in the first 4 weeks (maximum of 100 g weekly), followed by calcipotriol betamethasone ointment once daily for the remaining 8 weeks (maximum of 100 g weekly). The primary outcome measure is relapse rate in the treatment period and follow-up period. The secondary outcome measures include time to relapse, time to onset, rebound rate, cumulative consumption of topical medicine, visual analog scale (VAS), BSA, the Dermatology Life Quality Index (DLQI) and the Medical Outcomes Study (MOS) 36-item short form health survey (SF-36). Conclusions Application of this statistical analysis plan to the YXBCM01 for PV trial will facilitate unbiased evaluation of these important clinical data. This study will provide evidence regarding the value of YXBCM01 as an intervention for PV patients. Trial registration Chinese Clinical Trial Registry: ChiCTR-TRC-13003233, registered on 26 May 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1610-z) contains supplementary material, which is available to authorized users.

International audience; Framing “new ethics” within both Chinese and international characteristics has become a pressing issue, while China’s research and innovation policy encourages a turn towards a knowledge economy and while a number of international/Chinese corporations delocalize industrial production in poorer countries offering cheaper labour. Plural health ideas, practices and medical sciences currently develop within the broader framework of social and economic transformation of the Chinese society. Voices from civil society at large wish also to participate in the debates going on in the official, academic and media spheres. On one side, ethno-(medical) ethics may be contested by most international development actors who strongly support a universalistic view of ethics; on the other side, local/national knowledge through the voices of a number of lay people’s groups, locally-based and trained experts, and official actors gain ground for recognition. Of course positions taken by all these stakeholders towards such knowledge in terms of knowledge production, decision-making, and policy implementation may widely diverge. Issues raised in the 2000s relative to medical ethics, bioethics and the New Health Reform guidelines and implementation, will be discussed. My study is based on data collected using anthropological methodology within the framework of a research project (2006-2011), conducted in partnership between the Peking Union Medical College/Chinese Academy of Medical Sciences, Human and Social Sciences Department, Center for Bioethics (IRD and PUMC/CAMS) in Beijing. My paper is organized in three parts: the first part builds on the 2000s health reform; the second one is about ethno-ethnics in China and elsewhere; and the third reports about ongoing discussions in China on a few medical ethics-related issues.

Developing new pharmaceuticals requires massive amounts of time, money and efforts. The key step is how to find a safe and effective entity for a disease condition and how to develop it as new drug effectively. Unfortunately, the FDA's rate of approving new entities has declined dramatically in the last three decades. There is a strong need to review the current strategy and to optimize process in developing new drugs, both to shorten the process and increase the success rate. Chinese medicine has used natural products to treat patients for thousands of years, and Chinese medicine practitioners have chronicled the patients and treatment methods for thousands of years. There is much information that has not yet been used. The success stories of artimisinin and arsentic trioxide are wonderful examples of how the annals of Chinese medicine can provide leads for discovering new drugs. This paper argues that the annals of Chinese medicine are valuable and describes how they can be used in modern drug discovery. The major topics addressed are: (i) why Chinese medicine is a rich resource for finding new drugs; (ii) how to identify a potential valuable record from Chinese medicine annals; (iii) when a potential valuable record is identified from annals, how to proceed; and (iv) both why and how the approach used for chemical drugs should be revised for drugs based on the historical documents related to herbal medicine. In conclusion, we argue here that the annals of Chinese medicine offer not only a rich resource for new drugs, but also several centuries of patient data with regard to safety and efficacy, that in effect represent pilot studies. Acknowledging and using these data can shorten new drug discovery time and improve efficiency of the drug development process, bringing more effective, safe drugs to market much more quickly and cheaply.

Twenty traditional Chinese medicines (TCM) were evaluated for their antimicrobial activity against four common oral bacteria. TCMs were tested for sensitivity against Streptococcus mitis, Streptococcus sanguis, Streptococcus mutans and Porphyromonas gingivalis. Aliquots of suspension of each bacterial species were inoculated onto a horse blood agar plate with TCMs soaked separately on 6 mm paper disks. The plates were incubated for 48 h anaerobically and the mean diameters of growth inhibition of three different areas obtained. 0.2% (w/v) chlorhexidine was used as a positive control. Broth microdilution assay was used to determine minimum inhibitory concentration and minimum bactericidal concentration. Fructus armeniaca mume was effective against all four bacteria. Thirteen TCMs demonstrated antimicrobial activity against Porphyromonas gingivalis, including Cortex magnoliae officinalis, Cortex phellodendri, Flos caryophylli, Flos lonicerae japonicae, Fructus armeniaca mume, Fructus forsythiae suspensae, Herba cum radice violae yedoensitis, Herba menthae haplocalycis, Pericarpium granati, Radix et rhizoma rhei, Radix gentianae, Ramulus cinnamomi cassia and Rhizoma cimicifugae. Cortex phellodendri showed antimicrobial activity against Streptococcus mutans, while Radix et rhizoma rhei was effective against Streptococcus mitis and Streptococcus sanguis. Fructus armeniaca mume had inhibitory effects against Streptococcus mitis, Streptococcus sanguis, Streptococcus mutans and Porphyromonas gingivalis in vitro.

O presente artigo analisa as categorias de corpo e vida no pensamento de Hannah Arendt no contexto da crítica que a autora faz ao cientificismo moderno. Partindo da apresentação de alguns aspectos centrais da crítica arendtiana, passa-se a discutir em que medida essa crítica pode ser útil na discussão contemporânea acerca do biologismo e do mundo biotecnológico. Finalmente, tenta-se mostrar a radicalidade do pensamento da autora sobre o corpo e vida na sua relação com o conceito de corpo e vida da medicina tradicional chinesa.This paper analyzes the categories of body and life in Hannah Arendt's thought in the context of criticism that the author makes of modern scientific approach. From the presentation of some core aspects of Arendt's criticism, it discusses to what extent this criticism can be useful in contemporary discussion of biological and biotechnological world. Finally, it tries to show the radical thinking of the author about life in the body and its relationship to the concept of body and life of traditional Chinese medicine.

Many ethical concerns revolve around the four basic principles of research: merit and integrity, respect for human beings, weighting of risk–benefit and justice. These principles form the basis for any discussion concerning human research ethics and are applicable to all areas of research including acupuncture and Chinese herbal medicine. World Health Organisation document,Guidelines for Clinical Research on Acupuncture, states that ‘consideration should be given to the different value systems that are involved in human rights such as social, cultural and historical issues’ and that ‘further studies should be conducted in relation to ethical issues involved in clinical research on acupuncture’. In addition to outlining the four basic principles, this paper will also examine the effect of Asian culture on Western human research ethics and how this may impact upon issues such as informed consent and weighting of risk–benefit.

Aristolochic acid nephropathy (AAN) is a progressive tubulointerstitial nephropathy attributed to aristolochic acid (AA) toxicity. Five cases of AAN have been diagnosed in Hong Kong. Most were caused by the inadvertent substitution of innocuous herbs with Aristolochia species. Our findings contributed to the withdrawal of the AA-containing herbs and products in Hong Kong. This paper aims to review the topic of AAN from a Hong Kong perspective.

Studying health practices within various present and past cultures is a valuable area of research, in part because they mark a point where the physical and the symbolic meet. Health practices serve a functional role by caring for the physical body, but they can also display various beliefs within cultures. In researching the multiple healing methods of a culture, it is important to question what values these practices have and what beliefs they represent for the culture, along with studying what physical needs they fulfill. How does the comprehension of medicine within a culture show the thought processes of people? This paper focuses on Chinese medicine, which is currently comprised of traditional techniques as well as modern medical care. By examining how the Chinese health system has changed over time, through diffusion from other cultures and self-growth, the shifting values and beliefs within Chinese society become apparent.

Polycystic Ovarian Syndrome (PCOS) has the clinical manifestations of irregular menstrual cycles, anovulatory infertility, amenorrhoea, insulin resistance, polycystic ovaries, androgen disturbance, hirsutism and/or acne. The condition affects an estimated 5 to 10% of women of reproductive age (Hull 1987; Polson 1988; Lo 2006), although this varies depending on the diagnostic criteria used (Michelmore 1999). Farquhar et al. (1994) suggested the prevalence of PCOS to be 21% in a New Zealand study. Due to the lack of uniformed definition of PCOS, the prevalence of PCOS can have a highly variable prevalence estimates, ranging from 2.2% to 26% . (Nidhi 2011) Through researches, evidence suggests the potential usefulness of acupuncture in the treatment of the PCOS disorder (Ku 2001; Petti 1998; Ulett 1998). It was postulated that beta-endorphin and various neuropeptides (like protein pro-opiomelanocortin) within the nervous system may be implicated in producing the effects of acupuncture. Aleem (1987) revealed the presence of beta-endorphin in the follicular fluid of both normal and polycystic ovaries. Stener-Victorin (2000) s study suggested that acupuncture may have a role in ovulation induction. Further details of current acupuncture studies in PCOS can be found in Chapter Four. Acupuncture is currently used in public hospitals in China for the treatment of PCOS. Clinical studies conducted in China have suggested that the effectiveness of using acupuncture may be significant. However, the methodological quality of those trials was poor with limited long-term follow-up. The present study aimed to evaluate the action of body acupuncture on menstrual pattern through a pilot study (Stage II) and a randomised controlled study (Stage V). However, in order to plan the RCT properly from Chinese medicine point of view, it was important to first standardise the Chinese medicine syndrome differentiation for PCOS or otherwise an inaccurate clinical response may be obtained. This was achieved by utilising a questionnaire (Stage III) as a tool development in this study. In addition to understanding the needs of Chinese women with PCOS, an epidemiological data was performed in Stage IV, so as to attempting to address their needs in the RCT stage. An effective CM treatment protocol would then be proposed to serve as a guide for the clinical acupuncture management of adult women with PCOS. The findings are promising and further studies are required. The design for this doctoral program study composed of the following 6 stages: 1. Stage I Comprehensive systematic literature review of current acupuncture treatment for PCOS patients in human studies in all available Chinese and English Literature. This stage has been published as Cochrane Systematic Review paper; 2. Stage II Pilot Clinical Study involving real body acupuncture group; 3. Stage III Development of Traditional Chinese Medicine (TCM) Syndrome Differentiation Diagnostic Questionnaire (Tool) for PCOS according to the results of comprehensive literature review in stage I and also the National Disease Criteria set by the State Administration of Traditional Chinese Medicine in the Peoples Republic of China; This is important as to standardise the CM diagnosis of PCOS in Stage V; 4. Stage IV Collection of Epidemiological data among Asian women of PCOS, to ascertain the psychological needs of Chinese women with PCOS; and to attempting to fulfil this in Stage V; 5. Stage V Randomised Single Blinded Acupuncture Clinical Trial involving a) real body acupuncture group; b) placebo (sham) body acupuncture group; For this study, there are two types of outcome measures that are under consideration. The primary outcome measure was the return of menstruation from amenorrhea while the secondary measures were the changes in LH, FSH concentration, LH: FSH Ratio, Progesterone, Oestrogen and Androgenic hormone concentration; 6. Stage VI Investigation of the Mechanism of Acupuncture Treatment on the Management of PCOS. Based on the findings from Stage One, various case studies suggested that there may be a role for acupuncture in regulating menstruation pattern in PCOS but there was nil randomised controlled trial identified to assess the efficacy of action of acupuncture in treatment of PCOS when this project was proposed. Furthermore, preliminary evidence from the literature review suggested that acupuncture may be useful in regulating menstrual pattern in women with PCOS. This confirms the importance of this research project as to fill in the gap of current medical understanding of using acupuncture in women with PCOS. From the descriptive analysis that was performed in Stage Three, it can be concluded that the syndrome diagnostic questionnaire that developed in this project could possibly be a useful tool in Chinese medicine syndrome differentiation for women with PCOS. It is warranted for further analysis and tested for internal validity. In Stage Four, a total of 57 patients agreed to participate were interviewed. All patients responded to all 4 questions (Cronback s alpha > 0.9) asked thus for this study it has a 100% response rate. Among all the factors of concern, most of interviewed subject expressed problems of having PCOS as : difficulty to control weight, frustration about difficulty to reduce weight, frustrated due to PCOS and its related medical problems, unable to conceive and menstrual irregularity, as well as pressure from workplace. Based on the results from pilot study in Stage Two (11 subject recruited) and the RCT in Stage Five (146 subjects recruited), acupuncture can be recommended as effective menstrual regulation intervention for PCOS. In Stage V, the inter-menstrual days in the control group is 302.45 day and 348.32 days pre and post treatment respectively (p=0.001). In the interventional group, the mean inter-menstrual days are 297.69 and 33.82 days pre and post treatment respectively (p=0.000). There is no menstrual pattern change in the control group pre and post treatment. Acupuncture demonstrated statistically significant difference toward hormonal profiles before and after the real body acupuncture intervention among women with PCOS. Within the interventional group, it can be seen that there are six treatment outcomes that were found to have a significant differences (p0.05) in prolactin, oestrogen (E2) and testosterone in both control and interventional groups. Stage V is aimed to elicit whether acupuncture can assist in return of menstruation for lady with PCOS and has complete amenorrhoea. As this is the initial aim of the study, ovulation was not chosen to be the outcome measure for this RCT. This also becomes one of the limitations for this study as we cannot definitely answer whether acupuncture can induce ovulation for lady with PCOS, although improvements were noted in the LH:FSH ratio and progesterone level. It is important to note that menstruation return may not necessary to protect the uterus from hyperplasia. Overall speaking, the results from the statistical analysis and the insights that were gathered from those results have proposed the following mechanisms in relation to Chinese and Western medicine perspective: 1. Acupuncture significantly increases β-endorphin levels for periods up to 24 hours and may have regulatory effect on FSH, LH and androgen. 2. Decrease hypothalamic-pituitary-adrenal (HPA) axis activity by inhibiting release of corticotrophin-releasing factor (CRF), causing decreased adrenocorticotrophic hormone (ACTH) release from the pituitary gland and decreased cortisol and/or dehydroepiandrostenedione (sulfate) release from the adrenal cortex. 3. β-endorphin increased levels secondary to acupuncture affects the hyperthalamic-pituitary-adrenal (HPA) axis through promoting the release of ACTH through stimulation of its precursor pro-opiomelanocortin synthesis. 4. Needle insertion into the skin and muscle may stimulate ergoreceptors and initiate afferent nerves activity. 5. If acupuncture needles were placed in the same somatic segment of the ovary, they may stimulate the oxytocin axis resulting in decreased release and secretion of ovarian androgens. In conclusion, the designed acupuncture protocol for PCOS proposes that the usage of acupuncture is effective to induce return of menstruation from oligomenorrhoea.

O presente artigo analisa as categorias de corpo e vida no pensamento de Hannah Arendt no contexto da crítica que a autora faz ao cientificismo moderno. Partindo da apresentação de alguns aspectos centrais da crítica arendtiana, passa-se a discutir em que medida essa crítica pode ser útil na discussão contemporânea acerca do biologismo e do mundo biotecnológico. Finalmente, tenta-se mostrar a radicalidade do pensamento da autora sobre o corpo e vida na sua relação com o conceito de corpo e vida da medicina tradicional chinesa. This paper analyzes the categories of body and life in Hannah Arendt's thought in the context of criticism that the author makes of modern scientific approach. From the presentation of some core aspects of Arendt's criticism, it discusses to what extent this criticism can be useful in contemporary discussion of biological and biotechnological world. Finally, it tries to show the radical thinking of the author about life in the body and its relationship to the concept of body and life of traditional Chinese medicine.