Guidelines for the clinical application of the Xihuang pill for the prevention and treatment of breast hyperplasia diseases.

CONTEXT: The Xihuang pill (XHP) is a traditional Chinese medicine formulation that has been historically used in the prevention and treatment of proliferative breast diseases. However, there is a lack of guidelines that offer recommendations for its clinical use. OBJECTIVE: The task force from the Chinese Guangdong Pharmaceutical Association aims to develop evidence-based guidelines for XHP to prevent and treat proliferative breast diseases. METHODS: We searched six Chinese and English electronic databases, including the China National Knowledge Infrastructure, the Chinese Scientific Journal Database, the Wanfang Medical Database, PubMed, and Embase, up to November 1, 2022. Publications (case reports, clinical observation, clinical trials, reviews) on using XHP to treat proliferative breast diseases were manually searched. The search terms were Xihuang pill, hyperplasia of the mammary gland, breast lump, and mastalgia. The writing team developed recommendations based on the best available evidence. RESULTS: Treatment should be customized based on syndrome identification. We recommend using XHP for the prevention and treatment of breast hyperplasia disease when a patient presents the following syndromes: concurrent blood stasis syndrome, concurrent phlegm-stasis syndrome, and concurrent liver fire syndrome. Safety indicators, including blood analysis and liver and kidney function monitoring, should be performed regularly during treatment. CONCLUSIONS: Current clinical evidence suggests that XHP can be used as a standalone treatment or in conjunction with other medications to prevent and manage breast hyperplasia diseases. More randomized controlled studies are warranted to establish high-quality evidence of its use.

[Exploration of erectile dysfunction syndrome and syndrome differentiation based on latent structure].

OBJECTIVE: In order to exploring Erectile Dysfunction(ED) syndrome and syndrome differentiation based on latent structure to provide objective evidence to support Traditional Chinese Medicine(TCM) dialectic. METHODS: Cases and clinical experience in the treatment of erectile dysfunction in Chinese medicine in CNKI, Wanfang Database, cqVIP Database, were searched. Time from the database construction to January, 2023. Extraction and specification of symptom data with reference to national standards. Lantern 5.0 software was used to make the latent structure of the data based on LTM-EAST method. Latent probability, conditional probability, information coverage, mutual information and other data were combined to manually interpret the model and perform clustering analysis on the latent classes to analyze the symptomatic features and clinical evidence of erectile dysfunction and establish the rules of identification. RESULT: A total of 361 cases of erectile dysfunction were included, 21 latent variables were constructed, 9 comprehensive clustering models and 13 discriminative rules were established. The pathological factors of the obtained erectile dysfunction are dampness, heat, yin deficiency, blood stasis, spleen deficiency, kidney deficiency, liver depression, and qi stagnation. The certificate types are stasis of blood, liver qi stagnation, damp-heat entrapment (dampness is heavy, heat is heavy, damp-heat is heavy), yin deficiency (yin deficiency with heat, kidney yin deficiency), vital fire failure, qi deficiency (qi deficiency with heat, kidney qi deficiency), heart and spleen deficiency, panic injury to kidney, spleen and kidney deficiency. CONCLUSION: The common types of erectile dysfunction obtained are generally consistent with existing guidelines, but more subcategories exist in the certificate type. The presence of symptoms that cannot be well matched in some of the certificate types is presumed to be due to the complex pathogenesis of erectile dysfunction common compound evidence, many evidence models are seen in the main symptoms of liver qi stagnation evidence pulse strings, suggesting that clinical treatment should pay attention to the regulation of emotional and moral, to ease the patient's emotions. The corresponding dialectical rules can quantify the dialectical criteria and provide an objective basis for non-TCM professionals to clinically determine the TCM evidence type of patients.

[Clinical symptoms and distribution characteristics traditional Chinese medicine syndromes of pulmonary nodules].

A cross-sectional study method combined with two types of traditional Chinese medicine(TCM) syndrome differentiation methods was adopted to investigate the clinical symptoms and distribution characteristics of TCM syndromes in patients with pulmonary nodules from the perspectives of number, size, nature, and stability of pulmonary nodules by using the χ~2 test, systematic clustering and Apriori algorithm correlation analysis. The common clinical symptoms of pulmonary nodules were fatigue(77.35%) and irritability(75.40%), and 40 symptoms were clustered into 3 groups(digestive system symptoms, respiratory system symptoms, and emotional and systemic symptoms) and 8 major symptom categories. The proportion of cold and heat in complexity syndrome(63.43%) was higher based on cold-heat syndrome differentiation. The top two syndromes were Qi deficiency syndrome(88.03%) and Qi depression syndrome(83.17%) based on disease syndrome differentiation. Yang deficiency syndrome(60.52%) was more than Yin deficiency syndrome(50.16%). There were higher proportions of phlegm syndrome(78.67%) and Yang deficiency syndrome(69.33%) of so-litary pulmonary nodules in terms of the number of pulmonary nodules. In terms of size, the proportion of phlegm syndrome decreased as the mean diameter of pulmonary nodules increased, while the proportions of Yang deficiency syndrome and blood stasis syndrome increased. The distribution of Qi depression syndrome was more in those with mean diameter<10 mm(85.02%, P=0.044) and cold syndrome was more in those with mean diameter ≥10 mm(16.67%, P=0.024). In terms of the nature of pulmonary nodules, the proportions of Qi depression syndrome and heat syndrome decreased with the increase in solid components of pulmonary nodules, while the proportions of Yin deficiency syndrome and cold and heat in complexity syndrome increased. The blood stasis syndrome accounted for a higher proportion of pulmonary nodules with solid components. In terms of the stability of pulmonary nodules, dampness syndrome(72.97%), blood stasis syndrome(37.84%), and cold and heat in complexity syndrome(70.27%) accounted for higher proportions. In addition, patients with new nodules presented higher proportions in Qi inversion syndrome(52.00%, P=0.007) and cold and heat in complexity syndrome(66.00%, P=0.008). Meanwhile, 11 syndromes were associated and 4 common compound syndromes were obtained(Qi deficiency and depression syndrome, Qi depression and phlegm coagulation syndrome, Qi deficiency and phlegm coagulation syndrome, and Qi deficiency and dampness obstruction syndrome). Qi deficiency syndrome and Qi depression syndrome could be associated with other syndromes. The results show that the main clinical symptoms of pulmonary nodules are fatigue and irritability. The main TCM syndromes of pulmonary nodules are Qi deficiency syndrome, Qi depression syndrome, Yang deficiency syndrome, and cold and heat in complexity syndrome. The distribution of TCM syndromes is significantly correlated with the size of pulmonary nodules and the presence or absence of new nodules. The common compound syndromes are Qi deficiency and depression syndrome, Qi depression and phlegm coagulation syndrome, Qi deficiency and phlegm coagulation syndrome, and Qi deficiency and dampness obstruction syndrome.

[Traditional Chinese medicine health care from "long term taking" drugs in Shen Nong's Classic of Materia Medica].

"Taking drugs for a long term" is a qualitative expression of medication method based on the efficacy and safety of Chinese medicine, and the study on it is conducive to the full utilization of the efficacy and rational use of drugs. There are 148 drugs that can be taken for a long time recorded in Shen Nong's Classic of Materia Medica, accounting for 41% of the total drugs. This paper analyzed three-grade classification, natural qualities, four properties and five flavors, and efficacy features of the "long-term taking" drugs(LTTD), thus exploring the herbal source of traditional Chinese medicine health care and the rationality of effect accumulation by long-term taking. It was found that there were more than 110 top-grade LTTD in Shen Nong's Classic of Materia Medica, most of which were herbs, with sweet flavor, flat property, and no toxicity. The efficacies were mainly making body feel light and agile(Qingshen) and prolonging life. Eighty-three LTTD were included in the Chinese Pharmacopoeia(2020 edition). In the modern classification, tonic LTTD accounted for the most, followed by damp-draining diuretic LTTD and exterior-releasing LTTD. Twenty LTTD were included in the "List of Medicinal and Edible Products" and 21 were in the "List of Products Used for Health-care Food", involving in various modern health care effects, such as enhancing immunity, assisting in reducing blood lipids, and anti-oxidation. Shen Nong's Classic of Materia Medica is the classic source of traditional Chinese medicine health care, and its medication thought of taking drugs for a long term to accumulate effects has guiding significance for the regulation of sub-health and chronic diseases nowadays. The efficacy and safety of LTTD have been examined in practice for a long time, and some of the drugs are edible, which is unique in the whole cycle of health-care service, especially in line with the health-care needs in the aging society under the concept of Big Health. However, some records in the book are limited by the understanding of the times, which should be scientifically studied according to the Chinese Pharmacopoeia and the related regulations and technical requirements, under the attitude of eliminating falsifications and preserving the truth and keeping the right essence, so as to achieve further improvement, innovation, and development.

[Baihe Yuzi Prescription improves asthenospermia by up-regulating the expression of CFTR in the sperm].

OBJECTIVE: To observe the therapeutic efficacy of Baihe Yuzi Prescription (BYP) in the treatment of clinical syndrome-free asthenospermia and its effects on semen parameters, sperm DNA fragmentation index (DFI) and the expression of the cystic fibrosis transmembrane conductance regulator (CFTR) in the sperm. METHODS: We randomly divided 112 patients with clinical syndrome-free asthenospermia into a control group (n = 55) and an experimental group (n = 57), the former treated orally with L-carnitine liquid combined with vitamin E capsules and the latter with BYP in addition, both for 3 months. After treatment, we obtained the total sperm count, sperm motility, percentages of progressively motile sperm (PMS) and morphologically normal sperm (MNS), sperm DFI and expression of CFTR in the sperm, and compared the above parameters between the two groups of patients before and after medication. RESULTS: The total effectiveness rate was significantly higher in the experimental group (82.46%) than in the control (65.45%) (P < 0.05). Compared with the baseline, the patients in the experimental group showed significant improvement after treatment in the total sperm count (��53.5��3.5�� vs ��86.5��3.9�� ��106, P < 0.05), sperm motility (��23.5��3.5��% vs ��38.8��3.7��%, P < 0.05), PMS (��20.1��3.2��% vs ��30.3��3.3��%, P < 0.05), MNS (��2.3��0.3��% vs ��3.9��0.4��%, P < 0.05), sperm DFI (��37.3��3.1��% vs ��25.2��3.4��%, P < 0.05) and the expression of CFTR (P < 0.05), and even better improvement than the controls in sperm motility (��23.8��3.7��% vs ��30.2��3.4��%, P < 0.05), PMS (��19.6��3.1��% vs ��25.3��2.9��%, P < 0.05), MNS (��2.4��0.4��% vs ��3.1��0.3��%, P < 0.05), and sperm DFI (��36.6��3.3��% vs ��30.3��3.1��%, P < 0.05). The total sperm count and the expression of CFTR, however, were not significantly improved in the control group after treatment (P > 0.05). CONCLUSION: Baihe Yuzi Prescription can increase sperm count and motility, improve sperm morphology and DFI in patients with clinical syndrome-free asthenospermia, which may be related to the up-regulated expression of CFTR in the sperm.

[Application of metabonomics in study of traditional Chinese medicine syndrome:a review].

Syndrome is a nonlinear "internal-excess external-deficiency", "dynamic spatial-temporal" and "multi-dimensional" complex system and thus only by using a versatile method can the connotation be expounded. Metabonomics, which is dynamic, holistic, and systematic, is consistent with the overall mode of traditional Chinese medicine(TCM)(holistic view and syndrome differentiation and treatment). Therefore, metabonomics is very important for the research on the differentiation, material basis, and metabolic pathways of syndromes, and efficacy on syndromes. This study reviewed the application of metabonomics in the study of TCM syndromes in recent years, which is expected to objectify the research on TCM syndromes.

[Formulation regularity and thinking of adjuvant sleep-improving Chinese medicinal health products].

To summarize and analyze the current adjuvant sleep-improving Chinese medicinal health products,this study retrieved the information on health products with the sleep-improving effect published by the Department of Special Food Safety Supervision and Management,State Administration for Market Regulation( SMAR),which was statistically analyzed with Microsoft Excel and TCMISS for the characteristics of formulations. A total of 435 sleep-improving health products were collected,including 344 ones containing Chinese herbal medicines. Among them,413 health products were not suitable for adolescents,neither 194 for pregnant women. Ten Chinese herbal medicines showed a frequency of use ≥40,with 1 095 times( 73. 1%) in use. Through unsupervised hierarchical entropy-based clustering of the above Chinese herbal medicines of health products( degree of support of 45 and confidence coefficient of0. 7),12 new formulas were obtained. The composition of Chinese herbal medicines was consistent with the principles of improving sleep in traditional Chinese medicine( TCM) theories,i. e.,replenishing the heart and spleen,nourishing blood,calming the nerves,nourishing Yin,reducing internal heat,communicating the heart and kidney,replenishing Qi,relieving convulsions,clearing heat,resolving phlegm,regulating the middle warmer,soothing the liver,relieving heat,and calming the heart. According to TCM theories,syndrome differentiation was performed based on the existing sleep-improving health products,followed by data mining and analysis according to the formulation regularity,aiming to provide new ideas for the development of new Chinese medicinal health products. In particular,attention should be attached to the requirements of special populations to provide a basis for follow-up studies,exert the advantages of TCM,and lay a foundation for Chinese medicinal health products to service the public.

[Cognition of traditional Chinese medicine properties and thinking of clinical rational use of drug].

This paper discusses the rational use of traditional Chinese medicine based on chemical composition, body state and biological effect. The essence and connotations of traditional Chinese medicine are explained by modern scientific theory and technical means, and the mechanism of traditional Chinese medicine in the treatment of diseases is defined in modern medicine language, which is conducive to promoting rational and safe clinical use of drugs. Based on the chemical composition of traditional Chinese medicine,the selected genuine medicinal materials were collected and processed in a standardized way, and then used in the combination with other traditional Chinese medicines, with the aim to improve the efficacy of traditional Chinese medicine in clinical indications, increase the advantages, eliminate the disadvantages, and adapt to flexible and safe clinical drug demands. Based on the body state elements, clinical diagnosis and treatment shall be patient-centered, and doctors shall distinguish the differences of pathogenesis, symptoms and diseases, and consider the drug contraindications of special groups. According to the " dose-effect-toxicity" relationship, doctors shall select the appropriate dosage form, control the drug dosage, balance the benefits and risks of drugs, and carry out appropriate medical treatment. Based on the biological effect elements and the regulatory mechanism of traditional Chinese medicine on the target and pathway of disease, traditional Chinese medicine shall strengthen the precise positioning, provide accurate treatment; evaluate the safety of traditional Chinese medicine combination, explore the adverse reaction mechanism, strengthen the clinical safety monitoring of traditional Chinese medicine, and guide the clinical rational use of drugs, in the expectation of ensuring the safe use of traditional Chinese medicine and maximize the clinical efficacy of traditional Chinese medicine.

Effective attention-based network for syndrome differentiation of AIDS.

BACKGROUND: Syndrome differentiation aims at dividing patients into several types according to their clinical symptoms and signs, which is essential for traditional Chinese medicine (TCM). Several previous works were devoted to employing the classical algorithms to classify the syndrome and achieved delightful results. However, the presence of ambiguous symptoms substantially disturbed the performance of syndrome differentiation, This disturbance is always due to the diversity and complexity of the patients' symptoms. METHODS: To alleviate this issue, we proposed an algorithm based on the multilayer perceptron model with an attention mechanism (ATT-MLP). In particular, we first introduced an attention mechanism to assign different weights for different symptoms among the symptomatic features. In this manner, the symptoms of major significance were highlighted and ambiguous symptoms were restrained. Subsequently, those weighted features were further fed into an MLP to predict the syndrome type of AIDS. RESULTS: Experimental results for a real-world AIDS dataset show that our framework achieves significant and consistent improvements compared to other methods. Besides, our model can also capture the key symptoms corresponding to each type of syndrome. CONCLUSION: In conclusion, our proposed method can learn these intrinsic correlations between symptoms and types of syndromes. Our model is able to learn the core cluster of symptoms for each type of syndrome from limited data, while assisting medical doctors to diagnose patients efficiently.

[Study on syndrome differentiation of ancient arthralgia syndrome and drug use rules based on latent structure model].

In this study, the ancient doctors' concentrated prescriptions for arthralgia syndrome were collected and Lantern 3.2 software was used to construct and analyze the latent structure model of ancient arthralgia syndrome. A total of 10 syndrome types of ancient arthralgia syndrome were obtained, namely, cold-coagulation meridian syndrome(partial Yang deficiency), cold-dampness obstruction syndrome(cold weight), damp-heat obstruction syndrome, liver and kidney deficiency syndrome, essence deficiency syndrome, phlegm and blood stasis syndrome, spleen and stomach Qi deficiency syndrome, dampness evil accumulation syndrome, arthralgia meridian syndrome, cold-dampness binding lung syndrome, meridian obstruction syndrome, and wind-cold-dampness arthralgia syndrome(both wind-cold and dampness). This syndrome differentiation method further strengthened the thought on eight-class syndrome differentiation, and showed the characteristics of different syndrome differentiation types of the core drugs in the latent structure model, which was mainly reflected in paying attention to removing blood stasis and eliminating phlegm with use of pungent taste products having dispersing effect, emphasizing the effect of nourishing Yin and generating marrow to supplement congenital deficiency, invigorating spleen and replenishing Qi to regulate the spleen and stomach functions, nourishing vital energy and expelling evil. In addition, Python 3.7 software was used to mine the frequent item sets and association rules for the frequently used drugs for ancient arthralgia syndrome. The drug compatibility law is characterized by making good use of blood-nourishing drugs. Blood-activating drugs are often compatible with cold-dispelling drugs, liver and kidney tonifying drugs, and wind-dampness-dispelling drugs, following the compatibility principle of dispelling wind and dispelling cold as well as tonifying liver and kidney. The induction of syndrome differentiation types of ancient arthralgia syndrome and the discussion on the characteristics of drug use and compatibility law provide a new way for clinical syndrome differentiation and treatment, with certain reference value for the research and development of new Chinese patent medicines.

[Analysis on traditional Chinese medicine prescriptions treating cancerous fever based on grey screening method combined with multivariate analysis method and discovery of new prescriptions].

Cancerous fever is one of the common symptoms of advanced malignant tumors,which seriously affects the quality of life and survival of patients. At present,the clinical research on the treatment of cancerous fever by traditional Chinese medicine is limited,and there is a lack of research on the medication rules from multiple dimensions of disease-symptom-syndrome. The treatment of cancerous fever has not made substantial progress. In this study,we collected the literature on treatment of cancerous fever in Chinese medicine,and concluded that common syndrome types include Yin deficiency type,Qi deficiency type,Yang deficiency type,blood stasis type,damp-heat accumulation type,toxic heat flourishing type and liver meridian stagnated heat type. Two hundreds and fifty-seven prescriptions for Chinese medicine and 249 flavors for single medicine were extracted. The analysis of the drug composition of the drug found that the cancerous fever treatment was mainly based on heat-clearing drugs and deficiency-nourishing drugs. Apriori association analysis of the drug found that the second and third related drugs were mainly Rehmanniae Radix,Moutan Cortex,Artemisiae Annuae Herba,Trionycis Carapax and Anemarrhenae Rhizoma. The top five gray correlation degrees were Psoraleae Fructus,Bupleuri Radix,Hordei Fructus Germinatus,Scutellariae Radix and Massa Medicata Fermentata. And seven new prescriptions were evolved. The results showed that the treatment of cancerous fever can be started from the disease-symptom-syndrome,nourishing Yin and clearing heat is an important method for " disease differentiation and treatment". The combination of Bupleuri Radix and Scutellariae Radix is the embodiment of " symptom differentiation and treatment". The new prescriptions conform to the idea of " syndrome differentiation and treatment" of traditional Chinese medicine can provide reference for clinical medication. The grey screening method combined with multivariate analysis method was used to analyze the prescription rules of Chinese medicine in the treatment of cancer fever,which followed the black box structure of traditional Chinese medicine,made the potential rule of prescriptions explicit,broadened its thinking of Chinese medicine treatment,and made up for the deficiency of traditional analysis methods.

[Clinical study on traditional Chinese medicine syndrome differentiation and treatment of pneumoconiosis].

Objective: To explore the clinical effect of traditional Chinese medicine (TCM) syndrome differentiation in the treatment of pneumoconiosis. Methods: We selected 160 pneumoconiosis patients who were hospitalized in our hospital from July 2015 to July 2016. 102 patients were divided into experimental groups, and the other 58 patients were assigned to the control group. These patients were randomly assigned. The control group was given routine treatment, while the experimental group received conventional treatment combined with TCM syndrome differentiation. We rated patients' quality of life using the SF-36 Quality of Life Scale. C-reactive protein levels in both groups before and after treatment were detected by ELISA. Furthermore, we detected the expression levels of IL-6 mRNA and TGF-ß mRNA in serum before and after treatment by RT-PCR.The analysis was performed with SPSS19.0 software. The normal distribution measurement data was expressed by Mean±SD, and the t-test was used for statistical analysis. Non-normal distribution measurement data were expressed as median(M) and interquartile range (P(25), P(75)), and non-parametric test was used for statistical analysis. Results: Compared with the control group, the readmission rate in the experimental group decreased within 3 months; The SF-36 quality of life score results of the two groups showed a statistically significant difference in BP, VT and RE (P<0.05);The levelofCRPdecreasedsignificantlyafter treatment in bothgroups,and thedifferencewasstatistically significant (P<0.05).Comparedwith thecontrolgroup, the levelsofIL-6mRNAandTGF-ß1mRNA alsodecreased (P<0.05). Conclusion: TCM syndromedifferentiation and treatmentofpneumoconiosis can effectively improve the patient's condition and life quality. We predict that it may inhibit the progression of pulmonary fibrosis in pneumoconiosis.

[Essentials of the differentiation and standardization of syndromes for male impotence in Xu Fu-song's clinical experience].

OBJECTIVE: To analyze the essentials of the differentiation and standardization of syndromes for male impotence in Xu Fu-song's clinical practice. METHODS: We conducted a randomized survey of 183 cases of male impotence diagnosed and treated at Professor Xu Fu-song's Clinic. We collected the data on the four diagnostic methods of traditional Chinese medicine (TCM), namely, observation, auscultation and olfaction, inquiry, and pulse feeling and palpation, and subjected them to principal component and factor analyses. RESULTS: Eleven common factors were extracted in the principal component and factor analyses, which were in accordance with Xu Fu-song's clinical practice. Based on the results of the analysis of the 11 factors, male impotence is differentiated as 11 syndrome types as follows: damp-heat syndrome, with the manifestations of bitter taste, scrotal moisture, reddish yellow urine, dribbling urination, frequent urination, urgent urination, sticky stool, red tongue, yellow greasy fur, rapid pulse, slippery pulse, and soggy pulse; kidney-yin deficiency syndrome, featured by polyhidrosis of hands and feet, night sweating, cold drink preference, dry mouth, red tongue, less fur, thready pulse, and rapid pulse; liver-qi stagnation syndrome, presented as depression, anxiety, introvert, dark tongue, and stringy pulse; phlegm turbidity syndrome, shown as sticky mouth, phlegmy mouth, throat discomfort, chest congestion, gastric fullness, low sexual desire, white greasy fur, and slippery pulse; kidney-yang deficiency syndrome, manifested as intolerance of cold, mental fatigue, lower abdominal cold, nocturnal enuresis, hot drink preference, pale tongue, and deep pulse; lung and spleen deficiency syndrome, with the presentations of cough, easy cold, spontaneous sweating, nasal stuffiness, pale tongue, and thready pulse; qi stagnation and blood stasis syndrome, characterized by lower abdominal pain, perineal or testicular prolapse, purple tongue, and deep pulse; heart-kidney disharmony syndrome, distinguished by insomnia, gonobolia, premature ejaculation, red tongue, and thready pulse; heart and spleen deficiency syndrome, featured by palpitation, amnesia, pale complexion, pale tongue, and deep pulse; spleen and kidney deficiency syndrome, manifested as dizziness, pale complexion, pale tongue, deep pulse, and thready pulse; lung and kidney deficiency syndrome, characterized by five-center dysphoria, tinnitus, general heaviness, pale tongue, less fur, and thready pulse. CONCLUSIONS: The syndromes of male impotence are regularly differentiated and standardized in Xu Fu-song's clinical practice, each with its core symptoms and typical tongue and pulse manifestations.

[Connotation interpretation of "only one syndrome is evident for disease" in Treatise on Febrile Diseases by Zhang Zhongjing].

"Only one syndrome is evident for disease", a clinical guiding ideology in the Treatise on Febrile Diseases proposed by Zhang Zhongjing, has caused widespread controversy among physicians over the ages. The core lies in the divergence of the understanding of "one syndrome". The reason is that although many physicians sum up experience on the basis of their clinical experience, the premise of the clinical environment is ignored when interpreting the connotation. On the one hand, "only one syndrome is evident for disease" emphasizes the flexibility of grasping the main symptoms clinically. On the other hand, it emphasizes the evidence sufficiency of "one syndrome" as the basis for diagnosis. Generally speaking, specific symptoms are higher evidence as a basis for diagnosis. However, because of the clinical complexity, the symptoms with lower specificity, less targeting and lower evidence strength in common cases may become the key points of the final prescription selection in specific cases sometimes, increasing the strength of evidence and becoming the only important factor in determining the overall situation. In addition to the objective clinical conditions, some subjective factors such as clinical level and academic quality of the physicians are also important factors that affect the clinical application of "only one syndrome is evident for disease". Therefore, it is necessary to not only pay attention to the clinical objective conditions, but also try to improve the physicians' clinical level, appreciate the "only one syndrome is evident for disease" thought in the clinical environment, which is the key to solve this problem.

[Application of network biology on study of traditional Chinese medicine].

With the completion of the human genome project, people have gradually recognized that the functions of the biological system are fulfilled through network-type interaction between genes, proteins and small molecules, while complex diseases are caused by the imbalance of biological processes due to a number of gene expression disorders. These have contributed to the rise of the concept of the "multi-target" drug discovery. Treatment and diagnosis of traditional Chinese medicine are based on holism and syndrome differentiation. At the molecular level, traditional Chinese medicine is characterized by multi-component and multi-target prescriptions, which is expected to provide a reference for the development of multi-target drugs. This paper reviews the application of network biology in traditional Chinese medicine in six aspects, in expectation to provide a reference to the modernized study of traditional Chinese medicine.

Application of metabolomics on diagnosis and treatment of patients with psoriasis in traditional Chinese medicine.

Traditional Chinese medicine (TCM) is one of the oldest forms of medical system. With syndrome as the core of diagnosis and therapy in TCM, it has the advantage of collecting macroscopic information of patients for diagnosis. To understand the in vivo mechanism of TCM, a metabolomics approach was used to investigate the global biological characterization of the urine of psoriasis patients with Blood Stasis Syndrome and the therapeutic metabolomics mechanism of the Optimized Yinxieling formula. A total of 41 cases of psoriasis patients with Blood Stasis Syndrome and 19 healthy volunteers were enrolled in this study. Fasting urine samples from patients with consecutive Optimized Yinxieling intake after 0, 4, 8 and 12 weeks and from healthy volunteers were analyzed by Orthogonal Projection on Latent Structures Discriminant Analysis (OPLS-DA), which was utilized for High Performance Liquid Chromatography (HPLC) analysis and temporal metabolic changes identification. For psoriasis group, the scores of PASI of patients decreased after 12 weeks of Optimized Yinxieling treating. The metabolic variations visualized not only in the healthy group and psoriasis group, but also in the psoriasis group before and after Optimized Yinxieling treatment, demonstrated that the metabolic characteristics of the two groups were significantly different. The optimized complex structure of the target proteins from Protein Data Bank was analyzed by software package Discovery Studio. With docking score of original inhibitor and the receptor as the threshold values, two compounds from Chinese medicinal chemical database were predicted to have good interactions with the target proteins. The Metabolomics technique combining molecular docking analysis enhanced our current understanding of the metabolic response to Blood Stasis Syndrome of Psoriasis and the action mechanism of Optimized Yinxieling. This article is part of a Special Issue entitled: Computational Proteomics, Systems Biology & Clinical Implications. Guest Editor: Yudong Cai.

A critical review of traditional Chinese medicine use amongst women with menopausal symptoms.

OBJECTIVES: To provide the first critical review of traditional Chinese medicine (TCM) use amongst symptomatic menopausal women, drawing upon work examining the perspectives of both TCM users and TCM practitioners. METHODS: A search was conducted in three English-language databases (MEDLINE, CINAHL and AMED) and three Chinese-language databases (CNKI, VIP and CBM Disc) for 2002-2013 international peer-reviewed articles reporting empirical findings of TCM use in menopause. RESULTS: A total of 25 journal articles reporting 22 studies were identified as meeting the review inclusion criteria. Chinese herbal medicine appears to be the most common therapy amongst symptomatic menopausal women, and vasomotor symptoms and emotional changes are the most frequent symptoms for which TCM is sought. However, evidence regarding the prevalence of TCM use and users' profile in menopause is limited. Existing studies are of varied methodological quality, often reporting low response rate, extensive recall bias and a lack of syndrome differentiation. CONCLUSIONS: This review provides insights for practitioners and health policy-makers regarding TCM care to symptomatic menopausal women. More nationally representative studies are required to rigorously examine TCM use for the management of menopausal symptoms. Syndrome differentiation of menopausal women is an area which also warrants further attention.

Efficacy of Chinese Medicine Treatment Based on Syndrome Differentiation for Primary Insomnia: A Randomized Placebo Controlled Triple-Blinded Trial.

OBJECTIVE: To assess efficacy of Chinese medicine (CM) on insomnia considering characteristics of treatment based on syndrome differentiation. METHODS: A total of 116 participants aged 18 to 65 years with moderate and severe primary insomnia were randomized to the placebo (n=20) or the CM group (n=96) for a 4-week treatment and a 4-week follow-up. Three CM clinicians independently prescribed treatments for each patient based on syndromes differentiation. The primary outcome was change in total sleep time (TST) from baseline. Secondary endpoints included sleep onset latency (SOL), wake time after sleep onset (WASO), sleep efficiency, Pittsburgh Sleep Quality Index (PSQI) and CM symptoms. RESULTS: The CM group had an average 0.6 h more (95% confidence interval (CI): 0.3-0.9, P<0.001) TST and 34.1% (10.3%-58.0%, P=0.005) more patients beyond 0.5 h TST increment than that of the placebo group. PSQI was changed -3.3 (-3.8 to -2.7) in the CM group, a -2.0 (-3.2 to -0.8, P<0.001) difference from the placebo group. The CM symptom score in the CM group decreased -2.0 (-3.3 to -0.7, P=0.003) more than the placebo group. SOL and WASO changes were not significantly different between groups. The analysis of prescriptions by these clinicians revealed blood deficiency and Liver stagnation as the most common syndromes. Prescriptions for these clinicians displayed relative stability, while the herbs varied. All adverse events were mild and were not related to study treatment. CONCLUSION: CM treatment based on syndrome differentiation can increase TST and improve sleep quality of primary insomnia. It is effective and safe for primary insomnia. In future studies, the long-term efficacy validation and the exploratory of eutherapeutic clinicians' fixed herb formulas should be addressed (Registration No. NCT01613183).

Diagnosis knowledge constrained network based on first-order logic for syndrome differentiation.

Traditional Chinese medicine (TCM) has been recognized worldwide as a valuable asset of human medicine. The procedure of TCM is to treatment based on syndrome differentiation. However, the effect of TCM syndrome differentiation relies heavily on the experience of doctors. The gratifying progress of machine learning research in recent years has brought new ideas for TCM syndrome differentiation. In this paper, we propose a deep network model for TCM syndrome differentiation, which improves network performance by injecting TCM syndrome differentiation knowledge in the form of first-order logic into the deep network. Experimental results show that the accuracy of our proposed model reaches 89%, which is significantly better than the deep learning model MLP and other traditional machine learning models. In addition, we present the collected and formatted TCM syndrome differentiation (TSD) dataset, which contains more than 40,000 TCM clinical records. Moreover, 45 symptoms (""), 322 patterns(""), and more than 500 symptoms are labeled in TSD respectively. To the best of our knowledge, this is the first TCM syndrome differentiation dataset labeling diseases, syndromes and pattern. Such detailed labeling is helpful to explore the relationship between various elements of syndrome differentiation.